The Mediating Role of Self-Care Self-Efficacy in the Relationship between Health Behavior and Psychological Well-Being Among Community-Dwelling Older Adults with Hypertension

Shaimaa Mohamed Amin^1*Soher Ahmed Awad Abdel Aziz²Mohamed Hussein Ramadan Atta^3,4Ahmed Farghaly Tawfik^5,6Sally Mohammed Farghaly^7*Nesreen AbdelMonaem AbouZeid⁸Mahmoud Abdelwahab Khedr⁹Ayman Mohamed El-Ashry^10,3*

• ¹Community Health Nursing, Damanhour University Faculty of Nursing, Damanhour, Egypt
• ²Assiut University Faculty of Nursing, Asyut, Egypt
• ³Alexandria University Faculty of Nursing, Alexandria, Egypt
• ⁴Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
• ⁵Beni Suef University Faculty of Nursing, Beni Suef, Egypt
• ⁶Zarqa University Faculty of Nursing, Az-Zarqa, Jordan
• ⁷Department of Nursing Management and Education, Princess Nourah bint Abdulrahman University College of Nursing, Riyadh, Saudi Arabia
• ⁸Medical-Surgical Nursing Department, Princess Nourah bint Abdulrahman University College of Nursing, Riyadh, Saudi Arabia
• ⁹Psychiatric and Mental Health Nursing, Alexandria University Faculty of Nursing, Alexandria, Egypt
• ¹⁰Department of nursing, College of Applied Medical Sciences, Al Jouf University, Sakaka, Saudi Arabia

Background: Hypertension in older adults is a growing public health issue, often associated with decreased quality of life and increased healthcare demands. Health behaviors, self-efficacy in managing chronic illness, and psychological wellbeing are critical factors in effective hypertension control. Objective: To examine the mediating role of self-care self-efficacy in the relationship between health behaviors and psychological wellbeing among community-dwelling older adults with hypertension. Methods: A cross-sectional design was used, including 250 older adults attending outpatient geriatric clinics. Data were collected using a demographic questionnaire, the Arabic Geriatrics Health Behavior Questionnaire, the Arabic Self-Care Self-Efficacy Scale (SCSES), and the Psychological Wellbeing Scale. Results: Geriatric health behavior correlated positively with self-care self-efficacy and psychological wellbeing. Self-care self-efficacy was strongly associated with wellbeing. Self-care self-efficacy demonstrated a statistically significant partial mediating role between health behaviors and psychological well-being; the indirect effect (β = 0.399, p < .001) exceeded the direct effect (β = 0.140, p = .034). Education level showed a positive correlation with wellbeing, while age and longer hypertension duration were negatively correlated. The model explained 28.7% of the variance in self-care self-efficacy and 23.9% in wellbeing. Conclusions and Recommendations: Self-care self-efficacy plays a partial mediating role between health behaviors and psychological wellbeing in older adults with hypertension. Interventions should enhance self-care self-efficacy and health education while tailoring support to those with lower literacy or longer disease duration. Promoting confidence in self-management may improve wellbeing, treatment adherence, and support healthier aging.