The influence of social network structures on leisure-time physical activity in hypertensive patients: a mixed-methods study in China.

backgroundHypertension remains a major public health challenge in China. Leisure-time physical activity (LTPA) is critical for hypertension control. Yet its social network determinants, particularly key role models, are understudied in China's familial-centric cultural context.

methodsThis sequential mixed-methods study integrated quantitative surveys with qualitative interviews among hypertensive patients in Yichang, China. A total of 2639 patients were selected from 18 primary healthcare institutions using multi-stage random sampling method. Totally, 10,550 social relationships were nominated. Quantitative data on LTPA was measured by the International Physical Activity Questionnaire Long Form, and social network characteristics (size, density, LTPA aggregation, LTPA heterogeneity, and LTPA status of specific members) was gathered through the name generator method. Generalized additive mixed models assessed nonlinear associations between social network characteristics and LTPA levels (individual-level, n = 2639); mixed-effects logistic regression analyzed member-patient LTPA linkages (relationship-level, n = 10,550). Qualitative data (n = 37) via interviews underwent grounded theory coding to contextualize mechanisms.

resultsAmong participants, 70.56% engaged in light intensity LTPA (L-LTPA), whereas 34.82% achieved ≥ 150 minutes/week moderate-to-vigorous intensity LTPA (MV-LTPA). Nonlinear thresholds were identified: smaller networks (≤ 4 members) with higher kinship density (≥ 65%) significantly increased MV-LTPA adherence (P < 0.001). Network-level LTPA aggregation demonstrated linearly positive with MV-LTPA (P < 0.001) but triphasic associations (i.e., increase then decrease to steady) with L-LTPA (P = 0.006). Critically, having a physically active spouse was the strongest predictor of MV-LTPA adherence (OR = 1.967, 95% CI: 1.571-2.463, P < 0.001). Qualitative themes revealed that kinship networks fostered LTPA through shared norms and social support.

conclusionsSocial networks represent modifiable factors that influence LTPA behaviors. Integrating network-driven strategies into hypertension management and prioritizing spouses as "exercise advocates" could promote LTPA for middle-aged and elderly hypertensive patients in China. This study advances cross-cultural behavioral theory and offers actionable solutions for pragmatic solutions for global hypertension management in aging populations under similar social context.