Overview of HR Development and Performance of Health Workers during the Covid-19 Pandemic: Studies on Health Workers in Indonesia

Overview of HR Development and Performance of Health Workers during the Covid-19 Pandemic: Studies on Health Workers in Indonesia | 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 Article Overview of HR Development and Performance of Health Workers during the Covid-19 Pandemic: Studies on Health Workers in Indonesia Hasmin Hasmin, Jumiaty Nurung, Sri Rahmi, Andi Irsandi Yusri This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7002902/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract The COVID-19 pandemic has exposed significant weaknesses in public health systems, particularly in terms of workforce preparedness and responsiveness. Among the many interventions to improve service quality, training remains a core element of human resource development; however, its direct impact on health worker performance remains controversial. Building on Human Capital Theory, this study investigates how training effectiveness contributes to health workers’ performance through the mediating roles of knowledge management and employee capacity. A quantitative survey was conducted among 202 health professionals in South Sulawesi, Indonesia, and data were analyzed using structural equation modeling (SEM; AMOS). The results indicate that effective training is positively associated with performance both directly and indirectly. Knowledge management and employee capacity served as complementary mediators, with the latter perceived as being more critical by respondents. Significant causal pathways were identified among training, knowledge management, capacity building, and overall performance. These findings underscore the importance of integrating knowledge-sharing mechanisms and capacity development into training frameworks, particularly in post-crisis recovery. This study offers insights into the strategic value of intangible assets for workforce resilience in developing countries’ health systems and provides evidence to support more adaptive and learning-oriented HR policies in healthcare. Health sciences/Health care Humanities/Health humanities Health sciences/Health occupations training effectiveness knowledge management employee capacity health workforce human capital development Figures Figure 1 Introduction Human resources are considered fundamental to the achievement of organizational effectiveness through any form of operation, especially in service delivery, including healthcare. Among human resource management practices, training has elicited a strategic response as an intervention that enhances competencies at the individual level, among other common practices (Aryee et al., 2024 ; Giovanelli et al., 2024 ; Lehyani, Zouari, Ghorbel, & Tollenaere, 2023 ). In its sensitivity to health systems, good training has been defined as an enabler to improve service delivery and responsiveness and meet the demands of complex patients (Chakma et al., 2024 ; Conti et al., 2024 ). The connection between training and employee performance is still debated, both theoretically and empirically. Some studies have shown a strong positive relationship, while others find little to no effect (Amare et al., 2023 ; Ngusie et al., 2023 ; Rogers et al., 2023 ). This raises critical questions regarding the contextual effectiveness and design of workplace learning programs (Perrotta et al., 2023 ). Such mixed results lead one to posit that training outcomes are contingent upon underlying mechanisms and organizational conditions. This study responds to these inconsistencies by proposing an explanatory framework in which training effectiveness influences health workers’ performance indirectly through two critical mediators: knowledge management and employee capacity. It is argued that the success of training programs depends not only on content delivery, but also on their ability to foster knowledge sharing, promote organizational learning, and build individual capabilities (Afshari et al., 2023 ; Al-Husseini, 2023 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). The model is based on Human Capital Theory (HCT), which suggests that the money spent on education and training adds to output gains through the increase and use of knowledge and skills (El-Jardali et al., 2023 ; Obeng et al., 2024 ). Viewing human capital as a knowledge-based but critical asset, modern views stress its sustainability when used through processes based on knowledge and supporting institutions (Abbate et al., 2023 ; Shaikh et al., 2023 ). Though often criticized for its failure to address structural inequalities and institutional environments (Auerbach & Green, 2024 ), Health Compliant Theory is one of the available tools for analyzing employee development in environments affected by a crisis. The COVID-19 pandemic provides an excellent empirical opportunity to understand how health organizations may improve workforce resilience and responsiveness in service delivery through training, particularly underpinned by knowledge and capacity building (Deussom et al., 2022 ; Mwansisya et al., 2022 ). This study aims to understand how training-based human resource development supports health system performance during periods of disquiescence and unpredictability. Literature Review: Theoretical background and hypothesis development Training effectiveness Human resource training is a major player in ensuring the success of any organization in this era of rapid technological adaptation in a data-driven environment (Abbate et al., 2023 ; Giovanelli et al., 2024 ; Lehyani, Zouari, Ghorbel, & Tollenaere, 2023 ). The same investment in HR training should boost adaptability among employees, as well as communication and technological competence (Aryee et al., 2024 ; Hughes, 2021 ), which then leads to improved task execution, customer service, and leadership potential (Amare et al., 2023 ; Rogers et al., 2023 ). Effective training not only builds workers' motivation, creativity, and productivity (Chen et al., 2024 ; Kengia et al., 2023 ), but informal and formal education also provides sustained talent growth (Smythe et al., 2024 ). Individual- or group-based training is specific to improving service quality and maintaining ethical standards (Chakma et al., 2024 ; Conti et al., 2024 ). Effective training alone resulted in meaningful outcomes. As mentioned by some scholars, it enhances knowledge management by building self-efficacy and IT-based programs (Alharbi & Aloud, 2024 ; El-Jardali et al., 2023 ). It also bridges individual capacity and confidence (Afshari et al., 2023 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). This improved self-efficacy contributes to proactive and sustained performance. In addition, training shapes competencies (Upadhyay et al., 2023 ), facilitates knowledge management (Al-Husseini, 2023 ; Obeng et al., 2024 ), and is linked with higher performance (Alolayyan & Alyahya, 2023 ; Sheffel et al., 2024 ). Motivational learning theory, from which effective training is determined, reengineers behavior toward incremental change (Cavalcante de Oliveira et al., 2023 ; Shaikh et al., 2023 ). Therefore, the following hypothesis is posited: H1: Training effectiveness has a positive influence on knowledge management. H2: Training effectiveness positively influences employee competency. H3: The effectiveness of training can have a positive impact on the performance of health workers. Knowledge Management Knowledge consists of relevant information, skills, and values that spur innovation and guide action (Alharbi & Aloud, 2024 ; Karsikas et al., 2023 ). It is available as tacit and explicit knowledge (El-Jardali et al., 2023 ; Obeng et al., 2024 ), with the combination of both contributing to organizational value (Afshari et al., 2023 ; Lehyani, Zouari, Ghorbel, & Tollenaere, 2023 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). Knowledge management (KM) is a structured process for creating, storing, sharing, and applying knowledge to enable learning and adaptation to the environment to enhance performance and ultimately build competitive advantage. It supports the flow of knowledge, organizational learning, and strategic decisions (Abbate et al., 2023 ; Al-Husseini, 2023 ; Shaikh et al., 2023 ) while improving individual productivity and organizational outcomes (Alolayyan & Alyahya, 2023 ; Chen et al., 2024 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). KM builds an individual’s self-efficacy by increasing their confidence and motivation (Chakma et al., 2024 ; Sheffel et al., 2024 ; Smythe et al., 2024 ). It helps to share knowledge and create new knowledge (Abbate et al., 2023 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023), which later turns into capacity building (Rogers et al., 2023 ; Upadhyay et al., 2023 ). Recent studies have validated the strategic relevance of KM. In health care, KM has a positive impact on infection control (Ahsan et al., 2021 ), sustainability performance, and quality of care (Alboliteeh et al., 2023 ; Karsikas et al., 2023 ). It supports green innovation through manufacturing concerns (Shahzad et al., 2021 ) and improves employee effectiveness in SMEs (Lehyani, Zouari, Ghorbel, & Tollenaere, 2023 ). Knowledge management can dramatically enhance organizational performance when combined with training and soft TQM (Aziz et al., 2022 ; Ong & Tan, 2022 ). Based on the Resource-Based View (Al-Husseini, 2023 ; Giovanelli et al., 2024 ), KM is considered an important internal resource that relates to resilience, through which an organization can gain competitive and innovative outcomes. As viewed in terms of human capital, KM is viewed as the enabler of skill development, particularly in complicated and dynamic environments (Abbate et al., 2023 ; Memon et al., 2022 ). Therefore, KM is crucial for improving the knowledge asset, human capability, and sustainable performance of an employee’s KM framework. A subsequent hypothesis to be tested based on this framework is as follows: H4: Knowledge management enhances employees' capacity. Employee Capacity Employee capacity refers to the development of individual competencies, knowledge, and resources that enhance organizational adaptability and long-term performance (Giovanelli et al., 2024 ; Sheffel et al., 