Community Environment-Health Pathways from a Behavioural Perspective: A Study of Preschool Visual Acuity Using Digital Environmental Representation

Health and wellbeing form a core dimension of urban resilience. Addressing this dimension requires attention to the everyday environments that support healthy living. To explore how daily activity may connect community environments with health, this study uses preschool visual acuity as a specific health outcome. A cross-sectional analysis examined environment-activity-visual acuity associations among 195 children aged 3–6 years in Shanghai. Path analysis used a structured digital representation comprising 13 parent-perceived indicators and five mapped measures in the contextual model. The clearest pattern centred on perceived greenery, which was consistently associated with longer outdoor duration in the primary and contextual models. Both associations met the pointwise and hypothesis-specific Holm criteria, although neither met the main analysis-based criterion. Other environmental attributes showed weaker, activity-specific associations. Outdoor-acuity and corresponding greenery-outdoor activity-visual acuity indirect estimates were positive, but their confidence intervals included zero, and neither met the Holm-adjusted criterion. The findings suggest outdoor activity as a potential behavioural link between perceived neighbourhood greenery and reported visual acuity. The digital representation brings parental assessments and physical conditions into a common framework for examining how community environments relate to activity and health. This approach can inform the health and wellbeing priorities of urban resilience planning and their application in child-friendly communities.