A multicenter cross-sectional survey on the status and influencing factors of health communication competence among primary healthcare workers.

Objective: To evaluate the current status and influencing factors of health communication competence among primary healthcare workers, providing evidence for improving the quality of primary health promotion services. Methods: A cross-sectional survey was conducted in August 2023 among 5,449 primary healthcare workers in Zibo City, Shandong Province, using multi-stage stratified random sampling. A self-designed questionnaire assessed four dimensions: health literacy mastery, knowledge acquisition ability, communication practice behavior, and policy cognition level. Statistical analyses included t-tests, ANOVA, multiple linear regression, and structural equation modeling (SEM). Results: The overall competence score was 69.45 ± 16.23, indicating a moderate level. Scores for health literacy mastery were highest, while communication practice behavior was lowest, showing a knowledge-practice gap. Education level, professional title, self-rated health status, and institution type were positive predictors, whereas occupational stress negatively affected competence (P < 0.001). The final regression model explained 42.1% of variance (R 2 = 0.421). SEM confirmed the direct and indirect effects of these factors, with good model fit (χ 2/df = 2.34, RMSEA = 0.045, CFI = 0.96, TLI = 0.95). Conclusion: Health communication competence among primary healthcare workers remains moderate and unevenly distributed. Targeted interventions focusing on education, professional development, health promotion training, and stress reduction are essential to enhance competence and improve the effectiveness of primary health communication.