To describe the epidemiological characteristics of recurrent cases of hand, foot, and mouth disease (HFMD) in Yunnan province from 2008 to 2022 to inform the development of prevention and control strategies.

Records of HFMD cases diagnosed by various medical institutions in Yunnan province between May 8, 2008, and December 31, 2022, were collected via the Chinese Center for Disease Control and Prevention's Infectious Disease Information Reporting Management System. After cleaning and verifying the data, a database of recurrent HFMD cases was created. Then, we analyzed the temporal, regional, demographic, and pathogen distributions of the cases.

A total of 899 455 HFMD cases were registered during the study period, including 54 138 recurrent cases (cumulative recurrence rate: 6.02%). Of these recurrent cases, 97.84% involved two episodes, with a male-to-female ratio of 1.61:1. The median age was 3.74 years for cases involving two episodes and 4.43 years for cases involving three episodes. The peak season occurred from May to July. Second episodes were prevalent in 15 counties and districts, while third episodes were concentrated in Kunming′s urban area. Most recurrences involved different pathogens; only 4.97% of cases involved two consecutive infections of the same pathogen. Patients with severe symptoms in the first episode were at an increased risk of recurrent HFMD compared to patients without severe symptoms (relative risk = 1.80, 95% confidence interval: 1.71 - 1.91).

The HFMD recurrence rate in Yunnan province was high and increased over time, exhibiting distinct temporal, demographic, and regional patterns. Improving pathogen surveillance is crucial for developing multivalent vaccines, and targeted measures should focus on severe cases and high-incidence areas.

To investigate the residual paralysis in acute flaccid paralysis (AFP) cases and its influencing factors in Jiangxi province from 2012 to 2023, and to provide a reference for the development of strategies to reduce residual paralysis.

Data on 2118 AFP cases reported in Jiangxi province from January 1, 2012, to December 31, 2023, were collected from the Chinese Center for Disease Control and Prevention Information System. The residual paralysis status and its influencing factors were analyzed.

Among the 2118 AFP cases reported in Jiangxi province from 2012 to 2023, 338 cases had residual paralysis, with a residual paralysis rate of 15.96%. Multivariable unconditional logistic regression analysis showed that female sex, an interval of ≥ 3 days from onset to medical visit, a positive non-polio enterovirus or poliovirus isolation culture result, the presence of nuchal rigidity, the presence of limb sensory disturbance, the presence of urinary or fecal incontinence, and abnormal deep tendon reflexes were risk factors for residual paralysis in AFP cases in Jiangxi province. Age ≥ 1 years old, student status, having received ≥ 3 doses of polio vaccine, the presence of diarrhea, and the presence of muscle pain were protective factors against residual paralysis in AFP cases in Jiangxi province.

The incidence of residual paralysis in AFP cases in Jiangxi province from 2012 to 2023 was relatively high. Sex, age, population type, number of polio vaccine doses received, interval from onset to medical visit, enterovirus isolation culture results, and the presence or absence of diarrhea, nuchal rigidity, muscle pain, limb sensory disturbance, urinary or fecal incontinence, and abnormal deep tendon reflexes were the main influencing factors for residual paralysis in AFP cases in this region.

To analyze the transmissibility of varicella in Ningbo city from 2020 to 2023 and provide a reference for establishing herd immunity targets for varicella vaccination.

A retrospective analysis of varicella outbreak cases in Ningbo city from 2020 to 2023 that met the research criteria was conducted. Based on multiple outbreaks in Ningbo city, parameters required for the model were provided using data calculation or curve fitting methods. Important epidemic parameters such as attack rate, incubation period (Te), serial interval (Tg), basic reproduction number (R₀), and time-varying reproduction number (R_t) were calculated.

From 2020 to 2023, the annual varicella attack rate in Ningbo city showed a wave-like upward trend, with a total of 17 reported public health emergencies of varicella, all of which were school outbreaks. The outbreaks mainly occurred from October to January of the following year, exhibiting seasonality. The exposed population was 43 503, with 414 reported cases, resulting in a total attack rate of 0.952%. The median incubation period of varicella was 12.39 (95%CI: 11.83 - 12.94) days, and the average serial interval was 14.05 (95%CI: 12.75 - 15.35) days. The R₀ value was 3.74 ± 0.73, and the changing trend of R_t indicated that the spread of varicella in Ningbo city basically showed a trend of extinction around the 30th day.

