Viewpoints of community workers on public health emergency management in urban communities: A Q Methodology Research

Viewpoints of community workers on public health emergency management in urban communities: A Q Methodology Research | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Viewpoints of community workers on public health emergency management in urban communities: A Q Methodology Research Hongling Shi, Wentao Li, Tong Yue, Jiaxin Yu, Xue Wang, An Libin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8042402/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Urban communities serve as the front-line defense during public health emergencies, yet their capacity for effective response is often constrained by a lack of full understanding of the practical challenges faced by grassroots workers. The aim of this study is to explore community workers' viewpoints on managing public health emergencies in urban communities, identify practical weaknesses, and inform targeted improvements. Using Q methodology, the study collected viewpoints on public health emergency management through a Q set, a P set, Q sorting, and Q analysis. The 35-statement (Q set) was constructed using semi-structured interviews and literature reviews to capture key viewpoints. Eighteen community workers (P set) were recruited to rank and sort their agreement with the Q-set (scored from "-4" for "absolutely disagree" to "4" for "absolutely agree") and provide reasons for their ranking (Q sorting). Data analysis using Ken-Q software revealed three distinct perspectives after varimax rotation, which were prioritized as follows: Viewpoint 1 (Resource support) reflected concerns about human resource and incentive mechanism constraints; Viewpoint 2 (Information dissemination) exposed inadequate information sharing due to technological and coordination gaps; Viewpoint 3 (Risk prevention) specifically addressed vulnerabilities in reaching high-risk populations during public health emergencies. The findings shed light on the complex challenges faced by communities during emergency response. It provides strategies to enhance multi-stakeholder collaboration, innovate information-sharing mechanisms, and establish targeted protection for vulnerable groups. Public health emergency management Community workers Q-methodology Figures Figure 1 Figure 2 Introduction In an era marked by increasing frequency of public health emergencies, such as the COVID-19 pandemic, the resilience of front-line defense systems has been critically tested. Urban communities is responsible for prevention and emergency preparedness, monitoring and early warning, emergency management and rescue, and recovery and reconstruction[1], serving as "guardians" of residents' health. Their ability to be proactive and responsive is crucial for handling crises and minimizing losses. Research on public health emergency management, both domestically and internationally, has yielded significant findings over the past decades, these researches are mostly concentrated in the fields of the governance mode and system innovation[2-4], evaluation index construction on emergency response capability from the “community resilience” theory[1, 5], digitization to improve grassroots governance capacity[6]. With the deepening of community-level governance, increasing attentio n has been paid to the role of grassroots organizations in coordinating resources, disseminating information, and implementing preventive measures. There are still some deficiencies in the research of grassroots community in public health emergencies in our country. In particular, the community needs to be encouraged to take ownership of the problem-solving process for the health crisis. What’s more, the existing research on community emergency management still lacks the structured viewpoints on emergency response needs. Previous research has primarily analyzed the emergency prevention and control capabilities of urban communities from the viewpoint of government governance[5, 7, 8]. While these studies provide valuable macro-level insights, a significant gap remains in understanding the issue from the "inside-out"—that is, from the structured subjective viewpoints of community workers themselves. Their interpretations of policies and on-the-ground constraints directly shape the efficacy of emergency responses[9]. Little is known about obstacles from community workers’ viewpoints during health crisis emergency management. Therefore, this study employs Q-methodology to identify and interpret the typologies of structured viewpoints held by community workers regarding the challenges in public health emergency management. This approach aims to uncover the shared perspectives that underlie their subjective experiences, providing a evidence base for targeted interventions. Method Q-methodology, a form of by-person factor analysis proposed by British psychologist William Stephenson in 1935, is a scientific methodology used to study individual subjectivity and attitudes[10]. This approach integrates the advantages of quantitative and qualitative research, making it possible to transform subjective human viewpoints into objective outcomes through scientific means[9]. The methodology’s application has been described in nursing education and health research[11-13]. Figure 1 illustrated the study process. Concourse and Q set To build the concourse, data were collected using evaluation indicator system for the emergency management capability of major infectious diseases[1], literature review, semi-structured interview. The Q statement represents the main viewpoints related to the research topic. Twenty community residents' committee managers from representative cities where infectious diseases have broken out were selected as interviewees: Dalian (n=7), Wuhan (n=7) and Guangzhou (n=6). Inclusion criteria: (1) Having worked in the community for more than 5 years and being familiar with the community work; (2) voluntarily participating in this study. Each interview lasted no less than 30 minutes. During the interview, audio was recorded and non-verbal information was noted. Subsequently, the recorded information was transcribed into text, and finally, a statement set relevant to the research purpose was determined. The interviews and transcriptions continued until information saturation was reached. This process initially generated 56 statements for the concourse. We confirmed data saturation through repeated responses across interviews. Two experts (professors of public health service management) were invited to examine and refine each statement in the Q statement to reduce ambiguity and eliminate redundancy. Finally, a set of 35 representative and important Q statements was generated. P sample The Q method aims to explore the participants’ interesting or important viewpoints on research topics. Q-methodology is characterized by the use of a small sample and focused on the diversity of representation rather than the sample of the population. Thus, the participants of P-set was recruited based on their relevance to the research topic. P-set to Q-set ratio of research subjects is 2:1 [5] . In this study, 18 community workers from community residents committee in Dalian, China were recruited as research subjects. Q sorting A Q sorting table was developed with a nine-point scale ranging from “strongly disagree” (-4) through neutral (0) to“strongly agree” (+4). Participants in the P sample were asked to arrange the Q set into disagreed, neutral, and agreed groups based on their subjective importance by face to face, using a systematic forced distribution (Figure 2). Q-sort can be conducted using paper-based methods[14]. After each Q-sort, participants were asked to provide explanations for the most agreed-upon and disagreed-upon statements. This explanations will offer insight and better understanding of the participants’ viewpoints on the research topic. Data analysis We analyzed the Q sort using the Ken-Q Analysis Desktop Edition (KADE 1.3.1). By-person factor analysis followed by varimax factor rotation was carried out for the data analysis. To extract and compare factors, standardized (Z) scores were computed to identify the representative characteristics of a factor from other factors, employing an eigenvalue of 1.0 or