Preamble

Community Residents' Health Behavior Survey and Optimization Based on the Behavior Change Wheel Theory

Abstract

Objective: To investigate the current status of health behaviors among community residents based on the Behavior Change Wheel (BCW) theory and to explore optimization strategies for health interventions.

Methods: Using a multi-stage stratified sampling method, a survey was conducted among residents in representative communities. The survey instrument was designed based on the COM-B (Capability, Opportunity, Motivation - Behavior) model within the BCW framework. Data were collected on physical activity, dietary habits, smoking, and alcohol consumption, alongside the three core components of the COM-B model. Statistical analysis was performed to identify key determinants of health behaviors.

Results: The survey revealed that while residents generally possessed a basic level of health knowledge (Capability), there were significant gaps in social and physical environments (Opportunity) and intrinsic drive (Motivation). Specifically, physical activity levels were influenced by the availability of community facilities, while dietary choices were strongly linked to reflective motivation and social norms.

Conclusion: Health interventions for community residents should shift from simple knowledge dissemination to comprehensive strategies that address environmental barriers and enhance psychological motivation. Utilizing the BCW framework allows for the development of more targeted and effective public health policies.

1. Introduction

With the transition of the global disease burden from infectious diseases to chronic non-communicable diseases (NCDs), the importance of health behavior intervention has become increasingly prominent. In China, the "Healthy China 2030" initiative emphasizes the role of community-based health management. However, traditional health education often fails to achieve long-term behavior maintenance.

The Behavior Change Wheel (BCW), proposed by Michie et al., provides a systematic framework for understanding and changing behavior. At its core is the COM-B model, which posits that for any behavior ($B$) to occur, an individual must have the capability ($C$), the opportunity ($O$), and the motivation ($M$). This study applies the BCW theory to analyze the health behaviors of community residents and proposes optimized intervention paths.

[FIGURE:1]

2. Methods

2.1 Study Design and Participants

This cross-sectional study was conducted between January and June 2023. We employed a multi-stage stratified random sampling method to recruit residents aged 18 and above who had resided in the target communities for at least six months.

2.2 Theoretical Framework

1. 201799 Xiayang Street Community Health Service Center, Qingpu District, Shanghai

Department of General Practice, Yangpu Hospital Affiliated to Tongji University, Shanghai; Shanghai Research Center for the Development of General Practice and Community Health, Shanghai; Clinical Research Center for General Practice, Tongji University, Shanghai; Daqiao Community Health Service Center, Yangpu District, Shanghai. Doctoral Supervisor.

Background

As the burden of chronic diseases intensifies, promoting healthy behaviors among residents has become a critical objective of public health. Despite gradual improvements in health literacy and management awareness, a significant gap remains between knowledge and actual behavior. The Behavior Change Wheel (BCW) framework, a systematic tool for identifying behavioral determinants and designing intervention strategies, has been widely applied internationally. However, empirical research in the field of community health behavior in China remains limited. This study aims to understand the current status of health behaviors among community residents in Shanghai, analyze the influencing factors, and propose optimization strategies to improve these behaviors based on the BCW theoretical framework.

From February to May 2023, a stratified sampling method was employed to select 28 community health service centers across Shanghai. The selection was based on the permanent population of each administrative district and the total number of available centers, with 1 to 4 street-level community health service centers randomly selected from each district. The research team conducted surveys with 50 residents at each center, collecting comprehensive data on their health behaviors. The questionnaire was developed based on BCW theory, utilizing the Health Literacy Management Scale (HeLMS) to assess health literacy levels, alongside self-designed items to evaluate health management behaviors, beliefs, and participation in health management programs. To control for confounding variables, Propensity Score Matching (PSM) was applied to balance general individual characteristics, followed by an analysis of the primary factors influencing health behavior.

436 Community Residents, Results Show

Assessment and Optimization of Community Health Behaviors Guided by the Behaviour Change Wheel Theory

Among the dimensions of health management, health management beliefs achieved the highest score rate (mean score 2.58, score rate 86.0%), followed by health literacy levels (mean score 95.40, score rate 79.5%). In contrast, scores for health management behaviors were relatively low (mean score 4.24, score rate 60.6%), and participation in health management programs received the lowest scores (mean score 4.00, score rate 33.3%). Based on the health management behavior scores, participants were divided into a "good behavior" group (score $\geq 5$, $n=412$) and a "poor behavior" group (score $\leq 4$, $n=1,024$).

