This study has confirmed that mean score for health promotion lifestyle reaches (82.12±16.63), but 54.50% of the participants are in the status of average or poor, so the overall conditions of Chinese adults’ health promotion lifestyle is not good. That is consistent with previous studies of Chinese [21, 22], and is lower than studies of Xia, Chen et al. [23, 24]. The score of Nutrition is the highest (3.08±0.74), which is the same as the research results of Chen, Zhao and other scholars [22, 25]. With the increasing improvement of living standards and the popularization of nutrition knowledge, Chinese residents have higher requirements on diet, not only to satisfy their appetite, but also to pay more attention to nutrition ingredients and dietary collocation. The score of Physical Activity is the second highest (2.97±0.79), which is different from previous studies [23, 24]. The reason may be due to the differences between the scales used in this survey and those used in other surveys. After revision, the items that do not conform to Chinese culture had been deleted, so that they were easier to be understood [16]. It was worth noting that Chinese women showed better physical activity than men, which was different from studies of South Koreans [26] and Americans [27]. Perhaps this is because several Chinese women went square dancing as a way of exercise. Square dancing refers to dancing in an open and public space in China, usually on a flat patch such as a public square [28]. This group exercise has become popular in both urban and rural regions across China in recent 15 years [29, 30] and has been popular, mainly among women [28]. Thanks to its convenience, low cost and social function, square dancing has enabled Chinese women to get physical activity and spiritual satisfaction after work and housework [31]. It is interesting to note that unlike previous studies [32] reporting that living with a partner exerts positive influence on physical activity, this study found that married people’s Physical Activity is worse than that of unmarried people. That may be because in Chinese tradition, married people should take more family-oriented economic responsibilities and the responsibility of raising children, which makes them more inclined to spend their spare time and energy on work and raising children. The score of Health Responsibility got the lowest (2.42±0.89), similar results had been reported by Zhang [33], whose study also based on residents of northern China. This may be due to the lack of emphasis on self-responsibility for health in northern Chinese culture.
A significant and novel work of this study is to discover whether health attitude can influence health promotion lifestyle. Our main finding is that three aspects of health attitude have certain influence on health behavior, among which health cognition has the least influence, followed by health affection, and health behavioral intention has the greatest influence. The influence of health cognition on health promotion lifestyle has been discussed in many previous studies [34]. This study has found that health affection plays a more important role in the initiation of health promotion lifestyle than health cognition, that was not presented in other studies. The impact of health behavior intention on health behavior has been confirmed by several studies [35], some of which focus on promoting health promotion lifestyle in people without health motivation [36]. However, based on this study, if people can have health related knowledge and health affective experience at the same time and further develop corresponding behavioral intention, it is more likely to have health promotion lifestyle.
In addition to attitude, this study found that female residents may adopt more health promotion lifestyle, corroborating several studies [37, 38]. The effects of education and family income on health behavior are similar to previous studies [39, 40]. Prior studies suggested that poorly educated adults may have difficulty in understanding medical statistics, drug dose requirements, and basic health concepts such as daily nutritional value [41–43]. People with a high school diploma or above, tend to seek and use health information, regardless of their educational level and other sociodemographic factors [44, 45].
In China, as in other countries, inconsistencies in health behavior due to differences in gender, wealth, and education still persist; thus, decreasing the gap should be a top issue of particular urgency to both public and private sectors [46]. Due to the important influence of health attitude on health promotion lifestyle, affection and behavioral intention should be fully considered in the process of health promotion. For example, health promotion programs should be designed with elements that evoke affection in the residents, health-relevant motor manipulations can facilitate health behavior change and higher intention–behavior consistency [47]. Based on the characteristics of Chinese residents' greater emphasis on family responsibilities, more health promotion projects aimed at adolescents and requiring family participation could be designed. In order to compensate for the lack of health responsibility, while improving the accessibility and quality of health services, the propaganda of "everyone is the first person responsible for his/her own health" should be strengthened.
Limitations
The findings of this study should be considered in light of some limitations. Health attitudes and health promotion lifestyle are self-reported variables, so that report bias may exist. In the study, only Shandong Province residents have been conducted the survey, so that the representativeness may be limited. However, despite these limitations, this study can reflect the current health promotion lifestyle of Chinese residents and, reveal the influence of health attitude on health promotion lifestyle. It also provides relevant suggestions for the formulation of relevant health policies.