Measures

The questionnaire focuses on understanding the general public’s awareness and health-related behavior from the perspective of daily life. A total of 70 survey questions covering seven aspects were designed, including individual health awareness and behavior pertaining to work and rest; daily diet; tobacco, alcohol, nutrition; excretion (stool and urine); food quality; exercise, physical and mental conditions; and health cognition (Table S1).

We referenced the monitoring and evaluation standards of Chinese health literacy and the “Chinese Citizens’ Health Literacy - Basic Knowledge and Skills (2015 edition)” as the basis [28], and assigned the seven indicators to 1–5 points (Table S1). The questionnaire was designed with reference to Chinese residents’ health literacy monitoring and HLY-EU-Q16 [29, 30]. We evaluated the level of individual health literacy by using 70 indicators.

The questionnaire provides a maximum of five options for participants to choose from for each indicator. Each option under a given indicator was assigned a maximum score of five points. The overall health literacy score of an individual was obtained by summing the scores of all indicators. This study compared the individual’s health literacy score with the total score of the evaluation index system used to assess Chinese health literacy levels. The quotient resulting from this comparison represents the individual’s health literacy index. Additionally, we compared the scores of the seven dimensions of health awareness and behavior with the standard total score. We obtained distinct indices for each aspect: the health work and rest index, diet health index, health care index, health excretion (stool and urine) index, food health concern index, health exercise index, and health cognition index.

The gender structure of the respondents was 44.04% male (757) and 55.96% female (962). Respondents’ ages ranged from 12 to 83 years, with an average age of 50.71 years. Educational levels were categorized based on the highest completed level of education one year prior to survey completion. Basic school, primary educations, lower secondary, upper secondary, and vocational educations reflect the first and second education levels. Medium length educations including short and medium length tertiary, and bachelor’s educations, and higher length education containing master’s level and PhD-level educations reflect the third and fourth levels of education. We converted the education years of the samples according to the education years of different stages in China. The average education time of the respondents is 17.0, which is between the bachelor degree and the master degree.

The survey included various measures of health behavior such as work and rest conditions, daily diet, smoking habits, alcohol consumption, and physical activity. Work and rest conditions were assessed based on factors such as rest time and sleep status. Daily diet was evaluated with respect to meal patterns and food choices. Tobacco, alcohol, and nutritional products were the criteria of whether the individual smoked and drank alcohol and took nutritional health products. The condition of defecation is concerned about the individual’s physical condition and the degree of cognition of defecation. Food quality primarily examined individuals’ trust in the quality of the food they consumed. Exercise and physical and mental condition aimed to investigate the intensity and time of individual exercise, and to evaluate the physical and mental condition of individuals through fatigue and working hours. Health cognition was assessed based on the individual’s cognition of medical treatment, medical hygiene and individual health level. Self-reported height and weight data were obtained to allow calculation of body mass index (BMI, BMI = weight (kg) divided by the square of height (m)). The classification of BMI mainly refers to the standard defined by the Health Commission of the People’s Republic of China (BMI < 18.5: underweight; 18.5 ≤ BMI < 24.0: normal; 24 ≤ BMI < 28: overweight; BMI ≥ 28: obesity).