To control for confounding variables—including gender, age, education level, residential area, source of medical expenses, monthly income, and marital/childbearing status—a 1:1 Propensity Score Matching (PSM) method was employed. Following matching, a comparison between the two groups revealed statistically significant differences in health literacy and health management belief scores ($P < 0.05$). Furthermore, based on these research findings, an optimization strategy for the health behaviors of community residents was proposed using the Behaviour Change Wheel (BCW) framework. This strategy focuses on improving residents' health literacy levels and health management beliefs.

The results indicate that community residents in Shanghai possess relatively high levels of health management beliefs and health literacy; however, the execution of health behaviors and participation in health management programs require further improvement. Grounded in the Behaviour Change Wheel theory, this study proposes a multi-dimensional intervention strategy encompassing health education, capacity empowerment, incentive mechanisms, and environmental support. By optimizing core behavioral elements such as capability and motivation, these strategies aim to enhance the level of health behaviors among residents, providing both theoretical guidance and a practical pathway for systematic community health management interventions.

Keywords: Health behavior; Health management; Community residents; Proactive health; Behaviour Change Wheel

CLC Number: R 161
Document Code: A

Citation: 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, 2025. [Epub ahead of print] Editorial Office of Chinese General Practice. This is an open access article under the CC BY-NC-ND 4.0 license.

Chinese General Practice, Shanghai 200090, China; Tongji University, Shanghai 200090, China; Yangpu District, Shanghai 200090, China. Yu Dehua, Chief physician/Doctoral supervisor.

Background

With the increasing burden of chronic diseases, promoting health behaviors among residents has become a key public health priority. Although health literacy and awareness of health management have gradually improved, a significant gap remains between knowledge and actual behavioral change. The Behavior Change Wheel (BCW) theory, as a systematic framework for identifying behavioral determinants and designing targeted interventions, has been widely applied internationally. However, empirical research applying this model to the health behaviors of community residents in China remains limited.

Objective: To assess the current status of health behaviors among community residents in Shanghai, identify their influencing factors, and propose optimization strategies to improve health behaviors based on the Behavior Change Wheel framework.

Methods

From February to May 2023, a stratified sampling method was employed. Based on the permanent population and the number of community health service centers (CHSCs) in each administrative district of Shanghai, 1 to 4 CHSCs were randomly selected from each district, resulting in a total of 28 centers. At each site, 50 community residents attending outpatient services were invited to complete a structured questionnaire assessing their health behaviors. The questionnaire was developed based on the Behavior Change Wheel (BCW) framework. Health literacy was assessed using the Health Literacy Management Scale (HeLMS), while health management behaviors, health management beliefs, and participation in health management programs were evaluated using self-designed items. To control for confounding, propensity score matching (PSM) based on general individual characteristics was applied to balance baseline variables, and key influencing factors of health behaviors were subsequently analyzed.

Results

A total of 1,436 community residents were included in the study. Among the four dimensions evaluated, the highest score rate was observed in health management beliefs (mean score: 2.58; score rate: 86.0%), followed by health literacy (mean score: 95.40; score rate: 79.5%). In contrast, health management behaviors showed a lower score (mean: 4.24; score rate: 60.6%), and participation in health management programs was the lowest (mean: 4.00; score rate: 33.3%). Based on health management behavior scores, residents scoring $\geq 5$ were categorized as the good behavior group ($n=412$), and those scoring $\leq 4$ as the poor behavior group ($n=1,024$). Propensity score matching (1:1) was applied to control for potential confounding variables including gender, age, education level, residential area, source of medical payment, monthly income, and marital/childbearing status. After matching, significant differences remained between the two groups in health literacy and health management belief scores ($P < 0.05$). Targeted optimization strategies were subsequently proposed based on the Behavior Change Wheel framework: improving residents' health literacy and health management beliefs.

Conclusion

Community residents in Shanghai demonstrated relatively strong health management beliefs and health literacy. However, the execution of health-related behaviors and participation in health management programs remain suboptimal. Guided by the Behavior Change Wheel framework, this study proposed a set of multi-dimensional intervention strategies encompassing health education, capacity building, incentive mechanisms, and environmental support. These strategies target core behavioral determinants such as capability and motivation, aiming to enhance residents' health behavior performance and provide theoretical and practical guidance for systematic community health management interventions.

