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.

随着慢性病负担加重，促进居民健康行为已成为公共卫生的关键目标。尽管健康素养和管理意识逐步提升，但知识与行为之间仍存在明显差距。行为改变轮（BCW）理论作为系统识别行为影响因素和设计干预策略的工具，在国际上得到广泛应用。然而，在我国社区居民健康行为领域的实证研究仍较有限。

了解目前上海市社区居民健康行为现状并分析其影响因素，以BCW为理论基础，提出提高居民健康行为的优化策略。

于2023年2—5月，采用分层抽样方法，结合上海市各行政区常住人口数及社区卫生服务中心数量，从每个区中随机抽取1~4个街镇的社区卫生服务中心，共选取28家。研究团队在每家中心面向50名前来就诊的社区居民开展问卷调查，收集其健康行为相关信息。问卷内容基于BCW理论，采用健康素养管理量表（HeLMS）评估健康素养水平，自设条目评估健康管理行为、健康管理信念及健康管理项目参与情况。为控制混杂因素，采用一般个体特征倾向性得分匹配（PSM）方法进行数据平衡，并分析影响健康行为的主要因素。

共纳入1 436名社区居民，结果显示在健康管理信念维度中得分率最高[平均得分（2.58±0.63）分，得分率86.0%]，健康素养水平次之[平均得分（95.40±16.28）分，得分率79.5%]，而健康管理行为得分相对较低[平均得分（4.24±1.73）分，得分率60.6%]，实施健康管理项目的得分最低[平均得分（4.00±2.67）分，得分率33.3%]。根据健康管理行为得分，将得分≥5分者划为行为良好组（n=412），≤4分者划为行为欠佳组（n=1 024）。采用1∶1 PSM法控制性别、年龄、文化程度、居住区域、医疗费用来源、月收入及婚育情况等混杂变量，匹配后两组在健康素养及健康管理信念得分比较，差异有统计学意义（P<0.05）。此外，根据研究结果，提出了基于BCW的社区居民健康行为的优化策略：提高居民健康素养水平、健康管理信念。

上海市社区居民具备较好的健康管理信念和健康素养水平，但健康行为执行和健康管理项目参与度仍有待提升。基于BCW理论，本研究提出了涵盖健康教育、能力赋能、激励机制与环境支持等多维干预策略，针对能力与动机等核心行为要素开展优化，旨在提升居民健康行为水平，为社区健康管理的系统干预提供理论指导与实践路径。