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Article History

Received: 16 October 2024

Accepted: 7 January 2026

First Online: 17 January 2026

Competing interests

: The authors declare no competing interests.

: Ethical approval for this study was obtained from the China Three Gorges University Ethics Committee on 1 August 2023 (Approval No. IRB2023KF006). All procedures involving human participants were conducted in accordance with the ethical standards of the responsible institutional committee and with the Declaration of Helsinki (1964) and its later amendments. The approval covered non-interventional, questionnaire-based research involving adult participants residing in the study area.

: Oral consent was obtained from all participants prior to their participation in the study, during the period from 5 August to 31 October 2023. Consent was obtained by trained field enumerators from adult participants (18 years and above) who voluntarily agreed to take part in the research. Oral consent was used because the study involved non-interventional, questionnaire-based research conducted in field settings where no personally identifiable information was collected. Before administering the questionnaire, participants were read a standard participant information and consent statement printed at the beginning of the questionnaire, which served as the oral consent script. The consent script explained the purpose of the research, that participation was entirely voluntary, that responses would remain confidential and anonymous, that participants could decline to answer any question or withdraw at any time without any consequences, and that there were no direct risks associated with participation. Oral consent was recorded by proceeding with the questionnaire only after participants explicitly indicated their agreement to participate. The scope of consent covered participation in the survey, use of anonymised data for academic research and publication, and confidential handling of all responses. The study did not involve minors or vulnerable populations, and therefore no consent from legal guardians was required. A copy of the oral consent script is provided as Supplementary Material.