Geriatric Nursing 42 (2021) 1577 1582

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Geriatric Nursing
journal homepage: www.gnjournal.com

Perceived social support, resilience and health self-efficacy among

migrant older adults: A moderated mediation analysis
Ling-Na Kong, PhDa,*, Wen-Fen Zhu, MSa, Ping Hu, MSb, Hai-Yan Yao, MSc,**
a
School of Nursing, Chongqing Medical University, Chongqing 400016, PR China
b
Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
c
Department of Scientific Research, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China

A R T I C L E I N F O A B S T R A C T

Article history: Migrant older adults become more disadvantaged in health due to aging and migration-related problems.
Received 23 August 2021 This study aimed to examine the mediating role of resilience in the relationship between perceived social
Received in revised form 16 October 2021 support and health self-efficacy, and to test whether gender moderated the mediating effect of resilience
Accepted 19 October 2021
between perceived social support and health self-efficacy among migrant older adults. A total of 184 migrant
Available online xxx
older adults were recruited from five communities. Resilience played a partial mediating role in the relation-
ship between perceived social support and health self-efficacy. Moreover, age moderated the relationship
Keywords:
between resilience and health self-efficacy. The relationship between resilience and health self-efficacy was
Health self-efficacy
Perceived social support
stronger in male older adults than female ones. These findings provide a better understanding of the effects
Resilience of perceived social support and resilience on health self-efficacy, which could guide targeted interventions
Gender for community health nurses to promote health self-efficacy among migrant older adults.
Older adults © 2021 Elsevier Inc. All rights reserved.
Migrants
Moderated mediation

Introduction behaviors.6 Health self-efficacy can affect individuals’ motivation and

Population aging imposes a heavy burden on public health world-
wide, including in China. Aging and age-related chronic diseases
have adverse effects on older adults’ health and quality of life. In
China, about 18 million older adults have accompanied their adult
children to more developed areas,1 and the number of migrant older
adults will continue to grow.2 Migrant older adults become more dis-
advantaged in health due to aging and migration-related problems
such as limited social support and restricted access to health
services.3,4 Therefore, promoting the health of migrant older adults is
an essential component of public health. Health self-efficacy is con-
sidered as a motivating force in improving health and plays an
increasingly important role in the health management.5 It is impor-
tant to identify potentially modifiable factors related to health self-
efficacy to develop interventions to improve health self-efficacy for
migrant older adults.
Health self-efficacy is a task-specific self-efficacy and refers to
individuals’ belief in their abilities to engage in health-promoting
*Corresponding author. School of Nursing, Chongqing Medical University, Chongqing
400016, PR China
**Co-Corresponding author. Department of Scientific Research, The First Affiliated
Hospital of Chongqing Medical University, Chongqing 400016, PR China
E-mail addresses: konglingna926@126.com (L.-N. Kong), yaohy728@126.com
(H.-Y. Yao).
decision and subsequent action for promoting health. Existing evi-
dence has shown that health self-efficacy is positively related to
health-promoting behaviors and healthy aging.5,7,8 Previous studies
revealed that older adults usually had an unsatisfactory level of
health self-efficacy and suggested the need for effective interventions
to improve their health self-efficacy.5,7 To develop effective interven-
tions, it is critical to explore factors related to health self-efficacy.
According to Bandura’s Self-Efficacy Theory, four sources can influ-
ence individuals’ self-efficacy including performance accomplish-
ments, verbal persuasion (e.g. social support), vicarious experience,
and emotional or physiological arousal.9 Several studies have identi-
fied factors affecting older adults’ health self-efficacy, such as gender,
educational level, income, health insurance and social support.6,10
Despite the critical role of health self-efficacy in the initiation and
maintenance of health-promoting behaviors, little is known about
the level of health self-efficacy and its related factors among migrant
older adults.
Perceived social support refers to individuals’ perception of the
support that they receive from their social network.11 Perceived
social support reflects individuals’ subjective and true feelings and
can enhance their belief to solve health problems more effectively.
Evidence from previous studies has shown that perceived social sup-
port is associated with health self-efficacy, health-promoting behav-
iors,7 loneliness, depression,12 and quality of life.13,14 Older adults are

