Optimizing the narrative strategies of health science popularization articles to enhance their communication efficacy is of practical significance for advancing the "Healthy China" strategy. This study uses 173 award-winning health science popularization articles from seven consecutive editions of the New Era Health Science Popularization Contest as its sample. Drawing on narratological theories, particularly those of Roland Barthes, it establishes a three-level, ten-element narrative system. Communication efficacy is quantified using four indicators: reading volume, likes, comments, and replies. Nonparametric tests are used to screen for associated variables, and multiple linear regression is conducted to identify significant predictors. The findings show that event salience, virtual-character narrators (as opposed to doctors), internal focalization, innovative presentation formats, and high-NRI narrative environments are significantly and positively associated with communication efficacy. In addition, high-performing works exhibit multiple synergistic configurations of narrative elements. Future creators could systematically improve the communication efficacy of health science popularization articles at the narrative level through combinatorial creation strategies, interactive participation design, and professional intellectual-property development.