The prevention and control measures for varicella outbreaks in Ningbo city are effective, with the overall epidemic trending towards extinction, and the control effect becoming prominent in the third generation of cases. Prevention and control should be strengthened to further establish herd immunity to reduce the peak of the epidemic and shorten its duration.

To establish a whole-genome sequencing (WGS) workflow and molecular tracing method for monkeypox virus (MpxV) based on amplicon sequencing technology combined with a high-throughput sequencing platform and bioinformatics analysis techniques, providing technical support for molecular epidemiological research of monkeypox cases in Dalian city.

By taking total nucleic acid extracted from vesicle fluid samples of monkeypox cases as templates, a cDNA library was constructed on the Ion Torrent sequencing platform via WGS technology. Template preparation and sequencing were completed. Using the built-in plug-ins of Ion GeneStudio S5 Plus and NC063383.1 as the reference sequence, data quality control, base identification, sequence alignment, variant analysis, and whole-genome sequence assembly were performed to obtain consensus sequences (Fasta files). Online analysis tools were used to analyze the whole-genome characteristics, genotyping, and genetic evolutionary relationships of MpxV.

The cycle threshold (Ct) values of MpxV nucleic acid detection in vesicle fluid samples from the two patients were 28.03 and 29.60, respectively. The consensus sequence obtained from sample 1 was a 197 084 bp MpxV whole-genome sequence with a total of 3 470 722 reads, an average sequencing depth of 3 205, an average read length of 182 bp, and approximately 98.8% coverage. The consensus sequence obtained from sample 2 was a 197 099 bp MpxV whole-genome sequence with a total of 1 440 296 reads, an average sequencing depth of 746.7, an average read length of 105 bp, and approximately 97.8% coverage. Sample 1 had 84 single nucleotide mutations and 40 amino acid mutations, while sample 2 had 85 single nucleotide mutations and 42 amino acid mutations. Both samples belonged to the C.1.1 sub-branch of the MpxV IIb clade (West African clade). hMpxV/China/ DLCDC-01 was closely related to the sequences EPI_ISL18213375, EPI_ISL19058867, EPI_ISL18213374, EPI_ISL19058866, and EPI_ISL19058873 submitted from Guangdong province, China, and EPIISL_18059184 submitted from Yunnan province, China. hMpxV/China/DLCDC-02 was not homologous to hMpxV/China/DLCDC-01 or the 20 valid sequences from China uploaded to GISAID.

Consensus sequences of MpxV were obtained from vesicle fluid samples of two patients, successfully establishing WGS technology, bioinformatics analysis, and molecular tracing methods for MpxV in Dalian city.

To evaluate the effectiveness of control measures for a tuberculosis (TB) outbreak in a school setting by using a dynamic transmission model.

We developed a dynamic transmission model to simulate a TB outbreak in a school in Wuxi, Jiangsu province. We calibrated the model based on the observed progression of the outbreak and used it to compare the effectiveness of different control measures.

Using actual case data, we minimized the sum of squared errors (SSE) at a transmission rate coefficient (β) of 0.129. The basic reproduction number (R₀) for this outbreak was estimated to be 10.95. Without intervention, simulations projected that the outbreak would last 24 months, resulting in 35 cumulative cases and a 70% attack rate. With case isolation alone, the outbreak duration decreased to 11 months, yielding 13 cumulative cases and a 26% attack rate. Combining case isolation with preventive therapy for latent tuberculosis infection (LTBI) reduced the outbreak duration to six months, resulting in five cumulative cases and a 10% attack rate.

Dynamic transmission models are useful for evaluating the effectiveness of control measures during TB outbreaks in schools. Targeted preventive therapy for LTBI is highly effective in rapidly containing TB transmission in schools.

To systematically evaluate the current status, strengths, and weaknesses of the high-quality development of China’s public health system, and to propose targeted suggestions for improving the system, providing a basis for promoting the high-quality development of health undertakings.

Policy documents, information reports, and research literature related to public health were collected and analyzed from 34 provincial-level administrative regions. Based on appropriate public health system evaluation criteria, the current status and development trends of high-quality public health systems in various regions were assessed. Strengths and weaknesses of the system were identified through standardized gap analysis.

In 2023, the average score of China′s public health system was 657.26, reaching a moderately suitable level overall. From 2018 to 2023, the average score of the public health system increased by 11.49%, with progress made in areas such as health-priority environments, health literacy levels, organizational systems, monitoring capabilities, and joint prevention and control mechanisms. However, problems still exist, such as unbalanced regional development, a weak atmosphere of prevention-oriented approaches, inadequate staffing, unstable investment mechanisms, and weak scientific research innovation and translational application capabilities.

