Article(id=1311349920762781857, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512197, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1765728000000, receivedDateStr=2025-12-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579784813, onlineDateStr=2026-09-28, pubDate=1783612800000, pubDateStr=2026-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579784813, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579784813, creator=13701087609, updateTime=1790579784813, updator=13701087609, issue=Issue{id=1311349802038821144, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='1783612800000', pubDateStr='2026-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579756507, creator='13701087609', updateTime=1790588376143, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385955492258162, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385955496452467, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2431, endPage=2437, ext={EN=ArticleExt(id=1311349920980885666, articleId=1311349920762781857, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Health literacy assessment and comparison of urban-rural differences based on network analysis among residents in Chengdu, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To reveal the complex associations among six domains of health literacy among residents in Chengdu using network analysis, and to identify differences and key nodes in health literacy networks between urban and rural residents.

Methods

Participants were recruited using a multi-stage sampling design with probability proportional to size (PPS). A total of 6 450 participants aged 15-69 years were enrolled. Health literacy and sociodemographic characteristics were assessed using the National Residents’ Health Literacy Surveillance Questionnaire (Health Statistics Form No. 115). R 4.4.1 was used to conduct statistical analysis.

Results

Among six domains of health literacy, the possession rates of Scientific Health Perspectives, Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, Safety and First Aid, Basic Healthcare, and Health Information were 61.49%, 36.39%, 38.96%, 63.45%, 39.68%, 50.32% among urban residents, and 52.73%, 35.93%, 36.00%, 52.36%, 39.07%, 38.85% among rural residents. Network comparison showed differences in network structure and global strength between urban and rural residents. The strongest correlations in both urban and rural networks were between Scientific Health Perspectives and Safety and First Aid (urban: 1.489, rural: 1.386). Additionally, the associations between Scientific Health Perspectives and Chronic Disease Prevention and Management (urban: 1.047, rural:0.752), as well as between Infectious Disease Prevention and Control and Basic Healthcare (urban: 0.997, rural: 0.495), were stronger in urban areas than in rural areas. In contrast, the correlations between Scientific Health Perspectives and Infectious Disease Prevention and Control (rural: 0.917, urban: 0.675), Scientific Health Perspectives and Basic Healthcare (rural: 1.310, urban: 0.863), Chronic Disease Prevention and Management and Basic Healthcare (rural: 1.225, urban: 0.870), and Chronic Disease Prevention and Management and Health Information (rural: 1.257, urban: 1.009) were stronger in rural areas than in urban areas. The centrality strength values for Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, and Basic Healthcare differed between urban and rural networks (P<0.05).

Conclusion

Health literacy levels among rural residents still require comprehensive improvement, while persistent gaps remain in urban areas regarding literacy in Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, and Basic Healthcare. To enhance the overall health literacy level, tailored strategies are needed for different settings.

, authors=Xiu-chun YAO, Xiao-yan ZHANG, Tong-xin LI, Cun-yao PAN, Xiao-ge YE, authorsList=Xiu-chun YAO, Xiao-yan ZHANG, Tong-xin LI, Cun-yao PAN, Xiao-ge YE, authorCompany=null, correspAuthors=Xiao-ge YE, 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=1311349923669434543, articleId=1311349920762781857, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于网络分析的成都市居民健康素养评估和城乡差异比较, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

采用网络分析揭示成都市居民健康素养中六类健康问题间的复杂关联,识别城乡居民健康素养网络的差异和关键节点。

方法

采用多阶段按人口规模比例抽样(probability proportional to size,PPS),共纳入6 450名15~69岁研究对象。采用国家卫生健康委研制的“全国居民健康素养监测调查问卷(卫健统115表)”进行调查。调查内容包括健康素养和社会人口学信息。采用R 4.4.1进行统计分析。

