Family Harmony Mediates the Association Between Subjective Well-Being and Health-Promoting Behaviors Among Middle-Aged Women in Northern China.

PURPOSE: Health-promoting behaviors (HPB) are essential for disease prevention and healthy aging but remain suboptimal among middle-aged women (aged 45-59 years), who may face perimenopausal changes and work-family demands. Subjective well-being (SWB) is associated with HPB, but the role of family relational factors in this association remains unclear. Family harmony may represent a key relational pathway linking SWB to HPB; however, evidence from Northern China remains limited, and this pathway may differ by ethnicity because women's family roles and responsibilities vary across sociocultural contexts. This study examined whether family harmony mediates the SWB-HPB association among middle-aged women in Northern China and explored variation across HPB domains and by ethnicity. PATIENTS AND METHODS: A cross-sectional survey was conducted from June to October 2022 in eight communities in Yantai and Yanji, Northern China. A total of 529 middle-aged women, comprising 415 Han majority women (78.45%) and 114 Chinese Korean minority women (21.55%), completed validated measures of SWB, family harmony, and HPB. Descriptive, correlation, and mediation analyses using the Hayes PROCESS macro (Model 4) were performed, together with domain-specific and ethnicity-stratified analyses. RESULTS: Family harmony partially mediated the SWB-HPB association (indirect effect = 0.047, 95% confidence interval [0.014, 0.081]). The indirect effect was significant for health responsibility, physical activity, nutrition, stress management, and spiritual growth, but not interpersonal relationships. Among Han participants, the association was primarily direct; among Chinese Korean participants, an indirect-only mediation pattern through family harmony was observed. CONCLUSION: These findings highlight the importance of considering family relational contexts, alongside individual psychological resources, in efforts to support healthy lifestyles among middle-aged women. Community health programs may benefit from combining individual-level support with family-engaged components and tailoring the emphasis of these strategies to the sociocultural contexts of different population groups.