2024 ). It goes beyond maintaining skills to building capabilities through continuous learning and institutional support (Kengia et al., 2023 ; Upadhyay et al., 2023 ). Capacity building, viewed through Human Capital Theory and the Resource-Based View, should be directed towards organizational effectiveness and innovation (Al-Husseini, 2023 ; Auerbach & Green, 2024 ; Gerhart & Feng, 2021 ). It improves work conditions, reduces turnover, increases engagement, and fosters an enabling environment (Cavalcante de Oliveira et al., 2023 ). Formal education, soft skills and on-the-job training fill critical competency gaps and ensure sustained performance (Aryee et al., 2024 ; Mwansisya et al., 2022 ; Wu et al., 2023). Capacity should be viewed as the ability to make timely ad hoc decisions and identify priorities in complex tasks. This is related to creativity, retention, and team effectiveness. A study by Riyanto and Adhitama ( 2020 ) proved that improving capacity improves compassion in the delivery system. In another study, Ullah et al. ( 2021 ) proved that this also helps reduce delays. In another study, Hou et al. (2021) found that capacity significantly increased the efficiency of the delivery system. H5: The capacity of an employee introduces significant positive efficiency to health worker performance. Health Workers Performance Indonesia has experienced disparities in the delivery of health services caused by urban-rural imbalance and unequal allocation and use of resources (Sheffel et al., 2024 ). Shortages of staff in crucial areas (Jalal et al., 2023 ) have elicited some fairly new government rives, such as that of HRH2030, implemented with funds from USAID and PEPFAR, which focus on checking policies, boosting capacity, and getting different stakeholders to work toward meeting a country’s health targets. Health workers’ performance is a major outcome of human capital investment. Individual performance is defined as the degree to which training outcomes are implemented at the workplace (Aryee et al., 2024 ). It is usually measured in terms of post-training enhancement of competency, efficiency, and effectiveness (Ngusie et al., 2023 ; Wu et al., 2023), and may be appraised through self-reports or supervisor evaluations (Rogers et al., 2023 ). Effective training improves knowledge application (Giovanelli et al., 2024 ), develops capacity for work (Kugler et al., 2024 ), and enhances individual and team performance (Amare et al., 2023 ; Carboni et al., 2024 ; Smythe et al., 2024 ). Such effects improve with a good structure in knowledge management and capacity building (Conti et al., 2024 ). Recent evidence has indicated that competency-based training and supervision is accompanied by significant improvements in health service delivery (Deussom et al., 2022 ; Mwansisya et al., 2022 ). Soft skills, such as empathy and communication, are considered key, though critical; they remain underdeveloped (Al Badi et al., 2023 ; Sancho-Cantus et al., 2023 ). "Knowledge sharing and learning systems are tantamount to making the ability of employees more effective for the sustainability of performance" (Alboliteeh et al., 2023 ; Cometto et al., 2022 ). Aligned with the Resource-Based View (Gerhart & Feng, 2021 ), internal capabilities significantly shape health workers’ performance, which comprises the components of knowledge management and human capital development (Al-Husseini, 2023 ; Karsikas et al., 2023 ). Training, KM, and capacity development integrative approaches have proven worth in positively improving workforce outcomes in different sectors (Abbate et al., 2023 ; Ahsan et al., 2021 ; Vyas, 2024 ). H6: Training effectiveness mainly enhances the performance of a health worker through knowledge management and employee capacity. H7: Knowledge management mainly enhances the performance of health workers through the capacity of employees. Methodology Sample Criteria and Justification This study involved 202 health workers from South Sulawesi, Indonesia (Table 1 ), who were selected through random sampling. Although data collection was conducted after the peak of the COVID-19 pandemic, this study retrospectively examined perceptions of training and performance during the crisis period. The sample size falls within the widely accepted range of 30–500 for behavioral research (Howell, 2011 ), and is considered sufficient for structural equation modeling when model complexity is moderate and measurement reliability is high (MacCallum et al., 1999 ; Wolf et al., 2013 ). Table 1 Demographic Characteristics of Respondents (N = 202) Respondent Criteria Sub-Criteria Frequency Percentage (%) Professional Role Medical Doctor 13 6.43 Nurse 47 23.27 Midwife 35 17.33 Physiotherapist 11 5.45 Dental Technician 16 7.92 Laboratory Analyst 13 6.43 Environmental Health Officer 7 3.47 Nutritionist 5 2.47 Radiographer 10 4.95 Medical Records Officer 10 4.95 Public Health Graduate 33 16.34 Electromedical Technician 2 0.99 Job Position Echelon II 3 1.48 Echelon III 23 11.39 Echelon IV 25 12.38 Non-Echelon Staff 151 74.75 Educational Background Diploma (D1–D3) 81 40.10 Bachelor’s Degree (S1) 98 48.51 Master’s Degree (S2) 23 11.39 Gender Male 89 44.06 Female 113 55.94 Age Group 20–30 years 29 14.36 31–40 years 67 33.17 41–50 years 87 43.07 51–60 years 19 9.40 Given the use of validated constructs, complete response rates, and acceptable model fit, the sample was deemed both statistically and contextually appropriate to support the study’s analytical framework. [Insert Table . Demographic Characteristics of Respondents] The sample (Table 1 ) reflects diverse professional backgrounds, covering 12 medical occupations, with nurses being the most represented and biomedical engineers the least. Respondents also varied across employment levels, from non-managerial staff to senior executives (Echelon II). Most participants held a diploma or undergraduate degree, with female health workers dominating the sample. The majority were aged 31–50. Data collection faced limitations due to COVID-19, which restricted access to a larger respondent pool. Measurement A quantitative design using Structural Equation Modeling (SEM-Amos) was employed (Alshetewi, 2016 ; Ferdinand, 2014 ; Ghozali, 2017 ). The study population consisted of 18,240 health workers across South Sulawesi. A random sampling approach was used (Sugiyono, 2018 ), targeting at least 100 complete responses via an online survey. This approach aligns with recommended sample sizes for SEM, where 100–200 respondents enhance model accuracy (Ferdinand, 2006 ; Ghozali, 2017 ), and adheres to Roscoe’s rule of thumb, which suggests 30–500 as a suitable range for survey studies (Sekaran & Bougie, 2016 ; Sugiyono, 2018 ). By the end of the 8-week collection period, 202 valid responses were obtained. The instrument measured: Training Effectiveness (TE) via three indicators: additional knowledge, ability to remember, and ability to practice (Perdue et al., 2002 ; Wilson et al., 2002 ); see (Tamsah et al., 2021 ; Tamsah, Yusriadi, et al., 2023 ; Umar et al., 2020 ) for public sector applications); Knowledge Management (KM) using use, sharing, reflection, and identification of knowledge (Davidson & Voss, 2003 ); Employee Capacity (EC) through cooperation, commitment, involvement, and capacity-building initiatives (Kimutai et al., 2013 ); Health Worker Performance (HWP) through responsiveness, availability, productivity, and use of competence (Dieleman & Harnmeijer, 2006 ; Kimutai et al., 2013 ; Lutwama et al., 2012 ). Further information regarding the measurement of the variables is presented in Table 2 . Table 2. Operationalization of Variables and Measurement Items Variable Indicator References Item Training Effectiveness (TE) Additional knowledge (TE1) (Perdue et al., 2002; Tamsah et al., 2021, 2023; Umar et al., 2020; Wilson et al., 2002) I gained additional knowledge after completing the training sessions. I acquired new work-related skills after each training session. Ability to remember (TE2) I am able to recall activities conducted during the training. I understand the training activities and their relevance. Ability to practice (TE3) I can apply the training outcomes to my current work. I am able to implement practical lessons from the training in my job. Knowledge Management (KM) Use of knowledge (KM1) (Davidson & Voss, 2003) I am capable of managing and utilizing knowledge to discover new approaches or innovations in my work. Sharing knowledge (KM2) I am able to create, share, and apply knowledge effectively to disseminate useful information. Reflection of knowledge (KM3) I can transform raw data into meaningful insights as a reflection of my existing knowledge. Identification of knowledge (KM4) I am able to identify new ideas that may serve as a foundation for organizational knowledge development. Employee Capacity (EC) Employee cooperation (EC1) (Kimutai et al., 2013) I am able to collaborate effectively with colleagues to enhance work capacity. Employee commitment (EC2) I demonstrate strong commitment to my job and to the development of work capacity. Employee involvement (EC3) I consistently promote employee engagement in efforts to improve capacity. Employee capacity building initiatives (EC4) I actively initiate activities aimed at enhancing employee capacity. Health Worker Performance (HWP) Responsiveness (HWP1) (Dieleman & Harnmeijer, 2006; Kimutai et al., 2013; Lutwama et al., 2012) I maintain a high level of responsiveness in job-related tasks, even during the COVID-19 pandemic. Availability (HWP2) I ensure consistent presence and time availability for work tasks, including during the pandemic. Productivity (HWP3) I maintain work productivity as a key priority for performance improvement, even during the COVID-19 period. Use of competence (HWP4) I strive to utilize my full capabilities to improve job performance, even under pandemic-related constraints. Source : Authors’ own work. [ Insert Table 2 . Operationalization of Variables and Measurement Items ] The questionnaire method was chosen for its efficiency in large-scale data collection. Ensuring data validity and reliability required rigorous instrument development (Dörnyei & Taguchi, 2009 ). A total of 19 items were included, each rated on a 7-point Likert scale (1 = strongly disagree, 4 = neutral, 7 = strongly agree). This