Rural residents’ cognition of healthy lifestyles: a qualitative study in Shanxi Province, China

Adopting a healthy lifestyle is crucial for preventing chronic diseases, yet sustained behavioral change remains challenging, especially in rural residents. Assessing their health behavior cognition is key to designing effective interventions. We conducted face-to-face, semi-structured interviews with 61 rural residents across three counties in Shanxi Province. Qualitative data were analyzed using thematic analysis. Three core themes emerged regarding rural residents’ cognitive frameworks of healthy lifestyles: (1) Fundamental cognition (including knowledge level and health values), (2) Risk-benefit assessment (including perceived risks and perceived benefits), and (3) Control beliefs (including self-efficacy and health locus of control). The study revealed that a considerable proportion of rural residents exhibited cognitive gaps towards healthy lifestyles. These cognitions are not merely individual-level deficits but are profoundly shaped and reinforced by structural determinants. Consequently, effective health promotion requires multi-level interventions that address both cognitive patterns and their structural drivers. Key strategies include delivering accessible health information through trusted local channels, providing low-cost check-ups to create objective health feedback, and facilitating successful behavioral experiences through social support and regular follow-up from village clinics.