Article(id=1321170803052364684, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170720168726830, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145059, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1721145600000, receivedDateStr=2024-07-17, revisedDate=1724860800000, revisedDateStr=2024-08-29, acceptedDate=1746806400000, acceptedDateStr=2025-05-10, onlineDate=1792921265613, onlineDateStr=2026-10-25, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921265613, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921265613, creator=13701087609, updateTime=1792921265613, updator=13701087609, issue=Issue{id=1321170720168726830, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='8', pageStart='897', pageEnd='1024', issueExtLink='null', onlineDate='null', pubDate='1754755200000', pubDateStr='2025-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921245852, creator='13701087609', updateTime=1792921245852, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=971, endPage=976, ext={EN=ArticleExt(id=1321170804876886925, articleId=1321170803052364684, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Active health participation and its determinants among community-dwelling adults in two cities in Sichuan and Shandong provinces, China: a cross-sectional study, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate active health participation (including health-related self-management and self-empowerment) and its determinants among community-dwelling adults, and to provide evidence for the development of relevant policies and effective chronic disease control and prevention services.

Methods

The data were derived from two surveys conducted among 1 598 community-dwelling adults (aged ≥18 years) recruited through multistage random sampling: the first in Jinan city, Shandong province (August–October 2022), and the second in Neijiang city, Sichuan province (April–May 2023). The surveys used a questionnaire on health knowledge, attitude, and practice (KAP) and health care utilization, the 10-item Kessler Psychological Distress Scale (K10), and the EuroQol-5 Dimensions (EQ-5D). Active health participation was assessed by self-reported health-related self-management and self-empowerment practices. Multiple logistic regression analysis was employed to identify influencing factors, based on the three dimensions of Andersen’s Behavioral Model for healthcare utilization.

Results

Of the 1 598 participants with valid responses, 905 (56.6%) were classified as active health participants. Multiple binary logistic regression analysis showed that place of residence (towns vs. rural, odds ratio [OR] = 0.51, 95%confidence interval [CI]: 0.34–0.75), awareness of hypertension (no vs. yes, OR = 0.67, 95%CI: 0.53–0.86), average monthly household income (> 8 000 vs. < 2 000, OR = 2.76, 95%CI: 1.34–5.69), availability of free health screening programs (no vs. yes, OR = 0.49, 95%CI: 0.27–0.89), community health education programs (no vs. yes, OR = 0.27, 95%CI: 0.17–0.44), community provision of blood glucose and blood pressure testing (no vs. yes, OR = 0.63, 95%CI: 0.42–0.93), and individual EQ-5D score (OR = 0.23, 95%CI: 0.10–0.56) were significantly associated with active health participation.

Conclusions

The awareness of active health participation among community-dwelling adults in Sichuan and Shandong provinces remains relatively low and is primarily influenced by education level, economic income, availability of community health resources, and health-related quality of life. These findings highlight the urgent need to improve health awareness and address regional disparities in resource allocation.

, authors=Yunsha WANG, Xiaoyuan ZHOU, Zhao ZHANG, Jinfeng TANG, Yufan WANG, authorsList=Yunsha WANG, Xiaoyuan ZHOU, Zhao ZHANG, Jinfeng TANG, Yufan WANG, authorCompany=null, correspAuthors=Xiaoyuan ZHOU, authorNote=null, correspAuthorsNote=
ZHOU Xiaoyuan, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., 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=1321170806059680660, articleId=1321170803052364684, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=四川、山东两地居民主动健康参与现状及影响因素, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

了解居民主动健康参与现状及其影响因素,为提高慢性病管理效果,构建科学、高效、人性化的卫生健康服务体系提供相关政策依据。

方法

于2022年8—10月在山东省济南市、2023年4—5月在四川省内江市对1 598名≥18岁当地常住居民进行调查;以“主动健康的参与情况”作为因变量,根据安德森卫生服务利用行为模型的3个维度确定自变量,利用多因素logistic回归分析主动健康参与的影响因素。

结果

被调查的居民中积极主动健康参与者共905人(56.63%);多因素检验结果表明,常居地(OR=0.51,95%CI=0.34~0.75)、知晓高血压标准(OR=0.67,95%CI=0.53~0.86)、家庭月均收入水平(OR=2.76,95%CI=1.34~0.5.69)、社区有免费体检项目(OR=0.49,95%CI=0.27~0.89)、社区开展健康教育(OR=0.27,95%CI=0.17~0.44)、社区提供血糖血压等检测(OR=0.63,95%CI=0.42~0.93)、个体生命健康值(OR=0.23,95%CI=0.10~0.56)是居民主动健康参与的影响因素。

