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Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A CrossSectional Study
基于健康信念模型的中国农村老年人定期健康检查意愿：一项横断面研究

Zhuo Zhang, Ai-Tian Yin & Ying Bian

To cite this article: Zhuo Zhang, Ai-Tian Yin & Ying Bian (2021) Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study, Patient Preference and Adherence, , 1347-1358, DOI: 10.2147/ PPA.S312806
引用本文：Zhuo Zhang, Ai-Tian Yin & Ying Bian (2021) 基于健康信念模型的中国农村老年人定期健康检查意愿：一项横断面研究，《患者偏好与依从性》，1347-1358，DOI: 10.2147/ PPA.S312806
To link to this article: https://doi.org/10.2147/PPA.S312806
要链接到这篇文章：https://doi.org/10.2147/PPA.S312806

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Published online: 21 Jun 2021.
在线发布：2021 年 6 月 21 日。
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Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China: A Cross-Sectional Study
基于健康信念模型的中国农村老年人定期健康检查意愿：一项横断面研究

Zhuo Zhang ′ ′ ^('){ }^{\prime} Zhuo ZhangAi-Tian Yin 2 2 ^(2){ }^{2}Ying Bian ′ ′ ^('){ }^{\prime} Ying Bian'State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, People’s Republic of China; 2 2 ^(2){ }^{2} School of Health Care Management, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
中国澳门，澳门大学中国医学科学研究所中医药质量研究国家重点实验室；中国济南，山东大学齐鲁医学院健康管理学院

Correspondence: Ying Bian
通信：边颖

Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Room 2055, N22 Building, Taipa, Macau SAR, People’s Republic of China
澳门大学中国医学科学院，大学大道，2055 室，N22 大楼，氹仔，澳门特别行政区，中国人民共和国
Tel +853-66548926
Email bianyingum@163.com
电子邮件 bianyingum@163.com

Abstract 摘要

Purpose: This study aimed to explore factors affecting behavioral intention of receiving periodic health examinations (hereafter, BIE) among people aged 60 and over in rural China, namely, Shandong Province, using the extended health belief model (EHBM). Patients and Methods: Participants were selected using stratified multi-stage random sampling. Three cities were selected based on economic level. Subsequently, three counties and three villages were selected from each sample city and county. Finally, 30 respondents were selected from each sample village. Face-to-face surveys were conducted using a structured questionnaire between March and September 2017. Multiple linear regression was conducted to investigate the association between BIE and eight dimensions of EHBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, health knowledge, and social support. Results: Of the 509 rural respondents aged 60 years and older, the average score of behavioral intention was 4.43 ± 0.80 4.43 ± 0.80 4.43+-0.804.43 \pm 0.80. Multivariate linear regression analysis demonstrated poor BIE among participants who were men, were current smoker, were current drinker, were aged 70 years or over, had lower social support, and perceived lower self-efficacy, less benefits, and more barriers. Among them, barriers were found to have the strongest association with BIE ( B ′ = − 0.556 ; p < 0.001 B ′ = − 0.556 ; p < 0.001 B^(')=-0.556;p < 0.001\mathrm{B}^{\prime}=-0.556 ; \mathrm{p}<0.001 ). Qualitative interviews revealed that reasons for not receiving periodic health examinations (PHE) included pain, cost, difficulty in finding a health care provider, time and scheduling, potential lack of trust in the physician, and value of the PHE. Conclusion: This study highlighted the importance of psychological variables in the acceptance of PHE among the elderly in rural China and provided insights for further intervention designs targeting identified groups and performed by general practitioners. Addressing medical mistrust, strengthening, and enhancing one’s social support network and health communication channels, such as bulletin boards, may serve to facilitate BIE.
目的：本研究旨在探讨影响中国农村 60 岁及以上人群（以下简称 BIE）定期健康检查行为意图的因素，采用扩展健康信念模型（EHBM）。患者和方法：参与者采用分层多阶段随机抽样法选取。根据经济水平选择了三个城市。随后，从每个样本城市和县选择了三个县和三个村庄。最后，从每个样本村庄中选取了 30 名受访者。2017 年 3 月至 9 月期间，使用结构化问卷进行面对面调查。采用多元线性回归分析 BIE 与 EHBM 的八个维度之间的关联：感知易感性、感知严重性、感知益处、感知障碍、感知自我效能、行动线索、健康知识和社会支持。结果：在 509 名 60 岁及以上的农村受访者中，行为意图的平均分为 4.43 ± 0.80 4.43 ± 0.80 4.43+-0.804.43 \pm 0.80 。 多元线性回归分析显示，男性、当前吸烟者、当前饮酒者、年龄在 70 岁或以上、社会支持较低、感知自我效能较低、认为收益较少和障碍较多的参与者在 BIE 方面表现较差。其中，障碍与 BIE 的关联最强（ B ′ = − 0.556 ; p < 0.001 B ′ = − 0.556 ; p < 0.001 B^(')=-0.556;p < 0.001\mathrm{B}^{\prime}=-0.556 ; \mathrm{p}<0.001 ）。定性访谈揭示，不接受定期健康检查（PHE）的原因包括疼痛、费用、难以找到医疗服务提供者、时间和安排、对医生的潜在不信任以及对 PHE 的价值的看法。结论：本研究强调了心理变量在中国农村老年人接受 PHE 中的重要性，并为针对特定群体的进一步干预设计提供了见解，这些干预由全科医生实施。解决医疗不信任、加强和增强个人的社会支持网络以及健康沟通渠道（如公告栏）可能有助于促进 BIE。

Keywords: extended health belief model, periodic health examination, general practitioners, behavioral intention, elderly, rural China
关键词：扩展健康信念模型，定期健康检查，全科医生，行为意图，老年人，农村中国

Introduction 介绍

With increasing life expectancy and declining fertility due to China’s unique 36year one-child policy, China is experiencing rapid aging at a rate that is significantly faster than most countries. 1 1 ^(1){ }^{1} The increasing trend of population aging led to a dramatic increase in health and economic burdens. 2 2 ^(2){ }^{2} In addition, older adults with chronic disabling conditions not only have a reduced life expectancy but also significantly impact the mental health and quality of life of their caregivers. 3 3 ^(3){ }^{3}
随着寿命的延长和由于中国独特的 36 年独生子女政策导致的生育率下降，中国正以比大多数国家更快的速度经历快速老龄化。人口老龄化的趋势导致健康和经济负担的急剧增加。此外，患有慢性残疾的老年人不仅寿命缩短，还对照顾者的心理健康和生活质量产生显著影响。
This situation is considered alarming, as chronic diseases are generally preventable Through periodic health examinations (PHE), abnormal signs can be detected at an early stage, and correct diagnosis and effective treatment measures can be administered early. 4 4 ^(4){ }^{4}
这种情况被认为是令人担忧的，因为慢性疾病通常是可以预防的。通过定期健康检查（PHE），可以在早期发现异常迹象，并可以及早进行正确的诊断和有效的治疗措施。
PHE is a primary approach for general practitioners to perform clinical preventive services in China and delaying or avoiding unwanted outcomes through an organized PHE for people aged 60 years and older is a critical public health concern in China. 5 5 ^(5){ }^{5} The Chinese government officially approved the health management technical protocol for elderly people based on the principles of equitable access and use of clinical preventive services. This protocol, which was implemented formally on April 1, 2016, aimed to address the care needs of people aged 60 years and older and improve their quality of life. The protocol emphasized that people aged 60 years and older should be given periodic health assessments, where personal health records are updated, and an appointment is made for the next check. Notably, a dedicated approach to PHE and assessment was highlighted as a key priority.
PHE 是中国全科医生进行临床预防服务的主要方法，通过有组织的 PHE 延迟或避免 60 岁及以上人群的不良结果是中国一个重要的公共卫生问题。 5 5 ^(5){ }^{5} 中国政府正式批准了基于公平获取和使用临床预防服务原则的老年人健康管理技术规范。该规范于 2016 年 4 月 1 日正式实施，旨在满足 60 岁及以上人群的护理需求，提高他们的生活质量。该规范强调，60 岁及以上的人应定期进行健康评估，更新个人健康记录，并预约下次检查。值得注意的是，专门的 PHE 和评估方法被强调为关键优先事项。
The development of chronic diseases generally involves five stages: exposure, acquisition, advancement/ progression, complications, and death/disability. 6 6 ^(6){ }^{6} PHE helps to detect the impact factors of sub-health status at stage one, such as being overweight, obesity, smoking, alcohol use, and high blood pressure. A timely change in lifestyle or simple drug intervention can eliminate risk factors and reduce or avoid the occurrence of diseases. The second stage is the acquisition of early disease due to exposure. At this stage, PHE helps recognize asymptomatic but insidiously progressive diseases and postpone the development of subsequent adverse outcomes. PHE has been documented to be cost-saving or cost-effective. 7 7 ^(7){ }^{7} A study from Japan found a strong inverse association between older people’s medical expenditure and the use of PHE. 8 8 ^(8){ }^{8} Several community-based interventions involving health screening and primary care have found significant reductions in chronic diseases, such as stroke, 9 9 ^(9){ }^{9} ischemic heart disease, 10 10 ^(10){ }^{10} and chronic obstructive pulmonary disease. 11 11 ^(11){ }^{11} There is also convincing evidence that PHE is helpful in the early diagnosis of cancer and prevention of progression and potentially death. 12 12 ^(12){ }^{12}
慢性疾病的发展通常涉及五个阶段：暴露、获取、进展/发展、并发症和死亡/残疾。 6 6 ^(6){ }^{6} PHE 有助于在第一阶段检测亚健康状态的影响因素，例如超重、肥胖、吸烟、饮酒和高血压。及时改变生活方式或简单的药物干预可以消除风险因素，减少或避免疾病的发生。第二阶段是由于暴露而获得早期疾病。在这一阶段，PHE 有助于识别无症状但潜在进展的疾病，并推迟后续不良结果的发展。PHE 已被证明是节省成本或具有成本效益的。 7 7 ^(7){ }^{7} 一项来自日本的研究发现，老年人的医疗支出与 PHE 的使用之间存在强烈的负相关关系。 8 8 ^(8){ }^{8} 几项涉及健康筛查和初级保健的社区干预发现慢性疾病显著减少，例如中风， 9 9 ^(9){ }^{9} 缺血性心脏病， 10 10 ^(10){ }^{10} 和慢性阻塞性肺病。 还有令人信服的证据表明，PHE 有助于早期诊断癌症、预防病情进展和潜在的死亡。 12 12 ^(12){ }^{12}
The PHE participation rate in China is low. 13 13 ^(13){ }^{13} Moreover, surveys and focus groups found that rural residents were less likely to access recommended clinical preventive services than urban populations. 14 14 ^(14){ }^{14} However,
中国的公共卫生参与率较低。此外，调查和焦点小组发现，农村居民获取推荐的临床预防服务的可能性低于城市居民。
the total prevalence of individual chronic disease risk factors among rural residents was higher than that for urban residents. 15 15 ^(15){ }^{15} They tended to have more healthcare needs, while their underuse of primary care services was strikingly apparent compared to urban populations. 16 16 ^(16){ }^{16} Exploring the influencing factors of this utilization is crucial for PHE implementation.
农村居民的个体慢性疾病风险因素的总体流行率高于城市居民。 15 15 ^(15){ }^{15} 与城市人口相比，他们的医疗保健需求更高，而初级保健服务的使用不足显著。 16 16 ^(16){ }^{16} 探索这种利用的影响因素对公共卫生应急实施至关重要。
Health promotion programs based on theoretical frameworks were found to be more effective than programs that did not use theory. The Health Belief Model emphasizes how a person’s perceptions induce motivation and further produce behavior. 17 17 ^(17){ }^{17} To date, few studies examined psychosocial variables as a potentially influencing factor on BIE among people aged 60 years and older in rural China, underpinned by an extended health belief model (EHBM). Considering the utilization rate of PHE among the rural elderly population in China is extremely low while their health tends to be poor, analyzing factors that affect BIE is a vital health assessment approach for the aging Chinese society. Therefore, this study aimed to contribute timely direct policy suggestions. This study used representative data of Shandong Province to explore BIE systematically and clarify its influencing factors among elderly people in rural China, primarily based on EHBM in which factors were categorized into several groups.
基于理论框架的健康促进项目被发现比不使用理论的项目更有效。健康信念模型强调一个人的感知如何引发动机并进一步产生行为。迄今为止，只有少数研究考察了心理社会变量作为影响因素对中国农村 60 岁及以上人群的 BIE 的潜在影响，这些研究以扩展健康信念模型（EHBM）为基础。考虑到中国农村老年人群体的 PHE 利用率极低，而他们的健康状况往往较差，分析影响 BIE 的因素是对老龄化中国社会进行健康评估的重要方法。因此，本研究旨在提供及时的直接政策建议。本研究使用山东省的代表性数据系统地探讨 BIE，并阐明其在中国农村老年人中的影响因素，主要基于 EHBM，其中因素被分为几个组。

Patients and Methods
Design, Setting, and Participants
患者与方法 设计、环境和参与者

The target population of the present study was people in rural Shandong aged 60 years and older. The inclusion criteria were age of 60 years or older, permanent residence in Shandong, and ability to read and write Chinese. Utilizing stratified multi-stage sampling, a structured cross-sectional face-to-face questionnaire survey was conducted with 509 elderly people from 27 rural villages in 3 counties in Shandong Province between March to September 2017. The survey examined PHE behavior in the previous oneyear period. A sampling procedure was conducted, which contained county level, township level, and village level. First, all counties in Shandong Province were independently sorted in descending order by economic development ranking into 3 groups, and one county was selected at random from each group. Second, all townships in each of the sampled counties were divided into three groups based on their economic development level, and one township was selected from each group as a representative county ( 3 × 3 = ( 3 × 3 = (3xx3=(3 \times 3= 9 townships selected). Third, all villages in each sampled
本研究的目标人群是山东省 60 岁及以上的农村居民。纳入标准为 60 岁及以上、在山东省常住、能够读写中文。采用分层多阶段抽样方法，于 2017 年 3 月至 9 月对山东省 3 个县 27 个农村村庄的 509 名老年人进行了结构化的面对面问卷调查。调查考察了前一年内的公共卫生行为。抽样程序包括县级、乡级和村级。首先，山东省所有县按经济发展排名独立降序排序为 3 组，从每组中随机选择一个县。其次，抽样县的所有乡镇根据经济发展水平分为三组，从每组中选择一个乡镇作为代表县（共选择了 9 个乡镇）。第三，抽样的每个乡镇中的所有村庄。
township were grouped into three subgroups according to their regional economic status, and one village was randomly selected from each subgroup ( 3 × 3 × 3 = 27 3 × 3 × 3 = 27 3xx3xx3=273 \times 3 \times 3=27 villages). Finally, 30 individuals were randomly selected from each of the 27 villages. Thus, 810 rural residents were enrolled in the study and 805 completed the questionnaires with a response rate of 99.4 % 99.4 % 99.4%99.4 \%. In this study we only selected information from people aged 60 years and older for analysis. Among the respondents, 509 met the inclusion criteria. Additionally, 20 seniors were randomly obtained from the research subjects for qualitative research.
乡镇根据其区域经济状况被分为三个子组，并从每个子组中随机选择一个村庄（ 3 × 3 × 3 = 27 3 × 3 × 3 = 27 3xx3xx3=273 \times 3 \times 3=27 个村庄）。最后，从 27 个村庄中随机选择了 30 名个体。因此，共有 810 名农村居民参与了研究，805 人完成了问卷，响应率为 99.4 % 99.4 % 99.4%99.4 \% 。在本研究中，我们仅选择了 60 岁及以上人群的信息进行分析。在受访者中，509 人符合纳入标准。此外，从研究对象中随机选取了 20 名老年人进行定性研究。
Using the formula n = u 2 π ( 1 − π ) δ 2 n = u 2 π ( 1 − π ) δ 2 n=(u^(2)pi(1-pi))/(delta^(2))\mathrm{n}=\frac{\mathrm{u}^{2} \pi(1-\pi)}{\delta^{2}}, in which π π pi\pi referred to the percentage of elderly people in rural areas using PHE ( 53.6 % 53.6 % 53.6%53.6 \% ), δ = 0.1 π , α = 0.05 , u 0.05 = 1.96 δ = 0.1 π , α = 0.05 , u 0.05 = 1.96 delta=0.1 pi,alpha=0.05,u_(0.05)=1.96\delta=0.1 \pi, \alpha=0.05, u_{0.05}=1.96, the minimum sample size was calculated as n = 346 n = 346 n=346\mathrm{n}=346. Therefore, a sample size of 509 was sufficient.
使用公式 n = u 2 π ( 1 − π ) δ 2 n = u 2 π ( 1 − π ) δ 2 n=(u^(2)pi(1-pi))/(delta^(2))\mathrm{n}=\frac{\mathrm{u}^{2} \pi(1-\pi)}{\delta^{2}} ，其中 π π pi\pi 指的是使用 PHE 的农村地区老年人百分比 ( 53.6 % 53.6 % 53.6%53.6 \% )， δ = 0.1 π , α = 0.05 , u 0.05 = 1.96 δ = 0.1 π , α = 0.05 , u 0.05 = 1.96 delta=0.1 pi,alpha=0.05,u_(0.05)=1.96\delta=0.1 \pi, \alpha=0.05, u_{0.05}=1.96 ，最小样本量计算为 n = 346 n = 346 n=346\mathrm{n}=346 。因此，样本量为 509 是足够的。

