
==== Front
Sci Rep
Sci Rep
Scientific Reports
2045-2322
Nature Publishing Group UK London

39223269
71324
10.1038/s41598-024-71324-3
Article
Developing an assessment tool for the healthy lifestyles of the occupational population in China: a modified Delphi-analytic hierarchy process study
Min Zhang 1
Bin Hu 1
Wenjie Zhou 1
Tao Li 1
Yi Meng 1
Chunhua Zhang 2
http://orcid.org/0009-0004-9479-3378
Tong Yang yangtongqq520@qq.com

1
1 Shapingba District Disease Control and Prevention Center, Shapingba District, Chongqing, 400000 China
2 Chongqing Center for Disease Control and Prevention, Yuzhong District, Chongqing, 400010 China
2 9 2024
2 9 2024
2024
14 203598 7 2024
27 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Lifestyle is an important factor affecting people's health. Evaluating and promoting healthy lifestyles among occupational population can not only improve work ability and efficiency, but also contribute to the prevention a variety of potential diseases. This study developed a preliminary index system based on literature review and group discussion. Two rounds of expert consultation were conducted on 12 experts using Delphi method. The questionnaire recovery rate of the two rounds of Delphi survey was over 85%, the expert authority coefficient was over 0.70, and Kendall W was 0.450 and 0.446, which were significant (P < 0.001). The weighting coefficient of each indicator was calculated using the hierarchical analysis method. Among them, the weighting coefficients of physical health lifestyle, mental health lifestyle, social adaptation lifestyle and occupational health lifestyle were 0.4133, 0.2922, 0.1078 and 0.1867, respectively. The consistency index CI = 0.024 and the consistency ratio CR = 0.027 of the first-level index judgment matrix. The weighting coefficient is acceptable and the indicators do not cause logical confusion. The healthy lifestyle assessment tool of the occupational population constructed in this study consists of 4 primary indicators, 13 secondary indicators and 45 tertiary indicators, which can provide a standardized and operable assessment tool for monitoring and evaluating the healthy lifestyle of the Chinese occupational population. At the same time, the weight analysis of various indicators through the analytic hierarchy process can also provide reference for the key areas of occupational health intervention.

Keywords

Healthy lifestyle
Occupational population
Delphi method
Analytic hierarchy process
Evaluation indicator system
Subject terms

Disease prevention
Health services
Occupational health
Chongqing Science and Health Joint Medical Research Project2024MSXM172 Min Zhang Shapingba District Science and Health Joint Medical Research Project2023SQKWLH041 Tong Yang issue-copyright-statement© Springer Nature Limited 2024
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pmcIntroduction

It is proposed to enhance the good health and well-being of the population and thus contribute to the sustainable development of economic prosperity and vibrant societies in the United Nations 2030 Agenda for Sustainable Development1. The occupational population is the backbone of family security and social development2. However, the work tasks of the occupational population have gradually changed over the past decade. In the course of their work, members of the occupational population may encounter adverse health factors such as occupational stress, interaction stress, and occupational hazards3, which may not only cause a decrease in work capacity and efficiency4 but also lead to a high incidence of many types of potential diseases such as obesity5, stroke6, and muscle strain7. The World Health Organization (WHO) and the International Labor Organization (ILO) jointly released a report showing that occupationally linked diseases and workplace injuries cause nearly 2 million deaths globally each year8. In China, 34.1% of the occupational population has a definite diagnosis of disease or sub-health9. In the face of the increasing health risks of the occupational population, how to improve the health of the occupational population and prevent a variety of occupation-related diseases has become a common challenge of global concern10.

Lifestyle is an important factor affecting people's health11. Healthy lifestyle refers to a set of customized behaviors that can help an individual avoid many diseases and improve their health and quality of life12. The Outline of Healthy China 2030 clearly states that healthy lifestyle measures, such as eating a balanced diet, engaging in fitness activities, and controlling smoking and alcohol consumption, should be taken to improve people’s health13. Studies showed that the adoption of a healthy lifestyle has an overall effective rate of more than 80% in preventing and reversing cardiovascular, cerebrovascular, and metabolic diseases14, and improving the five-year survival rate of tumor patients15. Recently, there has been a growing interest in creating assessment tools for healthy lifestyles in the occupational population16, with studies measuring physical activity, nutrition and diet, and smoking17 as common healthy lifestyle factors, as well as family activities, Social interaction and psychological balance18, and positive thinking19 as factors influencing overall healthy lifestyles. Although many of these tools are available, there is still a significant amount of variation in terms of their range, emphasis, dependability, and accuracy20. The research on healthy lifestyle assessment tools for the occupational population started late in China. At the same time, under the special social background of high-quality development promoting Chinese modernization, the development of healthy lifestyle assessment tools for occupational groups has also put forward two major requirements: comprehensive and targetedness21. Therefore, this study aimed to construct an indicator evaluation index system using the Delphi expert consultation method with hierarchical analysis, which provided a standardized and operational tool for monitoring and evaluating the healthy lifestyles of the Chinese occupational population.

Methods

Literature review and preliminary indicator tool construction

Literature review was conducted on Web of Science, PubMed, Cochrane, Science Direct, InCite, CNKI, and Wangfang. The retrieval time was from the establishment of these databases to August 2022. We searched eligible studies published using the following search terms: (occupational population) or (occupational population health) or (healthy lifestyle) or (healthy lifestyle evaluation indicator system) or (healthy lifestyle influencing factors). The reference lists of all included studies were hand-searched to identify any potentially relevant studies. We also referred to the “Chinese Citizens’ Health Literacy-Basic Knowledge and Skills”, “Core Information on Healthy Lifestyle”22, “60 Articles on Occupational Health Literacy”23, and other government documents. Based on literature review and group discussion, the evaluation index system of healthy lifestyle of the occupational population was preliminarily developed, consisting of 5 first-level indicators, 18 second-level indicators and 45 third-level indicators, with a total of 68 evaluation indicators. The flow chart of searching the literature and identifying the initial index process of healthy lifestyle of the Chinese occupational population is shown in Fig. 1.Fig. 1 The flow chart of initial indicator construction.