Keywords: Health behavior; Health management; Community residents; Active health; Behavior change wheel

Health management occupies a central position in achieving universal health goals. This importance is reflected not only in the diagnosis and treatment of diseases by medical service providers but, more crucially, in its coverage of disease prevention, the enhancement of health literacy, and the improvement of the public health environment. With social progress and shifts in demographic structures, non-communicable diseases, such as chronic illnesses, have gradually become the focus of health management. This shift has prompted a transformation in health management models from a traditional "treatment-centered" approach to one that is "prevention-oriented," emphasizing the importance of health promotion and disease prevention.

Residents play a leading role in this transformation. Improving residents' health literacy—specifically, their ability to obtain, process, and understand basic health information and services—is critical for encouraging individuals to make health-beneficial decisions. Enhanced health literacy enables residents to manage their own health conditions more effectively, understand how to prevent diseases, and seek appropriate medical assistance when necessary. While improving health literacy is an important pathway to enhancing residents' health management capabilities, changing health behaviors is another key to achieving health management goals. Encouraging residents to adopt active lifestyles, such as regular exercise, a balanced diet, adequate sleep, and the avoidance of harmful habits, is an effective way to significantly reduce the risk of chronic diseases, improve quality of life, and decrease medical expenditures \cite{5-6}. By lowering the incidence of chronic diseases, these health behaviors not only improve individual daily quality of life but also exert a positive impact on the public health system. For patients with chronic diseases, proactive health management can help improve quality of life, mitigate the impact of the disease on daily activities, and control the condition more effectively. Furthermore, proactive management of chronic diseases can reduce the risk of complications and lower medical costs.

Therefore, enhancing residents' health management capabilities through education, resource provision, and environmental support not only benefits individual health but also provides support for reducing the economic burden on society as a whole. This comprehensive health management strategy ensures that both chronic disease patients and the general population receive the necessary support to achieve a healthier lifestyle.

In 2011, Michie first proposed the Behavior Change Wheel (BCW) theory, a framework designed for analyzing and planning behavior change interventions. The BCW model consists of a three-layered circular structure: the core layer, the middle layer, and the outer layer. The core layer, located at the center of the model, includes three elements: Capability, Opportunity, and Motivation, collectively referred to as the COM-B system. These three elements are considered the key factors driving behavior. The middle layer contains nine intervention functions used to change one or more elements in the COM-B system; these functions include education, persuasion, incentivization, coercion, enablement, modeling, restriction, environmental restructuring, and training. The outermost layer represents policy categories, providing methods for the implementation of intervention strategies. The Behavior Change Wheel helps identify the drivers of target behaviors and, by selecting appropriate intervention functions and policies, facilitates the formulation of more effective health behavior change strategies, ensuring that interventions are practical and have a sustainable impact. Currently, the BCW theory is widely applied in research on optimizing community health behaviors, aiming to promote healthier lifestyles and improve public health outcomes.

As the primary stakeholders responsible for their own health, community residents must have their current health behaviors and influencing factors analyzed as a necessary prerequisite for proposing optimization strategies. This study utilizes a questionnaire survey to approach the issue from the perspective of health behavior transformation. Based on the theoretical foundation of the Behavior Change Wheel, this research analyzes the relationships between capability, opportunity, motivation, and behavior to provide a theoretical basis for the subsequent formulation of optimization schemes.

1.1 Study Participants

From February to May 2023, a stratified sampling method was employed to select 28 community health service centers across Shanghai. The selection process was based on the permanent resident population and the total number of community health service centers in each administrative district, with 1 to 4 centers randomly chosen from each district. The research team conducted questionnaire surveys among 50 community residents visiting each selected center. According to Kendall’s principle, the required sample size for a questionnaire survey should be 5 to 10 times the number of items included in the instrument. Accounting for a potential loss-to-follow-up rate of 10% to 20%, the minimum required sample size was determined to be 672 participants. Ultimately, a total of 1,436 community residents participated in the study.

1.2.1 General Information Questionnaire

Based on \cite{10-11}, a self-designed questionnaire was developed. The content includes: gender, age, education level, residential jurisdiction, source of medical expenses, monthly income, marital status, and whether the participant has children.