结论

四川、山东两地居民主动健康参与的意识较弱,主要受文化水平、经济收入、社区健康资源不足、生命质量值等因素的影响,反映了健康意识提升与资源均衡化的迫切需求。

, authors=王运莎, 周晓媛*, *, 张昭, 唐金凤, 王寓凡, authorsList=王运莎, 周晓媛, 张昭, 唐金凤, 王寓凡, authorCompany=null, correspAuthors=周晓媛, authorNote=

王运莎(1998—),硕士在读,研究方向:主动健康,医疗保险,卫生政策

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周晓媛,E-mail:
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王运莎(1998—),硕士在读,研究方向:主动健康,医疗保险,卫生政策

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124-139., articleTitle=null, refAbstract=null), Reference(id=1321170814666392534, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=24, rfOrder=23, authorNames=null, journalName=null, refType=null, unstructuredReference=薛晓丹, 江国虹, 宋桂德, 等. 天津市居民社会经济地位对健康相关行为的影响[J]. 中国慢性病预防与控制, 2019, 27(5): 360-363., articleTitle=null, refAbstract=null), Reference(id=1321170814746084311, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=25, rfOrder=24, authorNames=null, journalName=null, refType=null, unstructuredReference=周王艳, 吉珂, 陈家应. 我国农村不同收入居民健康状况与生命质量研究[J]. 中国卫生政策研究, 2011, 4(05): 54-59., articleTitle=null, refAbstract=null), 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tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, companyId=1321170806277784469, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院,成都 610041)])], figs=[ArticleFig(id=1321170810048463801, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, language=EN, label=Tab.1, caption=

Number and proportion of community-dwelling adults (n=1 598) with and without active health practices (self-management and self-empowerment) by demographic characteristics, health knowledge, behaviors, awareness of social services, and chronic disease status in two cities in Shandong and Sichuan provinces

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类型名称选项人数占比/%主动健康参与情况/%χ2值P值
是(n=905)否(n=693)
倾向特征所在省市山东省济南市85553.5047952.9337654.260.280.613
四川省内江市74346.5042647.0731745.74
性别男性57736.1135238.9022532.47
女性1 02163.8955361.1046867.537.030.008
年龄/岁≤501096.82586.41497.07
51~6547729.8527129.9421030.30
>651 01263.3357663.6543462.630.340.844
婚姻状况未婚100.6350.5550.72
已婚1 35384.6777986.0857482.83
丧偶21013.1410611.7110415.01
离异251.56151.66101.444.030.259
受教育程度未受教育61938.7433537.0228440.98
小学26216.4014215.6912017.32
初中46429.0427430.2819027.42
高中/职高/中专20412.7712313.598111.69
大专及以上493.07313.43182.605.320.256
常居地农村88855.5748653.7040258.01
乡镇1449.01545.979012.99
县城825.13465.08365.19
城市48430.2931935.2516523.8139.740.001
知晓血压标准是44627.9128631.6016023.09
否1 15272.0961968.4053376.9114.140.001
知晓空腹血糖标准是41025.6622224.5318827.13
否1 18874.3468375.4750572.871.390.239
吸烟是27217.0216418.1210815.58
否1 32682.9874181.8858584.421.790.181
饮酒是36622.9022424.7514220.49
否1 23277.1068175.2555179.514.040.045
认为平时也需健康管理是1 28476.2873481.1055079.37
否17221.719510.507711.11
无所谓1422.01768.40669.520.850.655
使能资源家庭月均收入/元<2 00086253.9447051.9339256.57
2 000~400038824.2821924.2016924.39
4 001~6 00020813.0212213.488612.41
6 001~8 000835.19485.30355.05
>8 000573.57465.08111.5915.410.004
医疗保险类型无684.26333.65355.05
医疗救助70.4440.4430.43
城乡居民医保1 16072.5963369.9452776.05
城镇职工医保35922.4723225.6412718.33
公费医疗40.2530.3310.1413.710.008
是否有商业保险是17611.019910.947711.11
否1 42288.9980689.0661688.890.010.913
社会有免费体检是1 49593.5586595.5863090.91
否573.57212.32365.19
不清楚462.88192.10273.9014.410.001
社会开展健康教育是1 31182.0481189.6150072.15
否28717.969410.3919327.8581.230.001
社区提供饮食指导是1 28980.6677986.0851073.59
否30919.3412613.9218326.4139.220.001
社区提供运动指导是1 23777.4174582.3249271.00
否36122.5916017.6820129.0028.780.001
社区提供药物帮助是1 30481.6076784.7553777.49
否29418.4013815.2515622.5113.790.001
社区提供血糖血压等检测是1 37686.1181890.3955880.52
否22213.89879.6113519.4831.940.001
需求因素是否有慢病否62939.3635539.2327439.54
是96960.6455060.7741960.460.020.899
), ArticleFig(id=1321170810199458746, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, language=CN, label=表1, caption=

