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Article(id=1311350373806343148, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202603219, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1773417600000, receivedDateStr=2026-03-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579892826, onlineDateStr=2026-09-28, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579892826, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579892826, creator=13701087609, updateTime=1790579892826, updator=13701087609, issue=Issue{id=1311350363295417204, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1790579890321, creator='13701087609', updateTime=1790584112451, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311368072267653663, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311368072267653664, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2981, endPage=2986, ext={EN=ArticleExt(id=1311350374016058349, articleId=1311350373806343148, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Structural characteristics and influencing factors on health literacy among Sichuan residents during the 14th Five-Year Plan period, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the structural characteristics and core influencing factors of health literacy among residents in Sichuan Province during the 14th Five-Year Plan period (2021-2025), and provide empirical evidence for formulating health literacy optimization strategies for the 15th Five-Year Plan period.

Methods

Based on the health literacy surveillance data of Sichuan residents in 2021, 2023 and 2025, Chi-square test was used to analyze the structural characteristics of literacy on six categories of health issues, multivariate Logistic regression was applied to identify the influencing factors, and stepwise regression method was adopted to test the mediating effect of education level.

Results

During the 14th Five-Year Plan period, the overall health literacy rate of Sichuan residents increased from 24.10% to 33.80%, with a cumulative increase of 9.70 percentage points, and the level in 2025 was slightly higher than the national average. The literacy on six categories of health issues presented the characteristics of prominent strengths, obvious weaknesses, and peaking then declining in some dimensions: scientific health concept and safety & first aid were dominant fields, while chronic disease prevention and control, infectious disease prevention and control were core weaknesses. Education level of college degree or above (OR=5.467，95%CI=5.453-5.481) and occupation as medical staff (OR=1.796，95%CI=1.790-1.802) were strong promoting factors, while rural household registration, people aged 65-69 years and farmers were main risk factors. The mediating effect of education level accounted for 35.2% and 42.6% of the association between urban-rural status, farmer occupation and health literacy, respectively.

Conclusion

The health literacy of Sichuan residents has achieved significant improvement, but prominent problems such as structural imbalance, regional and population disparities still exist. Education level is the core mediating variable. Targeted optimization strategies should be implemented to promote the transformation of health literacy to qualitative optimization.

, authors=Yan-yan ZHANG1, Pan ZHANG1, Li ZHAO2, Zhi-xin LI1, authorsList=Yan-yan ZHANG, Pan ZHANG, Li ZHAO, Zhi-xin LI, authorCompany=null, correspAuthors=Zhi-xin LI, 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=1311350374695535600, articleId=1311350373806343148, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=“十四五”时期四川省居民健康素养结构性特征及影响因素的多维度分析, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=
目的

分析“十四五”时期四川省居民健康素养的结构性特征与核心影响因素，为“十五五”健康素养优化策略制定提供实证依据。

方法

基于2021、2023、2025年四川省居民健康素养监测数据，采用χ2检验分析六类健康问题素养的结构性特征，通过多因素logistic回归识别影响因素，以逐步回归法检验文化程度的中介效应。

结果

“十四五”时期四川省居民总体健康素养从24.10%升至33.80%，累计增幅9.70%，2025年水平略高于全国平均；六类健康问题素养呈“长板突出、短板明显、部分冲高回落”特征，科学健康观、安全与急救为优势领域，慢性病、传染病防治为核心短板；大专及以上文化程度（OR=5.467，95%CI=5.453~5.481）、医务人员职业（OR=1.796，95%CI=1.790~1.802）为强促进因素，农村户籍、65~69岁人群、农民为主要不利因素；文化程度在城乡、农民职业与健康素养间的中介效应占比分别为35.20%、42.60%。

结论

四川省居民健康素养提升成效显著，但结构性失衡、区域与人群差距突出，文化程度是核心中介变量，需实施针对性优化策略，推动健康素养向“质的优化”转型。

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张燕燕(1990—)，女，硕士，主管医师，研究方向：健康与社会行为学