Delphi surveys

The expert correspondence questionnaire had three parts: (1) a letter explaining the purpose and significance of the study and the methodology; (2) a consultation form to evaluate the healthy lifestyle of the occupational population, which entailed the use of a five-point Likert scale to rate the importance of each indicator (1—unimportant, 2—not too important, 3—generally important, 4—relatively important, 5—very important); (3) an information table to collect information on the experts’ basic demographics, familiarity with each indicator, and judgment basis. The experts’ judgment basis consisted of theoretical analysis, work experience, references, and intuition, and the degree of influence of each judgment basis was large, medium, or small. The experts’ degree of familiarity was categorized into five levels: very familiar, familiar, generally familiar, unfamiliar, and very unfamiliar.

Selection of experts

According to the purpose of the study and the principle of expert representativeness and authority, 13 experts were selected from Chongqing Preventive Medical Association and Chongqing Occupational Health Technical Expert database through convenience sampling The selection criteria for the participants were as follows: (1) More than 10 years of working experience in the field of occupational health; (2) holds a master degree or higher; (3) holds an associate professor (associate chief physician) position or higher; and (4) is interested in the study and can actively participate in the two rounds of consultations.

Data collection

Two rounds of Delphi expert consultations were completed between December 2022 and March 2023. In the first round of Delphi expert consultation, the expert questionnaire was sent by email and the expert was reminded by phone to complete the survey within 1 week. After the completion of the first round of consultation, indicators with an average importance score ≤ 3.5 or CV ≥ 25% were eliminated, and in-depth face-to-face interviews were conducted with experts to supplement the indicators jointly suggested to form the second round of expert consultation letter. In the second round of Delphi expert consultation, the expert questionnaire is also sent out by email. Until all indicators had an average importance score > 3.5 or CV < 25%, representing that the expert opinions had converged, and the consultation was concluded.

Statistical analysis

SPSS 25.0 and YAAHP 10.1 were used to analyze and process the data. The questionnaire effective recovery rate (%) reflected the enthusiasm of the experts. The coefficient of the degree of authority (Cr) indicated the experts’ level of authority, which was determined by using the coefficient of the judgment basis (Ca) and the coefficient of the degree of familiarity (Cs), that is, Cr = (Ca + Cs)/2. The mean, standard deviation, and coefficient of variation of the importance scores of the indices reflected the degree of concentration of the experts’ opinions. In addition, the coefficient of the coordination of the experts’ opinions (Kendall’s W) indicated the degree of coordination of the experts’ opinions. Meanwhile, hierarchical analysis was conducted to determine the weights of the indicators at all levels. First, the arithmetic mean of the importance scores of the indicators was calculated at all levels and taken as the initial weights. Second, the structural indicators were classified based on the initial weights. Third, the indicators were compared two by two by using the Saaty 1–9 scale to establish the judgment matrix. Last, the consistency ratio (CR) was used to test the logic and consistency of the weight calculation. If the CR is < 0.1, then the judgment matrix meets the consistency requirements, and the calculated weights of the indicators are acceptable.

Ethical issues

This study was performed in accordance with the 1964 Declaration of Helsinki and received the approval of the Ethics Committee of Shapingba District Center for Disease Prevention and Control (No: 20220304001). Informed consent was obtained from all individual participants included in the study.

Results

Characteristics of experts

A total of 13 experts from various fields were invited to participate in this study, 12 of whom completed the two rounds of expert consultations. The 12 experts reported various research interests, namely, public health and preventive medicine (9; 75.00%), clinical medicine (2; 16.67%), and psychology (1; 8.33%). Of the 12 participants, 5 (41.67%) held a senior associate position, and 7 (58.33%) held a senior position. The experts’ education level varied, with 6 (50.00%) holding a PhD, 5 (41.67%) holding a master’s degree, and 1 (8.33%) holding a bachelor’s degree. In addition, 5 (41.67%) of the participants worked at the Centers for Disease Control and Prevention, 1 (8.33%) worked at a community health service center, 4 (33.33%) worked at a medical college or university, and 2 (16.67%) worked at a tertiary hospital. In terms of the experts’ years of service, 2 (16.67%) had work experience of 10–15 years, 3 (25.00%) had work experience of 16–20 years, and 7 (58.33%) had work experience of more than 20 years (Table 1).Table 1 Characteristics of experts who completed two rounds of Delphi surveys.

Category	Characteristics	Number	Percentage (%)	
Gender	Male	5	41.67	
Female	7	58.33	
Professional title	Senior associate	5	41.67	
Senior	7	58.33	
Educational attainment	PhD	6	50.00	
Master’s degree	5	41.67	
Bachelor’s degree	1	8.33	
Main research interests	Public health and preventive medicine	9	75.00	
Clinical medicine	2	16.67	
Psychology	1	8.33	
Workplace	Centers for Disease Control and Prevention	5	41.67	
Community health service center	1	8.33	
Medical college or university	4	33.33	
Tertiary hospital	2	16.67	
Years of service	10–15 years	2	16.67	
16–20 years	3	25.00	
More than 20 years	7	58.33	

Experts’ motivation and authority coefficient

In the first round of the Delphi surveys, 12 experts completed the questionnaire (92.31%) after 2.75 ± 2.22 days, and 7 (58.33%) experts proposed revisions. In the second round, 12 experts completed the questionnaire (100%) after 2.58 ± 1.68 days, and 4 (33.33%) experts proposed revisions. The results indicated the experts’ high motivation. In the two rounds of surveys, the coefficient of the authority of the experts (Cr) was 0.89 and 0.91, which are greater than 0.70 and indicated the experts’ high authority (Table 2).Table 2 Experts’ authority coefficient in two rounds of Delphi surveys.