调查对象基本特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
类型名称选项人数占比/%主动健康参与情况/%χ2值P值
是(n=905)否(n=693)
倾向特征所在省市山东省济南市85553.5047952.9337654.260.280.613
四川省内江市74346.5042647.0731745.74
性别男性57736.1135238.9022532.47
女性1 02163.8955361.1046867.537.030.008
年龄/岁≤501096.82586.41497.07
51~6547729.8527129.9421030.30
>651 01263.3357663.6543462.630.340.844
婚姻状况未婚100.6350.5550.72
已婚1 35384.6777986.0857482.83
丧偶21013.1410611.7110415.01
离异251.56151.66101.444.030.259
受教育程度未受教育61938.7433537.0228440.98
小学26216.4014215.6912017.32
初中46429.0427430.2819027.42
高中/职高/中专20412.7712313.598111.69
大专及以上493.07313.43182.605.320.256
常居地农村88855.5748653.7040258.01
乡镇1449.01545.979012.99
县城825.13465.08365.19
城市48430.2931935.2516523.8139.740.001
知晓血压标准是44627.9128631.6016023.09
否1 15272.0961968.4053376.9114.140.001
知晓空腹血糖标准是41025.6622224.5318827.13
否1 18874.3468375.4750572.871.390.239
吸烟是27217.0216418.1210815.58
否1 32682.9874181.8858584.421.790.181
饮酒是36622.9022424.7514220.49
否1 23277.1068175.2555179.514.040.045
认为平时也需健康管理是1 28476.2873481.1055079.37
否17221.719510.507711.11
无所谓1422.01768.40669.520.850.655
使能资源家庭月均收入/元<2 00086253.9447051.9339256.57
2 000~400038824.2821924.2016924.39
4 001~6 00020813.0212213.488612.41
6 001~8 000835.19485.30355.05
>8 000573.57465.08111.5915.410.004
医疗保险类型无684.26333.65355.05
医疗救助70.4440.4430.43
城乡居民医保1 16072.5963369.9452776.05
城镇职工医保35922.4723225.6412718.33
公费医疗40.2530.3310.1413.710.008
是否有商业保险是17611.019910.947711.11
否1 42288.9980689.0661688.890.010.913
社会有免费体检是1 49593.5586595.5863090.91
否573.57212.32365.19
不清楚462.88192.10273.9014.410.001
社会开展健康教育是1 31182.0481189.6150072.15
否28717.969410.3919327.8581.230.001
社区提供饮食指导是1 28980.6677986.0851073.59
否30919.3412613.9218326.4139.220.001
社区提供运动指导是1 23777.4174582.3249271.00
否36122.5916017.6820129.0028.780.001
社区提供药物帮助是1 30481.6076784.7553777.49
否29418.4013815.2515622.5113.790.001
社区提供血糖血压等检测是1 37686.1181890.3955880.52
否22213.89879.6113519.4831.940.001
需求因素是否有慢病否62939.3635539.2327439.54
是96960.6455060.7741960.460.020.899
), ArticleFig(id=1321170810342065083, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, language=EN, label=Tab.2, caption=

Mean scores of the EuroQol-5 Dimensions and the 10-item Kessler Psychological Distress Scale in 1 598 community-dwelling adults stratified by active health practices (self-management and self-responsibility) vs. no active practices in two cities in Shandong and Sichuan provinces.