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李志新，E-mail：
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Medical Higher Vocational Education and Modern Nursing, 2025, 8(6): 483-487.(In Chinese), articleTitle=Practice exploration of modern first aid education and training integration from the perspective of healthy China, refAbstract=null), Reference(id=1311350380852772930, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2018, volume=38, issue=8, pageStart=1023, pageEnd=1026, url=null, language=null, rfNumber=[22], rfOrder=37, authorNames=周勇, 罗敏, journalName=中国农村卫生事业管理, refType=null, unstructuredReference=周勇，罗敏．职业教育视角下农民工健康教育路径研究［J］．中国农村卫生事业管理，2018，38(8)：1023-1026．, articleTitle=职业教育视角下农民工健康教育路径研究, refAbstract=null), Reference(id=1311350380915687491, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2018, volume=38, issue=8, pageStart=1023, pageEnd=1026, url=null, language=null, rfNumber=[22], rfOrder=38, authorNames=Zhou Y, Luo M, journalName=Chinese Rural Health Service Administration, refType=null, unstructuredReference=Zhou Y, Luo M. Research on health education path for migrant workers from the perspective of vocational education［J］. Chinese Rural Health Service Administration, 2018, 38(8): 1023-1026.(In Chinese), articleTitle=Research on health education path for migrant workers from the perspective of vocational education, refAbstract=null), Reference(id=1311350380999573572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2024, volume=24, issue=4, pageStart=343, pageEnd=351, url=null, language=null, rfNumber=[23], rfOrder=39, authorNames=蒋昀洁, 邵于钊, 张慧娟, journalName=南京医科大学学报（社会科学版）, refType=null, unstructuredReference=蒋昀洁，邵于钊，张慧娟，等．数字健康背景下南京农村留守老人数字困境与突破［J］．南京医科大学学报（社会科学版），2024，24(4)：343-351．, articleTitle=数字健康背景下南京农村留守老人数字困境与突破, refAbstract=null), Reference(id=1311350381070876741, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2024, volume=24, issue=4, pageStart=343, pageEnd=351, url=null, language=null, rfNumber=[23], rfOrder=40, authorNames=Jiang YJ, Shao YZ, Zhang HJ, journalName=Journal of Nanjing Medical University (Social Sciences), refType=null, unstructuredReference=Jiang YJ, Shao YZ, Zhang HJ, et al. The digital dilemma and breakthrough of the left-behind older adults in rural Nanjing under the background of digital health［J］. Journal of Nanjing Medical University (Social Sciences), 2024, 24(4): 343-351.(In Chinese), articleTitle=The digital dilemma and breakthrough of the left-behind older adults in rural Nanjing under the background of digital health, refAbstract=null), Reference(id=1311350381154762822, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2026, volume=29, issue=19, pageStart=2688, pageEnd=2694, url=null, language=null, rfNumber=[24], rfOrder=41, authorNames=黎婉钰, 金花, 杨森, journalName=中国全科医学, refType=null, unstructuredReference=黎婉钰，金花，杨森，等．基于行为改变轮理论的社区居民健康行为调查及优化策略［J］．中国全科医学，2026，29(19)：2688-2694．, articleTitle=基于行为改变轮理论的社区居民健康行为调查及优化策略, refAbstract=null), Reference(id=1311350381238648903, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2026, volume=29, issue=19, pageStart=2688, pageEnd=2694, url=null, language=null, rfNumber=[24], rfOrder=42, authorNames=Li WY, Jin H, Yang S, journalName=Chinese General Practice, refType=null, unstructuredReference=Li WY, Jin H, Yang S, et al. Assessment and optimization of community health behaviors guided by the behaviour change wheel theory［J］. Chinese General Practice, 2026, 29(19): 2688-2694.(In Chinese), articleTitle=Assessment and optimization of community health behaviors guided by the behaviour change wheel theory, refAbstract=null), Reference(id=1311350381326729288, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2025, volume=60, issue=5, pageStart=692, pageEnd=697, url=null, language=null, rfNumber=[25], rfOrder=43, authorNames=郑丽, 张华, 王静, journalName=郑州大学学报（医学版）, refType=null, unstructuredReference=郑丽，张华，王静．基于Kano模型的河南省不同健康素养水平居民健康科普需求比较［J］．郑州大学学报（医学版），2025，60(5)：692-697．, articleTitle=基于Kano模型的河南省不同健康素养水平居民健康科普需求比较, refAbstract=null), Reference(id=1311350381427392585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, doi=null, pmid=null, pmcid=null, year=2025, volume=60, issue=5, pageStart=692, pageEnd=697, url=null, language=null, rfNumber=[25], rfOrder=44, authorNames=Zheng L, Zhang H, Wang J, journalName=Journal of Zhengzhou University (Medical Sciences), refType=null, unstructuredReference=Zheng L, Zhang H, Wang J. Comparison of health science popularization demands among residents with different health literacy levels in Henan Province based on Kano model［J］. Journal of Zhengzhou University (Medical Sciences), 2025, 60(5): 692-697.(In Chinese), articleTitle=Comparison of health science popularization demands among residents with different health literacy levels in Henan Province based on Kano model, refAbstract=null)], funds=[Fund(id=1311350377677684763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, awardId=2026JDKP0026, language=CN, fundingSource=四川省重大科学传播推广项目(2026JDKP0026), fundOrder=null, country=null), Fund(id=1311350377761570844, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, awardId=2024ZD0524700, language=CN, fundingSource=国家科技重大专项(2024ZD0524700), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350374930416625, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, xref=1., ext=[AuthorCompanyExt(id=1311350374938805234, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, companyId=1311350374930416625, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1311350374947193843, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, companyId=1311350374930416625, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川省疾病预防控制中心，四川 成都 610041)]), AuthorCompany(id=1311350375018497012, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, xref=2., ext=[AuthorCompanyExt(id=1311350375026885621, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, companyId=1311350375018497012, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西公共卫生学院)])], figs=[ArticleFig(id=1311350376809463825, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=EN, label=Fig.1, caption=Comparison of the levelsof six types of health literacy on health issues and urban-rural population differences in Sichuan province in 2025, figureFileSmall=xEoyHJRSVcjIMtRRjH6oug==, figureFileBig=W7fW/oM76Y50Mxxr6kZuPg==, tableContent=null), ArticleFig(id=1311350376880766994, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=CN, label=图1, caption=2025年四川省六类健康问题素养水平及城乡人群差异对比图

