Article(id=1324078562038382647, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506358, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750435200000, receivedDateStr=2025-06-21, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614529379, onlineDateStr=2026-11-02, pubDate=1767974400000, pubDateStr=2026-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614529379, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614529379, creator=13701087609, updateTime=1793614529379, updator=13701087609, issue=Issue{id=1324078333767594037, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1767974400000', pubDateStr='2026-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614474956, creator='13701087609', updateTime=1793614571752, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078739914621270, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078739914621271, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=123, endPage=128, ext={EN=ArticleExt(id=1324078562453618744, articleId=1324078562038382647, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between health literacy and quality of life among rural residents in Changzhou City: mediating effect of health protective behavior, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between health literacy and quality of life of rural residents in Changzhou City, and to examine the mediating effect of health protective behavior.

Methods

A multi-stage random sampling method was employed to select 605 rural residents in Changzhou for the survey. The questionnaire comprised sections on general information, short-form health literacy scale, health protective behavior scale, and the EQ-5D-5L scale. Descriptive statistics and correlation analysis were performed using SPSS software. A structural equation model was constructed using Amos software, and the mediating effect of health protective behavior was examined through bootstrap analysis (with 5 000 resamples).

Results

The score of the health literacy index for rural residents in Changzhou City was 35.77±7.42, the average utility score was 0.95±0.09, and the average EQ-VAS score was 83.88±12.13. A positive correlation was observed between health literacy and health protective behavior among rural residents in Changzhou (β=0.463, P<0.001). Similarly, health protective behavior was positively correlated with quality of life (β=0.244, P=0.006), and health literacy also showed a positive correlation with quality of life (β=0.157, P=0.037). Mediating effect analysis revealed that the direct effect of health literacy on quality of life among rural residents in Changzhou was 0.157, with an indirect effect of 0.113, resulting in a total effect of 0.270. The confidence interval for the path of health literacy → health protective behavior → quality of life was [0.038, 0.201]. The mediating effect of health protective behavior between health literacy and quality of life accounted for 41.85% (P=0.004).

Conclusion

Efforts should be continuously made to enhance the health literacy of rural residents, facilitating the transformation of their health knowledge and beliefs into health protective behaviors, so as to further improve the quality of life among rural residents.

, authors=Xiao-xuan XU1, 2, Ling GENG1, Xiao-jun ZHAO1, Xue WAN2, Ran DAI2, Hong-yan TANG1, Hua YOU2, authorsList=Xiao-xuan XU, Ling GENG, Xiao-jun ZHAO, Xue WAN, Ran DAI, Hong-yan TANG, Hua YOU, authorCompany=null, correspAuthors=Hong-yan TANG, Hua YOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078564827594817, articleId=1324078562038382647, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=常州市农村居民健康素养与生命质量的关系——健康保护行为的中介效应, columnId=1228016573533847611, journalTitle=现代预防医学, columnName=基层卫生服务, runingTitle=null, highlight=null, articleAbstract=
目的

探索常州市农村居民健康素养与生命质量的关系及健康保护行为的中介作用。

方法

采用多阶段随机抽样的方法选取605名常州市农村居民进行调查。利用一般资料调查表、简版健康素养量表、健康保护行为量表以及EQ-5D-5L量表。利用SPSS软件进行描述性统计和相关性分析,利用Amos软件构建结构方程模型并采用bootstrap(重复抽样5 000次)分析健康保护行为的中介效应。

结果

常州市农村居民健康素养指数得分为(35.77±7.42)分,健康效用值均值为(0.95±0.09)分,EQ-VAS均值为(83.88±12.13)分。常州市农村居民健康素养与健康保护行为呈正相关(β=0.463,P<0.001);健康保护行为与生命质量呈正相关(β=0.244,P=0.006);健康素养与生命质量之间也呈正相关(β=0.157,P=0.037)。中介效应分析显示,常州市农村居民健康素养对生命质量的直接效应为0.157,间接效应为0.113,总效应为0.270。健康素养→健康保护行为→生命质量路径置信区间为[0.038,0.201],健康保护行为在健康素养与生命质量之间的中介效应占比为41.85%(P=0.004)。

