Background The Belt and Road Initiative is promoting the growth of the cross-border population, and there is still a lack of study on modifiable factors associated with health-related preventive behaviors among resident aliens in China. Public health events may highlight the relevant factors.

Objective To conduct a pilot study to preliminarily identify potential modifiable factors associated with preventive behaviors among resident aliens in China, and to explore possible mediating effects of positivity and self-efficacy on the relationship between satisfaction of health services and preventive behaviors, aiming to provide ideas for further research in this direction.

Methods A cross-sectional survey was conducted among foreigners in a city of East China by using snowball sampling in July 2023. Based on the protection motivation theory, the Self-Efficacy Scale, Positivity Scale, Preventive Behaviors Scale, and Satisfaction of Health Services Scale were adopted in the survey. Cronbach's α coefficient was used to evaluate scale reliability. A structural equation model was constructed for validity test and path analysis. Maximum likelihood method was used for parameter estimation, and bias-corrected percentile Bootstrap method was used to verify mediating effect.

Results A total of 187 resident aliens were approached and 180 of them returned valid questionnaires. The Cronbach's α coefficients of the Self-Efficacy Scale, Positivity Scale, and Preventive Behaviors Scale were 0.904, 0.784, and 0.821, respectively. The M (P₂₅, P₇₅) scores of self-efficacy, positivity, preventive behaviors, and satisfaction of health services were 32 (27, 35), 29 (25, 30), 17 (14, 20), and 4 (3, 5), respectively. Statistically significant differences in the scores of preventive behaviors were identified among the participants by religious belief, geographical location, and economy (P<0.05). The results of path analysis showed that satisfaction of health services, positivity, and self-efficacy had direct positive effects on preventive behaviors (P<0.05), and positivity and self-efficacy played multiple mediation roles in the relationship between satisfaction of health services and preventive behaviors. The results of mediating effect test showed that the indirect effects of the three identified paths mediated by positivity and self-efficacy were statistically significant, and the total size of indirect effect was 0.316 (95%CI: 0.180, 0.466) that accounted for 61.2% of the total effect size. The strongest mediating path was satisfaction of health services→positivity→preventive behaviors, with an indirect effect size of 0.167 (95%CI: 0.046, 0.335) that accounted for 32.4% of the total effect size.

Conclusion Future studies and policy formulation on preventive behaviors of foreigners in China should focus on the social demographic factors such as geographical location of home country, religious belief, and cultural customs. At the same time, the study of path relationship of preventive behaviors should embrace environmental factors, emotional factors, and cognitive factors.