https://doi.org/10.1016/j.gerinurse.2021.10.021
0197-4572/$ see front matter © 2021 Elsevier Inc. All rights reserved.
1578 L.-N. Kong et al. / Geriatric Nursing 42 (2021) 1577 1582
more prone to have fewer social resources.13 For migrant older
adults, migrating to a new environment means the change of their
social networks and more loss of social resources. One study indi-
cated that migrant older adults usually suffered from lower social
support compared to local older adults.15 However, limited evidence
shows that how perceived social support affects health self-efficacy
among this population.
The American Psychological Association defines resilience as the
ability to adapt well in the face of adversity or significant sources of
stress.16 Resilience is therefore proposed to alleviate the negative
effects of stress on health and wellbeing. Increasing evidence has
demonstrated the significant association between higher resilience
and better health outcomes for older adults, such as reduced depres-
sion, improved health behaviors and self-rated health, increased
quality of life and successful aging.17,18 Resilience also has a positive
effect on self-efficacy for disease management and emotion
management.19,20 Resilience is essential for migrant older adults
because they may face more migration-related stress, and this may
influence their self-efficacy in health. However, how resilience influ-
ences health self-efficacy among migrant older adults has not been
clearly studied.
Meanwhile, several studies explored the relationship between
perceived social support and resilience and found that perceived
social support was a positive predictor of resilience.12,21 Resilience
has also been demonstrated to act as an important mediator between
social support and some health variables (e.g. depression and quality
of life).21,22 Taken together, it is possible that resilience may play a
mediating role in the impact of perceived social support on health
self-efficacy among migrant older adults. In addition, there may be a
gender difference in the association between perceived social sup-
port, resilience and health self-efficacy. Previous studies revealed
that male older adults appeared to be generally with lower social
support and resilience than female older adults.17,23 Thus, gender
may be a potential moderator for the mediating effect of resilience
between perceived social support and health self-efficacy.
Based on the above literature review, this study aimed to explore
the mediating effect of resilience between perceived social support
and health self-efficacy, and to examine whether gender moderated
the mediating effect of resilience between perceived social support
and health self-efficacy among migrant older adults. Our hypotheses
were as follows: (1) perceived social support and resilience had posi-
tive effects on health self-efficacy; (2) resilience played a mediating
role in the relationship between perceived social support and health
self-efficacy; and (3) gender moderated the mediating effect of resil-
ience between perceived social support and health self-efficacy,
including gender moderated the effect of perceived social support on
resilience, gender moderated the effect of resilience on health self-
efficacy, and gender moderated the effect of perceived social support
on health self-efficacy.
Methods
Design and participants
This was a cross-sectional, descriptive study. Using convenience
sampling, a total of 184 migrant older adults were recruited from
two communities in Yuzhong District, two communities in Shapingba
District and one community in Jiulongpo District in Chongqing City,
China. The inclusion criteria were aged 60 years or above, residing in
the community at least six months without an officially local resi-
dency status, and willing to take part in this study. The exclusion cri-
teria were those who were unable to complete the questionnaire due
to poor health conditions or other reasons. The minimum sample size
was 116, with a=0.39 (path a), b=0.26 (path b) and power=0.80, based
on the sample size criteria for mediation analysis with a bias-cor-
rected bootstrapping procedure.24
Instruments
The self-report questionnaire included demographic characteris-
tics, the Multidimensional Scale of Perceived Social Support (MSPSS),
Connor-Davidson Resilience Scale-10 item (CD-RISC-10) and Self-
rated Abilities for the Health Practices Scale (SRAHP).
Demographic characteristics consisted of age, gender, marital sta-
tus, education level, and whether having a chronic disease or not.
Perceived social support was measured by the MSPSS.11 It com-
prises of 12 items and three subscales covering perceived support
from family, friends and others. Each item is rated by a 7-point Likert
scale (1=strongly disagree and 7=strongly agree). The total score
ranges from 12 to 84, with higher scores indicating greater social sup-
port perceived by the individual. Total score of 12-36, 37-60 and
61-84 indicates a low, moderate and high level. The Chinese version
of MSPSS has been demonstrated with good internal consistency
(Cronbach’s a=0.890).25 In this study, the Cronbach’s a was 0.944.
Resilience was assessed by the CD-RISC-10, which assessed an
individual’s perception of the ability to cope with adversity.26 Each
item is rated by a 5-point Likert scale from 0 (never) to 4 (always).
The total score ranges from 0 to 40 and higher scores indicate greater
resilience. The Chinese version of CD-RISC-10 was considered to be
reliable with satisfactory validity and reliability in older adults.27 The
Cronbach’s a was 0.936 and the test-retest reliability was 0.665. The
Cronbach’s a was 0.913 in this study.
Health self-efficacy were assessed by the SRAHP, which was
developed to assess individuals’ beliefs about their ability to perform
health-promoting behaviors.28 It includes 28 items and four sub-
scales: nutrition (7 items, self-efficacy in healthy diet), exercise (7
items, self-efficacy in physical activities), psychological well-being (7
items, self-efficacy in stress management and interpersonal relation-
ships) and health responsibility (7 items, self-efficacy in obtaining
health-related information and assistance). Items are rated by a 5-
point Likert scale (0=not at all and 4=completely). The total score
ranges from 0 to 112, with higher scores reflecting greater health
self-efficacy. Score index is calculated by (actual score/highest
score) £ 100%. Score index of <40%, 40%-80%, and >80% indicates a
low, moderate and high level. The Chinese version of SRAHP has been
validated with good reliability (Cronbach’s a=0.950) and validity (fac-
tor analysis).29 The Cronbach’s a was 0.915 in the present study.
Data collection
Data were collected by well-trained investigators from July 2019
to September 2020. With the help of staff from the five community
centers, 210 eligible participants were approached and 198 partici-
pants agreed to take part in this survey. A face-to-face interview
approach was used to collect data using a self-report questionnaire in
the community centers. Before the data collection, each participant
was informed of the aim of this survey and assured of confidentiality
of their information. Completion of the questionnaire took about 20
minutes.
Ethical considerations
The study protocol was approved by the ethic committee of the
First Affiliated Hospital of Chongqing Medical University. All partici-
pants were informed of voluntary participation, as well as the right
to decline any questions or withdraw from the survey at any time.
 L.-N. Kong et al. / Geriatric Nursing 42 (2021) 1577 1582 1579

