3.1.1. Research Hotspots in the Field of HC in China
In order to identify important research topics in HC research, the study conducted a keyword co-occurrence analysis. The parameters in CiteSpace remained the same, except that the node type was changed from “institution” to “keyword”. The keyword co-occurrence network map shown in Figure 2 consists of 731 institutions (nodes) and 904 connecting lines between nodes. In Figure 2, each node represents one keyword; larger nodes reflect a higher co-occurrence frequency, with the links between each two keywords revealing the co-occurrence relationships.
Figure 2. The keyword co-occurrence map for the field of HC from 1992 to 2021 in China. (Note: the authors added English to the map to aid understanding).
In accordance with Figure 2, the eleven keywords with the highest frequencies and strongest BCs are presented in Table 2. Keywords with a higher centrality are more significant and hold greater importance in the HC research domain. In the current study, only the BC values of HC, health education, and new media exceeded 0.1, illustrating that these three keywords hold key positions and have a connection with other keywords in the network.
Table 2. Top 10 keywords in the field of HC in China.
||WeChat public platform
||Public health emergency
Among the top 11 keywords, HC had the highest frequency, ranking in first place because it was a retrieval term in our study. Therefore, this study did not take it into consideration. In addition, social media and the WeChat public platform were considered to be research branches related to new media. The BC value of new media was found to be higher than those of the WeChat public platform and social media, illustrating that new media played a more significant role in HC research. From the three keywords, we extracted social media as a research hotspot. In addition, COVID-19 formed part of public health emergency. The BC value of public health emergency was found to be higher than that of COVID-19, revealing that public health emergency is more significant in HC research. Therefore, by considering both frequency and BC, we selected public health emergency as the research hotspot. Finally, we identified seven research hotspots as follows: health education, new media, health literacy, health information, AHVM, the doctor–patient relationship and public health emergencies. The following paragraphs will discuss these seven research hotspots in combination with the representative literature in the HC field in China.
Research on Health Education. In China, the primary objective of health education is to educate people in order heighten awareness of health, develop ideal healthy behaviors and lifestyles, and eliminate or reduce risk factors that affect health 
. In particular, HC is seen as one of the most important means of achieving health education. As such, this research hotspot can be divided into two main research directions. One of these is evaluating the effectiveness of health education. In particular, scholars have paid great attention to evaluating the effectiveness of health education concerning acquired immunodeficiency syndrome/human immunodeficiency virus (AIDS/HIV), infectious diseases such as severe acute respiratory syndrome (SARS), Asian lineage avian influenza A virus (H7N9), pulmonary tuberculosis, adolescent mental illness, and diabetes 
. The subjects of these studies have mainly included teenagers, rural women, army officers and soldiers, and children in poverty-stricken, minority areas. For example, Feng 
demonstrated that centralized teaching can encourage pregnant women to voluntarily accept HIV counseling and testing. Furthermore, to a large extent, education is recognized as an effective measure for altering the public’s understanding and behavior regarding their health. The other direction is the role of the communication medium in health education. The channels for accessing health education have been broadened in recent years, and there has been a significant body of discussion on the positive role of the Internet, the WeChat public platform, short videos, online games, and blogs communicating about health education 
. For instance, Jiang et al. 
found that for the majority of students, awareness regarding health knowledge and healthy practices had been effectively mobilized through their participation in a health education game named “Health Knowledge Mengmeng Answer”.
