Factors Associated With Sedentary Behavior Reduction in Older Adults Based on the Capability, Opportunity, Motivation, and Behavior Model: A Multicenter Cross-Sectional Study

OBJECTIVES: Reducing sedentary behavior (SB) is essential for improving health outcomes among older adults. However, much is still unknown about factors influencing SB in this population. This study aimed to identify the factors associated with SB reduction among older adults based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A total of 208 older adults with SB were recruited from 2 community hospitals, in Hangzhou, Zhejiang, and Zhengzhou, Henan, China, between July and September 2024. METHODS: The study used various tools to assess SB and its associated factors, including the Short Health Literacy Assessment Scale for Older Adults, the Subjective Socioeconomic Status Scale, the Multidimensional Scale of Perceived Social Support, the Adult SB Intention Scale, the Cravings for Rest and Volitional Energy Expenditure (CRAVE) Scale, and the SB Questionnaire. The mediation analysis was performed using structural equation modeling with bootstrapping. RESULTS: Regression-based path analysis showed statistically significant positive association of health literacy with social support (β = 0.422, P < .001), socioeconomic status (β = 0.400), and total sedentary time (β = 0.207). Rest motivation state (β = 0.162) and socioeconomic status (β = 0.162) were positively associated with total sedentary time, whereas social support showed a negative association (β = -0.252). Mediation analysis indicated that socioeconomic status (β = 0.037) and social support (β = 0.116) mediated the relationships between health literacy, physical activity (PA) motivation, and total sedentary time. Furthermore, motivation for PA (β = -0.023) also had a significant negative indirect effect on sedentary time through social support. The model demonstrated a strong fit: χ² = 3.792 (df = 5, P = .758), root mean square error of approximation ≤0.001, and comparative fit index = 1.000. CONCLUSION AND IMPLICATIONS: Factors associated with SB included health literacy, motivation state for rest, socioeconomic status, and social support. Social support and socioeconomic status mediated the relationships among health literacy, PA motivation, and SB, whereas health literacy mediated the associations of socioeconomic status and social support on SB. Interventions aimed at reducing SB in older adults should prioritize strengthening social support, socioeconomic status, health literacy, and movement motivation states while reducing the motivation for rest states.