结果

城市居民的六类健康问题素养具备率分别为:科学健康观61.49%、传染病防治36.39%、慢性病防治38.96%、安全与急救63.45%、基本医疗39.68%、健康信息50.32%;农村居民的六类健康问题素养具备率分别为:科学健康观52.73%、传染病防治35.93%、慢性病防治36.00%、安全与急救52.36%、基本医疗39.07%、健康信息38.85%。城乡网络比较结果显示,二者在网络结构和整体连接强度上存在差异。城市和农村网络中相关性最强的都是科学健康观与安全与急救(城市:1.489,农村:1.386)。此外,科学健康观与慢性病防治(城市:1.047,农村:0.752)、传染病防治与基本医疗(城市:0.997,农村:0.495)的关联呈现城市高于农村的现象;科学健康观与传染病防治(农村:0.917,城市:0.675)、科学健康观与基本医疗(农村:1.310,城市:0.863)、慢性病防治与基本医疗(农村:1.225,城市:0.870)、慢性病防治与健康信息(农村:1.257,城市:1.009)的关联呈现农村高于城市的现象。从中心性指标强度来看,传染病防治、慢性病防治、基本医疗的强度存在城乡差异(P<0.05)。

结论

成都市农村地区居民健康素养水平仍有待全面提升,城市地区在传染病防治素养、慢性病防治素养和基本医疗素养仍存在短板。为提高居民整体健康素养水平,需因地制宜开展健康素养促进工作。

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姚秀春(1996—),女,硕士,医师,研究方向:健康教育与健康促进

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叶晓舸,E-mail:
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(In Chinese), articleTitle=Mixed cross-sectional data, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1311349923883344048, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, xref=null, ext=[AuthorCompanyExt(id=1311349923891732657, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, companyId=1311349923883344048, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Health Education, Chengdu Center for Disease Control and Prevention (Chengdu Institute of Health Supervision), Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1311349923900121266, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, companyId=1311349923883344048, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=成都市疾病预防控制中心(成都市卫生监督所)健康教育科,四川 成都 610041)])], figs=[ArticleFig(id=1311349925733032147, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=EN, label=Figure 1, caption=Overall network of six domains of health literacy among residents in Chengdu, figureFileSmall=W8d5JlhM7UhG5pk/6CmLiw==, figureFileBig=Qcy1iqS4LR+Q7xhYl5LagQ==, tableContent=null), ArticleFig(id=1311349925808529620, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=CN, label=图1, caption=成都市居民六类健康问题素养总体网络, figureFileSmall=W8d5JlhM7UhG5pk/6CmLiw==, figureFileBig=Qcy1iqS4LR+Q7xhYl5LagQ==, tableContent=null), ArticleFig(id=1311349926001467605, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=EN, label=Figure 2, caption=The centrality indexes of total network, figureFileSmall=14B0UK4RmRjiYOnQrMuUpQ==, figureFileBig=IVwE0cZhkWn2NPZIHHTLfQ==, tableContent=null), ArticleFig(id=1311349926072770774, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=CN, label=图2, caption=总体网络中心性指标图, figureFileSmall=14B0UK4RmRjiYOnQrMuUpQ==, figureFileBig=IVwE0cZhkWn2NPZIHHTLfQ==, tableContent=null), ArticleFig(id=1311349926148268247, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=EN, label=Figure 3, caption=The estimation of edge weights in total network, figureFileSmall=bMGH8VM+tV7wBF4qJAbaEA==, figureFileBig=3ngz4ltID3zLr/e3PaJVYw==, tableContent=null), ArticleFig(id=1311349926211182808, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=CN, label=图3, caption=总体网络边权重准确性估计, figureFileSmall=bMGH8VM+tV7wBF4qJAbaEA==, figureFileBig=3ngz4ltID3zLr/e3PaJVYw==, tableContent=null), ArticleFig(id=1311349926278291673, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=EN, label=Figure 4, caption=The reliability of strength in total network, figureFileSmall=H+KuZxj5PNbtmpmswY7EZQ==, figureFileBig=nKlaCKcyV4s6Z/lVbdJqCw==, tableContent=null), ArticleFig(id=1311349927901487322, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=CN, label=图4, caption=总体网络的强度稳定性评估, figureFileSmall=H+KuZxj5PNbtmpmswY7EZQ==, figureFileBig=nKlaCKcyV4s6Z/lVbdJqCw==, tableContent=null), ArticleFig(id=1311349927964401883, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=EN, label=Figure 5, caption=Urban and rural network structures of six domains of health literacy among residents in Chengdu, figureFileSmall=VopNKnZhH6hE6ngdF/u08Q==, figureFileBig=sjJvsSw7ku0MEYZreE9QAg==, tableContent=null), ArticleFig(id=1311349928035705052, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=CN, label=图5, caption=成都市居民六类健康问题素养的城乡网络结构, figureFileSmall=VopNKnZhH6hE6ngdF/u08Q==, figureFileBig=sjJvsSw7ku0MEYZreE9QAg==, tableContent=null), ArticleFig(id=1311349928127979741, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=EN, label=Table 1, caption=

