The Helicobacter pylori- Early Gastrointestinal Cancer Screening Intention-Behaviour Gap: A Comparative Study of Two Chinese Populations

Background Helicobacter pylori (Hp) infection, one of the most prevalent chronic bacterial infections globally, has been unequivocally established as a major risk factor for gastric cancer. Advances in digestive endoscopy have significantly enhanced the detection rate of early gastrointestinal cancers, thereby helping to alleviate the associated disease burden. Nevertheless, low public awareness and suboptimal screening adherence continue to pose significant challenges. Thus, a systematic assessment of current public knowledge and the optimization of screening strategies are of critical importance. Methods This study employed a cross-sectional survey design utilizing a combination of random sampling and snowball sampling techniques. A total of 1,038 valid questionnaires were collected. Data were analyzed using SPSS 27.0. Univariate analysis was first performed, and variables showing a significance level of p ≤ 0.05 were subsequently entered into a multinomial logistic regression model to identify independent factors associated with levels of awareness and behavior. Results Respondents from both regions demonstrated moderate to high overall awareness scores; however, a significant difference was observed in the structure of their awareness (p < 0.001). Despite a high expressed willingness to undergo screening and treatment for H. pylori and early gastrointestinal cancers (ranging from 71.3% to 84.4%), the actual screening rates were considerably low (36.0% for H. pylori testing and 28.9% for gastroscopy/colonoscopy). In terms of information acquisition, the desire for community health lectures registered the most substantial increase among residents in both areas. Furthermore, multivariate analysis identified low income, low education level, and unhealthy behaviors as common risk factors for lower awareness. Conclusion Residents in Shanghai and Shanxi possess a certain foundational awareness of H. pylori and early gastrointestinal cancers, but a widespread "intention-behavior gap" in screening exists. The current core challenge lies in effectively translating screening intention into actual action. Trial registration This study was approved by the Ethics Committee of The First Hospital of Shanxi Medical University (Approval No. KYLL2025322) and was performed in accordance with the Declaration of Helsinki.Registration Date August 15, 2025