注：左侧柱状图为2025年全省平均素养水平，右侧折线图为农村/城市素养比值，比值<1代表农村水平低于城市；慢性病防治、传染病防治为四川省2025年健康素养核心短板领域，农村/城市比值均<0.8，人群差异最显著。

, figureFileSmall=xEoyHJRSVcjIMtRRjH6oug==, figureFileBig=W7fW/oM76Y50Mxxr6kZuPg==, tableContent=null), ArticleFig(id=1311350377077899283, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=EN, label=Table 1, caption=

Comparison of the overall health literacy level in Sichuan province with the national average and the eastern, central and western regions of China during the 14th Five-Year Plan period

, figureFileSmall=null, figureFileBig=null, tableContent=
地区2021年水平
（%）		2023年水平
（%）		2025年水平
（%）		累计增幅
（%）		年均增幅
（%）
四川省24.1027.7033.809.702.43
全国25.4029.7033.698.291.66
四川省-城市地区22.1032.3037.0014.903.73
四川省-农村地区25.1025.0032.407.301.83
东部地区30.4033.3036.716.311.58
中部地区23.8328.8532.989.152.29
西部地区19.4224.4429.099.672.42
), ArticleFig(id=1311350377140813844, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=CN, label=表1, caption=

“十四五”时期四川省健康素养总体水平与全国及东中西部地区比较

, figureFileSmall=null, figureFileBig=null, tableContent=
地区2021年水平
（%）		2023年水平
（%）		2025年水平
（%）		累计增幅
（%）		年均增幅
（%）
四川省24.1027.7033.809.702.43
全国25.4029.7033.698.291.66
四川省-城市地区22.1032.3037.0014.903.73
四川省-农村地区25.1025.0032.407.301.83
东部地区30.4033.3036.716.311.58
中部地区23.8328.8532.989.152.29
西部地区19.4224.4429.099.672.42
), ArticleFig(id=1311350377212117013, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=EN, label=Table 2, caption=

