Association of Self‐Efficacy With Functional Capacity, Life Engagement and Illness Avoidance in Middle‐Aged and Older Adults: Moderated Mediation Analysis With a Large Multistage Sample

Background: Research has confirmed the association of self-efficacy with social participation and other health outcomes, but to the best of our knowledge, no study has assessed a potential moderation of the association of self-efficacy with illness avoidance through life engagement by functional capacity. Aim: This study is aimed at assessing a potential moderated mediation by life engagement in the association of self-efficacy with functional capacity and illness avoidance. Methods: This study employed a cross-sectional design and multistage sampling to select 4147 middle-aged and older adults (mean age = 60 years). Standardised scales were used to measure constructs, and Hayes′ PROCESS Macro was utilised to test a moderated mediation model. The regression coefficients were stratified by age and chronic disease status. Results: Self-efficacy was positively associated with illness avoidance directly (β = 0.105; t = 6.335; CI: 0.074–0.135; p < 0.001) and indirectly through life engagement (β = 0.124; CI: 0.107–0.141; p < 0.001). Self-efficacy was more strongly associated with life engagement at higher functional capacity (β = 0.047; t = 4.813; CI: 0.028–0.066; p < 0.001). Moderated mediation was confirmed (β = 0.020; CI: 0.010–0.031; p < 0.001), implying that the indirect association of self-efficacy with illness avoidance through life engagement was stronger at higher functional capacity. The results were consistent across age groups and chronic disease statuses, but the standardised moderated mediation effect size appeared slightly larger in older adults aged over 60 years and those with chronic diseases. Conclusion: Illness avoidance is more strongly associated with self-efficacy through life engagement amongst adults with higher functional capacity. Higher self-efficacy can be associated with functional capacity and illness avoidance. The results support the rationale for future experimental and longitudinal studies.