The status of health literacy in six domains and urban-rural disparities among residents in Chengdu [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
健康素养总体城市农村χ2值P值
科学健康观49.208<0.001
具备3 732(57.86)2 323(61.49)1 409(52.73)
不具备2 718(42.14)1 455(38.51)1 263(47.27)
传染病防治0.1480.701
具备2 335(36.20)1 375(36.39)960(35.93)
不具备4 115(63.80)2 403(63.61)1 712(64.07)
慢性病防治55.8340.016
具备2 434(37.74)1 472(38.96)962(36.00)
不具备4 016(62.26)2 306(61.04)1 710(64.00)
安全与急救79.465<0.001
具备3 796(58.85)2 397(63.45)1 399(52.36)
不具备2 654(41.15)1 381(36.55)1 273(47.64)
基本医疗0.2400.624
具备2 543(39.43)1 499(39.68)1 044(39.07)
不具备3 907(60.57)2 279(60.32)1 628(60.93)
健康信息83.019<0.001
具备2 939(45.57)1 901(50.32)1 038(38.85)
不具备3 511(54.43)1 877(49.68)1 634(61.15)
), ArticleFig(id=1311349928203477214, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=CN, label=表1, caption=

成都市居民六类健康问题素养具备情况及城乡差异[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
健康素养总体城市农村χ2值P值
科学健康观49.208<0.001
具备3 732(57.86)2 323(61.49)1 409(52.73)
不具备2 718(42.14)1 455(38.51)1 263(47.27)
传染病防治0.1480.701
具备2 335(36.20)1 375(36.39)960(35.93)
不具备4 115(63.80)2 403(63.61)1 712(64.07)
慢性病防治55.8340.016
具备2 434(37.74)1 472(38.96)962(36.00)
不具备4 016(62.26)2 306(61.04)1 710(64.00)
安全与急救79.465<0.001
具备3 796(58.85)2 397(63.45)1 399(52.36)
不具备2 654(41.15)1 381(36.55)1 273(47.64)
基本医疗0.2400.624
具备2 543(39.43)1 499(39.68)1 044(39.07)
不具备3 907(60.57)2 279(60.32)1 628(60.93)
健康信息83.019<0.001
具备2 939(45.57)1 901(50.32)1 038(38.85)
不具备3 511(54.43)1 877(49.68)1 634(61.15)
), ArticleFig(id=1311349928283168991, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=EN, label=Table 2, caption=

Centrality indicators of the overall, urban, and rural networks of six domains of health literacy among residents in Chengdu

, figureFileSmall=null, figureFileBig=null, tableContent=
节点中心性指标-强度
总体网络城市网络农村网络城乡网络强度差异性检验的P值
科学健康观4.6654.7134.5450.535
传染病防治3.5413.3363.9250.006
慢性病防治4.4644.2254.8940.006
安全与急救5.0364.8775.1650.387
基本医疗4.5244.3214.9610.006
健康信息3.8423.8623.8340.900
), ArticleFig(id=1311349928350277856, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349920762781857, language=CN, label=表2, caption=

成都市居民六类健康问题素养总体网络和城乡网络的中心性指标

, figureFileSmall=null, figureFileBig=null, tableContent=
节点中心性指标-强度
总体网络城市网络农村网络城乡网络强度差异性检验的P值
科学健康观4.6654.7134.5450.535
传染病防治3.5413.3363.9250.006
慢性病防治4.4644.2254.8940.006
安全与急救5.0364.8775.1650.387
基本医疗4.5244.3214.9610.006
健康信息3.8423.8623.8340.900
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基于网络分析的成都市居民健康素养评估和城乡差异比较
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姚秀春 , 张晓燕 , 李童心 , 潘存瑶 , 叶晓舸
现代预防医学 | 卫生政策与管理 2026,53(13): 2431-2437
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现代预防医学 |卫生政策与管理 2026 , 53 (13) : 2431 -2437
基于网络分析的成都市居民健康素养评估和城乡差异比较
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姚秀春, 张晓燕, 李童心, 潘存瑶, 叶晓舸
作者信息
  • 成都市疾病预防控制中心(成都市卫生监督所)健康教育科,四川 成都 610041
通讯作者:
叶晓舸,E-mail:
作者简介:

