Development and validation of a competency-based assessment tool for public health workers in Shanghai community health centers: a population-based study

Development and validation of a competency-based assessment tool for public health workers in Shanghai community health centers: a population-based study | 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 Development and validation of a competency-based assessment tool for public health workers in Shanghai community health centers: a population-based study Ruijie Chang, Meihui Zhang, Rui Li, Qianqian Zhu, Yinqiao Dong, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5457143/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Nov, 2025 Read the published version in Human Resources for Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background The competence of public health workers is crucial for grassroots public health service capabilities. This study aimed to establish a competency model for public health workers and to test the reliability and validity of the model. Methods An evaluation indicators scale of competency of public health workers in Shanghai community health service centers (CHSCs) was constructed through a literature review, expert consultation, behavioral event interviews and questionnaire surveys. A questionnaire survey was carried out with 3809 public health workers from 249 Shanghai CHSCs to test the reliability and validity of the constructed scale. Results Exploratory factor analysis identified 5 common factors: comprehensive ability, professional spirit, professional knowledge, professional skills, research and development ability. The cumulative variance contribution rate was 62.241%. The factor load for each item ranged from 0.495 to 0.868. The overall Cronbach's alpha coefficient for the questionnaire was 0.985, for the five dimensions ranged from 0.916 to 0.969. The overall split-half reliability of the questionnaire was 0.842, and that of the five dimensions ranged from 0.913 to 0.952, with the Guttman split-half reliability coefficient ranging from 0.912 to 0.949. The correlation coefficients for all scale items with the total score ranged from 0.591 to 0.854 (P < 0.01). The correlation coefficients between each item and each dimension ranged from 0.434 to 0.925. Confirmatory factor analysis showed that the model had a good fitting effect (χ 2 /df = 2.288, TLI = 0.943, CFI = 0.957, IFI = 0.958, NFI = 0.928, RMSEA = 0.081). Using self-efficacy, self-esteem, work pressure, work motivation, and job satisfaction as benchmarks, all dimensions of the scale demonstrated significant positive correlations with the total scores of various benchmark questionnaires. Conclusions The constructed scale of competency of public health workers in Shanghai CHSCs has good reliability and validity and can be used as a tool to evaluate the competency level of public health workers. public health workers competency model reliability validity Figures Figure 1 Figure 2 Background Public health workers in community health centers (CHCs) refer to those who, after certain health vocational training, are engaged in medical and health care, residents' health management, disease prevention and other related work in the CHCs(Liang, 2013 ; Stone et al., 2023 ), a grass-roots medical and health institution, and are the practitioners of grass-roots public health services. In recent years, there has been a rapid acceleration in grassroots health system reform, with universal medical protection being a core element of the United Nations Sustainable Development Goals and the Healthy China Initiative(Ren et al., 2023 ). CHCs, as the primary prevention stage of disease and the maintenance of residents' health "gatekeeper", play a crucial role in identifying potential health risks early, implementing preventive measures, and intervening accurately in advance through activities such as regular health checkups, health lectures, and chronic disease screenings(Taylor, 2004 ). Currently, the international community is facing frequent public health emergencies, such as the COVID-19 pandemic and the monkeypox outbreak(Hemati et al., 2022 ). China plays a vital role in the global response to these crises(Xue & Zeng, 2019 ), with grass-roots public health workers in CHCs serving as a crucial component in managing and addressing these public health challenges(Lin et al., 2023 ). The competence of public health personnel in CHCs is essential for maintaining residents' health, and as frontline workers, they are increasingly pivotal in ensuring community well-being. The high-quality development of community health requires public health personnel in CHCs to possess a more comprehensive set of skills, including solid medical professional knowledge, good communication skills, coordination ability, organizational and management skills, among others(Holgate et al., 2018 ). This enables them to make decisions quickly and solve problems efficiently when facing various complex situations. The urgent task at hand is to determine how to use scientific and effective methods to evaluate the ability and quality of public health personnel in CHCs. To evaluate the competence of public health personnel in CHCs in Shanghai, this study introduces the concept of "competence." Initially proposed by American psychologist David McClelland in 1973, competence refers to the characteristics distinguishing levels of performance in specific jobs and organizational settings(McClelland, 1973 ). A "competence model" provides a comprehensive rating of the competency characteristics required for a specific job or role, aiding in predicting employee performance(Chouhan & Srivastava, 2014 ). Common research methods for developing such models include behavioral time interviews(Kurian et al., 2016 ), questionnaires(Patterson et al., 2013 ), and the Delphi method(Shewade et al., 2017 ). Previous studies have explored the competency model for medical staff positions in community health service organizations. In 1993, Spencer et al. proposed a 10-dimensional generic competency model for community service staff(LM, 1993 ). In 2002 and 2011, the World Organization of Family Doctors (WONCA) proposed and revised a core competency model for general practitioners (i.e., the WONCA Tree model), which covers six areas of core competencies in primary health care, person-centered care, problem-solving skills, integrative coping skills, community orientation, and holistic modularity(Europe, 2011 ). Research on competency in China began in the late 1990s, primarily focusing on enterprise management, human resources evaluation, and related areas. The exploration of competency within the health system dates back to 2004, marked by the inaugural research conducted by the Talent Exchange Service Center of the Ministry of Health. This pioneering study, titled "Research on Competency of Health Organization Manager Positions," laid the groundwork by establishing the "Dictionary of Competency Characteristics of Health Organization Manager Positions" and a competency model(L. Aitian et al., 2006 ; Y. Aitian et al., 2006 ; Qicheng, 2006 ; Yu et al.). Su Fang et al. utilized multiple research methods, including questionnaire surveys, Delphi expert consultations, behavioral event interviews, and checklists, to develop a competency model for general practitioners in township health centers in Guangxi. Their model identified key competency attributes such as grassroots service ability, grassroots communication ability, and innovation capability(Fang et al., 2015 ). In another study, Zhang Xifan et al. highlighted the need to enhance the business quality of public health personnel in township health centers, particularly for in-depth services. They proposed a competency quality model tailored to address these requirements(Xifan, 2015 ). Similarly, Liu Hong et al. investigated the competency of rural doctors in Jiangsu and observed continuous improvement in their quality and business level. However, they noted a need for further enhancement and balance in the development of competency among rural doctors(Hong, 2017 ). Ma Yanqiu Zi(Yanqiuzi et al., 2021 ) conducted a comprehensive review of 126 pieces of literature on public health system competency research in China. The analysis revealed a preference for qualitative and quantitative research methods in constructing competency models, with previous studies often integrating personal attributes, work attitudes, basic knowledge, professional skills, and a sense of responsibility into the basic competency framework for public health personnel(Bornioli et al., 2020 ; Cai et al.; Organization, 2020 ; Shickle et al., 2019 ; Subbarao et al., 2008 ). However, there is limited research on the construction of job competency models for public health personnel in CHCs. Given their increasing importance in grassroots health system reform, it is imperative to develop a competency model tailored to public health personnel in Shanghai's CHCs. This study aims to construct such a model and evaluate its reliability, contributing to the enhancement of public health service quality and the promotion of community well-being. Methods Constructing a pool of indicators Utilizing the keywords such as competency, competence, public health, influencing factors, public health workers and competency model, relative studies of competency model, competency assessment system, current status of competency in public health workers and its influence factors were searched from PubMed, Web of Science, Chinese CNKI, Wan Fang and other research literature website. All research processes are shown in Fig. 1 . Developing the questionnaire and implementing expert consultation The Delphi method was employed to consult experts in this field to gain a deep understanding of responsibilities of public health workers in CHCs within the context of the integration of medical and preventive care. This understanding served as the framework for building the competency model of public health workers in CHCs. McClelland Competency Dictionary was used for reference to form the consultation content including: (1) responsibilities of public health workers in CHCs, (2) basic qualities required for public health workers in CHCs, (3) current status of competency among public health workers in CHCs and (4) issues and opportunities faced by primary public health services under the background of the integration of medical and preventive care. Based on previous expert interviews and literature on competency of public health workers, a deep understanding of the abilities that public health workers in CHCs need to enhance within the context of the integration of medical and preventive care was gained and then potential elements was selected to be included in the competency model. We designed the Construction of Competency Model for Public Health Workers in CHCs in Shanghai Questionnaire, covering the assessment elements of competency including comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities. In addition, behavioral event interviews were conducted with public health workers in CHCs. Prior to each interview, A brief introduction of the interview topic was provided to the interviewee. Once the interviewee had no further questions, they were asked to describe their daily responsibilities and provide examples of representative behavioral events they encountered in their work, along with their thoughts, feelings, actions, and outcomes at the time. This included three successful events and three unsuccessful events. Following the interviews, the content was systematically organized and documented, allowing for the extraction of vocabulary related to competency characteristics, which subsequently facilitated the further refinement of the model. After construction of preliminary model, the questionnaire was adjusted and improved by anonymously soliciting and summarizing advice of directors of community management centers and managers of CHCs with extensive frontline work and management experience, then scoring the