Pilot Study 试点研究

A pilot study was conducted before the commencement of the study in February 2017 among 30 rural individuals aged 60 years and older in order to test the comprehensibility of the questionnaire items and establish the reliability of the questionnaire. Amendments were made to unfamiliar phrases that required clarification. In addition, experts from the School of Health Care Management at Shandong University assisted in revising the questionnaire. The pilot survey demonstrated a PHE usage rate of 53.6 % 53.6 % 53.6%53.6 \%.
在 2017 年 2 月研究开始之前，针对 30 名 60 岁及以上的农村个体进行了初步研究，以测试问卷项目的可理解性并建立问卷的可靠性。对需要澄清的不熟悉短语进行了修订。此外，来自山东大学健康管理学院的专家协助修订了问卷。初步调查显示 PHE 使用率为 53.6 % 53.6 % 53.6%53.6 \% 。

Data Collection 数据收集

Trained students from the School of Health Care Management at Shandong University were recruited to conduct individual face-to-face surveys in participants’ homes. The questionnaire items and response choices were read to
山东大学健康管理学院的受训学生被招募到参与者的家中进行个别面对面的调查。问卷项目和回答选项被读给
older participants in local languages in order to accommodate poor vision and other geriatric conditions. In addition, qualitative investigation was conducted using individual indepth interviews with 20 participants selected utilizing simple random sampling to explore reasons for low participation rate of PHE. To ensure data accuracy and completeness, the results were verified by quality controllers after finishing each questionnaire.
为了适应视力差和其他老年病状，针对当地语言的年长参与者进行了研究。此外，使用简单随机抽样选择了 20 名参与者，进行了个别深入访谈的定性调查，以探讨公共卫生教育参与率低的原因。为了确保数据的准确性和完整性，问卷完成后，质量控制人员对结果进行了验证。

Questionnaire 问卷

Structured self-designed questionnaires were used to assess PHE intention and each dimension of EHBM. The EHBM was adopted as a conceptual framework to predict healthrelated behavior, explain it, and further develop behavior change interventions (Figure 1). The EHBM is based on a hypothesis regarding the likelihood that individuals will take some preventive action and focus on adherence to preventive health behaviors. It has been commonly applied to address public health problems for risk reduction, prevention, and community health promotion. 18 18 ^(18){ }^{18} Behavioral intentions of receiving PHE (hereafter, BIE) and their determinants were measured using the eight domains of EHBM. According to this theory, individuals adopt certain preventive behaviors when they perceive themselves as susceptible to a disease or health problem (perceived susceptibility), perceive severity of the disease (perceived severity), perceive benefits of adopting a health behavior (perceived benefits), believe that the benefits of the behavior outweigh the costs (perceived barriers), have confidence in their ability to perform the action successfully (perceived self-efficacy), have health knowledge and social support, and there are factors that promote individuals to adopt such behaviors (cues to action).
使用结构化自设计问卷评估 PHE 意图及 EHBM 的各个维度。EHBM 被采用作为一个概念框架，以预测与健康相关的行为，解释这些行为，并进一步开发行为改变干预措施（图 1）。EHBM 基于一个假设，即个体采取某些预防行动的可能性，并专注于遵循预防健康行为。它通常被应用于解决公共卫生问题，以降低风险、预防和促进社区健康。 18 18 ^(18){ }^{18} 接受 PHE 的行为意图（以下简称 BIE）及其决定因素是通过 EHBM 的八个领域进行测量的。 根据这一理论，当个体感知到自己易受某种疾病或健康问题影响（感知易感性）、感知到疾病的严重性（感知严重性）、感知到采取健康行为的好处（感知好处）、相信行为的好处超过成本（感知障碍）、对自己成功执行该行为的能力有信心（感知自我效能）、具备健康知识和社会支持，并且存在促使个体采取这些行为的因素（行动提示）时，他们会采取某些预防行为。
Figure I Conceptual framework based on extended health belief model.
图 I 基于扩展健康信念模型的概念框架。
The questionnaire consisted of three parts. The first part included basic demographic information, such as sociodemographic data (gender, age, education level, marital status), economic status (per capita annual household income), health-related behavioral factor (tobacco use, alcohol use, exercise), and the need factor (number of noncommunicable chronic diseases). The second part was designed to explore BIE ( 1 item). The third part (49 items) targeted psychology, which was the major part based on selfdesigned eight-dimensional EHBM (Table 1). It contained statements regarding attitude and perceptions relating to PHE use behavior: perceived barriers ( 6 items), perceived benefits (3 items), perceived susceptibility ( 5 items), perceived severity ( 6 items), cues to action ( 5 items), self-efficacy ( 5 items), health knowledge ( 7 items), and social support ( 12 items). BIE, perceived barriers, perceived benefits, perceived susceptibility, perceived severity, cues to action, and selfefficacy were defined as an integrated view and these measurement items were revised from previous surveys. 19 − 21 19 − 21 ^(19-21){ }^{19-21} Furthermore, social support items were selected based previous research, 22 22 ^(22){ }^{22} which contained emotional support, tangible support, affectionate support, and positive interaction.
问卷由三个部分组成。第一部分包括基本的人口统计信息，如社会人口数据（性别、年龄、教育水平、婚姻状况）、经济状况（人均年家庭收入）、与健康相关的行为因素（吸烟、饮酒、锻炼）和需求因素（非传染性慢性疾病的数量）。第二部分旨在探讨 BIE（1 个项目）。第三部分（49 个项目）针对心理学，这是基于自设计的八维 EHBM（表 1）的主要部分。它包含与 PHE 使用行为相关的态度和感知的陈述：感知障碍（6 个项目）、感知收益（3 个项目）、感知易感性（5 个项目）、感知严重性（6 个项目）、行动线索（5 个项目）、自我效能（5 个项目）、健康知识（7 个项目）和社会支持（12 个项目）。BIE、感知障碍、感知收益、感知易感性、感知严重性、行动线索和自我效能被定义为一个综合视角，这些测量项目是从之前的调查中修订而来的。 此外，社会支持项目是根据之前的研究选择的，其中包括情感支持、实质支持、关爱支持和积极互动。
Table I Examples of the Questionnaire Items
表 I 问卷项目示例
Variables 变量 Items 物品 Range 范围 Item Example 项目示例
BIE I I~5

我打算定期进行 PHE。
I intend to perform PHE
regularly.
I intend to perform PHE regularly.| I intend to perform PHE | | :--- | | regularly. |
Self-efficacy 自我效能 5 5 ∼ 25 5 ∼ 25 5∼255 \sim 25

一般来说，我可以定期锻炼。
In general, I can exercise
regularly.
In general, I can exercise regularly.| In general, I can exercise | | :--- | | regularly. |

感知易感性
Perceived
susceptibility
Perceived susceptibility| Perceived | | :--- | | susceptibility |
 5 5 ∼ 25 5 ∼ 25 5∼255 \sim 25

我很担心如果我不进行公共卫生应急（PHE），会生病。
I worry a lot about becoming ill if
I do not perform PHE.
I worry a lot about becoming ill if I do not perform PHE.| I worry a lot about becoming ill if | | :--- | | I do not perform PHE. |
 感知的严重性
Perceived
severity
Perceived severity| Perceived | | :--- | | severity |
 6 6 ∼ 30 6 ∼ 30 6∼306 \sim 30

如果我生病了，我的职业将会受到威胁。
If I had an illness, my career
would be endangered.
If I had an illness, my career would be endangered.| If I had an illness, my career | | :--- | | would be endangered. |
 感知的好处
Perceived
benefits
Perceived benefits| Perceived | | :--- | | benefits |
 3 3 ∼ 15 3 ∼ 15 3∼153 \sim 15

当我进行 PHE 时，我不太担心疾病。
When I perform PHE, I do not
worry as much about illnesses.
When I perform PHE, I do not worry as much about illnesses.| When I perform PHE, I do not | | :--- | | worry as much about illnesses. |
 感知障碍
Perceived
barriers
Perceived barriers| Perceived | | :--- | | barriers |
 6 6 ∼ 30 6 ∼ 30 6∼306 \sim 30

进行 PHE 可能会耗费时间。
Performing PHE can be time-
consuming.
Performing PHE can be time- consuming.| Performing PHE can be time- | | :--- | | consuming. |
 行动提示
Cues to
action
Cues to action| Cues to | | :--- | | action |
 5 5 ∼ 25 5 ∼ 25 5∼255 \sim 25

村医的建议促使我进行公共卫生教育。
Village doctors'
recommendations prompted me
to perform PHE.
Village doctors' recommendations prompted me to perform PHE.| Village doctors' | | :--- | | recommendations prompted me | | to perform PHE. |
 健康知识
Health
knowledge
Health knowledge| Health | | :--- | | knowledge |
 7 7 ∼ 35 7 ∼ 35 7∼357 \sim 35

我熟悉临床预防服务。
I am familiar with the clinical
preventive services.
I am familiar with the clinical preventive services.| I am familiar with the clinical | | :--- | | preventive services. |
 社会支持
Social
support
Social support| Social | | :--- | | support |
 12 I2~60

我可以从我的家人那里获得必要的情感支持。
I can get the necessary emotional
support from my family.
I can get the necessary emotional support from my family.| I can get the necessary emotional | | :--- | | support from my family. |
Variables Items Range Item Example BIE I I~5 "I intend to perform PHE regularly." Self-efficacy 5 5∼25 "In general, I can exercise regularly." "Perceived susceptibility" 5 5∼25 "I worry a lot about becoming ill if I do not perform PHE." "Perceived severity" 6 6∼30 "If I had an illness, my career would be endangered." "Perceived benefits" 3 3∼15 "When I perform PHE, I do not worry as much about illnesses." "Perceived barriers" 6 6∼30 "Performing PHE can be time- consuming." "Cues to action" 5 5∼25 "Village doctors' recommendations prompted me to perform PHE." "Health knowledge" 7 7∼35 "I am familiar with the clinical preventive services." "Social support" 12 I2~60 "I can get the necessary emotional support from my family."| Variables | Items | Range | Item Example | | :--- | :--- | :--- | :--- | | BIE | I | I~5 | I intend to perform PHE <br> regularly. | | Self-efficacy | 5 | $5 \sim 25$ | In general, I can exercise <br> regularly. | | Perceived <br> susceptibility | 5 | $5 \sim 25$ | I worry a lot about becoming ill if <br> I do not perform PHE. | | Perceived <br> severity | 6 | $6 \sim 30$ | If I had an illness, my career <br> would be endangered. | | Perceived <br> benefits | 3 | $3 \sim 15$ | When I perform PHE, I do not <br> worry as much about illnesses. | | Perceived <br> barriers | 6 | $6 \sim 30$ | Performing PHE can be time- <br> consuming. | | Cues to <br> action | 5 | $5 \sim 25$ | Village doctors' <br> recommendations prompted me <br> to perform PHE. | | Health <br> knowledge | 7 | $7 \sim 35$ | I am familiar with the clinical <br> preventive services. | | Social <br> support | 12 | I2~60 | I can get the necessary emotional <br> support from my family. |
Abbreviations: BIE, behavioral intention of PHE; PHE, periodic health examination.
缩写：BIE，公共卫生行为意图；PHE，定期健康检查。
Health knowledge items were modified based on a previous study. 23 23 ^(23){ }^{23} The respondents were asked to indicate their agreement with statements on a five-point Likert-type scale (strongly disagree = 1 = 1 =1=1, disagree = 2 = 2 =2=2, neutral = 3 = 3 =3=3, agree = 4 = 4 =4=4, strongly agree = 5 = 5 =5=5 ).
健康知识项目根据之前的研究进行了修改。受访者被要求在五点李克特量表上表示他们对陈述的同意程度（强烈不同意 = 1 = 1 =1=1 ，不同意 = 2 = 2 =2=2 ，中立 = 3 = 3 =3=3 ，同意 = 4 = 4 =4=4 ，强烈同意 = 5 = 5 =5=5 ）。
The Cronbach’s α α alpha\alpha values for all the scales ranged from 0.72 to 0.94 . A panel of five experts, including family physicians, practitioner nurses, and public health experts, were invited to validate the questionnaire. Most items were evaluated by the experts to ensure appropriateness, with the Content Validity Index of 0.912 .
所有量表的 Cronbach's α α alpha\alpha 值范围为 0.72 到 0.94。邀请了包括家庭医生、执业护士和公共卫生专家在内的五位专家对问卷进行验证。大多数项目经过专家评估以确保适当性，内容效度指数为 0.912。

Statistics 统计数据

Data was processed using Microsoft Access and analyzed using STATA 15.1. The characteristics of subjects were described with number (percent). Mean (SD) was used to describe the scores of EHBM and BIE, and t t tt-tests or the oneway analysis of variance (ANOVA) were performed for groups comparisons. Pearson’s correlation analysis was conducted between EHBM constructs and BIE. In addition, a multiple linear regression analysis was used to identify the association between EHBM and BIE, with potential confounding factors adjusted. Standardized regression coefficient (B’) was used to explain the strength of the association. All P P PP values reported were two-sided, and P P PP values below 0.05 were considered statistically significant.
数据使用 Microsoft Access 处理，并使用 STATA 15.1 进行分析。用数字（百分比）描述受试者的特征。均值（标准差）用于描述 EHBM 和 BIE 的得分，并对组间比较进行了 t t tt -检验或单因素方差分析（ANOVA）。对 EHBM 构念和 BIE 之间进行了 Pearson 相关分析。此外，使用多元线性回归分析来识别 EHBM 与 BIE 之间的关联，并调整潜在的混杂因素。标准化回归系数（B'）用于解释关联的强度。所有报告的 P P PP 值均为双侧， P P PP 值低于 0.05 被认为具有统计学意义。

Results 结果

Participant Characteristics
参与者特征

Table 2 presents participant characteristics. The participants were predominantly male ( 65.6 % 65.6 % 65.6%65.6 \% ) and had an average age of 69.3 ± 7.1 69.3 ± 7.1 69.3+-7.169.3 \pm 7.1 years. The majority ( 78.2 % 78.2 % 78.2%78.2 \% ) had completed no more than junior school education. Approximately half of the families (56.6%) reported a per capita annual household income of less than 20,000 CNY (approximately 2950 USD). In addition, 75.6 % 75.6 % 75.6%75.6 \% of participants were married. Overall, 372 of the 509 respondents (73.1%) had one or more chronic diseases. Furthermore, health-related behavior information was collected, including tobacco use, alcohol use, and regular exercise. Overall, 34.4 % 34.4 % 34.4%34.4 \% of the respondents reported currently being a smoker, 37.5 % 37.5 % 37.5%37.5 \% reported currently being a drinker, and 66.8 % 66.8 % 66.8%66.8 \% reported regular exercise.
表 2 展示了参与者的特征。参与者主要为男性（ 65.6 % 65.6 % 65.6%65.6 \% ），平均年龄为 69.3 ± 7.1 69.3 ± 7.1 69.3+-7.169.3 \pm 7.1 岁。大多数（ 78.2 % 78.2 % 78.2%78.2 \% ）的教育水平不超过初中。约一半的家庭（56.6%）报告人均年收入低于 20,000 元人民币（约 2950 美元）。此外， 75.6 % 75.6 % 75.6%75.6 \% 的参与者已婚。总体而言，509 名受访者中有 372 人（73.1%）患有一种或多种慢性疾病。此外，还收集了与健康相关的行为信息，包括吸烟、饮酒和定期锻炼。总体而言， 34.4 % 34.4 % 34.4%34.4 \% 的受访者报告目前为吸烟者， 37.5 % 37.5 % 37.5%37.5 \% 报告目前为饮酒者， 66.8 % 66.8 % 66.8%66.8 \% 报告定期锻炼。

