{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T22:09:14Z","timestamp":1793743754836,"version":"4.6.1"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Promoting proactive health behaviors is an effective strategy for addressing public health challenges and advancing the \u201cHealthy China\u201d initiative. This study aims to explore the driving factors and mechanisms influencing proactive health behavior intention by integrating the theory of planned behavior (TPB) and the health belief model (HBM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey design was employed. A structured questionnaire was developed based on the theory of planned behavior (TPB) and the health belief model (HBM), covering eight dimensions: health behavior attitude, subjective norms, perceived behavioral control, self-efficacy, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. A total of 462 valid responses were collected using convenience sampling at a hospital health examination center in Jiangsu Province, China. Participants were approached on-site during routine check-ups and voluntarily completed the survey after providing informed consent. Data were analyzed using SPSS 26.0 and AMOS 26.0. Reliability and validity were tested using Confirmatory Factor Analysis (CFA), and hypotheses were examined through Structural Equation Modeling (SEM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The findings revealed that perceived susceptibility, severity, benefits, and barriers significantly influenced individuals\u2019 attitudes toward health behaviors. Attitudes, subjective norms, and perceived behavioral control significantly predicted intention, with self-efficacy partially mediating these effects. Perceived barriers had a negative effect, suggesting practical challenges hinder the development of health intentions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Health belief factors, especially perceived benefits, significantly influence health behavior attitude. TPB variables\u2014particularly attitude\u2014are key predictors of proactive health behavior intention. Self-efficacy acts as an important mediator, enhancing the explanatory power of the integrated TPB-HBM model. These findings provide theoretical and practical guidance for designing interventions to promote proactive health behavior in the general population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1629046","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T05:31:13Z","timestamp":1752125473000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":40,"title":["Influencing factors and mechanisms promoting proactive health behavior intention: an integration of the health belief model and the theory of planned behavior"],"prefix":"10.3389","volume":"13","author":[{"given":"Lidong","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoqiao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hu","family":"Lou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1001\/jama.2020.0734","article-title":"US health care spending by payer and health condition, 1996-2016","volume":"323","author":"Dieleman","year":"2020","journal-title":"JAMA"},{"key":"ref2","first-page":"791856","article-title":"Total health expenditure and its driving factors in China","volume":"9","author":"Zhang","year":"2021","journal-title":"Front Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e50959","DOI":"10.2196\/50959","article-title":"Digital health platform for improving the effect of the active health management of chronic diseases in the community: mixed methods exploratory study","volume":"26","author":"Zhou","year":"2024","journal-title":"J Med Internet Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4848","DOI":"10.1038\/s41598-023-31867-3","article-title":"Health-promoting behavior to enhance perceived meaning and control of life in chronic disease patients with role limitations and depressive symptoms: a network approach","volume":"13","author":"Yun","year":"2023","journal-title":"Sci Rep"},{"key":"ref5","year":"2016"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"20552076231183543","DOI":"10.1177\/20552076231183543","article-title":"Using a complexity science approach to evaluate the effectiveness of just-in-time adaptive interventions: a meta-analysis","volume":"9","author":"Xu","year":"2023","journal-title":"Digit Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"105089","DOI":"10.1016\/j.gerinurse.2024.10.029","article-title":"Factors influencing proactive health behaviors in pre-frailty older adults: a cross-sectional study","volume":"115","author":"Wang","year":"2024","journal-title":"Arch Gerontol Geriatr"},{"key":"ref8","year":"2019"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","article-title":"The theory of planned behavior","volume":"50","author":"Ajzen","year":"1991","journal-title":"Organ Behav Hum Decis Process"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"352","DOI":"10.5964\/ejop.v16i3.3107","article-title":"The theory of planned behavior: selected recent advances and applications","volume":"16","author":"Bosnjak","year":"2020","journal-title":"Eur J Psychol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1037\/hea0000940","article-title":"An extended theory of planned behavior for parent-for-child health behaviours: a meta-analysis","volume":"39","author":"Hamilton","year":"2020","journal-title":"Health Psychol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"101223","DOI":"10.1016\/j.pmedr.2020.101223","article-title":"The