Statistical analysis

Data were analysed using SPSS 25.0. Descriptive statistics were
used to present the demographic characteristics and study variables.
Bivariate Pearson’s correlation analysis was performed to test the cor-
relations between study variables. SPSS PROCESS macro was utilized
to test mediation and moderation analysis. Demographic variables
were controlled as covariates throughout the analysis. First, the media-
tion model (Fig. 1) was tested by Model 4 of PROCESS macro.30 Path a
refers to the effect of perceived social support (independent variable)
on resilience (mediator) and path b refers to the effect of resilience on
health self-efficacy (dependent variable). Path c (total effect) includes
a direct effect (path c’) of perceived social support on health self-effi-
cacy and an indirect effect (path a £ b) of perceived social support on
health self-efficacy via resilience. If zero is excluded in the 5,000 boot-
strap bias-corrected 95% confidence intervals (CI) for the indirect
effect, the mediating effect is significant. Second, after confirming the
mediation model, Model 59 and Model 14 were used to examine the
moderated mediation model (Fig. 2) according to the p value of the
interaction term between the moderator (gender) and independent
variable/mediator. In model 59, we preliminarily tested the signifi-
cance of interaction terms between gender and perceived social sup-
port or resilience, such as the effect of perceived social
support £ gender on resilience, the effect of perceived social
support £ gender on health self-efficacy, and the effect of
resilience £ gender on health self-efficacy. In model 14, the signifi-
cance of the interaction term between resilience and gender on health
self-efficacy was tested. Further, the significance of conditional indirect
effect at different levels of the moderator was tested according to the
95%CI. P<0.05 (two tailed) was considered statistically significant.
Fig. 2. Moderated mediation model. Notes: a, effect of perceived social support on
resilience; b, effect of resilience on health self-efficacy; c, total effect of perceived social
support on health self-efficacy; c’, direct effect of perceived social support on health
self-efficacy; d, moderated effect of gender between resilience and health self-efficacy;
*p<0.05, **p<0.01.
exercise (19.27§4.32), followed by nutrition (18.59§4.78) and psy-
chological well-being (18.11§5.80), and health responsibility showed
the least average subscale score (15.31§5.22). Further, the average
scores of perceived social support and resilience were 56.20
(SD=13.23) and 26.77 (SD=5.31), respectively. The percentage of low,
moderate and high level of perceived social support was 10.9%, 49.5%
and 39.6%, respectively.
The correlation analyses showed that health self-efficacy was pos-
itively correlated with perceived social support (r=0.408, p<0.01)
and resilience (r=0.441, p<0.01), and negatively correlated with age
(r=-0.244, p<0.01) and marital status (r=-0.162, p<0.05). Meanwhile,
more perceived social support was significantly correlated with
greater resilience (r=0.509, p<0.01). The correlation analyses
between study variables are shown in Table 2.