design supports generalizability and statistical reliability in HR research (Iacobucci & Churchill, 2018 ). Aligned with Human Capital Theory, the variables in this study reflect critical intangible assets—knowledge, skills, and capabilities—that collectively determine workforce productivity and organizational value (Bontis et al., 2000 ; Mayo, 2000 ). Results The model was conducted in two sequential stages. The first stage involved Confirmatory Factor Analysis (CFA) to examine the reliability and validity of the measurement model, including convergent and discriminant validity tests. The second stage employed structural path analysis to assess the overall model fit, test hypothesized relationships among constructs, and evaluate the mediation effects. Reliability Assessment Internal consistency was established through Cronbach’s alpha, with all constructs exceeding the commonly accepted threshold of 0.70 (Lance et al., 2006 ), indicating the high reliability of the measurement items (Table 3 ). Table 3 Summary of Reliability and Validity Assessments Variables Indicators Standardized Estimate Estimate Standard Error Critical Ratio P - Value Construct Reliability Average Variance Extracted Training Effectiveness (TE) Additional knowledge (TE1) 0.84 0.97 0.06 15.12 *** 0.92 0.84 Ability to remember (TE2) 0.85 0.97 0.06 15.35 *** Ability to practice (TE3) 0.87 1.00 Knowledge Management (KM) Use of knowledge (KM1) 0.84 1.00 0.97 0.95 Sharing knowledge (KM2) 0.89 1.12 0.07 15.74 *** Reflection of knowledge (KM3) 0.86 1.08 0.07 14.99 *** Identification of knowledge (KM4) deleted item Employee Capacity (EC) Employee cooperation (EC1) 0.82 1.00 0.98 0.95 Employee commitment (EC2) 0.87 1.13 0.08 14.93 *** Employee involvement (EC3) 0.73 0.97 0.09 11.23 *** Employee capacity building initiatives (EC4) 0.78 1.15 0.09 12.35 *** Health Workers Performance (HWP) Responsiveness (HWP1) deleted item 0.97 0.95 Availability (HWP2) 0.76 1.00 Productivity (HWP3) 0.87 1.08 0.09 12.64 *** Use of competence (HWP4) 0.83 1.03 0.09 11.97 *** Model Fit Testing Cut of Value Result Remark 1. Absolute Fit Indices: Chi-Square df = 60; X 2 = 79.08 117.60 Marginal Significance ≥ 0.05 (Laar and Braeken, 2021) 0.00 Marginal CMIN/df ≤ 3.00 (even < 5.00) (Dash and Paul, 2021) 1.98 Fit GFI ≥ 0.90 (Hair et al. , 2010) 0.92 Fit RMSEA 0.03–0.08 (Arbuckle, 2009) 0.07 Fit 2. Incremental Fit Indices: AGFI ≥ 0.90 (Hair et al. , 2010) 0.88 Marginal TLI ≥ 0.90 (Arbuckle, 2009) 0.96 Fit NFI ≥ 0.90 (Dash and Paul, 2021) 0.94 Fit CFI ≥ 0.90 (Laar and Braeken, 2021) 0.97 Fit 3. Parsimony Fit Indices: PNFI > 0.50 (Dash and Paul, 2021) 0.73 Fit PGFI > 0.50 (Dash and Paul, 2021) 0.61 Fit Note: *** (Significant at Level p < 0.01) [Insert Table 3 . Summary of Reliability and Validity Assessments] Validity Assessment Construct validity was examined to determine the degree to which the items accurately represented their respective theoretical constructs (Bernard, 2013 ; Hair et al., 2017 ). All factor loadings ranged between 0.73 and 0.89, surpassing the 0.50 benchmark (Ferdinand, 2014 ; Hair et al., 2017 ), thereby confirming convergent validity. The significance of each item was supported by Critical Ratios (CR > 2) and p-values below 0.05. Construct Reliability (CR ≥ 0.70) and Average Variance Extracted (AVE ≥ 0.50) further indicate the robustness of the latent constructs (Sekaran & Bougie, 2016 ). Measurement Model Summary Training Effectiveness (TE): Comprised of additional knowledge (0.84), memory retention (0.85), and practical application (0.87). CR = 0.94; AVE = 0.84. Knowledge Management (KM): Assessed through knowledge use (0.84), knowledge sharing (0.89), and reflection (0.86). One item (identification) was excluded from analysis. CR = 0.97; AVE = 0.95. Employee Capacity (EC): Represented by cooperation (0.82), commitment (0.87), involvement (0.73), and Capacity building (0.78). CR = 0.98; AVE = 0.95. Health Worker Performance (HWP): measured via availability (0.76), productivity (0.86), and use of competence (0.83). One item (Responsiveness) was excluded from the analysis. CR = 0.97; AVE = 0.95. Model Fit and Structural Validation CFA and structural model assessment demonstrated a strong fit with the observed data (Fig. 1 and Table 3 ). The fit indices reported were CMIN/DF = 1.96, GFI = 0.92, RMSEA = 0.07, TLI = 0.96, NFI = 0.94, CFI = 0.97, PNFI = 0.73, and PGFI = 0.61 indicating an acceptable and well-fitting model (Ferdinand, 2014 ; Hair et al., 2014 ). [Insert Fig. 1 . Structural Equation Model] Hypothesis Testing All the proposed hypotheses (H1–H7) were supported. Standardized regression weights were significant (t-values > 1.96), and p-values were below 0.05, confirming the statistical significance across all direct paths (Table 4 ). Table 4. Structural Model Results and Hypothesis Testing Hypothesis Standardized estimate Estimate Standard Error Critical Ratio P Value Result H1: Training Effectiveness → Knowledge Management 0.76 0.41 0.04 10.62 *** Supported H2: Training Effectiveness → Employee Capacity 0.30 0.13 0.04 3.32 *** Supported H3: Training Effectiveness → Health Worker Performance 0.32 0.13 0.04 3.67 *** Supported H4: Knowledge Management à Employee Capacity 0.61 0.49 0.08 6.46 *** Supported H5: Employee Capacity → Health Worker Performance 0.65 0.63 0.09 6.89 *** Supported H6: Training Effectiveness → Knowledge Management → Employee Capacity → Health Worker Performance 0.40 estimates/bootstrap (two tailed significance-BC) 0.00 Supported H7: Knowledge Management → Employee Capacity → Health Worker Performance 0.54 estimates/bootstrap (two tailed significance-BC) 0.01 Supported Note: *** (Significant at Level p< 0.01) Source : Authors’ own work, based on survey data (2024). [Insert Table 4 . Structural Model Results and Hypothesis Testing] Mediation Analysis Bootstrapping procedures were applied to test the mediating mechanisms, which is a robust technique suitable for moderate sample sizes and non-normal data distributions (Mattila, 2001 ; Preacher & Hayes, 2004 ). H6: Training Effectiveness positively influences Health Worker Performance through the sequential mediation of Knowledge Management and Employee Capacity (p = 0.003). H7: Knowledge Management influences Health Worker Performance through Employee Capacity (p = 0.011). These mediation results affirm the principles of Human Capital Theory (Bontis et al., 2000 ; Mayo, 2000 ), emphasizing that training impacts performance most effectively when cultivating knowledge application and organizational capacity. Moreover, in the post-pandemic context, these findings underscore the strategic role of intangible assets such as knowledge management systems and employee development processes in sustaining public sector performance during and after periods of crisis (Ahsan et al., 2021 ; Gerhart & Feng, 2021 ). Discussion Training Effectiveness and Knowledge Management (H1) This study demonstrates that training effectiveness significantly enhances knowledge management (β = 0.76; p < 0.001). Among KM indicators, knowledge sharing (0.89), reflection (0.86), and knowledge use (0.84) emerged as the strongest dimensions, highlighting the role of training in cultivating not only knowledge acquisition but also its integration and dissemination. From the lens of Human Capital Theory (HCT), training is a key investment that builds employees’ cognitive and behavioral capacities, aligning with organizational goals (Auerbach & Green, 2024 ; Bontis et al., 2000 ). As supported by Tamsah, Ilyas, et al., ( 2023 ), effective training enhances employees’ ability to remember, apply, and expand knowledge—three foundational elements for strong KM systems. This finding aligns with Giovanelli et al. ( 2024 ), who emphasize that training strengthens both knowledge and ability. Specifically, the ability to practice, as emphasized by Aryee et al. ( 2024 ), is particularly relevant for health professionals operating in dynamic service environments. However, not all knowledge dimensions contribute equally—this study excluded knowledge identification due to weak measurement loading, which corroborates (Chakma et al., 2024 ), who argue that knowledge must be actionable to influence performance. Recent literature reinforces these results. KM-based training has improved clinical behavior (Ahsan et al., 2021 ), academic performance (Vyas, 2024 ), and healthcare sustainability (Alboliteeh et al., 2023 ). Across industries, KM and training are interdependent levers for enhancing organizational capability (Alharbi & Aloud, 2024 ; Lehyani, Zouari, Ghorbel, & Tollenaere, 2023 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023), further validating the strategic role of training in developing human capital through knowledge optimization. Training Effectiveness and Employee Capacity (H2) The analysis confirms a significant positive effect of training effectiveness on employee capacity (β = 0.30; p < 0.001). Among capacity indicators, employee commitment (0.87), cooperation (0.82), capacity-building initiative (0.78), and involvement (0.73) emerged as core dimensions. These reflect the human capital components developed through effective training. Aligned with Human Capital Theory, training enhances not only skills but also psychological readiness and workplace engagement (Auerbach & Green, 2024 ; Leoni, 2023 ). Effective training enables practical skill application, reinforces memory, and introduces new knowledge, which collectively foster employees’ initiative, participation, and teamwork (Aryee et al., 2024 ; Giovanelli et al., 2024 ). As prior studies suggest, training contributes to higher commitment and collaboration by increasing self-confidence and morale, particularly in dynamic environments requiring adaptability (Chen et al., 2024 ; Kengia et al., 2023 ). This supports the argument that training is not merely a tool for knowledge transfer, but a strategic lever for strengthening employee capacity as a key organizational resource (Gerhart & Feng, 2021 ; Tamsah, Ilyas, et al., 2023 ). Furthermore, competency-based training fosters workforce flexibility and readiness, which are vital for enhancing individual and collective performance, especially in healthcare and public service sectors (Cometto et al., 2022 ; Conti et al., 2024 ). Therefore, employee capacity can be seen as the manifestation of