Objective To investigate active health participation (including health-related self-management and self-empowerment) and its determinants among community-dwelling adults, and to provide evidence for the development of relevant policies and effective chronic disease control and prevention services.

Methods The data were derived from two surveys conducted among 1 598 community-dwelling adults (aged ≥18 years) recruited through multistage random sampling: the first in Jinan city, Shandong province (August–October 2022), and the second in Neijiang city, Sichuan province (April–May 2023). The surveys used a questionnaire on health knowledge, attitude, and practice (KAP) and health care utilization, the 10-item Kessler Psychological Distress Scale (K10), and the EuroQol-5 Dimensions (EQ-5D). Active health participation was assessed by self-reported health-related self-management and self-empowerment practices. Multiple logistic regression analysis was employed to identify influencing factors, based on the three dimensions of Andersen’s Behavioral Model for healthcare utilization.

Results  Of the 1 598 participants with valid responses, 905 (56.6%) were classified as active health participants. Multiple binary logistic regression analysis showed that place of residence (towns vs. rural, odds ratio OR = 0.51, 95%confidence interval CI: 0.34–0.75), awareness of hypertension (no vs. yes, OR = 0.67, 95%CI: 0.53–0.86), average monthly household income (> 8 000 vs. < 2 000, OR = 2.76, 95%CI: 1.34–5.69), availability of free health screening programs (no vs. yes, OR = 0.49, 95%CI: 0.27–0.89), community health education programs (no vs. yes, OR = 0.27, 95%CI: 0.17–0.44), community provision of blood glucose and blood pressure testing (no vs. yes, OR = 0.63, 95%CI: 0.42–0.93), and individual EQ-5D score (OR = 0.23, 95%CI: 0.10–0.56) were significantly associated with active health participation.

Conclusions The awareness of active health participation among community-dwelling adults in Sichuan and Shandong provinces remains relatively low and is primarily influenced by education level, economic income, availability of community health resources, and health-related quality of life. These findings highlight the urgent need to improve health awareness and address regional disparities in resource allocation.