Structural characteristics and dynamic changes of six types of health literacy on health issues in Sichuan province during the 14th Five-Year Plan Period

, figureFileSmall=null, figureFileBig=null, tableContent=
健康问题领域2021年水平
（%）		2023年水平
（%）		2025年水平
（%）		累计增幅
（%）		“十四五”期间变化趋势2025年水平排序
科学健康观47.0058.7052.005.00缓慢上升1
传染病防治29.2030.8035.906.70平稳上升5
慢性病防治25.7032.8029.904.20缓慢上升6
安全与急救51.1057.7051.00-0.10缓慢下降2
基本医疗27.5035.3038.0010.50快速上升4
健康信息33.7038.8041.607.90持续上升3
), ArticleFig(id=1311350377291808790, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=CN, label=表2, caption=

“十四五”时期四川省六类健康问题素养的结构性特征及动态变化

, figureFileSmall=null, figureFileBig=null, tableContent=
健康问题领域2021年水平
（%）		2023年水平
（%）		2025年水平
（%）		累计增幅
（%）		“十四五”期间变化趋势2025年水平排序
科学健康观47.0058.7052.005.00缓慢上升1
传染病防治29.2030.8035.906.70平稳上升5
慢性病防治25.7032.8029.904.20缓慢上升6
安全与急救51.1057.7051.00-0.10缓慢下降2
基本医疗27.5035.3038.0010.50快速上升4
健康信息33.7038.8041.607.90持续上升3
), ArticleFig(id=1311350377358917655, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=EN, label=Table 3, caption=

Multivariate logistic regression analysis of influencing factors of health literacy (2025)

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素β值标准误Wald χ2 值P值OR值（95%CI）
性别（参照：男性）0.0660.00113 797.460<0.0011.068（1.067~1.069）
城乡（参照：城市）-0.0210.0011 087.469<0.0010.980（0.978~0.981）
年龄组（岁，参照：15~24）
25~340.1270.00117 598.724<0.0011.135（1.133~1.137）
35~440.2140.00142 373.220<0.0011.238（1.236~1.241）
45~540.0970.0019 521.465<0.0011.102（1.100~1.104）
55~64-0.1840.00125 554.713<0.0010.832（0.830~0.834）
65~69-0.4310.00191 669.075<0.0010.650（0.648~0.652）
文化程度（参照：小学以下）
小学0.4000.001117 755.997<0.0011.491（1.488~1.495）
初中0.8790.001610 720.884<0.0012.407（2.402~2.413）
高中/职高/中专1.2910.0011 018 454.246<0.0013.637（3.628~3.646）
大专及以上1.6990.0011 637 691.874<0.0015.467（5.453~5.481）
职业（参照：其他）
公务员/事业单位人员-0.0390.001860.859<0.0010.962（0.959~0.964）
教师0.1100.0022 941.412<0.0011.116（1.112~1.121）
医务人员0.5860.002105 757.984<0.0011.796（1.790~1.802）
农民-0.1280.00126 530.103<0.0010.880（0.879~0.882）
工人-0.0720.0014 032.493<0.0010.931（0.929~0.933）
家庭年收入（万元，参照：0~<1）
1~<20.0320.001845.502<0.0011.032（1.030~1.034）
2~<50.0590.0014 133.530<0.0011.061（1.059~1.063）
≥50.1120.00113 908.829<0.0011.119（1.117~1.121）
常量-1.6630.002996 929.975<0.0010.190
), ArticleFig(id=1311350377434415128, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=CN, label=表3, caption=