Scores of EHBM Variables EHBM 变量的分数

Table 3 shows the scores of the participants’ perceptions of PHE, and variables among respondents with different ages,
表 3 显示了参与者对 PHE 的感知得分，以及不同年龄受访者之间的变量
Table 2 Characteristics of Rural Elderly Aged 60 Years and Over
表 2 60 岁及以上农村老年人的特征
Characteristics 特征 Frequency  频率 ( n = 509 ) ( n = 509 ) (n=509)(n=509)
 百分比 (%)
Percentage
(%)
Percentage (%)| Percentage | | :--- | | (%) |
Socio-demographic characteristics
社会人口特征

年龄 < 70 < 70 < 70<70 70~80 ≥ 80 ≥ 80 >= 80\geq 80
Age
< 70 < 70 < 70<70
70~80
≥ 80 ≥ 80 >= 80\geq 80
Age < 70 70~80 >= 80| Age | | :--- | | $<70$ | | 70~80 | | $\geq 80$ |
 298 152 59 298 152 59 {:[298],[152],[59]:}\begin{aligned} & 298 \\ & 152 \\ & 59 \end{aligned} 58.5 29.9 I I. 6 58.5 29.9  I I.  6 {:[58.5],[29.9],[" I I. "6]:}\begin{aligned} & 58.5 \\ & 29.9 \\ & \text { I I. } 6 \end{aligned}

性别 男性 女性
Gender
Male
Female
Gender Male Female| Gender | | :--- | | Male | | Female |
 334 175 334 175 {:[334],[175]:}\begin{aligned} & 334 \\ & 175 \end{aligned} 65.6 34.3 65.6 34.3 {:[65.6],[34.3]:}\begin{aligned} & 65.6 \\ & 34.3 \end{aligned}

婚姻状况 单身 已婚
Marital status
Single
Married
Marital status Single Married| Marital status | | :--- | | Single | | Married |
 124 385 124 385 {:[124],[385]:}\begin{aligned} & 124 \\ & 385 \end{aligned} 24.4 75.6 24.4 75.6 {:[24.4],[75.6]:}\begin{aligned} & 24.4 \\ & 75.6 \end{aligned}

教育水平 小学或以下 初中或以上
Education level
Primary school or below Junior school or above
Education level Primary school or below Junior school or above| Education level | | :--- | | Primary school or below Junior school or above |
 398 111 398 111 {:[398],[111]:}\begin{aligned} & 398 \\ & 111 \end{aligned} 78.2 21.8 78.2 21.8 {:[78.2],[21.8]:}\begin{aligned} & 78.2 \\ & 21.8 \end{aligned}
Economic status 经济状况
Per capita annual household Income (yuan)
人均年家庭收入（元） < 10 , 000 10 , 000 ∼ 20 , 000 ≥ 20 , 000 < 10 , 000 10 , 000 ∼ 20 , 000 ≥ 20 , 000 {:[ < 10","000],[10","000∼20","000],[ >= 20","000]:}\begin{aligned} & <10,000 \\ & 10,000 \sim 20,000 \\ & \geq 20,000 \end{aligned}		 187 101 221 187 101 221 {:[187],[101],[221]:}\begin{aligned} & 187 \\ & 101 \\ & 221 \end{aligned} 36.7 19.8 43.4 36.7 19.8 43.4 {:[36.7],[19.8],[43.4]:}\begin{aligned} & 36.7 \\ & 19.8 \\ & 43.4 \end{aligned}
Health-related behavioral factor
健康相关行为因素

烟草使用 非吸烟者 前吸烟者 现吸烟者
Tobacco use
Nonsmoker
Ex-smoker
Current smoker
Tobacco use Nonsmoker Ex-smoker Current smoker| Tobacco use | | :--- | | Nonsmoker | | Ex-smoker | | Current smoker |
 263 71 175 263 71 175 {:[263],[71],[175]:}\begin{aligned} & 263 \\ & 71 \\ & 175 \end{aligned} 51.7 13.9 34.4 51.7 13.9 34.4 {:[51.7],[13.9],[34.4]:}\begin{aligned} & 51.7 \\ & 13.9 \\ & 34.4 \end{aligned}

酒精使用 不饮酒者 戒酒者 现饮者
Alcohol use
Nondrinker
Abstainer
Current drinker
Alcohol use Nondrinker Abstainer Current drinker| Alcohol use | | :--- | | Nondrinker | | Abstainer | | Current drinker |
 258 60 191 258 60 191 {:[258],[60],[191]:}\begin{aligned} & 258 \\ & 60 \\ & 191 \end{aligned} 50.7 11.8 37.5 50.7 11.8 37.5 {:[50.7],[11.8],[37.5]:}\begin{aligned} & 50.7 \\ & 11.8 \\ & 37.5 \end{aligned}

定期锻炼 不 < 45 min / d < 45 min / d < 45min//d<45 \mathrm{~min} / \mathrm{d} ≥ 45 min / d ≥ 45 min / d >= 45min//d\geq 45 \mathrm{~min} / \mathrm{d}
Exercise regularly
No
< 45 min / d < 45 min / d < 45min//d<45 \mathrm{~min} / \mathrm{d}
≥ 45 min / d ≥ 45 min / d >= 45min//d\geq 45 \mathrm{~min} / \mathrm{d}
Exercise regularly No < 45min//d >= 45min//d| Exercise regularly | | :--- | | No | | $<45 \mathrm{~min} / \mathrm{d}$ | | $\geq 45 \mathrm{~min} / \mathrm{d}$ |
 169 182 158 169 182 158 {:[169],[182],[158]:}\begin{aligned} & 169 \\ & 182 \\ & 158 \end{aligned} 33.2 35.8 31.0 33.2 35.8 31.0 {:[33.2],[35.8],[31.0]:}\begin{aligned} & 33.2 \\ & 35.8 \\ & 31.0 \end{aligned}
Need factor 需要因素

慢性病状态 否 是
Chronic disease status
No
Yes
Chronic disease status No Yes| Chronic disease status | | :--- | | No | | Yes |
 137 372 137 372 {:[137],[372]:}\begin{aligned} & 137 \\ & 372 \end{aligned} 26.9 73.1 26.9 73.1 {:[26.9],[73.1]:}\begin{aligned} & 26.9 \\ & 73.1 \end{aligned}
Characteristics Frequency (n=509) "Percentage (%)" Socio-demographic characteristics "Age < 70 70~80 >= 80" "298 152 59" "58.5 29.9 I I. 6" "Gender Male Female" "334 175" "65.6 34.3" "Marital status Single Married" "124 385" "24.4 75.6" "Education level Primary school or below Junior school or above" "398 111" "78.2 21.8" Economic status Per capita annual household Income (yuan) " < 10,000 10,000∼20,000 >= 20,000" "187 101 221" "36.7 19.8 43.4" Health-related behavioral factor "Tobacco use Nonsmoker Ex-smoker Current smoker" "263 71 175" "51.7 13.9 34.4" "Alcohol use Nondrinker Abstainer Current drinker" "258 60 191" "50.7 11.8 37.5" "Exercise regularly No < 45min//d >= 45min//d" "169 182 158" "33.2 35.8 31.0" Need factor "Chronic disease status No Yes" "137 372" "26.9 73.1"| Characteristics | Frequency $(n=509)$ | Percentage <br> (%) | | :---: | :---: | :---: | | Socio-demographic characteristics | | | | Age <br> $<70$ <br> 70~80 <br> $\geq 80$ | $\begin{aligned} & 298 \\ & 152 \\ & 59 \end{aligned}$ | $\begin{aligned} & 58.5 \\ & 29.9 \\ & \text { I I. } 6 \end{aligned}$ | | Gender <br> Male <br> Female | $\begin{aligned} & 334 \\ & 175 \end{aligned}$ | $\begin{aligned} & 65.6 \\ & 34.3 \end{aligned}$ | | Marital status <br> Single <br> Married | $\begin{aligned} & 124 \\ & 385 \end{aligned}$ | $\begin{aligned} & 24.4 \\ & 75.6 \end{aligned}$ | | Education level <br> Primary school or below Junior school or above | $\begin{aligned} & 398 \\ & 111 \end{aligned}$ | $\begin{aligned} & 78.2 \\ & 21.8 \end{aligned}$ | | Economic status | | | | Per capita annual household Income (yuan) $\begin{aligned} & <10,000 \\ & 10,000 \sim 20,000 \\ & \geq 20,000 \end{aligned}$ | $\begin{aligned} & 187 \\ & 101 \\ & 221 \end{aligned}$ | $\begin{aligned} & 36.7 \\ & 19.8 \\ & 43.4 \end{aligned}$ | | Health-related behavioral factor | | | | Tobacco use <br> Nonsmoker <br> Ex-smoker <br> Current smoker | $\begin{aligned} & 263 \\ & 71 \\ & 175 \end{aligned}$ | $\begin{aligned} & 51.7 \\ & 13.9 \\ & 34.4 \end{aligned}$ | | Alcohol use <br> Nondrinker <br> Abstainer <br> Current drinker | $\begin{aligned} & 258 \\ & 60 \\ & 191 \end{aligned}$ | $\begin{aligned} & 50.7 \\ & 11.8 \\ & 37.5 \end{aligned}$ | | Exercise regularly <br> No <br> $<45 \mathrm{~min} / \mathrm{d}$ <br> $\geq 45 \mathrm{~min} / \mathrm{d}$ | $\begin{aligned} & 169 \\ & 182 \\ & 158 \end{aligned}$ | $\begin{aligned} & 33.2 \\ & 35.8 \\ & 31.0 \end{aligned}$ | | Need factor | | | | Chronic disease status <br> No <br> Yes | $\begin{aligned} & 137 \\ & 372 \end{aligned}$ | $\begin{aligned} & 26.9 \\ & 73.1 \end{aligned}$ |
gender, education levels, per capita annual household income, marital status, health-related behavioral factors, and chronic disease status. Of the 509 respondents, the average score of behavioral intention was 4.43 ( 0.80 : behavioral intention), and scores of the eight dimensions of
性别、教育水平、人均年家庭收入、婚姻状况、与健康相关的行为因素和慢性疾病状态。在 509 名受访者中，行为意图的平均分为 4.43（0.80：行为意图），八个维度的分数为
EHBM were 21.33 (3.18: self-efficacy), 21.32 (5.51: health knowledge), 46.72 (13.08: social support), 17.87 (5.12: perceived susceptibility), 11.22 (3.68: perceived severity), 12.12 (2.90: perceived benefits), 10.91 (5.28: perceived barriers), 19.83 (4.73: cues to action), respectively.
EHBM 的得分分别为 21.33（3.18：自我效能），21.32（5.51：健康知识），46.72（13.08：社会支持），17.87（5.12：感知易感性），11.22（3.68：感知严重性），12.12（2.90：感知益处），10.91（5.28：感知障碍），19.83（4.73：行动提示）。
As depicted in Table 3, participants who had higher BIE were more likely to be 60-69 years old, female, exsmoker, abstainer, had per capita annual household income ranging from 10,000 to 20,000 CNY (1473-2950 USD). Participants who were male ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), were ex-smoker ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), were abstainer ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) and exercised regularly ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) perceived more self-efficacy. Participants who were aged 60-69 ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), were ex-smoker ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) and were abstainer ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ) perceived more social support. Participants who were female ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), were ex-smoker ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05), were abstainer ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) and exercised regularly ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ) perceived more susceptibility. Participants who had lower education level ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), were female ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), and had no habit of smoking and drinking ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ) perceived more severity. Participants who were aged 60-69 ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), were female ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05), were ex-smoker ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), were abstainer ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) and had an per capita annual household income ranging from 10,000 to 20,000 CNY (1473-2950 USD; P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ) perceived more benefits. Participants who were aged ≥ 80 ( P < 0.05 ) ≥ 80 ( P < 0.05 ) >= 80(P < 0.05)\geq 80(\mathrm{P}<0.05), were male ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), had per capita annual household income below 10,000 CNY ( 1473 USD; P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ), and had a habit of smoking ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ) and drinking ( P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ) perceived more barriers. Participants who were aged 60 − 69 ( P < 0.05 ) 60 − 69 ( P < 0.05 ) 60-69(P < 0.05)60-69(\mathrm{P}<0.05) and had an per capita annual household income ranging from 10,000 to 20,000 CNY (1473-2950 USD; P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ) scored higher on cues to action.
如表 3 所示，具有较高 BIE 的参与者更可能是 60-69 岁，女性，前吸烟者，禁酒者，家庭人均年收入在 10,000 到 20,000 元人民币（1473-2950 美元）之间。男性参与者（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），前吸烟者（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），禁酒者（ ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) ）和定期锻炼（ ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) ）的参与者感知到更多的自我效能。60-69 岁（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），前吸烟者（ ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) ）和禁酒者（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ）的参与者感知到更多的社会支持。女性参与者（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），前吸烟者（ ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) ），禁酒者（ ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) ）和定期锻炼（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ）的参与者感知到更多的易感性。教育水平较低（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），女性（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），并且没有吸烟和饮酒习惯（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ）的参与者感知到更多的严重性。60-69 岁（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），女性（ ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) ），前吸烟者（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），禁酒者（ ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(\mathrm{P}<0.05) ）并且家庭人均年收入在 10,000 到 20,000 元人民币（1473-2950 美元； P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ）的参与者感知到更多的益处。 年龄在 ≥ 80 ( P < 0.05 ) ≥ 80 ( P < 0.05 ) >= 80(P < 0.05)\geq 80(\mathrm{P}<0.05) 岁的参与者，男性（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），人均年家庭收入低于 10,000 元人民币（1473 美元； P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ），并且有吸烟（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ）和饮酒（ P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ）的习惯，感知到更多的障碍。年龄在 60 − 69 ( P < 0.05 ) 60 − 69 ( P < 0.05 ) 60-69(P < 0.05)60-69(\mathrm{P}<0.05) 岁且人均年家庭收入在 10,000 到 20,000 元人民币（1473-2950 美元； P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 ）的参与者在行动提示上得分更高。

Pearson's Correlation Analysis Between BIE and EHBM Constructs
BIE 与 EHBM 构念之间的皮尔逊相关分析