China′s public health system is improving year by year, but there are still many problems that need to be addressed urgently. In the future, clarifying the public health responsibilities and division of tasks among various departments should be the breakthrough point. It is recommended to establish a public health joint prevention and control working committee (or mechanism) at all levels of Party committees or governments to define the public health responsibilities and division of tasks of various departments, mobilize all parties to work together for improvement, and effectively promote the continuous development and improvement of China′s public health system.

To analyze the staffing levels and personnel structure of elderly care institutions in China from 2014 to 2022, assess their equity and spatial distribution, and provide recommendations for optimizing the allocation of human resources in these institutions.

Panel data on employees in elderly care institutions from 31 provinces in China were collected. Changes in the proportion of male and female employees, the proportion of professional and technical personnel, and the proportion of employees aged 65 and older were calculated for each province from 2014 to 2022. The Theil index and Dagum Gini coefficient, weighted by the elderly population, were used to assess trends in equity and their decomposition effects. Global and local Moran′s I were employed to calculate the spatial clustering of human resources in elderly care institutions across China.

The total number of human resources in elderly care institutions increased by 68.92%, but the number of staff per thousand elderly people showed a negative growth trend. In 2022, the proportion of employees with a bachelor′s degree or above was 8.42%, the proportion of professional and technical personnel was 75.23%, the proportion of employees aged 56 and older was 20.45%, and the proportion of female employees was 62.36%. The regional equity of human resource allocation in elderly care institutions improved, with the overall Theil index decreasing from 0.11 in 2014 to 0.05 in 2022, and the Dagum Gini coefficient decreasing from 0.41 in 2014 to 0.39 in 2022. Spatial autocorrelation analysis revealed a positive spatial clustering trend for human resources in elderly care institutions. The global Moran′s I increased from 0.273 in 2014 to 0.390 in 2022 (P < 0.01 for each year). Local Moran′s I scatter plots showed "high-high" and "low-low" clustering patterns among regions.

The total human resources in China′s elderly care institutions lag behind the growth of the elderly population. While equity has improved, there is a trend of positive spatial clustering. Future efforts should focus on both expanding capacity and improving quality, increasing the proportion of highly qualified and skilled personnel, and promoting inter-regional mobility of human resources in elderly care institutions.

To assess mental health literacy and its determinants among adults in Shandong province and provide a basis for the development of targeted mental health services.

From November to December 2023, a combined online and on-site face-to-face survey was conducted among 10 533 residents aged 18 years and older recruited from 39 districts/counties/cities in Shandong province using stratified multistage random sampling. A general questionnaire, the National Mental Health Literacy Questionnaire (NMHLQ) developed by the Institute of Psychology, Chinese Academy of Sciences, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Insomnia Severity Index (ISI) were used in the study.

Of 10 489 participants with valid responses, 12.51% were assessed as having adequate mental health literacy, with 15.47%, 99.05%, and 48.87% of participants having adequate mental health knowledge, mental health skills and awareness, and the ability to identify and manage common mental disorders, respectively. Chi-squared test results showed statistically significant differences in the proportion of adults with adequate mental health literacy across regions, gender, age, marital status, education, occupation, monthly household income, smoking, chronic disease status, anxiety, and depression Logistic regression analysis showed that female gender (odds ratio [OR] = 0.791, 95% confidence interval [95%CI]: 0.385 - 0.912), junior high school education (OR = 0.703, 95%CI: 0.576 - 0. 859), high school/vocational/technical education (OR = 0.743, 95%CI: 0.578 - 0.955), college degree or higher (OR = 0.594, 95%CI: 0.458 - 0.770), administrative/professional/technical occupation (OR = 0. 552, 95%CI: 0.442 - 0.689), other occupation (OR = 0.802, 95%CI: 0.663 - 0.968), monthly household income of 3 000 - 5 999 RMB yuan (OR = 0.630, 95%CI: 0.520 - 0.762), monthly household income of 6 000 - 9 999 RMB yuan (OR = 0.607, 95%CI: 0.494 - 0.746), and with fair/poor self-rated health (OR = 0.726, 95%CI: 0.612 - 0.860) were negatively associated with inadequate mental health literacy. Living in eastern Shandong province (OR = 1.190, 95%CI: 1.043 - 1.359), western Shandong province (OR = 1.483, 95%CI: 1.237 - 1.779), being married (OR = 1.363, 95%CI: 1.059 - 1.756), having other marital statuses (OR = 1.816, 95%CI: 1.112 - 2.964), having mild anxiety (OR = 1.408, 95%CI: 1.110 - 1.786), having moderate to severe anxiety (OR = 2.283, 95%CI: 1.183 - 4.408), having mild depression (OR = 1.443, 95%CI: 1.160 - 1.794), and having moderate to severe depression (OR = 1.819, 95%CI: 1.162 - 2.848) were positively associated with inadequate mental health literacy.

