Abstract
Population ageing is accelerating worldwide, making public attitudes towards older adults an increasingly important concern for public health. Using nationwide survey data from Chinese adults across multiple provinces, this study applies a multilevel analytical framework in which individual health behaviours are examined within provincial social climates, allowing both personal perceptions and contextual conditions to be considered simultaneously. The analysis focuses on two parallel pathways, namely the association between positive social cognition of ageing and health behaviour, and the association between age-related stereotypes and behavioural engagement, while also assessing how provincial discourse on ageing conditions these relationships. Results show that more favourable perceptions of ageing are strongly associated with higher levels of preventive care, physical activity, and social participation, with standardised coefficients ranging from approximately 0.46 to 0.55. About one quarter of this association is linked to an indirect pathway, whereby stronger social cognition corresponds to lower endorsement of negative stereotypes, which in turn is associated with healthier behaviour. Age-related stereotypes display a consistent negative association with health behaviour, with coefficients between -0.36 and -0.41, and this pattern is particularly pronounced in rural areas. Contextual conditions further shape these associations. In provinces characterised by more supportive public discourse on ageing, the link between cognition and behaviour is stronger, whereas in environments where stereotypes are more salient, their negative association with behaviour is amplified. Urban residents show a stronger alignment between positive views of ageing and behavioural engagement than rural residents, indicating an institutional gradient in healthy ageing. Taken together, the findings suggest that health behaviour in later life reflects not only individual orientations but also the social narratives and institutional environments surrounding ageing, implying that policies aimed at promoting healthy ageing may benefit from combining individual-level education with broader efforts to improve public discourse on ageing and to reduce persistent urban-rural inequalities in health systems.