Adult Behavior Research Articles

Analysis of socioeconomic and built environment factors influencing travel mode choice of older adults in Georgia

This paper explores the travel behavior of older adults in comparison to younger adults using the 2017 U.S. National Household Travel Survey Georgia Add-on. We employ a discrete mode choice model to examine how the relationships between travel outcomes and socioeconomic, trip, and built environment characteristics vary by age. Travel modes are categorized into automobile, public transit, and non-motorized modes (i.e., walking and biking). The analysis reveals significant differences in factors related to non-auto mode travel outcomes between age groups. The presence of health conditions is associated with a lower likelihood of older adults choosing non-auto modes, and this effect intensifies with age. The association between trip purposes and travel outcome also varies; home-based-other purpose trips, such as healthcare appointments or community activities, are associated with a higher probability of older adults choosing non-motorized modes compared to other trip purposes. Residential density is more of a factor for older adults' non-auto mode choices, and older adults living in non-auto mode supportive environments are more likely to maintain non-auto mode usage. The study further finds that older adults and those with health conditions live and travel in less dense, less walkable areas than their counterparts, which makes it difficult for them to have viable non-auto transportation options. To expand mobility options for older adults, planners should design programs for older adults with health conditions and provide services for those who can no longer drive or without access to automobiles. Additionally, considering built environment conditions and the varying needs of individuals based on trip purposes is recommended to satisfy the mobility needs of older adults in accordance with their lifestyles.

Feasibility and effectiveness of cardiac telerehabilitation for older adults with coronary heart disease: A pilot randomized controlled trial.

Cardiac rehabilitation is a beneficial multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to substantial disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person cardiac rehabilitation, however, older adults are under-reported with effectiveness, feasibility, and usability remains unclear. The study randomized 43 older adults (84% males) to the 12-week CTR intervention or standard of care. Guided by Social Cognitive Theory, participants received individualized in-person assessment and e-coaching sessions, followed by CTR usage at home. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). Participants in the CTR intervention group showed significant improvement in daily steps (T1: β=4126.58, p=0.001; T2: β=5285, p=0.01) and health-promoting lifestyle profile (T1: β=23.26, p<0.001; T2: β=12.18, p=0.008) across study endpoints. Twenty participants completed the intervention, with 40% used the website for data-uploading or experiential learning, 90% used the pedometer for tele-monitoring. Improving awareness of rehabilitation and an action focus were considered key facilitators while physical discomforts and difficulties in using the technology were described as the main barriers. The CTR is feasible, safe and effective in improving physical activity and healthy behaviors in older adults with CHD. Considering the variation in individual cardiovascular risk factors, full-scale RCT with a larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life.

The regulatory effect of the anterior cingulate cortex on helping behavior in juvenile social isolation model mice

Social isolation during adolescence negatively impacts the development of adult social behaviors. However, the exact link between social experiences during adolescence and social behaviors in adulthood is not fully understood. In the present study, we investigated how isolation during juvenility affects harm avoidance behavior in a mouse model of juvenile social isolation. We found that mice subjected to social isolation as juveniles display atypical harm avoidance behaviors and that neurons in the anterior cingulate cortex are involved in these abnormal behaviors. Furthermore, we discovered that the chemogenetic activation of anterior cingulate cortex pyramidal neurons can rescue impaired harm-avoidance behaviors in these mice. Our findings provide valuable insights into the potential mechanisms underlying the impact of social experiences on behavior and brain function. Understanding how social isolation during crucial developmental periods can lead to alterations in behavior opens up new avenues for exploring therapeutic interventions for neuropsychiatric disorders characterized by impaired prosocial behaviors.

Adaptive and Maladaptive Behaviour in Adults with Fragile X Syndrome and Down Syndrome

Adaptive and Maladaptive Behaviour in Adults with Fragile X Syndrome and Down Syndrome

Children in sync: exploring how interpersonal synchrony experience induces cooperation between child peers.

