The self-reinforcing cycle under dual constraints-a study of the behavioral logic of urban empty-nest older adults substituting self-medication for formal medical treatment.

Introduction: Against the stark backdrop of China's rapidly aging population and the high prevalence of chronic diseases among the older adults, urban empty-nesters face a dual challenge stemming from inadequate intergenerational support and heightened health vulnerability. A deeper understanding of their illness coping behavior is therefore critically needed. Methods: This study employs grounded theory methodology, conducting in-depth interviews with 25 empty-nest older adults in H City. A total of 290,000 words of interview texts were collected to generate a theoretical model, systematically revealing the individual cognitive framework and dynamic mechanisms of health behaviors within this group. Results: The study reveals a "dual constraints-trigger mechanism-self-reinforcing cycle" logic underpinning the health coping strategies of empty-nest elders: (1) At the precondition level, insufficient intergenerational support and self-perceived burden constitute structural dual constraints; (2) The trigger mechanism is activated by illness experience and self-diagnosed health anxiety, which interact and amplify each other through lay explanatory models of illness, thereby directly driving behavioral decisions; (3) The behavioral pathway follows a self-reinforcing sequence of "self-medication → consulting community networks for medication advice → seeking medical treatment," further exacerbated by structural contradictions within the healthcare system; (4) Outcomes form a closed loop, in which these health management practices not only conclude the current coping cycle but also often initiate new health issues, restarting the entire cycle. Discussion: The findings indicate that the behavior of "substituting self-medication for formal medical treatment" essentially functions as a survival strategy among the older adults under structural constraints. This strategy allows them to maintain autonomy through self-reliant narratives and achieve social adaptation via peer group-based mutual support. The study offers a theoretical pathway that integrates structural reflection with subjective care, contributing meaningfully to the development of healthy aging policies.