结论

应持续推进农村居民健康素养的提升工作,促进农村居民健康知识理念到健康保护行为的转化,以进一步提高农村居民生命质量水平。

, authors=徐晓轩1, 2, 耿玲1, 赵晓军1, 宛雪2, 戴冉2, 唐红艳1, 尤华2, authorsList=徐晓轩, 耿玲, 赵晓军, 宛雪, 戴冉, 唐红艳, 尤华, authorCompany=null, correspAuthors=唐红艳, 尤华, authorNote=

徐晓轩(2001—),女,硕士在读,研究方向:公共卫生

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唐红艳,E-mail:
尤华,E-mail:
唐红艳与尤华为共同通信作者
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=5ljekohGY+KMbpJM6D4uVw==, magXml=q7+0lYBGW1HbOUNGWnekpQ==, pdfUrl=null, pdf=GyQKdbmH4KReR0Qd1oeCVA==, pdfFileSize=649575, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=2jCjqFKucxIf7aN6z2btdg==, mapNumber=null, fund=null)}, authors=[Author(id=1324078565356077130, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1324078565498683469, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, authorId=1324078565356077130, language=EN, stringName=Xiao-xuan XU, firstName=Xiao-xuan, middleName=null, lastName=XU, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=Changzhou Center for Disease Control and Prevention, Changzhou, Jiangsu 213022, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1324078565569986638, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, authorId=1324078565356077130, language=CN, stringName=徐晓轩, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=1.常州市疾病预防控制中心,江苏 常州 213022
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(In Chinese), articleTitle=Analysis on chronic disease literacy and its influencing factor among residents, Kunming city,2018, refAbstract=null)], funds=[Fund(id=1324078568828960891, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, awardId=Jsjkjyxhzd-2023-002, language=CN, fundingSource=江苏省健康教育协会2023年度重点课题(Jsjkjyxhzd-2023-002), fundOrder=null, country=null), Fund(id=1324078568908652668, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, awardId=JSHD202406, language=CN, fundingSource=江苏省卫生健康发展研究中心2024年度开放课题(JSHD202406), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324078565167333443, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, xref=1., ext=[AuthorCompanyExt(id=1324078565175722052, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, companyId=1324078565167333443, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Changzhou Center for Disease Control and Prevention, Changzhou, Jiangsu 213022, China), AuthorCompanyExt(id=1324078565184110661, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, companyId=1324078565167333443, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.常州市疾病预防控制中心,江苏 常州 213022)]), AuthorCompany(id=1324078565267996742, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, xref=2., ext=[AuthorCompanyExt(id=1324078565276385351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, companyId=1324078565267996742, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南京医科大学公共卫生学院,江苏 南京 211166)])], figs=[ArticleFig(id=1324078568392753269, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, language=EN, label=Table 1, caption=

Comparison of quality of life scores by resident characteristics [n(%),()]

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变量人数(%)健康效用值EQ-VAS
年龄(岁)a
<46296(48.9)0.97±0.0986.10±11.24
≥46309(51.1)0.94±0.0981.74±12.58
t值3.694.50
P值<0.001<0.001
性别
男302(49.9)0.96±0.1083.88±11.62
女302(50.1)0.95±0.0783.88±12.64
t 值0.080.00
P值0.9401.000
婚姻状况
无配偶124(20.5)0.96±0.0985.23±12.60
有配偶481(79.5)0.95±0.0983.53±12.00
t值0.311.40
P值0.7560.163
SES
低分组105(17.4)0.94±0.0780.77±13.31
高分组500(82.6)0.96±0.0984.53±11.78
t值-1.44-2.90
P值0.1510.004
), ArticleFig(id=1324078568464056438, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, language=CN, label=表1, caption=