Synchronous interpersonal movements induce positive prosocial behaviors in adults and children. The processes that underlie this are debated. Here, we investigate the extent to which visual cues available during synchrony experience-particularly shared facial expressions and mutual eye contact-are necessary. Pairs of same-sex 4-year-olds (N = 216 children; 50% girls; 81% white) from the US were randomly assigned to synchronized versus asynchronized swinging experience. Access to visual information was experimentally manipulated by using a transparent versus translucent barrier between the children. The translucent barrier acted as a visual filter preventing children from monitoring facial cues while still enabling them to see whether the partner was swinging in synchrony. After the swinging experience, all pairs of children were administered the same tests of cooperation. The children administered synchronous movement performed better on the cooperation tasks, and there was no significant difference as a function of barrier transparency. This suggests that the positive effects of synchrony do not require visual resolution of the partner's social-emotional facial cues. These findings advance our understanding about factors contributing to synchrony-induced cooperation between children.

Personalized interventions for behaviour change: A scoping review of just-in-time adaptive interventions.

Examine the development, implementation and evaluation of just-in-time adaptive interventions (JITAIs) in behaviour change and evaluate the quality of intervention reporting. A scoping review of JITAIs incorporating mobile health (mHealth) technologies to improve health-related behaviours in adults. We searched MEDLINE, Embase and PsycINFO using terms related to JITAIs, mHealth, behaviour change and intervention methodology. Narrative analysis assessed theoretical foundations, real-time data capturing and processing methods, outcome evaluation and summarized JITAI efficacy. Quality of intervention reporting was assessed using the template for intervention description and replication (TIDieR) checklist. Sixty-two JITAIs across physical activity, sedentary behaviour, dietary behaviour, substance use, sexual behaviour, fluid intake, treatment adherence, social skills, gambling behaviour and self-management skills were included. The majority (71%) aimed to evaluate feasibility, acceptability and/or usability. Supporting evidence for JITAI development was identified in 46 studies, with 67% applying this to develop tailored intervention content. Over half (55%) relied solely on self-reported data for tailoring, and 13 studies used only passive monitoring data. While data processing methods were commonly reported, 44% did not specify their techniques. 89% of JITAI designs achieved full marks on the TIDieR checklist and provided sufficient details on JITAI components. Overall, JITAIs proved to be feasible, acceptable and user-friendly across behaviours and settings. Randomized trials showed tailored interventions were efficacious, though outcomes varied by behaviour. JITAIs offer a promising approach to developing personalized interventions, with their potential effects continuously growing. The recommended checklist emphasizes the importance of reporting transparency in establishing robust intervention designs.

The complex clinical and cognitive phenotype of adult patients with attention deficit hyperactivity disorder (ADHD) and comorbid hoarding disorder

Objectives Several studies consistently showed that patients with attention deficit hyperactivity disorder (ADHD) have high rates of hoarding disorder (HD) comorbidity. The aim of the present study was to compare the clinical and cognitive features of adult ADHD patients with and without hoarding comorbidity according to a self-report measure, and a sample of healthy controls. Methods Fifty-seven consecutive adult outpatients with a primary diagnosis of ADHD with comorbid hoarding disorder (ADHD+HD), 57 matched ADHD patients without hoarding disorder comorbidity (ADHD-HD), and a control group of 47 healthy controls (HCs) were enrolled. All subjects undergone a comprehensive clinical assessment and a neurocognitive assessment focused on attention, memory, and executive functions. Results The ADHD groups differed on most of the clinical and cognitive measures compared to HCs. ADHD+HD patients showed similar ADHD symptoms but greater subjective impulsivity, mood and anxiety symptoms, and a greater functional impairment compared to ADHD-HD patients as well as greater attentional and executive functioning impairments. Conclusions ADHD patients with comorbid hoarding disorder present a more complex clinical and neuropsychological phenotype correlated to a greater functional impairment compared to ADHD patients without this comorbidity. These results further highlight the relevance of assessing and treating hoarding behaviours in adults with ADHD.

Park proximity and all-day and time-specific physical activity and sedentary behaviour in older adults.