健康素养影响因素的多因素logistic回归分析（2025年）

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素β值标准误Wald χ2 值P值OR值（95%CI）
性别（参照：男性）0.0660.00113 797.460<0.0011.068（1.067~1.069）
城乡（参照：城市）-0.0210.0011 087.469<0.0010.980（0.978~0.981）
年龄组（岁，参照：15~24）
25~340.1270.00117 598.724<0.0011.135（1.133~1.137）
35~440.2140.00142 373.220<0.0011.238（1.236~1.241）
45~540.0970.0019 521.465<0.0011.102（1.100~1.104）
55~64-0.1840.00125 554.713<0.0010.832（0.830~0.834）
65~69-0.4310.00191 669.075<0.0010.650（0.648~0.652）
文化程度（参照：小学以下）
小学0.4000.001117 755.997<0.0011.491（1.488~1.495）
初中0.8790.001610 720.884<0.0012.407（2.402~2.413）
高中/职高/中专1.2910.0011 018 454.246<0.0013.637（3.628~3.646）
大专及以上1.6990.0011 637 691.874<0.0015.467（5.453~5.481）
职业（参照：其他）
公务员/事业单位人员-0.0390.001860.859<0.0010.962（0.959~0.964）
教师0.1100.0022 941.412<0.0011.116（1.112~1.121）
医务人员0.5860.002105 757.984<0.0011.796（1.790~1.802）
农民-0.1280.00126 530.103<0.0010.880（0.879~0.882）
工人-0.0720.0014 032.493<0.0010.931（0.929~0.933）
家庭年收入（万元，参照：0~<1）
1~<20.0320.001845.502<0.0011.032（1.030~1.034）
2~<50.0590.0014 133.530<0.0011.061（1.059~1.063）
≥50.1120.00113 908.829<0.0011.119（1.117~1.121）
常量-1.6630.002996 929.975<0.0010.190
), ArticleFig(id=1311350377493135385, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=EN, label=Table 4, caption=

Comparison of the levels of six types of health literacy on health issues between core vulnerable populations and advantaged populations in Sichuan province in 2025 (%)

, figureFileSmall=null, figureFileBig=null, tableContent=
健康问题领域全省平均核心脆弱人群优势人群差值χ2值P值
科学健康观52.036.867.530.718 965.323<0.001
传染病防治35.921.552.831.321 042.674<0.001
慢性病防治29.916.848.331.523 456.887<0.001
安全与急救51.035.266.731.522 879.451<0.001
基本医疗38.024.656.932.324 103.783<0.001
健康信息41.627.359.832.525 678.910<0.001
), ArticleFig(id=1311350377568632858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350373806343148, language=CN, label=表4, caption=

2025年四川省核心脆弱人群与优势人群六类健康问题素养水平对比（%）

, figureFileSmall=null, figureFileBig=null, tableContent=
健康问题领域全省平均核心脆弱人群优势人群差值χ2值P值
科学健康观52.036.867.530.718 965.323<0.001
传染病防治35.921.552.831.321 042.674<0.001
慢性病防治29.916.848.331.523 456.887<0.001
安全与急救51.035.266.731.522 879.451<0.001
基本医疗38.024.656.932.324 103.783<0.001
健康信息41.627.359.832.525 678.910<0.001
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“十四五”时期四川省居民健康素养结构性特征及影响因素的多维度分析
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张燕燕 1 , 张盼 1 , 赵莉 2 , 李志新 1
现代预防医学 | 卫生政策与管理 2026,53(16): 2981-2986
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现代预防医学 |卫生政策与管理 2026 , 53 (16) : 2981 -2986
“十四五”时期四川省居民健康素养结构性特征及影响因素的多维度分析
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张燕燕1, 张盼1, 赵莉2, 李志新1
作者信息
  • 1.四川省疾病预防控制中心，四川 成都 610041
  • 2.四川大学华西公共卫生学院
通讯作者:
李志新，E-mail：
作者简介:

张燕燕(1990—)，女，硕士，主管医师，研究方向：健康与社会行为学

Structural characteristics and influencing factors on health literacy among Sichuan residents during the 14th Five-Year Plan period
Yan-yan ZHANG1, Pan ZHANG1, Li ZHAO2, Zhi-xin LI1
Affiliations
  • Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China
出版时间: 2026-08-25 doi: 10.20043/j.cnki.MPM.202603219
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摘要
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目的

分析“十四五”时期四川省居民健康素养的结构性特征与核心影响因素，为“十五五”健康素养优化策略制定提供实证依据。

方法

基于2021、2023、2025年四川省居民健康素养监测数据，采用χ2检验分析六类健康问题素养的结构性特征，通过多因素logistic回归识别影响因素，以逐步回归法检验文化程度的中介效应。

