Health Risks Among Rural Aging Populations in China: A Cross-Sectional Study of Knowledge, Attitudes, and Practices in Chronic Disease Management.

Background: Chronic diseases are a leading cause of morbidity and mortality worldwide, creating significant health risks and adding strain to healthcare systems, particularly within rapidly aging societies. Rural older adults are especially vulnerable due to limited healthcare resources, lower socioeconomic status, and weaker support networks. Guided by the Knowledge, Attitude, and Practice (KAP) framework, this study aims to investigate chronic disease management behaviors among older patients in rural China and identify factors shaping their KAP dimensions to inform risk-responsive interventions. Methods: A cross-sectional survey was conducted with 1320 older adults with chronic conditions across three rural regions in Zhejiang Province. Descriptive analyses were used to assess demographic characteristics, health status, daily health-related behaviors and social support structures, while multinomial logistic regression models identified different predictors significantly associated with the KAP dimensions. Results: Overall, participants demonstrated relatively low levels across KAP dimensions, showing a pattern of attitude > practice > knowledge, with notable discrepancies among the three dimensions. Although attitudes toward chronic disease management were generally positive, deficiencies in health knowledge and proactive practices persisted. Lower educational attainment and poorer healthcare policy awareness were significantly associated with lower knowledge levels. Inactive medical care-seeking and irregular exercise habits were both associated with higher levels of indifference. For practices, respondents with weak neighborhood interactions or lack of routine health monitoring were significantly less likely to engage in proactive health behaviors, while those with minor psychological distress and low family support showed markedly greater engagement in village-level care. Conclusion: These findings highlight the need for context-sensitive policy interventions to mitigate health risks among rural aging populations. Expanding insurance coverage, strengthening health literacy, and enhancing access to community-based and family-centred support could help improve chronic disease management. Moreover, sustained health education and regular screenings should be prioritized to close gaps between knowledge and practice in chronic disease management.