Proximity to parks has been suggested as a factor influencing physical activity in older adults. However, it remains unclear the optimal distance between residences and parks for promoting physical activity and reducing sedentary time and whether these associations vary by the time of day. We examined whether the proximity to neighbourhood parks at varying distances is associated with all-day and time-specific physical activity and sedentary behaviour in older adults. Data were collected from 214 older adults receiving hospital services in Taipei, Taiwan. The number of parks within 400m, 800m, and 1,600m of participants' residences. Physical activity and sedentary behaviour, stratified by time of day (morning, afternoon, and evening), were measured using accelerometers. Adjusted linear regression models were used to estimate associations of park proximity with activity and sedentary outcomes. Parks located within 400m and 800m of participants' residences were more markedly associated with longer time in physical activity and less sedentary time compared to parks located 1,600m away. A greater number of parks within 400m and 800m was positively associated with walking steps and light-intensity physical activity while both distances were negatively associated with sedentary time. The associations between park proximity and behavioural outcomes were mainly attributable to that during the afternoon and evening. Our findings suggest that favourable access to parks within 800m of older adults' residences is associated with more physical activity and less sedentary time, particularly during the afternoon and evening. Future longitudinal studies are required to corroborate these associations.

Abstract 4139194: Predicting Cholesterol Screening Behavior After Age 50 Using Machine Learning: Insights from the Health and Retirement Study

Background: In the U.S., about 8% of adults never received cholesterol screening. Although machine learning (ML) has been used to develop decision tools for Atherosclerotic Cardiovascular Disease (ASCVD) risk prediction, its application in behavioral forecasting has not yet been explored in the context of cholesterol screening behaviors. This study aimed to examine the performance and accuracy of ML algorithms in forecasting cholesterol screening behaviors in adults after age 50. Methods: This analysis used deidentified data from the Health and Retirement Study (HRS) 2004-2018. HRS is a longitudinal survey among 23,000 households in the U.S. Participants were excluded from the current analysis if they passed away by 2019, ever had ASCVD or stroke, were under age 50 at baseline, or had missing data in self-reported cholesterol screening. In total, 7176 participants (mean age [SD]=62 [8]) met the inclusion criteria; participants were randomly split into a training set (80%) and a testing set (20%). The synthetic minority oversampling technique was used to solve the imbalance distribution of the rare event. Five ML algorithms were used: random forest, gradient boosting machine (GBM), XGBoost, Support Vector Machine (SVM), and logistic regression. Accuracy, AUROC, and positive predictive value (PPV) were used to compare model performance. The average gain was evaluated for feature importance in the demographic and health domains. Results: In total, 232 (3.2%) respondents did not receive any cholesterol screening from 2008 to 2018. Experiments with five ML algorithms suggested that XGBoost with deeper trees and learning rate performed better in classifying those who did not screen for cholesterol levels over 10 years. Adding prior cholesterol screening history (2004-2006) into the model significantly improved model performance. Hypertension, self-rated health, and smoking were the major health features, while insurance, poverty, and work status were the major demographic features in the predictive model (accuracy=0.97; AUROC=0.88; PPV=0.42). Conclusion: Findings underscore the potential utility of ML models in predicting cholesterol screening behaviors after age 50. This could be the basis for developing decision tools for clinicians to identify those with a lower chance of cholesterol screening or make reminders accordingly. The low-cost predictive model might improve the uptake of preventive screening behaviors in middle-aged and older adults.

The Relationship Between Alexithymia And Compulsive Shopping Among Young Adults

Although previous studies have investigated factors contributing to compulsive shopping, the specific role of alexithymia and its influence on emotional regulation in predicting this behavior remains underexplored. The study explores the link between alexithymia and compulsive shopping in young adults, focusing on whether emotional regulation difficulties predict problematic shopping behavior. A sample of 220 Italian young adults was assessed using the Toronto Alexithymia Scale (TAS-20) and the Shopping Behaviour Scale (SBS). Multiple regression analysis revealed that alexithymia's three dimensions explained 4.8% of the variance in compulsive shopping. Externally oriented thinking was the only significant predictor, while difficulty identifying and describing feelings were not. The findings suggest that individuals more focused on external realities are at higher risk for compulsive shopping. Improving emotional awareness and regulation may help reduce this behavior in young adults.