accumulated human capital shaped by strategic learning interventions. Training Effectiveness and Health Worker Performance (H3) The findings indicate a significant and positive relationship between training effectiveness and health worker performance (β = 0.32; p < 0.001). The strongest contributors to training effectiveness were ability to practice (0.87), ability to remember (0.85), and acquisition of new knowledge (0.84). For health worker performance, productivity was the most dominant indicator (0.86), followed by competence utilization (0.83), and availability (0.76). These results affirm that effective training enhances readiness and productivity—key attributes of high-performing health systems (Mwansisya et al., 2022 ; Sheffel et al., 2024 ). Grounded in Human Capital Theory, training develops workers’ competencies that drive performance in dynamic service contexts (Auerbach & Green, 2024 ; Giovanelli et al., 2024 ). As human capital is enhanced through practical skills and knowledge application, employees become more productive, and confident to organizational needs (Adhvaryu et al., 2023 ; Chen et al., 2024 ). Effective training also fosters adaptive capacity, allowing staff to adjust to changing demands, thus boosting overall health service delivery (Alolayyan & Alyahya, 2023 ; Kengia et al., 2023 ). Moreover, learning outcomes from structured training—such as motivation, engagement, and behavioral reinforcement—are essential mechanisms for sustaining high performance (Aryee et al., 2024 ). This suggests that beyond technical instruction, training serves as a motivational engine for behavior change and performance enhancement within healthcare systems (Cometto et al., 2022 ; Conti et al., 2024 ). Knowledge Management and Employee Capacity (H4) This study confirms that knowledge management (KM) has a positive and significant effect on employee capacity (β = 0.61; p < 0.001). Among KM dimensions, knowledge sharing, reflection, and application substantially contribute to strengthening employee commitment, cooperation, involvement, and capacity-building initiatives. These findings are consistent with prior studies demonstrating that KM improves employee competence and engagement (Al-Husseini, 2023 ; Lehyani, Zouari, Ghorbel, & Tollenaere, 2023 ). Under the lens of Human Capital Theory, KM functions as a strategic mechanism to accumulate, organize, and apply knowledge, thereby enhancing individual and organizational value (Gerhart & Feng, 2021 ; Karsikas et al., 2023 ). Employees who actively utilize and share knowledge are more likely to demonstrate proactive behaviors, including higher involvement and initiative, as knowledge becomes embedded in daily tasks (Afshari et al., 2023 ; El-Jardali et al., 2023 ). This supports the premise that effective KM contributes directly to the development of organizational human capital and improves workforce adaptability in dynamic environments (Abbate et al., 2023 ; Alharbi & Aloud, 2024 ). In line with HCT, KM-driven learning processes strengthen individual readiness and self-development—key components of capacity enhancement in modern, knowledge-based institutions (Obeng et al., 2024 ; Shaikh et al., 2023 ). Employee Capacity and Health Worker Performance (H5) The findings reveal a significant positive relationship between employee capacity and health worker performance (β = 0.65; p < 0.001). Employees with higher levels of commitment, cooperation, involvement, and capacity-building initiatives tend to demonstrate greater productivity, competence utilization, and work readiness. This supports prior evidence that employee capacity is a critical determinant of performance outcomes (Chen et al., 2024 ; Karsikas et al., 2023 ). From a Human Capital Theory perspective, employee capacity represents the embodiment of accumulated skills, motivation, and knowledge, which translate into improved task execution and adaptability (Gerhart & Feng, 2021 ; Leoni, 2023 ). Enhanced commitment and cooperation foster higher engagement and collaboration, while initiative and involvement support problem-solving and responsiveness—key to healthcare delivery effectiveness (Conti et al., 2024 ; Deussom et al., 2022 ). These findings align with research indicating that capacity development facilitates performance improvisation and helps employees prioritize tasks in complex environments (Afshari et al., 2023 ; Alolayyan & Alyahya, 2023 ). As organizations face dynamic challenges, fostering human capital through capacity strengthening becomes imperative to ensure sustainable improvements in health worker productivity and system responsiveness (Karsikas et al., 2023 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). Training Effectiveness and Health Worker Performance through Knowledge Management and Employee Capacity (H6) The study confirms that knowledge management and employee capacity significantly mediate the effect of training effectiveness on health worker performance (β = 0.40; p = 0.003). This indicates that training outcomes translate into performance improvements when newly acquired knowledge is effectively applied (Alharbi & Aloud, 2024 ; Aryee et al., 2024 ; Ngusie et al., 2023 ). Drawing from Human Capital Theory, effective training enhances individual skills and knowledge, while KM structures provide the mechanisms for retention, reflection, and application—thus reinforcing behavior change and performance (Gerhart & Feng, 2021 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). Knowledge management acts as a guidance system that enables knowledge to be embedded into practice, aligning with the learning motivation process theory, where reinforcement and application are essential for behavioral improvement (Afshari et al., 2023 ). The mediating role of KM is further supported by self-efficacy theory, which highlights the importance of context-specific reinforcement. Health workers with strong self-efficacy, shaped by structured KM and capacity-building initiatives, are more resilient and goal-oriented (Chen et al., 2024 ; Smythe et al., 2024 ). This aligns with recent evidence that organizational learning structures improve health system responsiveness (Cometto et al., 2022 ; Karsikas et al., 2023 ). While training directly contributes to performance (Giovanelli et al., 2024 ), its impact is significantly strengthened when mediated by KM and employee capacity. This addresses prior concerns that training alone may not improve performance (Al Badi et al., 2023 ; Cavalcante de Oliveira et al., 2023 ), emphasizing the strategic importance of knowledge-driven human capital development. Knowledge Management and Health Worker Performance through Employee Capacity (H7) The findings demonstrate that employee capacity significantly mediates the relationship between knowledge management and health worker performance, with an indirect effect of 0.54 (p = 0.011). This indicates that knowledge management has a stronger impact on performance when channeled through enhanced employee capacity. This result confirms that the contribution of employee capacity as a lever between KM and performance exceeds that of direct training effects. Employees may not immediately exhibit improved performance after training; instead, training often first builds capacity—through increased commitment, cooperation, initiative, and involvement—which then leads to sustainable performance gains, especially when supported by effective KM systems (Al-Husseini, 2023 ; Karsikas et al., 2023 ; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). Aligned with Human Capital Theory, this relationship affirms that investments in knowledge resources enhance intangible assets, such as employee capacity, which subsequently strengthen organizational performance (Bontis et al., 2000 ; Gerhart & Feng, 2021 ; Mayo, 2000 ). These findings also support the idea that performance improvement, particularly in healthcare settings, depends on how well knowledge is internalized, shared, and applied across roles (Abbate et al., 2023 ; Ahsan et al., 2021 ; El-Jardali et al., 2023 ). Thus, optimizing KM is not only about managing information but also about strategically developing human capital to amplify capacity and performance—particularly relevant during disruptive periods like the pandemic. Theoretical and Managerial Implications This study confirms that human resource development (HRD) plays a pivotal role in enhancing organizational resilience, particularly during crisis periods such as the COVID-19 pandemic. Effective training improves employee capacity, which in turn strengthens performance under uncertainty (Adhvaryu et al., 2023 ; Vyas, 2024 ). From a theoretical standpoint, the findings reinforce Human Capital Theory (HCT) by demonstrating that training not only enhances individual productivity but also builds intangible assets such as knowledge management capabilities and employee capacity (Bontis et al., 2000 ; Gerhart & Feng, 2021 ). These assets serve as mediators that drive sustainable performance improvements across organizational levels (Memon et al., 2022 ; Shahzad et al., 2021 ). Managerially, this study highlights the necessity of training programs that go beyond knowledge transmission. Training must foster retention, application, and reflective practice to improve both knowledge management processes and employee capacity (Ahsan et al., 2021 ; Akther & Rahman, 2021 ). Health organizations, in particular, should prioritize structured and competency-based training models to equip employees with adaptive capabilities needed in dynamic healthcare environments (Alt et al., 2023 ; Mwansisya et al., 2022 ). In sum, effective training serves as a foundational mechanism for building human capital that translates into higher organizational performance—especially when supported by strong knowledge management systems and employee development strategies. Conclusion This study has provided empirical evidence that structured training human resource development is instrumental in improving health worker performance, especially in times of crisis, such as during the COVID-19 pandemic. The results indicate that training effectiveness has both direct and indirect effects, the latter channeling through improved knowledge management and employee capacity. In this study, the mediating mechanisms were found to have