importance of questionnaire items. Moreover, advice from experts was aggregated and anonymous feedback was provided to them. 2–3 rounds of expert consultation were conducted totally and the final Competency Model for Public Health Workers in CHCs in Shanghai was formed. Questionnaire Development and Data Collection Through a literature review, factors related to competency were identified and integrated with the established Competency Model for Public Health Workers in CHCs in Shanghai. Subsequently, the Survey Questionnaire on Competency of Public Health Workers in CHCs in Shanghai was designed, which included scales for competency assessment, self-esteem, self-efficacy, work motivation, work stress, and job satisfaction. From October 2022 to December 2022, a census approach was adopted to recruit public health workers from 249 CHCs in Shanghai. The inclusion criteria were as follows: (1) public health workers primarily in the preventive healthcare department of CHCs in Shanghai, mainly including physicians, nurses, general practitioners, pharmacists, and medical technicians; (2) who willing to participate in the study and providing informed consent. The exclusion criterion was unable to complete the questionnaire using the SurveyStar platform. Eligible public health workers were invited to complete the Survey Questionnaire on Competency of Public Health Workers in CHCs in Shanghai by scanning the QR code on the recruitment poster. Logical settings were implemented in the questionnaire to guarantee the integrity of the responses. For CHCs with low response rates, the researchers further contacted the center managers to facilitate the collection of questionnaires. If participants had any questions about the survey, the investigators provided detailed explanations of the purpose of the study and emphasized the strict adherence to the principle of personal information privacy protection. Statistical Analysis Reliability and validity of the competence scale used in the formal questionnaire were examined after the formal questionnaire was collected. For reliability, Pearson correlations were calculated between each item and the total scale score, as well as between each item and the total score for each dimension. Cronbach's alpha coefficient was used to assess the internal consistency reliability of the questionnaire. Split-half reliability was evaluated using the Spearman-Brown coefficient and the Guttman split-half coefficient. For validity, structural validity was assessed using factor analysis and criterion-related validity was examined through correlation analysis. SPSS25.0 software was used for data analysis. Results Competency model construction The competency model constructed in this study for public health workers in CHCs in Shanghai included five key dimensions: comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities, comprising a total of 42 items. The dimension of comprehensive abilities included eight items: keen insights, communication abilities and skills, problem-solving abilities, teamwork abilities, stress resistance, clear understanding of job responsibilities, teaching abilities, and Putonghua and Shanghai dialect proficiency. The dimension of professional ethics included seven items: self-confidence and optimism, efficiency awareness, responsibility awareness, service awareness, ability to be prudent and logical, flexible and adaptable and patience. The dimension of professional knowledge included eight items: maternal, child and adolescent health, geriatrics, chronic diseases, infectious diseases, occupational health, environmental health, school health and health management. The dimension of professional skills included fifteen items: health education, promotion and management, epidemiological investigation abilities, data collection abilities, data analysis abilities, disinfection and sterilization, training and guidance for partner units (e.g., neighborhood committees), physical examination and health monitoring, personal protective awareness and skills, vaccination skills, follow-up skills, questionnaire survey skills, epidemiological investigation report writing, emergency response skills, public health monitoring equipment usage skills, and computer application skills. The dimension of research and development capabilities included four items: continuous learning abilities, research abilities, clear career planning, and a holistic health perspective (Table 1). Table1 Correlation Coefficients Between the Scores of Each Item and the Total Score of the Competency Questionnaire for Public Health Workers in Shanghai Community Health Centers （ N=3809 ） Item Correlation Coefficient A1 Keen Insights 0.792 A2 Communication Ability and Skills 0.794 A3 Problem-solving Abilities 0.826 A4 Teamwork Abilities 0.782 A5 Stress Resistance 0.718 A6 Clear Understanding of Job Responsibilities 0.774 A7 Teaching Abilities 0.763 A8 Putonghua and Shanghai Dialect Proficiency 0.591 A9 Self-confidence and Optimism 0.763 A10 Efficiency Awareness 0.798 A11 Responsibility Awareness 0.755 A12 Service Awareness 0.768 A13 Ability to be Prudent and Logical 0.823 A14 Flexible and Adaptable 0.828 Continued Table1 Item Correlation Coefficient A15 Patience 0.781 A16 Maternal, Child and Adolescent Health 0.730 A17 Geriatrics 0.746 A18 Chronic Diseases 0.788 A19 Infectious Diseases 0.809 A20 Occupational Health 0.774 A21 Environmental Health 0.781 A22 School Health 0.796 A23 Health Management 0.803 A24 Health Education, Promotion and Management 0.830 A25 Epidemiological Investigation Capabilities 0.829 A26 Data Collection Abilities 0.831 A27 Data Analysis Abilities 0.814 A28 Disinfection and Sterilization 0.815 A29 Training and Guidance for Partner Units 0.840 A30 Physical Examination and Health Monitoring 0.839 A31 Personal Protective Awareness and Skills 0.788 A32 Vaccination Skills 0.675 A33 Follow-up Skills 0.823 A34 Questionnaire Survey Skills 0.839 A35 Epidemiological Investigation Report Writing 0.782 A36 Emergency Response Skills 0.854 A37 Public Health Monitoring Equipment Usage Skills 0.796 A38 Computer Application Skills 0.774 A39 Continuous Learning Abilities 0.832 A40 Research Abilities 0.696 A41 Clear Career Planning 0.795 A42 Holistic Health Perspective 0.831 Correlation analysis The survey was conducted from October 11, 2022 to December 2, 2022, with a total of 3,809 valid questionnaires collected. The results of correlation analysis between each item and the total scale score, as well as between each item and the total score for each dimension are as follow. The result of correlation analysis between each item and the total scale score was presented in table 2. Pearson correlation between each item and the total scale score was calculated in order to test the internal consistency of the items in the scale. The results showed that the correlation coefficients between the 42 items and the total score ranged from 0.591 to 0.854, all of which were statistically significant (p<0.01). The correlation coefficients between each item and the total score were all greater than 0.5, indicating a strong positive correlation between them. Table2 Correlation Coefficients Between the Scores of Each Item and Each Dimension of the Competency Questionnaire for Public Health Workers in Shanghai Community Health Centers （ N=3809 ） Comprehensive Abilities Professional Ethics Professional Knowledge Professional Skills Research and Development Capabilities A1 Keen Insights 0.874 0.747 0.645 0.702 0.646 A2 Communication Ability and Skills 0.892 0.756 0.639 0.702 0.621 A3 Problem-solving Abilities 0.910 0.797 0.653 0.738 0.654 A4 Teamwork Abilities 0.875 0.810 0.594 0.687 0.585 A5 Stress Resistance 0.778 0.678 0.592 0.630 0.613 A6 Clear Understanding of Job Responsibilities 0.847 0.819 0.584 0.678 0.594 A7 Teaching Abilities 0.807 0.676 0.642 0.700 0.639 A8 Putonghua and Shanghai Dialect Proficiency 0.684 0.598 0.449 0.516 0.434 A9 Self-confidence and Optimism 0.779 0.839 0.599 0.659 0.628 A10 Efficiency Awareness 0.813 0.921 0.592 0.699 0.619 A11 Responsibility Awareness 0.768 0.912 0.537 0.659 0.557 A12 Service Awareness 0.773 0.918 0.563 0.670 0.574 A13 Ability to be Prudent and Logical 0.812 0.910 0.641 0.739 0.630 A14 Flexible and Adaptable 0.824 0.893 0.654 0.741 0.651 A15 Patience 0.760 0.882 0.612 0.688 0.621 A16 Maternal, Child and Adolescent Health 0.651 0.658 0.740 0.659 0.622 A17 Geriatrics 0.603 0.546 0.867 0.703 0.662 A18 Chronic Diseases 0.648 0.613 0.863 0.754 0.679 A19 Infectious Diseases 0.657 0.615 0.878 0.788 0.702 A20 Occupational Health 0.603 0.555 0.909 0.742 0.688 A21 Environmental Health 0.602 0.543 0.916 0.759 0.706 A22 School Health 0.629 0.573 0.903 0.774 0.711 A23 Health Management 0.629 0.564 0.920 0.783 0.728 A24 Health Education, Promotion and Management 0.688 0.650 0.822 0.831 0.728 A25 Epidemiological Investigation Capabilities 0.665 0.625 0.785 0.869 0.740 A26 Data Collection Abilities 0.671 0.630 0.771 0.873 0.756 A27 Data Analysis Abilities 0.643 0.590 0.780 0.856 0.771 A28 Disinfection and Sterilization 0.677 0.657 0.734 0.846 0.713 A29 Training and Guidance for Partner Units 0.717 0.695 0.728 0.866 0.738 A30 Physical Examination and Health Monitoring 0.711 0.704 0.724 0.864 0.746 A31 Personal Protective Awareness and Skills 0.713 0.759 0.596 0.797 0.649 Continued Table2 Comprehensive Abilities Professional Ethics Professional Knowledge Professional Skills Research and Development Capabilities A32 Vaccination Skills 0.589 0.588 0.560 0.700 0.552 A33 Follow-up Skills 0.733 0.739 0.654 0.845 0.687 A34 Questionnaire Survey Skills 0.736 0.737 0.676 0.867 0.720 A35 Epidemiological Investigation Report Writing 0.613 0.565 0.709 0.838 0.769 A36 Emergency Response Skills 0.707 0.661 0.757 0.891 0.804 A37 Public Health Monitoring Equipment Usage Skills 0.618 0.566 0.751 0.838 0.806 A38 Computer Application Skills 0.617 0.573 0.692 0.806 0.819 A39 Continuous Learning Abilities 0.691 0.682 0.703 0.832 0.902 A40 Research Abilities 0.524 0.457 0.686 0.700 0.864 A41 Clear Career Planning 0.644 0.608 0.722 0.781 0.925 A42 Holistic Health Perspective 0.713 0.703 0.700 0.814 0.886 Similarly, correlation analysis was conducted between each item and the scores of each dimension, and the correlation coefficients were calculated. The results showed that the correlation coefficients between each item and each dimension were all greater than 0.4, indicating a moderate positive correlation between them (table 3). Table3 Item Analysis and Exploratory Analysis of the Competency Questionnaire for Public Health Workers in Shanghai Community Health Centers (N = 3809) Item Factor Loading A1 Keen Insights 0.771 A2 Communication Ability and Skills 0.786 A3 Problem-solving Abilities 0.841 A4 Teamwork Abilities 0.784 A5 Stress Resistance 0.67 A6 Clear Understanding of Job Responsibilities 0.746 A7 Teaching Abilities 0.613 A8 Putonghua and Shanghai Dialect Proficiency 0.495 A9 Self-confidence and Optimism 0.721 A10 Efficiency Awareness 0.813 A11 Responsibility Awareness 0.821 A12 Service Awareness 0.817 A13 Ability to be Prudent and Logical 0.798 A14 Flexible and Adaptable 0.783 A15 Patience 0.737 A16 Maternal, Child and Adolescent Health 0.669 A17 Geriatrics 0.781 Continued Table3 Item Factor Loading A18 Chronic Diseases 0.749 A19 Infectious Diseases 0.795 A20 Occupational Health 0.839 A21 Environmental Health 0.862 A22 School Health 0.825 A23 Health Management 0.868 A24 Health Education, Promotion and Management 0.761 A25 Epidemiological Investigation Capabilities 0.836 A26 Data Collection Abilities 0.832 A27 Data Analysis Abilities 0.824 A28 Disinfection and Sterilization 0.727 A29 Training and Guidance for Partner Units 0.759 A30 Physical Examination and Health Monitoring 0.766 A31 Personal Protective Awareness and Skills 0.797 A32 Vaccination Skills 0.597 A33 Follow-up Skills 0.807 A34 Questionnaire Survey Skills 0.817 A35 Epidemiological Investigation Report Writing 0.764 A36 Emergency Response Skills 0.807 A37 Public Health Monitoring Equipment Usage Skills 0.787 A38 Computer Application