Multiple Mediation Research Articles

The Role of Multiple Mediation with Contextual Neighborhood Measures in Ovarian Cancer Survival..

BackgroundMediation by multiple agents can affect the relation between neighborhood deprivation and segregation indices and ovarian cancer survival. In this paper, we examine a variety of potential clinical mediators in the association between deprivation indices (DIs) and segregation indices (SIs) with all-cause survival among women with ovarian cancer in the African American Cancer Epidemiology Study (AACES). MethodsWe use novel Bayesian multiple mediation structural models to assess the joint role of mediators (stage at diagnosis, histology, diagnostic delay) combined with the DIs and SIs (Yost, ADI, Kolak’s URB, ICE-income) and a set of confounders with survival. The confounder set is selected in a preliminary step, and each DI or SI is included in separate model fits. ResultsWhen multiple mediators are included, the total impact of DIs and SIs on survival is much reduced. Unlike the single mediator examples previously reported, the Yost, ADI and ICE-income indices do not display significant direct effects. This suggests that when important clinical mediators are included, the impact of neighborhood SES indices is significantly attenuated. It is also clear that certain behavioral and demographic measures such as physical activity, smoking, or adjusted family income do not have a significant role in survival when mediated by clinical factors. ConclusionMultiple mediation via clinical and diagnostic-related measures reduces the contextual effects of neighborhood measures on ovarian cancer survival. The robust association of the Kolak URB index on survival may be due to its relevance to access to care, unlike SES-based indices whose impact was significantly reduced when important clinical mediators were included.

Heterogeneous Mediation Analysis for Cox Proportional Hazards Model With Multiple Mediators.

This study proposes a heterogeneous mediation analysis for survival data that accommodates multiple mediators and sparsity of the predictors. We introduce a joint modeling approach that links the mediation regression and proportional hazards models through Bayesian additive regression trees with shared typologies. The shared tree component is motivated by the fact that confounders and effect modifiers on the causal pathways linked by different mediators often overlap. A sparsity-inducing prior is incorporated to capture the most relevant confounders and effect modifiers on different causal pathways. The individual-specific interventional direct and indirect effects are derived on the scale of the logarithm of hazards and survival function. A Bayesian approach with an efficient Markov chain Monte Carlo algorithm is developed to estimate the conditional interventional effects through the Monte Carlo implementation of the mediation formula. Simulation studies are conducted to verify the empirical performance of the proposed method. An application to the ACTG175 study further demonstrates the method's utility in causal discovery and heterogeneity quantification.

Gene Augmentation Techniques to Stimulate Wound Healing Process: Progress and Prospects.

Gene therapy has traditionally been used to treat individuals with late-stage cancers or congenital abnormalities. Numerous prospects for therapeutic genetic modifications have emerged with the discovery that gene therapy applications are far more extensive, particularly in skin and exterior wounds. Cutaneous wound healing is a complex, multistep process involving multiple steps and mediators that operate in a network of activation and inhibition processes. This setting presents a unique obstacle for gene delivery. Many gene delivery strategies have been developed, including liposomal administration, high-pressure injection, viral transfection, and the application of bare DNA. Among several gene transfer techniques, categorical polymers, nanoparticles, and liposomalbased constructs show great promise for non-viral gene transfer in wounds. Clinical experiments have shown that efficient transportation of certain polypeptides to the intended wound location is a crucial factor in wound healing. Genetically engineered cells can be used to produce and control the delivery of specific growth factors, thereby addressing the drawbacks of mechanically administered recombinant growth factors. We have discussed how repair mechanisms are based on molecules and cells, as well as their breakdown, and provided an overview of the methods and research conducted on gene transmission in tissue regeneration.

The impact of pilot policies for low carbon city construction on the development of urban circular economy multiple time-point difference-in-differences model

IntroductionAs a means of environmental regulation, the low-carbon city pilot policy aims to address climate change and alleviate environmental resource pressures in economic development. The development of low-carbon cities often requires changes to the existing industrial and energy structures, which will have a significant impact on the regional economy.MethodsThe study is based on panel data from 273 prefecture level cities in China from 2012 to 2022, and uses the Analytic Hierarchy Process and Entropy Comprehensive Evaluation Method to construct an evaluation index system for urban circular benefits. Finally, the multiple time point differences model and mediation effect model were used to evaluate the impact and influencing factors of policies on urban economy.ResultsThe results indicate that at the 1% level, the explanatory variable coefficient significantly improves the level of urban circular economy development after adding control variables. The construction of low-carbon pilot cities has improved the performance of circular economy development by about 6.42%. The mediating effect of industrial structure rationalization is significantly positive at the 1% significance level, indicating that the construction of low-carbon pilot cities has greatly promoted the coordinated development of industrial relations within China’s low-carbon development regions.DiscussionIt can be seen that the low-carbon city pilot policy has a significant promoting effect on China’s economic development and the development of urban circular economy. Therefore, it is recommended to further expand the pilot scope of low-carbon cities and fully leverage their promoting role.

