Independent associations between health-promoting behaviours, healthcare access, and health-related quality of life in Singapore

Population-level evidence on how health-promoting behaviours and healthcare access affect health-related quality of life (HRQoL) in Singapore’s ageing population remains limited. This cross-sectional study examined their independent associations with HRQoL among community-dwelling adults and identified factors associated with complete adherence to health-promoting behaviours and adequate healthcare access. Using 2022 Population Health Survey data from 2,320 participants, adherence to health-promoting behaviours was classified as complete or partial, and healthcare access as adequate or inadequate. Multiple logistic regressions identified associated factors. HRQoL was measured using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and EQ Visual Analogue Scale (EQ-VAS). Two-part models for EQ-5D index and generalised linear models for EQ-VAS examined associations with HRQoL. Complete adherence to health-promoting behaviours and adequate healthcare access prevalence was 19.8% and 90.3%, respectively, with divergent associated factors. After adjustment, both variables were independently associated with higher likelihood of perfect health (odds ratio 1.55 and 2.16, respectively) and higher EQ-VAS scores (beta 3.62 and 2.53, respectively), but not with HRQoL among those with imperfect health. Both health-promoting behaviours and healthcare access are independent factors associated with HRQoL. Their largely distinct socio-demographic correlates suggest public health strategies should adopt a dual-track approach: promoting healthy behaviours alongside addressing access barriers to support healthy ageing.