结果

“十四五”时期四川省居民总体健康素养从24.10%升至33.80%，累计增幅9.70%，2025年水平略高于全国平均；六类健康问题素养呈“长板突出、短板明显、部分冲高回落”特征，科学健康观、安全与急救为优势领域，慢性病、传染病防治为核心短板；大专及以上文化程度（OR=5.467，95%CI=5.453~5.481）、医务人员职业（OR=1.796，95%CI=1.790~1.802）为强促进因素，农村户籍、65~69岁人群、农民为主要不利因素；文化程度在城乡、农民职业与健康素养间的中介效应占比分别为35.20%、42.60%。

结论

四川省居民健康素养提升成效显著，但结构性失衡、区域与人群差距突出，文化程度是核心中介变量，需实施针对性优化策略，推动健康素养向“质的优化”转型。

健康素养  /  结构性特征  /  影响因素  /  中介效应
Objective

To analyze the structural characteristics and core influencing factors of health literacy among residents in Sichuan Province during the 14th Five-Year Plan period (2021-2025), and provide empirical evidence for formulating health literacy optimization strategies for the 15th Five-Year Plan period.

Methods

Based on the health literacy surveillance data of Sichuan residents in 2021, 2023 and 2025, Chi-square test was used to analyze the structural characteristics of literacy on six categories of health issues, multivariate Logistic regression was applied to identify the influencing factors, and stepwise regression method was adopted to test the mediating effect of education level.

Results

During the 14th Five-Year Plan period, the overall health literacy rate of Sichuan residents increased from 24.10% to 33.80%, with a cumulative increase of 9.70 percentage points, and the level in 2025 was slightly higher than the national average. The literacy on six categories of health issues presented the characteristics of prominent strengths, obvious weaknesses, and peaking then declining in some dimensions: scientific health concept and safety & first aid were dominant fields, while chronic disease prevention and control, infectious disease prevention and control were core weaknesses. Education level of college degree or above (OR=5.467，95%CI=5.453-5.481) and occupation as medical staff (OR=1.796，95%CI=1.790-1.802) were strong promoting factors, while rural household registration, people aged 65-69 years and farmers were main risk factors. The mediating effect of education level accounted for 35.2% and 42.6% of the association between urban-rural status, farmer occupation and health literacy, respectively.

Conclusion

The health literacy of Sichuan residents has achieved significant improvement, but prominent problems such as structural imbalance, regional and population disparities still exist. Education level is the core mediating variable. Targeted optimization strategies should be implemented to promote the transformation of health literacy to qualitative optimization.