Maternal and paternal harsh parenting and anxiety symptoms in Chinese adolescents: examining a multiple mediation model

BackgroundHarsh parenting has been recognized as a risk factor for adolescent anxiety; however, the underlying mechanisms of this relationship remain unclear, and it is unknown whether this relationship is influenced by different parental roles and living arrangements. This study aimed to investigate the mediating mechanisms between harsh parenting and adolescent anxiety symptoms using a multiple mediation model and to further compare specific roles of harsh parenting and distinguish between the living arrangements.MethodsA total of 3505 adolescents completed this survey, and 3295 adolescents (54.7% girls, Mage = 14.97 years) were included in the study. Participants completed self-assessments measuring harsh parenting, self-efficacy, school connectedness, Internet addiction, sleep problems, and anxiety. They were categorized into three groups based on living arrangements: living with both parents, only with the mother, or only with the father.ResultsCorrelational analyses revealed that both maternal and paternal harsh parenting were associated with increased anxiety symptoms. Structural equation modeling (SEM) mediation analyses and multigroup analyses showed that the independent mediating effects of school connectedness, Internet addiction, and sleep problems, as well as the sequential mediating pathways involving self-efficacy → school connectedness, self-efficacy → Internet addiction, and self-efficacy → sleep problems, vary across the adolescents’ living arrangements in the association between maternal and paternal harsh parenting and adolescent anxiety symptoms.ConclusionsThis study elucidated the mechanisms linking harsh parenting to adolescent anxiety symptoms and validated the effects of different parental roles and living arrangements. The findings provide important insights for developing targeted interventions to address anxiety symptoms in adolescents exposed to harsh parenting.

PUBLIC PARTICIPATION MECHANISM IN LOW-CARBON TRANSPORTATION FROM THE PERSPECTIVE OF CARBON NEUTRALITY

Under the goal of carbon neutrality, public participation in green travel is the fundamental premise of low-carbon transportation development. Based on the multiple mediation effect model, this paper explores the mechanism of social interaction on public participation in low-carbon transportation, and the hierarchical regression method is used to test the moderating effect of social network intensity and information network intensity. The results show that: (1) Both network media and social relations have a prominent positive effect on public participation, but the effect of network media is better than that of social relations. (2) Network media and social relations affect residents’ low-carbon travel behavior through three mediating variables, namely, traffic information, environmental protection knowledge and social norms. (3) The moderating effect of social network intensity on the relationship between network media and low-carbon travel behavior is prominently negative, while the moderating effect of information network intensity is significantly positive. Therefore, it is necessary to stimulate more public participation in low-carbon transport through real-time pushing of traffic information and strengthening the closeness of social relations.

Serial Multiple Mediation of the Marital Satisfaction and Parenting Competence in the Relationship Between Postpartum Depression and Parent-Infant Attachment in First-Time Parents With Low- and High-Risk Pregnancy Experiences: A Cross-Sectional Study.

Little is known regarding the effects of postpartum depression on parent-infant attachment in high-risk parents. Based on Mercer's theory of becoming a mother, this study aimed to (1) examine the mediating effects of marital satisfaction and parenting competence in the relationship between postpartum depression and parent-infant attachment using a serial mediation model in first-time parent couples during the first 6 months postpartum, and (2) compare the serial mediation models between parents who had experienced low-risk and high-risk pregnancies. In this cross-sectional study, a total of 194 first-time parent couples at 1 to 6 months postpartum were included. Participants completed an online survey on postpartum depression, marital satisfaction, parenting competence, and parent-infant attachment. In both low- and high-risk groups, parenting competence was a common mediator of the impact of postpartum depression on parent-infant attachment. A sequential mediation effect involving both marital satisfaction and parenting competence was observed in high-risk mothers. Our findings suggest that the adverse impacts of postpartum depression on parent-infant attachment can be mitigated by boosting parenting competence or improving the marital satisfaction in couples experiencing first high-risk pregnancy.