Table 4 shows the correlations between each of the EHBM construct and BIE using Pearson’s correlation analysis. The results revealed that BIE was significantly correlated with self-efficacy, social support, susceptibility, benefits, barriers, and cues to action. P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 was considered statistically significant. Positive correlations were found between BIE and perceived self-efficacy, social support, perceived susceptibility, perceived benefits, and cues to action. Negative correlations were revealed between BIE and perceived barriers. BIE was not associated with health knowledge or perceived severity.
表 4 显示了每个 EHBM 构念与 BIE 之间的相关性，使用皮尔逊相关分析。结果显示，BIE 与自我效能、社会支持、易感性、益处、障碍和行动线索显著相关。 P < 0.05 P < 0.05 P < 0.05\mathrm{P}<0.05 被认为具有统计学意义。BIE 与感知自我效能、社会支持、感知易感性、感知益处和行动线索之间存在正相关。BIE 与感知障碍之间则显示出负相关。BIE 与健康知识或感知严重性没有关联。
Table 3 Participants’ Scores on BIE, and Variables of EHBM
表 3 参与者在 BIE 上的得分及 EHBM 的变量
Demographic Features 人口特征
 自我效能
Self-
Efficacy
Self- Efficacy| Self- | | :--- | | Efficacy |
 Health Knowledge 健康知识 Social Support 社会支持 Susceptibility 易感性 Severity 严重性 Benefits 好处 Barriers 障碍
 行动提示
Cues to
Action
Cues to Action| Cues to | | :--- | | Action |
 BIE
Total 总计 21.33 ± 3.18 21.33 ± 3.18 21.33+-3.1821.33 \pm 3.18 21.32 ± 5.51 21.32 ± 5.51 21.32+-5.5121.32 \pm 5.51 46.72 ± 13.08 46.72 ± 13.08 46.72+-13.0846.72 \pm 13.08 17.87 ± 5.12 17.87 ± 5.12 17.87+-5.1217.87 \pm 5.12 11.22 ± 3.68 11.22 ± 3.68 {:[11.22],[+-3.68]:}\begin{aligned} & 11.22 \\ & \pm 3.68 \end{aligned} 12.12 ± 2.90 12.12 ± 2.90 {:[12.12],[+-2.90]:}\begin{aligned} & 12.12 \\ & \pm 2.90 \end{aligned} 10.91 ± 5.28 10.91 ± 5.28 {:[10.91],[+-5.28]:}\begin{aligned} & 10.91 \\ & \pm 5.28 \end{aligned} 19.83 ± 4.73 19.83 ± 4.73 19.83+-4.7319.83 \pm 4.73 4.43 ± 0.80 4.43 ± 0.80 {:[4.43],[+-0.80]:}\begin{aligned} & 4.43 \\ & \pm 0.80 \end{aligned}
Age(years) 年龄（年） < 70 70 ∼ 80 ≥ 80 < 70 70 ∼ 80 ≥ 80 {:[ < 70],[70∼80],[ >= 80]:}\begin{aligned} & <70 \\ & 70 \sim 80 \\ & \geq 80 \end{aligned} 21.15 ± 3.51 21.53 ± 2.70 21.78 ± 2.40 21.15 ± 3.51 21.53 ± 2.70 21.78 ± 2.40 {:[21.15+-3.51],[21.53+-2.70],[21.78+-2.40]:}\begin{aligned} & 21.15 \pm 3.51 \\ & 21.53 \pm 2.70 \\ & 21.78 \pm 2.40 \end{aligned} 21.45 ± 5.48 20.61 ± 5.47 22.48 ± 5.64 21.45 ± 5.48 20.61 ± 5.47 22.48 ± 5.64 {:[21.45+-5.48],[20.61+-5.47],[22.48+-5.64]:}\begin{aligned} & 21.45 \pm 5.48 \\ & 20.61 \pm 5.47 \\ & 22.48 \pm 5.64 \end{aligned}

