The Relationship Between Friend-based Social Support Networks and Older Adults’ Self-Efficacy in Managing Chronic Conditions, and its Meditation by Health Knowledge

Background: Rising chronic condition prevalence amidst an ageing population underscores the need to identify modifiable factors that strengthen self-management in older adults. However, the role of friend-based networks and its pathway to chronic condition self-management remains less understood. This study examined the time-lagged association between friend-based social support networks and self-efficacy in managing chronic conditions among older adults in Singapore, and the mediating role of health knowledge. Methods: We analysed 2180 older adults aged ≥60 years with at least one chronic condition, using two waves of a nationally representative longitudinal survey conducted in 2016-2017 (baseline) and 2019 (follow-up). Generalised structural equation modeling approach tested the time-lagged association between friend-based social support networks at baseline with self-efficacy at follow-up, and the mediating effect of health knowledge at follow-up. Results: Participants (mean age: 70.2 years; 52.6% female)had an average friend-based social support networks score of 12 out of 30 and a mean self-efficiency score of 4 out of 5. Slightly more than half (54.3%) reported knowing “a lot” about their conditions. Stronger baseline friend-based social support networks were associated with greater follow-up self-efficacy in managing chronic conditions, and the association was fully mediated by higher health knowledge at follow-up. Both network size and strength were crucial to enhancing health knowledge and self-efficacy, although network size showed a slightly stronger mediation effect. Conclusions: Strengthening friend-based social support networks and implementing interventions to improve health knowledge, particularly for those with weaker ties with friends, may enhance older adults’ self-efficacy in managing chronic conditions.