不同特征居民的生命质量得分比较[n(%),()]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数(%)健康效用值EQ-VAS
年龄(岁)a
<46296(48.9)0.97±0.0986.10±11.24
≥46309(51.1)0.94±0.0981.74±12.58
t值3.694.50
P值<0.001<0.001
性别
男302(49.9)0.96±0.1083.88±11.62
女302(50.1)0.95±0.0783.88±12.64
t 值0.080.00
P值0.9401.000
婚姻状况
无配偶124(20.5)0.96±0.0985.23±12.60
有配偶481(79.5)0.95±0.0983.53±12.00
t值0.311.40
P值0.7560.163
SES
低分组105(17.4)0.94±0.0780.77±13.31
高分组500(82.6)0.96±0.0984.53±11.78
t值-1.44-2.90
P值0.1510.004
), ArticleFig(id=1324078568531165303, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, language=EN, label=Table 2, caption=

Correlation coefficients (r values) of health literacy,health protective behavior, and quality of life among rural residents in Changzhou City

, figureFileSmall=null, figureFileBig=null, tableContent=
变量健康素养健康保护行为健康效用值EQ-VAS评分
健康素养1
健康保护行为0.367***1
健康效用值0.114**0.130**1
EQ-VAS评分0.184***0.184***0.382***1
), ArticleFig(id=1324078568594079864, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, language=CN, label=表2, caption=

常州市农村居民健康素养、健康保护行为、生命质量的相关系数(r值)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量健康素养健康保护行为健康效用值EQ-VAS评分
健康素养1
健康保护行为0.367***1
健康效用值0.114**0.130**1
EQ-VAS评分0.184***0.184***0.382***1
), ArticleFig(id=1324078568665383033, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, language=EN, label=Table 3, caption=

Bootstrap analysis of direct, indirect, and total effects in Amos

, figureFileSmall=null, figureFileBig=null, tableContent=
路径标准化效应值 95%CIP值占总效应之比(%)
LLCLULCL
直接效应0.1570.0780.0100.3100.03758.15
间接效应0.1130.0420.0380.2010.00441.85
总效应0.2700.0650.1470.3980.001—
), ArticleFig(id=1324078568736686202, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078562038382647, language=CN, label=表3, caption=

在Amos中对直接、间接以及总效应进行bootstrap分析

, figureFileSmall=null, figureFileBig=null, tableContent=
路径标准化效应值 95%CIP值占总效应之比(%)
LLCLULCL
直接效应0.1570.0780.0100.3100.03758.15
间接效应0.1130.0420.0380.2010.00441.85
总效应0.2700.0650.1470.3980.001—
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常州市农村居民健康素养与生命质量的关系——健康保护行为的中介效应
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徐晓轩 1, 2 , 耿玲 1 , 赵晓军 1 , 宛雪 2 , 戴冉 2 , 唐红艳 1 , 尤华 2
现代预防医学 | 基层卫生服务 2026,53(1): 123-128
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现代预防医学 |基层卫生服务 2026 , 53 (1) : 123 -128
常州市农村居民健康素养与生命质量的关系——健康保护行为的中介效应
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徐晓轩1, 2, 耿玲1, 赵晓军1, 宛雪2, 戴冉2, 唐红艳1 , 尤华2
作者信息
  • 1.常州市疾病预防控制中心,江苏 常州 213022
  • 2.南京医科大学公共卫生学院,江苏 南京 211166
通讯作者:
唐红艳,E-mail:
尤华,E-mail:
唐红艳与尤华为共同通信作者
作者简介:

徐晓轩(2001—),女,硕士在读,研究方向:公共卫生

Relationship between health literacy and quality of life among rural residents in Changzhou City: mediating effect of health protective behavior
Xiao-xuan XU1, 2, Ling GENG1, Xiao-jun ZHAO1, Xue WAN2, Ran DAI2, Hong-yan TANG1 , Hua YOU2
Affiliations
  • Changzhou Center for Disease Control and Prevention, Changzhou, Jiangsu 213022, China
出版时间: 2026-01-10 doi: 10.20043/j.cnki.MPM.202506358
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目的

探索常州市农村居民健康素养与生命质量的关系及健康保护行为的中介作用。

方法

采用多阶段随机抽样的方法选取605名常州市农村居民进行调查。利用一般资料调查表、简版健康素养量表、健康保护行为量表以及EQ-5D-5L量表。利用SPSS软件进行描述性统计和相关性分析,利用Amos软件构建结构方程模型并采用bootstrap(重复抽样5 000次)分析健康保护行为的中介效应。