Promoting motivation and reducing stress in medical students by utilizing self-determination theory - a randomized controlled trial in practical psychiatry courses.

Medical students experience high levels of stress and related mental health problems. Students' autonomous and controlled motivation and their mental well-being are interconnected. This study aimed to investigate whether an innovative teaching concept based on self-determination theory (SDT) could improve students' motivation and thereby reduce their stress levels, ultimately providing a healthier framework for learning. In a week-long practical psychiatry course for medical students, a new didactic concept was implemented in half the groups (n = 73) and compared with the preexisting concept (n = 75) as a randomized controlled trial (RCT). To promote the SDT-target factors of perceived autonomy, competence, and relatedness, the methods used included team building, exclusively positive feedback, group discussions, and choice in task distribution. Significant group differences in motivation, stress, performance, and their relationships were analyzed through t-tests, multiple linear regression analyses, mediation analyses, and hierarchical linear modeling (HLM) using questionnaires collected before (t0) and after (t1) the course, and students' exam results (t2). In the innovation group (n = 53), intrinsic motivation/interest (d = 0.41; p = .019) and perceived choice/autonomy (d = 0.33; p = .048) were greater than in the control group (n = 52). While autonomous regulation remained stable, the innovation group showed reduced controlled regulation (d = -0.36; p = .033) and reported significantly lower stress (d = -0.55; p = .003). The observed changes in motivation collectively mediated the stress reduction. However, students in the innovation group achieved lower exam scores, which seemed to result from the absence of critical feedback, but not from the observed differences in motivation or stress. This study demonstrated that enhancing intrinsic motivation through SDT-based teaching can effectively reduce stress in medical students. Exclusively strengths-based positive feedback may have hindered exam performance, but optimizing educational concepts to promote motivation and reduce stress will be a valuable step toward improving medical students' mental well-being.

Engaging hearts and minds in hospitality: the interplay between authentic leadership, affective commitment, and the Et-Moone cultural bond

ABSTRACT The fast-based and diverse work environments at hotels and tourism settings comprise specific dynamics that drive employees’ attitudes and behaviours at the workplace. However, scant attention has been dedicated towards investigating the stance of employee engagement via the lens of employees’ domestic cultural and social norms. Therefore, guided by social exchange theory, we embrace an employee-centred approach integrating various lines of inquiries (individual, institutional, and cultural) in one nomological network. Towards that end, a purposeful sampling technique was used to gather data from 681 employees working for 4–5 hotels in Jordan. Conducting multiple mediation analyses, the results revealed that indirect-only mediation regulates the associations between authentic leadership, affective commitment, and Et-Moone. Further, the findings reported a complementary mediation between the affective commitment-Et-Moone-employee engagement associations, indicating direct and indirect (via Et-Moone) influence of affective commitment on employee engagement. The findings of the current study provide a novel contingency view advancing the state of knowledge on employee engagement and relationship development and guiding firms on how to foster positive attitudes and behaviours in hospitality and tourism-relevant contexts. This research endeavour has also discussed significant conceptual and practical implications, along with research limitations and guidance for future research.

Personal Resources and Total Pain: Exploring the Multiple Mediation of Fear of Recurrence, Meaning-Making, and Coping in Posttreatment Cancer Patients.

People with cancer who have completed treatment still experience negative effects, such as an increased risk of experiencing cancer-related pain. Psychological factors tend to influence cancer patients' ability to cope with pain in various dimensions. Although personal resources are an important factor in buffering total pain, still little is known about the intervening variables and underlying mechanisms. The current study examined the relationship between psychological flexibility, self-esteem, and total pain, while considering fear of recurrence, meaning-making, and coping as potential mediating factors. Adults (N = 304) who completed medical treatment (radiotherapy, chemotherapy, and combined therapy) participated in this study. They completed questionnaires measuring the aforementioned variables. Structural equation models were used to examine mediation effects. Psychological flexibility, and partly self-esteem, were negatively related to the dimensions of total pain. However, to a large extent, these relationships were serially and parallelly mediated by fear of recurrence, meaning-making, and emotion-oriented coping. Consistent with the meaning-making model, cognitive (meaning-making), and affective (fear of recurrence and emotional coping) factors may be potential mechanisms underlying the association between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. In this study, they tended to interact in the area of physiological and psychosocial experiences of cancer-related pain.

Satisfaction with the Exercise Program and Successful Aging Among Older Adults Who Exercise Regularly: The Multiple Mediation of Physical Self-Efficacy and Exercise Adherence.

