Abstract: Background　With evolving health concepts and changing disease spectra, the importance of proactive health management in disease prevention and health promotion has become increasingly prominent. As the cornerstone of primary health care at the community level, general practitioners play a pivotal role in implementing proactive health management. However, evidence on the current status of community general practitioners' knowledge, beliefs, and behaviors regarding proactive health management, as well as the factors influencing these domains, remains limited. Objectives　This study aims to assess the current status of knowledge, beliefs, and behaviors related to proactive health management among community general practitioners in Shanghai, to analyze the major influencing factors, and to propose targeted strategies for improvement. Methods　From February to May 2023, a questionnaire survey was conducted in two community health service centers in each of the 16 administrative districts of Shanghai, and a total of 691 community general practitioners were enrolled. A self-developed Community General Practitioners' Proactive Health Management Knowledge, Beliefs, and Behaviors Questionnaire was used, comprising three dimensions (knowledge, beliefs, and behaviors) and demonstrating acceptable reliability and validity. Independent-samples t tests, one-way analysis of variance, and multiple linear regression analyses were performed to examine differences across subgroups and to identify associated influencing factors. Results　Overall, community general practitioners reported positive beliefs regarding proactive health management (score rate 84.12%), a moderately high level of knowledge (75.90%), and comparatively lower levels of related behaviors (71.98%). Multiple linear regression analysis showed that educational level, professional title, serving as a team leader, and practice region were significant predictors of knowledge scores (P<0.05); educational level, years of working in general practice, and serving as a team leader were significant predictors of belief scores (P<0.05); and educational level, years of working in general practice, professional title, serving as a team leader, and practice region were significant predictors of behavior scores (P<0.05). The main perceived barriers to implementing proactive, health-oriented management among community general practitioners included lack of policy support (n=473, 68.45%), heavy clinical workload (n=469, 68.02%), insufficient health awareness among residents (n=410, 59.33%), and limited institutional resources (n=383, 55.43%). Conclusion　Community general practitioners in Shanghai demonstrate generally positive attitudes toward proactive health management; however, their knowledge remains insufficiently systematic and their behaviors are not fully translated into practice. Educational level, professional title, years of general practice experience, team leadership roles, and practice region significantly influence their levels of knowledge, beliefs, and behaviors. Stratified training, optimized policy support, strengthened allocation of digital resources, and enhanced health education for community residents are warranted to promote the effective translation from “knowing” and “believing” to “doing” in proactive health management, thereby improving the quality and effectiveness of proactive health management at the primary care level.

Key words: General practitioners, Proactive health, Health management, Knowledge-attitude-practice, Root cause analysis

摘要： 背景　随着健康观念的转变和疾病谱的变化，主动健康管理在预防疾病、促进健康方面的重要性日益凸显。社区全科医生作为基层医疗卫生服务的核心力量，在实施主动健康管理中发挥着关键作用。然而，目前关于社区全科医生主动健康管理的知识、信念和行为（知信行）现状及其影响因素的研究仍较有限。目的　本研究旨在调查上海市社区全科医生实施主动健康管理的知信行现状，分析其主要影响因素，并提出针对性改进策略。方法　于2023年2—5月，在上海市16个行政区各选取2家社区卫生服务中心进行问卷调查，共纳入691名社区全科医生。采用自制《社区全科医生主动健康管理知信行调查问卷》，包括知识、信念、行为三个维度，并通过信效度检验。运用t检验、方差分析及多元线性回归分析不同特征群体的差异及影响因素。结果　社区全科医生在主动健康管理中总体信念积极（得分率84.12%），知识掌握处于中等偏上水平（75.90%），行为表现相对较低（71.98%）。多元线性回归结果显示：学历、职称、是否担任团队长及工作地区是知识维度的影响因素（P<0.05）；学历、从事全科工作年限、是否担任团队长是信念维度的影响因素（P<0.05）；学历、从事全科年限、职称、是否担任团队长及工作地区是行为维度的影响因素（P<0.05）。社区全科医生对实施主动健康导向的健康管理的主要障碍包括缺乏政策支持（473名，68.45%）、临床工作负担重（469名，68.02%）、居民健康意识不足（410名，59.33%）及机构资源有限（383名，55.43%）。结论　上海市社区全科医生在主动健康管理中整体态度积极，但知识系统性与行为落实不足。学历、职称、年资、团队管理角色及工作地区等因素显著影响其知信行水平。应通过分层培训、优化政策支持、加强数字化资源配置与居民健康教育，促进主动健康管理从“知”“信”向“行”的有效转化，提升基层主动健康管理的质量与效能。

关键词: 全科医生, 主动健康, 健康管理, 知信行, 影响因素分析