Round	Cs	Ca	Cr	
One	0.87 ± 0.09	0.92 ± 0.07	0.89 ± 0.07	
Two	0.89 ± 0.07	0.93 ± 0.09	0.91 ± 0.07	

Consistency and coordination of experts’ opinions

In the first round of surveys, the mean importance score of each indicator ranged from 3.75 to 4.92, and the coefficient of variation ranged from 5.89 to 28.39%. In the second round of surveys, the mean importance score of each indicator ranged from 3.50 to 4.83, and the coefficient of variation ranged from 8.05 to 24.64%. In the two rounds of surveys, Kendall’s coordination coefficient (W) of the experts’ opinions was 0.450 and 0.446 and significant (P < 0.001), which indicated that all the experts reached a high degree of consensus on the study results (Table 3).Table 3 Results of coordination analysis in two rounds of expert consultations.

Round	Kendall’s W	χ2	df	P	
One	0.450	113.935	11	 < 0.001	
Two	0.446	304.020	11	 < 0.001	

Indicator screening

After the first round of expert consultation, the first-level indicator of "disease prevention and control" was deleted, and the six second-level indicators of "living environment", "emotion", "spirit", "interpersonal relationship", "disease prevention and control knowledge" and "disease prevention and control behavior" were deleted, and the second-level indicator "health responsibility" was added. After the second round of expert consultation, modify the eight three-level indicators of "self-understanding", "emotional control", "personality bias", "pressure release", "pressure coping", "communication willingness", "communication ability", and "use and maintenance of occupational hazard protection equipment". The changes of index screening in two rounds of Delphi expert consultation are shown in Fig. 2.Fig. 2 The changes of index screening in two rounds of Delphi expert consultation.

After the two rounds of expert consultations, the final healthy lifestyle evaluation indicator system for the occupational population consisted of 62 indicators, that is, four first-level indicators, 13 s-level indicators, and 45 third-level indicators, as shown in Table 4.Table 4 Importance score and variation coefficient of each index after two rounds of Delphi survey.

Indicators	Importance (points)	Coefficient of variation	
Mean	Standard deviation	
I Physical health lifestyle	4.83	0.39	8.05	
II Mental health lifestyle	4.75	0.45	9.52	
III Social adaptation lifestyle	4.33	0.78	17.97	
IV Occupational health lifestyle	4.58	0.67	14.59	
I-1 Diet	4.67	0.49	10.55	
I-2 Motion	4.75	0.45	10.55	
I-3 Sleep	4.67	0.49	10.55	
I-4 Addictive behavior	4.00	0.95	23.84	
I-5 Hygiene	4.33	0.78	17.97	
I-6 Sexual behavior	3.58	0.90	25.13	
I-7 Health responsibility	4.17	0.94	22.50	
II-1 Psychological condition	4.58	0.51	11.23	
II-2 Stress management	4.58	0.67	14.59	
III-1 Interpersonal relationship	4.50	0.67	14.98	
III-2 Social participation	4.17	0.83	20.04	
IV-1 Working conditions	4.42	0.79	17.95	
IV-2 Occupational protection	4.67	0.65	13.96	
I-1–1 Diet	4.58	0.51	11.23	
I-1–2 Eating regularly	4.58	0.67	14.59	
I-1–3 Dietary preferences	4.00	0.95	23.84	
I-1–4 Eating safely	4.58	0.51	11.23	
I-2–1 Exercise patterns	4.83	0.39	8.05	
I-2–2 Exercise intensity	4.25	0.75	17.74	
I-2–3 Exercise frequency	4.58	0.67	14.59	
I-2–4 Workout duration	4.17	0.72	17.23	
I-2–5 Static physical activity	4.33	0.65	15.03	
I-3–1 Sleep quality	4.58	0.51	11.23	
I-3–2 Sleep duration	4.42	0.51	11.66	
I-3–3 Routine	4.42	0.67	15.14	
I-4–1 Smoking	4.50	0.80	17.73	
I-4–2 Alcohol consumption	4.42	0.79	17.95	
I-4–3 Use of electronic devices such as mobile phones and computers	4.08	0.79	19.42	
I-4–4 Use of addictive drugs	4.08	0.67	16.37	
I-5–1 Hand hygiene	4.67	0.49	10.55	
I-5–2 Oral hygiene	4.42	0.67	15.14	
I-5–3 Other personal cleanliness and hygiene practices	4.17	0.94	22.50	
I-5–4 Sanitation	4.00	0.95	23.84	
I-6–1 Sexual bias	3.75	0.62	16.58	
I-6–2 Frequency of sexual activity	3.50	0.52	14.92	
I-6–3 Safe sex	4.25	0.75	17.74	
I-7–1 Daily healthcare	4.33	0.78	17.97	
I-7–2 Acts of seeking medical care	4.33	0.65	15.03	
I-7–3 Health check-ups	4.58	0.51	11.23	
I-7–4 Injury prevention	4.50	0.80	17.73	
II-1–1 Self-awareness	4.33	0.78	17.97	
II-1–2 Emotional control	4.67	0.49	10.55	
II-1–3 Personality bias	3.92	0.79	20.25	
II-2–1 Attitude toward stress	4.58	0.51	11.23	
II-2–2 Stress release	4.17	1.19	28.64	
II-2–3 Coping with stress	4.58	0.51	11.23	
III-1–1 Willingness to socialize	4.17	0.83	20.04	
III-1–2 Sociability	4.00	0.85	21.32	
III-1–3 Communication skills	4.25	0.87	20.38	
III-1–4 Relationships with others	4.08	0.79	19.42	
III-2-1 Participation in group activities	4.17	0.72	17.23	
III-2-2 Social event participation	4.17	0.72	17.23	
IV-1-1 Working hours	4.58	0.67	14.59	
IV-1-2 Working environment	4.17	0.83	20.04	
IV-1-3 Job competence	4.17	0.72	17.23	
IV-2-1 Occupational protection awareness	4.75	0.45	9.52	
IV-2-2 Use and maintenance of occupational hazards protection equipment	4.50	0.67	14.98	
IV-2-3 Disposal after exposure to occupational hazards	4.42	0.79	17.95	

Indicator weights

The results of the indicator weight calculation by using the analytic hierarchy process method showed that among the first-level indicators, physical health lifestyle, mental health lifestyle, social adaptation lifestyle, and occupational health lifestyle had a weighting coefficient of 0.4133, 0.2922, 0.1078, and 0.1867, respectively. The consistency index CI = 0.024 and the consistency ratio CR = 0.027 of the first-level index judgment matrix, which are less than 0.10. Thus, the indicators were logically sound, and their weighting coefficients were acceptable. The weighting coefficients of the secondary and tertiary indicators are shown in Table 5.Table 5 Weights of four indices.