47.47 ± 12.55 ∗ ± 12.55 ∗ +-12.55^(**)\pm 12.55^{*} 46.96±12.14 46.96±12.1446.96+-12.1446.96 \pm 12.14 42.31±16.92 42.31±16.9242.31+-16.9242.31 \pm 16.92
47.47 ± 12.55 ∗ ± 12.55 ∗ +-12.55^(**)\pm 12.55^{*}
46.96 ± 12.14 46.96 ± 12.14 46.96+-12.1446.96 \pm 12.14 42.31 ± 16.92 42.31 ± 16.92 42.31+-16.9242.31 \pm 16.92
47.47 +-12.55^(**) 46.96+-12.14 42.31+-16.92| 47.47 $\pm 12.55^{*}$ | | :--- | | $46.96 \pm 12.14$ $42.31 \pm 16.92$ |
 18.12 ± 4.68 17.61 ± 5.49 17.29 ± 6.13 18.12 ± 4.68 17.61 ± 5.49 17.29 ± 6.13 {:[18.12+-4.68],[17.61+-5.49],[17.29+-6.13]:}\begin{aligned} & 18.12 \pm 4.68 \\ & 17.61 \pm 5.49 \\ & 17.29 \pm 6.13 \end{aligned} 11.43 ± 3.59 10.89 ± 3.84 11.05 ± 3.72 11.43 ± 3.59 10.89 ± 3.84 11.05 ± 3.72 {:[11.43],[+-3.59],[10.89],[+-3.84],[11.05],[+-3.72]:}\begin{aligned} & 11.43 \\ & \pm 3.59 \\ & 10.89 \\ & \pm 3.84 \\ & 11.05 \\ & \pm 3.72 \end{aligned} 12.56 ± 2.60 # 11.80 ± 2.86 10.69 ± 3.79 12.56 ± 2.60 # 11.80 ± 2.86 10.69 ± 3.79 {:[12.56],[+-2.60^(#)],[11.80],[+-2.86],[10.69],[+-3.79]:}\begin{aligned} & 12.56 \\ & \pm 2.60^{\#} \\ & 11.80 \\ & \pm 2.86 \\ & 10.69 \\ & \pm 3.79 \end{aligned} 10.34 ± 4.62 # 10.72 ± 4.72 14.25 ± 8.01 10.34 ± 4.62 # 10.72 ± 4.72 14.25 ± 8.01 {:[10.34],[+-4.62^(#)],[10.72],[+-4.72],[14.25],[+-8.01]:}\begin{aligned} & 10.34 \\ & \pm 4.62^{\#} \\ & 10.72 \\ & \pm 4.72 \\ & 14.25 \\ & \pm 8.01 \end{aligned} 20.12 ± 4.50 # 19.99 ± 4.32 17.92 ± 6.32 20.12 ± 4.50 # 19.99 ± 4.32 17.92 ± 6.32 {:[20.12+-4.50^(#)],[19.99+-4.32],[17.92+-6.32]:}\begin{aligned} & 20.12 \pm 4.50^{\#} \\ & 19.99 \pm 4.32 \\ & 17.92 \pm 6.32 \end{aligned} 4.54 ± 0.67 # 4.43 ± 0.71 3.92 ± 1.29 4.54 ± 0.67 # 4.43 ± 0.71 3.92 ± 1.29 {:[4.54],[+-0.67^(#)],[4.43],[+-0.71],[3.92],[+-1.29]:}\begin{aligned} & 4.54 \\ & \pm 0.67^{\#} \\ & 4.43 \\ & \pm 0.71 \\ & 3.92 \\ & \pm 1.29 \end{aligned}
Gender 性别
 男性 女性
Male
Female
Male Female| Male | | :--- | | Female |
 22.15 ± 2.61 # 19.78 ± 3.57 22.15 ± 2.61 # 19.78 ± 3.57 {:[22.15],[+-2.61^(#)],[19.78+-3.57]:}\begin{aligned} & 22.15 \\ & \pm 2.61^{\#} \\ & 19.78 \pm 3.57 \end{aligned} 21.20 ± 5.53 21.53 ± 5.50 21.20 ± 5.53 21.53 ± 5.50 {:[21.20+-5.53],[21.53+-5.50]:}\begin{aligned} & 21.20 \pm 5.53 \\ & 21.53 \pm 5.50 \end{aligned} 45.96 ± 13.90 48.16 ± 11.27 45.96 ± 13.90 48.16 ± 11.27 {:[45.96+-13.90],[48.16+-11.27]:}\begin{aligned} & 45.96 \pm 13.90 \\ & 48.16 \pm 11.27 \end{aligned} 17.53 ± 5.38 ∗ 18.51 ± 4.52 17.53 ± 5.38 ∗ 18.51 ± 4.52 {:[17.53+-5.38^(**)],[18.51+-4.52]:}\begin{aligned} & 17.53 \pm 5.38^{*} \\ & 18.51 \pm 4.52 \end{aligned} 10.93 ± 3.60 ∗ 11.79 ± 3.78 10.93 ± 3.60 ∗ 11.79 ± 3.78 {:[10.93],[+-3.60^(**)],[11.79],[+-3.78]:}\begin{aligned} & 10.93 \\ & \pm 3.60^{*} \\ & 11.79 \\ & \pm 3.78 \end{aligned} 11.91 ± 3.10 ∗ 12.52 ± 2.43 11.91 ± 3.10 ∗ 12.52 ± 2.43 {:[11.91],[+-3.10^(**)],[12.52],[+-2.43]:}\begin{aligned} & 11.91 \\ & \pm 3.10^{*} \\ & 12.52 \\ & \pm 2.43 \end{aligned} 11.50 ± 6.10 # 9.77 ± 2.89 11.50 ± 6.10 # 9.77 ± 2.89 {:[11.50],[+-6.10^(#)],[9.77+-2.89]:}\begin{aligned} & 11.50 \\ & \pm 6.10^{\#} \\ & 9.77 \pm 2.89 \end{aligned} 19.66 ± 5.03 20.14 ± 4.10 19.66 ± 5.03 20.14 ± 4.10 {:[19.66+-5.03],[20.14+-4.10]:}\begin{aligned} & 19.66 \pm 5.03 \\ & 20.14 \pm 4.10 \end{aligned} 4.31 ± 0.90 # 4.66 ± 0.47 4.31 ± 0.90 # 4.66 ± 0.47 {:[4.31],[+-0.90^(#)],[4.66],[+-0.47]:}\begin{aligned} & 4.31 \\ & \pm 0.90^{\#} \\ & 4.66 \\ & \pm 0.47 \end{aligned}
Education 教育 Primary school or below Junior school or above
小学或以下 初中或以上		 21.27 ± 3.07 21.57 ± 3.52 21.27 ± 3.07 21.57 ± 3.52 {:[21.27+-3.07],[21.57+-3.52]:}\begin{aligned} & 21.27 \pm 3.07 \\ & 21.57 \pm 3.52 \end{aligned} 21.16 ± 5.35 21.88 ± 6.06 21.16 ± 5.35 21.88 ± 6.06 {:[21.16+-5.35],[21.88+-6.06]:}\begin{aligned} & 21.16 \pm 5.35 \\ & 21.88 \pm 6.06 \end{aligned} 46.95 ± 12.58 45.90 ± 14.79 46.95 ± 12.58 45.90 ± 14.79 {:[46.95+-12.58],[45.90+-14.79]:}\begin{aligned} & 46.95 \pm 12.58 \\ & 45.90 \pm 14.79 \end{aligned} 17.84 ± 5.03 17.97 ± 5.44 17.84 ± 5.03 17.97 ± 5.44 {:[17.84+-5.03],[17.97+-5.44]:}\begin{aligned} & 17.84 \pm 5.03 \\ & 17.97 \pm 5.44 \end{aligned} 11.41 ± 3.76 ∗ 10.55 ± 3.29 11.41 ± 3.76 ∗ 10.55 ± 3.29 {:[11.41],[+-3.76^(**)],[10.55],[+-3.29]:}\begin{aligned} & 11.41 \\ & \pm 3.76^{*} \\ & 10.55 \\ & \pm 3.29 \end{aligned} 12.07 ± 2.85 12.29 ± 3.09 12.07 ± 2.85 12.29 ± 3.09 {:[12.07],[+-2.85],[12.29],[+-3.09]:}\begin{aligned} & 12.07 \\ & \pm 2.85 \\ & 12.29 \\ & \pm 3.09 \end{aligned} 10.95 ± 5.10 10.75 ± 5.92 10.95 ± 5.10 10.75 ± 5.92 {:[10.95],[+-5.10],[10.75],[+-5.92]:}\begin{aligned} & 10.95 \\ & \pm 5.10 \\ & 10.75 \\ & \pm 5.92 \end{aligned} 19.77 ± 4.59 20.03 ± 5.23 19.77 ± 4.59 20.03 ± 5.23 {:[19.77+-4.59],[20.03+-5.23]:}\begin{aligned} & 19.77 \pm 4.59 \\ & 20.03 \pm 5.23 \end{aligned} 4.44 ± 0.77 4.43 ± 0.89 4.44 ± 0.77 4.43 ± 0.89 {:[4.44],[+-0.77],[4.43],[+-0.89]:}\begin{aligned} & 4.44 \\ & \pm 0.77 \\ & 4.43 \\ & \pm 0.89 \end{aligned}
Per capita annual household income
人均年家庭收入		 < 10 , 000 10 , 000 ∼ 20 , 000 ≥ 20 , 000 < 10 , 000 10 , 000 ∼ 20 , 000 ≥ 20 , 000 {:[ < 10","000],[10","000∼20","000],[ >= 20","000]:}\begin{aligned} & <10,000 \\ & 10,000 \sim 20,000 \\ & \geq 20,000 \end{aligned} 21.51 ± 2.92 21.13 ± 3.86 21.28 ± 3.04 21.51 ± 2.92 21.13 ± 3.86 21.28 ± 3.04 {:[21.51+-2.92],[21.13+-3.86],[21.28+-3.04]:}\begin{aligned} & 21.51 \pm 2.92 \\ & 21.13 \pm 3.86 \\ & 21.28 \pm 3.04 \end{aligned} 20.98 ± 5.60 22.29 ± 5.99 21.16 ± 5.17 20.98 ± 5.60 22.29 ± 5.99 21.16 ± 5.17 {:[20.98+-5.60],[22.29+-5.99],[21.16+-5.17]:}\begin{aligned} & 20.98 \pm 5.60 \\ & 22.29 \pm 5.99 \\ & 21.16 \pm 5.17 \end{aligned}
45.99 ± 13.95 45.99 ± 13.95 45.99+-13.9545.99 \pm 13.95
48.76 ± 12.11 48.76 ± 12.11 48.76+-12.1148.76 \pm 12.11
46.40 ± 12.71 46.40 ± 12.71 46.40+-12.7146.40 \pm 12.71
45.99+-13.95 48.76+-12.11 46.40+-12.71| $45.99 \pm 13.95$ | | :--- | | $48.76 \pm 12.11$ | | $46.40 \pm 12.71$ |
 17.59 ± 5.53 18.5 I ± 4.54 I 7.82 ± 5.00 17.59 ± 5.53 18.5 I ± 4.54 I 7.82 ± 5.00 {:[17.59+-5.53],[18.5I+-4.54],[I7.82+-5.00]:}\begin{aligned} & 17.59 \pm 5.53 \\ & 18.5 \mathrm{I} \pm 4.54 \\ & \mathrm{I} 7.82 \pm 5.00 \end{aligned} 11.12 ± 3.98 10.98 ± 3.62 11.42 ± 3.44 11.12 ± 3.98 10.98 ± 3.62 11.42 ± 3.44 {:[11.12],[+-3.98],[10.98],[+-3.62],[11.42],[+-3.44]:}\begin{aligned} & 11.12 \\ & \pm 3.98 \\ & 10.98 \\ & \pm 3.62 \\ & 11.42 \\ & \pm 3.44 \end{aligned} 11.69 ± 3.22 # 13.17 ± 2.13 12.00 ± 2.81 11.69 ± 3.22 # 13.17 ± 2.13 12.00 ± 2.81 {:[11.69],[+-3.22^(#)],[13.17],[+-2.13],[12.00],[+-2.81]:}\begin{aligned} & 11.69 \\ & \pm 3.22^{\#} \\ & 13.17 \\ & \pm 2.13 \\ & 12.00 \\ & \pm 2.81 \end{aligned} 11.65 ± 5.98 # 9.53 ± 3.80 10.91 ± 5.13 11.65 ± 5.98 # 9.53 ± 3.80 10.91 ± 5.13 {:[11.65],[+-5.98^(#)],[9.53+-3.80],[],[10.91],[+-5.13]:}\begin{aligned} & 11.65 \\ & \pm 5.98^{\#} \\ & 9.53 \pm 3.80 \\ & \\ & 10.91 \\ & \pm 5.13 \end{aligned} 19.00 ± 5.49 # 20.52 ± 4.34 20.21 ± 4.10 19.00 ± 5.49 # 20.52 ± 4.34 20.21 ± 4.10 {:[19.00+-5.49^(#)],[20.52+-4.34],[20.21+-4.10]:}\begin{aligned} & 19.00 \pm 5.49^{\#} \\ & 20.52 \pm 4.34 \\ & 20.21 \pm 4.10 \end{aligned} 4.35 ± 0.92 # 4.68 ± 0.47 4.39 ± 0.79 4.35 ± 0.92 # 4.68 ± 0.47 4.39 ± 0.79 {:[4.35],[+-0.92^(#)],[4.68],[+-0.47],[4.39],[+-0.79]:}\begin{aligned} & 4.35 \\ & \pm 0.92^{\#} \\ & 4.68 \\ & \pm 0.47 \\ & 4.39 \\ & \pm 0.79 \end{aligned}
Marital status 婚姻状况
 单身 已婚
Single
Married
Single Married| Single | | :--- | | Married |
 21.42 ± 2.83 21.31 ± 3.28 21.42 ± 2.83 21.31 ± 3.28 {:[21.42+-2.83],[21.31+-3.28]:}\begin{aligned} & 21.42 \pm 2.83 \\ & 21.31 \pm 3.28 \end{aligned} 20.89 ± 5.35 21.46 ± 5.56 20.89 ± 5.35 21.46 ± 5.56 {:[20.89+-5.35],[21.46+-5.56]:}\begin{aligned} & 20.89 \pm 5.35 \\ & 21.46 \pm 5.56 \end{aligned} 45.13 ± 13.20 47.23 ± 13.02 45.13 ± 13.20 47.23 ± 13.02 {:[45.13+-13.20],[47.23+-13.02]:}\begin{aligned} & 45.13 \pm 13.20 \\ & 47.23 \pm 13.02 \end{aligned} 17.76 ± 5.08 17.91 ± 5.14 17.76 ± 5.08 17.91 ± 5.14 {:[17.76+-5.08],[17.91+-5.14]:}\begin{aligned} & 17.76 \pm 5.08 \\ & 17.91 \pm 5.14 \end{aligned} 10.98 ± 3.69 11.30 ± 3.68 10.98 ± 3.69 11.30 ± 3.68 {:[10.98],[+-3.69],[11.30],[+-3.68]:}\begin{aligned} & 10.98 \\ & \pm 3.69 \\ & 11.30 \\ & \pm 3.68 \end{aligned} 11.72 ± 2.78 12.25 ± 2.93 11.72 ± 2.78 12.25 ± 2.93 {:[11.72],[+-2.78],[12.25],[+-2.93]:}\begin{aligned} & 11.72 \\ & \pm 2.78 \\ & 12.25 \\ & \pm 2.93 \end{aligned} 11.26 ± 5.17 10.76 ± 5.32 11.26 ± 5.17 10.76 ± 5.32 {:[11.26],[+-5.17],[10.76],[+-5.32]:}\begin{aligned} & 11.26 \\ & \pm 5.17 \\ & 10.76 \\ & \pm 5.32 \end{aligned} 19.26 ± 4.89 20.00 ± 4.67 19.26 ± 4.89 20.00 ± 4.67 {:[19.26+-4.89],[20.00+-4.67]:}\begin{aligned} & 19.26 \pm 4.89 \\ & 20.00 \pm 4.67 \end{aligned} 4.36 ± 0.75 4.46 ± 0.82 4.36 ± 0.75 4.46 ± 0.82 {:[4.36],[+-0.75],[4.46],[+-0.82]:}\begin{aligned} & 4.36 \\ & \pm 0.75 \\ & 4.46 \\ & \pm 0.82 \end{aligned}
Exercise regularly 定期锻炼
No
<45 min/d
≥ 45 min / d ≥ 45 min / d >= 45min//d\geq 45 \mathrm{~min} / \mathrm{d}
No <45 min/d >= 45min//d| No | | :--- | | <45 min/d | | $\geq 45 \mathrm{~min} / \mathrm{d}$ |
 20.37 ± 3.63 # 21.63 ± 3 22.03 ± 2.56 20.37 ± 3.63 # 21.63 ± 3 22.03 ± 2.56 {:[20.37],[+-3.63^(#)],[21.63+-3],[],[22.03+-2.56]:}\begin{aligned} & 20.37 \\ & \pm 3.63^{\#} \\ & 21.63 \pm 3 \\ & \\ & 22.03 \pm 2.56 \end{aligned} 21.49 ± 5.6 21.31 ± 5.91 21.14 ± 4.94 21.49 ± 5.6 21.31 ± 5.91 21.14 ± 4.94 {:[21.49+-5.6],[21.31+-5.91],[21.14+-4.94]:}\begin{aligned} & 21.49 \pm 5.6 \\ & 21.31 \pm 5.91 \\ & 21.14 \pm 4.94 \end{aligned} 45.34 ± 14.17 48.04 ± 12.37 46.66 ± 12.59 45.34 ± 14.17 48.04 ± 12.37 46.66 ± 12.59 {:[45.34+-14.17],[48.04+-12.37],[46.66+-12.59]:}\begin{aligned} & 45.34 \pm 14.17 \\ & 48.04 \pm 12.37 \\ & 46.66 \pm 12.59 \end{aligned} 17.01 ± 5.59 ∗ 18.36 ± 4.84 18.23 ± 4.81 17.01 ± 5.59 ∗ 18.36 ± 4.84 18.23 ± 4.81 {:[17.01+-5.59^(**)],[18.36+-4.84],[18.23+-4.81]:}\begin{aligned} & 17.01 \pm 5.59^{*} \\ & 18.36 \pm 4.84 \\ & 18.23 \pm 4.81 \end{aligned} 11.73 ± 4.04 10.92 ± 3.28 11.02 ± 3.68 11.73 ± 4.04 10.92 ± 3.28 11.02 ± 3.68 {:[11.73],[+-4.04],[10.92],[+-3.28],[11.02],[+-3.68]:}\begin{aligned} & 11.73 \\ & \pm 4.04 \\ & 10.92 \\ & \pm 3.28 \\ & 11.02 \\ & \pm 3.68 \end{aligned} 11.91 ± 3.21 12.39 ± 2.63 12.03 ± 2.84 11.91 ± 3.21 12.39 ± 2.63 12.03 ± 2.84 {:[11.91],[+-3.21],[12.39],[+-2.63],[12.03],[+-2.84]:}\begin{aligned} & 11.91 \\ & \pm 3.21 \\ & 12.39 \\ & \pm 2.63 \\ & 12.03 \\ & \pm 2.84 \end{aligned} 11.34 ± 5.98 10.75 ± 4.96 10.63 ± 4.85 11.34 ± 5.98 10.75 ± 4.96 10.63 ± 4.85 {:[11.34],[+-5.98],[10.75],[+-4.96],[10.63],[+-4.85]:}\begin{aligned} & 11.34 \\ & \pm 5.98 \\ & 10.75 \\ & \pm 4.96 \\ & 10.63 \\ & \pm 4.85 \end{aligned} 19.46 ± 5.04 19.55 ± 4.83 20.53 ± 4.21 19.46 ± 5.04 19.55 ± 4.83 20.53 ± 4.21 {:[19.46+-5.04],[19.55+-4.83],[20.53+-4.21]:}\begin{aligned} & 19.46 \pm 5.04 \\ & 19.55 \pm 4.83 \\ & 20.53 \pm 4.21 \end{aligned} 4.38 ± 0.96 4.45 ± 0.67 4.47 ± 0.75 4.38 ± 0.96 4.45 ± 0.67 4.47 ± 0.75 {:[4.38],[+-0.96],[4.45],[+-0.67],[4.47],[+-0.75]:}\begin{aligned} & 4.38 \\ & \pm 0.96 \\ & 4.45 \\ & \pm 0.67 \\ & 4.47 \\ & \pm 0.75 \end{aligned}
Demographic Features "Self- Efficacy" Health Knowledge Social Support Susceptibility Severity Benefits Barriers "Cues to Action" BIE Total 21.33+-3.18 21.32+-5.51 46.72+-13.08 17.87+-5.12 "11.22 +-3.68" "12.12 +-2.90" "10.91 +-5.28" 19.83+-4.73 "4.43 +-0.80" Age(years) " < 70 70∼80 >= 80" "21.15+-3.51 21.53+-2.70 21.78+-2.40" "21.45+-5.48 20.61+-5.47 22.48+-5.64" "47.47 +-12.55^(**) 46.96+-12.14 42.31+-16.92" "18.12+-4.68 17.61+-5.49 17.29+-6.13" "11.43 +-3.59 10.89 +-3.84 11.05 +-3.72" "12.56 +-2.60^(#) 11.80 +-2.86 10.69 +-3.79" "10.34 +-4.62^(#) 10.72 +-4.72 14.25 +-8.01" "20.12+-4.50^(#) 19.99+-4.32 17.92+-6.32" "4.54 +-0.67^(#) 4.43 +-0.71 3.92 +-1.29" Gender "Male Female" "22.15 +-2.61^(#) 19.78+-3.57" "21.20+-5.53 21.53+-5.50" "45.96+-13.90 48.16+-11.27" "17.53+-5.38^(**) 18.51+-4.52" "10.93 +-3.60^(**) 11.79 +-3.78" "11.91 +-3.10^(**) 12.52 +-2.43" "11.50 +-6.10^(#) 9.77+-2.89" "19.66+-5.03 20.14+-4.10" "4.31 +-0.90^(#) 4.66 +-0.47" Education Primary school or below Junior school or above "21.27+-3.07 21.57+-3.52" "21.16+-5.35 21.88+-6.06" "46.95+-12.58 45.90+-14.79" "17.84+-5.03 17.97+-5.44" "11.41 +-3.76^(**) 10.55 +-3.29" "12.07 +-2.85 12.29 +-3.09" "10.95 +-5.10 10.75 +-5.92" "19.77+-4.59 20.03+-5.23" "4.44 +-0.77 4.43 +-0.89" Per capita annual household income " < 10,000 10,000∼20,000 >= 20,000" "21.51+-2.92 21.13+-3.86 21.28+-3.04" "20.98+-5.60 22.29+-5.99 21.16+-5.17" "45.99+-13.95 48.76+-12.11 46.40+-12.71" "17.59+-5.53 18.5I+-4.54 I7.82+-5.00" "11.12 +-3.98 10.98 +-3.62 11.42 +-3.44" "11.69 +-3.22^(#) 13.17 +-2.13 12.00 +-2.81" "11.65 +-5.98^(#) 9.53+-3.80 10.91 +-5.13" "19.00+-5.49^(#) 20.52+-4.34 20.21+-4.10" "4.35 +-0.92^(#) 4.68 +-0.47 4.39 +-0.79" Marital status "Single Married" "21.42+-2.83 21.31+-3.28" "20.89+-5.35 21.46+-5.56" "45.13+-13.20 47.23+-13.02" "17.76+-5.08 17.91+-5.14" "10.98 +-3.69 11.30 +-3.68" "11.72 +-2.78 12.25 +-2.93" "11.26 +-5.17 10.76 +-5.32" "19.26+-4.89 20.00+-4.67" "4.36 +-0.75 4.46 +-0.82" Exercise regularly "No <45 min/d >= 45min//d" "20.37 +-3.63^(#) 21.63+-3 22.03+-2.56" "21.49+-5.6 21.31+-5.91 21.14+-4.94" "45.34+-14.17 48.04+-12.37 46.66+-12.59" "17.01+-5.59^(**) 18.36+-4.84 18.23+-4.81" "11.73 +-4.04 10.92 +-3.28 11.02 +-3.68" "11.91 +-3.21 12.39 +-2.63 12.03 +-2.84" "11.34 +-5.98 10.75 +-4.96 10.63 +-4.85" "19.46+-5.04 19.55+-4.83 20.53+-4.21" "4.38 +-0.96 4.45 +-0.67 4.47 +-0.75"| Demographic Features | | Self- <br> Efficacy | Health Knowledge | Social Support | Susceptibility | Severity | Benefits | Barriers | Cues to <br> Action | BIE | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | Total | | $21.33 \pm 3.18$ | $21.32 \pm 5.51$ | $46.72 \pm 13.08$ | $17.87 \pm 5.12$ | $\begin{aligned} & 11.22 \\ & \pm 3.68 \end{aligned}$ | $\begin{aligned} & 12.12 \\ & \pm 2.90 \end{aligned}$ | $\begin{aligned} & 10.91 \\ & \pm 5.28 \end{aligned}$ | $19.83 \pm 4.73$ | $\begin{aligned} & 4.43 \\ & \pm 0.80 \end{aligned}$ | | Age(years) | $\begin{aligned} & <70 \\ & 70 \sim 80 \\ & \geq 80 \end{aligned}$ | $\begin{aligned} & 21.15 \pm 3.51 \\ & 21.53 \pm 2.70 \\ & 21.78 \pm 2.40 \end{aligned}$ | $\begin{aligned} & 21.45 \pm 5.48 \\ & 20.61 \pm 5.47 \\ & 22.48 \pm 5.64 \end{aligned}$ | 47.47 $\pm 12.55^{*}$ <br> $46.96 \pm 12.14$ $42.31 \pm 16.92$ | $\begin{aligned} & 18.12 \pm 4.68 \\ & 17.61 \pm 5.49 \\ & 17.29 \pm 6.13 \end{aligned}$ | $\begin{aligned} & 11.43 \\ & \pm 3.59 \\ & 10.89 \\ & \pm 3.84 \\ & 11.05 \\ & \pm 3.72 \end{aligned}$ | $\begin{aligned} & 12.56 \\ & \pm 2.60^{\#} \\ & 11.80 \\ & \pm 2.86 \\ & 10.69 \\ & \pm 3.79 \end{aligned}$ | $\begin{aligned} & 10.34 \\ & \pm 4.62^{\#} \\ & 10.72 \\ & \pm 4.72 \\ & 14.25 \\ & \pm 8.01 \end{aligned}$ | $\begin{aligned} & 20.12 \pm 4.50^{\#} \\ & 19.99 \pm 4.32 \\ & 17.92 \pm 6.32 \end{aligned}$ | $\begin{aligned} & 4.54 \\ & \pm 0.67^{\#} \\ & 4.43 \\ & \pm 0.71 \\ & 3.92 \\ & \pm 1.29 \end{aligned}$ | | Gender | Male <br> Female | $\begin{aligned} & 22.15 \\ & \pm 2.61^{\#} \\ & 19.78 \pm 3.57 \end{aligned}$ | $\begin{aligned} & 21.20 \pm 5.53 \\ & 21.53 \pm 5.50 \end{aligned}$ | $\begin{aligned} & 45.96 \pm 13.90 \\ & 48.16 \pm 11.27 \end{aligned}$ | $\begin{aligned} & 17.53 \pm 5.38^{*} \\ & 18.51 \pm 4.52 \end{aligned}$ | $\begin{aligned} & 10.93 \\ & \pm 3.60^{*} \\ & 11.79 \\ & \pm 3.78 \end{aligned}$ | $\begin{aligned} & 11.91 \\ & \pm 3.10^{*} \\ & 12.52 \\ & \pm 2.43 \end{aligned}$ | $\begin{aligned} & 11.50 \\ & \pm 6.10^{\#} \\ & 9.77 \pm 2.89 \end{aligned}$ | $\begin{aligned} & 19.66 \pm 5.03 \\ & 20.14 \pm 4.10 \end{aligned}$ | $\begin{aligned} & 4.31 \\ & \pm 0.90^{\#} \\ & 4.66 \\ & \pm 0.47 \end{aligned}$ | | Education | Primary school or below Junior school or above | $\begin{aligned} & 21.27 \pm 3.07 \\ & 21.57 \pm 3.52 \end{aligned}$ | $\begin{aligned} & 21.16 \pm 5.35 \\ & 21.88 \pm 6.06 \end{aligned}$ | $\begin{aligned} & 46.95 \pm 12.58 \\ & 45.90 \pm 14.79 \end{aligned}$ | $\begin{aligned} & 17.84 \pm 5.03 \\ & 17.97 \pm 5.44 \end{aligned}$ | $\begin{aligned} & 11.41 \\ & \pm 3.76^{*} \\ & 10.55 \\ & \pm 3.29 \end{aligned}$ | $\begin{aligned} & 12.07 \\ & \pm 2.85 \\ & 12.29 \\ & \pm 3.09 \end{aligned}$ | $\begin{aligned} & 10.95 \\ & \pm 5.10 \\ & 10.75 \\ & \pm 5.92 \end{aligned}$ | $\begin{aligned} & 19.77 \pm 4.59 \\ & 20.03 \pm 5.23 \end{aligned}$ | $\begin{aligned} & 4.44 \\ & \pm 0.77 \\ & 4.43 \\ & \pm 0.89 \end{aligned}$ | | Per capita annual household income | $\begin{aligned} & <10,000 \\ & 10,000 \sim 20,000 \\ & \geq 20,000 \end{aligned}$ | $\begin{aligned} & 21.51 \pm 2.92 \\ & 21.13 \pm 3.86 \\ & 21.28 \pm 3.04 \end{aligned}$ | $\begin{aligned} & 20.98 \pm 5.60 \\ & 22.29 \pm 5.99 \\ & 21.16 \pm 5.17 \end{aligned}$ | $45.99 \pm 13.95$ <br> $48.76 \pm 12.11$ <br> $46.40 \pm 12.71$ | $\begin{aligned} & 17.59 \pm 5.53 \\ & 18.5 \mathrm{I} \pm 4.54 \\ & \mathrm{I} 7.82 \pm 5.00 \end{aligned}$ | $\begin{aligned} & 11.12 \\ & \pm 3.98 \\ & 10.98 \\ & \pm 3.62 \\ & 11.42 \\ & \pm 3.44 \end{aligned}$ | $\begin{aligned} & 11.69 \\ & \pm 3.22^{\#} \\ & 13.17 \\ & \pm 2.13 \\ & 12.00 \\ & \pm 2.81 \end{aligned}$ | $\begin{aligned} & 11.65 \\ & \pm 5.98^{\#} \\ & 9.53 \pm 3.80 \\ & \\ & 10.91 \\ & \pm 5.13 \end{aligned}$ | $\begin{aligned} & 19.00 \pm 5.49^{\#} \\ & 20.52 \pm 4.34 \\ & 20.21 \pm 4.10 \end{aligned}$ | $\begin{aligned} & 4.35 \\ & \pm 0.92^{\#} \\ & 4.68 \\ & \pm 0.47 \\ & 4.39 \\ & \pm 0.79 \end{aligned}$ | | Marital status | Single <br> Married | $\begin{aligned} & 21.42 \pm 2.83 \\ & 21.31 \pm 3.28 \end{aligned}$ | $\begin{aligned} & 20.89 \pm 5.35 \\ & 21.46 \pm 5.56 \end{aligned}$ | $\begin{aligned} & 45.13 \pm 13.20 \\ & 47.23 \pm 13.02 \end{aligned}$ | $\begin{aligned} & 17.76 \pm 5.08 \\ & 17.91 \pm 5.14 \end{aligned}$ | $\begin{aligned} & 10.98 \\ & \pm 3.69 \\ & 11.30 \\ & \pm 3.68 \end{aligned}$ | $\begin{aligned} & 11.72 \\ & \pm 2.78 \\ & 12.25 \\ & \pm 2.93 \end{aligned}$ | $\begin{aligned} & 11.26 \\ & \pm 5.17 \\ & 10.76 \\ & \pm 5.32 \end{aligned}$ | $\begin{aligned} & 19.26 \pm 4.89 \\ & 20.00 \pm 4.67 \end{aligned}$ | $\begin{aligned} & 4.36 \\ & \pm 0.75 \\ & 4.46 \\ & \pm 0.82 \end{aligned}$ | | Exercise regularly | No <br> <45 min/d <br> $\geq 45 \mathrm{~min} / \mathrm{d}$ | $\begin{aligned} & 20.37 \\ & \pm 3.63^{\#} \\ & 21.63 \pm 3 \\ & \\ & 22.03 \pm 2.56 \end{aligned}$ | $\begin{aligned} & 21.49 \pm 5.6 \\ & 21.31 \pm 5.91 \\ & 21.14 \pm 4.94 \end{aligned}$ | $\begin{aligned} & 45.34 \pm 14.17 \\ & 48.04 \pm 12.37 \\ & 46.66 \pm 12.59 \end{aligned}$ | $\begin{aligned} & 17.01 \pm 5.59^{*} \\ & 18.36 \pm 4.84 \\ & 18.23 \pm 4.81 \end{aligned}$ | $\begin{aligned} & 11.73 \\ & \pm 4.04 \\ & 10.92 \\ & \pm 3.28 \\ & 11.02 \\ & \pm 3.68 \end{aligned}$ | $\begin{aligned} & 11.91 \\ & \pm 3.21 \\ & 12.39 \\ & \pm 2.63 \\ & 12.03 \\ & \pm 2.84 \end{aligned}$ | $\begin{aligned} & 11.34 \\ & \pm 5.98 \\ & 10.75 \\ & \pm 4.96 \\ & 10.63 \\ & \pm 4.85 \end{aligned}$ | $\begin{aligned} & 19.46 \pm 5.04 \\ & 19.55 \pm 4.83 \\ & 20.53 \pm 4.21 \end{aligned}$ | $\begin{aligned} & 4.38 \\ & \pm 0.96 \\ & 4.45 \\ & \pm 0.67 \\ & 4.47 \\ & \pm 0.75 \end{aligned}$ |
Tobacco use 烟草使用

