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

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

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

A total of 1 436 community residents were included in the study. Among the four dimensions evaluated, the highest score rate was observed in health management beliefs (mean score: 2.58±0.63; score rate: 86.0%) , followed by health literacy (mean score: 95.40±16.28; score rate: 79.5%) . In contrast, health management behaviors showed a lower score (mean score: 4.24±1.73; score rate: 60.6%), and participation in health management programs was the lowest (mean score: 4.00±2.67; score rate: 33.3%) . Based on health management behavior scores, residents scoring ≥5 were categorized as the good behavior group (n=412) , and those scoring ≤4 as the poor behavior group (n=1 024) . PCM (1∶1) was applied to control for potential confounding variables including gender, age, education level, residential area, source of medical payment, monthly income, and marital/childbearing status. After matching, significant differences remained between the two groups in health literacy and health management belief scores (P<0.05) . Targeted optimization strategies were subsequently proposed based on the BCW framework: improving residents' health literacy and health management beliefs.

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