1.2.2 Elements of the Behavior Change Wheel

To promote healthy behaviors among community residents, core elements were transformed into measurable variables. Behavior was operationalized as the "Healthy Behavior Level," structured as a multiple-choice item where each selected option contributed 1 point, resulting in a score range of 1 to 7. Drawing upon the "Healthy China 2030" Planning Outline, McNerney’s framework for healthy behavior, and the specific characteristics of the surveyed population, the options for healthy behavior were categorized into three dimensions: (1) Physiological: "paying attention to physical abnormalities and actively seeking professional advice," "proactively reading health information," "developing an exercise plan and engaging in appropriate physical activity," and "maintaining regular meals with attention to nutritional balance"; (2) Psychological: "self-relaxation and stress management to maintain a positive mood"; and (3) Social: "maintaining harmonious interpersonal relationships." Capability was transformed into the "Health Literacy Level," with scores ranging from 24 to 120; higher scores indicate a higher level of health literacy.

This study utilized the Health Literacy Management Scale (HeLMS) to assess health literacy levels. Originally developed by Professor Jordan and colleagues at the University of Melbourne in 2010, the scale was translated and validated in Chinese by Sun Haolin et al. in 2012. The questionnaire comprises 24 items across four dimensions, with each item scored on a scale of 1 to 5. Total scores range from 24 to 120, where higher scores represent superior health literacy. Participants were required to select their responses promptly after understanding each item. The scale demonstrates excellent internal consistency, with a Cronbach's $\alpha$ ranging from 0.857 to 0.947. Motivation was operationalized as "Health Management Beliefs," measured by the item: "Do you believe it is necessary to engage in health management?" Responses were scored as follows: 3 points for "Health management is necessary at all times," 2 points for "Health management is necessary only when ill," and 1 point for "Not necessary." Scores range from 1 to 3, with higher scores indicating stronger health management beliefs. Opportunity was operationalized as "Access to Health Management," defined by the item: "Which community-provided health management or clinical services have you received?" This was a multiple-choice question consisting of 12 items, with each item assigned 1 point, resulting in a score range of 0 to 12.

Statistical Analysis

Data entry was performed using Excel, and statistical analysis was conducted using SPSS 26.0 software. Quantitative data are expressed as mean $\pm$ standard deviation ($\bar{x} \pm s$), with inter-group comparisons performed using independent samples $t$-tests. Qualitative data are expressed as relative numbers (frequencies and percentages), with inter-group comparisons performed using the $\chi^2$ test. To control for confounding factors, Propensity Score Matching (PSM) was employed to balance the groups. Using gender, age, educational level, residential area, source of medical expenses, monthly income, and marital/childbearing status as covariates, we set a caliper value of 0.02. A 1:1 nearest neighbor matching method was used to pair individuals from the group with good health management behaviors with those from the group with poor health management behaviors. Following the matching process, inter-group comparisons were performed again to examine differences in health literacy, health management beliefs, and participation in health management projects. All statistical tests were two-sided, and a $P$-value of less than 0.05 was considered to indicate a statistically significant difference.

2.1 Descriptive Statistics of Community Residents' Basic Information

Among the 1,436 community residents surveyed, 44.8% (643) were male and 55.2% (793) were female. Regarding age distribution, 22.2% (319) of residents were aged 44 or younger, 49.0% (704) were between 45 and 59 years old, and 28.8% (413) were aged 60 or older. In terms of educational attainment, 38.9% (558) of residents had a junior high school education or below, while 41.0% (589) had completed high school or vocational college.

Furthermore, 20.1% (289) of the residents held a bachelor's degree or higher. Regarding residential areas, 35.0% (502) of the participants lived in urban areas, while 65.0% (934) resided in suburban areas. In terms of medical insurance coverage, 50.0% (718) of the residents were covered by the Urban Employee Basic Medical Insurance, 33.3% (478) were covered by the Urban and Rural Resident Basic Medical Insurance (including the New Rural Cooperative Medical Scheme), and 16.7% (240) utilized other forms of medical insurance. Monthly income data revealed that 40.3% (578) of residents earned 5,000 yuan or less, while 59.7% (858) earned 5,001 yuan or more. Regarding marital status, 88.7% (1,274) were married, while 11.3% (162) belonged to other marital categories. Finally, in terms of reproductive history, 91.5% (1,314) of the residents reported having children, while 8.5% (122) reported having no children.

Health Behavior Levels and Influencing Factors Among Community Residents

2.2.1 Health Management Behavior Levels.

The conceptual dimension achieved a relatively high score, whereas the implementation of health management projects received a lower score. In this context, the scoring rate refers to the ratio of the actual score to the maximum possible score for that dimension, reflecting the performance level of residents regarding that specific behavioral element. The scores for each dimension are presented in [TABLE:1].