Primary indicators	Weight	Secondary indicators	Weight	Combined weight	Tertiary indicators	Weight	Combined weight	
I Physical health lifestyle	0.4133	I-1 Diet	0.2140	0.0884	I-1-1 Diet	0.3186	0.0282	
I-1-2 Eating regularly	0.2680	0.0237	
I-1-3 Dietary preferences	0.0947	0.0084	
I-1-4 Eating safely	0.3187	0.0282	
I-2 Motion	0.3000	0.1240	I-2-1 Exercise patterns	0.4128	0.0512	
I-2-2 Exercise intensity	0.1008	0.0125	
I-2-3 Exercise frequency	0.2572	0.0319	
I-2-4 Workout duration	0.0764	0.0095	
I-2-5 Static physical activity	0.1528	0.0189	
I-3 Sleep	0.2140	0.0884	I-3-1 Sleep quality	0.5000	0.0442	
I-3-2 Sleep duration	0.2500	0.0221	
I-3-3 Routine	0.2500	0.0221	
I-4 Addictive behavior	0.0548	0.0226	I-4-1 Smoking	0.4410	0.0100	
I-4-2 Alcohol consumption	0.3118	0.0070	
I-4-3 Use of electronic devices such as mobile phones and computers	0.1236	0.0028	
I-4-4 Use of addictive drugs	0.1236	0.0028	
I-5 Hygiene	0.1078	0.0446	I-5-1 Hand hygiene	0.4668	0.0208	
I-5-2 Oral hygiene	0.2776	0.0124	
I-5-3 Other personal cleanliness and hygiene practices	0.1603	0.0071	
I-5-4 Sanitation	0.0953	0.0043	
I-6 Sexual behavior	0.0293	0.0121	I-6-1 Sexual bias	0.2385	0.0029	
I-6-2 Frequency of sexual activity	0.1365	0.0017	
I-6-3 Safe sex	0.6250	0.0076	
I-7 Health responsibility	0.0801	0.0331	I-7-1 Daily healthcare	0.1650	0.0055	
I-7-2 Acts of seeking medical care	0.1650	0.0055	
I-7-3 Health check-ups	0.3925	0.0130	
I-7-4 Injury prevention	0.2775	0.0092	
II Mental health lifestyle	0.2922	II-1 Psychological condition	0.5000	0.1461	II-1-1 Self-awareness	0.2684	0.0392	
II-1-2 Emotional control	0.6144	0.0898	
II-1-3 Personality bias	0.1172	0.0171	
II-2 Stress management	0.5000	0.1461	II-2-1 Attitude toward stress	0.4286	0.0626	
II-2-2 Stress release	0.1428	0.0209	
II-2-3 Coping with stress	0.4286	0.0626	
III Social adaptation lifestyle	0.1078	III-1 Interpersonal relationships	0.5190	0.0559	III-1-1 Willingness to socialize	0.2761	0.0154	
III-1-2 Sociability	0.1381	0.0077	
III-1-3 Communication skills	0.3905	0.0218	
III-1-4 Relationships with others	0.1953	0.0109	
III-2 Social participation	0.4810	0.0518	III-2-1 Participation in group activities	0.5000	0.0259	
III-2-2 Social event participation	0.5000	0.0259	
IV Occupational health lifestyle	0.1867	IV-1 Working conditions	0.4862	0.0908	IV-1-1 Working hours	0.6000	0.0545	
IV-1-2 Working environment	0.2000	0.0182	
IV-1-3 Job competence	0.2000	0.0182	
IV-2 Occupational protection	0.5138	0.0959	IV-2-1 Occupational protection awareness	0.5396	0.0517	
IV-2-2 Use and maintenance of occupational hazards protection equipment	0.2970	0.0285	
IV-2-3 Disposal after exposure to occupational hazards	0.1634	0.0157	

Discussion

In this study, the feedback time of the experts in the two rounds of Delphi surveys was 5 days, which reflected their enthusiasm. In the two rounds of expert consultations, Kendall’s coordination coefficient W was 0.450 and 0.446 and significant (P < 0.001), which indicated that the experts’ opinions tended to be the same in the two rounds of consultations, as well as the reliability of the results. All the experts held a position higher than a deputy senior, and the coefficient of authority (Cr) in the two rounds of investigations was 0.89 and 0.91, which are greater than 0.70. Thus, the experts demonstrated a high level of theoretical knowledge and possessed practical skills, and the results were credible. Moreover, the experts were employed in various types of institutions, such as a military academy, a medical university, a grassroots social service organization, and a tertiary hospital, and the Centers for Disease Control and Prevention, which covered different fields such as public health and preventive medicine, clinical medicine, and medical psychology and thus are representative. After the expert consultations, the hierarchical analysis method was used to construct an indicator evaluation system. A judgment matrix for the two-by-two comparison of the indicators was developed, and the weights of the indicators were calculated by using the Saaty 1–9 scale, which is more scientific and objective than the subjective experiences of the experts.

Health is a comprehensive outcome influenced by the interplay of multiple factors, such as genetics, the environment, and behavior24. The adoption of unhealthy lifestyle practices can adversely affect one’s quality of life and survival rate and is the main cause of diseases among the population25. Among the four primary indicators in this study, the weight coefficient of healthy lifestyle (0.4133) is the highest, which reflects that improving physical fitness is the core of protecting the health of the occupational population, and it is also the most urgent health goal to achieve in formulating health interventions26. The health promotion principle is one of the five principles presented by the World Health Organization for occupational health27 and safety to optimize the behavior and lifestyle and promote the quality of life of the occupational population, as well as sustainable economic development. With the intensification of occupational competition and changes in lifestyles, the prevalence of chronic diseases such as hypertension28, diabetes, and hyperlipidemia, which may be caused by unhealthy lifestyle practices, such as not eating a balanced diet, not engaging in adequate physical exercise, not getting an adequate amount of sleep, and smoking and drinking excessive amounts of alcohol, has increased among the occupational population29. Moreover, new occupation-related diseases have emerged, such as musculoskeletal disorders, anxiety, and depression30,31. Therefore, in this study, diet, exercise, sleep, addictive behavior, hygiene, sexual behavior, and health responsibility were added to the healthy lifestyle evaluation system. Furthermore, static physical activity was included under the secondary indicator of “exercise,” routine and sleep quality were included under “sleep,” and injury prevention was included under “health responsibility,” which are indicators befitting the lifestyle of modern working individuals.