a more pronounced contribution than the direct influence of training. This finding therefore suggests that training interventions should not be perceived as a stand-alone solution; rather, their effective output is a greater percentage when enforced with organizational systems that enhance knowledge sharing and capacity development. This pathway suggests that improvements in performance often come protractedly. First, there is an enhancement of knowledge processes, capacity building, and later manifest behavior and performance outcomes. From a larger perspective, these insights demand a more strategic approach to workforce development in public health institutions. The study suggests that the design of training programs aligned with knowledge utilization goals and capacity priorities could offer a more sustainable route to achieving long-term resilience in the health system. Therefore, this study is expected to add value to the understanding of how interventions based on training intersect with organizational learning and capacity dynamics to enhance the delivery of public services. Declarations Author Declarations Availability of Data and Materials: The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request. Funding: This research received no external funding. Ethics Approval and Consent to Participate: This study was reviewed and approved by the Institutional Review Board of the Research and Community Service Center (PPPM), STIE Amkop Makassar, Indonesia (Ethical Clearance No. 112/KomTik-PPPM/STIEAMKOP/IX/2024; approval date: 23 September 2024; certificate issued: 24 February 2025). The data were collected while the corresponding author was affiliated with STIE Amkop Makassar; therefore, ethical oversight for this project was provided by that institution. All procedures complied with relevant guidelines and regulations and adhered to ethical principles for research involving human participants. Although data collection occurred in March–May 2024, the protocol later approved by the IRB is identical to the procedures applied during data collection and therefore covers the dataset gathered in that period. 1 Informed consent . All participants received an information sheet describing the study’s objectives, procedures, risks/benefits, confidentiality, and their rights as respondents. Written informed consent was obtained prior to participation during the data collection period (March–May 2024). Participation was voluntary; no identifying information was recorded; confidentiality and anonymity were assured; and participants could withdraw at any time without consequence. Competing Interests: The authors declare no competing interests. AI Use Declaration: The authors used generative AI tools (ChatGPT by OpenAI) exclusively for language enhancement and editing purposes. All conceptual content, interpretations, and final revisions are entirely based on the authors’ intellectual contributions and have been verified for accuracy and originality. Consent for Publication: Not applicable. 1 Institutional policy reference for research ethics and governance (PPPM STIE Amkop Makassar): https://ppm.stieamkop.ac.id/zg-content/uploads/19._standar_peneliti_penelitian.pdf References Abbate, S., Centobelli, P., Cerchione, R., Oropallo, E., & Riccio, E. (2023). Investigating Healthcare 4.0 Transition Through a Knowledge Management Perspective. IEEE Transactions on Engineering Management , 70 (9), 3297–3310. https://doi.org/10.1109/tem.2022.3200889 Adhvaryu, A. R., Kala, N., & Nyshadham, A. (2023). Returns to On-the-Job Soft Skills Training. 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Co-development of a training programme on disability for healthcare wo rkers in Uganda. BMC Health Services Research , 24 (1). https://doi.org/10.1186/s12913-024-10918-z Sugiyono. (2018). Metode Penelitian Kuantitatif, Kualitatif, dan R&D. In ke-26 . Bandung: Alfabeta. Tamsah, H., Ilyas, G. B., Nurung, J., Jusuf, E., & Rahmi, S. (2023). Soft skill competency and employees’ capacity as the intervening factors between training effectiveness and health workers’ performance. Cogent Business and Management , 10 (1). https://doi.org/10.1080/23311975.2023.2199493 Tamsah, H., Ilyas, J. B., & Yusriadi, Y. (2021). Create teaching creativity through training management, effectiveness training, and teacher quality in the covid-19 pandemic. Journal of Ethnic and Cultural Studies , 8 (4), 18–35. https://doi.org/10.29333/ejecs/800 Tamsah, H., Yusriadi, Y., Hasbi, H., Haris, A., & Ajanil, B. (2023). Training Management on Training Effectiveness and Teaching Creativity in The Covid-19 Pandemic. Hindawi - Education Research International , 2023 , 15. https://doi.org/10.1155/2023/6588234 Ullah, Z., Ahmad, N., Scholz, M., Ahmed, B., Ahmad, I., & Usman, M. (2021). Perceived accuracy of electronic performance appraisal systems: The case of a non‐for‐profit organization from an emerging economy. Sustainability (Switzerland) , 13 (4), 1–16. https://doi.org/10.3390/su13042109 Umar, A., Tamsah, H., Mattalatta, M., Baharuddin, B., & Latief R, A. (2020). Training–Effectiveness and Team-Performance in Public Organization. Journal of Asian Finance, Economics and Business , 7 (11), 1021–1031. https://doi.org/10.13106/jafeb.2020.vol7.no11.1021 Upadhyay, K., Goel, S., & John, P. (2023). Developing a capacity building training model for public health manage rs of low and middle income countries. PLOS ONE , 18 (4), e0272793. https://doi.org/10.1371/journal.pone.0272793 Vyas, P. (2024). Knowledge management and higher education institute: Review & topic analysis. Journal of Open Innovation: Technology, Market, and Complexity , 10 (3), 100349. https://doi.org/10.1016/j.joitmc.2024.100349 Wilson, P. H., Strutton, D., & Farris, M. T. (2002). Investigating the perceptual aspect of sales training. Journal of Personal Selling and Sales Management , 22 (2), 77–86. https://doi.org/10.1080/08853134.2002.10754296 Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample Size Requirements for Structural Equation Models: An Evaluation of Power, Bias, and Solution Propriety. Educational and Psychological Measurement , 73 (6), 913–934. https://doi.org/10.1177/0013164413495237 Wu, Wei, Zhou, E, Zhu, Xu, Chen, Shang, Guo, Li, Yang, & Li. (2023). The effectiveness of continuing education programmes for health worker s in rural and remote areas: a systematic review and meta-analysis. Rural and Remote Health . https://doi.org/10.22605/rrh8275 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7002902","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":550432565,"identity":"6cc14424-61a0-4896-b620-3de380a76546","order_by":0,"name":"Hasmin 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1","display":"","copyAsset":false,"role":"figure","size":106063,"visible":true,"origin":"","legend":"\u003cp\u003eStructural equation model showing the direct and indirect paths between training effectiveness, knowledge management, employee capacity, and health worker performance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e: Authors’ own work, based on survey data (2024).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7002902/v1/b8ad56a413352597d9caf595.png"},{"id":97136296,"identity":"8971f1b8-a3ca-4fc5-9205-7bdbf6a5f2f4","added_by":"auto","created_at":"2025-12-01 09:56:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1730964,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7002902/v1/37ed1891-3217-422a-b61c-04db57138ecf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Overview of HR Development and Performance of Health Workers during the Covid-19 Pandemic: Studies on Health Workers in Indonesia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHuman resources are considered fundamental to the achievement of organizational effectiveness through any form of operation, especially in service delivery, including healthcare. Among human resource management practices, training has elicited a strategic response as an intervention that enhances competencies at the individual level, among other common practices (Aryee et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lehyani, Zouari, Ghorbel, \u0026amp; Tollenaere, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In its sensitivity to health systems, good training has been defined as an enabler to improve service delivery and responsiveness and meet the demands of complex patients (Chakma et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Conti et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe connection between training and employee performance is still debated, both theoretically and empirically. Some studies have shown a strong positive relationship, while others find little to no effect (Amare et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ngusie et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Rogers et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This raises critical questions regarding the contextual effectiveness and design of workplace learning programs (Perrotta et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Such mixed results lead one to posit that training outcomes are contingent upon underlying mechanisms and organizational conditions.\u003c/p\u003e\u003cp\u003eThis study responds to these inconsistencies by proposing an explanatory framework in which training effectiveness influences health workers\u0026rsquo; performance indirectly through two critical mediators: knowledge management and employee capacity. It is argued that the success of training programs depends not only on content delivery, but also on their ability to foster knowledge sharing, promote organizational learning, and build individual capabilities (Afshari et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023).