As the Republic of Korea transitions towards a super-aged society, the health and mental well-being of older adults are emerging as critical issues. While many researchers are focusing on successful aging among older adults who participate in exercise, there is a research gap in the Korean literature regarding the preconditions that foster this outcome. Therefore, this study analyzed the relationship between satisfaction and exercise, physical self-efficacy (PSE), exercise adherence, and successful aging among Korean older adults who exercise regularly. The participants were 369 (234 male and 135 female) older adults aged 65 or older living in the Republic of Korea, with an average age of 69.91 years. Data were collected from March 2024 to June 2024 and analyzed using descriptive statistics, correlation analysis, and structural equation modeling. There was no problem with the model fit. Satisfaction with exercise positively affected PSE (β = 0.317, p < 0.001), exercise adherence (β = 0.487, p < 0.001), and successful aging (β = 0.669, p < 0.001). PSE positively affected exercise adherence (β = 0.356, p < 0.001), and exercise adherence positively affected successful aging (β = 0.190, p < 0.05). Furthermore, PSE (β = 0.019, p < 0.01) and exercise adherence (β = 0.081, p < 0.05) mediated the relationship between satisfaction with exercise and successful aging. Satisfaction with exercise is important for promoting successful aging among Korean older adults who exercise. Satisfaction with exercise can increase their efficacy for performing physical activities and encourage them to continue exercising. This can ultimately lead to a happy life in old age.

Investigating the Impact of CSR Practices on Financial Performance: A Multiple Mediation Analysis in the Moroccan Exporting SMEs

Numerous pieces of research have shown that corporate social responsibility (CSR) orientation is key to driving long-term survival, growth and sustainable performance in a complex and dynamic environment. However, studies of the relationship between CSR and financial performance (FP) have yielded disparate results. Therefore, the current study aims to examine the effect of CSR on FP by using customer satisfaction (CS), reputation (REP) and competitive advantage (CA) as mediating variables. The data for this study was collected via a survey of 207 Moroccan exporting small and medium-sized enterprises (SMEs) and analyzed using SPSS 25 and Structural-equation Modeling with the aid of AMOS 23. Outcomes revealed that CSR has no significant direct effect on FP, but rather an indirect effect through REP and CS. Likewise, the link between CSR and FP is mediated on the one hand by CS and CA, successively and on the other hand by REP and CA, successively. These findings provide a verified theoretical framework for SME managers to plan and execute CSR to enhance FP by indirectly targeting the aforementioned intangible assets. The paper contributes to the knowledge of how CSR practices lead to FP in an under-explored context of SMEs in a developing country.

Amor Fati and the Negation of Life: Examining Existential Meaning in Life and Regret as Processes Involved in the Association Between One’s Love of Fate and Suicidal Ideation

This study examined how amor fati, a positive psychological construct, was associated with suicidal ideation in a sample of 215 young adults. Specifically, components of existential meaning in life (viz., comprehension, purpose, and mattering) and regret were evaluated as potential mediators of the association between amor fati and suicidal ideation. Results of conducting bootstrapped mediation testing with multiple mediators indicated that amor fati was indirectly associated with suicidal ideation through comprehension and mattering. Purpose and regret were not found to mediate the association between amor fati and suicidal ideation. In support of partial mediation, however, the negative association between amor fati and suicidal ideation remained significant even after including components of existential meaning in life and regret in the model. The present findings indicate that amor fati is an important protective factor that should be considered in studies of suicidality in young adults.

A Multiple Mediator Model of Depression, Dysfunctional Beliefs about Sleep, and Sleep Effort in the Relationship between Psychological Inflexibility and Insomnia in Shift Working Nurses.

The aims of this study were to explore the influence of shift working nursing professionals' psychological inflexibility on their level of insomnia. Additionally, we investigated the mediation effect of depression and sleep-related cognitions on this association. An online survey was conducted among 202 nursing professionals at Asan Medical Center from July to August, 2023. Participants responded to questionnaires including the Insomnia Severity Index (ISI), Acceptance and Action Questionnaire-II (AAQ-II), Dysfunctional Beliefs and Attitudes about Sleep - 16 (DBAS-16), Glasgow Sleep Effort Scale (GSES), Patient Health Questionnaire-9 items (PHQ-9), and the Discrepancy between desired time in bed and desired total sleep time index (DBST index). Pearson's correlation and linear regression were performed to explore the factors predicting ISI scores. Mediation analysis was implemented. Linear regression revealed that insomnia severity was predicted by DBAS-16 (β = 0.15, p = 0.008), GSES (β = 0.48, p < 0.001), and PHQ-9 (β = 0.26, p < 0.001). Mediation analysis showed that the relationship between the psychological inflexibility of shift-working nursing professionals' and insomnia severity was fully mediated by depression, dysfunctional beliefs about sleep, and sleep effort. Psychological inflexibility does not directly influence insomnia severity, but depression, dysfunctional beliefs about sleep, and sleep effort fully mediate the relationship.

