Under the pressing concerns of global environmental degradation, governmental bodies and associated institutions are progressively intensifying environmental propaganda, thereby further advocating for the adoption of energy-saving and emission-reduction concepts by the general public[1]. In light of this prevailing circumstance, an appreciable level of awareness concerning environmental protection has been cultivated among the majority of denizens inhabiting remote mountainous regions and rural vicinities. A mounting number of rural inhabitants have made the choice to employ eco−friendly pesticides and energy sources, while simultaneously repurposing waste as fertilizers (Tai and Tan 2012; Masera et al. 2000). The relatively closed conditions in mountainous areas make rural residents have different degrees of environmental awareness, resulting in different pollution situations (De Han and Arjan 1999). If this is the case for a long time, it will further exacerbate pollution levels, with detrimental consequences on the productive and living conditions of the local residents. Therefore, it is of practical significance to place emphasis on the awareness of environmental protection, lifestyle, and health status of rural residents.Internationally, awareness of environmental protection refers to the extent to which individuals exhibit concern for the overall processes of the environment, possess an understanding of environmental issues and the quality of the environment, and demonstrate a commitment to environmental preservation in their daily lives (Yeung 1998). This awareness can be further categorized into three components: environmental cognition, environmental behavior, and environmental attitudes (Du et al. 2018; Kousar et al. 2022; Daghagh et al. 2019; Liu et al. 2020; Xie et al. 2021). Recent research has indicated that awareness of environmental protection has the potential to influence various aspects of rural residents' livelihoods and productivity (Li et al. 2010). For instance, a heightened awareness of environmental protection positively impacts rural residents' responses to policies, while also influencing their environmental behaviors in a positive manner. Scholars have presented three dimensions of rural residents' environmental awareness, namely: awareness of environmental issues, attitudes towards environmental protection, and tolerance for environmental pollution. Through studying the relationship between rural residents' environmental awareness and the enhancement of their living environment, researchers have discovered a significant influence of environmental awareness on their improvement behaviors (Qing et al. 2022). However, it should be noted that certain studies have identified a discrepancy between awareness of environmental protection and actual pro-environmental behaviors among rural residents (Hao et al. 2017; Li et al. 2009). Therefore, further in-depth studies are required to fully comprehend the tangible impact of environmental awareness on the production-related activities of rural residents.
Currently, the literature pertaining to the health of rural residents predominantly adopts a medical standpoint, focusing primarily on the determinants influencing their health status. Within this domain, subjective psychological factors have gradually garnered attention. Broadly speaking, health concerns are increasingly situated within the purview of natural, economic, and social systems, and analytical approaches are characterized by a more holistic and systemic utilization of concepts and methodologies (Li and Gao 2007). Both domestic and international scholars dedicate their attention to the determinants of health, whereby foreign scholars generally regard that income and wealth bear no direct association with health. Instead, marital status, employment, proficiency in health-related knowledge, environmental conditions, social relations, educational quality, community standing, and self-awareness exhibit stronger correlations with health status (Mel 2004; Godbey 1990). The study into factors impacting the health degree of rural residents has been explored from diverse angles, chiefly encompassing regional economic and social development, the economic and cultural circumstances of rural residents, and the capacity of regional health services (Tan 2012; Gong et al. 2016). Notably, certain scholars have delved into the factors influencing self-reported ailments among residents residing in impoverished rural areas, deducing that health consciousness, economic circumstances, and psychological stress serve as predominant determinants (Zhou and Rao 1999; Ma et al. 2003). Existing research on the health of rural residents primarily emanates from a medical perspective, with a conspicuous dearth of an encompassing empirical analytical framework (Cui and Du 2004).
In addition, the measurement of the health degree in the research has also changed from a single physiological or psychological indicator to comprehensive physiological, social and psychological indicators, and it will be more scientific to transform these indicators into a relatively objective health index for health research. The prevailing quantitative research on the health status of rural households primarily employs health degree as independent variables rather than dependent variables. In addition, the utilization of distinct models and indicators has led to substantial variations in the derived conclusions. Moreover, the factors under consideration have predominantly encompassed objective variables, such as age, gender, and the natural and economic circumstances of the rural community. Conversely, scant attention has been given to investigating the influence of subjective factors, including ecological awareness and environmental protection, on the health of rural residents. Furthermore, a theoretical framework for such analysis is notably lacking. Factors such as awareness of environmental protection, attitudes, behaviors, and perceptions regarding pollution may exert an impact on the production and lifestyle of rural residents. Consequently, this study has the potential to address gaps in the existing literature and advance the research framework pertaining to the health degree and lifestyles of rural residents.
The Knowledge-Attitude-Practice (KAP) model, which originated from learning theory and diffusion of innovation theory, provides a theoretical framework for this study (Xu and Zhang 2021). In this study, the KAP model was used to examine the knowledge, attitudes and behaviors of rural residents towards environmental protection. The KAP model suggests that knowledge is an antecedent to attitude formation and drives practical behaviors through attitudes. In this context, knowledge is the awareness or understanding of information, attitude indicates a positive or negative evaluation of a goal, and behavior refers to regular activities carried out in the face of different problems. The model has been widely used in social research fields such as family planning, public health, education, sports, etc., and its applicability in identifying cognitive differences, attitudinal barriers and individual behaviors has been well tested. As the model continues to mature, the KAP model has also been expanded for use in research fields such as sustainable development and green low-carbon, land use change, and rural land policy practice (Hungerford and Volk 1990)
This paper combines the KAP model and existing domestic and international studies to improve the theoretical analytical framework from the specific situation of rural residents in mountainous areas of China in order to elucidate the interactive influence mechanism of their healthiness (Fig. 1). Subsequently, this study conducted research and analyses based on this framework, dividing the investigated influencing factors into core observational variables and control variables. The core observational variable adds "pollution perception" to the KAP model, which consists of four main aspects: rural residents' knowledge of environmental protection (In this study, we use environmental protection awareness to summarize this content), attitudes towards environmental protection, perception of pollution, and participation in environmental protection behaviors. These variables collectively encapsulate the residents' cognitive stance towards the environment. On the other hand, the control variables predominantly encompass individual factors of rural residents (e.g., age, gender, marital status, and educational level) as well as aspects related to the villages they inhabit, such as terrain type, urbanization rate, and distance to the city center. The control variables exhibit interplay and mutual reinforcement, collectively influencing both the awareness of environmental protection factors and the health degree of rural residents. Simultaneously, the core observational variables also exert a certain impact on health degree. This paper seeks to appraise the correlation between the awareness of environmental protection and the attitudes of rural residents in mountainous areas with their health degree. Therefore, it establishes a theoretical analysis framework for exploring the research on health degree in relation to these factors. The study addresses the research gap pertaining to the impact of awareness of environmental protection and attitudes on the health of rural residents, while providing strategies to enhance the health status of rural residents in mountainous areas.