Objective To explore the types, characteristics and generating mechanisms of proactive health behaviors for people at high risk of stroke, and to construct a proactive health behavior modelfor this population. Methods From March to June 2024, a theore-tical sampling method was utilized to select 22 high-risk stroke patients and 9 medical staff from the cerebrovascular disease center of a class A tertiary hospital in Shanghai as research subjects for structured interviews. The procedural grounded theory research approach was employed, with data analysis conducted through coding and continuous comparison methods. Results The proactive health behavior model for people at high risk of stroke was the result of the joint action of situational factors, subject characteristics, external support and health motivation, it was divided into 3 behavior types (positive inertia behavior, proactive engagement behavior, and adaptive adjustment behavior)and showed 4 behavioral characteristics (spontaneity, proactivity, persistence, and prospective). Conclusion The model contributes to a deeper understanding of the types, characteristics, and generative mechanisms of proactive health behaviors for people at high risk of stroke, and provides theoretical guidance for the subsequent development of specific measurement tools and behavior interventions.