Abstract
Background
Infectious diseases pose significant challenges to global public health security, which necessitates robust prevention and control capabilities within national public health systems. This study aimed to assess the infectious disease control competencies of provincial and prefecture-level public health professionals in China and investigate their willingness and demand for professional training to inform future training plans.
Methods
A cross-sectional survey was conducted from June 2023 to December 2023 among public health professionals from 15 provinces in China. The infectious disease control competency scale was utilized to evaluate professionals’ competencies across four dimensions: knowledge, practical skills, leadership, and personal qualities. Descriptive statistics and multivariable analyses were performed.
Results
Among 883 participants enrolled in the study, the median total competency score was 74.70 (IQR 67.97–81.00) out of 100. The most deficient areas identified were scientific research abilities (scoring rate 63.76%), knowledge of public health emergency management (65.35%), and skills in infectious disease prevention and emergency preparedness (70.15%). Higher education level (OR 1.565; 95% CI 1.137–2.153), longer work experience (OR 2.448; 95% CI 1.354–4.427), more frequent outbreak response involvement (OR 3.931; 95% CI 2.517–6.141), continued professional development through training (OR 4.100; 95% CI 2.096–8.019), and higher job satisfaction (OR 6.199; 95% CI 3.659–10.502) were all associated with enhanced competency scores. Most participants (87.5%) expressed willingness to participate in future training, with preferences for case analysis, scenario simulations, public health response to infectious diseases, research design, and report and paper writing.
Conclusions
This nationwide survey revealed moderate infectious disease control competencies among Chinese public health professionals, with specific areas for improvement. Tailored training initiatives focusing on identified gaps and preferred topics, coupled with strategies to foster continuous professional development, are crucial for enhancing the public health workforce’s capabilities.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12960-025-01035-x.
Keywords: Infectious disease control, Public health professionals, Competency assessment, Training needs, Professional development, China
Introduction
Infectious diseases pose a persistent and formidable challenge to global public health security. In recent decades, the world has witnessed the emergence of numerous infectious disease outbreaks, such as the coronavirus disease 2019 (COVID-19) pandemic, Ebola virus disease, Middle East Respiratory Syndrome (MERS), and Zika virus disease epidemics, which have exacted a tremendous toll on human lives and socioeconomic development [1]. Confronting the ever-present threat of novel and re-emerging pathogens requires robust prevention and control capabilities within national public health systems.
In China, significant strides have been made to bolster infectious disease control mechanisms following the 2003 severe acute respiratory syndrome (SARS) outbreak. These endeavors encompass revising the Law on Prevention and Treatment of Infectious Diseases [2], establishing nationwide disease surveillance networks [3], and enhancing emergency response capacities [4]. However, deficiencies persist in early outbreak detection, rapid response capabilities, technical expertise, and interdepartmental coordination [5], underscoring the need for further strengthening of public health preparedness and response mechanisms.
The World Health Organization (WHO) has emphasized that a competent public health workforce is crucial for the adequate delivery and implementation of public health services and activities [6]. In line with this, China has regarded cultivating high-caliber public health professionals as a key initiative to promote high-quality development of disease prevention and control in China [7]. At the forefront of these efforts to control infectious diseases are the provincial and prefecture-level public health professionals, who form the backbone of disease prevention and control institutions. These frontline personnel shoulder pivotal responsibilities spanning disease surveillance, outbreak investigations, policy advisory, and implementation of control measures [8]. Their competencies directly influence the effectiveness of outbreak response and prevention strategies. However, their current specialized skills in infectious disease control remain under-assessed, particularly in the post-COVID era. Furthermore, the most effective methods for conducting training programs and the specific areas of interest for these professionals remain uncertain.
While several international and domestic frameworks have been developed to evaluate public health workforce competencies [9, 10], these tools primarily focus on generalized public health functions or clinical care, and thus fail to comprehensively capture the distinct skill sets demanded for infectious disease prevention and control. The primary goal of training projects for public health professionals is to cultivate leading talents who can make informed decisions in the emergency response of public health emergencies and major epidemic outbreaks. Consequently, the training of such talents should not only focus on the necessary professional skills, but also emphasize the acquisition of management knowledge [11]. Previously, we established an infectious disease control competency scale (IDCCS) for public health professionals through the Delphi method, exploratory factor analysis, and confirmatory factor analysis, encompassing four dimensions: knowledge, practical skills, leadership, and personal qualities [12]. The IDCCS demonstrated good psychometric properties, with an exceptionally high internal consistency as indicated by a Cronbach’s Alpha of 0.98. As a measure of internal consistency reliability, Cronbach’s Alpha assesses the extent to which a set of items are related by comparing the shared variance among the items to the total variance of the scale [13]. This high value reflects that the scale’s items are highly inter-correlated and cohere to accurately measure the single underlying construct of infectious disease control competency. Therefore, this scale is expected to accurately reflect the competencies of infectious disease control among public health professionals in China. It is imperative to conduct a nationwide competency survey using the IDCCS among this population to identify their weaknesses and to guide the direction of professional training.
Accordingly, this study aimed to assess the infectious disease control competencies of provincial and prefecture-level public health professionals in China using the IDCCS. We also examined their willingness and demand for professional training in infectious disease control to guide the future development of training plans.