Results
Table 1
Demographic characteristics Sample characteristics (n=184)

Characteristics Mean (SD) / N (%)

Of the 198 eligible participants agreed to participate, 14 partici-
Age (years) 68.52 (6.44)
pants did not complete the questionnaires for personal reasons. Thus,
Gender
the response rate was 92.9% (184/198). The mean age was 68.52§ male 64 (34.8)
6.44 years (range: 60-89 years). 65.2% of participants were female, female 120 (65.2)
90.8% were married, and 61.4% had a low education level. 59.8% par- Marital status
married 167 (90.8)
ticipants reported having at least one chronic disease. Participants'
unmarried 17 (9.2)
characteristics are presented in Table 1. Education level
primary school 113 (61.4)
Correlations between study variables junior middle school 41 (22.3)
high school 24 (13.0)
 college 6 (3.3)
As shown in Table 2, the average score of health self-efficacy was Chronic disease
71.29 (SD=16.13), suggesting that migrant older adults in this study yes 110 (59.8)
had moderate level of health self-efficacy. The percentage of low, no 74 (40.2)
moderate and high level of health self-efficacy was 3.8%, 86.4% and
9.8%, respectively. The highest average subscale score was for

Table 2
Bivariate correlations among study variables

Variables Health self-efficacy Perceived social Resilience

Fig. 1. Mediation model. Notes: a, effect of perceived social support on resilience; b,
support
effect of resilience on health self-efficacy; c, total effect of perceived social support on
health self-efficacy; c’, direct effect of perceived social support on health self-efficacy; Health self-efficacy 1
*p<0.05, **p<0.01 Perceived social support 0.408** 1
Resilience 0.441** 0.509** 1
Age -0.244** -0.271** -0.124
Gender -0.024 -0.144 -0.024
Marital status -0.162* -0.200** -0.227**
Education level 0.120 0.090 0.145*
Chronic disease -0.100 -0.018 0.042
Mean (SD) 71.29 (16.13) 56.20 (13.23) 26.77 (5.31)
* p < 0.05,
** p < 0.01
1580 L.-N. Kong et al. / Geriatric Nursing 42 (2021) 1577 1582

Table 3
Mediation of resilience between perceived social support and health self-efficacy

Independent variables Resilience Health self-efficacy Health self-efficacy

b t b t b t

Age 0.027 0.416 -0.132 -1.877 -0.140 -2.085*

Marital status -0.143 -2.213* -0.089 -1.303 -0.045 -0.671
Education level 0.116 1.806 0.074 1.091 0.038 0.579
Chronic disease 0.057 0.897 -0.085 -1.265 -0.102 -1.592
Perceived social support 0.479 7.148** 0.346 4.881** 0.197 2.555*
Resilience - - - - 0.312 4.094**
R2 0.292 0.205 0.274
F 14.690** 9.201** 11.140**
b: standardized coefficient;
* P < 0.05,
** P < 0.01