Skills 0.773 A39 Continuous Learning Abilities 0.799 A40 Research Abilities 0.819 A41 Clear Career Planning 0.819 A42 Holistic Health Perspective 0.747 Reliability and validity testing of competency For reliability test, the overall Cronbach's alpha coefficient of the questionnaire was 0.985. The Cronbach's alpha coefficients for the five core dimensions, namely comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities, were 0.935, 0.959, 0.955, 0.969, and 0.916, respectively. These results indicated that the internal consistency coefficients of the overall questionnaire and each dimension were good. The overall split-half reliability of the questionnaire was 0.842. The Spearman-Brown split-half reliability coefficients for the five core dimensions, were 0.913, 0.940, 0.924, 0.952, and 0.919, respectively. The Guttman split-half reliability coefficients for the five core dimensions were 0.912, 0.919, 0.923, 0.949, and 0.919. These results indicated good internal consistency among the items, and the split-half reliability of the questionnaire was good. For validity test, the feasibility of factor analysis was tested using the Kaiser-Meyer-Olkin (KMO) test and Bartlett's test. The KMO sampling adequacy parameter was 0.984, and the Bartlett's sphericity test value was 195959.181 (p<0.001), indicating that the data were suitable for factor analysis. Using principal component analysis, five common factors were extracted, with a cumulative variance explanation rate of 62.241%. The factor loadings of the items ranged from 0.495 to 0.868 (Table 4). Further confirmatory factor analysis results are shown in Figure 2. Items A1-A8 belong to comprehensive abilities, items A9-A15 belong to professional ethics, Items A16-A23 belong to professional knowledge, items A24-A38 belong to professional skills, and items A39-42 belong to research and development capabilities. The result showed that the model fit the data well (c 2 /df= 2.288, TLI = 0.943, CFI = 0.957, IFI = 0.958, NFI = 0.928, RMSEA = 0.081). The result of the criterion-related validity analysis showed that the scores of each dimension of the Public Health Workers Competency Scale were significantly and positively correlated with the total scores of the different criterion questionnaires. Table 4 Correlation Analysis between the Competency Questionnaire and Individual or Work-related Characteristics for Public Health Workers in Shanghai Community Health Centers (N = 3809) Variables Comprehensive Abilities Professional Ethics Professional Knowledge Professional Skills Research and Development Capabilities Self-esteem 0.104*** 0.079*** 0.195*** 0.157*** 0.167*** Self-efficacy 0.463*** 0.442** 0.446*** 0.485*** 0.492*** Work Motivation 0.331*** 0.324** 0.310*** 0.350*** 0.353*** Work Pressure 0.162*** 0.116*** 0.172*** 0.183*** 0.159*** Job Satisfaction 0.316*** 0.324*** 0.297*** 0.327*** 0.353*** Note: *** indicates p<0.001 Discussion In this study, we constructed the competency model for public health workers in CHCs in Shanghai, which included five key dimensions of comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities. The model was constructed and revised multiple rounds based on relevant domestic literature, existing international evaluation projects, and combined with the context of the COVID-19 pandemic. In terms of comprehensive competency dimension, considering the significant elderly population in the Shanghai region, the requirement for proficiency in the Shanghai dialect has been specifically added to better adapt to the unique local work environment. The elements within the professional spirit dimension reflect the noble values of healthcare professionals, highlighting both professional ethics and their aspiration for self-actualization(Krieger, 2004 ). The professional knowledge dimension is broad, encompassing not only public health-related knowledge but also some clinical medical knowledge, such as geriatrics and chronic disease management, as supplements to ensure the efficiency and scientific nature of public health work. The elements within the professional skills dimension are kept current. As the socio-ecological environment continues to evolve, the focus of public health work is gradually shifting from concentrating primarily on prevention and control of infectious diseases to addressing emerging public health incidents and the management of chronic non-communicable diseases. This transition has undoubtedly brought new challenges and opportunities to the public health field. Therefore, enhancing the practical skills of public health workers is critical to improving the quality of public health services and achieving higher standards(Liang et al., 2019 ). The policy documents issued by the National Health Commission have clearly stated the responsibilities and competency requirements for public health workers, including but not limited to on-site response capabilities, laboratory testing and inspection skills, epidemiological investigation abilities, public health knowledge, epidemic prevention and control knowledge, disease prevention and control, health education, maternal and child health, public health emergency response, and public health safety. Compared to previous studies about competency elements, this study added items like emergency response skills, public health monitoring, equipment usage skills and so on, in order to better adapt to the normalized pandemic context and meet the practical needs of the field. Last but not least, research and development capability is also an indispensable skill for healthcare workers in CHCs. In the context of scientific advancement, research plays an irreplaceable role, and the performance of public health professionals in academic research and innovation offers crucial momentum for this process. As a core component of the public health service system, community health services leverage their extensive population base and relatively high levels of resident education and culture to provide rich facilitative conditions and ample development space for various scientific research activities(Likumahuwa et al., 2013 ). With the continuously rising in public and national expectations for public health services, CHCs have gradually become the new frontier for the core role of public health workers. A batch of public health graduates have chosen to start their careers here, and the staff of the Centers for Disease Control and Prevention have also gradually penetrated into the basic-level community health service system(Green et al., 2016 ). In this context, effectively integrating medical and preventive functions, ensuring the CHCss to achieve integrated medical and preventive operations, and providing basic public health services that cater to the actual needs of the public have become an urgent task for workers in this field. As the core carrier of public health service supply, public health workers must possess a high-level combination of qualities and skills necessary to cope with multiple challenges, in order to fully undertake the important responsibilities bestowed by this era. Especially in the increasingly complex and changing social environment currently, the profound transformation in the disease control field has further highlighted the indispensability of the public health talent team. Research on competency in China originated from the field of corporate management, while relevant exploration abroad was earlier in comparison. Subsequently, this theoretical research has gradually penetrated into diverse groups such as college teachers and civil servants in China, contributing to the expansion and deepening of competency researches. However, although some research work has been carried out in different fields in China, the methods and content of competency research remain relatively scarce in the medical and health field, particularly in public health workers. The literature review showed that the iceberg model and onion model were commonly adopted as the core framework when constructing competency models both domestically and internationally. These models comprehensively covered multiple dimensions including knowledge and skills, role positioning, self-awareness, inherent traits, and motivations. For example, the Japanese scholar Chikako Michibayashi et al. utilized the iceberg model to establish a competency model for public health nurses in tobacco control work in their country(Michibayashi et al., 2020 ), which included three categories of motivations, three categories of attitudes, and eight specific skills. Furthermore, drawing on the KSAO (Knowledge, Skill, Ability, and Others) theory proposed by Mirable in 1977(O'Reilly III et al., 1992 ), the competency elements have been further refined(Pronk et al., 2022 ). For instance, Corrianne Billings et al. identified six indicators in their research on the competency model of workers in infection control and epidemiology fields, including leadership, professional management, quality improvement, IPC (Infection Prevention and Control) operations, IPC informatics knowledge, and research capabilities(Billings et al., 2019 ). Meanwhile, the competency model for public health workers proposed by Shi L et al. consisted of seven dimensions, including basic medical knowledge, public health knowledge system, health management and health promotion strategies, professional expertise and skills, research and innovation capabilities, comprehensive judgment and decision-making abilities, and professional ethos(Shi et al., 2019 ). In this study, reliability and validity analyses of the designed measurement tool were also conducted to evaluate its quality and reliability. For the reliability analysis, both the internal consistency reliability and the split-half reliability of the measurement tool were evaluated. Regarding validity, the construct validity and criterion-related validity of the tool were analyzed. The results indicated that each item correlated positively with the overall score and with their respective dimensions, demonstrating good discriminative ability for all items. This validates the quality and reliability of the designed measurement tool, providing a solid data foundation and assurance of reliability for subsequent research. This study constructed a multidimensional competency assessment tool through a questionnaire survey involving 3,809 public health workers from 249 CHCs in Shanghai. The large sample size enhanced the statistical power and generalizability of the findings. Additionally, this study addressed the evolving demands on public health workers in the context of the COVID-19 pandemic by incorporating critical components such as emergency response skills and epidemiological investigation capabilities into the model, increasing the tool's practical applicability. Nevertheless, this study also had several limitations. First, it was conducted within China, which constrained its generalizability to other regions and limited its relevance to international contexts. In fact, our focus on China was justified by the significant variations in the requirements for public health workers globally. Given the large number of public health workers in China and limited prior studies in this area, conducting research within this group hold considerable significance. Second, the reliance on self-reported data might introduce bias. Finally, although we assessed competencies across multiple dimensions, there remained additional factors that warrant further investigation and refinement in future research. Declarations Funding This study was funded by the key discipline projects of Shanghai Three-Year Action Plan for Public Health under Grant (GWVI-11.1-29), the Science and Technology Commission Shanghai Municipality (No.20JC1410204) for the Seroepidemiological Study of Novel Coronavirus Pneumonia in Key Populations, and Shanghai Municipal Education Commission (grant number 2024-Sports, Health, Arts and Science Department 01-43). Acknowlegements The authors extend their sincere appreciation to all the individuals