Methods
Study design
A cross-sectional study was conducted using a convenience sampling approach. The data collection process spanned two phases: the initial survey from June to July 2023 and an additional sample supplement in December 2023. Electronic questionnaires were distributed online across designated provinces in China.
Participants
Public health professionals meeting the following criteria were recruited for this study: (1) employed at provincial or prefecture-level CDCs; (2) aged between 35 and 50 years; (3) engaged in public health emergency or infectious disease control work; (4) holding intermediate or higher professional titles; and (5) providing informed consent. Exclusion criteria included: (1) individuals with disabilities or severe illnesses; and (2) those only occasionally engaged in infectious disease control activities. The survey encompassed public health professionals from 15 provinces across China: Beijing, Zhejiang, Shandong, Guangdong, Tianjin, Jiangsu, Fujian, Hunan, Anhui, Gansu, Shaanxi, Guizhou, Inner Mongolia, Heilongjiang, and Jilin.
Measurements
The questionnaire for this study was designed to collect data on four main areas: participants’ sociodemographic characteristics, their infectious disease control competencies, their willingness and demand for training, and their job satisfaction.
The competency of infectious disease control was measured using the IDCCS, which was developed and validated in our previous work [12]. The IDCCS is a comprehensive tool consisting of four main dimensions: knowledge, practical skills, leadership, and personal qualities (as detailed in Supplementary Table 1). It evaluates a total of 64 weighted items. For instance, the “Knowledge” dimension assesses understanding of infectious disease epidemiology and public health emergency management, while the “Practical skills” dimension includes items on infectious disease surveillance and scientific research ability (e.g., study design and paper writing). The “Leadership” dimension focuses on abilities like team mobilization and decision-making, and the “Personal qualities” dimension measures professional attributes. An overall competency score for each individual was calculated using the weighted scores of these items (as detailed in Supplementary Table 2). Participants self-rated each item using a five-point Likert scale.
Training needs and willingness were assessed through questions about past training frequency, satisfaction, future willingness to participate, preferred training topics, and acceptable training duration. Job satisfaction was assessed using a 20-item Minnesota Satisfaction Questionnaire [14]. The complete questionnaire is provided in the Supplementary Materials.
Data collection
The electronic questionnaire was established on the Wen-Juan Xing platform (Changsha Ranxing Information Technology Co., Ltd., Hunan, China) and required approximately 18 min to complete. Detailed information regarding the purpose, content, and instructions of the survey was provided to the directors of 15 provincial CDCs, who subsequently disseminated the questionnaire through internal communication channels (e.g., WeChat groups) to potential participants at both provincial and prefecture-level CDCs. On the first page, participants were given the informed consent and had the option to continue or opt out of the survey. Successful submission of the questionnaire was contingent upon completing all questions. Questionnaires were completed anonymously and underwent manual review. The following quality control measures were implemented to eliminate low-quality responses: (1) a quality control question (“Please choose ‘Not very familiar’ in this question.”) was included, and questionnaires with incorrect responses were excluded; (2) questionnaires with highly uniform answers were excluded; (3) questionnaires with response times less than 10 min were excluded. Data from valid questionnaires were downloaded from the Wen-Juan Xing platform for further analysis.
Data analysis
The basic characteristics of public health professionals were compared between provincial and prefecture levels using Chi-square tests. Categorical variables were presented as frequencies and proportions. All participants were stratified into three areas (high, medium, and low) based on the GDP per capita of their respective provinces in 2023 [15].
For primary and secondary items, the scoring rate was calculated by the percentage of the median score over the total score of the corresponding item. The distribution of competency items contributing to the competency score losses was presented using pie charts. Median competency scores of provincial-level and prefecture-level professionals were compared utilizing rank-sum tests. Average scores of tertiary items were presented in descending order within each primary dimension. Rank-sum tests were conducted to investigate associations between the total score and potential impact factors.
Initially, we planned to use a multiple linear regression model to analyze the predictors of competency. However, diagnostic checks revealed a violation of the homoscedasticity assumption. To address this, we opted for an alternative approach. The continuous total competency score was categorized into four ordered levels based on quartiles, and an ordinal logistic regression model was employed to identify associated factors. This method is appropriate for analyzing an ordered categorical outcome and avoids the homoscedasticity assumption required by linear models.
Training participation in the past five years, satisfaction with previous training, willingness to participate in future training, acceptable training duration for participants, and training duration allowed by the work unit were presented using percentage bar charts. Reasons for unwillingness to participate in training, preferred training methods, and training content of interest were presented in descending order using bar charts.
All data analyses were conducted using Stata 17 (StataCorp, TX, United States) with a significance level set at 0.05.
Results
Sociodemographic and professional profile
Initially, 927 questionnaires were collected, of which 44 were excluded due to low quality, resulting in 883 valid questionnaires (222 provincial-level and 661 prefecture-level) for further analysis.
