Health-Related Social Media Use and Health-Promoting Behaviors Among Community-Engaged, Functionally Independent Older Adults in Rural Thai Communities

Background: Health-promoting behavior is central to healthy aging, and digital platforms are an increasingly important channel through which older adults encounter health information. This study examined demographic, health-status, and health-related social media use factors associated with health-promoting behavior among older adults in Samut Songkhram Province, Thailand, a small province with a disproportionately large share of older residents. Methods: A cross-sectional study was conducted among 402 community-engaged, functionally independent adults aged ≥ 60 years, recruited through a mixed multistage procedure with convenience recruitment at the individual level in the final stage, at community gathering points. Health-related social media use (22 items, four proposed content domains) and health-promoting behavior (31 items, six domains, adapted from the Health-Promoting Lifestyle Profile-II) were measured using structured, pilot-tested questionnaires. Associations were assessed with Spearman correlation and simultaneous multiple linear regression. Because regression diagnostics indicated heteroscedasticity, HC3 heteroscedasticity-consistent standard errors, 95% confidence intervals, and p-values were used as the primary regression inference. Results: Overall health-related social media use (M = 2.58, SD = 0.55) and health-promoting behavior (M = 3.34, SD = 0.48) were both classified as “high” under the pre-specified four-band descriptive convention. The adjusted model explained 54.65% of the variance in health-promoting behavior (R2 = 0.5465; adjusted R2 = 0.5349). Under HC3 robust inference, overall health-related social media use (β = 0.715, p < 0.001), marital status, bachelor’s-degree-or-higher education (inverse association), chronic condition status, and average monthly income (small inverse association, p = 0.032) were independently associated with the outcome. In a domain-specific sensitivity model, general/recreational use (B = 0.439, HC3 95% CI: 0.345 to 0.533, p < 0.001) and diverse types of use (B = 0.112, HC3 95% CI: 0.040 to 0.184, p = 0.002) were independently associated with health-promoting behavior, whereas duration of use and interpersonal health communication were not. Conclusions: Greater overall health-related social media use was associated with health-promoting behavior among community-engaged, functionally independent older adults; however, the domain-specific pattern suggests that this association primarily reflects broader digital/social engagement rather than specifically health-focused social media activity. Given the cross-sectional design, weak support for the proposed social-media subdomain structure, and the possibility of common-method variance and construct overlap, the findings should be regarded as hypothesis-generating and require confirmation in longitudinal or intervention studies using psychometrically refined measures.