high[15]. Statements with a Z-score above +1.0 are considered positive views, while those below -1.0 are considered negative views[16]. The percentage of variance explained by each factor, the cumulative variance explained by all factors, and the number of P sample in each factor were also computed. Factor interpretation was performed using factor arrays, which provide z-scores for each statement. Both quantitative and qualitative data contributed to the depth and clarity of our interpretation. Results P sample characteristics Eighteen participants of P sample with community manager or staff completed the Q sorting process of 35 statements in the Q set. The characteristics of participant are presented in Table 1. Q sorter The four factors explained 73% of the total variance, with Factor 1 counting for 41%, Factor 2 for 14%, and Factor 3 for 7%. The eigenvalues for Factor 1, Factor 2, and Factor 3 were 7.4117, 2.5798, and 1.239, respectively. Thus, we computer the Factor 1, Factor 2, and Factor 3 into the varimax factor rotation with the total 62% of the variance. The correlation coefficients between factor 1 and factor 2, factor 1 and factor 3, and factor 2 and factor 3 were 0.1333, 0.5451, and 0.0.2024, respectively. The low correlations indicate that the three factors are relatively independent. Characteristics and labeling of each factor Table 2 presents the factor scores alongside the corresponding Q-sort values for each factor. In this study, we named the viewpoints by Q-sort values and participant comments on the sorting Process. Viewpoint 1（Factor 1） Resource support Viewpoint 1 included 9 Q sorters. The most agreed statement (Z≥+1.0) was S34:“Community can effectively requisition infectious disease materials and provide certain compensation” (+4; Z =1.760) followed by S16:“Community can effectively requisition infectious disease materials and provide certain compensation” (+4; Z =1.388) (Table 2). The most disagreed statement (Z≤1.0) was S24:“Community is capable of assessing the risk of occurrence and spread of infectious diseases.” (- 4; Z =-1.765). The most influential P sample (P7) in viewpoint 1 was a community manager with 44-year-old female who has undergraduate education, and had over 20 years of work experience. She stated as follow: “ community workers undertake the front-line prevention and control tasks, and appropriate subsidies can help to improve their motivation” . Similarly, P9 was a community manager with 38-year-old, female who has undergraduate education, and had 6-10 years of work experience. She added that community had 9 staff members serving over 20,000 residents, often work around the clock, and enduring a heavy workload . P13 (40-year old, female, 11-15 years of work experience) emphasized that:“ there should be incentive mechanisms for social organizations and volunteers, as otherwise it is difficult to sustain their engagement in the long term ”. People in the viewpoint 1 believe that community should fully utilize, integrate, and reasonably allocate resources rom all parties, which is crucial guarantee for the sustained development of emergency management. Community staff also express concerns about their lack of professional expertise and the absence of specialized epidemic prevention personnel, which limits their capacity for effective public health emergency communication and assessment. Based on these views, we labeled this factor as "resource support". Viewpoint 2 （Factor 2）Information dissemination Viewpoint 2 included 9 Q sorters. The most agreed statement (Z≥+1.0) was S2:“Community conduct emergency response based on the information of infectious diseases pushed by higher authority” (+4; Z =1.712) followed by S1:“Community should pay attention to the information dynamics of infectious disease, and adjust the work focus timely” (+3; Z =1.308) (Table 2). P17 in viewpoint 2 was a community manager with 48-year-old female who has undergraduate education, and had 11-15 years of work experience. She explained, “ We adjusted work priorities upon receiving the information regarding infectious disease from the superior departmen t. The most disagreed statement (Z≤1.0) was S4:“Community should use big data to screen and capture infectious diseases information.” (- 4; Z =-1.887), and S27:“Community should effectively share the information among various departments.” Participants in the viewpoint 2 believed that the management of infectious disease information within the community is fragmented and decentralized, which hinders comprehensive data sharing and efficient resource integration during the initial response. This has the potential to result in delays in the dissemination and availability of critical information. P10 stated as the follow:“ The technical capacity of grassroots communities is often limited, which hinders their ability to effectively screen and capture critical information .” P8 added “ The community communicates information through work groups or resident groups by Wechat. Since we cannot fully control all information, it would be preferable to have information shared across multiple departments.” Similarly, P12 said, “I have to deal with various forms required by different departments, which significantly impacts my work efficiency.” For these reasons, we classified this group as “Information management.” Viewpoint 3 （Factor 3）Risk prevention Viewpoint 3 included 9 Q sorters. The most agreed statement (Z≥+1.0) was S7:“Community uses a variety of ways to make residents pay attention to the infectious disease information” (+4; Z =1.461) followed by S8:“Community enables the elderly to obtain timely information on the infectious diseases through various means” (+3; Z =1.431), and S9:“Community raises awareness among the elderly in a variety of ways to attach importance to infectious disease.” (+3; Z =1.385), (Table 2). P3 in viewpoint 3 was a community manager with 47-year-old female who has undergraduate education, and had 11-15 years of work experience. She explained, “ Elderly individuals who are unable to use smartphones may not receive timely information on the prevention and control of public health emergencies. ” P6 added “ As a vulnerable group, the elderly have weaker immune systems, poor ability and psychological resilience to cope emergency event, which can easily worsen the condition and have a longer recovery period, so special attention should be given to the elderly.” P15 said, “The floating population is unable to precisely obtain information on the public health emergencies, which increases the difficulty of prevention.” The most disagreed statement (Z≤1.0) was S29:“Community should establish rapid assessment process for infectious disease.” (-4; Z=-1.903), and S28:“Community can effectively control the source of infectious diseases..” Participants in the viewpoint 3 argue that it is difficult for them to conduct rapid assessments, emergency warnings and early disposal to high-risk populations due to the lack of professional knowledge and skills. P20 explain that , “ The community merely executes tasks related to the prevention of public health emergencies as directed by higher authorities, and lacks the capability to assess and control the infection source .” For these reasons, we labeled this group as “risk prevention.” They hold a highly negative view of risk management, avoid such content, and emphasize its professionalism. Discussion This study aimed to gain a deeper understanding of community subjective viewpoints of emergency management in public health, and consequently identified three distinctive viewpoints using Q methodology. Despite the emphasis placed on different aspects by the three viewpoints, this also reaffirms the barriers to public health emergency management. These findings are also in line with the 4R Crisis Management Model theory, encompassing reduction, readiness, response and recovery[8], and is usually applied throughout the entire life cycle of crisis events. These findings indicated that the complex need for comprehensive consideration for prevention and management of public health emergency event among community. Viewpoint 1 Resource support Community engagement has resurfaced as a shared responsibility to address public health emergencies[17]. Participants in the Chinese community work