, figureFileSmall=null, figureFileBig=null, tableContent=
名称平均值($ \overline{x}\pm s $)主动健康参与情况χ2值P值
是(n=905)否(n=693)
生命质量值0.926±0.1350.92±0.140.93±0.123.640.057
心理测量总分15.905±5.81815.84±5.6315.99±6.060.290.591
), ArticleFig(id=1321170810455311292, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, language=CN, label=表2, caption=

调查对象基本资料中计量数据的比较

, figureFileSmall=null, figureFileBig=null, tableContent=
名称平均值($ \overline{x}\pm s $)主动健康参与情况χ2值P值
是(n=905)否(n=693)
生命质量值0.926±0.1350.92±0.140.93±0.123.640.057
心理测量总分15.905±5.81815.84±5.6315.99±6.060.290.591
), ArticleFig(id=1321170810581140413, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, language=EN, label=Tab.3, caption=

Associations of sex, place of residence, hypertension knowledge, alcohol consumption, average monthly household income, type of medical insurance, free community health examination/education, dietary/exercise counseling, medication instruction, blood pressure/glucose measurement, and EQ-5D score with active health practices among community-dwelling adults in two cities in Shandong and Sichuan provinces: results of three binary multiple logistic regression models with varying independent variables and goodness of fit

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类型变量比较组对照组模型Ⅰ模型Ⅱ模型Ⅲ
P值OR值95%CIP值OR值95%CIP值OR值95%CI
倾向特征
性别女性男性0.0720.790.62~1.020.1520.830.63~1.070.1300.820.63~1.06
常住地乡镇农村0.0010.470.33~0.680.0010.480.326~0.7070.0010.510.34~0.75
县城0.8341.050.66~1.660.8580.960.60~1.540.7661.080.67~1.74
城市0.0011.550.23~1.960.0011.651.24~2.190.0011.811.36~2.42
知晓高血压标准否是0.0010.670.53~0.840.0010.670.53~0.860.0010.670.53~0.86
饮酒否是0.5131.100.82~1.470.5361.100.81~1.490.4161.130.84~1.54
使能资源家庭月均收入/元2 000~4 000<2 0000.2660.860.65~1.130.3680.880.67~1.16
4 001~6 0000.4300.870.60~1.240.4910.880.61~1.26
6 001~8 0000.2890.760.45~1.270.2640.740.44~1.25
>8 0000.0082.661.29~5.470.0062.761.340~5.69
医疗保险类型医疗救助无0.9170.920.18~4.640.8370.840.16~4.35
城乡居民医保0.3791.260.75~2.120.2451.370.81~2.31
城镇职工医保0.2821.390.77~2.510.1621.540.84~2.80
公费医疗0.1985.220.42~64.390.1685.740.48~68.89
社区免费体检否是0.0180.480.27~0.880.0190.490.27~0.89
不清楚0.3280.730.38~1.380.2720.700.36~1.33
社区健康教育否是0.0010.260.16~0.420.0010.270.17~0.44
社区饮食指导否是0.6101.160.65~2.090.7311.110.62~2.00
社区运动指导否是0.5361.160.73~1.850.6251.120.70~1.79
社区药物帮助否是0.1461.320.91~1.910.1001.370.94~1.98
社区血糖等检测否是0.0200.630.43~0.930.0200.630.42~0.93
需求因素生命质量值0.0010.230.10~0.56
–2LL22 126.7002 019.7002 007.700
Cox&Snell R20.0370.1000.106
Ngelkerke R20.0500.1340.142
), ArticleFig(id=1321170810715358142, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170803052364684, language=CN, label=表3, caption=

主动健康多因素分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
类型变量比较组对照组模型Ⅰ模型Ⅱ模型Ⅲ
P值OR值95%CIP值OR值95%CIP值OR值95%CI
倾向特征
性别女性男性0.0720.790.62~1.020.1520.830.63~1.070.1300.820.63~1.06
常住地乡镇农村0.0010.470.33~0.680.0010.480.326~0.7070.0010.510.34~0.75
县城0.8341.050.66~1.660.8580.960.60~1.540.7661.080.67~1.74
城市0.0011.550.23~1.960.0011.651.24~2.190.0011.811.36~2.42
知晓高血压标准否是0.0010.670.53~0.840.0010.670.53~0.860.0010.670.53~0.86
饮酒否是0.5131.100.82~1.470.5361.100.81~1.490.4161.130.84~1.54
使能资源家庭月均收入/元2 000~4 000<2 0000.2660.860.65~1.130.3680.880.67~1.16
4 001~6 0000.4300.870.60~1.240.4910.880.61~1.26
6 001~8 0000.2890.760.45~1.270.2640.740.44~1.25
>8 0000.0082.661.29~5.470.0062.761.340~5.69
医疗保险类型医疗救助无0.9170.920.18~4.640.8370.840.16~4.35
城乡居民医保0.3791.260.75~2.120.2451.370.81~2.31
城镇职工医保0.2821.390.77~2.510.1621.540.84~2.80
公费医疗0.1985.220.42~64.390.1685.740.48~68.89
社区免费体检否是0.0180.480.27~0.880.0190.490.27~0.89
不清楚0.3280.730.38~1.380.2720.700.36~1.33
社区健康教育否是0.0010.260.16~0.420.0010.270.17~0.44
社区饮食指导否是0.6101.160.65~2.090.7311.110.62~2.00
社区运动指导否是0.5361.160.73~1.850.6251.120.70~1.79
社区药物帮助否是0.1461.320.91~1.910.1001.370.94~1.98
社区血糖等检测否是0.0200.630.43~0.930.0200.630.42~0.93
需求因素生命质量值0.0010.230.10~0.56
–2LL22 126.7002 019.7002 007.700
Cox&Snell R20.0370.1000.106
Ngelkerke R20.0500.1340.142
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四川、山东两地居民主动健康参与现状及影响因素
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王运莎 , 周晓媛 *, * , 张昭 , 唐金凤 , 王寓凡
中国公共卫生 | 调查报告与分析 2025,41(8): 971-976
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中国公共卫生 |调查报告与分析 2025 , 41 (8) : 971 -976
四川、山东两地居民主动健康参与现状及影响因素
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王运莎(1998—),硕士在读,研究方向:主动健康,医疗保险,卫生政策