结果

常州市农村居民健康素养指数得分为(35.77±7.42)分,健康效用值均值为(0.95±0.09)分,EQ-VAS均值为(83.88±12.13)分。常州市农村居民健康素养与健康保护行为呈正相关(β=0.463,P<0.001);健康保护行为与生命质量呈正相关(β=0.244,P=0.006);健康素养与生命质量之间也呈正相关(β=0.157,P=0.037)。中介效应分析显示,常州市农村居民健康素养对生命质量的直接效应为0.157,间接效应为0.113,总效应为0.270。健康素养→健康保护行为→生命质量路径置信区间为[0.038,0.201],健康保护行为在健康素养与生命质量之间的中介效应占比为41.85%(P=0.004)。

结论

应持续推进农村居民健康素养的提升工作,促进农村居民健康知识理念到健康保护行为的转化,以进一步提高农村居民生命质量水平。

农村居民  /  健康素养  /  健康保护行为  /  生命质量
Objective

To explore the relationship between health literacy and quality of life of rural residents in Changzhou City, and to examine the mediating effect of health protective behavior.

Methods

A multi-stage random sampling method was employed to select 605 rural residents in Changzhou for the survey. The questionnaire comprised sections on general information, short-form health literacy scale, health protective behavior scale, and the EQ-5D-5L scale. Descriptive statistics and correlation analysis were performed using SPSS software. A structural equation model was constructed using Amos software, and the mediating effect of health protective behavior was examined through bootstrap analysis (with 5 000 resamples).

Results

The score of the health literacy index for rural residents in Changzhou City was 35.77±7.42, the average utility score was 0.95±0.09, and the average EQ-VAS score was 83.88±12.13. A positive correlation was observed between health literacy and health protective behavior among rural residents in Changzhou (β=0.463, P<0.001). Similarly, health protective behavior was positively correlated with quality of life (β=0.244, P=0.006), and health literacy also showed a positive correlation with quality of life (β=0.157, P=0.037). Mediating effect analysis revealed that the direct effect of health literacy on quality of life among rural residents in Changzhou was 0.157, with an indirect effect of 0.113, resulting in a total effect of 0.270. The confidence interval for the path of health literacy → health protective behavior → quality of life was [0.038, 0.201]. The mediating effect of health protective behavior between health literacy and quality of life accounted for 41.85% (P=0.004).

Conclusion

Efforts should be continuously made to enhance the health literacy of rural residents, facilitating the transformation of their health knowledge and beliefs into health protective behaviors, so as to further improve the quality of life among rural residents.