Childhood socioeconomic position relates to adult decision-making: Evidence from a large cross-cultural investigation.

Early exposure to poverty may have profound and enduring impacts on developmental trajectories over the lifespan. This study investigated potential links between childhood socioeconomic position, recent economic change, and temporal discounting in a large international cohort (N = 12,951 adults from 61 countries). Temporal discounting refers to the tendency to prefer smaller immediate rewards over larger rewards delivered after a delay, and connects to consequential outcomes including academic achievement, occupational success, and risk-taking behaviors. Consistent with multiple theories about the impacts of stress exposure, individuals who reported lower socioeconomic positions in childhood exhibited greater temporal discounting in adulthood compared to peers who did not. Furthermore, an interaction emerged between childhood socioeconomic position and recent economic change, such that the steepest temporal discounting was found among those from lower childhood socioeconomic positions who also recently experienced negative economic change as a result of the COVID pandemic. These associations remained significant even when accounting for potentially confounding factors like education level and current employment. Findings provide new evidence that childhood socioeconomic position relates to greater temporal discounting and steeper devaluation of future rewards later in adulthood, particularly in response to contemporaneous economic change. This suggests childhood socioeconomic position may have longer-term impacts on developmental trajectories. Speculatively, childhood socioeconomic position may shape adult behavior through increased life stress, diminished access to resources, and lower perceived trust and reliability in social systems. These findings underscore the long-term implications of socioeconomic gaps, cycles of disadvantage and economic marginalization.

Circadian desynchrony in early life leads to enduring autistic-like behavioral changes in adulthood.

Circadian rhythm regulates a variety of biological processes in almost all living organisms. Modern lifestyles, e.g. transmeridian travel, night shift, light at night, etc., frequently disrupt people's regular sleep-wake cycles and create a misalignment (circadian desynchrony) between the natural environment and the endogenous body clock, and between different circadian oscillators within the body. The long-term consequences of circadian desynchrony on neurodevelopment and adult behavior remain elusive. Increasing clinical evidence supports a correlation between the disruption of the circadian system and neurodevelopmental disorders, such as autism spectrum disorders. Despite clinical correlations, experimental evidence is yet to establish a link between circadian disturbance in early life and adult behavioral changes. Here, using a "short day" (SD) mouse model, in which mice were exposed to an 8 h/8 h light/dark (LD) cycle mimicking a "shift work" schedule from gestation day 1 to postnatal day 21, we performed a battery of behavioral tests to assess changes in adult behaviors, including sociability, affective behaviors, stereotypy, cognition and locomotor functions. In contrast to the control mice kept in a 12 h/12 h LD cycle, the adult SD mice entrained to the 8 h/8 h LD cycle, but their free running rhythms remained normal in constant darkness. Interestingly, however, the SD mice displayed diminished sociability, a reduced preference for social novelty, excessive repetitive behaviors, and compromised cognitive functions, all of which resemble characteristics of autism-like behavioral alterations. In addition, the SD mice exhibited significant anxiety- and depressive-like behaviors and impaired motor functions. By western blotting and immunostaining analyses, hyperactivation of the mTORC1/S6K1 pathway was detected in multiple forebrain regions of SD mice. These findings underscore the enduring impact of early-life circadian disruption on neurochemical signaling and behavioral patterns into adulthood, highlighting a pivotal role for circadian regulation in neurodevelopment.

The role of Southern context in shaping life course exposures linked to dementia incidence for Black and White older adults in the United States.

While racial inequities in dementia risk are well-documented in the United States, research has paid less attention to role of US Southern context in shaping dementia risk through life course exposures. In this study, we examine how Southern birth and Southern residence in adulthood are linked to dementia incidence for Black and White older adults in the United States. Using the Health and Retirement Study (N = 15,613), we estimate a series of hazard models to evaluate how life course risk factors such as childhood health and social disadvantage, education, adult socioeconomic status, health behaviors, and cardiometabolic conditions impact the association between Southern life course residency and dementia risk. We find different patterns in how Southern life course context shapes dementia risk among Black and White adults, with dementia risk among Blacks especially sensitive to combinations of Southern life course context. These findings demonstrate the importance of considering potential heterogenous life course pathways to cognitive aging and health that may be shaped by larger socio-historical experiences.