\u003c/p\u003e\u003cp\u003eThe model is based on Human Capital Theory (HCT), which suggests that the money spent on education and training adds to output gains through the increase and use of knowledge and skills (El-Jardali et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Obeng et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Viewing human capital as a knowledge-based but critical asset, modern views stress its sustainability when used through processes based on knowledge and supporting institutions (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Shaikh et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThough often criticized for its failure to address structural inequalities and institutional environments (Auerbach \u0026amp; Green, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), Health Compliant Theory is one of the available tools for analyzing employee development in environments affected by a crisis. The COVID-19 pandemic provides an excellent empirical opportunity to understand how health organizations may improve workforce resilience and responsiveness in service delivery through training, particularly underpinned by knowledge and capacity building (Deussom et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mwansisya et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This study aims to understand how training-based human resource development supports health system performance during periods of disquiescence and unpredictability.\u003c/p\u003e\n\u003ch3\u003eLiterature Review: Theoretical background and hypothesis development\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eTraining effectiveness\u003c/h2\u003e\u003cp\u003eHuman resource training is a major player in ensuring the success of any organization in this era of rapid technological adaptation in a data-driven environment (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lehyani, Zouari, Ghorbel, \u0026amp; Tollenaere, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The same investment in HR training should boost adaptability among employees, as well as communication and technological competence (Aryee et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Hughes, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), which then leads to improved task execution, customer service, and leadership potential (Amare et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Rogers et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEffective training not only builds workers' motivation, creativity, and productivity (Chen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kengia et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), but informal and formal education also provides sustained talent growth (Smythe et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Individual- or group-based training is specific to improving service quality and maintaining ethical standards (Chakma et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Conti et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEffective training alone resulted in meaningful outcomes. As mentioned by some scholars, it enhances knowledge management by building self-efficacy and IT-based programs (Alharbi \u0026amp; Aloud, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; El-Jardali et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). It also bridges individual capacity and confidence (Afshari et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). This improved self-efficacy contributes to proactive and sustained performance.\u003c/p\u003e\u003cp\u003eIn addition, training shapes competencies (Upadhyay et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), facilitates knowledge management (Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Obeng et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and is linked with higher performance (Alolayyan \u0026amp; Alyahya, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sheffel et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Motivational learning theory, from which effective training is determined, reengineers behavior toward incremental change (Cavalcante de Oliveira et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Shaikh et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTherefore, the following hypothesis is posited:\u003c/p\u003e\u003cp\u003e\u003cem\u003eH1: Training effectiveness has a positive influence on knowledge management.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eH2: Training effectiveness positively influences employee competency.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eH3: The effectiveness of training can have a positive impact on the performance of health workers.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eKnowledge Management\u003c/h3\u003e\n\u003cp\u003eKnowledge consists of relevant information, skills, and values that spur innovation and guide action (Alharbi \u0026amp; Aloud, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). It is available as tacit and explicit knowledge (El-Jardali et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Obeng et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), with the combination of both contributing to organizational value (Afshari et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, \u0026amp; Tollenaere, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023).\u003c/p\u003e\u003cp\u003eKnowledge management (KM) is a structured process for creating, storing, sharing, and applying knowledge to enable learning and adaptation to the environment to enhance performance and ultimately build competitive advantage. It supports the flow of knowledge, organizational learning, and strategic decisions (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Shaikh et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) while improving individual productivity and organizational outcomes (Alolayyan \u0026amp; Alyahya, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Chen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023).\u003c/p\u003e\u003cp\u003eKM builds an individual\u0026rsquo;s self-efficacy by increasing their confidence and motivation (Chakma et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sheffel et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Smythe et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). It helps to share knowledge and create new knowledge (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023), which later turns into capacity building (Rogers et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Upadhyay et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent studies have validated the strategic relevance of KM. In health care, KM has a positive impact on infection control (Ahsan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), sustainability performance, and quality of care (Alboliteeh et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). It supports green innovation through manufacturing concerns (Shahzad et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and improves employee effectiveness in SMEs (Lehyani, Zouari, Ghorbel, \u0026amp; Tollenaere, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Knowledge management can dramatically enhance organizational performance when combined with training and soft TQM (Aziz et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ong \u0026amp; Tan, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBased on the Resource-Based View (Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), KM is considered an important internal resource that relates to resilience, through which an organization can gain competitive and innovative outcomes. As viewed in terms of human capital, KM is viewed as the enabler of skill development, particularly in complicated and dynamic environments (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Memon et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTherefore, KM is crucial for improving the knowledge asset, human capability, and sustainable performance of an employee\u0026rsquo;s KM framework. A subsequent hypothesis to be tested based on this framework is as follows:\u003c/p\u003e\u003cp\u003e\u003cem\u003eH4: Knowledge management enhances employees' capacity.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eEmployee Capacity\u003c/h3\u003e\n\u003cp\u003eEmployee capacity refers to the development of individual competencies, knowledge, and resources that enhance organizational adaptability and long-term performance (Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sheffel et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). It goes beyond maintaining skills to building capabilities through continuous learning and institutional support (Kengia et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Upadhyay et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCapacity building, viewed through Human Capital Theory and the Resource-Based View, should be directed towards organizational effectiveness and innovation (Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Auerbach \u0026amp; Green, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It improves work conditions, reduces turnover, increases engagement, and fosters an enabling environment (Cavalcante de Oliveira et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Formal education, soft skills and on-the-job training fill critical competency gaps and ensure sustained performance (Aryee et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Mwansisya et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Wu et al., 2023).\u003c/p\u003e\u003cp\u003eCapacity should be viewed as the ability to make timely ad hoc decisions and identify priorities in complex tasks. This is related to creativity, retention, and team effectiveness. A study by Riyanto and Adhitama (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) proved that improving capacity improves compassion in the delivery system. In another study, Ullah et al. (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) proved that this also helps reduce delays. In another study, Hou et al. (2021) found that capacity significantly increased the efficiency of the delivery system.\u003c/p\u003e\u003cp\u003e\u003cem\u003eH5: The capacity of an employee introduces significant positive efficiency to health worker performance.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eHealth Workers Performance\u003c/h3\u003e\n\u003cp\u003eIndonesia has experienced disparities in the delivery of health services caused by urban-rural imbalance and unequal allocation and use of resources (Sheffel et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Shortages of staff in crucial areas (Jalal et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) have elicited some fairly new government rives, such as that of HRH2030, implemented with funds from USAID and PEPFAR, which focus on checking policies, boosting capacity, and getting different stakeholders to work toward meeting a country\u0026rsquo;s health targets.