[TABLE:1] Scores of community residents' health management behaviors across dimensions

2.2.2 Comparison of General Individual Characteristics Before and After PSM.

Based on their health management behavior scores, the participants were categorized into two groups: 412 individuals with a score of $\geq 5$ were defined as the "good behavior group," while 1,024 individuals with a score of $\leq 4$ were defined as the "poor behavior group."

Prior to matching, statistically significant differences were observed between the two groups in terms of gender, age, educational level, residential area, source of medical expenses, and fertility status ($P < 0.05$), indicating the presence of baseline imbalance. Using the Propensity Score Matching (PSM) method with a 1:1 ratio to match covariates, 391 pairs were successfully matched. After matching, there were no statistically significant differences in general characteristics between the two groups ($P > 0.05$), achieving a balance of individual characteristics as shown in [TABLE:2].

2.2.3 Univariate analysis of community residents' health behaviors after PSM.

Following PSM, the good behavior group scored significantly higher than the poor behavior group in both health literacy and health management beliefs ($P < 0.05$); however, there was no statistically significant difference between the two groups regarding their scores for implementing health management projects ($P > 0.05$).

Optimization strategies for community residents' health behavior based on the Behavior Change Wheel (BCW). When proposing these optimization strategies, the three main stages of the BCW were followed: understanding the target behavior, identifying intervention options, and determining intervention content and implementation options.

2.3.1 Understanding the Target Behavior

The implementation process consists of four specific steps: (1) defining the behavioral problem; (2) selecting the target behavior; (3) refining the target behavior; and (4) identifying the specific content that requires change. This study aims to improve the health management behaviors of community residents. Based on the research findings presented in Section 2.2, we identified the key elements of community residents' health behaviors—namely, that capability and motivation are the primary factors influencing the improvement of these behaviors.

2.3.2 Identifying Intervention Options

(1) Determining Intervention Functions: The relationship matrix between COM-B components and BCW intervention functions was utilized to identify appropriate intervention strategies. These were further refined using the APEASE criteria (affordability, practicability, effectiveness and cost-effectiveness, acceptability, side-effects/safety, and equity). Based on the diagnostic results from the previous stage, the "Capability" component led to the selection of three intervention functions: education, training, and enablement. The "Motivation" component was mapped to six intervention functions: persuasion, incentivization, coercion, environmental restructuring, modeling, and enablement. (2) Selection of Policy Categories: Following the identification of these intervention functions, the relationship matrix between BCW intervention functions and policy categories was employed to identify the specific policy categories that align with the selected interventions.

2.3.3 Determining Optimization Strategies

Based on the preliminary research results and literature review, and guided by the Behavior Change Wheel (BCW) theory, a set of optimization strategies for improving the health behaviors of community residents has been developed. During the formulation process, "coercion" was excluded as it failed to meet the APEASE criteria for feasibility, practicability, and acceptability.

2.3.4 Comprehensive Optimization Strategies for Community Residents' Health Behaviors

2.3.4.1 Improving Health Literacy Levels

(1) Policy Support and Institutional Development
It is essential to develop and publish comprehensive health management guidebooks that include specific indicators and actionable steps for disease prevention and healthy lifestyles. Efforts should be made to promote the formulation of relevant health regulations to ensure that public spaces—such as schools, parks, and workplaces—provide guidance on healthy living. At the community level, formal rules should be established to implement regular health check-up systems, encouraging or requiring residents to participate in health education and training activities. Furthermore, subsidies or rewards should be provided to residents who participate in health management training to incentivize active engagement. Financial support should also be offered for the purchase of health management tools, such as blood pressure monitors and pedometers, to facilitate self-monitoring among residents.

(2) Health Education and Training
Health education lectures and seminars should be organized regularly, focusing on the prevention and management of chronic diseases and the cultivation of daily healthy habits. Easy-to-understand health education materials should be produced and widely distributed, with a particular focus on key populations such as the elderly, patients with chronic diseases, and children. Regular health management training courses should be conducted for chronic disease patients and general residents, covering fundamental knowledge such as healthy diets, regular exercise, and disease self-management. For groups with specific health needs, skill-based training should be provided for monitoring health metrics, such as blood glucose and blood pressure monitoring techniques. Additionally, health consultation windows should be established within the community to provide personalized health management plans and counseling. Social media, community radio, and online platforms—including health management apps and online health courses—should be utilized to disseminate health information broadly.