Mental health is an important public health problem affecting economic and social development32. This study found that the weight coefficient of mental health lifestyle (0.2922) ranked second, further highlighting the importance of mental health to the occupational population health. The work-related diseases of and occupational hazards experienced by the occupational population, such as stress, anxiety, and depression, owing to the accelerated pace of life and their work have attracted widespread attention33. Labor force injury caused by occupational stress ranks among the top 10 most common occupational diseases34, and mental and behavioral disorders have been listed in the International Catalogue of Occupational Diseases35, which served as an important reference for this study. This study jointly assessed the mental health style of the occupational population through self-psychological cognition and stress management and control, which has certain guiding significance for strengthening the construction and planning management of mental health service system of the occupational population. In this era of digitally driven occupational changes, work styles such as remote and home-based work can reduce work stress and safety accidents caused by the occupational environment36. However, remote and home-based work styles may increase employees’ social adaptation risk of working alone, blur work–life boundaries, and negatively affect individuals’ communication with others37. Meanwhile, the Self-assessment of Health Status of Urban Residents in China38 and the Questionnaire for the Assessment of Health Risk Factors of Occupational Population39 regard social adaptation as an important health promotion factor. Thus, this study emphasized the supportive role of interpersonal relationships and social participation and the improvement of the physical and mental health of the occupational population through perceived well-being.

Global studies showed that among 18 identified occupational hazards, the disease burden of occupational exposure to asbestos declined from 1990 to 2019, but the disease burden of other occupational hazards increased by nearly 7%40. The health risk of traditional occupational hazards remains high; thus, occupational health information on occupational protection awareness, the use and maintenance of occupational hazards protective equipment, and the disposal of hazardous material after exposure is essential to the occupational population41. The occupational environment is an important supportive environment that can facilitate changes in occupational health behavior42. The “work conditions” indicator in the evaluation system developed in this study revealed the impact of the occupational environment on the health of the occupational population in terms of working hours, the work environment, and work competence. This study also assessed occupational engagement, inefficiency, overexertion, apathy, and burnout on a “burnout-engagement continuum” to promote occupational success43. It must be mentioned that although the weight coefficient of occupational health lifestyle (0.1867) in this study is low, in high-risk occupations such as manufacturing, mining and outdoor work, ensuring appropriate working conditions and improving occupational protection ability is still the key to ensure occupational health44.

Limitation

Despite its contributions, this study has some limitations. Correspondence experts mostly from the same municipality were selected through convenience sampling, and there may be selection bias. Meanwhile, this study was conducted during the special period of the COVID-19 pandemic, which may have some potential impact on the construction of the indicator system. Therefore, in the Post COVID-19 Era, it is of great significance to continuously and timely update the indicator system according to the evolution of social norms, technological advances, and emerging health trends, and to devote ourselves to conducting empirical research on the assessment of healthy lifestyles of Chinese occupational population.

Conclusion

On the basis of a large number of literature studies, this study revised and improved the assessment of healthy lifestyles of the occupational population by combining "quantitative" and "qualitative" through two rounds of Delphi expert consultation and the analytic hierarchy process, and finally established an assessment tool covering 4 first-level indicators, 13 s-level indicators, 45 third-level indicators, and 62 indicators in total, which has good objectivity and scientificity. This study not only evaluates health from the perspectives of physiology, psychology, and social adaptation, but also includes the impact of occupational hazards on health. It can provide certain reference for the evaluation and promotion of health for the occupational population by taking into account the various occupational hazards that occupational people may face, as well as the health threats brought by their job characteristics.

Acknowledgements

The authors would like to thank all the experts who participated in the questionnaire survey and interviews.

Author contributions

All authors contributed to the interpretation of the findings, writing of the manuscript, and have approved the final version. Z.M. and Y.T. were responsible for the editorial writing and revision of the article; Z.W.J. was responsible for the data cleaning and statistical analysis; H.B. was responsible for contacting the correspondence experts; L.T. was responsible for the collection of the correspondence questionnaires from the experts; M.Y. was responsible for the interviews with the experts; and Z.C.H. was responsible for reviewing and guiding the article.

Funding

This study was financially supported by the Chongqing Science and Health Joint Medical Research Project (2024MSXM172) and the Shapingba District Science and Health Joint Medical Research Project (2023SQKWLH041).

Data availability

The data that support the findings of this study are available from the authors but restrictions apply to the availability of these data, which were used under license from the experts involved in the Delphi survey for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission from these experts.

Competing interests

The authors declare no competing interests.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