closely together to leverage their respective strengths based on the joint prevention and control mechanism of 'party organization leadership, public participation and social support', which effectively improve the overall level of emergency response during health crisis[8]. The joint prevention and control mechanism in China is still in its nascent stages, facing a conflict between strategic aspirations and practical implementation. The primary resource support challenges in this study included the heavy workload of community staff, inadequate emergency funds, and a lack of specialized epidemic prevention personnel. An excessive workload, coupled with a shortage of emergency management professionals not only impacts the mental health of community workers, but also prolongs the response time in information dissemination, material distribution, and isolation management[18-20]. Furthermore, inadequate incentives is one of reported challenge for community workers in this study. Similar findings were reported in other low-income countries[21, 22]. Therefore, it is crucial to cultivate community grassroots governance subjects and allocate rights and responsibilities, as well as innovate incentive mechanism, to enhance community emergency management capacities. Viewpoint 2 Information dissemination Information dissemination is key to achieving a rapid emergency response and effective disposal. Participants in viewpoint 2 perceived that communities primarily rely on information pushed by higher-level departments to initiate emergency responses, which reflecting the characteristics of emergency governance by government, but exposed the passivity of community grassroots levels in information acquisition. This lag and fragmentation in information dissemination stem not only from a lack of technical support but, more fundamentally, reflects the absence of collaborative mechanisms. Thus, strengthen the information technology forces and coordination prevention can realize the linkage of governance capabilities and precise governance[8]. More critically, communities demonstrate severe deficiencies in leveraging big data for information screening and achieving effective cross-departmental information dissemination. This indicates substantial barriers to information integration and coordination during the initial response phase of emergency management. This finding is consistent with previous research into the challenges of sharing health information, particularly in settings where resources are limited[23]. Insufficient information exchange make community face greater challenges in impeding crucial decision making, resource allocation, and outbreak monitoring activities[23]. Thus, an innovation information-sharing mechanism based on different social principles can promote the construction of an information system for community emergencies. Viewpoint 3 Risk prevention This study reveals the critical challenge of risk prevention failure among high-risk populations, particularly highlighting the elevated exposure risks faced by the elderly due to the digital divide and their physiological vulnerability, consistent with previous studies[24, 25]. Barriers in risk information access and communication hinder community workers' ability to prioritize the needs of the elderly, greatly reducing the relevance and effectiveness of services[26]. Participants in the viewpoint 3 realized the importance of risk communication for vulnerable groups, but demonstrated significant lack of confidence in establishing rapid infectious disease assessment procedures and effectively controlling infection sources. The finding reflects the structural deficiencies in community grassroots capabilities for risk assessment and early intervention due to a lack of expertise and skill training. Therefore, a dual-track approach is needed to develop a future community risk prevention system, including emergency preparedness plans in the age-friendly digital community and targeted intervention capabilities to address emergency communication barriers faced. Limitation The limitations of this study are as follows. (1) A primary limitation of this study is that its participant sample was composed of community workers. Consequently, the findings may not fully represent the diverse viewpoints of other crucial groups, including residents and volunteers, whose viewpoints are equally essential to a comprehensive understanding of community emergency management. (2) Q-sampling and Q-sorting require retrospective self-narratives of community emergency management experiences, which may introduce biases in expression and attrition of experience during interviews. Conclusion This study is a significant attempt to transform community workers’ subjective viewpoints into objective data through scientific methods. The findings provide critical theoretical insights and practical evidence for grass-roots communities public health emergency response. By examining the subjective perceptions and psychological processes of the participants, the study identified three barriers to community emergency response including shortages of emergency resources, inadequate information dissemination and ineffective risk prevention. To address these challenges, it is crucial to optimize the collaborative participation of multiple principals, innovate information-sharing mechanism, and create appropriate risk prevention for vulnerable populations. Such efforts are vital for improving urban communities' overall emergency preparedness and reducing the adverse impact on residents' well-being. Future research could involve expanding the research team to explore novel viewpoints and methodologies aimed at enhancing urban communities' emergency management capacities in dealing with public health emergencies through additional empirical investigations. Declarations Ethics statement Ethical review and approval was not required for the study on human participants in accordance with Article 2 of the Circular on the Issuance of the Measures for Ethical Review of Science and Technology (Trial) (2023) and Article 3 of the Circular on the Issuance of the Measures for Ethical Review of Life Science and Medical Research Involving Human Beings (2023). All participants gave written informed consent before data collection. Funding This research is funded by the National Social Science Fund of China. (Grant No. 20BSH046). Acknowledgement We sincerely thank all the experts involved in this study. Competing interests The authors declare no competing interests. Author details 1School of Nursing, Dalian University, 24 Luxun Road, Zhongshan District, Dalian, Liaoning 116001, China Authors’ contributions An, Li, and Shi formulated the research questions and were responsible for the conception and design of the study; Yu and Wang prepared the methodology; Shi and Yue collected and analyzed the data; Shi and Li were responsible for drafting and revising the paper; and An and Li were responsible for the quality control and review of the article. References Guan X, Li W, Cui N, Yu J, An L: Construction of an evaluation indicator system for the emergency management capability of major infectious diseases in urban communities . BMC Health Serv Res 2025, 25 (857).https://doi.org/10.1186/s12913-025-12936-x Huang J: The Prevention and Management System of Public Emergencies based on Community . 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Journal of Urban Health 2025.https://doi.org/10.1007/s11524-025-01011-9 Tables Table 1 Demographics data of P sample(N=18) Demographic n Percent Age 33-39 7 39 40-49 10 56 50-59 1 6 Gender male 2 11 female 16 89 education undergraduate 16 89 graduate 2 11 Working time 1-5 3 17 6-10 3 17 11-15 9 50 16-20 1 6 ＞20 2 11 Occupation community manager 16 89 community worker 2 11 Table 2 Factor scores and Q-sort values of each factor No. Q set Factor 1 Factor 2 Factor 3 Z score Q sort value Z score Q sort value Z score Q sort value S1 communities should pay attention to the information dynamics of infectious disease, and adjust the work focus timely. -0.548 -1 1.308 3 * 0.158 0 S2 communities conduct emergency response based on the information of infectious diseases pushed by higher authority. -1.022 -2 * 1.712 4 * 0.003 0 * S3 communities conduct epidemiological surveys. -0.335 -1 1.21 3 * -0.589 -1 S4 communities should use big data to screen and capture infectious diseases information. -1.732 -3 -1.887 -4 * -1.133 -2 S5 communities use big data platforms to verify infectious disease information. -1.421 -2 0.579 1 -1.133 -3 S6 communities received infectious diseases information from superior. -0.635 -1 0.683 1 -0.137 0 S7 communities uses a variety of ways to make residents pay attention to the infectious disease information. 