Among the 883 participants, the main characteristics included being aged 35–40 years (46.4%), female (55.0%), holding a Bachelor’s degree (50.1%), specializing in public health and preventive medicine (69.3%), having a sub-senior professional title (48.6%), 10–14 years of experience in infectious disease control (30.2%), holding professional technical positions (76.9%), being at the level of deputy section chief or higher (61.2%), lacking postgraduate supervisor qualifications (76.8%), having a monthly income of 5000–9999 yuan (approximately 695–1389 US dollars, 69.3%), actively participating in the COVID-19 response (97.3%), having more than 10 instances of involvement in outbreak response (55.2%), and being located in an area with a high GDP per capita (47.7%) (Table 1). The distributions of education level, major, professional title, years of infectious disease control experience, position, postgraduate supervisor qualifications, net monthly income, and experience in handling H1N1 influenza and COVID-19 significantly differed between provincial-level and prefecture-level public health professionals (all P < 0.05).
Table 1.
Comparison of basic characteristics of participants between the provincial and municipal levels
| Characteristics | Total n (%) |
Provincial n (%) |
Prefecture n (%) |
P |
|---|---|---|---|---|
| Age, years | 0.263 | |||
| 35–40 | 410 (46.4) | 107 (48.2) | 303 (45.8) | |
| 41–45 | 288 (32.6) | 77 (34.7) | 211 (31.9) | |
| 46–50 | 185 (21.0) | 38 (17.1) | 147 (22.2) | |
| Gender | 0.288 | |||
| Male | 397 (45.0) | 93 (41.9) | 304 (46.0) | |
| Female | 486 (55.0) | 129 (58.1) | 357 (54.0) | |
| Education level | < 0.001 | |||
| Doctor degree | 36 (4.1) | 25 (11.3) | 11 (1.7) | |
| Master’s degree | 389 (44.1) | 154 (69.4) | 235 (35.6) | |
| Bachelor’s degree | 442 (50.1) | 42 (18.9) | 400 (60.5) | |
| Junior college or below | 16 (1.8) | 1 (0.5) | 15 (2.3) | |
| Major of bachelor/college | 0.001 | |||
| Public health and preventive medicine | 612 (69.3) | 157 (70.7) | 455 (68.8) | |
| Clinical medicine | 124 (14.0) | 23 (10.4) | 101 (15.3) | |
| Other medical disciplines | 56 (6.3) | 11 (5.0) | 45 (6.8) | |
| Management disciplines | 31 (3.5) | 4 (1.8) | 27 (4.1) | |
| Other | 60 (6.8) | 27 (12.2) | 33 (5.0) | |
| Professional title | < 0.001 | |||
| Senior | 142 (16.1) | 56 (25.2) | 86 (13.0) | |
| Sub-senior | 429 (48.6) | 111 (50.0) | 318 (48.1) | |
| Intermediate | 312 (35.3) | 55 (24.8) | 257 (38.9) | |
| Years of work related to infectious disease prevention and control | 0.016 | |||
| < 5 | 92 (10.4) | 11 (5.0) | 81 (12.3) | |
| 5–9 | 134 (15.2) | 37 (16.7) | 97 (14.7) | |
| 10–14 | 267 (30.2) | 73 (32.9) | 194 (29.3) | |
| 15–19 | 206 (23.3) | 60 (27.0) | 146 (22.1) | |
| ≥ 20 | 184 (20.8) | 41 (18.5) | 143 (21.6) | |
| Job type | 0.300 | |||
| Management | 24 (2.7) | 3 (1.4) | 21 (3.2) | |
| Professional technical | 679 (76.9) | 176 (79.3) | 503 (76.1) | |
| Both | 180 (20.4) | 43 (19.4) | 137 (20.7) | |
| Position | < 0.001 | |||
| Deputy section chief and above | 540 (61.2) | 102 (45.9) | 438 (66.3) | |
| Section member | 343 (38.8) | 120 (54.1) | 223 (33.7) | |
| Postgraduate supervisor qualifications | < 0.001 | |||
| Doctoral supervisor | 82 (9.3) | 26 (11.7) | 56 (8.5) | |
| Master’s supervisor | 123 (13.9) | 53 (23.9) | 70 (10.6) | |
| None | 678 (76.8) | 143 (64.4) | 535 (80.9) | |
| Net monthly income, yuan | < 0.001 | |||
| < 5000 | 103 (11.7) | 10 (4.5) | 93 (14.1) | |
| 5000–9999 | 612 (69.3) | 133 (59.9) | 479 (72.5) | |
| ≥ 10,000 | 168 (19) | 79 (35.6) | 89 (13.5) | |
| Experience in prevention and control of infectious diseases | ||||
| Zika virus disease | 106 (12.0) | 26 (11.7) | 80 (12.1) | 0.877 |
| H1N1 influenza | 501 (56.7) | 81 (36.5) | 420 (63.5) | < 0.001 |
| MERS | 122 (13.8) | 25 (11.3) | 97 (14.7) | 0.202 |
| Coronavirus disease 2019 | 859 (97.3) | 209 (94.1) | 650 (98.3) | 0.001 |
| Ebola virus disease | 104 (11.8) | 28 (12.6) | 76 (11.5) | 0.656 |
| Other | 345 (39.1) | 127 (57.2) | 218 (33.0) | < 0.001 |
| Number of participations in outbreak response | 0.302 | |||
| 0 | 24 (2.7) | 8 (3.6) | 16 (2.4) | |
| 1–2 | 102 (11.6) | 24 (10.8) | 78 (11.8) | |
| 3–5 | 158 (17.9) | 49 (22.1) | 109 (16.5) | |
| 6–10 | 112 (12.7) | 28 (12.6) | 84 (12.7) | |
| > 10 | 487 (55.2) | 113 (50.9) | 374 (56.6) | |
| Area by GDP per capita | 0.204 | |||
| High | 421 (47.7) | 106 (47.7) | 315 (47.7) | |
| Medium | 196 (22.2) | 41 (18.5) | 155 (23.4) | |
| Low | 266 (30.1) | 75 (33.8) | 191 (28.9) |
The comparison of basic characteristics between two groups employed Chi-square test
MERS Middle East Respiratory Syndrome; GDP gross domestic product
Competency scoring and deficit analysis among public health professionals
The median total score of the 883 participants was 74.70 (IQR 67.97–81.00), which did not vary between provincial-level and prefecture-level public health professionals (74.99 vs. 74.68, P = 0.167). The scoring rates for “A Knowledge”, “B Practical skills”, and “C Leadership” ranged from 73.20% to 74.80%, noticeably lower than the 80.63% rate observed for “D Personal quality” (Table 2).