who took part in this research. Author Contributions Ruijie Chang and Meihui Zhang contributed equally to this work. They were responsible for designing the research framework, conducting the experiments, analyzing the data, and drafting the initial manuscript. Qianqian Zhu, Yinqiao Dong and Yujie Liu played a significant role in data collection and preprocessing. Yufei Chen and Zuxin Wang assisted in the experimental setup and data recording. Yong Cai and Hong Huang were the principal investigators of this research. Institutional Review Board Statement The research adhered to the principles laid out in the Declaration of Helsinki and obtained ethical clearance from the Ethical Review Committee of School of Public Health, Shanghai Jiao Tong University School of Medicine (approval number: SJUPN-202108). Informed Consent Statement Every participant provided written informed consent before participating in the study. Data Availability Statement The data are not publicly available due to privacy constraints. Statements and Declarations The authors wish to state that they have no conflicting interests. References Aitian, L., Qingyue, M., Suzhen, F., Yongchao, L., & Zhejuan, C. (2006). Research on the Competence of Directors of Disease Prevention and Control Centers. Chinese Journal of Hospital Administration (10), 678-680. https://kns.cnki.net/kcms2/article/abstract?v=8XtZWovJaITyXV1E8cFWLATkbcVa5oL83SEUO0eU2QKKaGMyWXtedLouo-qJ7tV35gGSvMPncAnIxltdq8q4HVX50KMw_-780Qjfi39mXaXUH90WaBQqAecxj1dqgMfCpXvOGX12SjofPgkErp-D3UPQAfRQsUorXAQQiApHBVxz2ATvxjq7dBD7sKNi3DKD&uniplatform=NZKPT&language=CHS Aitian, Y., Feng, L., Xianyu, D., Wen, L., & Qi, L. (2006). Research on the Competence of Hospital Directors in 30 Hospitals. Chinese Journal of Hospital Administration (10), 670-672. https://kns.cnki.net/kcms2/article/abstract?v=8XtZWovJaIQD_wwU9vzs7wJT6J_W5IrsrMQrdtJlcVo_AVaQdB5vRykXzHJkVmGasv4P-nI5A35GD8PDgTZiSDNqU-j8VuVJCrgC_CSS0FpLr0TROFj9iKsTRzQtJFmZDL-2zqkw-Lo-hD_fu9bOYn8rri4DtBCjbLMPaiVNY8ae2vEqdjaGKQHIMeHxSHUO&uniplatform=NZKPT&language=CHS Billings, C., Bernard, H., Caffery, L., Dolan, S. A., Donaldson, J., Kalp, E., & Mueller, A. (2019). Advancing the profession: an updated future-oriented competency model for professional development in infection prevention and control. American Journal of Infection Control , 47 (6), 602-614. Bornioli, A., Evans, D., & Cotter, C. (2020). Evaluation of the UK Public Health Skills and Knowledge Framework (PHSKF): implications for international competency frameworks. BMC Public Health , 20 , 1-8. Cai, Y., Wang, J., & Ding, P. A competency model for basic public health professionals in public health emergencies. Journal of Evaluation in Clinical Practice . 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Competency model for public health nurses working on tobacco control in local governments in Japan: A qualitative study. Japan Journal of Nursing Science , 17 (1), e12288. O'Reilly III, C. A., Caldwell, D. F., & Mirable, R. (1992). A PROFILE COMPARISON APPROACH TO PERSON-JOB FIT: MORE THAN A MIRAGE. Academy of Management Proceedings, Organization, W. H. (2020). WHO-ASPHER competency framework for the public health workforce in the European region . Patterson, F., Tavabie, A., Denney, M., Kerrin, M., Ashworth, V., Koczwara, A., & MacLeod, S. (2013). A new competency model for general practice: implications for selection, training, and careers. British Journal of General Practice , 63 (610), e331-e338. Pronk, T., Molenaar, D., Wiers, R. W., & Murre, J. (2022). Methods to split cognitive task data for estimating split-half reliability: A comprehensive review and systematic assessment. Psychon Bull Rev , 29 (1), 44-54. https://doi.org/10.3758/s13423-021-01948-3 Qicheng, J. (2006). Research on the Competence of Township Hospital Directors. Proceedings of the 2nd Academic Annual Meeting of the Chinese Preventive Medicine Association and the 2nd Annual Meeting of the Global Chinese Public Health Association, Xianghe, Hebei, China. Ren, M., Zhang, T., Xu, J., Qiao, J., Qiao, J., Zhan, S., Qin, J., Song, D., Fang, Y., & Lin, Y. (2023). Building quality primary health care development in the new era towards universal health coverage: a Beijing initiative. Global Health Research and Policy , 8 (1), 53. Shewade, H. D., Jeyashree, K., Kalaiselvi, S., Palanivel, C., & Panigrahi, K. C. (2017). Competency-based tool for evaluation of community-based training in undergraduate medical education in India–a Delphi approach. Advances in Medical Education and Practice , 277-286. Shi, L., Fan, L., Xiao, H., Chen, Z., Tong, X., Liu, M., & Cao, D. (2019). Constructing a general competency model for Chinese public health physicians: a qualitative and quantitative study. European journal of public health , 29 (6), 1184-1191. Shickle, D., Stroud, L., Day, M., & Smith, K. (2019). The applicability of the UK Public Health Skills and Knowledge Framework to the practitioner workforce: lessons for competency framework development. Journal of Public Health , 41 (1), e109-e117. Stone, K. W., Jagger, M. A., Horney, J. A., & Kintziger, K. W. (2023). Changes in anxiety and depression among public health workers during the COVID-19 pandemic response. Int Arch Occup Environ Health , 96 (9), 1235-1244. https://doi.org/10.1007/s00420-023-02002-6 Subbarao, I., Lyznicki, J. M., Hsu, E. B., Gebbie, K. M., Markenson, D., Barzansky, B., Armstrong, J. H., Cassimatis, E. G., Coule, P. L., & Dallas, C. E. (2008). A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness. Disaster medicine and public health preparedness , 2 (1), 57-68. Taylor, J. (2004). Fundamentals of community health centers. Xifan, Z. (2015). Research on the Development of Public Health Human Resources in Township Hospitals Based on the Competency Model [PHD, https://kns.cnki.net/kcms2/article/abstract?v=8XtZWovJaIRd2De1R65yhE60plZITKcElVxCqfebX7QA4PreLxEDrR5H8uT_lMAdwsSzrPZkIlnvL_s8k7ITqnb91FEQIFfSGoLPKNuF2Vyalb9FKgyhJPP99STYsl1Zd9H-V0JyvoGvnL5U2D-YzuVyJLsokIpFERjCgGZe-R-CAxTDBSJoCLIOy904rnakMthz59BA66o=&uniplatform=NZKPT&language=CHS Yanqiuzi, M., Haoyan, G., Guyue, H., Ran, T., & Yujie, G. (2021). Bibliometric Analysis of Competence Research in China's Public Health System. Chinese Journal of Public Health Management , 37 (01), 9-12. https://doi.org/10.19568/j.cnki.23-1318.2021.01.0003 Yu, Z., Yanmin, D., Suzhen, F., Jinhu, Y., Wenxiu, Y., & Qi, L. Research on the Competence of Directors of Community Health Service Centers. Chinese Journal of Hospital Administration (10), 673-675. https://kns.cnki.net/kcms2/article/abstract?v=8XtZWovJaIRSq46zC5a0Pwpi8fROQrDzuOyDaYEtkeXNZmhS4IC35N54TcnL9mpq9kiwSJYj0mqNmK6qUpxl70b79m9vUI4J3ncs8z0qzdgOheEdygkwDAEHSBji4PkJM-PhU-m54bAbZexd2IuLBDQyT-DkkG4U6SI6E3zE184LwMHRuxCGOSPA79_BCCcG&uniplatform=NZKPT&language=CHS Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Nov, 2025 Read the published version in Human Resources for Health → Version 1 posted Editorial decision: Revision requested 16 Nov, 2024 Editor assigned by journal 15 Nov, 2024 Submission checks completed at journal 15 Nov, 2024 First submitted to journal 14 Nov, 2024 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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02:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5457143/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5457143/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12960-025-01034-y","type":"published","date":"2025-11-24T15:57:39+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71550712,"identity":"c63ee196-495d-4eaa-aeba-cc54dd5f0ae5","added_by":"auto","created_at":"2024-12-16 15:43:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":112880,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResearch on the Construction of Competency Model for Public Health Workers in Shanghai Community Health Service Centers\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5457143/v1/98e99c0cd69e1f93c7b0b3c8.png"},{"id":71550711,"identity":"36334774-5484-4e6e-8ae8-59647d101c31","added_by":"auto","created_at":"2024-12-16 15:43:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":258367,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCFA Model for the competency model for public health workers in CHCs in Shanghai (with unstandardized estimates).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNames of factors: Factor 1 (F1, comprehensive abilities); factor 2 (F2, professional ethics); factor 3 (F3, professional knowledge); factor 4 (F4, professional skills); factor 5 (F5, research and development capabilities).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5457143/v1/41462be42940914d7a6a1cc6.png"},{"id":97179565,"identity":"3d693b76-cc1c-4be4-b409-3d5c1d35a91a","added_by":"auto","created_at":"2025-12-01 16:16:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1745128,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5457143/v1/1e93828f-bc28-4b9b-b06e-43ba0735cd6f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and validation of a competency-based assessment tool for public health workers in Shanghai community health centers: a population-based study","fulltext":[{"header":"Background","content":"\u003cp\u003ePublic health workers in community health centers (CHCs) refer to those who, after certain health vocational training, are engaged in medical and health care, residents' health management, disease prevention and other related work in the CHCs(Liang, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Stone et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), a grass-roots medical and health institution, and are the practitioners of grass-roots public health services. In recent years, there has been a rapid acceleration in grassroots health system reform, with universal medical protection being a core element of the United Nations Sustainable Development Goals and the Healthy China Initiative(Ren et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). CHCs, as the primary prevention stage of disease and the maintenance of residents' health \"gatekeeper\", play a crucial role in identifying potential health risks early, implementing preventive measures, and intervening accurately in advance through activities such as regular health checkups, health lectures, and chronic disease screenings(Taylor, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Currently, the international community is facing frequent public health emergencies, such as the COVID-19 pandemic and the monkeypox outbreak(Hemati et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). China plays a vital role in the global response to these crises(Xue \u0026amp; Zeng, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), with grass-roots public health workers in CHCs serving as a crucial component in managing and addressing these public health challenges(Lin et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe competence of public health personnel in CHCs is essential for maintaining residents' health, and as frontline workers, they are increasingly pivotal in ensuring community well-being. The high-quality development of community health requires public health personnel in CHCs to possess a more comprehensive set of skills, including solid medical professional knowledge, good communication skills, coordination ability, organizational and management skills, among others(Holgate et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This enables them to make decisions quickly and solve problems efficiently when facing various complex situations. The urgent task at hand is to determine how to use scientific and effective methods to evaluate the ability and quality of public health personnel in CHCs.\u003c/p\u003e \u003cp\u003eTo evaluate the competence of public health personnel in CHCs in Shanghai, this study introduces the concept of \"competence.