1. Ávila-Gutiérrez MJ Suarez-Fernandez de Miranda S Aguayo-González F Occupational safety and health 5.0—A model for multilevel strategic deployment aligned with the sustainable development goals of agenda 2030 Sustainability 2022 14 11 6741 6741 10.3390/su14116741
Ávila-Gutiérrez, M. J., Suarez-Fernandez de Miranda, S. & Aguayo-González, F. Occupational safety and health 5.0—A model for multilevel strategic deployment aligned with the sustainable development goals of agenda 2030. Sustainability 14(11), 6741–6741 (2022).10.3390/su14116741
2. He WL Yang JH He YY Yang SF Analysis of occupational health literacy level and influencing factors among occupational population in Guizhou Province in 2022 China Occup. Med. 2022 50 394 398
He, W. L., Yang, J. H., He, Y. Y. & Yang, S. F. Analysis of occupational health literacy level and influencing factors among occupational population in Guizhou Province in 2022. China Occup. Med. 50, 394–398 (2022).
3. Abikenova S Issamadiyeva G Kulmagambetova E Daumova G Abdrakhmanova N Assessing occupational risk: A classification of harmful factors in the production environment and labor process Int. J. Saf. Secur. Eng. 2023 13 871 881
Abikenova, S., Issamadiyeva, G., Kulmagambetova, E., Daumova, G. & Abdrakhmanova, N. Assessing occupational risk: A classification of harmful factors in the production environment and labor process. Int. J. Saf. Secur. Eng. 13, 871–881 (2023).
4. Zyska A Kiriliuk O Influence of life style on safety and work efficiency Syst. Saf. Hum. Tech. Facil. Environ. 2020 2 1 62 72 10.2478/czoto-2020-0009
Zyska, A. & Kiriliuk, O. Influence of life style on safety and work efficiency. Syst. Saf. Hum. Tech. Facil. Environ. 2(1), 62–72 (2020).10.2478/czoto-2020-0009
5. Zhao Z Lu H Meng R Risk factor analysis and risk prediction study of obesity in steelworkers: Model development based on an occupational health examination cohort dataset Lipids Health Dis. 2024 23 1 10 10 10.1186/s12944-023-01994-x 38191357
Zhao, Z. et al. Risk factor analysis and risk prediction study of obesity in steelworkers: Model development based on an occupational health examination cohort dataset. Lipids Health Dis. 23(1), 10–10 (2024).38191357 10.1186/s12944-023-01994-x
6. Sun YC Kalpakavadi S Prior S Thrift AG Waddingham S Phan H Socioeconomic status and health-related quality of life after stroke: A systematic review and meta-analysis Health Qual. Life Outcomes 2023 21 115 10.1186/s12955-023-02194-y 37875951
Sun, Y. C. et al. Socioeconomic status and health-related quality of life after stroke: A systematic review and meta-analysis. Health Qual. Life Outcomes 21, 115 (2023).37875951 10.1186/s12955-023-02194-y
7. Crizol RG Sá MMK Santos MG Work-related musculoskeletal disorders in dockworkers. Systematic review and meta-analysis Work 2024 79 1 16 10.3233/WOR-230666
Crizol, R. G. et al. Work-related musculoskeletal disorders in dockworkers. Systematic review and meta-analysis. Work 79, 1–16 (2024).10.3233/WOR-230666
8. Hulshof CTJ Frank P Subas N The prevalence of occupational exposure to ergonomic risk factors: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury Enviro. Int. 2021 146 106157 10.1016/j.envint.2020.106157
Hulshof, C. T. J. et al. The prevalence of occupational exposure to ergonomic risk factors: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Enviro. Int. 146, 106157 (2021).10.1016/j.envint.2020.106157
9. Killingmo MR Tveter TA Pripp HA Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: Findings from an occupational cohort study BMJ Open 2024 14 3 e080567 10.1136/bmjopen-2023-080567 38431296
Killingmo, M. R. et al. Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: Findings from an occupational cohort study. BMJ Open 14(3), e080567 (2024).38431296 10.1136/bmjopen-2023-080567
10. Jing G Ying Q Chen C Does a GP service package matter in addressing the absence of health management by the occupational population? A modelling study BMC Health Serv. Res. 2024 24 1 638 638 10.1186/s12913-024-10954-9 38760746
Jing, G. et al. Does a GP service package matter in addressing the absence of health management by the occupational population? A modelling study. BMC Health Serv. Res. 24(1), 638–638 (2024).38760746 10.1186/s12913-024-10954-9
11. Kinoshita S Hirooka N Kusano T Saito K Aoyagi R Does health literacy influence health-related lifestyle behaviors among specialists of health management? A cross-sectional study BMC Primary Care 2024 25 29 29 10.1186/s12875-024-02263-1 38245688
Kinoshita, S., Hirooka, N., Kusano, T., Saito, K. & Aoyagi, R. Does health literacy influence health-related lifestyle behaviors among specialists of health management? A cross-sectional study. BMC Primary Care 25, 29–29 (2024).38245688 10.1186/s12875-024-02263-1
12. Oster H Chaves I Effects of healthy lifestyles on chronic diseases: Diet, sleep and exercise . Nutrients 2023 15 4627 10.3390/nu15214627 37960280
Oster, H. & Chaves, I. Effects of healthy lifestyles on chronic diseases: Diet, sleep and exercise. . Nutrients 15, 4627 (2023).37960280 10.3390/nu15214627
13. National Action Office for the Action on a Healthy Lifestyle for All. Key points of a healthy lifestyle in 2023. https://www.chinacdc.cn/jkzt/mxfcrjbhsh/jcysj/202310/t20231018_270167.html (2023)
14. Goeun C HyeJin K Lifestyle and health behaviors associated with metabolic syndrome and cardiovascular disease Metab. Syndr. Relat. Disord. 2023 22 105 113 38011536
Goeun, C. & HyeJin, K. Lifestyle and health behaviors associated with metabolic syndrome and cardiovascular disease. Metab. Syndr. Relat. Disord. 22, 105–113 (2023).38011536
15. Wullaert L Voigt KR Verhoef C Husson O Grünhagen DJ Follow-up approaches after oncological surgery and the impact on health related quality of life: A systematic review and meta-analysis Eur. J. Surg. Oncol. 2023 49 e141 e142 10.1016/j.ejso.2022.11.400
Wullaert, L., Voigt, K. R., Verhoef, C., Husson, O. & Grünhagen, D. J. Follow-up approaches after oncological surgery and the impact on health related quality of life: A systematic review and meta-analysis. Eur. J. Surg. Oncol. 49, e141–e142 (2023).10.1016/j.ejso.2022.11.400