非吸烟者 前吸烟者 现吸烟者
Nonsmoker
Ex-smoker
Current smoker
Nonsmoker Ex-smoker Current smoker| Nonsmoker | | :--- | | Ex-smoker | | Current smoker |
 20.69 ± 3.33 # 23.14 ± 2.47 21.57 ± 2.88 20.69 ± 3.33 # 23.14 ± 2.47 21.57 ± 2.88 {:[20.69],[+-3.33^(#)],[23.14+-2.47],[],[21.57+-2.88]:}\begin{aligned} & 20.69 \\ & \pm 3.33^{\#} \\ & 23.14 \pm 2.47 \\ & \\ & 21.57 \pm 2.88 \end{aligned} 21.4 ± 5.29 21.59 ± 6.53 21.09 ± 5.42 21.4 ± 5.29 21.59 ± 6.53 21.09 ± 5.42 {:[21.4+-5.29],[21.59+-6.53],[21.09+-5.42]:}\begin{aligned} & 21.4 \pm 5.29 \\ & 21.59 \pm 6.53 \\ & 21.09 \pm 5.42 \end{aligned} 47.33 ± 11.94 # 50.65 ± ∣ 2.33 44.2 ± 14.51 47.33 ± 11.94 # 50.65 ± ∣ 2.33 44.2 ± 14.51 {:[47.33+-11.94^(#)],[50.65+-∣2.33],[44.2+-14.51]:}\begin{aligned} & 47.33 \pm 11.94^{\#} \\ & 50.65 \pm \mid 2.33 \\ & 44.2 \pm 14.51 \end{aligned} 17.63 ± 4.76 # 19.9 ± 5.36 17.4 ∣ ± 5.36 17.63 ± 4.76 # 19.9 ± 5.36 17.4 ∣ ± 5.36 {:[17.63+-4.76^(#)],[19.9+-5.36],[17.4∣+-5.36]:}\begin{aligned} & 17.63 \pm 4.76^{\#} \\ & 19.9 \pm 5.36 \\ & 17.4 \mid \pm 5.36 \end{aligned} 11.79 ± 3.88 # 10.39 ± 3.51 10.7 ± 3.3 11.79 ± 3.88 # 10.39 ± 3.51 10.7 ± 3.3 {:[11.79],[+-3.88^(#)],[10.39],[+-3.51],[10.7+-3.3]:}\begin{aligned} & 11.79 \\ & \pm 3.88^{\#} \\ & 10.39 \\ & \pm 3.51 \\ & 10.7 \pm 3.3 \end{aligned} 12.18 ± 2.59 # 13.34 ± 2.38 11.53 ± 3.35 12.18 ± 2.59 # 13.34 ± 2.38 11.53 ± 3.35 {:[12.18],[+-2.59^(#)],[13.34],[+-2.38],[11.53],[+-3.35]:}\begin{aligned} & 12.18 \\ & \pm 2.59^{\#} \\ & 13.34 \\ & \pm 2.38 \\ & 11.53 \\ & \pm 3.35 \end{aligned} 10.64 ± 4.3 # 9.28 ± 4.66 11.97 ± 6.53 10.64 ± 4.3 # 9.28 ± 4.66 11.97 ± 6.53 {:[10.64],[+-4.3^(#)],[9.28+-4.66],[],[11.97],[+-6.53]:}\begin{aligned} & 10.64 \\ & \pm 4.3^{\#} \\ & 9.28 \pm 4.66 \\ & \\ & 11.97 \\ & \pm 6.53 \end{aligned} 19.96 ± 4.11 20.14 ± 5.44 19.5 ± 5.29 19.96 ± 4.11 20.14 ± 5.44 19.5 ± 5.29 {:[19.96+-4.11],[20.14+-5.44],[19.5+-5.29]:}\begin{aligned} & 19.96 \pm 4.11 \\ & 20.14 \pm 5.44 \\ & 19.5 \pm 5.29 \end{aligned} 4.54 ± 0.62 # 4.72 ± 0.68 4.16 ± 0.99 4.54 ± 0.62 # 4.72 ± 0.68 4.16 ± 0.99 {:[4.54],[+-0.62^(#)],[4.72],[+-0.68],[4.16],[+-0.99]:}\begin{aligned} & 4.54 \\ & \pm 0.62^{\#} \\ & 4.72 \\ & \pm 0.68 \\ & 4.16 \\ & \pm 0.99 \end{aligned}
Alcohol use 酒精使用

不饮酒者 节制者 现饮者
Nondrinker
Abstainer
Current drinker
Nondrinker Abstainer Current drinker| Nondrinker | | :--- | | Abstainer | | Current drinker |
 20.62 ± 3.39 # 22.98 ± 2.68 21.77 ± 2.73 20.62 ± 3.39 # 22.98 ± 2.68 21.77 ± 2.73 {:[20.62],[+-3.39^(#)],[22.98+-2.68],[],[21.77+-2.73]:}\begin{aligned} & 20.62 \\ & \pm 3.39^{\#} \\ & 22.98 \pm 2.68 \\ & \\ & 21.77 \pm 2.73 \end{aligned} 21.5 ± 5.46 20.98 ± 6.36 21.17 ± 5.31 21.5 ± 5.46 20.98 ± 6.36 21.17 ± 5.31 {:[21.5+-5.46],[20.98+-6.36],[21.17+-5.31]:}\begin{aligned} & 21.5 \pm 5.46 \\ & 20.98 \pm 6.36 \\ & 21.17 \pm 5.31 \end{aligned} 47.38 ± 12.19 ∗ 49.52 ± 12.38 44.95 ± ∣ 4.25 47.38 ± 12.19 ∗ 49.52 ± 12.38 44.95 ± ∣ 4.25 {:[47.38+-12.19^(**)],[49.52+-12.38],[44.95+-∣4.25]:}\begin{aligned} & 47.38 \pm 12.19^{*} \\ & 49.52 \pm 12.38 \\ & 44.95 \pm \mid 4.25 \end{aligned} 18.14 ± 4.79 # 19.65 ± 5.39 16.95 ± 5.29 18.14 ± 4.79 # 19.65 ± 5.39 16.95 ± 5.29 {:[18.14+-4.79^(#)],[19.65+-5.39],[16.95+-5.29]:}\begin{aligned} & 18.14 \pm 4.79^{\#} \\ & 19.65 \pm 5.39 \\ & 16.95 \pm 5.29 \end{aligned} 11.46 ± 3.72 10.42 ± 3.53 11.15 ± 3.66 11.46 ± 3.72 10.42 ± 3.53 11.15 ± 3.66 {:[11.46],[+-3.72],[10.42],[+-3.53],[11.15],[+-3.66]:}\begin{aligned} & 11.46 \\ & \pm 3.72 \\ & 10.42 \\ & \pm 3.53 \\ & 11.15 \\ & \pm 3.66 \end{aligned} 12.29 ± 2.59 # 13.17 ± 2.55 11.55 ± 3.27 12.29 ± 2.59 # 13.17 ± 2.55 11.55 ± 3.27 {:[12.29],[+-2.59^(#)],[13.17],[+-2.55],[11.55],[+-3.27]:}\begin{aligned} & 12.29 \\ & \pm 2.59^{\#} \\ & 13.17 \\ & \pm 2.55 \\ & 11.55 \\ & \pm 3.27 \end{aligned} 10.15 ± 3.65 # 9.43 ± 4.84 12.4 ± 6.76 10.15 ± 3.65 # 9.43 ± 4.84 12.4 ± 6.76 {:[10.15],[+-3.65^(#)],[9.43+-4.84],[],[12.4+-6.76]:}\begin{aligned} & 10.15 \\ & \pm 3.65^{\#} \\ & 9.43 \pm 4.84 \\ & \\ & 12.4 \pm 6.76 \end{aligned}