\" Initially proposed by American psychologist David McClelland in 1973, competence refers to the characteristics distinguishing levels of performance in specific jobs and organizational settings(McClelland, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1973\u003c/span\u003e). A \"competence model\" provides a comprehensive rating of the competency characteristics required for a specific job or role, aiding in predicting employee performance(Chouhan \u0026amp; Srivastava, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Common research methods for developing such models include behavioral time interviews(Kurian et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), questionnaires(Patterson et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), and the Delphi method(Shewade et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Previous studies have explored the competency model for medical staff positions in community health service organizations. In 1993, Spencer et al. proposed a 10-dimensional generic competency model for community service staff(LM, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). In 2002 and 2011, the World Organization of Family Doctors (WONCA) proposed and revised a core competency model for general practitioners (i.e., the WONCA Tree model), which covers six areas of core competencies in primary health care, person-centered care, problem-solving skills, integrative coping skills, community orientation, and holistic modularity(Europe, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch on competency in China began in the late 1990s, primarily focusing on enterprise management, human resources evaluation, and related areas. The exploration of competency within the health system dates back to 2004, marked by the inaugural research conducted by the Talent Exchange Service Center of the Ministry of Health. This pioneering study, titled \"Research on Competency of Health Organization Manager Positions,\" laid the groundwork by establishing the \"Dictionary of Competency Characteristics of Health Organization Manager Positions\" and a competency model(L. Aitian et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Y. Aitian et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Qicheng, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Yu et al.). Su Fang et al. utilized multiple research methods, including questionnaire surveys, Delphi expert consultations, behavioral event interviews, and checklists, to develop a competency model for general practitioners in township health centers in Guangxi. Their model identified key competency attributes such as grassroots service ability, grassroots communication ability, and innovation capability(Fang et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In another study, Zhang Xifan et al. highlighted the need to enhance the business quality of public health personnel in township health centers, particularly for in-depth services. They proposed a competency quality model tailored to address these requirements(Xifan, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Similarly, Liu Hong et al. investigated the competency of rural doctors in Jiangsu and observed continuous improvement in their quality and business level. However, they noted a need for further enhancement and balance in the development of competency among rural doctors(Hong, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Ma Yanqiu Zi(Yanqiuzi et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) conducted a comprehensive review of 126 pieces of literature on public health system competency research in China. The analysis revealed a preference for qualitative and quantitative research methods in constructing competency models, with previous studies often integrating personal attributes, work attitudes, basic knowledge, professional skills, and a sense of responsibility into the basic competency framework for public health personnel(Bornioli et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Cai et al.; Organization, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Shickle et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Subbarao et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, there is limited research on the construction of job competency models for public health personnel in CHCs. Given their increasing importance in grassroots health system reform, it is imperative to develop a competency model tailored to public health personnel in Shanghai's CHCs. This study aims to construct such a model and evaluate its reliability, contributing to the enhancement of public health service quality and the promotion of community well-being.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eConstructing a pool of indicators\u003c/h2\u003e \u003cp\u003eUtilizing the keywords such as competency, competence, public health, influencing factors, public health workers and competency model, relative studies of competency model, competency assessment system, current status of competency in public health workers and its influence factors were searched from PubMed, Web of Science, Chinese CNKI, Wan Fang and other research literature website. All research processes are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDeveloping the questionnaire and implementing expert consultation\u003c/h3\u003e\n\u003cp\u003eThe Delphi method was employed to consult experts in this field to gain a deep understanding of responsibilities of public health workers in CHCs within the context of the integration of medical and preventive care. This understanding served as the framework for building the competency model of public health workers in CHCs. McClelland Competency Dictionary was used for reference to form the consultation content including: (1) responsibilities of public health workers in CHCs, (2) basic qualities required for public health workers in CHCs, (3) current status of competency among public health workers in CHCs and (4) issues and opportunities faced by primary public health services under the background of the integration of medical and preventive care. Based on previous expert interviews and literature on competency of public health workers, a deep understanding of the abilities that public health workers in CHCs need to enhance within the context of the integration of medical and preventive care was gained and then potential elements was selected to be included in the competency model. We designed the Construction of Competency Model for Public Health Workers in CHCs in Shanghai Questionnaire, covering the assessment elements of competency including comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities.\u003c/p\u003e \u003cp\u003eIn addition, behavioral event interviews were conducted with public health workers in CHCs. Prior to each interview, A brief introduction of the interview topic was provided to the interviewee. Once the interviewee had no further questions, they were asked to describe their daily responsibilities and provide examples of representative behavioral events they encountered in their work, along with their thoughts, feelings, actions, and outcomes at the time. This included three successful events and three unsuccessful events. Following the interviews, the content was systematically organized and documented, allowing for the extraction of vocabulary related to competency characteristics, which subsequently facilitated the further refinement of the model.\u003c/p\u003e \u003cp\u003eAfter construction of preliminary model, the questionnaire was adjusted and improved by anonymously soliciting and summarizing advice of directors of community management centers and managers of CHCs with extensive frontline work and management experience, then scoring the importance of questionnaire items. Moreover, advice from experts was aggregated and anonymous feedback was provided to them. 2\u0026ndash;3 rounds of expert consultation were conducted totally and the final Competency Model for Public Health Workers in CHCs in Shanghai was formed.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire Development and Data Collection\u003c/h3\u003e\n\u003cp\u003eThrough a literature review, factors related to competency were identified and integrated with the established Competency Model for Public Health Workers in CHCs in Shanghai. Subsequently, the Survey Questionnaire on Competency of Public Health Workers in CHCs in Shanghai was designed, which included scales for competency assessment, self-esteem, self-efficacy, work motivation, work stress, and job satisfaction.\u003c/p\u003e \u003cp\u003eFrom October 2022 to December 2022, a census approach was adopted to recruit public health workers from 249 CHCs in Shanghai. The inclusion criteria were as follows: (1) public health workers primarily in the preventive healthcare department of CHCs in Shanghai, mainly including physicians, nurses, general practitioners, pharmacists, and medical technicians; (2) who willing to participate in the study and providing informed consent. The exclusion criterion was unable to complete the questionnaire using the SurveyStar platform. Eligible public health workers were invited to complete the Survey Questionnaire on Competency of Public Health Workers in CHCs in Shanghai by scanning the QR code on the recruitment poster.\u003c/p\u003e \u003cp\u003eLogical settings were implemented in the questionnaire to guarantee the integrity of the responses. For CHCs with low response rates, the researchers further contacted the center managers to facilitate the collection of questionnaires. If participants had any questions about the survey, the investigators provided detailed explanations of the purpose of the study and emphasized the strict adherence to the principle of personal information privacy protection.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eReliability and validity of the competence scale used in the formal questionnaire were examined after the formal questionnaire was collected. For reliability, Pearson correlations were calculated between each item and the total scale score, as well as between each item and the total score for each dimension. Cronbach's alpha coefficient was used to assess the internal consistency reliability of the questionnaire. Split-half reliability was evaluated using the Spearman-Brown coefficient and the Guttman split-half coefficient. For validity, structural validity was assessed using factor analysis and criterion-related validity was examined through correlation analysis. SPSS25.0 software was used for data analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCompetency model construction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe competency model constructed in this study for public health workers in CHCs in Shanghai included five key dimensions: comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities, comprising a total of 42 items. The dimension of comprehensive abilities included eight items: keen insights, communication abilities and skills, problem-solving abilities, teamwork abilities, stress resistance, clear understanding of job responsibilities, teaching abilities, and Putonghua and Shanghai dialect proficiency. The dimension of professional ethics included seven items: self-confidence and optimism, efficiency awareness, responsibility awareness, service awareness, ability to be prudent and logical, flexible and adaptable and patience. The dimension of professional knowledge included eight items: maternal, child and adolescent health, geriatrics, chronic diseases, infectious diseases, occupational health, environmental health, school health and health management. The dimension of professional skills included fifteen items: health education, promotion and management, epidemiological investigation abilities, data collection abilities, data analysis abilities, disinfection and sterilization, training and guidance for partner units (e.g., neighborhood committees), physical examination and health monitoring, personal protective awareness and skills, vaccination skills, follow-up skills, questionnaire survey skills, epidemiological investigation report writing, emergency response skills, public health monitoring equipment usage skills, and computer application