Influence of Defense Mechanisms on Sport Burnout: A Multiple Mediation Analysis Effects of Resilience, Stress and Recovery.

The aims of this study were: (a) to explore the relationships between adaptive defense mechanisms (ADMs), maladaptive defense mechanisms (MADMs), stress, recovery, resilience, and sport burnout; and (b) to examine resilience, stress, and recovery as mediators of the relationship between defense mechanisms and burnout. One hundred and seventy-five athletes (M = 20.30 years, SD = 3.75) completed self-report questionnaires assessing defense mechanisms, resilience, stress, and recovery. Correlation analysis revealed that MADMs were positively associated with burnout, while ADMs had no significant link with burnout. Concerning mediation analysis, results showed a mediating effect of resilience in the relationship between ADMs and burnout. The findings also demonstrated a mediating effect of resilience and recovery in the relationship between MADMs and burnout. Our study highlighted that certain defenses categorized as adaptive might not be suitable in specific situations, thus underscoring the influence of mediating variables. The findings of mediation analysis demonstrated that resilience appears to serve as a particularly protective factor against burnout. On the contrary, MADMs would have a deleterious influence in the management of stress, which could lead to burnout. Coaches may consider fostering athletes' resilience in conjunction with ADMs and implementing targeted psychological exercises to reduce the use of MADMs.

The effect of childhood memories of happiness and peace on distress tolerance: the mediating role of emotional intelligence

BackgroundThe main objectives of this study were to examine whether childhood memories of happiness and peace are associated with distress tolerance and to determine whether distress tolerance mediates the relationship between childhood memories of happiness and peace. We hypothesized that childhood memories of happiness and peace are directly and indirectly associ-ated with distress tolerance through emotional intelligence.Participants and procedureParticipants consisted of 538 individuals aged between 19 and 27 years and in emerging adulthood. Among these partici-pants, 426 were female and 112 were male. The data collection tools used in this study included the Early Memories of Warmth and Safeness Scale, the Distress Tolerance Scale, and the Rotterdam Emotional Intelligence Scale. A multiple medi-ation model was analysed using the bootstrapping technique.ResultsEarly memories of warmth and safety, other-focused emotion evaluation, self-focused emotion control, and distress toler-ance were positively correlated. Early warm and safe memories were positively correlated with self-focused, other-focused, and self-regulated emotions. However, self-focused emotion appraisal did not substantially affect distress tolerance. Boot-strapping technique indicated that early memories of warmth and safeness increased other-focused emotion appraisal and self-focused emotion regulation and increased distress tolerance. Early memories of warmth and safeness did not indirectly affect distress tolerance through self-focused emotion appraisal and other-focused emotion regulation.ConclusionsWe found positive associations between distress tolerance, early warmth and safety memories, and other- and self-focused emotion regulation. Early memories of warmth and safeness directly raised distress tolerance, without mediation by self-focused emotion evaluation or other-focused emotion control.

The Mediating Effect of Perceived Social Support and Health Literacy on the Relationship Between Decisional Dilemma and Participation in Shared Decision-Making Among Chinese Parents of Premature Infants.

This research was conducted to explore the mediating effect of perceived social support and health literacy on the relationship between decisional dilemmas and participation in shared decision-making among Chinese parents of premature infants. This cross-sectional study recruited 225 Chinese parents of premature infants in a neonatal ward of a Chinese hospital through convenience sampling. Data were collected from August 2022 to February 2023 using 5 self-administered instruments. Structural equation modeling and multiple mediation tests were applied to explore the interplay among perceived social support, health literacy, decisional dilemmas, and participation in shared decision-making. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Decisional dilemmas were found to negatively impact participation in shared decision-making. Perceived social support and health literacy were identified as partial mediators in this relationship, collectively accounting for a mediation effect of -0.413, which represents 50.0% of the total effect. The findings elucidate a multifaceted model of factors influencing participation in shared decision-making among Chinese parents of premature infants. Prompt recognition of these variables can enable nursing professionals to incorporate tailored management strategies within patient-centered care frameworks, thereby enhancing decisional outcomes.