Rural residents  /  Health literacy  /  Health protective behavior  /  Quality of life
徐晓轩, 耿玲, 赵晓军, 宛雪, 戴冉, 唐红艳, 尤华. 常州市农村居民健康素养与生命质量的关系——健康保护行为的中介效应. 现代预防医学, 2026 , 53 (1) : 123 -128 . DOI: 10.20043/j.cnki.MPM.202506358
Xiao-xuan XU, Ling GENG, Xiao-jun ZHAO, Xue WAN, Ran DAI, Hong-yan TANG, Hua YOU. Relationship between health literacy and quality of life among rural residents in Changzhou City: mediating effect of health protective behavior[J]. Modern Preventive Medicine, 2026 , 53 (1) : 123 -128 . DOI: 10.20043/j.cnki.MPM.202506358
健康素养是指个人获取、理解基本健康信息和服务,并运用这些信息和服务做出合理决策,以维护和促进自身健康的能力[1]。近年来,我国农村居民的健康素养水平实现稳步增长,从2012年的7.13%提高至2024年的29.11%[2-3],但城乡居民之间健康素养水平差异显著,农村居民的健康素养仍处于较低水平[4]。健康保护行为特指以主动预防疾病、降低健康风险为核心目的的行为集合(如定期体检、营养膳食等),被认为是健康生活方式和行为的重要组成部分[5-7]。既往研究表明,提升健康素养水平对生命质量的改善具有积极作用[8-9],并且在那些具备较高健康素养的个体中,健康保护相关行为的实践频率也会有所增加[10],此外,营养饮食、健康管理等健康保护相关行为与生命质量之间亦呈现出正相关关系[11-12],可见从心理认知到行为改变都显著影响居民的生命质量。目前的研究多集中于健康素养、健康相关行为和生命质量之间的两两关系,并且主要是针对特定疾病人群进行分析[13-15],对于农村居民健康素养、健康保护行为和生命质量关系的系统研究相对不足。因此,三者之间的关系路径仍需要进一步验证。本研究通过结构方程模型构建常州市农村居民健康素养、健康保护行为与生命质量的路径关系,旨在了解常州市农村居民健康素养水平与生命质量之间的关系,并探讨健康保护行为在其中的作用机制。
2024年5—6月,采用多阶段随机抽样方法,首先在常州市选取武进区和金坛区作为样本地区,其次在这2个样本地区各随机抽取3个乡镇作为样本乡镇,再次在抽中的6个样本乡镇中各随机抽取1个村作为样本村,从抽中的6个样本村中各随机抽取100个家庭户作为样本家庭户,最后在抽中的样本家庭户中各招募1名家庭成员作为调查对象进行问卷调查,最终共调查605人。根据结构方程模型要求,样本量需大于200且至少为观测变量的5~10倍。本研究共包含25个变量,计算出样本量为200~250例,考虑10%的无效样本,则至少需要收集的总样本份数为220,调查人数符合样本量的最低需求。本研究经常州市疾病预防控制中心医学伦理委员会审查批准(批号:常疾控伦审[2023]05号),且所有调查对象均签署了知情同意书。
主要为一般人口学资料:年龄、性别、婚姻状况、受教育程度、职业、个人年收入。其中参照以往研究[16-17]将受教育程度、职业和个人年收入概括为社会经济地位(socioeconomic status,SES)。受教育程度划分为未接受教育、小学及以下、初中及以上三类并依次赋值0~2;个人年收入按照四分位数间距法划分为低收入组(最低的25%)、中收入组(中间的50%)和高收入组(最高的25%),并依次赋值0~2;职业分为未就业、农业、非农业,并依次赋值为0~2,加总求和后该变量的取值范围为0~6,按照综合得分将SES评分分为低分组(≤3分)和高分组(>3分)。
该量表由孙小楠等[18-19]基于Duong等[20]编制的12条目版本的健康素养量表进行汉化并简化,适用于快速测评中国人群的健康素养水平。该量表包含卫生保健(3个条目)、疾病预防(3个条目)、健康促进(3个条目)3个维度,共9个条目。采用4级评分(1=非常困难,2=困难,3=容易,4=非常容易),使用公式计算标准化健康素养指数(health literacy index, HL),指数范围为0~50,指数越高代表健康素养水平越高。计算公式为HL=(平均值-1)×(50/3),其中平均值是每个个体所有参与项目的平均值,1是平均值的最小可能值(此时指数的最小值为0),3是平均值的范围,50是指数的最大值。本研究中该量表Cronbachα系数为0.838。