skills. The dimension of research and development capabilities included four items: continuous learning abilities, research abilities, clear career planning, and a holistic health perspective (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable1 Correlation Coefficients Between the Scores of Each Item and the Total Score of the Competency Questionnaire for Public Health Workers in Shanghai Community Health Centers\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eN=3809\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA1 Keen Insights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA2 Communication Ability and Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA3 Problem-solving Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA4 Teamwork Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA5 Stress Resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA6 Clear Understanding of Job Responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA7 Teaching Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA8 Putonghua and Shanghai Dialect Proficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA9 Self-confidence and Optimism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA10 Efficiency Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA11 Responsibility Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.755\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA12 Service Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA13 Ability to be Prudent and Logical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA14 Flexible and Adaptable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eContinued Table1\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eCorrelation Coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA15 Patience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA16 Maternal, Child and Adolescent Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.730\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA17 Geriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA18 Chronic Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA19 Infectious Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA20 Occupational Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA21 Environmental Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA22 School Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA23 Health Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.803\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA24 Health Education, Promotion and Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA25 Epidemiological Investigation Capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA26 Data Collection Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA27 Data Analysis Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA28 Disinfection and Sterilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA29 Training and Guidance for Partner Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.840\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA30 Physical Examination and Health Monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA31 Personal Protective Awareness and Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA32 Vaccination Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA33 Follow-up Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA34 Questionnaire Survey Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA35 Epidemiological Investigation Report Writing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA36 Emergency Response Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA37 Public Health Monitoring Equipment Usage Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA38 Computer Application Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA39 Continuous Learning Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA40 Research Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA41 Clear Career Planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eA42 Holistic Health Perspective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe survey was conducted from October 11, 2022 to December 2, 2022, with a total of 3,809 valid questionnaires collected. The results of correlation analysis between each item and the total scale score, as well as between each item and the total score for each dimension are as follow.\u003c/p\u003e\n\u003cp\u003eThe result of correlation analysis between each item and the total scale score was presented in table 2. Pearson correlation between each item and the total scale score was calculated in order to test the internal consistency of the items in the scale. The results showed that the correlation coefficients between the 42 items and the total score ranged from 0.591 to 0.854, all of which were statistically significant (p\u0026lt;0.01). The correlation coefficients between each item and the total score were all greater than 0.5, indicating a strong positive correlation between them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable2 Correlation Coefficients Between the Scores of Each Item and Each Dimension of the Competency Questionnaire for Public Health Workers in Shanghai Community Health Centers\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eN=3809\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"140%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eComprehensive\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAbilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eProfessional\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEthics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eProfessional\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eProfessional\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSkills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eResearch and\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDevelopment Capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA1 Keen Insights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA2 Communication Ability and Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA3 Problem-solving Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA4 Teamwork Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.585\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA5 Stress Resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA6 Clear Understanding of Job Responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA7 Teaching Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA8 Putonghua and Shanghai Dialect Proficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA9 Self-confidence and Optimism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA10 Efficiency Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA11 Responsibility Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA12 Service Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA13 Ability to be Prudent and Logical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA14 Flexible and Adaptable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.651\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA15 Patience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA16 Maternal, Child and Adolescent Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA17 Geriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.662\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA18 Chronic Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA19 Infectious Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA20 Occupational Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.742\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA21 Environmental Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA22 School Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA23 Health Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA24 Health Education, Promotion and Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA25 Epidemiological Investigation Capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA26 Data Collection Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA27 Data Analysis Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.771\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA28 Disinfection and Sterilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA29 Training and Guidance for Partner Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.738\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA30 Physical Examination and Health Monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA31 Personal Protective Awareness and Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eContinued Table2\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"140%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eComprehensive\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAbilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eProfessional\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEthics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eProfessional\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eProfessional\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSkills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eResearch and\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDevelopment Capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA32 Vaccination Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA33 Follow-up Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.845\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA34 Questionnaire Survey Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA35 Epidemiological Investigation Report Writing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA36 Emergency Response Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA37 Public Health Monitoring Equipment Usage Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA38 Computer Application Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA39 Continuous Learning Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.691\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA40 Research Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA41 Clear Career Planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003eA42 Holistic Health Perspective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSimilarly, correlation analysis was conducted between each item and the scores of each dimension, and the correlation coefficients were calculated. The results showed that the correlation coefficients between each item and each dimension were all greater than 0.4, indicating a moderate positive correlation between them (table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable3 Item Analysis and Exploratory Analysis of the Competency Questionnaire for Public Health Workers in Shanghai Community Health Centers (N = 3809)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"93%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eFactor Loading\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA1 Keen Insights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.771\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA2 Communication Ability and Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA3 Problem-solving Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA4 Teamwork Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA5 Stress Resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA6 Clear Understanding of Job Responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA7 Teaching Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA8 Putonghua and Shanghai Dialect Proficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA9 Self-confidence and Optimism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA10 Efficiency Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA11 Responsibility Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA12 Service Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA13 Ability to be Prudent and Logical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA14 Flexible and