Mental health literacy among adult residents in Shandong province is at a relatively low level. Demographic characteristics such as place of residence, gender and marital status, and anxiety and depression status are influencing factors. Mental health services should focus on people with low levels of education, low income, and those with anxiety or depression.

To examine the temporal trends in the burden of CIrrhosis among residents of Guangdong province from 1990 to 2019, thereby providing data support and evidence for the development of targeted prevention strategies and effective intervention measures for CIrrhosis.

Data on the burden of CIrrhosis among residents of Guangdong province from 1990 to 2019 were obtained from the 2019 Global Burden of Disease (GBD 2019) study. The age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), age-standardized disability- adjusted life years (DALY) rate, and estimated annual percentage change (EAPC) were calculated to analyze trends in the burden of CIrrhosis and its five etiologies over the study period. EAPC, a measure of the average annual rate of change, was used to assess trends over time.

The ASPR, ASMR, and age-standardized DALY rate of CIrrhosis (all per 100 000 population) among residents decreased from 28 849.8, 21.7, and 637.5 in 1990 to 23 440.3, 6.2, and 173.9 in 2019, with EAPCs of -0.88% (95%CI confidence interval [95%CI]: -1.13% to -0.63%), -4.65% (95%CI: -5.20% to -4.10%), and -4.80% (95%CI: -5.34% to -4.25%), respectively, showing a decreasing trend over the period. The ASPR, ASMR, and age-standardized DALY rate of CIrrhosis attributable to viral hepatitis B and C decreased from 14 094.1 and 2 217.4, 8.2 and 5.4, and 242.4 and 163.6, respectively, in 1990 to 7 450.2 and 1 074.6, 1.7 and 1.9, and 47.6 and 53.8, respectively, in 2019, with EAPCs of -2.39% (95%CI: -2.55% to -2.23%) and -3.39% (95%CI: -4.56% to -2.20%), -5.77% (95%CI: -6.62% to -4.91%) and -3.97% (95%CI: -4.43% to -3.51%), and -5.84% (95%CI: -6.66% to -5.01%) and -4.13% (95%CI: -4.58% to -3.68%), respectively, showing a decreasing trend over the period. For CIrrhosis attributable to nonalcoholic fatty liver disease, the ASPR increased from 12 318.3 in 1990 to 14 709.2 in 2019, with an EAPC of 0.57% (95%CI: 0.20% to 0.95%), while both the ASMR and the age-standardized DALY rate decreased from 1.7 and 42.9 in 1990 to 0.6 and 14.1 in 2019, respectively, with EAPCs of -4.04% (95%CI: -4.44% to -3.63%) and -4.27% (95%CI: -4.67% to -3.89%). For CIrrhosis attributable to alcohol-related liver disease, the ASPR increased slightly from 111.4 in 1990 to 114.9 in 2019, but the difference was not statistically significant, with an EAPC of 0.12% (95%CI: -0.09% to 0.33%); the ASMR and the age-standardized DALY rate decreased from 3.6 and 106.8 in 1990 to 1.2 and 34.7 in 2019, respectively, both showing decreasing trends, with EAPCs of -4.09% (95%CI: -4.53% to -3.65%) and -4.22% (95%CI: -4.65% to -3.79%), respectively. For cirrhosis caused by other causes, The ASPR, ASMR and age-standardized DALY rate among residents decreased from 108.7, 2.8 and 81.7 in 1990 to 91.4, 0.9 and 23.8 in 2019, with EAPCs of -0.74% (95%CI: -0.93 % to -0.55 %), -4.44% ( 95%CI: -4.85 to -4.03), and -4.69% (95%CI: -5.10 to -4.29). The ASPR, ASMR, and age-standardized DALY rate of CIrrhosis for male residents were all higher than those for female residents in both 1990 and 2019. From 1990 to 2019, the ASMR and age-standardized DALY rate of CIrrhosis showed a decreasing trend for both male and female residents. In terms of age group, the prevalence, mortality, and DALY rate of CIrrhosis all increased with age, but the prevalence of CIrrhosis decreased in residents younger than 30 years, while the mortality and DALY rate decreased across all age groups.