0.798 1 -0.723 -2 * 1.461 4 * S8 communities enables the elderly to obtain timely information on the infectious diseases through various means. 0.197 0 -2.014 -4 1.431 3 * S9 communities raises awareness among the elderly in a variety of ways to attach importance to infectious disease. -0.203 0 -0.527 -1 1.385 3 * S10 communities should concern the needs of the elderly. 0.448 0 -0.856 -2 * 1.323 3 * S11 communities should employ diverse approaches to ensure that the floating population acquire on infectious diseases information. -0.285 -1 0.175 0 0.714 1 * S12 communities should ensure an adequate supply and good performance of emergency equipment for infectious disease . 0.843 2 1.354 4 -0.298 -1 * S13 communities regularly organizes training sessions on the utilization of emergency equipment for infectious disease. 0.398 0 0.728 1 0.272 1 S14 communities has strengthened the routine management of supplies for infectious disease. 0.697 1 0.983 2 -0.893 -2 S15 communities should be equipped with effective transportation vehicles (electric vehicles, bicycles, etc.) for infectious disease emergency management. 1.262 3 1.112 2 1.063 2 S16 communities should be staffed with sufficient personnel specialized in the emergency management of infectious diseases. 1.388 4 -1.887 -4 0.744 1 S17 communities should strengthen capacity to implement early warning and response measures. 0.952 2 * -1.053 -2 -0.460 -1 S18 communities should be allocated special funds for emergency management from higher authority. 0.878 2 1.031 2 0.146 0 S19 communities should update and revise the emergency plan to ensure its effective implementation. 0.658 1 -0.66 -1 0.861 2 S20 communities should optimize the emergency management process for infectious diseases. 0.968 2 -0.301 0 0.475 1 S21 communities should strengthen emergency drills for infectious disease. 0.701 1 -0.833 -2 1.610 4 S22 communities should increase promotional, educational, and training activities regarding infectious diseases. -0.047 0 -0.428 -1 -0.054 10 S23 communities should publicize the risks of the occurrence and spread of infectious diseases. -1.639 -3 * -0.052 0 -1.631 -3 S24 communities is capable of assessing the risk of occurrence and spread of infectious diseases. -1.765 -4 * -0.151 0 -0.430 -1 S25 communities should pay attention to environmental sanitation. -0.230 -1 1.007 2 0.281 1 S26 communities focus on the key population at risk for infectious disease. 1.086 3 1.308 3 * -1.470 -3 S27 communities should effectively share the information among various departments. 1.102 3 * -1.308 -3 * 0.065 0 S28 communities can effectively control the source of infectious diseases. -0.650 -2 * 0.271 0 -1.861 -3 * S29 communities should establish rapid assessment process for infectious disease. -0.902 -2 -0.655 -1 -1.903 -4 * S30 communities possess the capability for rapid assessment of infectious disease. -1.604 -3 0.225 0 * -1.903 -4 S31 communities can identify and monitor high-risk groups of infectious disease. -0.639 -2 0.504 1 -0.861 -2 S32 communities should enhance collaborative efforts in the prevention and contro of infectious disease. 0.616 0 * -0.602 -1 -0.033 0 S33 communities should promote active participation from social organizations and residents in the prevention and control of infectious diseases through various forms. 1.090 3 * 0.278 0 0.914 2 S34 communities can effectively requisition infectious disease materials and provide certain compensation. 1.760 4 -1.059 -3 -0.633 -2 S35 communities should provide a certain amount of funding subsidies for emergency management of infectious disease to personnel and volunteers. 1.100 3 * 0.324 1 -0.589 -1 *p< 0.05 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8042402","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542798837,"identity":"055b0bbb-7dee-42f2-93db-3bf8edece8c0","order_by":0,"name":"Hongling Shi","email":"","orcid":"","institution":"Dalian University","correspondingAuthor":false,"prefix":"","firstName":"Hongling","middleName":"","lastName":"Shi","suffix":""},{"id":542798838,"identity":"cc0ec989-cbea-4848-822e-a7f09cc7e9bf","order_by":1,"name":"Wentao Li","email":"","orcid":"","institution":"Dalian 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1","display":"","copyAsset":false,"role":"figure","size":115911,"visible":true,"origin":"","legend":"\u003cp\u003eStudy process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8042402/v1/6ee99482b5cd2eb3bfe44994.png"},{"id":96320321,"identity":"eff1aceb-fe01-4eb3-b848-25481336cd7c","added_by":"auto","created_at":"2025-11-19 18:47:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22032,"visible":true,"origin":"","legend":"\u003cp\u003eThe Q sorting table with 35 grids for the current study\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8042402/v1/7446d5106e8509ae7b88afa7.png"},{"id":96452998,"identity":"2a0a0d5f-7a47-4b68-9d87-9c2403f6824a","added_by":"auto","created_at":"2025-11-21 09:57:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1827383,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8042402/v1/2e0a7264-59c6-4dbd-82ea-cae7dd9d553a.pdf"}],"financialInterests":"","formattedTitle":"Viewpoints of community workers on public health emergency management in urban communities: A Q Methodology Research","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn an era marked by increasing frequency of public health emergencies, such as the COVID-19 pandemic, the resilience of front-line defense systems has been critically tested. Urban communities is responsible for prevention and emergency preparedness, monitoring and early warning, emergency management and rescue, and recovery and reconstruction[1], serving as \u0026quot;guardians\u0026quot; of residents\u0026apos; health. Their ability to be proactive and responsive is crucial for handling crises and minimizing losses.\u003c/p\u003e\n\u003cp\u003eResearch on public health emergency management, both domestically and internationally, has yielded significant findings over the past decades, these researches are mostly concentrated in the fields of the governance mode and system innovation[2-4], evaluation index construction on emergency response capability from the \u0026ldquo;community resilience\u0026rdquo; theory[1, 5], digitization to improve grassroots governance capacity[6]. With the deepening of community-level governance, increasing attentio n has been paid to the role of grassroots organizations in coordinating resources, disseminating information, and implementing preventive measures. There are still some deficiencies in the research of grassroots community in public health emergencies in our country. In particular, the community needs to be encouraged to take ownership of the problem-solving process for the health crisis. What\u0026rsquo;s more, the existing research on community emergency management still lacks the structured viewpoints on emergency response needs.\u003c/p\u003e\n\u003cp\u003ePrevious research has primarily analyzed the emergency prevention and control capabilities of urban communities from the viewpoint of government governance[5, 7, 8]. While these studies provide valuable macro-level insights, a significant gap remains in understanding the issue from the \u0026quot;inside-out\u0026quot;\u0026mdash;that is, from the structured subjective viewpoints of community workers themselves. Their interpretations of policies and on-the-ground constraints directly shape the efficacy of emergency responses[9]. Little is known about obstacles from community workers\u0026rsquo; viewpoints during health crisis emergency management. Therefore, this study employs Q-methodology to identify and interpret the typologies of structured viewpoints held by community workers regarding the challenges in public health emergency management. This approach aims to uncover the shared perspectives that underlie their subjective experiences, providing a evidence base for targeted interventions.