Healthiteracy  /  Structural haracteristics  /  Influencing actors  /  Mediating ffect
张燕燕, 张盼, 赵莉, 李志新. “十四五”时期四川省居民健康素养结构性特征及影响因素的多维度分析. 现代预防医学, 2026 , 53 (16) : 2981 -2986 . DOI: 10.20043/j.cnki.MPM.202603219
Yan-yan ZHANG, Pan ZHANG, Li ZHAO, Zhi-xin LI. Structural characteristics and influencing factors on health literacy among Sichuan residents during the 14th Five-Year Plan period[J]. Modern Preventive Medicine, 2026 , 53 (16) : 2981 -2986 . DOI: 10.20043/j.cnki.MPM.202603219
正文
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健康素养的结构性优化是健康促进工作从“规模增长”向“质量提升”转型的核心标志，六类健康问题素养的均衡发展直接关系到居民整体健康能力的提升［1］。“十四五”时期是推进健康中国建设的关键阶段，四川省作为西部经济与人口大省，其健康素养的结构性特征及影响因素对西南地区健康素养高质量发展具有重要引领作用［2］。
现有研究已证实四川省居民健康素养呈增长趋势，但对六类健康问题素养的结构性失衡研究不足，尚未明确结构性失衡的核心成因及区域、人群差异的驱动机制［3-4］。本研究基于“十四五”关键节点（2021、2023、2025年）的监测数据，系统探究健康素养的结构性特征、核心影响因素及中介作用机制，为“十五五”时期四川省健康素养结构优化及精准干预提供实证依据。
1　资料与方法
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1.1　数据来源
研究数据来源于2021、2023、2025年四川省居民健康素养省级连续性监测，调查对象为四川省15~69岁城乡常住人口，纳入标准为具备正常理解与沟通能力、自愿参与且当地居住时间≥6个月，排除认知障碍、精神疾病等无法配合调查者及临时流动人口。3个年度有效样本量分别为13 873、11 573、68 486人，合计93 932人，样本覆盖全省21个市（州），具有省级代表性。
1.2　抽样与调查方法
采用多阶段分层整群概率抽样法，按城乡属性分层，2021、2023年设置56个监测点（含14个国家监测点），2025年扩增至187个。采用国家卫生健康委统一制定的《全国居民健康素养监测调查问卷》，由经标准化培训的调查员开展面对面入户调查。问卷涵盖科学健康观、传染病防治、慢性病防治、安全与急救、基本医疗、健康信息六类健康问题素养模块，以问卷得分≥80%判定为具备相应素养，计算各类素养水平。
1.3　统计方法
采用SPSS 22.0软件进行数据处理。以百分比描述健康素养水平及构成，通过χ2检验分析六类健康问题素养的年度差异；构建多因素非条件logistic回归模型，以“是否具备总体健康素养”为二分类因变量（是=1，否=0），总体健康素养判定标准参照《全国居民健康素养监测调查问卷》统一计分规则：问卷得分≥80%判定为具备总体健康素养（赋值为1），<80%判定为不具备（赋值为0），纳入性别、城乡、年龄、文化程度、职业、家庭年收入为自变量，识别独立影响因素；采用逐步回归法检验文化程度在城乡、农民职业与健康素养间的中介效应。采用双侧检验，检验水准α=0.05。
2　结果
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2.1　总体健康素养水平及区域比较
“十四五” 时期四川省居民总体健康素养呈持续稳健增长趋势，累计增幅9.70%，年均增长2.43%，2025年水平略高于全国平均。区域与城乡差异显著，整体水平仍低于东部地区；省内城乡差距持续扩大，城市累计增幅约为农村的2倍，详见表1。
2.2　六类健康问题素养的结构性特征及动态变化
六类健康问题素养发展不均衡，年度变化趋势差异均有统计学意义（P均<0.001），核心特征为长板突出、短板明显、部分冲高回落：科学健康观、安全与急救为优势领域，均于2023年达峰后回落；慢性病防治、传染病防治为核心短板，增幅缓慢；基本医疗、健康信息素养增长最快，详见表2、图1。
2.3　健康素养影响因素的多因素logistic回归分析
多因素logistic回归模型显示，性别、城乡、年龄、文化程度、职业、家庭年收入6个变量均与居民健康素养水平显著相关（P均< 0.001），详见表3。其中文化程度为最强促进因素，大专及以上群体具备健康素养的概率为小学以下群体的5.467倍；职业维度中医务人员促进作用最显著，农民为主要不利因素；年龄呈中青年高、老年低特征，65~69岁群体素养劣势最明显；农村户籍、低收入与素养水平负相关，女性略优于男性。
2.4　文化程度的中介效应分析
文化程度在城乡、农民职业与健康素养之间均存在部分中介效应（P均<0.001），中介效应占比分别为35.2%、42.6%；纳入文化程度后，城乡、农民职业对健康素养的直接效应仍具有统计学意义。
2.5　六类健康问题素养的人群差异特征
2025年六类健康问题素养均存在显著人群差异（P均<0.001），核心脆弱人群（农村、老年、农民）素养水平普遍偏低，短板领域的人群差距更为突出，即使是科学健康观、安全与急救等优势领域，脆弱人群与优势人群（中青年、高学历、城市）的差距仍达15.00%~20.00%，详见表4。