health belief model and colorectal cancer screening in the general population: a systematic review","volume":"20","author":"Lau","year":"2020","journal-title":"Prev Med Rep"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12889-023-15725-5","article-title":"A theory-informed systematic review to understand physical activity among women in Gulf Cooperation Council countries","volume":"23","author":"Osabi","year":"2023","journal-title":"BMC Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0269059","DOI":"10.1371\/journal.pone.0269059","article-title":"Assessment of acceptability of the COVID-19 vaccine based on the health belief model among Malaysians-a qualitative approach","volume":"17","author":"Rani","year":"2022","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1016\/j.ijnss.2022.06.005","article-title":"Health beliefs toward lung cancer screening among Chinese American high-risk smokers: interviews based on health belief model","volume":"9","author":"Lei","year":"2022","journal-title":"Int J Nurs Sci"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e0290412","DOI":"10.1371\/journal.pone.0290412","article-title":"Integrating health belief model and theory of planned behavior to assess COVID-19 vaccine acceptance among urban slum people in Bangladesh","volume":"18","author":"Patwary","year":"2023","journal-title":"PLoS One"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1049358","DOI":"10.3389\/fpsyg.2023.1049358","article-title":"Using an integrated model of the theory of planned behavior and the temporal self-regulation theory to explain physical activity in patients with coronary heart disease","volume":"14","author":"Wang","year":"2023","journal-title":"Front Psychol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1377430","DOI":"10.3389\/fpsyg.2024.1377430","article-title":"Understanding physical exercise among individuals with substance use disorders using an integrated theoretical perspective of the health action process approach and theory of planned behavior","volume":"15","author":"Meng","year":"2024","journal-title":"Front Psychol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"772564","DOI":"10.3389\/fpubh.2021.772564","article-title":"Integrating the extended theory of planned behavior with the stages of change to predict exercise among Chinese people with type 2 diabetes","volume":"9","author":"Gao","year":"2021","journal-title":"Front Public Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3390\/bs14010026","article-title":"The role of triggers in physical activity among college students: an extended model of the theory of planned behavior","volume":"14","author":"Wang","year":"2024","journal-title":"Behav Sci (Basel)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1037\/hea0001153","article-title":"Perceived behavioral control moderating effects in the theory of planned behavior: a meta-analysis","volume":"41","author":"Hagger","year":"2022","journal-title":"Health Psychol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s41043-025-00790-w","article-title":"Fertility intention and its correlates with reproductive-aged married women in Ethiopia: an adapted theory of planned behavior (TPB)","volume":"44","author":"Fantaye","year":"2025","journal-title":"J Health Popul Nutr"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1186\/s12884-024-06728-0","article-title":"The effect of nutrition education based on the health belief model (HBM) on food intake in pregnant Afghan immigrant women: a semi-experimental study","volume":"24","author":"Riazi","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref24","author":"Ajzen","year":"2019"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1002\/hpm.3582","article-title":"Predicting intentions to get the COVID-19 vaccine in India: An integration of theory of planned behaviour and health belief model","volume":"38","author":"Tarkar","year":"2023","journal-title":"Int J Health Plann Manag"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"S23","DOI":"10.1016\/j.ijnss.2020.07.006","article-title":"Development and evaluation of the health belief model scale for exercise","volume":"7","author":"Wu","year":"2020","journal-title":"Int J Nurs Sci"},{"key":"ref27","first-page":"359","article-title":"Predicting health behavior intentions in response to COVID-19: theory of planned behavior and the role of attitudes, norms and perceived control","volume":"41","author":"Karekla","year":"2022","journal-title":"Curr Psychol"},{"key":"ref28","year":"2024"},{"key":"ref29","year":""},{"key":"ref30","doi-asserted-by":"publisher","first-page":"534","DOI":"10.12114\/j.issn.1007-9572.2024.0381","article-title":"Construction of conceptual framework of proactive health behavior in stroke patients","volume":"28","author":"Zhou","year":"2025","journal-title":"Chin General Pract"},{"key":"ref31","first-page":"2223654","article-title":"Investigating the intention to receive COVID-19 vaccination in Bangladesh: health belief model, theory of planned behavior, or both?","volume":"19","author":"Patwary","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"ref32","first-page":"12387","article-title":"Integrating health belief model and theory of planned behavior to predict parents\u2019 intention for their children\u2019s myopia preventive behaviors: evidence from China","volume":"19","author":"Jiang","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.3390\/nu12041203","article-title":"Social-psychological