The overall burden of CIrrhosis among residents of Guangdong province showed a significant decreasing trend from 1990 to 2019, while the ASPR of CIrrhosis caused by nonalcoholic fatty liver disease exhibited a notable increase. Men and the elderly remained high-risk groups with a disproportionately higher burden of CIrrhosis.

To investigate the relationship between resting heart rate (RHR) and metabolic syndrome (MS) in middle-aged and elderly individuals residing in plateau regions, and to provide new scientific evidence for elucidating the influence of RHR on the mechanism of MS.

From June 2021 to December 2022, a multi-stage stratified cluster sampling method was employed to select 6 269 middle-aged and elderly individuals in Xizang Autonomous Region. Based on the quartile distribution of RHR, the participants were divided into four groups: Q1 (RHR < 66.5 beats/min), Q2 (66.5 ≤ RHR ≤ 73.0 beats/min), Q3 (73.1 ≤ RHR ≤ 80.5 beats/min), and Q4 (RHR > 80.5 beats/min). Unconditional logistic regression analysis was used to explore the potential association between RHR and MS.

The overall prevalence of MS among the 6 269 middle-aged and elderly individuals was 22.35%. The prevalence varied across different RHR groups: 17.12% in Q1, 20.24% in Q2, 22.77% in Q3, and 29.48% in Q4, with statistically significant differences (χ² = 74.934, P < 0.001). After adjusting for sex, age, alcohol consumption, and body mass index (BMI), compared with the RHR < 66.5 beats/min group, the risk of MS was significantly elevated in the 73.1 ≤ RHR ≤ 80.5 beats/min group (OR = 1.371, 95%CI: 1.121 - 1.678) and substantially increased in the RHR > 80.5 beats/min group (OR = 2.027, 95%CI: 1.672 - 2.482). Stratified analysis by sex and age revealed that in males, the risk of MS increased by 37.0% (OR = 1.370, 95%CI: 1.024 - 1.832) and 137.9% (OR = 2.379, 95%CI: 1.803 - 3.139) in the 73.1 ≤ RHR ≤ 80.5 beats/min and RHR > 80.5 beats/min groups, respectively. In females, the corresponding risks increased by 36.6% (OR = 1.366, 95%CI: 1.030 - 1.810) and 76.4% (OR = 1.764, 95%CI:1.328 - 2.343), respectively. When RHR > 80.5 beats/min, the risk of MS was significantly elevated in all age groups except for the 70 - 75 age group, with the highest risk observed in the 40 - 49 age group (OR = 2.777, 95%CI: 1.922 - 4.010).

An RHR > 80.5 beats/min significantly increases the risk of MS in middle-aged and elderly individuals in plateau regions, with higher risks observed in males and individuals aged 40 - 49. RHR may be an important predictor of MS, and further investigation into its influence mechanisms in different populations is warranted.

To understand the changes in human resources of disease prevention and control (hereinafter referred to as CDC) institutions in Shenzhen city from 2019 to 2023, and to provide a scientific basis for optimizing human resource allocation.

Human resource data of Shenzhen city and district CDC institutions from 2019 to 2023 were collected through questionnaires. The current status and trends of authorized staff size, on-the-job staff number, position distribution, personnel identity, age, working years, education level, and professional titles were analyzed.

In 2023, the authorized staff sizes of city, city-level, and district-level CDC institutions were 975, 264 and 711, respectively, representing increases of 9.30%, 13.79%, and 7.73% compared to 2019. The on-the-job staff numbers were 1 560, 348 and 1 212, respectively, representing increases of 13.37%, 12.26%, and 13.69% compared to 2019. The proportion of professional and technical personnel was > 85% in all institutions. In 2023, the proportion of authorized staff in CDC institutions at all levels in the city ranged from 52.23% to 66.95%, a decrease of 5.65 to 7.57 percentage points compared to 2019, showing a "diversified" characteristic in employment methods. From 2019 to 2023, the age distribution of CDC institutions at all levels in the city presented a "spindle" shape, with a large middle and small ends. The age group with the highest proportion shifted from 35 - 44 years old to 25 - 34 years old. The proportion of staff with a bachelor′s degree or above increased by 2.95 to 5.33 percentage points, while the proportion with a sub-senior professional title or above decreased by 1.45 to 3.96 percentage points, and the overall working years slightly decreased. In 2023, the staff of city and district-level CDC institutions were mainly characterized by a bachelor′s degree (57.05%, 62.46%), junior and intermediate professional titles (50.96%, 55.94%), and 10 - 19 years of working experience (27.95%, 29.95%). The staff of city-level CDC was mainly characterized by a master′s degree or above (50.86%) and a sub-senior professional title or above (42.81%).