3　讨论
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3.1　健康素养提升成效显著，区域发展差距仍需弥补
本研究结果显示，“十四五” 时期四川省居民健康素养累计增长9.70%，2025年水平略超全国平均，印证了全省健康素养促进行动的实施成效［5-7］。但区域发展不平衡问题依然突出：整体水平与东部地区仍有差距，且省内城乡差距持续扩大，城市增幅约为农村的2倍，提示城乡健康资源与信息可及性的二元差异，仍是农村健康素养提升的主要制约因素［8］。
3.2　六类健康问题素养结构性失衡特征突出，成因具有多维度性
本研究发现，四川省六类健康问题素养结构性失衡特征明显，与西部同类研究结论一致［9］。慢性病、传染病防治作为核心短板，与基层慢病自我管理指导不足、传染病常态化科普持续性弱直接相关［10-11］；优势领域出现冲高回落，反映了传统集中灌输式宣教的长期巩固效果有限［12］；基本医疗与健康信息素养的快速增长，则对应了近年基层医疗服务体系完善、健康信息科普专项行动的工作成效［13］。
3.3　健康素养影响因素呈显著社会梯度特征，文化程度为核心中介变量
本研究结果显示，四川省健康素养分布呈现显著的社会梯度特征，与国内外经典研究结论契合［14-15］。文化程度既是健康素养的最强促进因素，也是城乡、农民职业与健康素养间的核心中介变量，揭示了教育水平差异是城乡、职业素养差距的核心路径之一。老年、农民群体的素养劣势，以及女性的轻微优势，均与人群的健康信息获取能力、健康关注程度差异相关［16-17］。同时，部分中介效应也提示，城乡医疗资源不均、职业宣教可及性差异等直接因素仍发挥重要作用［18］。
3.4　面向“十五五”的健康素养结构优化策略
结合研究结论，从四个维度提出针对性优化策略：①攻坚短板领域，实施专项素养提升工程。将慢性病防治素养提升列为重点，依托家庭医生签约服务开展个性化自我管理指导，包括用药依从性教育、膳食运动处方、血糖血压自测技能培训，建立闭环管理机制［19］；将传染病常态化科普纳入基本公共卫生服务项目，针对农村地区开发多语种方言科普材料，实现基层渠道全覆盖［20］。②创新宣教模式，推动知识向行为技能转化。在基层设置健康教育实操阵地，配备心肺复苏模拟人、血压计、血糖仪等基础教具开展健康技能实操培训，巩固宣教效果［21］。③破解中介瓶颈，实施脆弱人群精准赋能行动。将健康素养教育融入农民职业培训、老年教育体系［22］，针对低文化程度群体开发通俗化宣教材料，提升健康信息理解能力。④完善基层支持体系，强化资源下沉与数字赋能。推动健康促进资源向农村倾斜，保留传统宣教渠道的同时开展老年数字健康帮扶［23］，可通过社区智能手机操作培训班、子女远程协助等方式，缩小素养获取的渠道差异。［24-25］。
4　结论
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“十四五”时期四川省居民健康素养提升成效显著，2025年总体水平略高于全国平均，但仍面临结构性失衡、区域差距、人群不均等三重挑战：六类健康问题素养呈“长板突出、短板明显、部分冲高回落”特征，慢性病防治、传染病防治为核心短板；与东部发达地区仍有差距，省内城乡差距持续扩大；健康素养分布呈显著社会梯度，农村居民、老年群体、农民、低学历人群为核心脆弱人群。文化程度是城乡、职业差异影响健康素养的核心中介变量。
面向“十五五”，四川省应聚焦健康素养结构优化，实施针对性综合策略，重点强化短板领域素养提升，创新健康教育模式，以文化程度提升为抓手破解人群差异，推动健康资源向基层和脆弱人群下沉，实现健康素养从“规模增长”向“质量公平、结构均衡”的高质量发展。
基金
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  • 四川省重大科学传播推广项目(2026JDKP0026)
  • 国家科技重大专项(2024ZD0524700)
文献
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2026年第53卷第16期
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doi: 10.20043/j.cnki.MPM.202603219
  • 接收时间：2026-03-14
  • 首发时间：2026-09-28
  • 出版时间：2026-08-25
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  • 收稿日期：2026-03-14
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四川省重大科学传播推广项目(2026JDKP0026)
国家科技重大专项(2024ZD0524700)
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    1.四川省疾病预防控制中心，四川 成都 610041
    2.四川大学华西公共卫生学院

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李志新，E-mail：
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2种不同金属材料的力学参数
科
Family		 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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