factors in food consumption of rural residents: the role of perceived need and habit within the theory of planned behavior","volume":"12","author":"Huang","year":"2020","journal-title":"Nutrients"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1177\/109019817400200403","article-title":"Historical origins of the health belief model","volume":"2","author":"Rosenstock","year":"1974","journal-title":"Health Educ Monogr"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"15732","DOI":"10.3390\/ijerph192315516","article-title":"Association between the health belief model, exercise, and nutrition behaviors during the COVID-19 pandemic","volume":"19","author":"Kiely","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref36","first-page":"382","article-title":"Psychological predictors of protective behaviours during the COVID pandemic: theory of planned behaviour and risk perception","volume":"2","author":"Trifiletti","year":"2021","journal-title":"J Community Appl Soc Psychol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1348\/014466601164939","article-title":"Efficacy of the theory of planned behaviour: a meta-analytic review","volume":"40","author":"Armitage","year":"2001","journal-title":"Br J Soc Psychol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e54","DOI":"10.1017\/jns.2024.50","article-title":"Factors influencing the intention of young adults to adopt genotype-based personalised advice on diet and physical activity according to perceived weight status","volume":"13","author":"King","year":"2024","journal-title":"J Nutr Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1111\/aphw.12231","article-title":"Application of health behavior theory to social distancing during the COVID-19 pandemic: a systematic review","volume":"12","author":"Hamilton","year":"2020","journal-title":"Appl Psychol Health Well Being"},{"key":"ref40","first-page":"1","article-title":"The intention\u2013behaviour gap: an empirical examination of an integrative perspective to explain exercise behaviour","volume":"15","author":"Gomes","year":"2017","journal-title":"Int J Sport Exerc Psychol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s40359-022-00847-z","article-title":"Physical exercise and its associated factors among Ethiopian pregnant women: a cross-sectional study based on the theory of planned behavior","volume":"10","author":"Addis","year":"2022","journal-title":"BMC Psychol"},{"key":"ref42","volume-title":"The theory of planned behaviour and physical activity in pregnancy: exploring the moderating effect of antenatal depressive symptomology [D]","author":"Dhaliwal","year":"2022"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.3760\/cma.j.cn112338-20240104-00003","article-title":"Current status of parental decision-making of childhood 13-valent pneumococcal conjugate vaccine immunization and related factors in China","volume":"45","author":"Li","year":"2024","journal-title":"Chin J Epidemiol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/BF00846423","article-title":"Prediction of leisure-time exercise behavior: a path analysis (LISREL V) model","volume":"10","author":"Godin","year":"1987","journal-title":"J Behav Med"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1017\/9781108677318.002","article-title":"Changing behavior using the theory of planned behavior","volume-title":"The handbook of behavior change","author":"Ajzen","year":"2020"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"477","DOI":"10.3760\/cma.j.cn112338-20220728-00669","article-title":"Sedentary behavior, screen time and mental health of college students: a meta-analysis","volume":"44","author":"Gao","year":"2023","journal-title":"Chin J Epidemiol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.jesf.2024.09.002","article-title":"The effect of electronic health (eHealth) interventions for promoting physical activity self-efficacy in children: a systematic review and meta-analysis","volume":"22","author":"Lu","year":"2024","journal-title":"J Exerc Sci Fit"},{"key":"ref48","doi-asserted-by":"crossref","first-page":"1320920","DOI":"10.3389\/fpubh.2024.1320920","article-title":"Influencing factors of health screening among retirees: an extended TPB approach","volume":"12","author":"Xu","year":"2024","journal-title":"Front Public Health"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1123\/jpah.2019-0108","article-title":"Self-efficacy, not peer or parent support, is associated with more physical activity and less sedentary time among 8- to 12-year-old youth with elevated body mass index","volume":"17","author":"Schroeder","year":"2020","journal-title":"J Phys Act Health"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"12158","DOI":"10.3390\/ijerph191912152","article-title":"The mediation role of self-control in the association of self-efficacy and physical activity in college students","volume":"19","author":"Yu","year":"2022","journal-title":"Int J Environ Res Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1629046\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T05:31:17Z","timestamp":1752125477000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1629046\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,10]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2025.1629046"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1629046","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,10]]},"article-number":"1629046"}}