Table 2.
Comparison of competencies of primary and secondary levels between the provincial and municipal levels
| Item | No. of tertiary items included | Full score | Overall median (IQR) |
Scoring rate (%) | Provincial median (IQR) |
Prefecture median (IQR) |
P |
|---|---|---|---|---|---|---|---|
| Total | 64 | 100 | 74.70 (67.97, 81.00) | 74.70 | 74.99 (68.83, 82.81) | 74.68 (67.42, 80.33) | 0.167 |
| A Knowledge | 15 | 40.64 | 30.40 (27.48, 33.11) | 74.80 | 30.50 (27.64, 33.48) | 30.39 (27.40, 32.99) | 0.468 |
| B Practical skills | 19 | 28.78 | 21.19 (18.64, 23.02) | 73.63 | 21.25 (18.99, 23.28) | 21.17 (18.49, 22.99) | 0.241 |
| C Leadership | 21 | 20.82 | 15.24 (13.24, 16.66) | 73.20 | 15.29 (13.87, 16.66) | 15.24 (13.07, 16.66) | 0.146 |
| D Personal quality | 9 | 9.81 | 7.91 (7.61, 9.03) | 80.63 | 8.22 (7.75, 9.18) | 7.85 (7.55, 8.95) | 0.005 |
| A1 Knowledge of infectious diseases | 4 | 19.93 | 15.94 (14.97, 18.17) | 79.98 | 15.94 (14.97, 18.56) | 15.94 (14.97, 17.89) | 0.114 |
| A2 Knowledge of public health emergency management | 6 | 12.67 | 8.28 (7.60, 9.82) | 65.35 | 8.36 (7.39, 9.62) | 8.28 (7.60, 9.92) | 0.497 |
| A3 Laws, plans and mechanisms for responding to public health emergencies | 5 | 8.04 | 5.74 (4.82, 6.43) | 71.39 | 5.74 (4.82, 6.43) | 5.74 (4.82, 6.43) | 0.976 |
| B1 Infectious diseases prevention and emergency preparedness | 5 | 6.13 | 4.30 (3.68, 4.79) | 70.15 | 4.10 (3.63, 4.73) | 4.36 (3.68, 4.90) | 0.006 |
| B2 Infectious diseases surveillance and early warning | 6 | 8.48 | 6.52 (5.50, 6.78) | 76.89 | 6.61 (5.61, 6.89) | 6.52 (5.35, 6.78) | 0.103 |
| B3 Public health response to infectious diseases | 5 | 11.99 | 9.36 (7.81, 9.82) | 78.07 | 9.36 (7.96, 10.21) | 9.36 (7.58, 9.59) | 0.481 |
| B4 Scientific research ability | 3 | 2.18 | 1.39 (1.26, 1.74) | 63.76 | 1.53 (1.39, 1.74) | 1.31 (1.17, 1.53) | < 0.001 |
| C1 Leadership fundamentals | 4 | 4.34 | 3.30 (2.60, 3.47) | 76.04 | 3.37 (2.60, 3.47) | 3.30 (2.60, 3.47) | 0.272 |
| C2 Decision-making ability | 5 | 4.35 | 3.21 (2.61, 3.48) | 73.79 | 3.21 (2.79, 3.48) | 3.18 (2.61, 3.48) | 0.051 |
| C3 Team mobilization ability | 3 | 2.95 | 2.24 (1.77, 2.36) | 75.93 | 2.36 (1.77, 2.36) | 2.24 (1.77, 2.36) | 0.154 |
| C4 Self-regulation and communication abilities | 6 | 7.16 | 5.35 (4.57, 5.73) | 74.72 | 5.47 (4.72, 5.73) | 5.29 (4.45, 5.73) | 0.273 |
| C5 Team learning and development | 3 | 2.02 | 1.42 (1.21, 1.62) | 70.30 | 1.54 (1.21, 1.62) | 1.41 (1.21, 1.62) | 0.022 |
| D1 Professional qualifications | 2 | 1.96 | 1.57 (1.57, 1.96) | 80.10 | 1.57 (1.57, 1.96) | 1.57 (1.57, 1.96) | 0.032 |
| D2 Professional quality | 7 | 7.85 | 6.28 (6.14, 7.22) | 80.00 | 6.42 (6.28, 7.37) | 6.28 (6.10, 7.17) | 0.004 |
Rank-sum tests were used to compared the median scores between provincial-level and prefecture-level participants
IQR interquartile range
The three highest-scoring secondary items were “D1 Professional qualifications” (80.10%), “D2 Professional quality” (80.00%), and “A1 Knowledge of infectious diseases” (79.98%), while the secondary items with the lowest scoring rates were “B4 Scientific research ability” (63.76%), “A2 Knowledge of public health emergency management” (65.35%), and “B1 Infectious diseases prevention and emergency preparedness” (70.15%).
