Health commitment's associations with health outcomes are independent of health behaviours: insights from a cross-sectional population health survey in Singapore.

Background: An individual's commitment to health is a crucial component of their healthcare engagement. However, research is scarce that has systematically examined the association between commitment and health behaviours as well as health outcomes. We conducted this study to examine their associations in a representative community-dwelling adult population in Singapore.

Methods: This cross-sectional study analysed data from the Khoo Teck Puat Hospital and Yishun Community Hospital's Population Health Survey 2022, which interviewed a representative sample of community-dwelling residents aged 18 years and above in Singapore's Northern Region between July and December 2022. Health commitment was assessed using the validated Commitment subscale of the Altarum Consumer Engagement (ACE) Measure™. Assessment of health behaviours encompassed smoking status, alcohol consumption, vegetable and fruit consumption, sleep duration and physical activity. Additionally, various health outcomes spanning physical, mental, and social health domains, as well as healthcare utilisation indicators, were collected. Social-demographic factors associated with commitment were identified via multiple linear regression. Multiple logistic or ordinal logistic regression models were employed to examine the associations between commitment and individual health behaviours and outcomes, adjusting for basic demographic variables.

Results: The mean age of the participants was 49.7 years, ranging from 18 to 94 years, with 51% being females, and 68.2% belonging to the Chinese ethnicity. The results identified age group, ethnicity, marital status, housing type, monthly household income, and number of medications as factors associated with commitment. Significant associations were found between health commitment and various health behaviours. Furthermore, higher health commitment was consistently associated with an increased likelihood of subjective health outcomes (odds ratios range:1.17-1.28) and a reduced likelihood of healthcare utilisation (odds ratios range: 0.91-0.93), even after adjusting for health behaviours.

Conclusions: These findings underscore the importance of assessing and addressing health commitment in healthcare practice and policy. Strategies to enhance health commitment hold potential for improving health behaviours and health outcomes, thereby contributing to overall well-being. However, it is important to note that the cross-sectional nature of this study does not allow for confirmation of causal pathways. Hence, longitudinal studies are needed to further clarify these relationships and their potential impact on overall well-being.