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eQ-methodology, a form of by-person factor analysis proposed by British psychologist William Stephenson in 1935, is a scientific methodology used to study individual subjectivity and attitudes[10]. This approach integrates the advantages of quantitative and qualitative research, making it possible to transform subjective human viewpoints into objective outcomes through scientific means[9]. The methodology\u0026rsquo;s application has been described in nursing education and health research[11-13]. Figure 1 illustrated the study process.\u003c/p\u003e\n\u003cp\u003eConcourse and Q set\u003c/p\u003e\n\u003cp\u003eTo build the concourse, data were collected using evaluation indicator system for the emergency management capability of major infectious diseases[1], literature review, semi-structured interview.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Q statement represents the main viewpoints related to the research topic. Twenty community residents\u0026apos; committee managers from representative cities where infectious diseases have broken out were selected as interviewees: Dalian (n=7), Wuhan (n=7) and Guangzhou (n=6). Inclusion criteria: (1) Having worked in the community for more than 5 years and being familiar with the community work; (2) voluntarily participating in this study. Each interview lasted no less than 30 minutes. During the interview, audio was recorded and non-verbal information was noted. Subsequently, the recorded information was transcribed into text, and finally, a statement set relevant to the research purpose was determined. The interviews and transcriptions continued until information saturation was reached. This process initially generated 56 statements for the concourse. We confirmed data saturation through repeated responses across interviews. Two experts (professors of public health service management) were invited to examine and refine each statement in the Q statement to reduce ambiguity and eliminate redundancy. Finally, a set of 35 representative and important Q statements was generated.\u003c/p\u003e\n\u003cp\u003eP sample\u003c/p\u003e\n\u003cp\u003eThe Q method aims to explore the participants\u0026rsquo; interesting or important viewpoints on research topics. Q-methodology is characterized by the use of a small sample and focused on the diversity of representation rather than the sample of the population. Thus, the participants of P-set was recruited based on their relevance to the research topic. P-set to Q-set ratio of research subjects is 2:1\u003csup\u003e[5]\u003c/sup\u003e. In this study, 18 community workers from community residents committee in Dalian, China were recruited as research subjects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQ sorting\u003c/p\u003e\n\u003cp\u003eA Q sorting table was developed with a nine-point scale ranging from \u0026ldquo;strongly disagree\u0026rdquo; (-4) through neutral (0) to\u0026ldquo;strongly agree\u0026rdquo; (+4). Participants in the P sample were asked to arrange the Q set into disagreed, neutral, and agreed groups based on their subjective importance by face to face, using a systematic forced distribution (Figure 2). Q-sort can be conducted using paper-based methods[14]. After each Q-sort, participants were asked to provide explanations for the most agreed-upon and disagreed-upon statements. This explanations will offer insight and better understanding of the participants\u0026rsquo; viewpoints on the research topic.\u003c/p\u003e\n\u003cp\u003eData analysis\u003c/p\u003e\n\u003cp\u003eWe analyzed the Q sort using the Ken-Q Analysis Desktop Edition (KADE 1.3.1). By-person factor analysis followed by varimax factor rotation was carried out for the data analysis. To extract and compare factors, standardized (Z) scores were computed to identify the representative characteristics of a factor from other factors, employing an eigenvalue of 1.0 or high[15]. Statements with a Z-score above +1.0 are considered positive views, while those below -1.0 are considered negative views[16]. The percentage of variance explained by each factor, the cumulative variance explained by all factors, and the number of P sample in each factor were also computed. Factor interpretation was performed using factor arrays, which provide z-scores for each statement. Both quantitative and qualitative data contributed to the depth and clarity of our interpretation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eP sample characteristics\u003c/p\u003e\n\u003cp\u003eEighteen participants of P sample with community manager or staff completed the Q sorting process of 35 statements in the Q set. The characteristics of participant are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eQ sorter\u003c/p\u003e\n\u003cp\u003eThe four factors explained 73% of the total variance, with Factor 1 counting for 41%, Factor 2 for 14%, and Factor 3 for 7%. The eigenvalues for Factor 1, Factor 2, \u0026nbsp;and Factor 3 were 7.4117, 2.5798, and 1.239, respectively. Thus, we computer the Factor 1, Factor 2, and Factor 3 into the varimax factor rotation with the total 62% of the variance. The correlation coefficients between factor 1 and factor 2, factor 1 and factor 3, and factor 2 and factor 3 were 0.1333, 0.5451, and 0.0.2024, respectively. The low correlations indicate that the three factors are relatively independent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCharacteristics and labeling of each factor\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents the factor scores alongside the corresponding Q-sort values for each factor. In this study, we named the viewpoints by Q-sort values and participant comments on the sorting Process.\u003c/p\u003e\n\u003cp\u003eViewpoint 1（Factor 1）\u0026nbsp;Resource support\u003c/p\u003e\n\u003cp\u003eViewpoint 1 included 9 Q sorters. The most agreed statement (Z\u0026ge;+1.0) was S34:\u0026ldquo;Community can effectively requisition infectious disease materials and provide certain compensation\u0026rdquo; (+4; Z =1.760) followed by S16:\u0026ldquo;Community can effectively requisition infectious disease materials and provide certain compensation\u0026rdquo; (+4; Z =1.388) (Table 2). The most disagreed statement (Z\u0026le;1.0) was S24:\u0026ldquo;Community is capable of assessing the risk of occurrence and spread of infectious diseases.\u0026rdquo; (- 4; Z =-1.765).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most influential P sample (P7) in viewpoint 1 was a community manager with 44-year-old female who has undergraduate education, and had over 20 years of work experience. She stated as follow: \u0026ldquo;\u003cem\u003ecommunity workers undertake the front-line prevention and control tasks, and appropriate subsidies can help to improve their motivation\u0026rdquo;\u003c/em\u003e. Similarly, P9 was a community manager with 38-year-old, female who has undergraduate education, and had 6-10 years of work experience. She added that \u003cem\u003ecommunity had 9 staff members serving over 20,000 residents, often work around the clock, and enduring a heavy workload\u003c/em\u003e. P13 (40-year old, female, 11-15 years of work experience) emphasized that:\u0026ldquo;\u003cem\u003ethere should be incentive mechanisms for social organizations and volunteers, as otherwise it is difficult to sustain their engagement in the long term\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003ePeople in the viewpoint 1 believe that community should fully utilize, integrate, and reasonably allocate resources rom all parties, which is crucial guarantee for the sustained development of emergency management. Community staff also express concerns about their lack of professional expertise and the absence of specialized epidemic prevention personnel, which limits their capacity for effective public health emergency communication and assessment. Based on these views, we labeled this factor as \u0026quot;resource support\u0026quot;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eViewpoint 2\u0026nbsp;（Factor 2）Information dissemination\u003c/p\u003e\n\u003cp\u003eViewpoint 2 included 9 Q sorters. The most agreed statement (Z\u0026ge;+1.0) was S2:\u0026ldquo;Community conduct emergency response based on the information of infectious diseases pushed by higher authority\u0026rdquo; (+4; Z =1.712) followed by S1:\u0026ldquo;Community should pay attention to the information dynamics of infectious disease, and adjust the work focus timely\u0026rdquo; (+3; Z =1.308) (Table 2). P17 in viewpoint 2 was a community manager with 48-year-old female who has undergraduate education, and had 11-15 years of work experience. She explained, \u0026ldquo;\u003cem\u003eWe adjusted work priorities upon receiving the information regarding infectious disease from the superior departmen\u003c/em\u003et.