姚秀春(1996—),女,硕士,医师,研究方向:健康教育与健康促进

Health literacy assessment and comparison of urban-rural differences based on network analysis among residents in Chengdu
Xiu-chun YAO, Xiao-yan ZHANG, Tong-xin LI, Cun-yao PAN, Xiao-ge YE
Affiliations
  • Department of Health Education, Chengdu Center for Disease Control and Prevention (Chengdu Institute of Health Supervision), Chengdu, Sichuan 610041, China
出版时间: 2026-07-10 doi: 10.20043/j.cnki.MPM.202512197
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目的

采用网络分析揭示成都市居民健康素养中六类健康问题间的复杂关联,识别城乡居民健康素养网络的差异和关键节点。

方法

采用多阶段按人口规模比例抽样(probability proportional to size,PPS),共纳入6 450名15~69岁研究对象。采用国家卫生健康委研制的“全国居民健康素养监测调查问卷(卫健统115表)”进行调查。调查内容包括健康素养和社会人口学信息。采用R 4.4.1进行统计分析。

结果

城市居民的六类健康问题素养具备率分别为:科学健康观61.49%、传染病防治36.39%、慢性病防治38.96%、安全与急救63.45%、基本医疗39.68%、健康信息50.32%;农村居民的六类健康问题素养具备率分别为:科学健康观52.73%、传染病防治35.93%、慢性病防治36.00%、安全与急救52.36%、基本医疗39.07%、健康信息38.85%。城乡网络比较结果显示,二者在网络结构和整体连接强度上存在差异。城市和农村网络中相关性最强的都是科学健康观与安全与急救(城市:1.489,农村:1.386)。此外,科学健康观与慢性病防治(城市:1.047,农村:0.752)、传染病防治与基本医疗(城市:0.997,农村:0.495)的关联呈现城市高于农村的现象;科学健康观与传染病防治(农村:0.917,城市:0.675)、科学健康观与基本医疗(农村:1.310,城市:0.863)、慢性病防治与基本医疗(农村:1.225,城市:0.870)、慢性病防治与健康信息(农村:1.257,城市:1.009)的关联呈现农村高于城市的现象。从中心性指标强度来看,传染病防治、慢性病防治、基本医疗的强度存在城乡差异(P<0.05)。

结论

成都市农村地区居民健康素养水平仍有待全面提升,城市地区在传染病防治素养、慢性病防治素养和基本医疗素养仍存在短板。为提高居民整体健康素养水平,需因地制宜开展健康素养促进工作。

健康素养  /  网络分析  /  城乡差异
Objective

To reveal the complex associations among six domains of health literacy among residents in Chengdu using network analysis, and to identify differences and key nodes in health literacy networks between urban and rural residents.

Methods

Participants were recruited using a multi-stage sampling design with probability proportional to size (PPS). A total of 6 450 participants aged 15-69 years were enrolled. Health literacy and sociodemographic characteristics were assessed using the National Residents’ Health Literacy Surveillance Questionnaire (Health Statistics Form No. 115). R 4.4.1 was used to conduct statistical analysis.

Results

Among six domains of health literacy, the possession rates of Scientific Health Perspectives, Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, Safety and First Aid, Basic Healthcare, and Health Information were 61.49%, 36.39%, 38.96%, 63.45%, 39.68%, 50.32% among urban residents, and 52.73%, 35.93%, 36.00%, 52.36%, 39.07%, 38.85% among rural residents. Network comparison showed differences in network structure and global strength between urban and rural residents. The strongest correlations in both urban and rural networks were between Scientific Health Perspectives and Safety and First Aid (urban: 1.489, rural: 1.386). Additionally, the associations between Scientific Health Perspectives and Chronic Disease Prevention and Management (urban: 1.047, rural:0.752), as well as between Infectious Disease Prevention and Control and Basic Healthcare (urban: 0.997, rural: 0.495), were stronger in urban areas than in rural areas. In contrast, the correlations between Scientific Health Perspectives and Infectious Disease Prevention and Control (rural: 0.917, urban: 0.675), Scientific Health Perspectives and Basic Healthcare (rural: 1.310, urban: 0.863), Chronic Disease Prevention and Management and Basic Healthcare (rural: 1.225, urban: 0.870), and Chronic Disease Prevention and Management and Health Information (rural: 1.257, urban: 1.009) were stronger in rural areas than in urban areas. The centrality strength values for Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, and Basic Healthcare differed between urban and rural networks (P<0.05).