\u003c/p\u003e\u003cp\u003eHealth workers\u0026rsquo; performance is a major outcome of human capital investment. Individual performance is defined as the degree to which training outcomes are implemented at the workplace (Aryee et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). It is usually measured in terms of post-training enhancement of competency, efficiency, and effectiveness (Ngusie et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wu et al., 2023), and may be appraised through self-reports or supervisor evaluations (Rogers et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEffective training improves knowledge application (Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), develops capacity for work (Kugler et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and enhances individual and team performance (Amare et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Carboni et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Smythe et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Such effects improve with a good structure in knowledge management and capacity building (Conti et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent evidence has indicated that competency-based training and supervision is accompanied by significant improvements in health service delivery (Deussom et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mwansisya et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Soft skills, such as empathy and communication, are considered key, though critical; they remain underdeveloped (Al Badi et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sancho-Cantus et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). \"Knowledge sharing and learning systems are tantamount to making the ability of employees more effective for the sustainability of performance\" (Alboliteeh et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Cometto et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAligned with the Resource-Based View (Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), internal capabilities significantly shape health workers\u0026rsquo; performance, which comprises the components of knowledge management and human capital development (Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Training, KM, and capacity development integrative approaches have proven worth in positively improving workforce outcomes in different sectors (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ahsan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Vyas, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cem\u003eH6: Training effectiveness mainly enhances the performance of a health worker through knowledge management and employee capacity.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eH7: Knowledge management mainly enhances the performance of health workers through the capacity of employees.\u003c/em\u003e\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSample Criteria and Justification\u003c/h2\u003e\u003cp\u003eThis study involved 202 health workers from South Sulawesi, Indonesia (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), who were selected through random sampling. Although data collection was conducted after the peak of the COVID-19 pandemic, this study retrospectively examined perceptions of training and performance during the crisis period. The sample size falls within the widely accepted range of 30\u0026ndash;500 for behavioral research (Howell, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), and is considered sufficient for structural equation modeling when model complexity is moderate and measurement reliability is high (MacCallum et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Wolf et al., \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of Respondents (N\u0026thinsp;=\u0026thinsp;202)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespondent Criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional Role\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical Doctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMidwife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysiotherapist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDental Technician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLaboratory Analyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnvironmental Health Officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNutritionist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRadiographer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical Records Officer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePublic Health Graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElectromedical Technician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob Position\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEchelon II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEchelon III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEchelon IV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-Echelon Staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Background\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiploma (D1\u0026ndash;D3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s Degree (S1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s Degree (S2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u0026ndash;60 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eGiven the use of validated constructs, complete response rates, and acceptable model fit, the sample was deemed both statistically and contextually appropriate to support the study\u0026rsquo;s analytical framework.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e[Insert Table . Demographic Characteristics of Respondents]\u003c/h3\u003e\n\u003cp\u003eThe sample (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) reflects diverse professional backgrounds, covering 12 medical occupations, with nurses being the most represented and biomedical engineers the least. Respondents also varied across employment levels, from non-managerial staff to senior executives (Echelon II). Most participants held a diploma or undergraduate degree, with female health workers dominating the sample. The majority were aged 31\u0026ndash;50. Data collection faced limitations due to COVID-19, which restricted access to a larger respondent pool.\u003c/p\u003e\n\u003ch3\u003eMeasurement\u003c/h3\u003e\n\u003cp\u003eA quantitative design using Structural Equation Modeling (SEM-Amos) was employed (Alshetewi, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Ferdinand, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ghozali, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The study population consisted of 18,240 health workers across South Sulawesi. A random sampling approach was used (Sugiyono, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), targeting at least 100 complete responses via an online survey. This approach aligns with recommended sample sizes for SEM, where 100\u0026ndash;200 respondents enhance model accuracy (Ferdinand, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Ghozali, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), and adheres to Roscoe\u0026rsquo;s rule of thumb, which suggests 30\u0026ndash;500 as a suitable range for survey studies (Sekaran \u0026amp; Bougie, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Sugiyono, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBy the end of the 8-week collection period, 202 valid responses were obtained. The instrument measured:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTraining Effectiveness (TE) via three indicators: additional knowledge, ability to remember, and ability to practice (Perdue et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Wilson et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2002\u003c/span\u003e); see (Tamsah et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tamsah, Yusriadi, et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Umar et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) for public sector applications);\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKnowledge Management (KM) using use, sharing, reflection, and identification of knowledge (Davidson \u0026amp; Voss, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2003\u003c/span\u003e);\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEmployee Capacity (EC) through cooperation, commitment, involvement, and capacity-building initiatives (Kimutai et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2013\u003c/span\u003e);\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHealth Worker Performance (HWP) through responsiveness, availability, productivity, and use of competence (Dieleman \u0026amp; Harnmeijer, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Kimutai et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Lutwama et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eFurther information regarding the measurement of the variables is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 2. Operationalization of Variables and Measurement Items\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndicator\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eTraining Effectiveness (TE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eAdditional knowledge (TE1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(Perdue et al., 2002; Tamsah et al., 2021, 2023; Umar et al., 2020; Wilson et al., 2002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI gained additional knowledge after completing the training sessions.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eI acquired new work-related skills after each training session.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eAbility to remember (TE2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI am able to recall activities conducted during the training.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eI understand the training activities and their relevance.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eAbility to practice (TE3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI can apply the training outcomes to my current work.