Within the tertiary items, only “A1_4” and “A1_1” exceeded four points (out of a full mark of five) in the knowledge dimension, whereas all tertiary items in the practical skills and leadership dimensions scored below four points (Fig. 1). In contrast, all tertiary items in the personal quality dimension, except for “D2_1 Physical fitness”, scored above four points.
Fig. 1.
Scores of tertiary items among four primary dimensions. A, the knowledge dimension; B, the practical skills dimension; C, the leadership dimension; D, the personal quality dimension
Among the total participants and subgroups, the domains of “Public health emergency management knowledge”, “Infectious disease knowledge”, “Public health response to infectious diseases”, and “Laws, plans, and mechanisms for public health emergency response” accounted for over 50% of the overall competency deficits (Fig. 2). This distribution of key competency gaps was consistent across CDC administrative levels and professional titles.
Fig. 2.
The distribution of competency items contributing to the competency score losses. A, overall; B, provincial participants; C, prefecture-level participants; D, participants with senior professional titles; E, participants with intermediate professional titles
Correlates of infectious disease control competency among public health professionals
In the univariate analysis, gender, education level, major of bachelor/college, professional title, years of infectious disease control experience, job type, position, postgraduate supervisor qualifications, net monthly income, number of participations in outbreak response, geographic area, number of training participations in the past five years, and job satisfaction were observed to be significantly related to the total competency scores (all P < 0.05) (supplementary Table 3). Public health professionals aged 35–40, 41–45, and 46–50 years exhibited respective median total scores of 74.35, 75.15, and 75.85 (Fig. 3). The total scores of public health professionals with senior title, sub-senior title, and intermediate title were 79.14, 75.17, and 73.02, respectively.
Fig. 3.
Median competency scores and associated factors among the total participants. CI, confidence interval
In the ordinal logistic regression model for all participants, being male (compared to female, OR 1.447; 95% CI 1.098–1.905), holding a Master’s degree or higher (compared to Bachelor’s degree or lower, OR 1.565; 95% CI 1.137–2.153), having ≥ 20 years of infectious disease control experience (compared to < 5 years, OR 2.448; 95% CI 1.354–4.427), occupying professional technical and management positions (compared to only professional technical positions, OR 1.493; 95% CI 1.064–2.096), holding a position of deputy section chief or above (compared to section member, OR 1.444; 95% CI 1.070–1.949), participating in over 10 outbreak response instances (compared to ≤ 2 times, OR 3.931; 95% CI 2.517–6.141), attending more than three training sessions in the past 5 years (compared to 0 times, OR 4.100; 95% CI 2.096–8.019), and high job satisfaction (compared to low satisfaction, OR 6.199; 95% CI 3.659–10.502) were significantly associated with higher competency scores (Fig. 3 and supplementary Table 4).
Among provincial participants, being a Master’s supervisor (compared to no supervisor qualification, OR = 1.995; 95% CI 1.006–3.956) and participating in over 10 outbreak response instances (compared to ≤ 2 times, OR 7.082; 95% CI 2.814–17.824) were significantly associated with higher competency scores (supplementary Fig. 1 and supplementary Table 5).
Among prefecture-level participants, being male (compared to female, OR 1.581; 95% CI 1.143–2.186), holding a Master’s degree or higher (compared to Bachelor’s degree or lower, OR 1.754; 95% CI 1.172–2.623), having ≥ 20 years of infectious disease control experience (compared to < 5 years, OR 2.148; 95% CI 1.108–4.165), occupying professional technical and management positions (compared to only professional technical positions, OR 1.561; 95% CI 1.057–2.306), participating in over 10 outbreak response instances (compared to ≤ 2 times, OR 3.537; 95% CI 2.086–6.000), attending more than three training sessions in the past five years (compared to 0 times, OR 4.320; 95% CI 1.883–9.913), and high job satisfaction (compared to low satisfaction, OR 9.711; 95% CI 5.293–17.816) were significantly associated with higher competency scores (supplementary Fig. 2 and supplementary Table 6).
Willingness and demand of professional training
A substantial proportion of participants (68.5%) had attended at least three training sessions in the past 5 years (Fig. 4A). Furthermore, 64.6% of participants expressed satisfaction with previous training initiatives (Fig. 4B). A large majority of participants (87.5%) exhibited a willingness to participate in future training programs (Fig. 4C). The most frequently cited reasons for unwillingness to participate in training were lack of time (66.4%), perception of previous training as ineffective (35.5%), and belief that training was not important to the individual or their job (15.5%) (Fig. 4D).
Fig. 4.