A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial.

Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Approval was granted by the university's institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant's progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults' compliance and engagement in intensive longitudinal studies. DERR1-10.2196/57664.

Early-life exposure to political violence and domestic violence

Globally, one in three women experiences domestic violence over their lifetimes. Yet, the factors that shape adult behavior toward domestic violence remain poorly understood. We examine the effect of exposure to political violence in early stages of life on likelihood of domestic violence in marital life. Combining household level survey with political violence datasets from 1988 to 2018, our findings show that it is the exposure of men to political violence that matters, but not the exposure of their wives. Furthermore, we show that the critical age bracket is between 4 and 6 years of age in which exposure to political violence seems to shape adult behavior toward domestic violence. This is true for physical and emotional violence. Moreover, exposure to political violence at almost any point in male individuals’ life increases their likelihood to perpetrate sexual violence on their wives. JEL classification: J12, J15, J16, O12

Awareness, Attitudes, and Behaviors of Adults About Vaccination in the North Cyprus

Awareness, Attitudes, and Behaviors of Adults About Vaccination in the North Cyprus

Psychopathological Aspects of Parasuicidal Behavior in Adolescents and Young Adults

Objective. The aim of this study was to determine the psychopathological symptoms associated with self-harming behavior in order to develop preventive measures.Materials and Methods. We included individuals aged 18 to 35. The main group consisted of individuals with a history of self-harming behavior, while the control group included individuals without any history of self-harming behavior. All participants completed a structured interview and the following questionnaires: SCL-90-R, the questionnaire of propensity to deviant behavior, and the «Coping Behavior Methods» questionnaire. We assessed the severity of psychopathological symptoms, motivation, and other characteristics of self-harming behavior.Results. A total of 77 participants were included, divided into the main (n=39) and control (n=38) groups. Correlations were identified between the main characteristics of self-harming behavior. According to the SCL-90-R questionnaire, individuals with a history of self-harming behavior had higher scores in somatization, obsessions, sensitivity, depression, anxiety, hostility, phobic anxiety, paranoia, and psychoticism (p&lt;0.01). The «avoidance» coping strategy was more prevalent in the main group (p&lt;0.05). According to the questionnaire of propensity to deviant behavior, individuals in the main group had higher scores in overcoming rules, aggression and violence, volitional control, and addictive, self-destructive, and delinquent behavior (p&lt;0.05). There were correlations between the regularity of self-harming behavior and the use of multiple types of self-harming behavior (r=0.497; p&lt;0.01), pursuit of internal goals (r=0.333; p&lt;0.05), occurrence of positive emotions after self-harm (r=0.352; p&lt;0.05), increasing desire to stop this behavior (r=0.359; p&lt;0.05), and difficulty achieving remission (r= –0.553; p&lt;0.01). Experiencing negative emotions after an act of self-harm was negatively associated with the use of multiple types of self-harming behavior (r= –0.412; p&lt;0.01) and addictive behavior (r= –0.408; p&lt;0.05).Conclusion. Adolescents and young adults with a history of self-harming behavior differ significantly from their peers in the presence of concomitant psychopathological symptoms. The regularity of self-harming behavior is associated with the use of multiple types of self-harming behavior and difficulty achieving remission. Our findings have clinical significance and may be incorporated into the development of preventive measures.

