Health perceptions and behaviors among aging same-gender Kazakh ethnic minority siblings in rural and urban Xinjiang, China: The impact of migration

• Urban siblings had greater access to care but reduced cultural engagement • Rural siblings adhered to traditions but faced limited health resources • Food safety and pollution were common concerns across all participants • Religious beliefs strongly shaped health behaviors and mental well-being This study investigates health perceptions and behaviors among Kazakh-Chinese same-sex siblings in rural and urban Xinjiang, China. It explores how environmental context and migration experiences shape differences in health-related outcomes. We conducted semi-structured interviews with 24 participants (12 same-gender sibling dyads), with one sibling residing in an urban setting and the other in a rural area. A convergent mixed-methods approach was used, combining qualitative interview data with demographic and health screening information to examine health behaviors and perceptions across environments. Urban siblings demonstrated greater access to healthcare and health literacy but reported challenges including environmental pollution, stress, and diminished traditional social engagement. In contrast, rural siblings maintained traditional dietary habits and robust social rituals but faced limited healthcare access, irregular eating patterns, and more physical labor. Both groups expressed concern about food safety and environmental degradation. Religious and spiritual beliefs were found to influence participants' health behaviors and understanding of well-being. Health outcomes among Kazakh-Chinese older adults are shaped by a complex interplay of cultural tradition, religious belief, and environmental exposure. These findings underscore the need for culturally sensitive, place-based public health strategies to support healthy aging among ethnic minorities undergoing rural–urban transitions.