Conclusion

Health literacy levels among rural residents still require comprehensive improvement, while persistent gaps remain in urban areas regarding literacy in Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, and Basic Healthcare. To enhance the overall health literacy level, tailored strategies are needed for different settings.

Health literacy  /  Network analysis  /  Urban-rural differences
姚秀春, 张晓燕, 李童心, 潘存瑶, 叶晓舸. 基于网络分析的成都市居民健康素养评估和城乡差异比较. 现代预防医学, 2026 , 53 (13) : 2431 -2437 . DOI: 10.20043/j.cnki.MPM.202512197
Xiu-chun YAO, Xiao-yan ZHANG, Tong-xin LI, Cun-yao PAN, Xiao-ge YE. Health literacy assessment and comparison of urban-rural differences based on network analysis among residents in Chengdu[J]. Modern Preventive Medicine, 2026 , 53 (13) : 2431 -2437 . DOI: 10.20043/j.cnki.MPM.202512197
健康素养是一种个人获取和理解基本健康信息和服务以此来维护和促进自身健康的能力[1]。全国居民健康素养监测问卷将健康素养划分为六类健康问题素养,即科学健康观素养、传染病防治素养、慢性病防治素养、安全与急救素养、基本医疗素养和健康信息素养。国外的一项研究结果显示健康素养各个维度之间存在相互关联[2]。我国健康素养监测问卷中,六类健康问题包括知识相关素养和技能相关素养,不同维度素养间可能相互关联[3]。现有研究多探讨健康素养现状和影响因素[4-5],而六类健康问题素养间的关联尚不清楚。网络分析可用于分析多个变量之间复杂关系[6],已广泛应用于健康相关研究[7-8]。多地研究表明健康素养水平存在城乡差异,城市居民健康素养水平高于农村居民[9-10],四川省居民健康素养水平也表现为城市高于农村[11]。总体健康素养水平存在城乡差异,六类健康问题素养间的网络结构是否也存在差异?因此,本研究旨在通过网络分析揭示六类健康问题素养间的复杂关联,识别城乡居民健康素养网络的差异和关键节点,为提升居民健康素养水平提供新视角。
2024年4月,采用多阶段按人口规模比例抽样(probability proportional to size,PPS)的方法选择研究对象,人口规模信息采用家庭户总数。第一阶段,在成都市23个区(市)县中,根据人口规模使用PPS法在每个区(市)县抽取3个乡镇(街道);第二阶段,根据人口规模使用PPS法在每个乡镇(街道)抽取2个村(社区);第三阶段,每个村(社区)随机抽取1个片区(约750个家庭户);第四阶段,每个片区抽取55个家庭户,每户随机抽取1名15~69岁常住人口作为调查对象,最终每个片区完成50户调查为止。本研究通过了成都市疾病预防控制中心伦理委员会审批(2025015)。
本研究依据国家卫生健康委研制的“全国居民健康素养监测调查问卷(卫健统115表)”进行调查[1]。调查方式为面对面问卷调查或自填问卷。调查内容包括:(1)健康素养;(2)社会人口学信息。
(1)科学健康观:总分11分,被调查对象得分≥8分判定为具备该类健康问题素养。(2)传染病防治:总分7分,被调查对象得分≥6分判定为具备该类健康问题素养。(3)慢性病防治:总分12分,被调查对象得分≥10分判定为具备该类健康问题素养。(4)安全与急救:总分14分,被调查对象得分≥11分判定为具备该类健康问题素养。(5)基本医疗:总分14分,被调查对象得分≥11分判定为具备该类健康问题素养。(6)健康信息:总分8分,被调查对象得分≥6分判定为具备该类健康问题素养。