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王运莎, 周晓媛*, * , 张昭, 唐金凤, 王寓凡
作者信息
  • 四川大学华西公共卫生学院/华西第四医院,成都 610041
通讯作者:
周晓媛,E-mail:
作者简介:

王运莎(1998—),硕士在读,研究方向:主动健康,医疗保险,卫生政策

Active health participation and its determinants among community-dwelling adults in two cities in Sichuan and Shandong provinces, China: a cross-sectional study
Yunsha WANG, Xiaoyuan ZHOU , Zhao ZHANG, Jinfeng TANG, Yufan WANG
Affiliations
  • West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu 610041, China
  • Corresponding Author:
    ZHOU Xiaoyuan, E-mail:
出版时间: 2025-08-10 doi: 10.11847/zgggws1145059
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目的

了解居民主动健康参与现状及其影响因素,为提高慢性病管理效果,构建科学、高效、人性化的卫生健康服务体系提供相关政策依据。

方法

于2022年8—10月在山东省济南市、2023年4—5月在四川省内江市对1 598名≥18岁当地常住居民进行调查;以“主动健康的参与情况”作为因变量,根据安德森卫生服务利用行为模型的3个维度确定自变量,利用多因素logistic回归分析主动健康参与的影响因素。

结果

被调查的居民中积极主动健康参与者共905人(56.63%);多因素检验结果表明,常居地(OR=0.51,95%CI=0.34~0.75)、知晓高血压标准(OR=0.67,95%CI=0.53~0.86)、家庭月均收入水平(OR=2.76,95%CI=1.34~0.5.69)、社区有免费体检项目(OR=0.49,95%CI=0.27~0.89)、社区开展健康教育(OR=0.27,95%CI=0.17~0.44)、社区提供血糖血压等检测(OR=0.63,95%CI=0.42~0.93)、个体生命健康值(OR=0.23,95%CI=0.10~0.56)是居民主动健康参与的影响因素。

结论

四川、山东两地居民主动健康参与的意识较弱,主要受文化水平、经济收入、社区健康资源不足、生命质量值等因素的影响,反映了健康意识提升与资源均衡化的迫切需求。

主动健康参与  /  安德森卫生服务利用行为模型  /  多因素logistic回归  /  成年居民
Objective

To investigate active health participation (including health-related self-management and self-empowerment) and its determinants among community-dwelling adults, and to provide evidence for the development of relevant policies and effective chronic disease control and prevention services.

Methods

The data were derived from two surveys conducted among 1 598 community-dwelling adults (aged ≥18 years) recruited through multistage random sampling: the first in Jinan city, Shandong province (August–October 2022), and the second in Neijiang city, Sichuan province (April–May 2023). The surveys used a questionnaire on health knowledge, attitude, and practice (KAP) and health care utilization, the 10-item Kessler Psychological Distress Scale (K10), and the EuroQol-5 Dimensions (EQ-5D). Active health participation was assessed by self-reported health-related self-management and self-empowerment practices. Multiple logistic regression analysis was employed to identify influencing factors, based on the three dimensions of Andersen’s Behavioral Model for healthcare utilization.