16. Dehghani E Karimi K Sokke GH Healthy lifestyle scales to assess general and clinical population: A systematic review with narrative synthesis Lifestyle Med. 2024 5 3 e104 10.1002/lim2.104
Dehghani, E. et al. Healthy lifestyle scales to assess general and clinical population: A systematic review with narrative synthesis. Lifestyle Med. 5(3), e104 (2024).10.1002/lim2.104
17. Chai X Tan Y Dong Y An investigation into social determinants of health lifestyles of Canadians: A nationwide cross-sectional study on smoking, physical activity, and alcohol consumption BMC Public Health 2024 24 1 2080 10.1186/s12889-024-19427-4 39090633
Chai, X., Tan, Y. & Dong, Y. An investigation into social determinants of health lifestyles of Canadians: A nationwide cross-sectional study on smoking, physical activity, and alcohol consumption. BMC Public Health 24(1), 2080 (2024).39090633 10.1186/s12889-024-19427-4
18. Friebel GA Potter ER Dollard M Health and safety representatives’ perceptions of occupational health and safety policy developments to improve work-related psychological heath: Applying the theory of planned behaviour Saf. Sci. 2024 172 106410 10.1016/j.ssci.2023.106410
Friebel, G. A., Potter, E. R. & Dollard, M. Health and safety representatives’ perceptions of occupational health and safety policy developments to improve work-related psychological heath: Applying the theory of planned behaviour. Saf. Sci. 172, 106410 (2024).10.1016/j.ssci.2023.106410
19. Parsamanesh P Vysochyn M A psychological exploration of the power of our mindset and its influence on physiological health Cureus 2024 16 1 e52505 38371054
Parsamanesh, P. & Vysochyn, M. A psychological exploration of the power of our mindset and its influence on physiological health. Cureus 16(1), e52505 (2024).38371054
20. Los FS van der Molen H de Boer AG Hulshof CT Ketelaar SM Nieuwenhuijsen K Evaluation of a training for occupational health care professionals to implement a workers’ health surveillance mental health module focussed on healthcare workers Saf. Health Work 2022 13 S S101 10.1016/j.shaw.2021.12.1068
Los, F. S. et al. Evaluation of a training for occupational health care professionals to implement a workers’ health surveillance mental health module focussed on healthcare workers. Saf. Health Work 13(S), S101 (2022).10.1016/j.shaw.2021.12.1068
21. Yujie W Hong C Bei L A systematic review on the research progress and evolving trends of occupational health and safety management: A bibliometric analysis of mapping knowledge domains Front. Public Health 2020 8 81 10.3389/fpubh.2020.00081 32300581
Yujie, W. et al. A systematic review on the research progress and evolving trends of occupational health and safety management: A bibliometric analysis of mapping knowledge domains. Front. Public Health 8, 81 (2020).32300581 10.3389/fpubh.2020.00081
22. The Health Commission of the People's Republic of China. Chinese Citizen Health Literacy—Basic Knowledge and Skills. http://www.nhc.gov.cn/xcs/s3581/201601/e02729e6565a47fea0487a212612705b.shtml (2016)
23. National Health Commission. 60 articles on occupational health literacy. https://niohp.chinacdc.cn/sndt/202203/t20220307_257538.htm (2023)
24. Park H Choi S Kim HK Kang E Ko A Park MS Association between social trust and metabolic syndrome in a previously healthy population—A longitudinal cohort study in South Korea Int. J. Environ. Res. Public Health 2020 16 5629 10.3390/ijerph17165629
Park, H. et al. Association between social trust and metabolic syndrome in a previously healthy population—A longitudinal cohort study in South Korea. Int. J. Environ. Res. Public Health 16, 5629 (2020).10.3390/ijerph17165629
25. Alissa S Fraser F Ashley R Lara D Natasha V Hetal O Addressing diabetes burden with personalized lifestyle and habit change coaching Can. J. Diabet. 2022 46 S3 10.1016/j.jcjd.2022.09.007
Alissa, S. et al. Addressing diabetes burden with personalized lifestyle and habit change coaching. Can. J. Diabet. 46, S3 (2022).10.1016/j.jcjd.2022.09.007
26. Araya C Charin S Yupha W Lifestyle, clinical, and occupational risk factors of recurrent stroke among the working-age group: A systematic review and meta-analysis Heliyo 2023 9 3 e13949 10.1016/j.heliyon.2023.e13949
Araya, C., Charin, S. & Yupha, W. Lifestyle, clinical, and occupational risk factors of recurrent stroke among the working-age group: A systematic review and meta-analysis. Heliyo 9(3), e13949 (2023).10.1016/j.heliyon.2023.e13949
27. Fahim A Abdallah A 1614 Occupational health promotion, safety and wellbeing: A sustainability perspective Occup. Environ. Med. 2018 75 A298
Fahim, A. & Abdallah, A. 1614 Occupational health promotion, safety and wellbeing: A sustainability perspective. Occup. Environ. Med. 75, A298 (2018).
28. Lai C Fu R Huang C Wang L Ren H Zhu Y Healthy lifestyle decreases the risk of the first incidence of non-communicable chronic disease and its progression to multimorbidity and its mediating roles of metabolic components: a prospective cohort study in China J. Nutr. Health Aging 2024 3 100 164
Lai, C. et al. Healthy lifestyle decreases the risk of the first incidence of non-communicable chronic disease and its progression to multimorbidity and its mediating roles of metabolic components: a prospective cohort study in China. J. Nutr. Health Aging 3, 100–164 (2024).
29. Alba JD Gregorio AB Pablo C Health risk behaviors by occupation in working population in Spain Gaceta Sanitaria 2021 36 4 301 308 34924218
Alba, J. D. et al. Health risk behaviors by occupation in working population in Spain. Gaceta Sanitaria 36(4), 301–308 (2021).34924218
30. Ning J Meibian Z Huadong Z Ruijie L Yimin L Gang L Incidence and risk factors of the upper-limb musculoskeletal disorders among occupational groups in key industries—China, 2018–2021 China CDC Wkly. 2022 50 1123 1130
Ning, J. et al. Incidence and risk factors of the upper-limb musculoskeletal disorders among occupational groups in key industries—China, 2018–2021. China CDC Wkly. 50, 1123–1130 (2022).