Mediation Analysis
Table 3 and Fig. 1 present the results of mediation analysis. After
controlling demographic variables, perceived social support was pos-
itively related to resilience (b=0.479, p<0.01) and health self-efficacy
(b=0.346, p<0.01), and resilience was positively related to health
self-efficacy (b=0.312, p<0.01). The direct effect of perceived social
support on health self-efficacy was significant (b=0.197, p<0.05). The
indirect effect of perceived social support on health self-efficacy via
resilience was 0.149 (95%CI=0.064, 0.243). Taken together, resilience
partially mediated the relationship between perceived social support
and health self-efficacy, accounting for 43.1% of the total effect.
Moderated mediation analysis
Tables 4 presents the results of moderated mediation analysis. In
Model 59 (Table 4), the interaction term between perceived social
support and gender was not significantly associated with resilience
(b=-0.076, p>0.05) and health self-efficacy (b=0.153, p>0.05), indi-
cating that gender did not moderate the relationship between per-
ceived social support and resilience, as well as the relationship
between perceived social support and health self-efficacy. In addi-
tion, the interaction term between resilience and gender was signifi-
cantly related to health self-efficacy (b=-0.462, p<0.01), which
demonstrated that gender moderated the relationship between resil-
ience and health self-efficacy.
Model 14 was used to further test the moderation mediation
effect (Table 4 and Fig. 2). The interaction term between resilience
and gender was significantly associated with health self-efficacy
(b=-0.384, p<0.01), indicating that gender moderated the effect of
resilience on health self-efficacy. The index of moderated mediation
was significant (b=-0.184, 95%CI=-0.331, -0.032). For male migrant
older adults, perceived social support had a significantly positive
effect on health self-efficacy via resilience (b=0.276, 95%CI=0.124,
0.430). As for female migrant older adults, the indirect effect was
weaker (b=0.092, 95%CI=0.017, 0.178).
Discussion
The present study revealed that resilience partially mediated the
relationship between perceived social support and health self-effi-
cacy among migrant older adults. Moreover, gender moderated the
relationship between resilience and health self-efficacy. These find-
ings provide a better understanding of the relationship between per-
ceived social support, resilience and health self-efficacy and offer
evidence on developing interventions to improve health self-efficacy
among migrant older adults.
In this study, the average score of health self-efficacy was approxi-
mately 63.6% of the total score, similar to previous studies,5,7 indicat-
ing a moderate level of self-efficacy for performing health-promoting
behaviors among this population. More specifically, health responsi-
bility presented the lowest subscale score, indicating that migrant
older adults had lower belief in their ability to obtain health-related
information and assistance. In addition, average subscale scores for
exercise, nutrition and psychological well-being showed that migrant
older adults’ self-efficacy for the three aspects also needed to be
improved. Migrant older adults may face a series of adversities
related to migration, such as drastic changes on lifestyle and living

Table 4
Results of the moderated mediation analysis

Independent variables Model 59 Model 14

Resilience Health self-efficacy Resilience Health self-efficacy

coeff. t coeff. t coeff. t coeff. t

Age 0.006 0.558 -0.022 -2.113* 0.004 0.416 -0.021 -2.027*

Marital status -0.485 -2.164* -0.050 -0.221 -0.493 -2.213* -0.050 -0.217
Education level 0.145 1.877 0.015 0.194 0.138 1.806 0.016 0.209
Chronic disease 0.117 0.911 -0.235 -1.818 0.115 0.897 -0.228 -1.769
Gender 0.151 1.110 0.011 0.080 - - 0.028 0.209
Perceived social support 0.621 2.402* -0.062 -0.204 0.479 7.148** 0.204 2.652**
Perceived social support £ Gender -0.076 -0.527 0.153 0.906 - - - -
Resilience - - 1.096 3.836** - - 0.962 3.937**
Resilience £ Gender - - -0.462 -2.858** - - -0.384 -2.802**
R2 0.298 0.309 0.292 0.306
F 10.656** 8.635** 14.690** 9.621**
* P < 0.05,
** P < 0.01
 L.-N. Kong et al. / Geriatric Nursing 42 (2021) 1577 1582 1581