Childhood poverty, social support, immigration background and adolescent health and life satisfaction: A population-based longitudinal study.

This study examined whether poverty (neighborhood and household) was associated with future health or life satisfaction outcomes and whether the association operated through social support (adult support at home, adult support at school, peer belonging), or differed by the immigration background (nonimmigrant family or immigrant family) of the family. This study utilized a retrospective, longitudinal, population-based cohort that included self-reported survey data from the Middle Years Development Instrument (MDI) completed by children at age 9 and age 12, linked to administrative records. Participants included 5906 children in British Columbia, Canada. Neighborhood and household poverty were observed at age 8. Social support from adults and peers was self-reported at age 9. Outcomes (overall health; life satisfaction) were self-reported at age 12. Adjusted multi-level multiple linear regression analyses and parallel mediation analyses were utilized. The interaction between poverty exposure and immigration background was also examined. Exposure to either poverty type was associated with lower levels of life satisfaction and overall health at age 12, though household poverty appeared to be associated with lower outcomes in comparison to neighborhood poverty. The indirect effects of poverty on outcomes appeared to operate primarily through adult support at home and peer belonging. Children in immigrant families had a larger negative association between neighborhood poverty and life satisfaction. Household poverty had a larger negative association to outcomes in comparison to neighborhood poverty. The association of poverty to outcomes differed by immigration background and operated partially through adult support at home and peer belonging.

The role of health literacy in the association between social support and self-rated health: a Danish population-based study in 10,787 individuals with a long-term condition.

Managing a long-term condition requires higher health literacy. Social networks may play a crucial role for self-management. However, the pathway is not entirely understood. This study aimed to examine whether the association between social support and self-rated health is mediated by health literacy among individuals with a long-term condition. This cross-sectional study used data from the "How are you?" 2021 survey in Central Denmark Region. Social support was assessed using a single question, health literacy with two dimensions from the Health Literacy Questionnaire (HLQ): 'Understanding health information' and 'Engaging with healthcare providers', and self-rated health with a single question from SF-36. Multiple logistic regression analyses were used to examine the associations, and multiple mediation analyses were performed using the Karlson-Holm-Breen method. A total of 10,787 individuals with a long-term condition were included in the study, whereas 6% (n = 595) reported a low level of social support. Both health literacy scales mediated the association between social support and self-rated health, particularly the ability to engage with healthcare providers, accounting for 25% of the variance. After adjustment for sociodemographic factors, individuals with a low level of social support had significantly higher odds of reporting difficulties in understanding health information (OR 2.53 (95% CI: 1.84-3.48)) and engaging with healthcare providers (OR 3.77 (95% CI: 2.96-4.79)). Health literacy, particularly the ability to engage with healthcare providers, was a mediator between social support and self-rated health. Additionally, a low level of social support was associated with higher odds of reporting lower health literacy. These findings suggest that strategies to enhance health literacy, improve health outcomes, and reduce health inequities may benefit from strengthening individuals' social network, particularly focusing on those with limited support.

Preventive health-care behavior: a serial multiple mediation analysis

Purpose Preventive health-care behavior (PHB) adoption as a primordial prevention to stay healthy and avoid lifestyle disease risk is a global trend. This paper aims to use the PHB model and stimulus-organism-response theory to empirically examine the role of individual and technological factors in influencing primordial PHB. Design/methodology/approach A sequential mixed-method was adopted to identify the primordial PHB adoption and propose a conceptual framework. The identified determinants and the hypothesized relationships were empirically tested using a convenience sample of 406 urban Indians. Partial least square structural equation modeling is used for data analysis. Findings The derived conceptual framework was empirically tested to assess the role of health literacy (HL), health value (HV) and digital health information seeking (DHIS) on primordial PHB. Findings confirmed the significant influence of DHIS on HL, HL on HV and PHB and HV on PHB. The direct effects of DHIS on PHB and HV were insignificant. HL solely mediated the indirect effect of DHIS on PHB, while the mediation of HV was insignificant. HL and HV fully mediated the relationship between DHIS and PHB. Research limitations/implications The impact of DHIS on PHB adoption and the serial multiple mediating roles of HL and HV are significant in understanding primordial PHB adoption for both academic theory and practice. However, the cross-sectional study on urban Indians needs further validation across geographies. Originality/value To the best of the authors’ knowledge, this pioneering study is among the first to propose and validate a comprehensive model of primordial PHB adoption.