Adaptable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA15 Patience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA16 Maternal, Child and Adolescent Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA17 Geriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eContinued Table3\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"93%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eFactor Loading\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA18 Chronic Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.749\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA19 Infectious Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA20 Occupational Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.839\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA21 Environmental Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA22 School Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA23 Health Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.868\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA24 Health Education, Promotion and Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.761\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA25 Epidemiological Investigation Capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA26 Data Collection Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA27 Data Analysis Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA28 Disinfection and Sterilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA29 Training and Guidance for Partner Units\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA30 Physical Examination and Health Monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA31 Personal Protective Awareness and Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA32 Vaccination Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA33 Follow-up Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 378px;\"\u003e\n \u003cp\u003eA34 Questionnaire Survey Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA35 Epidemiological Investigation Report Writing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.764\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA36 Emergency Response Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA37 Public Health Monitoring Equipment Usage Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.787\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA38 Computer Application Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA39 Continuous Learning Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.799\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA40 Research Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA41 Clear Career Planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eA42 Holistic Health Perspective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eReliability and validity testing of competency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor reliability test, the overall Cronbach\u0026apos;s alpha coefficient of the questionnaire was 0.985. The Cronbach\u0026apos;s alpha coefficients for the five core dimensions, namely comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities, were 0.935, 0.959, 0.955, 0.969, and 0.916, respectively. These results indicated that the internal consistency coefficients of the overall questionnaire and each dimension were good. The overall split-half reliability of the questionnaire was 0.842. The Spearman-Brown split-half reliability coefficients for the five core dimensions, were 0.913, 0.940, 0.924, 0.952, and 0.919, respectively. The Guttman split-half reliability coefficients for the five core dimensions were 0.912, 0.919, 0.923, 0.949, and 0.919. These results indicated good internal consistency among the items, and the split-half reliability of the questionnaire was good.\u003c/p\u003e\n\u003cp\u003eFor validity test, the feasibility of factor analysis was tested using the Kaiser-Meyer-Olkin (KMO) test and Bartlett\u0026apos;s test. The KMO sampling adequacy parameter was 0.984, and the Bartlett\u0026apos;s sphericity test value was 195959.181 (p\u0026lt;0.001), indicating that the data were suitable for factor analysis. Using principal component analysis, five common factors were extracted, with a cumulative variance explanation rate of 62.241%. The factor loadings of the items ranged from 0.495 to 0.868 (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurther confirmatory factor analysis results are shown in Figure 2. Items A1-A8 belong to comprehensive abilities, items A9-A15 belong to professional ethics, Items A16-A23 belong to professional knowledge, items A24-A38 belong to professional skills, and items A39-42 belong to research and development capabilities. The result showed that the model fit the data well (c\u003csup\u003e2\u003c/sup\u003e/df= 2.288, TLI = 0.943, CFI = 0.957, IFI = 0.958, NFI = 0.928, RMSEA = 0.081).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe result of the criterion-related validity analysis showed that the scores of each dimension of the Public Health Workers Competency Scale were significantly and positively correlated with the total scores of the different criterion questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Correlation Analysis between the Competency Questionnaire and Individual or Work-related Characteristics for Public Health Workers in Shanghai Community Health Centers (N = 3809)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eComprehensive Abilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eProfessional Ethics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eProfessional Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eProfessional Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eResearch and Development Capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSelf-esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.104***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.079***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.195***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.157***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.167***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSelf-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.463***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.442**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.446***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.485***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.492***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eWork Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.331***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.324**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.310***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.350***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.353***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eWork Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.162***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.116***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.172***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.183***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.159***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eJob Satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.316***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.324***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.297***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.327***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.353***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote: *** indicates p\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we constructed the competency model for public health workers in CHCs in Shanghai, which included five key dimensions of comprehensive abilities, professional ethics, professional knowledge, professional skills, and research and development capabilities. The model was constructed and revised multiple rounds based on relevant domestic literature, existing international evaluation projects, and combined with the context of the COVID-19 pandemic.\u003c/p\u003e \u003cp\u003eIn terms of comprehensive competency dimension, considering the significant elderly population in the Shanghai region, the requirement for proficiency in the Shanghai dialect has been specifically added to better adapt to the unique local work environment. The elements within the professional spirit dimension reflect the noble values of healthcare professionals, highlighting both professional ethics and their aspiration for self-actualization(Krieger, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). The professional knowledge dimension is broad, encompassing not only public health-related knowledge but also some clinical medical knowledge, such as geriatrics and chronic disease management, as supplements to ensure the efficiency and scientific nature of public health work. The elements within the professional skills dimension are kept current. As the socio-ecological environment continues to evolve, the focus of public health work is gradually shifting from concentrating primarily on prevention and control of infectious diseases to addressing emerging public health incidents and the management of chronic non-communicable diseases. This transition has undoubtedly brought new challenges and opportunities to the public health field. Therefore, enhancing the practical skills of public health workers is critical to improving the quality of public health services and achieving higher standards(Liang et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The policy documents issued by the National Health Commission have clearly stated the responsibilities and competency requirements for public health workers, including but not limited to on-site response capabilities, laboratory testing and inspection skills, epidemiological investigation abilities, public health knowledge, epidemic prevention and control knowledge, disease prevention and control, health education, maternal and child health, public health emergency response, and public health safety. Compared to previous studies about competency elements, this study added items like emergency response skills, public health monitoring, equipment usage skills and so on, in order to better adapt to the normalized pandemic context and meet the practical needs of the field. Last but not least, research and development capability is also an indispensable skill for healthcare workers in CHCs. In the context of scientific advancement, research plays an irreplaceable role, and the performance of public health professionals in academic research and innovation offers crucial momentum for this process. As a core component of the public health service system, community health services leverage their extensive population base and relatively high levels of resident education and culture to provide rich facilitative conditions and ample development space for various scientific research activities(Likumahuwa et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith the continuously rising in public and national expectations for public health services, CHCs have gradually become the new frontier for the core role of public health workers. A batch of public health graduates have chosen to start their careers here, and the staff of the Centers for Disease Control and Prevention have also gradually penetrated into the basic-level community health service system(Green et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In this context, effectively integrating medical and preventive functions, ensuring the CHCss to achieve integrated medical and preventive operations, and providing basic public health services that cater to the actual needs of the public have become an urgent task for workers in this field. As the core carrier of public health service supply, public health workers must possess a high-level combination of qualities and skills necessary to cope with multiple challenges, in order to fully undertake the important responsibilities bestowed by this era. Especially in the increasingly complex and changing social environment currently, the profound transformation in the disease control field has further highlighted the indispensability of the public health talent team.