Experience and willingness toward professional training among public health professionals. A, proportion of the number of training participations in the past five years; B, proportion of the satisfaction with previous training; C, proportion of the willingness to participate in future training; D, distribution of the reasons for not willing to participate in training
Preferred training methods were case analysis (92.8%), scenario simulation (81.7%), and project training (73.0%) (Fig. 5A). A training duration of one week or less was deemed acceptable for 38.2% of participants, and this duration was also allowed by 38.2% of the CDCs where participants were employed (Fig. 5B and C). The most preferred training content areas among participants included public health response to infectious diseases (55.6%), research design and project application (54.1%), report writing and paper writing (50.8%), international cutting-edge knowledge in the field (50.4%), and infectious disease surveillance and early warning (49.7%) (Fig. 5D).
Fig. 5.
Demand of professional training among public health professionals. A, distribution of the training methods of interest to the participants; B, proportion of the acceptable training duration for the participants; C, proportion of training duration allowed by the work unit of the participants; D, distribution of the training content of interest to the participants
Discussion
This nationwide survey comprehensively evaluated infectious disease control competencies among provincial and prefecture-level public health professionals in China using a validated scale (IDCCS). The findings revealed an overall moderate competency level, with a median total score of 74.70 out of 100. The personal quality dimension scored highest, while scientific research ability, public health emergency management knowledge, and infectious disease prevention preparedness skills were relatively weaker. Encouragingly, 87.5% of participants expressed willingness to engage in future training, with preferred content closely aligned to identified competency gaps. This convergence between self-assessed needs and the evaluated competency profiles underscores the potential of targeted training programs to strengthen workforce capacity.
Competency levels varied across dimensions. In the primary dimensions, the scoring rates for knowledge, practical skills, and leadership were below 80%, indicating a need for comprehensive improvement. The 80.63% scoring rate for personal qualities suggested that public health professionals possessed adequate professional qualifications and traits. Knowledge, practical skills, and leadership scored similarly around 74%, collectively accounting for 90% of the weight. However, significant variation existed across secondary items, revealing specific weaknesses. Within the knowledge dimension, infectious disease knowledge exhibited the highest familiarity (scoring rate close to 80%), reasonably attributable to professionals’ duties and COVID-19 control experiences. Nonetheless, due to its high scoring weight, this domain emerged as the second-greatest contributor (13.7%) to competency score deficits. Continuous improvement in infectious disease knowledge is imperative, as mastering this area is a prerequisite for effective infectious disease prevention and control. In contrast, public health emergency management knowledge was the least sufficient (65.35% scoring rate) and the primary factor responsible for competency score losses (17.37%), reflecting its recent establishment as a discipline with limited university offerings in China [16]. Systematic education in public health emergency management through future training or adult education initiatives is warranted for professionals. Similarly, laws, plans, and mechanisms for responding to public health emergencies were also unfamiliar (71.39% scoring rate), and this area was responsible for 9.41% of the competency score losses. Regarding practical skills, scientific research ability was most lacking (63.76% scoring rate), necessitating substantial improvement. However, this item contributed only 3.48% to competency score losses due to its low assigned weight among public health professionals’ competency factors. Enhancing epidemiological methods such as infectious disease modeling could contribute to surveillance and early warning practices [17]. Additionally, augmenting research abilities may improve job performance, income, and consequently, job satisfaction [18]. Infectious disease prevention and emergency preparedness skills were unsatisfactorily scored (70.15%), with participation in emergency plan development being the weakest (mean score 3.06/5). This oft-overlooked skill enables professionals to deeply understand response measures, pre-plan emergency work, and enhance team response capabilities through interdepartmental communication and information sharing during plan development. Therefore, increased participation and training in emergency plan development is warranted. The skills in public health response to infectious diseases, while scoring the highest among practical skills (78.07%), were the third-greatest contributor (10.63%) to competency score deficits. Maintaining proficiency in basic infectious disease response skills among public health professionals is significant for improving their competency. In the leadership dimension, mean scores below four across all items indicated a lack of systematic leadership learning and training, necessitating supplementation through future initiatives.
Our results are consistent with international findings. A study in South Korea identified a significant gap in epidemiological methods among infectious disease response practitioners [19], aligning with our finding of relatively weaker scientific research abilities. This suggests a potential international need to enhance epidemiological capacity. Similarly, a study on China’s public health emergency personnel’s field coping capacity highlighted needs in crisis communication and personal protection [20], differing from our finding of weaker emergency management knowledge, indicating that specific competency gaps can vary by role and assessment focus. Furthermore, research on risk assessment competencies among CDC staff in China [21] showed self-perceived low competence, suggesting a broader need for stronger technical skills. A study in Guangdong on dengue fever preparedness emphasized climate change awareness and surveillance [22]. These varied findings highlight the complexity of infectious disease control competencies and the importance of context-specific evaluations.
Determinants of competency in our study included education, years of experience, outbreak response participation, and training frequency, in line with established theories linking competency development to education, practical experience, and ongoing learning opportunities [23, 24]. Consequently, encouraging highly educated professionals to join infectious disease prevention and control teams is necessary. Additionally, establishing a robust training system, conducting regular relevant training, constantly updating knowledge and skills, and fostering continuous professional growth are suggested. However, the brain drain of experienced key personnel poses a serious challenge affecting competency levels across public health institutions, primarily driven by low salaries [25, 26]. Our results also showed that 69.3% of public health professionals reported net monthly income of 5000–9999 RMB (about 695–1389 US dollars), significantly below that of clinicians [27]. Increasing public health professionals’ salaries may be crucial for reducing attrition. Furthermore, job satisfaction positively correlated with competency scores, consistent with prior studies [28, 29]. Job satisfaction encompasses external factors such as wages, policies, and promotion opportunities, as well as internal factors such as autonomy, ability utilization, and achievement [30]. Hence, improving both external and internal job satisfaction factors is vital for enhancing competency.