(3) Resource Provision and Infrastructure Improvement
Necessary health monitoring equipment should be provided to community residents, accompanied by instruction on correct usage for daily health management. The physical environment should be enhanced by establishing walking trails and fitness areas to encourage residents to engage in physical activity.

Comparison of General Demographic Characteristics and Factors Associated with Health Management Behaviors

1. Comparison of General Demographic Characteristics Before and After Propensity Score Matching (PSM)

To ensure the robustness of the analysis and minimize potential selection bias, Propensity Score Matching (PSM) was employed to balance the baseline characteristics between the group with "Good Health Management Behavior" and the group with "Poor Health Management Behavior."

[TABLE:2]

As shown in [TABLE:2], prior to matching, significant differences were observed in several demographic variables between the two groups. After applying PSM, the distribution of these characteristics became balanced, allowing for a more accurate comparison of health management outcomes. The final matched sample size consisted of 391 pairs, providing a statistically significant basis for further analysis.

2. Factors Associated with Health Management Behaviors After PSM

Following the matching process, a multivariate analysis was conducted to identify the key determinants of health management behaviors among community residents. The results indicate that several factors remain significantly associated with the adoption of positive health behaviors.

2.1 Health Management Beliefs

Health management beliefs emerged as a primary predictor of behavior. Residents who possess a strong conviction in the efficacy of preventive measures and maintain a high level of health consciousness are significantly more likely to engage in consistent health management activities. This suggests that psychological empowerment and health literacy are critical components in fostering long-term behavioral change.

2.2 Implementation of Health Management Programs

The availability and active implementation of community-based health management programs also play a decisive role. Residents who have access to structured programs—such as regular health screenings, chronic disease monitoring, and wellness workshops—demonstrate higher levels of adherence to healthy lifestyles. The data suggest that the systematic delivery of these services by community health centers directly facilitates the transition from health knowledge to health action.

2.3 Socio-Environmental Influences

Beyond individual beliefs and program availability, the analysis highlighted that the social environment and the quality of interaction with healthcare providers significantly influence health management behaviors. Residents who perceive strong support from their community health teams are more likely to sustain "Good Health Management Behavior" over time.

3. Conclusion

The application of PSM effectively balanced the demographic characteristics of the study population, revealing that health management beliefs and the structured implementation of health programs are the most influential factors driving resident behavior. These findings underscore the importance of not only providing health services but also fostering positive health beliefs to improve the overall health behavior of the community.

$P$-values $<0.001$, $0.002$, $0.065$

Physical exercise. Collaborate with schools, senior centers, and other community organizations to jointly conduct health education and activities. Optimize community health facilities by establishing more public walking trails and fitness areas. Organize various health-related events within the community, such as walking groups and health knowledge competitions, to enhance residents' participation and interest in healthy behaviors.

(5) Empowerment Intervention: Provide residents with tools including the formulation of personalized health plans. For residents with suboptimal health management behaviors, empower them through targeted support and resources to improve their self-efficacy and long-term adherence to healthy lifestyles.

Health advisory services, including disease management recommendations and regular follow-up assessments, should be provided. Online health training resources should be made available via network platforms to facilitate convenient, anytime learning for residents to apply in their daily lives. Furthermore, a community-based health support network should be established to encourage mutual support and the sharing of health management experiences among residents.

2.3.4.2 Enhancing Residents' Health Management Beliefs

(1) Education: Lectures and seminars should be held regularly, inviting health experts to explain the benefits of a healthy lifestyle and enhance residents' awareness of the importance of health management. Health knowledge should be widely disseminated within the community using posters, flyers, and other media, with a particular emphasis on the long-term benefits of healthy behaviors.

(2) Persuasion: Success stories and case studies of residents' health management achievements should be published through media and social platforms to serve as a means of motivating and encouraging others to participate in health-related activities.

(3) Incentives and Reward Mechanisms: Regular health challenges, such as walking competitions or healthy eating challenges, should be organized, with rewards established for active participants. A health credit system should be implemented, allowing residents to earn points by participating in health activities or achieving specific health goals.

Good health management behavior.

