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Objectives This study aims to develop assessment indicators of health education and promotion for non-communicable disease (NCD) demonstration districts in China and to identify significant factors associated with NCD health education and promotion work. Methods Three complementary techniques were used to conduct this study in Hunan Province, China, between late 2013 and 2015. The Delphi technique was used to develop weighted assessment indicators, followed by the rank sum ratio (RSR) to normalise the weights through rank conversion. Lastly, the technique for order of preference by similarity to ideal solution was conducted to assess five randomly selected NCD demonstration districts representing five different orientations in the province. Results A total of 24 assessment indicators were constructed covering the following sections: organisational management, fund support, personnel supplies, health education and promotion, people’s awareness of NCDs, management and control of patients with NCD, satisfaction with health education and promotion and health literacy of residents. Five districts were selected as samples for evaluation (Furong District, Ziyang District, Shaodong County, Shuangfeng County and Luxi County). Performance varied among the sites, with Furong District greatly surpassing the other sites, especially in fund support, media promotion, technical support for publicity materials, community promotion and supportive environment supplies. The latter four factors were also much greater in the second-ranked Luxi County site than those in the other sites (except Furong District).Conclusions There were gaps in health education and promotion work in NCD demonstration districts in Hunan Province. The districts that performed better had obvious advantages in fund support, media promotion, technical support, community promotion and supportive environment supplies. Our study provided both a methodological reference and an assessment indicator framework for similar future studies. [ABSTRACT FROM AUTHOR]