Differences between administrative levels were notable. Provincial-level professionals typically assume more specialized and advisory roles, concentrating on policy formulation, strategic planning, and technical guidance. Consequently, factors such as postgraduate qualifications and extensive outbreak response experience may be more pertinent in shaping their competencies. In contrast, prefecture-level professionals are often more directly involved in frontline implementation, outbreak investigation, and community engagement. Their competencies could be influenced by a broader array of factors, including educational attainment, years of experience, professional roles, training frequency, job satisfaction, and gender dynamics within the workforce.
The results showed that most of the public health professionals had participated in the professional training of infectious disease prevention and control, and were satisfied with it, and were willing to participate in related training in the future. This demonstrates the feasibility of improving competency through training. Participants expressed interest in public health response to infectious diseases, research design and project applications, report and academic writing, international frontier knowledge, and infectious disease surveillance and early warning. Future training programs should prioritize these areas, primarily utilizing case analyses and scenario simulations, as professionals often possess sufficient basic knowledge. Considering acceptable training durations, organizing short-term training of less than one week may be suitable for most public health professionals.
This study has several limitations that warrant consideration. First, this study employed a cross-sectional design, which provides a snapshot of the infectious disease control competencies of public health professionals at a specific time. Therefore, it reflects the current situation rather than establishing causal relationships. Longitudinal studies are needed to observe changes in competency levels over time. Second, the convenience sampling method used may introduce selection bias, affecting the representativeness of the results. Future studies should employ more rigorous random sampling methods to enhance the generalizability of the findings. Third, the voluntary nature of participation in this survey might have introduced a bias. Public health professionals with a greater interest in professional development or those who perceive themselves as more competent might have been more inclined to participate. This could potentially lead to an overestimation of the overall competency levels observed in our study. Additionally, although strict quality control measures were implemented, the possibility of some random or dishonest responses cannot be entirely ruled out, potentially affecting the accuracy of the results to some extent. Finally, this study solely evaluated the self-assessed competencies of public health professionals, lacking external evaluators’ assessments, which may introduce subjective biases. Future research could combine multiple evaluation methods to enhance the objectivity and credibility of the findings.
In conclusion, this nationwide survey comprehensively evaluated the infectious disease control competencies among Chinese provincial and prefecture-level public health professionals. The findings reveal moderate overall competency levels, with notable strengths in personal qualities but gaps in scientific research abilities, emergency management knowledge, and prevention preparedness skills. Targeted training programs, continuous professional development, higher education, practical experience, and improved job satisfaction are essential for strengthening capacity. Addressing salary disparities may also mitigate workforce attrition. By implementing competency-based training programs, public health institutions can better equip professionals to respond effectively to emerging infectious disease threats and safeguard population health and security.
Supplementary Information
Acknowledgements
Not applicable.
Author contributions
QBL and FC conceived and designed the experiments, analyzed the data, reviewed drafts of the paper, and approved the final draft. YZ, XN and WXZ collected and analyzed the data, prepared figures and tables, authored drafts of the paper, and approved the final draft. SSZ, NHH, JZ, HY, QYM, LA, YQL, and JD collected the data and reviewed the draft. All authors have approved the final draft and agreed to the published version of the manuscript.
Funding
This work was supported by the Joint Research Fund for Beijing Natural Science Foundation and Haidian Original Innovation (L222029, L202007 and L222028) and PKU-MSD Joint Laboratory on Infectious Disease Prevention and Control.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
This study received approval from the Peking University Institutional Review Board (No. IRB00001052-23038).
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Qing-Bin Lu, Email: qingbinlu@bjmu.edu.cn.
Fuqiang Cui, Email: cuifuq@bjmu.edu.cn.
References
- 1.Weiss RA, Sankaran N. Emergence of epidemic diseases: zoonoses and other origins. Fac Rev. 2022;11:2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Cao C. China’s evolving biosafety/biosecurity legislations. J Law Biosci. 2021;8:lsab020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Vlieg WL, Fanoy EB, van Asten L, Liu X, Yang J, Pilot E, et al. Comparing national infectious disease surveillance systems: China and the Netherlands. BMC Public Health. 2017;17:415. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Hu J, Chen C, Kuai T. Improvement of emergency management mechanism of public health crisis in rural China: a review article. Iran J Public Health. 2018;47:156–65. [PMC free article] [PubMed] [Google Scholar]
- 5.National Health Commission of the People’s Republic of China. Circular of the National Health and Family Planning Commission on the issuance of the 13th five-year plan (2016–2020) for the prevention and control of emerging infectious Diseases. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=0efc0c2e658740de8c3cdcfbb75b7f2f. 2016. Accessed Apr 3 2024.
