Perceived healthy community environment and loneliness among older adults in China: indirect psychosocial pathways through community belongingness and multi-source received social support

Abstract

Introduction Loneliness in later life is closely linked to older adults' living environments and psychosocial resources. Although digital inclusion has received increasing attention in aging societies, less is known about whether perceived healthy community environments remain relevant to loneliness among older adults. This study examined whether community belongingness (CB) and multi-source received social support (MRSS) formed indirect psychosocial pathways linking perceived healthy community environment (PHCE) to loneliness among older adults in China. Methods Data were drawn from a face-to-face cross-sectional survey conducted across 21 communities in Wuxi, China. The analytical sample included 469 adults aged 60 years or older. A serial multiple mediator model was estimated using 5,000 bootstrap samples to assess indirect associations. Models adjusted for demographic, socioeconomic, health-related, and technology-related covariates. Results Higher PHCE was associated with stronger CB and higher MRSS. CB and MRSS were both negatively associated with loneliness, whereas the direct association between PHCE and loneliness was not statistically significant after these psychosocial variables were included. Bootstrap analyses indicated statistically significant indirect associations through CB [effect = −0.085, 95% CI (-0.197,−0.004)], through MRSS [effect = −0.046, 95% CI (-0.125,−0.010)], and through the sequential PHCE–CB–MRSS–loneliness pathway [effect = −0.027, 95% CI (-0.082,−0.006)]. Sensitivity analyses showed that MRSS-related pathways were attenuated after adjustment for e-health literacy, while the pathway through CB remained more stable. Discussion Perceived healthy community environments may be linked to lower loneliness among older adults through psychosocial pathways involving belongingness and received social support. These findings suggest that community-based loneliness prevention should attend not only to physical and service environments, but also to older adults' psychological attachment and accessible support resources.