Nineteenth-century narratives of addiction: Relational harm and the child as witness

Through close reading of medical and cultural texts, this article demonstrates how the narrativisation of relational harm underpinned the emerging categorisation of ‘addiction’ in the 19th century: excessive consumption was conceived through its detrimental impact upon others, and more specifically, upon the family. The problem was portrayed as physiological, psychological, and social: ‘addiction’ could not be located securely within a single individual, nor was it conceived simply as a social vice. While other societal themes emerge in the medical writing of the period, such as the relationship between drinking and criminality, and the visibility of drinking in the working-classes, these are not presented as proto-diagnostic criteria in the same way as relational harm. In theorising addiction, medicine relied upon rhetorical devices and narrative modes, and authors and artists took an active role in defining the terms of the debate around drinking, drug use, and gambling. Charles Dickens and George Cruikshank represent childhood through the adult's compulsive behaviour, which the child witnesses, while the adult's behaviour itself is conceived as harm directed towards child. The article demonstrates how 21st-century attitudes, particularly located in the fields of psychiatric diagnosis and child protection social work, echo debates established by 19th-century narratives, arguing that that the disease model of addiction was closely associated with the medico-legal production of childhood. Nineteenth-century narratives of addiction therefore anticipate late 20th- and 21st-century attitudes regarding the impact of parental substance use upon children.

Nudge theories and strategies influencing adult health behaviors and outcomes in COPD management: a systematic review

ObjectiveChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence and mortality, and self-management is a key component for better outcomes of COPD. Recently, nudging has shown promising potential in COPD management. In the present study, we conducted a systematic review to collate the list of nudges and identified the variables that influence nudging.MethodsWe undertook a systematic review. We employed database searches and snowballing. Data from selected studies were extracted. The risk of bias was assessed using the Cochrane Effective Practice and Organization of Care risk of bias tool. The study is registered with PROSPERO, CRD42023427051.ResultsWe retrieved 4,022 studies from database searches and 38 studies were included. By snowballing, 5 additional studies were obtained. Nudges were classified into four types: social influence, gamification, reminder, and feedback. Medication adherence, inhalation technique, physical activity, smoking cessation, vaccination administration, exercise capacity, self-efficacy, pulmonary function, clinical symptoms, and quality of life were analyzed as targeted health behaviors and outcomes. We found medication adherence was significantly improved by reminders via mobile applications or text materials, as well as feedback based on devices. Additionally, reminders through text materials greatly enhance inhalation techniques and vaccination in patients.ConclusionThis review demonstrates nudging can improve the health behaviors of patients with COPD and shows great potential for certain outcomes, particularly medication adherence, inhalation techniques, and vaccination. Additionally, the delivery modes, the patient characteristics, and the durations and seasons of interventions may influence the successful nudge-based intervention.Clinical trial registrationThis review has been registered in the international Prospective Registry of Systematic Evaluation (PROSPERO) database (identifier number CRD42023427051).

Factors influencing proactive health behaviors in pre-frailty older adults: A qualitative study based on theory of planned behavior

Aimsto explore factors that can influence proactive health behaviors in pre-frailty older adults. Designthis is a qualitative content analysis study. Methodsdata collected through interviews with 20 pre-frailty older adults in a geriatric unit at a general hospital in Guangzhou, China. We used deductive content analysis to categorize codes and calculate their frequency based on the theory of planned behavior. Inductive content analysis was used to analyze data that could not be analyzed according to the theory of planned behavior. Resultsthe data were analyzed and grouped into categories by beliefs similarity, counted from the frequencies. The factors of 6 behavioral beliefs, 6 normative beliefs, and 14 control beliefs were issued. Six themes emerged, including positive attitudes toward proactive health behaviors outcomes, lack of proactive health awareness the negative influence of children on proactive health behaviors, lack of knowledge of proactive health behaviors, spouses play an important role in proactive health behaviors, low resistance to unhealthy behavior. Conclusionthis research will support to the construction of a psychometric scale to measure the intentions of proactive health behaviors in pre-frailty older adults. These influencing factors will also help us to develop measures to improve the ability of pre-frailty older adults to be proactive health in the future. Impactthis research validates and extends the theory of planned behavior. The findings of factors influencing proactive health behaviors help us to develop strategies to enhance proactive health in pre-frailty older adults in the future. These findings also provide content for the construction of the psychometrics of proactive health intentions scales. Reporting Methodthis study follows the COREQ reporting norms.