Peer-reviewed article

Knowledge-behavior mechanisms and configurations for drowning prevention among Chinese school-aged children: a hybrid multi-analytical study combining regression-based mediation and fsQCA.

Yuan C, Yang X, Li Z, Qiu S, Wu S et al. · 14 Sept 2026

Abstract

Objective This study examined the psychological mechanisms and configurational pathways by which water safety knowledge is associated with high-risk swimming behaviors among fifth- and sixth-grade primary school children in Hubei Province, China, with the goal of establishing a theoretical and empirical foundation for targeted drowning-prevention interventions. Methods In a hybrid multi-analytical study combining regression-based mediation and fsQCA, we analyzed a single quantitative survey dataset of 1,573 fifth- and sixth-grade primary school children from four schools in Hubei Province, China mean age 11.31 ± 0.46 years; 850 boys (54.04%), 723 girls (45.96%). Data collection employed the self-report Water Safety Knowledge Scale (perceived mastery), Risk Perception Scale, Drowning Risk Attitude Scale, Swimming Self-Efficacy Scale, Sensation Seeking Scale, and Swimming High-Risk Behavior Scale. Regression-based mediation was tested with the PROCESS 4.2 macro (model 82, 5000 bias-corrected bootstrap resamples) in SPSS 27.0, and configurational analysis was conducted in fsQCA 4.2. Results (1) After controlling for the grade factor, water safety knowledge had no significant direct effect on high-risk swimming behaviors (β = 0.006, t = 0.570, p > 0.05). (2) Bootstrap mediation analysis produced a total effect of ES = -0.037 (t = -2.724, p < 0.01, 95% CI [-0.059, -0.009]). The direct effect was ES = 0.006 (t = 0.570, p > 0.05, 95% CI [-0.014, 0.026]). The mediating effect of risk attitude was ES = -0.035 (95% CI [-0.050, -0.020]). The mediating effect of self-efficacy was ES = 0.002 (95% CI [0.00001, 0.005]). The mediating effect of sensation seeking was ES = -0.016 (95% CI [-0.023, -0.009]). The chain mediating effect of self-efficacy and sensation seeking was significant (ES = 0.003, 95% CI [0.001, 0.005]). (3) Configurational analysis of high-risk swimming behaviors yielded an overall solution consistency of 0.887 and coverage of 0.431. The solution yielded seven sufficient configurations; the two configurations with water safety knowledge as a core present condition are foregrounded: the "disconnect between knowledge and action-attitude deviation" type and the "disconnect between knowledge and action-impulse breakthrough" type. Conclusions (1) Water safety knowledge is associated with high-risk swimming behaviors through two parallel mediating paths: "cognition - emotion" and "motivation - impulse". (2) Configuration analysis shows that the association between water safety knowledge and high-risk swimming behaviors follows a nonlinear, equifinal, and conjunctural pattern. Drowning-prevention interventions for school-age children may benefit from extending beyond knowledge transmission to comprehensive psychological adjustment.