19.81 ± 4.49 19.81 ± 4.49 19.81+-4.4919.81 \pm 4.49 20.3±5.5 20.3±5.520.3+-5.520.3 \pm 5.5 |9.7±4.8| |9.7±4.8||9.7+-4.8||9.7 \pm 4.8|
19.81 ± 4.49 19.81 ± 4.49 19.81+-4.4919.81 \pm 4.49
20.3 ± 5.5 20.3 ± 5.5 20.3+-5.520.3 \pm 5.5 | 9.7 ± 4.8 | | 9.7 ± 4.8 | |9.7+-4.8||9.7 \pm 4.8|
19.81+-4.49 20.3+-5.5 |9.7+-4.8|| $19.81 \pm 4.49$ | | :--- | | $20.3 \pm 5.5$ $\|9.7 \pm 4.8\|$ |
 4.59 ± 0.56 # 4.67 ± 0.73 4.16 ± 1 4.59 ± 0.56 # 4.67 ± 0.73 4.16 ± 1 {:[4.59],[+-0.56^(#)],[4.67],[+-0.73],[4.16+-1]:}\begin{aligned} & 4.59 \\ & \pm 0.56^{\#} \\ & 4.67 \\ & \pm 0.73 \\ & 4.16 \pm 1 \end{aligned}
Chronic disease status 慢性疾病状态
 不 是
No
Yes
No Yes| No | | :--- | | Yes |
 21.26 ± 3.22 21.53 ± 3.06 21.26 ± 3.22 21.53 ± 3.06 {:[21.26+-3.22],[21.53+-3.06]:}\begin{aligned} & 21.26 \pm 3.22 \\ & 21.53 \pm 3.06 \end{aligned} 21.43 ± 5.51 21.02 ± 5.52 21.43 ± 5.51 21.02 ± 5.52 {:[21.43+-5.51],[21.02+-5.52]:}\begin{aligned} & 21.43 \pm 5.51 \\ & 21.02 \pm 5.52 \end{aligned} 47.13 ± 12.86 45.58 ± 13.66 47.13 ± 12.86 45.58 ± 13.66 {:[47.13+-12.86],[45.58+-13.66]:}\begin{aligned} & 47.13 \pm 12.86 \\ & 45.58 \pm 13.66 \end{aligned} 17.88 ± 5.17 17.83 ± 4.98 17.88 ± 5.17 17.83 ± 4.98 {:[17.88+-5.17],[17.83+-4.98]:}\begin{aligned} & 17.88 \pm 5.17 \\ & 17.83 \pm 4.98 \end{aligned} 11.35 ± 3.72 10.88 ± 3.58 11.35 ± 3.72 10.88 ± 3.58 {:[11.35],[+-3.72],[10.88],[+-3.58]:}\begin{aligned} & 11.35 \\ & \pm 3.72 \\ & 10.88 \\ & \pm 3.58 \end{aligned} 12.10 ± 2.92 12.18 ± 2.85 12.10 ± 2.92 12.18 ± 2.85 {:[12.10],[+-2.92],[12.18],[+-2.85]:}\begin{aligned} & 12.10 \\ & \pm 2.92 \\ & 12.18 \\ & \pm 2.85 \end{aligned} 10.91 ± 5.17 10.89 ± 5.61 10.91 ± 5.17 10.89 ± 5.61 {:[10.91],[+-5.17],[10.89],[+-5.61]:}\begin{aligned} & 10.91 \\ & \pm 5.17 \\ & 10.89 \\ & \pm 5.61 \end{aligned} 19.80 ± 4.60 19.91 ± 5.09 19.80 ± 4.60 19.91 ± 5.09 {:[19.80+-4.60],[19.91+-5.09]:}\begin{aligned} & 19.80 \pm 4.60 \\ & 19.91 \pm 5.09 \end{aligned} 4.43 ± 0.78 4.45 ± 0.87 4.43 ± 0.78 4.45 ± 0.87 {:[4.43],[+-0.78],[4.45],[+-0.87]:}\begin{aligned} & 4.43 \\ & \pm 0.78 \\ & 4.45 \\ & \pm 0.87 \end{aligned}
Tobacco use "Nonsmoker Ex-smoker Current smoker" "20.69 +-3.33^(#) 23.14+-2.47 21.57+-2.88" "21.4+-5.29 21.59+-6.53 21.09+-5.42" "47.33+-11.94^(#) 50.65+-∣2.33 44.2+-14.51" "17.63+-4.76^(#) 19.9+-5.36 17.4∣+-5.36" "11.79 +-3.88^(#) 10.39 +-3.51 10.7+-3.3" "12.18 +-2.59^(#) 13.34 +-2.38 11.53 +-3.35" "10.64 +-4.3^(#) 9.28+-4.66 11.97 +-6.53" "19.96+-4.11 20.14+-5.44 19.5+-5.29" "4.54 +-0.62^(#) 4.72 +-0.68 4.16 +-0.99" Alcohol use "Nondrinker Abstainer Current drinker" "20.62 +-3.39^(#) 22.98+-2.68 21.77+-2.73" "21.5+-5.46 20.98+-6.36 21.17+-5.31" "47.38+-12.19^(**) 49.52+-12.38 44.95+-∣4.25" "18.14+-4.79^(#) 19.65+-5.39 16.95+-5.29" "11.46 +-3.72 10.42 +-3.53 11.15 +-3.66" "12.29 +-2.59^(#) 13.17 +-2.55 11.55 +-3.27" "10.15 +-3.65^(#) 9.43+-4.84 12.4+-6.76" "19.81+-4.49 20.3+-5.5 |9.7+-4.8|" "4.59 +-0.56^(#) 4.67 +-0.73 4.16+-1" Chronic disease status "No Yes" "21.26+-3.22 21.53+-3.06" "21.43+-5.51 21.02+-5.52" "47.13+-12.86 45.58+-13.66" "17.88+-5.17 17.83+-4.98" "11.35 +-3.72 10.88 +-3.58" "12.10 +-2.92 12.18 +-2.85" "10.91 +-5.17 10.89 +-5.61" "19.80+-4.60 19.91+-5.09" "4.43 +-0.78 4.45 +-0.87"| Tobacco use | Nonsmoker <br> Ex-smoker <br> Current smoker | $\begin{aligned} & 20.69 \\ & \pm 3.33^{\#} \\ & 23.14 \pm 2.47 \\ & \\ & 21.57 \pm 2.88 \end{aligned}$ | $\begin{aligned} & 21.4 \pm 5.29 \\ & 21.59 \pm 6.53 \\ & 21.09 \pm 5.42 \end{aligned}$ | $\begin{aligned} & 47.33 \pm 11.94^{\#} \\ & 50.65 \pm \mid 2.33 \\ & 44.2 \pm 14.51 \end{aligned}$ | $\begin{aligned} & 17.63 \pm 4.76^{\#} \\ & 19.9 \pm 5.36 \\ & 17.4 \mid \pm 5.36 \end{aligned}$ | $\begin{aligned} & 11.79 \\ & \pm 3.88^{\#} \\ & 10.39 \\ & \pm 3.51 \\ & 10.7 \pm 3.3 \end{aligned}$ | $\begin{aligned} & 12.18 \\ & \pm 2.59^{\#} \\ & 13.34 \\ & \pm 2.38 \\ & 11.53 \\ & \pm 3.35 \end{aligned}$ | $\begin{aligned} & 10.64 \\ & \pm 4.3^{\#} \\ & 9.28 \pm 4.66 \\ & \\ & 11.97 \\ & \pm 6.53 \end{aligned}$ | $\begin{aligned} & 19.96 \pm 4.11 \\ & 20.14 \pm 5.44 \\ & 19.5 \pm 5.29 \end{aligned}$ | $\begin{aligned} & 4.54 \\ & \pm 0.62^{\#} \\ & 4.72 \\ & \pm 0.68 \\ & 4.16 \\ & \pm 0.99 \end{aligned}$ | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | Alcohol use | Nondrinker <br> Abstainer <br> Current drinker | $\begin{aligned} & 20.62 \\ & \pm 3.39^{\#} \\ & 22.98 \pm 2.68 \\ & \\ & 21.77 \pm 2.73 \end{aligned}$ | $\begin{aligned} & 21.5 \pm 5.46 \\ & 20.98 \pm 6.36 \\ & 21.17 \pm 5.31 \end{aligned}$ | $\begin{aligned} & 47.38 \pm 12.19^{*} \\ & 49.52 \pm 12.38 \\ & 44.95 \pm \mid 4.25 \end{aligned}$ | $\begin{aligned} & 18.14 \pm 4.79^{\#} \\ & 19.65 \pm 5.39 \\ & 16.95 \pm 5.29 \end{aligned}$ | $\begin{aligned} & 11.46 \\ & \pm 3.72 \\ & 10.42 \\ & \pm 3.53 \\ & 11.15 \\ & \pm 3.66 \end{aligned}$ | $\begin{aligned} & 12.29 \\ & \pm 2.59^{\#} \\ & 13.17 \\ & \pm 2.55 \\ & 11.55 \\ & \pm 3.27 \end{aligned}$ | $\begin{aligned} & 10.15 \\ & \pm 3.65^{\#} \\ & 9.43 \pm 4.84 \\ & \\ & 12.4 \pm 6.76 \end{aligned}$ | $19.81 \pm 4.49$ <br> $20.3 \pm 5.5$ $\|9.7 \pm 4.8\|$ | $\begin{aligned} & 4.59 \\ & \pm 0.56^{\#} \\ & 4.67 \\ & \pm 0.73 \\ & 4.16 \pm 1 \end{aligned}$ | | Chronic disease status | No <br> Yes | $\begin{aligned} & 21.26 \pm 3.22 \\ & 21.53 \pm 3.06 \end{aligned}$ | $\begin{aligned} & 21.43 \pm 5.51 \\ & 21.02 \pm 5.52 \end{aligned}$ | $\begin{aligned} & 47.13 \pm 12.86 \\ & 45.58 \pm 13.66 \end{aligned}$ | $\begin{aligned} & 17.88 \pm 5.17 \\ & 17.83 \pm 4.98 \end{aligned}$ | $\begin{aligned} & 11.35 \\ & \pm 3.72 \\ & 10.88 \\ & \pm 3.58 \end{aligned}$ | $\begin{aligned} & 12.10 \\ & \pm 2.92 \\ & 12.18 \\ & \pm 2.85 \end{aligned}$ | $\begin{aligned} & 10.91 \\ & \pm 5.17 \\ & 10.89 \\ & \pm 5.61 \end{aligned}$ | $\begin{aligned} & 19.80 \pm 4.60 \\ & 19.91 \pm 5.09 \end{aligned}$ | $\begin{aligned} & 4.43 \\ & \pm 0.78 \\ & 4.45 \\ & \pm 0.87 \end{aligned}$ |
Table 4 Pearson’s Correlation Analysis Between BIE and EHBM Constructs
表 4 BIE 与 EHBM 构念之间的皮尔逊相关分析
Self-Efficacy 自我效能 Health Knowledge 健康知识 Social Support 社会支持 Susceptibility 易感性 Severity 严重性 Benefits 好处 Barriers 障碍 Cues to Action 行动提示
r r rr 0.252 -0.012 0.485 0.392 -0.046 0.650 -0.800 0.448
P P PP 0.000 0.779 0.000 0.000 0.298 0.000 0.000 0.000
Self-Efficacy Health Knowledge Social Support Susceptibility Severity Benefits Barriers Cues to Action r 0.252 -0.012 0.485 0.392 -0.046 0.650 -0.800 0.448 P 0.000 0.779 0.000 0.000 0.298 0.000 0.000 0.000| | Self-Efficacy | Health Knowledge | Social Support | Susceptibility | Severity | Benefits | Barriers | Cues to Action | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | $r$ | 0.252 | -0.012 | 0.485 | 0.392 | -0.046 | 0.650 | -0.800 | 0.448 | | $P$ | 0.000 | 0.779 | 0.000 | 0.000 | 0.298 | 0.000 | 0.000 | 0.000 |

Predictors Affecting BIE Among People Aged 60 or Over in Rural Shandong
影响山东农村 60 岁及以上人群 BIE 的预测因素

A multiple linear regression analysis was implemented to adjust for the effects of other confounding variables affecting BIE among the participants. All variables, including EHBM constructs as well as the demographic characteristics of the respondents, were entered as independent variables to predict the dependent variable, BIE.
实施了多元线性回归分析，以调整影响参与者 BIE 的其他混杂变量的影响。所有变量，包括 EHBM 构念以及受访者的人口特征，都作为自变量输入，以预测因变量 BIE。
As shown in Table 5, eight predicting variables, including age, gender, tobacco use, alcohol use, self-efficacy, social support, benefits, and barriers, were retained in the multiple linear regression analysis model to predict BIE (Table 5). Among all the significant predictors, the factor of perceived barriers had the highest standardized regression coefficient ( B ′ = − 0.556 ; p < 0.001 B ′ = − 0.556 ; p < 0.001 B^(')=-0.556;p < 0.001B^{\prime}=-0.556 ; p<0.001 ). That is, participants who perceived fewer barriers were more likely to have a higher BIE. Moreover, benefits, self-efficacy, and social support demonstrated relative higher contributions toward BIE, suggesting that significant variables in the extended health belief model were important in predicting BIE. With an R 2 R 2 R^(2)R^{2} of 64.2 % 64.2 % 64.2%64.2 \%, the overall variance in BIE accounted for by the model appeared
如表 5 所示，八个预测变量，包括年龄、性别、烟草使用、酒精使用、自我效能、社会支持、收益和障碍，被保留在多元线性回归分析模型中以预测 BIE（表 5）。在所有显著预测因素中，感知障碍的标准化回归系数最高（ B ′ = − 0.556 ; p < 0.001 B ′ = − 0.556 ; p < 0.001 B^(')=-0.556;p < 0.001B^{\prime}=-0.556 ; p<0.001 ）。也就是说，感知障碍较少的参与者更有可能拥有更高的 BIE。此外，收益、自我效能和社会支持对 BIE 的贡献相对较高，这表明扩展健康信念模型中的显著变量在预测 BIE 中是重要的。模型的 R 2 R 2 R^(2)R^{2} 为 64.2 % 64.2 % 64.2%64.2 \% ，BIE 的整体方差由模型解释的部分似乎
Table 5 Multivariate Linear Regression Analysis Model Examining Predictors Associated with BIE Among Rural Elderly Aged 60 or Over in Shandong
表 5 多元线性回归分析模型，考察与山东 60 岁及以上农村老年人 BIE 相关的预测因素
Predictor 预测器 B B' SE T P P P\boldsymbol{P}
Constant 常量 3.415 0.308 1 I .070 1 I .070 1I.0701 I .070 0.000
Age 年龄 -0.076 -0.066 0.030 -2.540 0.01 I 0.01 I 0.01 I0.01 I
Gender 性别 0.137 0.08 I 0.08 我 0.053 2.560 0.01 I 0.01 我
Tobacco use 烟草使用
quad\quad Ex-smoker 前吸烟者 -0.026 -0.01 I -0.01 我 0.100 -0.260 0.796
quad\quad Current smoker  quad\quad 目前吸烟者 -0.162 -0.097 0.049 -3.300 0.001
Alcohol use 酒精使用
quad\quad Abstainer  quad\quad 戒酒者 -0.086 -0.035 0.101 -0.850 0.393
quad\quad Current drinker 当前饮酒者 -0.105 -0.063 0.048 -2.200 0.028
Self-efficacy 自我效能 0.034 0.136 0.007 4.840 0.000
Social support 社会支持 0.003 0.057 0.002 2.050 0.041
Benefits 好处 0.069 0.249 0.008 8.540 0.000
Barriers 障碍 -0.084 -0.556 0.005 -15.870 0.000
Predictor B B' SE T P Constant 3.415 0.308 1I.070 0.000 Age -0.076 -0.066 0.030 -2.540 0.01 I Gender 0.137 0.08 I 0.053 2.560 0.01 I Tobacco use quad Ex-smoker -0.026 -0.01 I 0.100 -0.260 0.796 quad Current smoker -0.162 -0.097 0.049 -3.300 0.001 Alcohol use quad Abstainer -0.086 -0.035 0.101 -0.850 0.393 quad Current drinker -0.105 -0.063 0.048 -2.200 0.028 Self-efficacy 0.034 0.136 0.007 4.840 0.000 Social support 0.003 0.057 0.002 2.050 0.041 Benefits 0.069 0.249 0.008 8.540 0.000 Barriers -0.084 -0.556 0.005 -15.870 0.000| Predictor | B | B' | SE | T | $\boldsymbol{P}$ | | :--- | :--- | :--- | :--- | :--- | :--- | | Constant | 3.415 | | 0.308 | $1 I .070$ | 0.000 | | Age | -0.076 | -0.066 | 0.030 | -2.540 | $0.01 I$ | | Gender | 0.137 | 0.08 I | 0.053 | 2.560 | 0.01 I | | Tobacco use | | | | | | | $\quad$ Ex-smoker | -0.026 | -0.01 I | 0.100 | -0.260 | 0.796 | | $\quad$ Current smoker | -0.162 | -0.097 | 0.049 | -3.300 | 0.001 | | Alcohol use | | | | | | | $\quad$ Abstainer | -0.086 | -0.035 | 0.101 | -0.850 | 0.393 | | $\quad$ Current drinker | -0.105 | -0.063 | 0.048 | -2.200 | 0.028 | | Self-efficacy | 0.034 | 0.136 | 0.007 | 4.840 | 0.000 | | Social support | 0.003 | 0.057 | 0.002 | 2.050 | 0.041 | | Benefits | 0.069 | 0.249 | 0.008 | 8.540 | 0.000 | | Barriers | -0.084 | -0.556 | 0.005 | -15.870 | 0.000 |
Notes: R 2 = 0.642 R 2 = 0.642 R^(2)=0.642R^{2}=0.642. B ′ B ′ B^(')B^{\prime} :standardized regression coefficient.
备注： R 2 = 0.642 R 2 = 0.642 R^(2)=0.642R^{2}=0.642 。 B ′ B ′ B^(')B^{\prime} ：标准化回归系数。
to be high. Thus, the model had a good prediction for BIE. However, severity, susceptibility, cues to action, and health knowledge subscales did not show a relation to BIE.
保持高水平。因此，该模型对 BIE 的预测效果良好。然而，严重性、易感性、行动线索和健康知识子量表与 BIE 没有显示出关系。