采用R 4.4.1进行统计分析。描述性分析中,定量资料采用() 表示。单因素分析中,采用χ2检验分析六类健康问题素养的城乡差异。
在网络分析中,采用R qgraph包构建综合评估网络。将六类健康问题作为网络中的6个节点,每个节点以是否具备该类问题素养的二分类变量纳入。在本研究网络图中,实线与虚线分别代表节点间的正相关与负相关关系,连线的粗细反映关联强度。网络中的核心节点指标有强度,预期影响度,亲近度与中介度。若网络中仅存在正相关,采用强度判断核心节点;若存在负相关,则采用预期影响度。由于中介度和亲近度被指出在网络分析中稳定性不足[12],结合本研究网络全为正关联的特性,最终采用强度中心性作为核心节点的判别标准,即强度越高的节点越核心。
采用R bootnet包进行网络结构稳定性评估。边权重准确性通过自助抽样法对原始数据进行 1 000次重复抽样,计算各边权重的 95% 置信区间,以此衡量边权重的稳定程度。节点中心性的稳定性指标是相关稳定性系数,既往研究认为相关稳定性系数不应低于0. 25,最好高于0. 50。
为检验城乡网络间的差异,采用R NetworkComparisionTest包,分别对网络结构不变性、整体连接强度不变性及中心性不变性进行了检验,检验水准α=0.05。
调查前期,采用绘图列表确定抽样框,并对所有调查员进行统一培训。调查时,均入户调查,调查员不能对自行填写者作任何解释,面对面问卷调查的调查员不能使用诱导性或暗示性语言。调查完成后,调查员现场核查问卷完整性和逻辑性,质控员当天核查填写是否正确,确保问卷完整性和逻辑性。
2024年共完成有效问卷6 450份。男性3 209人,女性3 241人,平均年龄(57.2±15.2)岁。被调查者中,3 778人(58.57%)居住在城市,2 672人(41.43%)居住在农村。成都市居民在科学健康观、传染病防治、慢性病防治、安全与急救、基本医疗和健康信息六类健康问题的具备率分别是57.86%、36.20%、37.74%、58.85%、39.43%、45.57%。从城乡比较看,在科学健康观、慢性病防治、安全与急救、健康信息素养上,城市居民的具备率均高于农村居民,差异有统计学意义(P<0.05)。见表1。
六类健康问题素养的总体网络见图1。六个节点共形成15条连接,均为正相关。科学健康观与安全与急救之间的关联最为紧密,边权重为1.478;其次为慢性病防治与健康信息、科学健康观与基本医疗、慢性病防治与基本医疗,边权重分别为1.095、1.017、1.000。六个节点的强度由大到小依次为:安全与急救(5.036)、科学健康观(4.665)、基本医疗(4.524)、慢性病防治(4.464)、健康信息(3.842)、传染病防治(3.541)。见图2、表2。
边权重准确性评估见图3,图中绝大多数边的置信区间范围较窄,表明总体网络边权重评估具有较高的准确性。图4是中心性稳定性评估图,结果显示强度的稳定性系数为0.75>0.5,说明网络强度中心性的评估结果稳定可靠。
城乡差异检验结果见表2和图5。城乡网络在结构上存在差异(M=0.501,P=0.018)、在整体连接强度上存在差异[GS(global strength,城市)=12.667,GS(农村)=13.662,P=0.002]。城乡网络六类健康问题素养强度的差异性检验P值见表2,传染病防治、慢性病防治、基本医疗在城乡间的差异有统计学意义(P<0.05)。
从图5可以看出,城市和农村网络中相关性最强的都是科学健康观与安全与急救(城市:1.489,农村:1.386)。城市网络中,以下节点间的相关性高于农村:科学健康观与慢性病防治(城市:1.047,农村:0.752)、传染病防治与基本医疗(城市:0.997,农村:0.495)。农村网络中,以下节点间的相关性高于城市:科学健康观与传染病防治(农村:0.917,城市:0.675)、科学健康观与基本医疗(农村:1.310,城市:0.863)、慢性病防治与基本医疗(农村:1.225,城市:0.870)、慢性病防治与健康信息(农村:1.257,城市:1.009)。
从表2可以看出,城市网络六类健康问题素养的强度由大到小依次是;安全与急救(4.877)、科学健康观(4.713)、基本医疗(4.321)、慢性病防治(4.225)、健康信息(3.862)、传染病防治(3.336)。农村居民六类健康问题素养的强度由大到小依次是:安全与急救(5.165)、基本医疗(4.961)、慢性病防治(4.894)、科学健康观(4.545)、传染病防治(3.925)、健康信息(3.834)。