environment, reduced social resources and support, and limited Limitations

access to health care services,3,4 which may affect their health self-
efficacy. Our findings highlight the need for healthcare professionals To our best knowledge, this is the first study to examine the mod-
to address interventions to promote health self-efficacy among this erated mediation effect of resilience on the relationship between per-
population. ceived social support and health self-efficacy. However, several
Perceived social support was the key factor associated with limitations should be noted in this study. First, the cross-sectional
health self-efficacy among migrant older adults, consistent with a design made it difficult to explore causal interpretations of the rela-
previous study in which there was a positive association between tionship between these variables. Longitudinal study design is
social support and health self-efficacy among community-dwelling needed to examine the detailed causal relationship. Second, partici-
older adults.8 Our result indicated that migrant older adults who pants were recruited from one city using a convenience sampling
perceived more support from family members and others were method and this may limit the generalizability of the findings. Future
more likely to have greater confidence in the ability to undertake study should recruit participants from more regions. Third, self-
health-promoting behaviors. Social support could provide confi- report questionnaire may lead to reporting bias and socially desirable
dence for older adults to resolve the health problems more effec- responses. Lastly, health self-efficacy is not the same as health behav-
tively.31 More perceived social support may also enhance the sense iors. Future research should further explore the health behaviors and
of responsibility to manage health behaviors.32 Furthermore, higher related factors among migrant older adults.
perceived social support means more social contacts with others
and more utilization of community healthcare services,33 which
Implications
facilitates migrant older adults to obtain more health-related infor-
mation and skills and accordingly increase their health self-efficacy.
Although conducted in the Chinese context, our findings have
Our study revealed that 60.4% of migrant older adults perceived low
some implications for future research and clinical practice to promote
to moderate support from their social networks after migration. The
health self-efficacy among migrant older adults. First, health self-effi-
level of perceived social support may influence their confidence in
cacy should be a major consideration of health promotion manage-
the ability to adopt and maintain health-promoting behaviors.
ment for migrant older adults. Given the modifiable nature of
Therefore, it is crucial to assist them to rebuild a new social network
perceived social support and resilience, integrated interventions
and enhance their support from families, friends and communities
included methods to improve both perceived social support and resil-
to increase their health self-efficacy.
ience could be effective to enhance their health self-efficacy. Second,
In line with previous studies in older adults,22,34 migrant older
perceived social support plays a key role in promoting health self-
adults reported a moderate level of resilience. As hypothesized, resil-
efficacy. Specific strategies should be designed to increase their per-
ience had a positive effect on health self-efficacy among migrant
ceived social support to build resilience and increase health self-effi-
older adults. This suggested that migrant older adults with greater
cacy. Community health nurses could assist them in receiving and
resilience had a tendency to feel more confident and able to imple-
strengthening support from family and others, such as encouraging
ment health-promoting behaviors. Greater resilience can promote
more communication with family members, organizing community
effective coping with adverse situations 17 and enable people to reject
activities, and optimizing the access to healthcare services. Third,
negative thoughts about their abilities,35 which may increase their
resilience training programs should be emphasized to build greater
belief in health-related activities. One study found that older adults
resilience for migrant older adults. It is suggested to design the resil-
with higher resilience tended to perform healthy behaviors in diet
ience interventions based on the need of the target population and
and exercise than those with lower resilience.36
consolidate theoretical foundations before conducting feasibility
Additionally, this study found that resilience was an important
studies.16 Lastly, more attention should be given to male migrant
mediator between perceived social support and health self-efficacy,
older adults to help them build greater resilience to cope with stress
and mediated about 43.1% of the total effect. More perceived social
and increase their health self-efficacy.
support can promote the development of resilience by providing
favorable external environmental conditions 17,37 and thereby pro-
duce a greater sense of self-efficacy in health. Our study confirmed Conclusion
that resilience was a significant positive factor in health self-efficacy
among migrant older adults. Resilience is a modifiable psychological The present study demonstrated the mediating role of resilience
factor and can be learned and enhanced by resilience training inter- between perceived social support and health self-efficacy among
ventions.16 Strategies to enhance resilience are required to help migrant older adults. Moreover, gender moderated the mediating
improve health self-efficacy for migrant older adults. effect of resilience between perceived social support and health self-
As expected, gender moderated the relationship between resil- efficacy. These findings contribute to the understanding of the mech-
ience and health self-efficacy. Specifically, the mediating effect of anism of perceived social support and resilience on health self-effi-
resilience between perceived social support and health self-efficacy cacy and put forward suggestions for community health nurses.
was stronger in male migrant older adults than female counterparts, Integrated interventions of promoting both perceived social support
reflecting the need for providing specific considerations on the and resilience may be effective in enhancing health self-efficacy
improvement of resilience for male migrant older adults. In Chinese among migrant older adults in the community.
traditional culture, men are less encouraged to seek support for
dealing with adversities.38 Male older adults may be generally less
Funding
resilient than females to recover from stress.27 This may influence
their confidence in the ability to engage in health-promoting activi-
This study was supported by Nursing Research Fund of the First
ties. Contrary to our hypothesis, gender did not moderate the rela-
Affiliated Hospital of Chongqing Medical University (HLJJ2019-07).
tionship between perceived social support and resilience, as well as
the relationship between perceived social support and health self-
efficacy. This may be due to that perceived social support is impor- Declaration of Competing interest
tant for increasing resilience and health self-efficacy, regardless of
gender. No conflict of interest has been declared by the authors.
1582 L.-N. Kong et al. / Geriatric Nursing 42 (2021) 1577 1582
Acknowledgments
We would like to thank all participants for their involvement in
the study.
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