Chinese General Practice: To achieve target points, which can be exchanged for small gifts or services; provide bonuses or discounts to encourage residents to actively participate in health management activities. (4) Environmental restructuring: Simplify the health management service process to make services more convenient and reduce barriers for residents accessing medical services; improve the accessibility and quality of community medical services to ensure residents can easily obtain necessary healthcare and health consultations. (5) Modeling: Medical personnel establish a positive and healthy image through their own health behaviors to inspire residents to follow suit; showcase residents who successfully practice healthy lifestyles in community activities, media, or social networks as role models to encourage others to emulate them. (6) Empowerment: Conduct one-on-one communication with residents to provide personalized health management advice tailored to their specific health conditions and living habits; publicly commend residents who have achieved significant accomplishments in health management during community events, serving as positive demonstrations to motivate others.

3. Discussion

Research findings indicate that while community residents may possess a certain level of motivation for health management, there remains significant room for improvement in translating this motivation into practical action. Challenges are particularly pronounced in the implementation of specific health management projects, which may stem from a lack of effective health management plans, insufficient resources, or inadequate awareness of health management. The complexity of community residents' health behaviors suggests that these actions are influenced not only by individual knowledge and beliefs but also by the interplay of the community environment, social structures, and policy frameworks. An analysis of the multidimensional factors influencing health behavior reveals that individual health literacy and health beliefs collectively shape residents' health behavior patterns. Consequently, strategies to improve health behavior must comprehensively consider these factors rather than focusing solely on increasing health knowledge or altering beliefs.

Although community residents may possess basic health management knowledge and beliefs, this foundation does not always translate effectively into concrete actions. This disconnect may be caused by various factors, such as a lack of necessary health resources, insufficient social support, or weak motivation for behavioral change. Residents with higher health literacy demonstrate better performance in health management behaviors, suggesting that high levels of literacy enable individuals to more effectively understand and utilize health information to make health-conducive decisions. This underscores the critical role of enhancing public health literacy in improving health behaviors and promoting overall wellness. Furthermore, residents with strong health management beliefs are more likely to adopt positive health behaviors. These beliefs not only encourage residents to undergo regular health check-ups and actively seek health information but also increase their receptivity to and participation in health interventions. Improving the health behavior levels of community residents requires strategic health interventions and a multi-layered, multi-strategy comprehensive approach. These methods include policy integration, community empowerment, and the application of technology, all aimed at constructing an ecosystem that promotes healthy behavior and fundamentally improves residents' health literacy and performance. Therefore, continuous monitoring and evaluation of the implementation effects of these strategies are essential for adjusting and optimizing health interventions.

The establishment of policies and systems requires both continuity and adaptability. Health management manuals and relevant health regulations must be updated regularly to reflect the latest progress in medical research and practice. Ensuring that the most current information from these policies and manuals is effectively communicated to every community member is key to improving policy implementation. Given the diverse health needs of community residents, providing personalized health management plans is crucial. Furthermore, the application of big data and artificial intelligence to analyze residents' health data—providing them with tailored health advice and education—represents a significant direction for future development. While financial incentives can increase resident participation in the short term, their long-term effectiveness and sustainability remain challenging. Consequently, it is necessary for the government and community organizations to jointly seek sustainable funding sources and effective management models.

The optimization of the community environment is not limited to physical space but also encompasses cultural dimensions. Therefore, residents can be encouraged to participate in daily outdoor activities by designing environments that promote healthy behavior, such as adding walking and cycling paths and optimizing parks and recreational areas. Environmental improvement requires cross-departmental cooperation involving multiple fields, including urban planning, public health, and community development.

Changes in social interaction patterns and the establishment of health support networks can be achieved by organizing health volunteer teams and launching health partner programs, thereby enhancing mutual assistance and resource sharing among residents. Such networks not only provide real-time health assistance and information exchange but also strengthen community cohesion and the collective capacity of residents to address health challenges.

4. Summary

Based on the Theory of the Behavior Change Wheel, this study systematically analyzes the current status of health behaviors among community residents and their influencing factors. Furthermore, targeted intervention optimization strategies are proposed, aiming to enhance the health management capabilities of community residents through comprehensive interventions. This research provides both theoretical and practical guidance for the continuous optimization of community health management.

Author Contributions: Li Wanyu was responsible for drafting the manuscript; Jin Hua was responsible for data collection; Fu Qiangqiang was responsible for statistical analysis; Yang Sen was responsible for manuscript revision; Yu Dehua revised the final version and is accountable for the paper.

The authors declare no conflicts of interest.

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(Received: 2024-10-15; Revised: 2025-07-28) (Editor: Cui Sha)