本研究通过对云南省怒江傈僳族自治州一个少数民族易地搬迁安置社区的田野调查，考察在现代性卫生观念尚未扎根、健康传播的“知信行”模式难以启动的情境下，现代化卫生观念的在地化传播实践。研究表明，第一阶段，外来扶贫干部通过入户帮扶催生受帮扶者的“还报”义务，实现了大部分居民的卫生知晓和短期行为转变；第二阶段，社区两委以签订就业责任协议的形式将卫生与居民的家庭生计相挂钩，解决了大多数家庭的卫生持续治理问题。第三阶段，少数群体以卫生“拒作为”对官员展开反向制衡，基层干部通过对困难户的安抚与钉子户的惩治，实现对边缘人群顽固观念的“清除”工作。如此，当地的健康传播悬置了卫生的科学话语，将“讲卫生”与人情交换、责任契约、抑强扶弱的日常“小义”相整合，成为一项惠而不费的日常实践，令居民的卫生行动在科学理念缺席的情况下被先行动员起来。这一替代性健康传播实践既不同于民国时期诉诸“大义”的情感动员式“拓荒”策略，又不同于现代社会中知信形模式的科学“播种”方略。

This study examines how modern hygiene concepts spread among the deeply impoverished population in an ethnic minority relocation community in the Nujiang Lisu Autonomous Prefecture in Yunnan Province, where modern hygiene concepts have yet to take root and the knowledge, attitudes and practices model of health communication is difficult to activate. The study shows that, in the first stage, foreign poverty alleviation cadres helped the recipients by going to their homes and creating an obligation to “pay back”, which resulted in the majority of the population’s knowledge of hygiene and short-term behavioural change. In the second stage, community committees linked hygiene to household livelihoods by signing employment responsibility agreements, solving the problem of sustained hygiene management for most households. In the third phase, minority groups used hygiene “refusal” as a counterbalance to officials, and grassroots cadres were able to “clean up” the persistent attitudes of marginalised groups by appeasing households in need and punishing those who were at the centre of the problem. Community A’s health communication suspends medical and scientific knowledge, integrating “hygiene” with the daily “small justice” of human exchange, responsibility contract, and support for the strong and the weak, so that the residents’ health actions are mobilised in the absence of scientific concepts.This alternative health communication practice is not only different from the emotional mobilisation strategy of the Republican period, which resorted to “great righteousness”, but also different from the scientific “seeding” strategy of the modern society, which is based on the model of knowledge, attitudes and practices.