Results

Of the 1 598 participants with valid responses, 905 (56.6%) were classified as active health participants. Multiple binary logistic regression analysis showed that place of residence (towns vs. rural, odds ratio [OR] = 0.51, 95%confidence interval [CI]: 0.34–0.75), awareness of hypertension (no vs. yes, OR = 0.67, 95%CI: 0.53–0.86), average monthly household income (> 8 000 vs. < 2 000, OR = 2.76, 95%CI: 1.34–5.69), availability of free health screening programs (no vs. yes, OR = 0.49, 95%CI: 0.27–0.89), community health education programs (no vs. yes, OR = 0.27, 95%CI: 0.17–0.44), community provision of blood glucose and blood pressure testing (no vs. yes, OR = 0.63, 95%CI: 0.42–0.93), and individual EQ-5D score (OR = 0.23, 95%CI: 0.10–0.56) were significantly associated with active health participation.

Conclusions

The awareness of active health participation among community-dwelling adults in Sichuan and Shandong provinces remains relatively low and is primarily influenced by education level, economic income, availability of community health resources, and health-related quality of life. These findings highlight the urgent need to improve health awareness and address regional disparities in resource allocation.

active health participation  /  Andersen′s behavioral model for healthcare utilization  /  multiple logistic regression  /  adult residents
王运莎, 周晓媛, 张昭, 唐金凤, 王寓凡. 四川、山东两地居民主动健康参与现状及影响因素. 中国公共卫生, 2025 , 41 (8) : 971 -976 . DOI: 10.11847/zgggws1145059
Yunsha WANG, Xiaoyuan ZHOU, Zhao ZHANG, Jinfeng TANG, Yufan WANG. Active health participation and its determinants among community-dwelling adults in two cities in Sichuan and Shandong provinces, China: a cross-sectional study[J]. Chinese Journal of Public Health, 2025 , 41 (8) : 971 -976 . DOI: 10.11847/zgggws1145059
随着居民疾病谱的改变,慢性非传染性疾病已成为影响居民健康的主要疾病[1]。有研究表明,生活行为中的不良行为习惯占据慢病主导因素的75%[2]。而现阶段国际公认的慢性病管理目标在于预防疾病,强调自我管理、全人群参与[1–4]。为应对不断增长的慢性病管理需求,国家先后颁布《“健康中国2030”规划纲要》《“十四五”国民健康规划》,明确提出树立个人健康责任,将“被动健康”理念转为“主动健康”理念。主动健康是我国多领域专家围绕慢病治疗的主动干预问题联合提出的本土化概念[5]。与健康责任人不明晰的健康管理不同,主动健康涵盖主动、预防、干预和参与四类特征[6],核心强调个人的“主观能动性”,以防病治病为目的,个体主动选择并接受现代健康理念和新医学模式,获取健康信息及实施有利于健康的行为[7–11]。可见,主动健康涉及“健康管理+健康责任人”两方面。自2015年科技部首次提出“主动健康”起,学者们从多视角多维度对主动健康进行了有益的探讨和研究,但当前对于我国居民主动健康参与行为现状及其潜在影响因素的相关研究仍较少。基于此,本研究将积极主动健康参与定义为“进行健康管理并承担健康责任人责任”,消极主动健康参与定义为“不进行健康管理或不承担健康责任人责任”,以医疗卫生服务研究领域的安德森卫生服务利用行为模型(以下简称安德森模型)为理论基础,利用实地现场调查数据分析居民主动健康参与现状及其可能的影响因素,为有效激发居民主动参与健康管理的积极性,构建科学、高效、人性化的卫生健康服务体系提供相关政策依据。