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most disagreed statement (Z\u0026le;1.0) was S4:\u0026ldquo;Community should use big data to screen and capture infectious diseases information.\u0026rdquo; (- 4; Z =-1.887), and S27:\u0026ldquo;Community should effectively share the information among various departments.\u0026rdquo; Participants in the viewpoint 2 believed that the management of infectious disease information within the community is fragmented and decentralized, which hinders comprehensive data sharing and efficient resource integration during the initial response. This has the potential to result in delays in the dissemination and availability of critical information. P10 stated as the follow:\u0026ldquo; \u003cem\u003eThe technical capacity of grassroots communities is often limited, which hinders their ability to effectively screen and capture critical information\u003c/em\u003e.\u0026rdquo; P8 added\u003cem\u003e\u0026ldquo; The community communicates information through work groups or resident groups by Wechat. Since we cannot fully control all information, it would be preferable to have information shared across multiple departments.\u0026rdquo;\u0026nbsp;\u003c/em\u003eSimilarly, P12 said,\u003cem\u003e\u0026nbsp;\u0026ldquo;I have to deal with various forms required by different departments, which significantly impacts my work efficiency.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor these reasons, we classified this group as \u0026ldquo;Information management.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eViewpoint 3\u0026nbsp;（Factor 3）Risk prevention\u003c/p\u003e\n\u003cp\u003eViewpoint 3 included 9 Q sorters. The most agreed statement (Z\u0026ge;+1.0) was S7:\u0026ldquo;Community uses a variety of ways to make residents pay attention to the infectious disease information\u0026rdquo; (+4; Z =1.461) followed by S8:\u0026ldquo;Community enables the elderly to obtain timely information on the infectious diseases through various means\u0026rdquo; (+3; Z =1.431), and S9:\u0026ldquo;Community raises awareness among the elderly in a variety of ways to attach importance to infectious disease.\u0026rdquo; (+3; Z =1.385), (Table 2). P3 in viewpoint 3 was a community manager with 47-year-old female who has undergraduate education, and had 11-15 years of work experience. She explained, \u0026ldquo;\u003cem\u003eElderly individuals who are unable to use smartphones may not receive timely information on the prevention and control of public health emergencies.\u003c/em\u003e\u0026rdquo; P6 added \u003cem\u003e\u0026ldquo; As a vulnerable group, the elderly have weaker immune systems, poor ability and psychological resilience to cope emergency event, which can easily worsen the condition and have a longer recovery period, so special attention should be given to the elderly.\u0026rdquo; P15\u003c/em\u003e said,\u003cem\u003e\u0026nbsp;\u0026ldquo;The floating population is unable to precisely obtain information on the public health emergencies, which increases the difficulty of prevention.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe most disagreed statement (Z\u0026le;1.0) was S29:\u0026ldquo;Community should establish rapid assessment process for infectious disease.\u0026rdquo; (-4; Z=-1.903), and S28:\u0026ldquo;Community can effectively control the source of infectious diseases..\u0026rdquo; Participants in the viewpoint 3 argue that it is difficult for them to conduct rapid assessments, emergency warnings and early disposal to high-risk populations due to the lack of professional knowledge and skills. P20 explain that , \u0026ldquo;\u003cem\u003eThe community merely executes tasks related to the prevention of public health emergencies as directed by higher authorities, and lacks the capability to assess and control the infection source\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eFor these reasons, we labeled this group as \u0026ldquo;risk prevention.\u0026rdquo; They hold a highly negative view of risk management, avoid such content, and emphasize its professionalism.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to gain a deeper understanding of community subjective viewpoints of emergency management in public health, and consequently identified three distinctive viewpoints using Q methodology. Despite the emphasis placed on different aspects by the three viewpoints, this also reaffirms the barriers to public health emergency management. These findings are also in line with the 4R Crisis Management Model theory, encompassing reduction, readiness, response and recovery[8], and is usually applied throughout the entire life cycle of crisis events. These findings indicated that the complex need for comprehensive consideration for prevention and management of public health emergency event among community. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eViewpoint 1 Resource support\u003c/p\u003e\n\u003cp\u003eCommunity engagement has resurfaced as a shared responsibility to address public health emergencies[17]. Participants in the Chinese community work closely together to leverage their respective strengths based on the joint prevention and control mechanism of 'party organization leadership, public participation and social support', which effectively improve the overall level of emergency response during health crisis[8]. The joint prevention and control mechanism in China is still in its nascent stages, facing a conflict between strategic aspirations and practical implementation. The primary resource support challenges in this study included the heavy workload of community staff, inadequate emergency funds, and a lack of specialized epidemic prevention personnel. An excessive workload, coupled with a shortage of emergency management professionals not only impacts the mental health of community workers, but also prolongs the response time in information dissemination, material distribution, and isolation management[18-20]. Furthermore, inadequate incentives is one of reported challenge for community workers in this study. Similar findings were reported in other low-income countries[21, 22]. Therefore, it is crucial to cultivate community grassroots governance subjects and allocate rights and responsibilities, as well as innovate incentive mechanism, to enhance community emergency management capacities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eViewpoint 2 Information dissemination\u003c/p\u003e\n\u003cp\u003eInformation dissemination is key to achieving a rapid emergency response and effective disposal. Participants in viewpoint 2 perceived that communities primarily rely on information pushed by higher-level departments to initiate emergency responses, which reflecting the characteristics of emergency governance by government, but exposed the passivity of community grassroots levels in information acquisition. This lag and fragmentation in information dissemination stem not only from a lack of technical support but, more fundamentally, reflects the absence of collaborative mechanisms. Thus, strengthen the information technology forces and coordination prevention can realize the linkage of governance capabilities and precise governance[8]. More critically, communities demonstrate severe deficiencies in leveraging big data for information screening and achieving effective cross-departmental information dissemination. This indicates substantial barriers to information integration and coordination during the initial response phase of emergency management. This finding is consistent with previous research into the challenges of sharing health information, particularly in settings where resources are limited[23]. Insufficient information exchange make community face greater challenges in impeding crucial decision making, resource allocation, and outbreak monitoring activities[23]. Thus, an innovation information-sharing mechanism based on different social principles can promote the construction of an information system for community emergencies.