Discussion 讨论

The present study revealed significant potential for improvement in BIE among the participants. This study focused on EHBM-based psychological variables, as these psychological variables could be targeted for further interventions to change the low participation rate in PHE. This study utilized behavioral intention as an outcome variable to determine the effect of EHBM dimensions on BIE. The explanatory power of the six-dimensional HBM is limited in predicting health behaviors, 24 − 26 24 − 26 ^(24-26){ }^{24-26} particularly in some specific studies. 27 27 ^(27){ }^{27} This study added two dimensions to the HBM model, namely, health knowledge and social support, to construct an eight-dimensional EHBM in order to improve the predictive validity. Health knowledge is believed to promote attitude change before behavior change occurs. 28 28 ^(28){ }^{28} In addition, Chinese older adults who live alone or lack social support have extremely low utilization of preventive health services, 29 29 ^(29){ }^{29} and rural Chinese older populations face severe social support deficits due to rural-urban migration. Social support can significantly influence physical and mental health status of older adults. 30 30 ^(30){ }^{30} Therefore, the variable of social support was added to the HBM.
本研究揭示了参与者在 BIE 方面显著的改善潜力。本研究集中于基于 EHBM 的心理变量，因为这些心理变量可以作为进一步干预的目标，以改变 PHE 中的低参与率。本研究利用行为意图作为结果变量，以确定 EHBM 维度对 BIE 的影响。六维 HBM 在预测健康行为方面的解释力有限，特别是在一些特定研究中。本研究在 HBM 模型中增加了两个维度，即健康知识和社会支持，以构建一个八维 EHBM，以提高预测效度。健康知识被认为在行为改变发生之前促进态度改变。此外，独居或缺乏社会支持的中国老年人预防健康服务的利用率极低，而农村中国老年人群体由于农村-城市迁移面临严重的社会支持缺失。社会支持可以显著影响老年人的身心健康状况。 因此，社会支持的变量被添加到健康信念模型中。
Consistent with the model’s predictions, participants were more likely to engage in PHE services if they had high self-efficacy, few perceived barriers, high-perceived benefits, and received more social support. Of these, perceived barriers were the most important determinant, followed by perceived benefits, self-efficacy, and social support. Past HBM-based meta-analyses and reviews of critical quantitative studies have shown that important predictors of behavior were typically perceived susceptibility, perceived severity, perceived barriers, and perceived benefits. 31 − 33 31 − 33 ^(31-33){ }^{31-33} This study found that perceived benefits were independently associated with performing PHE, which was consistent with Rosenstock and Alhalaseh. 34 , 35 34 , 35 ^(34,35){ }^{34,35} Likewise, a recent study showed that
与模型的预测一致，参与者在自我效能感高、感知障碍少、感知收益高以及获得更多社会支持的情况下，更有可能参与公共健康教育服务。在这些因素中，感知障碍是最重要的决定因素，其次是感知收益、自我效能感和社会支持。以往基于健康信念模型的荟萃分析和关键定量研究的回顾表明，行为的重要预测因素通常是感知易感性、感知严重性、感知障碍和感知收益。 31 − 33 31 − 33 ^(31-33){ }^{31-33} 本研究发现，感知收益与进行公共健康教育独立相关，这与 Rosenstock 和 Alhalaseh 的研究一致。 34 , 35 34 , 35 ^(34,35){ }^{34,35} 同样，最近的一项研究表明
perceived barriers and perceived benefits were the two strongest predictors of individual intention to receive the COVID-19 vaccine. 36 36 ^(36){ }^{36} An article exploring predictors of condom use intention among female sex workers in two cities in Hubei Province, China, showed that perceived benefits and barriers were the most direct determinants of condom use. 37 37 ^(37){ }^{37} Therefore, there is a need to focus on increasing awareness of PHE benefits while reducing the identified barriers.
感知障碍和感知收益是个人接种 COVID-19 疫苗意图的两个最强预测因素。 36 36 ^(36){ }^{36} 一篇探讨中国湖北省两个城市女性性工作者避孕套使用意图预测因素的文章显示，感知收益和障碍是避孕套使用的最直接决定因素。 37 37 ^(37){ }^{37} 因此，需要关注提高对公共卫生收益的认识，同时减少已识别的障碍。
Previous studies found that high self-efficacy had a positive effect on intention to preventive health behaviors. Zhao confirmed that higher self-efficacy was associated with more positive perceptions of condom use. 37 37 ^(37){ }^{37} In addition, scholars have noted that higher self-efficacy was a predictor of improved alcohol treatment outcomes. 38 38 ^(38){ }^{38} This study is in line with previous studies that cited the importance of self-efficacy in BIE in older adults, 39 39 ^(39){ }^{39} and demonstrated that people who were more confident and competent in obtaining PHE were more likely to do it regularly. 39 39 ^(39){ }^{39} Interventions based on self-efficacy theory are also thought to help promote health behavior change. 40 40 ^(40){ }^{40}
先前的研究发现，高自我效能对预防健康行为的意图有积极影响。赵确认，自我效能越高，与对安全套使用的积极看法越相关。此外，学者们指出，高自我效能是改善酒精治疗结果的预测因素。本研究与之前的研究一致，后者强调了自我效能在老年人 BIE 中的重要性，并证明那些在获取 PHE 方面更有信心和能力的人更有可能定期进行此行为。基于自我效能理论的干预措施也被认为有助于促进健康行为的改变。
Based on existing studies documenting that social support has a positive effect on BIE in different populations, 4 − 43 4 − 43 ^(4-43){ }^{4-43} this study found that participants with more social support were more likely to report scheduling PHE. Mitsuhashi showed that older adults who received PHE had friends who were members of various groups, 43 43 ^(43){ }^{43} such as neighborhood associations and clubs. Another survey demonstrated that social support was a significant predictor of annual use of physical health screening. 42 42 ^(42){ }^{42} These results provide direct evidence indicating the irreplaceable role of social support in effectively reducing feelings of anxiety, improving health perceptions, and maintaining a healthy physical and psychological state, which in turn contribute to positive PHE acceptance. In addition, the present study confirmed these findings and further suggested the inclusion of social support into interventions to increase PHE acceptance.
基于现有研究记录的社会支持对不同人群的 BIE 有积极影响， 4 − 43 4 − 43 ^(4-43){ }^{4-43} 本研究发现，拥有更多社会支持的参与者更有可能报告安排 PHE。三桥显示，接受 PHE 的老年人有朋友是各种团体的成员， 43 43 ^(43){ }^{43} 如邻里协会和俱乐部。另一项调查表明，社会支持是年度身体健康筛查使用的重要预测因素。 42 42 ^(42){ }^{42} 这些结果提供了直接证据，表明社会支持在有效减少焦虑感、改善健康认知和维持健康的身体和心理状态方面的不可替代作用，这反过来又有助于积极接受 PHE。此外，本研究确认了这些发现，并进一步建议将社会支持纳入干预措施，以提高 PHE 的接受度。
Furthermore, this study suggested that health knowledge, perceived severity, perceived susceptibility, and cues to action did not predict BIE. A meta-analysis study of willingness to screen for cancer showed that only cues to action, health literacy, and perceived susceptibility positively predicted willingness. 44 44 ^(44){ }^{44} Another investigation showed that cues to action, perceived severity, and perceived benefits had a significant impact on women’s choice of mode of birth. 45 45 ^(45){ }^{45} A survey in western Turkey showed that knowledge was a significantly associated
此外，这项研究表明，健康知识、感知严重性、感知易感性和行动提示并未预测 BIE。一项关于癌症筛查意愿的荟萃分析研究显示，只有行动提示、健康素养和感知易感性对意愿有正向预测作用。另一项调查显示，行动提示、感知严重性和感知益处对女性选择分娩方式有显著影响。土耳其西部的一项调查显示，知识与此显著相关。
variable with preventive health screening for breast cancer. 46 46 ^(46){ }^{46} However, this association was not maintained in the relationship between knowledge, gender, and health service use in Green’s household interview survey. 47 47 ^(47){ }^{47} Similarly, several other studies found that perceived severity was consistently not an important predictor of preventive health behaviors. 48 , 49 48 , 49 ^(48,49){ }^{48,49} This may be related to the chosen focus groups. In the present study, respondents did not have a specific illness that required urgent care. Therefore, they did not perceive severity. Additionally, perceived susceptibility failed to explain the acceptance of PHE services among the participants, which was consistent with Carpenter. 31 31 ^(31){ }^{31} This difference could be explained by the fact that the events studied were behavioral intentions during major disease screenings, such as cancer screening, or emergency time decisions, such as childbirth. When people are faced with these events, they require advice from medical professionals and expertise to help them, and they can directly feel the susceptibility and severity of the threat of the disease. In addition, 94.3 % 94.3 % 94.3%94.3 \% of the participants had an education level of junior high school or less. Thus, their education level could not influence their behavioral intentions. Among elderly people in rural areas of China, PHE may be perceived as an unnecessary event, which to some extent affects their perception of the severity of the disease. Further, older people in rural areas may not believe in the value of preventive health services compared to clinical treatments.
与乳腺癌的预防健康筛查相关的变量。然而，在格林的家庭访谈调查中，知识、性别和健康服务使用之间的关系并未维持这种关联。同样，其他几项研究发现，感知的严重性始终不是预防健康行为的重要预测因素。这可能与所选择的焦点小组有关。在本研究中，受访者没有需要紧急护理的特定疾病。因此，他们没有感知到严重性。此外，感知的易感性未能解释参与者对 PHE 服务的接受，这与卡彭特的研究一致。这种差异可以通过研究的事件是主要疾病筛查期间的行为意图（如癌症筛查）或紧急时刻的决策（如分娩）来解释。当人们面临这些事件时，他们需要来自医疗专业人士的建议和专业知识来帮助他们，并且他们可以直接感受到疾病威胁的易感性和严重性。 此外， 94.3 % 94.3 % 94.3%94.3 \% 的参与者的教育水平为初中或以下。因此，他们的教育水平可能不会影响他们的行为意图。在中国农村地区的老年人中，公共卫生教育可能被视为一项不必要的活动，这在一定程度上影响了他们对疾病严重性的认知。此外，农村地区的老年人可能不相信预防性健康服务的价值，相较于临床治疗。
The findings on the factors that influence BIE suggested the importance of targeting specific characteristics of non-users, including gender, age, tobacco use, and alcohol use. These may provide information necessary to promote the use of PHE in these individuals. For instance, as predicted by EHBM, men had weaker BIE. Many scholars reported that women experience more illness, are more sensitive to their health status, and have poor self-reported health status. As a result, they use preventive health services more than men do. 50 50 ^(50){ }^{50} However, men are less willing to take on the role of patient and receive preventive health services, as traditional men fear revealing their weaknesses. 51 51 ^(51){ }^{51} In addition, researchers found that women had more health knowledge than men did, which is thought to account for higher health-seeking behaviors. As a result, men had lower behavioral intentions to use PHE and seek medical help. 52 52 ^(52){ }^{52}
关于影响 BIE 的因素的研究表明，针对非用户的特定特征（包括性别、年龄、烟草使用和酒精使用）具有重要性。这些特征可能提供必要的信息，以促进这些个体使用 PHE。例如，正如 EHBM 所预测的，男性的 BIE 较弱。许多学者报告称，女性经历更多的疾病，对自身健康状况更敏感，并且自我报告的健康状况较差。因此，她们比男性更频繁地使用预防性健康服务。然而，男性不太愿意承担患者的角色并接受预防性健康服务，因为传统男性害怕暴露自己的弱点。此外，研究人员发现女性的健康知识比男性更多，这被认为是导致更高健康寻求行为的原因。因此，男性在使用 PHE 和寻求医疗帮助方面的行为意图较低。
Based on qualitative interviews with participants, difficulty in finding a provider, time and scheduling, possible lack of trust in physicians, pain, cost, and beliefs about the
根据对参与者的定性访谈，寻找提供者的困难、时间和安排、对医生可能缺乏信任、疼痛、成本以及对的信念
value of PHE were the main barriers to PHE among the participants. A qualitative study of Korean American women found that the main barriers were cost, time, language, fear, denial, and Confucianism, 53 53 ^(53){ }^{53} which supports the present results. In addition, distance to the nearest medical facility was a barrier, particularly for participants with physical mobility problems. Low trust in doctors and low confidence in PHE may be due to a lack of effective health communication channels for elderly people in rural areas. Health facilities must improve the health literacy of older adults in rural areas to increase willingness to participate in PHE. Health communication provided by family physicians may be an effective strategy to improve health literacy and change attitudes and beliefs about preventive health services, further promoting the use of PHE. In addition, watching television was found to be another effective way to improve health literacy. A survey in western Turkey reported that nearly 40 % 40 % 40%40 \% of the study group received key information about breast cancer screening from television. 46 46 ^(46){ }^{46} Furthermore, bulletin boards in rural China are an effective health communication channel due to their credibility as representatives of the public and the government.
参与者对 PHE 的主要障碍是 PHE 的价值。一项针对韩裔美国女性的定性研究发现，主要障碍是成本、时间、语言、恐惧、否认和儒家思想，这支持了目前的结果。此外，距离最近的医疗设施也是一个障碍，特别是对于有身体活动问题的参与者。对医生的信任度低和对 PHE 的信心不足可能是由于农村地区老年人缺乏有效的健康沟通渠道。医疗设施必须提高农村地区老年人的健康素养，以增加参与 PHE 的意愿。家庭医生提供的健康沟通可能是提高健康素养和改变对预防健康服务的态度和信念的有效策略，从而进一步促进 PHE 的使用。此外，观看电视被发现是提高健康素养的另一种有效方式。土耳其西部的一项调查报告称，近 40 % 40 % 40%40 \% 的研究组从电视中获得了关于乳腺癌筛查的关键信息。 此外，中国农村的公告栏由于作为公众和政府的代表而具有可信度，是有效的健康传播渠道。

Strengths and Limitations
优势与局限性

To our knowledge, there is no EHBM applicable to Chinese rural elderly and comprehensively to general PHE as opposed to specific titles. The data presented in this study offered the perceptions of elderly people in rural China regarding PHE and determinants of PHE acceptance, which may provide a reference for the health agency. This sample may have differed from others in this issue in that it did not focus on urban people. Furthermore, the participants reported diverse demographic backgrounds, which likely affected the psychological variables and use of PHE. One of the limitations to this study is that some predictors found by other researchers were not included. Another research limitation is that this study used closed-ended questions, which may have allowed participants to guess the correct answer. In addition, this study was cross-sectional, and causality could not be assumed. Moreover, as data were self-reported, there is a risk of self-report bias.
据我们所知，尚无适用于中国农村老年人的 EHBM，也没有全面适用于一般 PHE，而是针对特定标题。本研究中提供的数据反映了中国农村老年人对 PHE 及其接受决定因素的看法，这可能为卫生机构提供参考。该样本可能与本问题中的其他样本不同，因为它没有关注城市人群。此外，参与者报告了多样的人口背景，这可能影响了心理变量和 PHE 的使用。本研究的一个局限性是未包括其他研究者发现的一些预测因素。另一个研究局限性是本研究使用了封闭式问题，这可能使参与者能够猜测正确答案。此外，本研究是横断面的，因而无法假设因果关系。此外，由于数据是自我报告的，因此存在自我报告偏差的风险。

Conclusion 结论

The present study highlighted a need to perform health interventions for people aged 60 years and older, particularly in rural areas. Health interventions are required
本研究强调了对 60 岁及以上人群，特别是在农村地区，进行健康干预的必要性。需要进行健康干预。
especially on targeted individuals who perceive more barriers, less self-efficacy, less benefits, and had less social support as well as those who are men, aged 70 years and over, with smoking or drinking behavior. As physicians largely determine the utilization of existing services, general practitioners should be encouraged to screen all elderly people regarding various risk factors and, in addition to appropriate intervention, consider reminding people who are at higher risk of the PHE repeatedly when their PHE is due. Other health communication channels, such as bulletin boards and television based in the community, should be used frequently to help elderly people in rural areas form a habit of using preventive health services. In the future, similar studies implementing in a wider range of areas should be considered to obtain a more reliable conclusion.
特别是针对那些感知到更多障碍、较低自我效能、较少收益以及缺乏社会支持的个体，以及那些男性、年龄在 70 岁及以上、有吸烟或饮酒行为的人。由于医生在很大程度上决定了现有服务的利用，应该鼓励全科医生对所有老年人进行各种风险因素的筛查，并在适当干预的基础上，考虑在其公共卫生事件（PHE）到期时反复提醒高风险人群。应经常使用社区内的公告板和电视等其他健康传播渠道，以帮助农村地区的老年人养成使用预防性健康服务的习惯。未来，应考虑在更广泛的领域实施类似研究，以获得更可靠的结论。
This study was approved by the Medical Ethics Committee of Medical School, Shandong University (LL 201 , 401 , 048 201 , 401 , 048 201,401,048201,401,048 ), and conforms to the ethics guidelines of the Declaration of Helsinki. Informed consent was obtained from all participants prior to questionnaire administration.
本研究获得了山东大学医学院医学伦理委员会的批准（LL 201 , 401 , 048 201 , 401 , 048 201,401,048201,401,048 ），并符合《赫尔辛基宣言》的伦理指南。在问卷发放之前，所有参与者均已获得知情同意。

Acknowledgment 确认

We would like to thank all participants in the study, all the staffs who coordinate the field work and all the investigators who contributed to data collection. This research was supported by the National Natural Science Foundation of China (71373147) and the research fund to YB from the University of Macau (MYRG2019-00044-ICMS). The funding bodies had no role in the study design, data collection and analysis, or the writing of the manuscript.
我们要感谢所有参与研究的人员，所有协调实地工作的工作人员，以及所有为数据收集做出贡献的研究人员。本研究得到了中国国家自然科学基金（71373147）和澳门大学（MYRG2019-00044-ICMS）对 YB 的研究基金的支持。资助机构在研究设计、数据收集和分析或手稿撰写中没有参与。

Disclosure 披露

The authors report no conflicts of interest in this work.
作者在这项工作中报告没有利益冲突。

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Patient Preference and Adherence
患者偏好与依从性

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Patient Preference and Adherence is an international, peer-reviewed, open access journal that focusing on the growing importance of patient preference and adherence throughout the therapeutic continuum. Patient satisfaction, acceptability, quality of life, compliance, persistence and their role in developing new therapeutic modalities and compounds to optimize clinical outcomes for existing disease
患者偏好与依从性是一本国际同行评审的开放获取期刊，专注于患者偏好和依从性在治疗连续体中日益重要性。患者满意度、可接受性、生活质量、依从性、持续性及其在开发新治疗方式和化合物以优化现有疾病的临床结果中的作用。
states are major areas of interest for the journal. This journal has been accepted for indexing on PubMed Central. The manuscript management system is completely online and includes a very quick and fair peer-review system, which is all easy to use. Visit http:// www.dovepress.com/testimonials.php to read real quotes from published authors.
各州是该期刊的主要关注领域。该期刊已被接受在 PubMed Central 进行索引。手稿管理系统完全在线，包含一个非常快速和公正的同行评审系统，使用起来非常简单。访问 www.dovepress.com/testimonials.php 阅读已发表作者的真实引用。