本研究对Weiwei Ping等[21]编制的健康保护行为量表进行改编,用来衡量常州市农村居民的健康保护行为。改编后的量表包含日常饮食(3个条目)、自我防护(4个条目)、健康管理(3个条目)、心理调节(4个条目)4个维度,共14个条目。采用5级评分(1 = 从不,2 = 很少,3 = 有时,4 = 通常,5 = 总是),得分越高代表越倾向于采取健康保护行为。本研究中该量表各维度的Cronbach α系数为0.758~0.804,量表总的Cronbach α系数为0.802。对改编后的HPBS进行探索性因子分析(exploratory factor analysis, EFA)和验证性因子分析(confirmatory factor analysis,CFA),4个因子的累积解释力为65.723%,健康保护行为量表各维度的组合信度>0.7,聚合效度估计值(convergent validity estimate,AVE)>0.5,并且AVE开方值>其与其它维度的相关系数,结果表明,该量表具有良好的信效度。CFA模型检验结果显示,RMSEA、GFI、NFI、IFI、CFI分别为0.07(<0.08)、0.929、0.901、0.923、0.922(>0.9),均达到模型适配标准,CFA模型可接受。
生命质量的测量采用EQ-5D-5L量表[22],该量表包括五个维度:行动能力、自我照顾、日常活动、疼痛或不舒服、焦虑或沮丧。各维度分为无困难、轻度困难、中度困难、重度困难以及无法完成/非常严重五个水平,健康效用值根据中国EQ-5D-5L积分体系公式进行计算[23],范围为-0.391~1,得分越高代表居民的健康相关生命质量越高。本研究中EQ-5D-5L量表的Cronbach α系数为0.606。此外,EQ-5D-5L量表还包含对整体健康状况进行0~100分评分的视觉模拟标尺(the EQ visual analogue scale, EQ-VAS)部分,分值越高代表被评价对象的整体健康状况越好。本研究综合采用健康效用值和EQ-VAS评分来衡量农村居民的生命质量情况。
采用SPSS 25.0进行数据整理与基本特征分析。其连续性变量采用()表示,分类变量使用频数和百分比(%)表示。使用独立样本t检验进行组间比较,采用偏相关分析健康素养、健康保护行为与生命质量之间的相关性。利用Amos 24.0软件,将健康素养、健康保护行为和生命质量作为潜变量,以健康素养为自变量,生命质量为因变量,健康保护行为为中介变量,人口学特征作为控制变量构建结构方程模型分析中介作用,并采用bootstrap方法(重复抽样5 000次)进行显著性检验。双侧检验,检验水准α=0.05。
采用Harman单因素检验所有量表条目,第一因子累积百分比为20.39%,低于40%,本研究不存在严重的共同方法偏差[24]。
共有605名常州市农村居民参与本次调查,其中男性302人(49.9%),女性303人(50.1%);年龄14~71岁,平均年龄(43.66±13.71)岁;SES低分组105人(17.4%),高分组500人(82.6%)。健康素养指数得分为(35.77±7.42)分,健康保护行为总分为(56.60±7.29)分。健康效用值范围为-0.160~1,均值为(0.95±0.09)分;EQ-VAS均值为(83.88±12.13)分。单因素分析结果显示,常州市农村居民的生命质量在年龄和SES间差异有统计学意义(P<0.05)。见表1。
为控制混杂因素的影响,本研究采用偏相关分析变量之间的相关关系,健康素养与健康保护行为、健康效用值、EQ-VAS均呈正相关(r=0.367、0.114、0.184,P<0.01),健康保护行为与健康效用值、EQ-VAS均呈正相关(r=0.130、0.184,P<0.01)。见表2。
在相关性分析结果的基础上,以常州市农村居民健康素养为自变量,生命质量为因变量,健康保护行为为中介变量,年龄和SES为控制变量,应用Amos 24.0软件构建中介效应模型。模型适配度检验结果显示,基于研究假设的模型拟合良好:χ2/v=2.506,RMSEA=0.050,GFI= 0.908,IFI=0.912,TLI=0.900,CFI=0.911。
结构方程模型结果显示,健康素养与健康保护行为呈正相关(β=0.463,P<0.001);健康保护行为与生命质量呈正相关(β=0.244,P=0.006);健康素养与生命质量之间也呈正相关(β=0.157,P=0.037)。
通过bootstrap方法对常州市农村居民健康保护行为在健康素养和生命质量之间的中介效应进行检验。结果显示,直接效应为0.157,间接效应为0.113,总效应为0.270。健康素养→健康保护行为→生命质量路径的bootstrap偏差矫正的置信区间为[0.038,0.201],不包含0,表明该中介效应成立。健康保护行为在健康素养与生命质量之间的中介效应占比为41.85%(P=0.004)。见表3。
本研究通过构建结构方程模型探讨了常州市农村居民健康素养、健康保护行为与生命质量之间的关系,同时分析了健康保护行为的中介效应。结果显示,健康素养对生命质量具有积极影响,健康保护行为在两者之间发挥部分中介作用。