- 6.World Health Organization (WHO) Regional Office for Europe. European action plan for strengthening public health capacities and services. https://www.euro.who.int/__data/assets/pdf_file/0005/171770/RC62wd12rev1-Eng.pdf. 2012. Accessed Apr 3, 2024.
- 7.Central People’s Government of the People’s Republic of China. Guidelines of The General Office of the State Council on promoting the high-quality development of disease prevention and control. https://www.gov.cn/zhengce/content/202312/content_6922483.htm. 2023. Accessed Apr 3 2024.
- 8.European center for disease prevention and control. core competencies for EU public health epidemiologists in communicable disease surveillance and response. https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/training-core-competencies-EU-public-health-epidemiologists.pdf. 2010. Accessed Apr 3 2024.
- 9.UK Government. Public health skills and knowledge framework, 2019 Update. https://www.gov.uk/government/publications/public-health-skills-and-knowledge-framework-phskf/public-health-skills-and-knowledge-framework-august-2019-update. 2023. Accessed Apr 3 2024.
- 10.Pan American Health Organization. Core competencies for public health: a regional framework for the Americas. https://iris.paho.org/bitstream/handle/10665.2/28439/9789275118153_eng.pdf;sequence=1. 2013. Accessed Apr 3 2024.
- 11.Liang W. To cultivate cross-disciplinary public health talents. Int Talent 2023;8–9.
- 12.Zhou Y, Zhang W-X, Zhang S-S, Huang N-H, Zeng J, Yang H, et al. Development and validation of an infectious disease control competency scale for public health professionals. Glob Health Res Policy. 2024;9:39. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Weiss DJ, Dawis RV, England GW. Manual for the minnesota satisfaction questionnaire. Minnesota stud vocational rehabil 1967.
- 15.Sohu News. Ranking of Chinese provinces’ GDP per capita in 2023. https://www.sohu.com/a/763349384_121894857. 2024. Accessed Apr 3 2024.
- 16.Wu F, Wang L. Public health emergency management personnel training strategy and path analysis. Chin Health Resour. 2020;23:89–93. [Google Scholar]
- 17.Plymoth A, Codd MB, Barry J, Boncan A, Bosman A, Conyard KF, et al. Core competencies in applied infectious disease epidemiology: a framework for countries in Europe. Euro Surveill. 2023;28:2200517. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Li S, Ding S. Research ability of clinical nurses and its relationship with nursing job satisfaction. J Nurs Sci. 2013;28:53–5. [Google Scholar]
- 19.Kim Y, Gwack J, Kwon Y, Cheong MJ, Lee JH. Needs assessment for public health competency in infection prevention and control: importance and performance analysis (IPA) of infectious disease response practitioners. J Korean Med Sci. 2025;40:e23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Zhao M, Liu B, Wang L, Wu Q, Kang Z, Hao Y, et al. A cross-sectional study on China’s public health emergency personnel’s field coping-capacity: need, influencing factors, and improvement options. Disaster Med Public Health Prep. 2020;14:192–200. [DOI] [PubMed] [Google Scholar]
- 21.Hao J, Ren J, Wu Q, Hao Y, Sun H, Ning N, et al. Identifying factors associated with risk assessment competencies of public health emergency responders. Int J Environ Res Public Health. 2017. 10.3390/ijerph14060597. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Tong MX, Hansen A, Hanson-Easey S, Xiang J, Cameron S, Liu Q, et al. Perceptions of capacity for infectious disease control and prevention to meet the challenges of dengue fever in the face of climate change: a survey among CDC staff in Guangdong Province, China. Environ Res. 2016;148:295–302. [DOI] [PubMed] [Google Scholar]
- 23.Alainati S, Alshawi S, Al-Karaghouli W. The effect of education and training on competency. European and Mediterranean Conference on Information System. 2010.
- 24.Medium. Competence vs Experience: how each impacts your unique value. https://blog.mecentric.io/competence-vs-experience-how-each-impacts-your-unique-value-9a837859c16c. 2023. Accessed Apr 3 2024.
- 25.Wu Q, Huang L, Liu Y, Guo Y. Current situation and suggestions on the construction of talent team in the institutions of disease control and prevention in China. Chin J Public Health Manag. 2021;37:165–8. [Google Scholar]
- 26.Chen S. Analysis of human resource flow in a provincial center for disease control and prevention from 2018 to 2022. Jiangsu Health Syst Manag. 2023;34:1339–49. [Google Scholar]
- 27.China Youth Daily. Fudan doctor’s annual income 82,000, what caused the disease control talent shortage?. https://shareapp.cyol.com/cmsfile/News/202005/25/share385568.html?t=1590889312&nid=385568. 2020. Accessed Apr 3 2024.
- 28.Wijaya H, Andronicus M. Effect of competence, stress and job satisfaction on employee performance in PT. Dhamma Niaga Plastindo. J Res Bus Econ Education. 2020;2:863–73. [Google Scholar]
- 29.Mahayana IBA, Putra IBU, Yasa PNS. The role of job satisfaction as a mediation of competence and motivation on employee performance at Marthalia Skincare Clinic Denpasar. J Econ Finance Manag Stud. 2021;5:3959–69. [Google Scholar]
- 30.Lee TJ. Relationship between intrinsic job satisfaction, extrinsic job satisfaction, and turnover intentions among internal auditors. Walden University. Dissertation/Thesis 2017.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.