Table 4_Perceived healthy community environment and loneliness among older adults in China: indirect psychosocial pathways through community belongingness and multi-source received social support.docx

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.</p>Discussion<p>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.</p>