{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:00:11Z","timestamp":1790431211635,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72074122"],"award-info":[{"award-number":["72074122"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["nyaspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann NY Acad Sci"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Rural populations often face structural barriers to accessing, interpreting, and using health information, contributing to persistent health literacy disparities. This cluster randomized controlled trial evaluated whether a theory of planned behavior\u2013based intervention could improve health literacy acquisition behaviors and overall health literacy among rural residents in Changzhou, China. Twenty villages were randomized to a 12\u2010month multicomponent intervention or routine health education. The intervention targeted behavioral attitude, subjective norms, and perceived behavioral control through health information materials, WeChat\u2010based messaging, interactive lectures, peer discussion, and practical training in health information seeking and appraisal. Outcomes were assessed at baseline and 12 months using the Short\u2010Form Health Literacy Scale and theory of planned behavior\u2013based measures. Linear mixed\u2010effects models accounting for clustering and repeated measurement showed significant intervention effects on behavioral attitude, subjective norms, behavioral intention, health literacy acquisition behavior, and overall health literacy, but not perceived behavioral control. Results were consistent in intention\u2010to\u2010treat, per\u2010protocol, and generalized estimating equation sensitivity analyses. These findings suggest that theory\u2010informed behavioral strategies can strengthen health literacy\u2010related motivation and practices in rural communities, although additional structural support may be needed to improve perceived control over health information access and use.<\/jats:p>","DOI":"10.1111\/nyas.70410","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:05:20Z","timestamp":1790093120000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Theory of Planned Behavior\u2013Based Cluster Randomized Trial to Improve Health Literacy Among Rural Adults in China"],"prefix":"10.1111","volume":"1563","author":[{"given":"Ran","family":"Dai","sequence":"first","affiliation":[{"name":"School of Public Health Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingjie","family":"Zhou","sequence":"additional","affiliation":[{"name":"National Health Commission Key Laboratory of Contraceptives Vigilance and Fertility Surveillance, Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment Jiangsu Health Development Research Center  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Wan","sequence":"additional","affiliation":[{"name":"School of Public Health Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxuan","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Public Health Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"He","sequence":"additional","affiliation":[{"name":"School of Public Health Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxu","family":"Guo","sequence":"additional","affiliation":[{"name":"School of Nursing Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Tang","sequence":"additional","affiliation":[{"name":"Section of Health Education and Promotion Changzhou Municipal Center for Disease Control and Prevention  Changzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"You","sequence":"additional","affiliation":[{"name":"School of Public Health Nanjing Medical University  Nanjing China"},{"name":"Laboratory for Digital Intelligence and Health Governance Nanjing Medical University  Nanjing China"},{"name":"Institute of Healthy Jiangsu Development Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/su141912142"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939\u2010024\u201002150\u20102"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010019\u20107381\u20101"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.2147\/RMHP.S479868"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/dax015"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010publhealth\u2010090419\u2010102529"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1034907"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBISRIR\u2010D\u201018\u201000023"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1348\/135910702169385"},{"key":"e_1_2_12_11_1","volume-title":"Attitudes, Personality and Behaviour","author":"Ajzen I.","year":"2005"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2015.04.006"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2021.03.060"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730.2011.604391"},{"key":"e_1_2_12_15_1","first-page":"1","article-title":"Health Literacy Interventions and Outcomes: An Updated Systematic Review","volume":"199","author":"Berkman N. 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