Research on New Media. Differing from traditional media, new media have changed the way health information is disseminated. This research hotspot has mainly focused on the use of, and changes wrought by, new media in the HC field. Among the types of new media, social media—especially the WeChat public platform—have been considered to be the most popular platforms for disseminating knowledge on health in recent years, especially during the COVID-19 lockdown period in China 
. Using new media to disseminate health information may lead to a series of issues 
. For example, false health information spreads quickly in the virtual space due to a lack of supervision of the dissemination of health information 
. In order to deal with this problem, scholars suggested strengthening the position of authoritative experts on HC and building HC channels under the supervision of the government, the public, and enterprises in the Internet space 
Research on Health Literacy. In China, the study of health literacy first began in 2005, when an article titled “Progress in Health Literacy Research” 
introduced the concept of health literacy in China for the first time. Following this, scholars began to explore the ways in which health literacy could be evaluated 
. They initially drew on evaluation scales from abroad for measuring levels of health literacy, such as the Rapid Estimate Adult Literacy in Medicine and the Test of Functional Health Literacy in Adults scales, to measure China’s health literacy level. Subsequently, in order to develop a health literacy measurement tool in line with the Chinese cultural environment, Xiao 
established a health literacy evaluation indicator system using the Delphi method, including a total of 60 indicators such as personal hygiene, disease prevention and control, and diet/nutrition. These indicators can be used to evaluate four aspects of health literacy: health knowledge, healthy behaviors, health beliefs, and health skills. Furthermore, in recent years, scholars have paid increasing attention to discussing the health literacy of media personalities in the HC process 
, the influence of the communication mode on health literacy 
, and the significance of new media in improving public health literacy 
Research on Health Information. This research hotspot focused on research concerning the demand for, and acquisition of, health information and the use of the Internet as a source of health information. Scholars found that social media, such as apps, the Internet, WeChat and TikTok, had become the main channels and avenues by which the public obtained health information in China, which, to a large extent, has led to the majority of patients tending to search for relevant health information on the Internet before visiting a doctor 
. However, the health information published on the Internet may be incomplete, incorrect, and/or misleading, and Bai 
therefore suggested that patients and their families should instead seek advice from experts in professional fields, and authoritative medical institutions should provide medical guidelines through social media and the Internet.
Research on AHVM. The study of HC in the AHVM field is in the early stages of exploration in China. Nevertheless, its significance has been recognized by scholars, governments, and enterprises in recent years. In particular, this research hotspot has focused on the application of HC to the practice of AHVM, and scholars have found that HC can effectively enhance the public and workers’ awareness of health management and epidemic prevention and control, decrease the spread of zoonoses, and reduce the risk of contracting foodborne diseases 
. However, the significance and role of HC in the practice of AHVM was to a large extent ignored, due to a lack of expertise in the communication field, resulting in a situation where health knowledge concerning AHVM was not distributed or disseminated effectively. In order to solve this problem, a series of suggestions were made; for example, Gao 
suggested establishing a professional course on HC at the related AHVM college, while Hu 
proposed that hospitals and public health organizations should use digital media such as the WeChat public platform, micro-blogs, short videos, and apps for timely reports on the situation in epidemics and other emergencies such as bird flu, to guide public opinion in the correct direction. Excessive reporting and fake information concerning AHVM can produce a significant negative impact 
, and therefore it is important to disseminate the relevant information objectively and impartially.
Research on the Doctor–Patient Relationship. The doctor–patient relationship is changing with the decline of doctors’ patriarchal role and the rise of patients’ autonomous consciousness in China 
. The media play an important role in building and fostering public understanding of the doctor–patient relationship. As such, this research hotspot focused on the doctor–patient relationship as constructed in media reporting. For example, Gao 
analyzed reports on the doctor–patient relationship published in the People’s Daily from 1978 to 2018 and found that the status and power over the discourse between doctors and patients were unequal, with doctors being more powerful and having more discursive power. Moreover, positive publicity was still the mainstream view regarding reporting on the doctor–patient relationship, aiming to shape the image of doctors as having good medical ethics, while minimizing the doctor–patient disputes presented in reports 
. However, in recent years, a special situation has arisen in which social media channels such as Sina Weibo have been keen to hype up or exaggerate doctor–patient conflicts in order to pursue economic interests and cater to the particular psychology of their readers 
. Therefore, much attention should be paid to profoundly reconsidering and further studying the responsibilities of the media in reporting news relating to the doctor–patient relationship.
Research on Public Health Emergencies. China’s media and academic circles began paying attention to the HC of public health emergencies due to the outbreak of SARS in 2003. At that time, the Chinese Government lacked the capability to respond to such public health emergencies, and the media failed to effectively convey health information related to SARS, resulting in social rumors abounding and thus leading to social chaos 
. Subsequently, scholars studied the relationship between media reports and crises with regard to China’s HC practices since the SARS epidemic and put forward some suggestions on how the media should better carry out the practice of HC in the face of public health emergencies 
. In the last two years, COVID-19 has become an important topic in the HC field in China. Scholars have become committed to research on the communication of information on the risk of COVID-19 in the family 
, the role of We Media and the mainstream media in HC during COVID-19 
, and the digital generation gaps and health generation gaps that have appeared during the COVID-19 period 
. A remarkable feature is that the dual role of the government as the authoritative source of information and the main body for HC was emphasized during the COVID-19 period.