本研究利用“主动健康和老龄化科技应对”专项“健康管理综合服务应用示范”项目组调查数据。于2022年8—10月在山东省济南市、2023年4—5月在四川省内江市对1 629名居民进行多阶段随机整群抽样调查,调查内容包括个人基本信息、健康知识知晓情况、健康相关行为情况、健康管理服务利用情况、K10 (10-item Kessler Psychological Distress Scale)量表、EQ-5D (EuroQol-5 Dimensions)量表等。调查前对相关人员进行培训,调查后对收集数据仔细核查,确保数据准确性。最终排除缺失、逻辑错误数据,纳入1 598名研究对象。此次调查对象的纳入标准:年满18岁的山东省、四川省两地常住居民;具备客观判断能力;对本研究知情同意并自愿参与问卷调查。调查对象排除标准:存在认知、精神障碍;不愿意参与调查的常住居民。项目通过了华中科技大学同济学院医学伦理委员会伦理审查(审查批准号:2023S065),所有被调查对象均已签署知情同意书。
安德森模型是目前医疗卫生服务研究的权威模型,其理论架构被认为是各种卫生服务利用行为模型中最完整的,国内医疗卫生领域学者也逐渐利用安德森模型指导实证分析。该模型将影响个体卫生服务利用的因素归为倾向特征、使能资源、需求资源3类[12]。本研究以安德森模型为理论框架,将主动健康参与情况作为结果变量,并依据研究目的选取相关因素作为控制变量[13],其中,性别、年龄、常居地、吸烟、饮酒、婚姻状况、教育程度、健康管理、所在省市、知晓血压标准、知晓空腹血糖标准作为倾向特征;家庭月均收入、医疗保险类型、是否有商业保险、社区提供的资源(免费体检、健康教育、饮食指导、运动指导、药物帮助、血糖血压等检测)作为使能资源;是否具有慢病、生命质量、心理健康作为需求资源。最后,通过居民主动健康参与情况进行调查,分析其主动健康参与现状及其影响因素。
利用Excel 2019进行数据整理,SPSS 25.0进行数据分析。统计描述和分析中,计数资料用频数和构成比表示,各组之间的比较用χ2检验;计量资料用$ \overline{x}\pm s $表示,数据差异的比较用方差检验;采用二分类logistic回归进行影响因素分析,将倾向特征、使能资源、需求因素作为控制变量,分别构建模型Ⅰ、模型Ⅱ、模型Ⅲ。检验水准$ {\mathrm{\alpha }}_{\mathrm{入}}=0.05,{\mathrm{\alpha }}_{\mathrm{出}}=0.1 $。
本研究共纳入了1 598名调查对象,其中山东省济南市占53.50%(855人),四川省内江市占46.50%(743人)。男性占比36.11%(577人),女性占比63.89%(1 021人),年龄主要为>50岁人群(93.18%,1 489人)。大部分居民的健康认知较低,其中有72.09%(1 152人)不知晓高血压标准,74.34%(1 188人)不知晓空腹血糖标准。生活习惯中,不吸烟者占比82.98%(1 326人),不饮酒者占比77.10%(1 232人)。在社区服务方面,大部分社区提供免费体检(93.55%,1 495人)、开展健康教育(82.04%,1 311人)、提供饮食指导(80.66%,1 289人)、运动指导(77.41%,1 237人)、药物帮助(81.60%,1304人)以及血糖、血压等检测(86.11%,1 376人)。调查对象中患慢性病者居多占60.64%(969人),生命质量平均值为0.926±0.135,心理测量总分平均值为(15.905±5.818)分。
积极主动健康参与者905人(56.63%),消极主动健康参与者693人(43.37%)。结果显示,倾向特征中性别(P=0.008)、常居地(P=0.001)、饮酒(P=0.045)3个变量差异有统计学意义;使能资源中家庭月均收入(P=0.004)、医保类型(P=0.008)、社区有免费体检项目(P=0.001)、社区开展健康教育(P=0.001)、社区提供饮食指导(P=0.001)、社区提供运动指导(P=0.001)、社区提供药物帮助(P=0.001)、社区提供血糖血压(P=0.001)等检测8个变量差异具有统计学意义;需求因素中仅生命质量值1个变量差异具有统计学意义。
以“主动健康参与情况”(消极=0,积极=1)作为因变量,以单因素分析中有统计学意义的12变量作为自变量,逐个纳入多因素logistic回归分析。结果显示,3个模型的–2 LL值逐渐缩小,而Cox&Snell R2值与Nagelkerke R2值逐渐增大,说明模型解释能力不断增强,模型Ⅲ的拟合优度最好,因此主要对模型Ⅲ进行分析。从模型Ⅲ中可以看出,常居地、知晓高血压标准、家庭月均收入、社区体检项目、社区健康教育、社区血糖血压等检测、个体生命健康值7个变量影响居民的主动健康参与。由Cox&Snell R2值与Nagelkerke R2值显示,模型Ⅰ在加入使能资源后,对于模型Ⅱ因变量的解释效率最高,而在模型Ⅱ基础上再加入需求因素后,解释度上升幅度较小。因此,倾向特征影响显著,使能资源影响最大,需求因素影响最小。
本次调查结果显示,仅有56.63%的被调查者积极主动健康参与,说明被调查居民普遍缺乏主动健康的意识,与张倩倩居民主动健康认识不足的结论类似[14]。被调查者的文化水平与经济收入等因素,可能限制其对主动健康相关知识的认知,进而影响了健康管理的积极性。这一解释与居民健康素养[15]和资源公平性[16]等类似观点不谋而合。因此,为满足慢性病管理需求及全民健康目标,政府及卫生机构需紧密合作协同努力,采取丰富的情景化方式宣讲主动健康政策,并利用抖音、小视频等公众喜爱的途径创新宣传,推动健康信息的有效传播。同时,居民应树立健康责任人意识,培养健康生活方式[17]。