\u003c/p\u003e \u003cp\u003eResearch on competency in China originated from the field of corporate management, while relevant exploration abroad was earlier in comparison. Subsequently, this theoretical research has gradually penetrated into diverse groups such as college teachers and civil servants in China, contributing to the expansion and deepening of competency researches. However, although some research work has been carried out in different fields in China, the methods and content of competency research remain relatively scarce in the medical and health field, particularly in public health workers.\u003c/p\u003e \u003cp\u003eThe literature review showed that the iceberg model and onion model were commonly adopted as the core framework when constructing competency models both domestically and internationally. These models comprehensively covered multiple dimensions including knowledge and skills, role positioning, self-awareness, inherent traits, and motivations. For example, the Japanese scholar Chikako Michibayashi et al. utilized the iceberg model to establish a competency model for public health nurses in tobacco control work in their country(Michibayashi et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), which included three categories of motivations, three categories of attitudes, and eight specific skills. Furthermore, drawing on the KSAO (Knowledge, Skill, Ability, and Others) theory proposed by Mirable in 1977(O'Reilly III et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1992\u003c/span\u003e), the competency elements have been further refined(Pronk et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). For instance, Corrianne Billings et al. identified six indicators in their research on the competency model of workers in infection control and epidemiology fields, including leadership, professional management, quality improvement, IPC (Infection Prevention and Control) operations, IPC informatics knowledge, and research capabilities(Billings et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Meanwhile, the competency model for public health workers proposed by Shi L et al. consisted of seven dimensions, including basic medical knowledge, public health knowledge system, health management and health promotion strategies, professional expertise and skills, research and innovation capabilities, comprehensive judgment and decision-making abilities, and professional ethos(Shi et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, reliability and validity analyses of the designed measurement tool were also conducted to evaluate its quality and reliability. For the reliability analysis, both the internal consistency reliability and the split-half reliability of the measurement tool were evaluated. Regarding validity, the construct validity and criterion-related validity of the tool were analyzed. The results indicated that each item correlated positively with the overall score and with their respective dimensions, demonstrating good discriminative ability for all items. This validates the quality and reliability of the designed measurement tool, providing a solid data foundation and assurance of reliability for subsequent research.\u003c/p\u003e \u003cp\u003eThis study constructed a multidimensional competency assessment tool through a questionnaire survey involving 3,809 public health workers from 249 CHCs in Shanghai. The large sample size enhanced the statistical power and generalizability of the findings. Additionally, this study addressed the evolving demands on public health workers in the context of the COVID-19 pandemic by incorporating critical components such as emergency response skills and epidemiological investigation capabilities into the model, increasing the tool's practical applicability. Nevertheless, this study also had several limitations. First, it was conducted within China, which constrained its generalizability to other regions and limited its relevance to international contexts. In fact, our focus on China was justified by the significant variations in the requirements for public health workers globally. Given the large number of public health workers in China and limited prior studies in this area, conducting research within this group hold considerable significance. Second, the reliance on self-reported data might introduce bias. Finally, although we assessed competencies across multiple dimensions, there remained additional factors that warrant further investigation and refinement in future research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the key discipline projects of Shanghai Three-Year Action Plan for Public Health under Grant (GWVI-11.1-29), the Science and Technology Commission Shanghai Municipality (No.20JC1410204) for the Seroepidemiological Study of Novel Coronavirus Pneumonia in Key Populations, and Shanghai Municipal Education Commission (grant number 2024-Sports, Health, Arts and Science Department 01-43).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowlegements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere appreciation to all the individuals who took part in this research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRuijie Chang and Meihui Zhang contributed equally to this work. They were responsible for designing the research framework, conducting the experiments, analyzing the data, and drafting the initial manuscript. Qianqian Zhu, Yinqiao Dong and Yujie Liu played a significant role in data collection and preprocessing. Yufei Chen and Zuxin Wang assisted in the experimental setup and data recording. Yong Cai and Hong Huang were the principal investigators of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research adhered to the principles laid out in the Declaration of Helsinki and obtained ethical clearance from the Ethical Review Committee of School of Public Health, Shanghai Jiao Tong University School of Medicine (approval number: SJUPN-202108).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvery participant provided written informed consent before participating in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are not publicly available due to privacy constraints.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatements and Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to state that they have no conflicting interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAitian, L., Qingyue, M., Suzhen, F., Yongchao, L., \u0026amp; Zhejuan, C. 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Research on the Competence of Directors of Community Health Service Centers. \u003cem\u003eChinese Journal of Hospital Administration\u003c/em\u003e(10), 673-675. https://kns.cnki.net/kcms2/article/abstract?v=8XtZWovJaIRSq46zC5a0Pwpi8fROQrDzuOyDaYEtkeXNZmhS4IC35N54TcnL9mpq9kiwSJYj0mqNmK6qUpxl70b79m9vUI4J3ncs8z0qzdgOheEdygkwDAEHSBji4PkJM-PhU-m54bAbZexd2IuLBDQyT-DkkG4U6SI6E3zE184LwMHRuxCGOSPA79_BCCcG\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"human-resources-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrhe","sideBox":"Learn more about [Human Resources for Health](http://human-resources-health.biomedcentral.com)","snPcode":"12960","submissionUrl":"https://submission.nature.com/new-submission/12960/3","title":"Human Resources for Health","twitterHandle":"@HRH_Journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"public health workers, competency model, reliability, validity","lastPublishedDoi":"10.21203/rs.3.rs-5457143/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5457143/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe competence of public health workers is crucial for grassroots public health service capabilities. This study aimed to establish a competency model for public health workers and to test the reliability and validity of the model.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e An evaluation indicators scale of competency of public health workers in Shanghai community health service centers (CHSCs) was constructed through a literature review, expert consultation, behavioral event interviews and questionnaire surveys. A questionnaire survey was carried out with 3809 public health workers from 249 Shanghai CHSCs to test the reliability and validity of the constructed scale.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eExploratory factor analysis identified 5 common factors: comprehensive ability, professional spirit, professional knowledge, professional skills, research and development ability. The cumulative variance contribution rate was 62.241%. The factor load for each item ranged from 0.495 to 0.868. The overall Cronbach's alpha coefficient for the questionnaire was 0.985, for the five dimensions ranged from 0.916 to 0.969. The overall split-half reliability of the questionnaire was 0.842, and that of the five dimensions ranged from 0.913 to 0.952, with the Guttman split-half reliability coefficient ranging from 0.912 to 0.949. The correlation coefficients for all scale items with the total score ranged from 0.591 to 0.854 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The correlation coefficients between each item and each dimension ranged from 0.434 to 0.925. Confirmatory factor analysis showed that the model had a good fitting effect (χ\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;=\u0026thinsp;2.288, TLI\u0026thinsp;=\u0026thinsp;0.943, CFI\u0026thinsp;=\u0026thinsp;0.957, IFI\u0026thinsp;=\u0026thinsp;0.958, NFI\u0026thinsp;=\u0026thinsp;0.928, RMSEA\u0026thinsp;=\u0026thinsp;0.081). Using self-efficacy, self-esteem, work pressure, work motivation, and job satisfaction as benchmarks, all dimensions of the scale demonstrated significant positive correlations with the total scores of various benchmark questionnaires.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe constructed scale of competency of public health workers in Shanghai CHSCs has good reliability and validity and can be used as a tool to evaluate the competency level of public health workers.\u003c/p\u003e","manuscriptTitle":"Development and validation of a competency-based assessment tool for public health workers in Shanghai community health centers: a population-based study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-16 15:43:04","doi":"10.21203/rs.3.rs-5457143/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-16T08:03:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-15T07:05:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-15T07:02:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Human Resources for Health","date":"2024-11-15T02:49:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"human-resources-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hrhe","sideBox":"Learn more about [Human Resources for Health](http://human-resources-health.biomedcentral.com)","snPcode":"12960","submissionUrl":"https://submission.nature.com/new-submission/12960/3","title":"Human Resources for Health","twitterHandle":"@HRH_Journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"031f22b4-f2be-4b05-864a-d1af6a329240","owner":[],"postedDate":"December 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:12:34+00:00","versionOfRecord":{"articleIdentity":"rs-5457143","link":"https://doi.org/10.1186/s12960-025-01034-y","journal":{"identity":"human-resources-for-health","isVorOnly":false,"title":"Human Resources for Health"},"publishedOn":"2025-11-24 15:57:39","publishedOnDateReadable":"November 24th, 2025"},"versionCreatedAt":"2024-12-16 15:43:04","video":"","vorDoi":"10.1186/s12960-025-01034-y","vorDoiUrl":"https://doi.org/10.1186/s12960-025-01034-y","workflowStages":[]},"version":"v1","identity":"rs-5457143","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5457143","identity":"rs-5457143","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}