2.1.2. The Evolution of Research Hotspots in the Field of HC
The time-zone map of keywords produced by CiteSpace focused on depicting the evolution of research hotspots chronologically in the field of HC. According to the words with the highest frequency, as shown in Figure 3, this study divided the development of HC research into four stages. Each stage is discussed in combination with the representative articles and key events at that time.
Figure 3. The time-zone map of HC research in China between 1992 and 2021. (Note: the authors added English to the map to aid understanding).
Stage 1 (1992–1999). The highest-frequency keywords that appeared in this stage mainly included HC, communication studies, health education, and information communication (see Figure 3
). This stage focused on the study of the basic objectives of HC. The definition of HC was first proposed by Mi G.M. in 1992 and refers to the transmission of credible scientific health information to the public through various communication channels and strategies to promote personal and public health behaviors 
. Furthermore, it was found that HC was used as a measure for social intervention to improve levels of public health, although this concept was not widely accepted by Chinese academics, even though it established a foundation for follow-up research. Subsequently, scholars in the field of public health discussed the concepts of HC 
and laid particular emphasis on the value of communication in the fields of medicine and public health. However, few communication scholars participated in the study of HC during this stage. One remarkable characteristic, however, was that the majority of the academic papers on HC research were published in the Chinese Journal of Health Education
, founded by the China Health Publicity and Education Association.
Stage 2 (2003–2011). Figure 3
shows the highest-frequency keywords for this period, which mainly included public health emergency, communication knowledge, communication effect, health promotion, health literacy, AIDS, and communication strategy. This indicated that the research themes of HC became more diversified during this period. In addition, the HC on public health emergencies attracted the most attention. One reasonable explanation for this would be the outbreak of SARS in 2003, which led to China experiencing a major public health crisis, bringing about a high level of attention and reflection from the news media, the public, the government, and communication scholars on HC, especially regarding public health, safety, and security. In December of the same year, the “China Health Education and Mass Media Forum” was held in Beijing, making the integration and development of communication and medical and public hygiene a reality for the first time. However, it is worth noting that scholars from the fields of medicine and public health were still the main force driving HC research. In addition, one of the prominent changes was that scholars paid considerable attention to the HC of marginalized groups, e.g., regarding AIDS and homosexuality 
. For example, Yang et al. 
found that unlicensed prostitutes preferred to learn more about AIDS prevention and treatment from doctors, while drug addicts tended to obtain this knowledge from AIDS prevention and control staff.
Stage 3 (2012–2018). The highest-frequency keywords included new media, mass media, big data, We Media, the WeChat public platform, and All Media (see Figure 6
). This indicated that scholars were demonstrating interest in the study of digital media use in HC practices. One possible explanation for this could be that communication scholars gradually became the main force driving HC research, focusing on the role and effects of the application of new media in the HC field. Significantly, scholars held a critical perspective on the role of new media in HC practice. On the one hand, they found that new media could promote the audience’s ability to actively and easily obtain health information, strengthen their health awareness, and construct an equal dialogue and communication between doctors and patients 
. On the other hand, they stressed that new media may cause a series of issues to arise, including the transmission of false health information, excessive health marketing, and the homogenization of communication content 
. Among all the types of new media, great attention was paid to research on the influence of WeChat and apps on audience attitudes and behavior. For example, the forwarding behavior of WeChat users was an important factor in promoting the increase in health information 
Stage 4 (2019–2021). In this period, the highest-frequency keywords included short videos, health science popularization, COVID-19, and epidemic prevention and control (see Figure 3
). This indicated that scholars focused on the role and influence of short videos during the COVID-19 period. Furthermore, COVID-19 first broke out in China, which caused a great deal of social panic and worry, mainly due to a lack of detailed and accurate information on the situation surrounding the epidemic. Therefore, timely information disclosure and dissemination are particularly critical in public emergencies. In this context, scholars found that short videos play an important role in information communication, media supervision, positive guidance of public opinion, healthy communication, and mobilization of the public 
. However, it is necessary to clearly recognize the limitations of short videos, as their ability to warn and reflect on emergencies is relatively weak 
; they are not the most important means of crisis communication for public emergencies, but rather a supplement and an aid.