\u003c/p\u003e\n\u003cp\u003eViewpoint 3 Risk prevention\u003c/p\u003e\n\u003cp\u003eThis study reveals the critical challenge of risk prevention failure among high-risk populations, particularly highlighting the elevated exposure risks faced by the elderly due to the digital divide and their physiological vulnerability, consistent with previous studies[24, 25]. Barriers in risk information access and communication hinder community workers' ability to prioritize the needs of the elderly, greatly reducing the relevance and effectiveness of services[26]. Participants in the viewpoint 3 realized the importance of risk communication for vulnerable groups, but demonstrated significant lack of confidence in establishing rapid infectious disease assessment procedures and effectively controlling infection sources. The finding reflects the structural deficiencies in community grassroots capabilities for risk assessment and early intervention due to a lack of expertise and skill training. Therefore, a dual-track approach is needed to develop a future community risk prevention system, including emergency preparedness plans in the age-friendly digital community and targeted intervention capabilities to address emergency communication barriers faced.\u003c/p\u003e\n\u003cp\u003eLimitation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe limitations of this study are as follows. (1) A primary limitation of this study is that its participant sample was composed of community workers. Consequently, the findings may not fully represent the diverse viewpoints of other crucial groups, including residents and volunteers, whose viewpoints are equally essential to a comprehensive understanding of community emergency management. (2) Q-sampling and Q-sorting require retrospective self-narratives of community emergency management experiences, which may introduce biases in expression and attrition of experience during interviews.\u003c/p\u003e\n\n"},{"header":"Conclusion","content":"\u003cp\u003eThis study is a significant attempt to transform community workers’ subjective viewpoints into objective data through scientific methods. The findings provide critical theoretical insights and practical evidence for grass-roots communities public health emergency response. By examining the subjective perceptions and psychological processes of the participants, the study identified three barriers to community emergency response including shortages of emergency resources, inadequate information dissemination and ineffective risk prevention. To address these challenges, it is crucial to optimize the collaborative participation of multiple principals, innovate information-sharing mechanism, and create appropriate risk prevention for vulnerable populations. Such efforts are vital for improving urban communities' overall emergency preparedness and reducing the adverse impact on residents' well-being. Future research could involve expanding the research team to explore novel viewpoints and methodologies aimed at enhancing urban communities' emergency management capacities in dealing with public health emergencies through additional empirical investigations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical review and approval was not required for the study on human participants in accordance with Article 2 of the Circular on the Issuance of the Measures for Ethical Review of Science and Technology (Trial) (2023) and Article 3 of the Circular on the Issuance of the Measures for Ethical Review of Life Science and Medical Research Involving Human Beings (2023). All participants gave written informed consent before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is funded by the National Social Science Fund of China. (Grant No. 20BSH046).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all the experts involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare\u0026nbsp;no competing\u0026nbsp;interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1School of Nursing, Dalian University, 24 Luxun Road, Zhongshan District, Dalian, Liaoning 116001, China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn, Li, and Shi formulated the research questions and were responsible for the conception and design of the study; Yu and Wang prepared the methodology; Shi and Yue collected and analyzed the data; Shi and Li were responsible for drafting and revising the paper; and An and Li were responsible for the quality control and review of the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGuan X, Li W, Cui N, Yu J, An L: \u003cstrong\u003eConstruction of an evaluation indicator system for the emergency management capability of major infectious diseases in urban communities\u003c/strong\u003e. \u003cem\u003eBMC Health Serv Res \u003c/em\u003e2025, \u003cstrong\u003e25\u003c/strong\u003e(857).https://doi.org/10.1186/s12913-025-12936-x\u003c/li\u003e\n\u003cli\u003eHuang J: \u003cstrong\u003eThe Prevention and Management System of Public Emergencies based on Community\u003c/strong\u003e. \u003cem\u003eIJOMSR \u003c/em\u003e2-24, \u003cstrong\u003e7\u003c/strong\u003e(5):21-27.https://doi.org/10.53469/ijomsr.2024.07(05).05\u003c/li\u003e\n\u003cli\u003eZhang S, Feng Y, Zhu A, Huang X, Huang T: \u003cstrong\u003eCreation and use of an index of the emergency resilience of urban public health management in China\u003c/strong\u003e. 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Incentives and remuneration\u003c/strong\u003e. \u003cem\u003eHealth Res Policy Syst \u003c/em\u003e2021, \u003cstrong\u003e19\u003c/strong\u003e(Suppl 3):106.https://doi.org/10.1186/s12961-021-00750-w\u003c/li\u003e\n\u003cli\u003eSasie SD, Van Zuylen P, Ayano G, Aragaw FM, Spigt M: \u003cstrong\u003eInformation sharing across institutions: Practices and barriers during public health emergencies in Ethiopia\u003c/strong\u003e. \u003cem\u003eInt J Med Inform \u003c/em\u003e2024, \u003cstrong\u003e186\u003c/strong\u003e:105439.https://doi.org/10.1016/j.ijmedinf.2024.105439\u003c/li\u003e\n\u003cli\u003eLuyao W, Le W, Ziqiong Z: \u003cstrong\u003eThe Antecedents of Elderly\u0026apos;s Information Technology Avoidance for Pandemic Prevention Based on Public Health Emergenc\u003c/strong\u003e. \u003cem\u003eNankai Business Review \u003c/em\u003e2024, \u003cstrong\u003e28\u003c/strong\u003e(06):198-208\u003c/li\u003e\n\u003cli\u003eGuotao Z, Shengli D: \u003cstrong\u003eResearch on the Elderly\u0026apos;s Information Perception and Protective ActionDecision under the Sudden Public Health Event\u003c/strong\u003e. \u003cem\u003eInformation and Documentation Services \u003c/em\u003e2021, \u003cstrong\u003e042\u003c/strong\u003e(002):31-42.https://doi.org/CNKI:SUN:QBZL.0.2021-02-010.\u003c/li\u003e\n\u003cli\u003eWong AKC, Liu T, Liu LZ, Bayuo J, Tao X, Wong FKY: \u003cstrong\u003eHealthcare and Social Needs of Older Adults in Underserved Urban Communities: Insights from Community Health Workers\u003c/strong\u003e. \u003cem\u003eJournal of Urban Health \u003c/em\u003e2025.https://doi.org/10.1007/s11524-025-01011-9\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 \u0026nbsp;Demographics data of P sample(N=18)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"429\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 270px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e33-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eeducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003egraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eWorking time\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e6-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e11-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e16-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e＞20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003ecommunity manager\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003ecommunity worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1002\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 1002px;\"\u003e\n \u003cp\u003eTable 2 \u0026nbsp;Factor scores and Q-sort values of each factor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 494px;\"\u003e\n \u003cp\u003eQ set\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFactor 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFactor 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFactor 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eZ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eQ sort value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eZ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eQ sort value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eZ score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eQ sort value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should pay attention to the information dynamics of infectious disease, and adjust the work focus timely.