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Structural Equation Modeling of Social Cognitive Theory-based Constructs,
Physical Activity, and Blood Pressure in Young and Middle-aged Adults Living
with Hypertension

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W. Suriyawong, T. A. Kao, L. Robbins, J. Ling, and L. Malete 3
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1 Faculty of Nursing, Chiang Mai University, Thailand, College of Nursing, Michigan State University,
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United States, and Kinesiology, Michigan State University, United States
Background: In contrast to older adults, young- and middle-aged adults in Thailand grappling with
hypertension often exhibit inadequate blood pressure management, possibly due to psychosocial- or
work-related barriers to adhering to recommended lifestyle behaviors like physical activity.

Objective: This cross-sectional study aimed to examine how Social Cognitive Theory (SCT)-based
constructs (perceived stress, self-efficacy, outcome expectancy, functional support, workplace
support) relate to physical activity (PA) and systolic/diastolic blood pressure (BP). Additionally, the
study sought to investigate whether PA mediates the associations between SCT-based constructs
and BP, and whether hypertensive medication adherence and hypertension diagnosis duration
moderate these relationships. The research employed group comparison modeling to analyze these
interactions.

Methods: The analysis encompassed 400 adults with hypertension from 25 primary care settings in a
Thai province. Confirmatory factor analysis validated latent variables, followed by structural equation
modeling with maximum likelihood and robust standard errors to analyze direct and indirect effects
on physical activity and blood pressure. Using the Mplus IND function, we performed a mediation
analysis to explore the mediating effect of PA. Lastly, we utilized the DIFFTEST procedure within Mplus to
determine moderation effects.

Oral Presentation Abstracts
Results: Findings highlight self-efficacy as a significant predictor of moderate-to-vigorous physical
activity (MVPA) (ß = 0.26, p <.001), while functional support correlated with reduced systolic BP
(ß = -0.24, p <.001). MVPA mediated the relationship between self-efficacy (indirect effect = -0.050, p
= .005) or functional support (indirect effect = -0.031, p = .046) and systolic BP. Hypertension duration
(diagnosis ≤12 months versus >12 months) moderated the relationship between MVPA (∆x2 = 7.424,
p = .006) or functional support (∆x2 = 4.173, p = .041) and diastolic BP.

Conclusion: These findings enhance understanding of how psychosocial factors relate to PA and BP,
informing the development of effective interventions for early BP control in young and middle-aged
adults with hypertension.

Keywords: physical activity, young adults, middle-aged adults, hypertension, psychosocial factors,
blood pressure, hypertension duration, medication adherence, structural equation model

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Correspondence: Wachira Suriyawong, Faculty of Nursing, Chiang Mai University, Thailand
E-mail: wachira.s@cma.ac.th

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