本研究中,常州市农村居民的健康效用值为(0.95±0.09)分,与中国城镇居民的健康效用值(0.957±0.069)报告的一致[25];EQ-VAS评分得分为(83.88±12.13)分,与安徽省(83.82±15.36)、湖北省(83.23±19.66)等农村居民的调查结果基本一致[26-27],但是略高于中国农村居民的EQ-VAS评分[28],提示样本人群的自感健康水平较高,这可能与常州市位于长江三角洲,经济发达,医疗服务和社会保障制度较为完善有关[29]。并且有研究显示,SES与生命质量之间存在关联[30],本研究中所调查的常州市农村居民SES大多数处于较高阶层,可能促进居民更加关注自身健康。但是,常州市农村居民的主要健康问题为疼痛或不舒服、焦虑或沮丧,分别有35.6%和22.5%的常州市农村居民有不同程度的疼痛或不舒服、焦虑或沮丧,其他部分省份以及中国农村居民整体研究也呈现出类似的结果[28,31-32]。表明在今后对农村地区居民健康干预促进的过程中,既要注重农村居民的生理健康,也要考虑农村居民的心理健康需求,促进居民身心健康发展,改善生命质量。
相关性分析结果显示,健康素养与生命质量之间呈正相关关系,健康素养水平越高的农村居民,其健康效用值和EQ-VAS评分越高,表明健康素养对生命质量具有一定的积极作用。既往研究同样支持本研究结论。例如,王瑞等人[8]对青岛市农村居民进行调查,表明健康素养水平对其健康相关生命质量具有直接作用;郑梦云[33]通过对江苏省大学生的健康素养水平与生命质量之间的关系进行分析,发现健康素养与生命质量之间存在一定的正相关性。另外,结构方程模型的路径分析结果也再次印证了常州市农村居民健康素养水平与生命质量之间存在关联。本研究中常州市农村居民健康素养指数得分是(35.77±7.42)分,与我国农村居民总的健康素养得分(35.36±6.18)相似[34],并且高于Duong[20]报道亚洲6个国家或地区的结果,证明“健康中国2030”策略及近年来国家对于提升居民的健康素养水平所作出的努力取得了一定的成效[34]。
健康素养水平较高的个体更能认识到行为与健康结局之间的关系,从而更容易采纳并维持健康行为[34]。本研究中介效应分析结果显示,健康素养不仅直接关联生命质量,还可以通过健康保护行为与生命质量产生间接关联。健康素养能够促进健康行为的养成,促进生命健康[35],提升健康素养可以促使个体主动获取健康知识,更好地理解健康信息和技能,有效将其转化为实际行动,从而增强应对健康问题的信心,缓解疾病带来的负面情绪,促进长期健康目标的实现[8]。本研究中健康保护行为的中介效应占健康素养对生命质量总效应的41.85%,发挥了重要作用,也在一定程度上解释了具备基本健康素养却未能具有较高的生命质量的现象。因此,在今后开展农村居民健康教育工作的过程中,不仅要注重健康知识理念和技能的传播,还应注重居民健康行为的养成[36]。基于农村居民是属于健康的脆弱人群,应持续推进其健康素养的提升工作,在健康教育中可以通过加强新媒体传播方式的使用和推广[10],来促进农村居民健康知识理念到健康保护行为的转化,以改善农村居民的生命质量。本文对常州市农村居民健康素养、健康保护行为与生命质量三者之间的关系路径进行了分析,为促进提高农村居民生命质量的健康干预工作提供了依据。但本文为一项横断面设计,限制了因果关系的推断,并且自我报告的相关数据可能存在回忆偏差。未来的调查地区也可进一步扩大,以探索研究结果的普遍性。
  • 江苏省健康教育协会2023年度重点课题(Jsjkjyxhzd-2023-002)
  • 江苏省卫生健康发展研究中心2024年度开放课题(JSHD202406)
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2026年第53卷第1期
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doi: 10.20043/j.cnki.MPM.202506358
  • 接收时间:2025-06-21
  • 首发时间:2026-11-02
  • 出版时间:2026-01-10
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  • 收稿日期:2025-06-21
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江苏省健康教育协会2023年度重点课题(Jsjkjyxhzd-2023-002)
江苏省卫生健康发展研究中心2024年度开放课题(JSHD202406)
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    1.常州市疾病预防控制中心,江苏 常州 213022
    2.南京医科大学公共卫生学院,江苏 南京 211166

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2种不同金属材料的力学参数
科
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属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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