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities conduct emergency response based on the information of infectious diseases pushed by higher authority.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities conduct epidemiological surveys.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should use big data to screen and capture infectious diseases information.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities use big data platforms to verify infectious disease information.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities received infectious diseases information from superior.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities uses a variety of ways to make residents pay attention to the infectious disease information.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities enables the elderly to obtain timely information on the infectious diseases through various means.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities raises awareness among the elderly in a variety of ways to attach importance to infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should concern the needs of the elderly.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should employ diverse approaches to ensure that the floating population acquire on infectious diseases information.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should ensure an adequate supply and good performance of emergency equipment for infectious disease .\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities regularly organizes training sessions on the utilization of emergency equipment for infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities has strengthened the routine management of supplies for infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should be equipped with effective transportation vehicles (electric vehicles, bicycles, etc.) for infectious disease emergency management.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should be staffed with sufficient personnel specialized in the emergency management of infectious diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should strengthen capacity to implement early warning and response measures.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should be allocated special funds for emergency management from higher authority.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should update and revise the emergency plan to ensure its effective implementation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should optimize the emergency management process for infectious diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should strengthen emergency drills for infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should increase promotional, educational, and training activities regarding infectious diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should publicize the risks of the occurrence and spread of infectious diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities is capable of assessing the risk of occurrence and spread of infectious diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should pay attention to environmental sanitation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities focus on the key population at risk for infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should effectively share the information among various departments.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities can effectively control the source of infectious diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should establish rapid assessment process for infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-4\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities possess the capability for rapid assessment of infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities can identify and monitor high-risk groups of infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should enhance collaborative efforts in the prevention and contro of infectious disease.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should promote active participation from social organizations and residents in the prevention and control of infectious diseases through various forms.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities can effectively requisition infectious disease materials and provide certain compensation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-1.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eS35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 494px;\"\u003e\n \u003cp\u003ecommunities should provide a certain amount of funding subsidies for emergency management of infectious disease to personnel and volunteers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt; 0.05\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Public health emergency management, Community workers, Q-methodology","lastPublishedDoi":"10.21203/rs.3.rs-8042402/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8042402/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eUrban communities serve as the front-line defense during public health emergencies, yet their capacity for effective response is often constrained by a lack of full understanding of the practical challenges faced by grassroots workers. The aim of this study is to explore community workers' viewpoints on managing public health emergencies in urban communities, identify practical weaknesses, and inform targeted improvements. Using Q methodology, the study collected viewpoints on public health emergency management through a Q set, a P set, Q sorting, and Q analysis. The 35-statement (Q set) was constructed using semi-structured interviews and literature reviews to capture key viewpoints. Eighteen community workers (P set) were recruited to rank and sort their agreement with the Q-set (scored from \"-4\" for \"absolutely disagree\" to \"4\" for \"absolutely agree\") and provide reasons for their ranking (Q sorting). Data analysis using Ken-Q software revealed three distinct perspectives after varimax rotation, which were prioritized as follows: Viewpoint 1 (Resource support) reflected concerns about human resource and incentive mechanism constraints; Viewpoint 2 (Information dissemination) exposed inadequate information sharing due to technological and coordination gaps; Viewpoint 3 (Risk prevention) specifically addressed vulnerabilities in reaching high-risk populations during public health emergencies. The findings shed light on the complex challenges faced by communities during emergency response. It provides strategies to enhance multi-stakeholder collaboration, innovate information-sharing mechanisms, and establish targeted protection for vulnerable groups.\u003c/p\u003e","manuscriptTitle":"Viewpoints of community workers on public health emergency management in urban communities: A Q Methodology Research","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 18:47:40","doi":"10.21203/rs.3.rs-8042402/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"102f503d-5d64-49c6-937d-d9c62c87fe1d","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-19T18:47:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 18:47:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8042402","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8042402","identity":"rs-8042402","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}