本研究中,城市居民在科学健康观、慢性病防治、安全与急救、健康信息四类问题的素养具备率均高于农村居民,尤其是科学健康观、安全与急救、健康信息三类问题的素养具备率高出10%左右。这一结果表明,城市地区居民对健康的认知较高,健康信息获取和资源利用能力较强,可能得益于城市地区经济水平较高、医疗资源丰富、健康知识和技能传播多样等有利因素[13]。城市地区慢性病防治素养虽略高于农村地区,但均处于较低水平。此外,城乡两地传染病防治素养和基本医疗素养水平相近,且在六类健康问题中处于较低水平,与部分地区结果相近[14-15]。
在总体网络评估中,科学健康观与安全与急救之间的关联最为紧密,城市和农村网络中也是如此。科学健康观素养主要涉及日常健康问题,是健康认知的基本体现;安全与急救素养主要包含常见的生产工作和急救问题,二者均与日常生活息息相关,因此具有高度相关性。网络比较显示,城乡居民在六类健康问题素养的网络结构存在差异。在科学健康观与慢性病防治的关联中,城市网络高于农村网络,在科学健康观与传染病防治和基本医疗的关联中,农村网络高于城市网络。可能是因为城市地区慢性病患病率相对较高[16],慢性病管理和相关知识科普工作进入常态化,使科学健康观更容易与慢性病防治知识建立紧密关联。而在农村地区,传染病和基本医疗可能是农村居民日常健康关注和卫生服务供给的重点[17],从而表现出与科学健康观的强关联。慢性病防治与健康信息间的关联表现为农村高于城市,可能是因为农村居民慢性病防治知识相对薄弱,面临慢性病威胁时获取健康信息的意识和积极性提高,使慢性病防治与健康信息获取需求高度同步,二者关联增强。此外,城乡两地六类健康问题素养网络的整体连接强度上也存在差异。中心性指标显示,传染病防治、慢性病防治、基本医疗三个节点的强度均表现为农村高于城市。有研究指出,近年来农村地区传染病防治素养[18]和慢性病防治素养[19]增长速度高于城市地区。可能是农村居民传染病和慢性病防治基础薄弱,随着基本公共卫生服务均等化水平逐步提高[20],结合慢性病示范区创建[21]和新冠疫情后开展的全民传染病健康教育,加之互联网的普及使农村居民更容易获得健康信息[22],共同作用缩小了传染病和慢性病防治的城乡差异,并且增强了二者与其他健康问题的联系。
综上所述,本研究中农村地区居民健康素养水平仍有待全面提升,城市地区在传染病防治素养、慢性病防治素养和基本医疗素养仍存在短板,需因地制宜开展健康素养促进工作。在城市地区,应继续强化基本科学健康观和疾病防治知识的深度融合,整合日常开展的各类健康促进资源,促进城市居民总体素养水平提升。在农村地区,应充分利用现有基本公共卫生服务和慢性病防控体系,培养科学健康观,逐步提高居民健康信息获取能力,将健康素养知识嵌入到传染病和慢性病防治的各个环节,推动疾病防治与基本医疗素养协同发展,以此推动农村居民的总体素养水平提高。
本研究存在如下局限性:一是本研究为横断面调查,研究结果仅表示六类健康问题素养间的关联,难以推断各指标间的因果关系及相互影响的时间顺序。二是本研究进行了城乡网络比较,但未考虑年龄、性别等其他社会人口学特征的影响,未来研究可进一步深入分析不同社会人口学特征中六类健康问题素养的关联情况。

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2026年第53卷第13期
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doi: 10.20043/j.cnki.MPM.202512197
  • 接收时间:2025-12-15
  • 首发时间:2026-09-28
  • 出版时间:2026-07-10
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    成都市疾病预防控制中心(成都市卫生监督所)健康教育科,四川 成都 610041

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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
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