倾向特征对被调查居民的主动健康参与情况影响显著。常住地类型与居民主动健康参与之间存在显著关联,相较于农村居民的主动健康参与,乡镇居民参与意识较弱(OR=0.51,95%CI=0.34~0.75),城市的居民健康意识较强(OR=1.81,95%CI=1.37~2.42)。这一差异可能归因于城市地区等拥有更为丰富的医疗资源,使得居民更易获取医疗服务和健康咨询,更倾向于关注自身健康状况,侧面说明卫生资源的不平衡,与于宏博等[18]研究结论类似。对此蔡永龙等[19]、陶卓霖等[20]学者建议应合理配置城乡间的卫生资源。此外。是否了解高血压标准与主动健康参与密切相关,不了解高血压标准的居民主动健康参与意识较弱(OR=0.67,95%CI=0.53~0.86),从而不了解高血压对健康的危害性,与欧光忠等[21]健康素养水平低,健康管理能力差结论相似,对此赵运昇等人[22]的研究提示应加强相关高血压的认识,提升自身健康状况。综上所述,大多数山东、四川两地居民健康素养水平较低。郭泰鼎等学者[23]发现中国居民具备高素养水平的人群不足30%,即普遍处于中低水平。因此,应加强慢性病、传染病等基本知识的普及,让居民树立正确健康观念,培养良好健康习惯。
使能资源对居民主动健康参与具有显著促进作用。本研究发现,家庭月均收入>8 000元的居民,其主动健康参与积极性是月均收入低于2 000元群体的2.76倍(OR=2.76,95%CI=1.340~5.59),表明高收入群体更有能力获取主动健康相关服务,与薛晓丹等[24]高收入人群拥有更多的经济资源进行健康相关行为的结论类似。值得注意的是,调查样本中低收入群体(月均收入<2 000元)占比达53.94%,而高收入群体(月均收入>8 000元)仅占3.57%,这一人口分布特征凸显研究地区居民整体收入水平偏低。周王艳等[25]研究证明低收入人群面临较多的健康问题,这可能使得主动健康促进策略的推行受到居民经济收入这一现实问题的制约。此外,社区免费体检项目(OR=0.49,95%CI=0.27~0.89)、社区健康教育(OR=0.27,95%CI=0.17~0.44)以及社区血糖血压等检测服务(OR=0.49,95%CI=0.27~0.89)等使能资源的缺失对居民的主动健康参与情况产生一定的负向影响,健康服务资源的缺失或不足可能限制了居民获取健康信息和享受健康服务的渠道,进而削弱了他们的主动健康参与意识,殷一鸣等[26]研究也表明区健康资源的空间可达性对居民健康行为产生影响。
需求因素对居民主动健康参与情况的影响较弱。仅生命质量值与主动健康参与具有统计学意义。生命质量值(分数值介于–0.11~1.00)能够较好地反映居民个体的身体健康情况[27],调研对象的总体生命质量分值较高(0.926±0.135),与田明政等[17]研究结论相似。但生命质量值与主动健康参与存在负相关关系(OR=0.23,95%CI=0.10~0.56),结论与廖雁鸣等[28]健康行为与生命质量的关系的结论不一致,这可能是因为生命质量值较高的居民可能较少面临健康相关问题,对自身身体的评价更积极,故而对主动健康的态度较为消极。
本研究通过多维度分析框架揭示收入、地域、健康认知对主动健康参与的复合影响,为健康政策提供实证依据。此外,如何让全体居民不仅仅是患病居民都积极参与主动健康是下一步值得研究的问题。不过横断面设计难以推断因果关系,高收入群体样本量偏少(3.57%)可能影响统计效力,研究结论受限于两省区域特征,缺乏全国普适性的验证。

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doi: 10.11847/zgggws1145059
  • 接收时间:2024-07-17
  • 首发时间:2026-10-25
  • 出版时间:2025-08-10
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  • 收稿日期:2024-07-17
  • 修回日期:2024-08-29
  • 录用日期:2025-05-10
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    四川大学华西公共卫生学院/华西第四医院,成都 610041

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2种不同金属材料的力学参数
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species
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Percentage of
total species (%)
属
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species
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Percentage of total
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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
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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