From 2019 to 2023, the total number of staff in Shenzhen city CDC institutions increased significantly, with a reasonable proportion of professional and technical personnel and a clear trend toward younger age and higher education levels. However, there are still problems such as insufficient total staffing, a high proportion of non-authorized staff, an unbalanced professional title structure, and difficulties in attracting high-level talents, which require further strengthening.

To construct a public health risk assessment index system for sudden water pollution incidents to provide a reference tool for conducting public health risk assessments of such incidents.

An initial index list was established through literature review and group discussions. A two-round Delphi expert consultation method was employed to evaluate and screen the indicators, and a comprehensive integration empowerment method was used to calculate indicator weights.

The expert positive coefficients for the two rounds of consultation were 83.33% and 100.00%, respectively, and the authority coefficients were (0.79 ± 0.11) and (0.82 ± 0.08), respectively. The overall Kendall′s W values were 0.250 and 0.460 (both P < 0.001). Finally, 4 first-level indicators, 17 second-level indicators, and 66 third-level indicators were established. The top three third-level indicators by weight were the speed of emergency resource allocation (0.049 9), regular monitoring of drinking water quality by the jurisdictional water quality supervision department with monitoring items covering the conventional indicators listed in GB 5749 - 2022 (0.044 4), and the professional and technical level of emergency personnel (0.039 1).

The constructed public health risk assessment index system for sudden water pollution incidents provides a reference for the health emergency response to water pollution incidents.

To understand the intention and behavior of rural residents in Changzhou city, Jiangsu province, to improve their health literacy and its influencing factors, so as to provide a reference for improving the health literacy level of rural residents in this area.

From May to June 2024, a multi-stage random sampling method was used to select 605 rural residents in Wujin district and Jintan district of Changzhou city for a questionnaire survey, and 27 rural residents were randomly selected for in-depth interviews. Based on the theory of planned behavior (TPB), a mixed quantitative and qualitative methodology was used to analyze the intention and behavior of rural residents in Changzhou city to improve their health literacy and its influencing factors.

The average scores of health literacy self-improvement intention and behavior of 605 rural residents in Changzhou city who participated in the questionnaire survey were (14.75 ± 2.81) and (23.99 ± 7.03), respectively. The average scores of behavioral attitude, subjective norms, and perceived behavioral control in TPB theory were (11.97 ± 2.41), (11.34 ± 2.35), and (16.38 ± 2.17), respectively. The results of structural equation model analysis showed that perceived behavioral control had a positive impact on both the intention (β = 0.68, P < 0.001) and behavior (β = 0.17, P = 0.001) of rural residents to improve their health literacy. Gender moderated the path from perceived behavioral control to health literacy self-improvement intention (diff β = 0.02, P = 0.002) and behavior (diff β = 0.04, P = 0.021). Personal annual income also moderated the path from perceived behavioral control to health literacy self-improvement intention (diff β = 0.15, P = 0.001) and behavior (diff β = 0.19, P < 0.001). Among the 27 rural residents in Changzhou city who participated in the interviews, 25 (92.6%) believed that improving health literacy was very important and that it was necessary to learn health knowledge and skills, but only 8 (29.6%) were willing to take actions to improve their health literacy. 16 (59.3%) said that they would only pay attention to health knowledge and skills that were helpful for the prevention and control of their own diseases due to their own health needs and rarely communicated with their family and friends. 10 (37.0%) said that although they were willing to consult doctors to improve their health literacy, the help they received from village doctors was limited. 13 (48.1%) said that they would look for opportunities to learn if there were suitable and convenient ways to improve their health literacy. 20 (74.1%) said that online methods were more convenient and that they were able and willing to search for health information online.

Perceived behavioral control has a positive impact on the intention and behavior of health literacy self-improvement, and there are differences between different genders and personal annual incomes. Rural residents in Changzhou city generally believe that health literacy is important, but they have not yet formed the motivation to learn health-related knowledge and skills.