31. Zhovnerchuk EV Bukhtiyarov IV Khatin DE Moskovenko AV Serikov VV Anxiety-depressive symptoms in patients in the clinic of occupational diseases Russ. J. Occup. Health Ind. Ecol. 2020 2 74 80 10.31089/1026-9428-2020-60-2-74-80
Zhovnerchuk, E. V., Bukhtiyarov, I. V., Khatin, D. E., Moskovenko, A. V. & Serikov, V. V. Anxiety-depressive symptoms in patients in the clinic of occupational diseases. Russ. J. Occup. Health Ind. Ecol. 2, 74–80 (2020).10.31089/1026-9428-2020-60-2-74-80
32. Rajeswari S Anitha J Edimansyah A Occupational groups and its physical and mental health correlates: Results from the Singapore Mental Health Study 2016 Int. Arch. Occup. Environ. Health 2021 95 3 1 12
Rajeswari, S. et al. Occupational groups and its physical and mental health correlates: Results from the Singapore Mental Health Study 2016. Int. Arch. Occup. Environ. Health 95(3), 1–12 (2021).
33. Yihua L Haoxiang L Hao Z Correlation analysis between physical activity and depressive tendencies among occupational groups: An isotemporal substitution approach BMC Public Health 2023 23 1 2241 10.1186/s12889-023-17134-0 37964346
Yihua, L. et al. Correlation analysis between physical activity and depressive tendencies among occupational groups: An isotemporal substitution approach. BMC Public Health 23(1), 2241 (2023).37964346 10.1186/s12889-023-17134-0
34. Hossein AK Saleh SA Marziyeh M Saeid Y Marc OB Fereydoon L Occupational stress and musculoskeletal disorders in firefighters: The mediating effect of depression and job burnout Sci. Rep. 2024 14 4649 10.1038/s41598-024-55468-w 38409336
Hossein, A. K. et al. Occupational stress and musculoskeletal disorders in firefighters: The mediating effect of depression and job burnout. Sci. Rep. 14, 4649 (2024).38409336 10.1038/s41598-024-55468-w
35. China Science and Technology Press. International Catalogue of Occupational Diseases [updated 2012 Dec 24; cited 2024 Mar 15]. https://niohp.chinacdc.cn/cbw/201212/t20121224_74089.htm
36. Krick A Arnold M Felfe J SelfCare when working from home: Easier but also more important Frontiers Organ. Psychol. 2024 1 2
Krick, A., Arnold, M. & Felfe, J. SelfCare when working from home: Easier but also more important. Frontiers Organ. Psychol. 1, 2 (2024).
37. Lyzwinski NL Organizational and occupational health issues with working remotely during the pandemic: A scoping review of remote work and health J. Occup. Health 2024 1 66
Lyzwinski, N. L. Organizational and occupational health issues with working remotely during the pandemic: A scoping review of remote work and health. J. Occup. Health 1, 66 (2024).
38. Nie XQ Li YH Pang J Yang C Tao MX A study on the health and social factors of employees in enterprises and institutions in six provinces and cities in China Chin. J. Health Educ. 2011 11 807 812
Nie, X. Q., Li, Y. H., Pang, J., Yang, C. & Tao, M. X. A study on the health and social factors of employees in enterprises and institutions in six provinces and cities in China. Chin. J. Health Educ. 11, 807–812 (2011).
39. Zhao FH Li YH Development of evaluation standards for occupational health intervention and health promotion in the workplace Chin. J. Health Educ. 2014 02 182 185
Zhao, F. H. & Li, Y. H. Development of evaluation standards for occupational health intervention and health promotion in the workplace. Chin. J. Health Educ. 02, 182–185 (2014).
40. Yali H Tongchao Z Hui C Xiaorong Y Global magnitude and temporal trend of mesothelioma burden along with the contribution of occupational asbestos exposure in 204 countries and territories from 1990 to 2019: Results from the Global Burden of Disease Study 2019 Crit. Rev. Oncol./Hematol. 2022 179 103821 10.1016/j.critrevonc.2022.103821 36165817
Yali, H., Tongchao, Z., Hui, C. & Xiaorong, Y. Global magnitude and temporal trend of mesothelioma burden along with the contribution of occupational asbestos exposure in 204 countries and territories from 1990 to 2019: Results from the Global Burden of Disease Study 2019. Crit. Rev. Oncol./Hematol. 179, 103821 (2022).36165817 10.1016/j.critrevonc.2022.103821
41. Elena AR González AJJ Chi-square automatic interaction detection (CHAID) analysis of the use of safety goggles and face masks as personal protective equipment (PPE) to protect against occupational biohazards J. Biosaf. Biosecur. 2024 6 2 125 133 10.1016/j.jobb.2024.05.001
Elena, A. R. & González, A. J. J. Chi-square automatic interaction detection (CHAID) analysis of the use of safety goggles and face masks as personal protective equipment (PPE) to protect against occupational biohazards. J. Biosaf. Biosecur. 6(2), 125–133 (2024).10.1016/j.jobb.2024.05.001
42. Massimiliano C Fabio T Simona B Maria VU Consuelo B Silvia N How does environmental and occupational exposure contribute to carcinogenesis in genitourinary and lung cancers? Cancers 2023 15 2836 10.3390/cancers15102836 37345174
Massimiliano, C. et al. How does environmental and occupational exposure contribute to carcinogenesis in genitourinary and lung cancers?. Cancers 15, 2836 (2023).37345174 10.3390/cancers15102836
43. Yu Y Wang J Zhang QY Chen HQ Yang F Lou JL The distribution and influencing factors of five states of “occupational burnout work engagement continuum” among the occupational population in China J. Environ. Occup. 2023 4 389 395
Yu, Y. et al. The distribution and influencing factors of five states of “occupational burnout work engagement continuum” among the occupational population in China. J. Environ. Occup. 4, 389–395 (2023).
44. Cunyue Z Mingguang Y Aijun W Construction of an evaluation system for medical staff's occupational protection ability based on knowledge, attitude, and practice theory, and a cross-sectional survey of current conditions BMC Nurs. 2023 22 1 78 78 10.1186/s12912-023-01242-8 36949466
Cunyue, Z. et al. Construction of an evaluation system for medical staff’s occupational protection ability based on knowledge, attitude, and practice theory, and a cross-sectional survey of current conditions. BMC Nurs. 22(1), 78–78 (2023).36949466 10.1186/s12912-023-01242-8