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eI am able to implement practical lessons from the training in my job.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eKnowledge Management (KM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eUse of knowledge (KM1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(Davidson \u0026amp; Voss, 2003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI am capable of managing and utilizing knowledge to discover new approaches or innovations in my work.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eSharing knowledge (KM2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI am able to create, share, and apply knowledge effectively to disseminate useful information.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eReflection of knowledge (KM3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI can transform raw data into meaningful insights as a reflection of my existing knowledge.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eIdentification of knowledge (KM4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI am able to identify new ideas that may serve as a foundation for organizational knowledge development.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eEmployee Capacity (EC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eEmployee cooperation (EC1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(Kimutai et al., 2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI am able to collaborate effectively with colleagues to enhance work capacity.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eEmployee commitment (EC2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI demonstrate strong commitment to my job and to the development of work capacity.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eEmployee involvement (EC3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI consistently promote employee engagement in efforts to improve capacity.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eEmployee capacity building initiatives (EC4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI actively initiate activities aimed at enhancing employee capacity.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eHealth Worker Performance (HWP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eResponsiveness (HWP1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e(Dieleman \u0026amp; Harnmeijer, 2006; Kimutai et al., 2013; Lutwama et al., 2012)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI maintain a high level of responsiveness in job-related tasks, even during the COVID-19 pandemic.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eAvailability (HWP2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI ensure consistent presence and time availability for work tasks, including during the pandemic.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eProductivity (HWP3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI maintain work productivity as a key priority for performance improvement, even during the COVID-19 period.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eUse of competence (HWP4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eI strive to utilize my full capabilities to improve job performance, even under pandemic-related constraints.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e: Authors\u0026rsquo; own work.\u003c/p\u003e\u003cp\u003e[\u003cb\u003eInsert\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cb\u003eOperationalization of Variables and Measurement Items\u003c/b\u003e]\u003c/p\u003e\u003cp\u003eThe questionnaire method was chosen for its efficiency in large-scale data collection. Ensuring data validity and reliability required rigorous instrument development (D\u0026ouml;rnyei \u0026amp; Taguchi, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). A total of 19 items were included, each rated on a 7-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree, 4\u0026thinsp;=\u0026thinsp;neutral, 7\u0026thinsp;=\u0026thinsp;strongly agree). This design supports generalizability and statistical reliability in HR research (Iacobucci \u0026amp; Churchill, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAligned with Human Capital Theory, the variables in this study reflect critical intangible assets\u0026mdash;knowledge, skills, and capabilities\u0026mdash;that collectively determine workforce productivity and organizational value (Bontis et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Mayo, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe model was conducted in two sequential stages. The first stage involved Confirmatory Factor Analysis (CFA) to examine the reliability and validity of the measurement model, including convergent and discriminant validity tests. The second stage employed structural path analysis to assess the overall model fit, test hypothesized relationships among constructs, and evaluate the mediation effects.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eReliability Assessment\u003c/h2\u003e\u003cp\u003eInternal consistency was established through Cronbach\u0026rsquo;s alpha, with all constructs exceeding the commonly accepted threshold of 0.70 (Lance et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), indicating the high reliability of the measurement items (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Reliability and Validity Assessments\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandardized Estimate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEstimate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCritical Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP - Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eConstruct Reliability\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAverage Variance Extracted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTraining Effectiveness (TE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdditional knowledge (TE1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to remember (TE2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to practice (TE3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eKnowledge Management (KM)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse of knowledge (KM1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSharing knowledge (KM2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReflection of knowledge (KM3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIdentification of knowledge (KM4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u003cp\u003edeleted item\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEmployee Capacity (EC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee cooperation (EC1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee commitment (EC2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee involvement (EC3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee capacity building initiatives (EC4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eHealth Workers Performance (HWP)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponsiveness (HWP1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u003cp\u003edeleted item\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAvailability (HWP2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProductivity (HWP3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse of competence (HWP4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eModel Fit Testing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eCut of Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e\u003cb\u003eResult\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eRemark\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e1. Absolute Fit Indices:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eChi-Square\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003edf\u0026thinsp;=\u0026thinsp;60; \u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;79.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e117.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMarginal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.05 (Laar and Braeken, 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMarginal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCMIN/df\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;3.00 (even \u0026lt;\u0026thinsp;5.00) (Dash and Paul, 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.90 (Hair \u003cem\u003eet al.\u003c/em\u003e, 2010)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e0.03\u0026ndash;0.08 (Arbuckle, 2009)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e2. Incremental Fit Indices:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAGFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.90 (Hair \u003cem\u003eet al.\u003c/em\u003e, 2010)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMarginal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTLI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.90 (Arbuckle, 2009)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.90 (Dash and Paul, 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.90 (Laar and Braeken, 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e3. Parsimony Fit Indices:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePNFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.50 (Dash and Paul, 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePGFI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.50 (Dash and Paul, 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eFit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: *** (Significant at Level p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Summary of Reliability and Validity Assessments]\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003eValidity Assessment\u003c/h2\u003e\u003cp\u003eConstruct validity was examined to determine the degree to which the items accurately represented their respective theoretical constructs (Bernard, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Hair et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). All factor loadings ranged between 0.73 and 0.89, surpassing the 0.50 benchmark (Ferdinand, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Hair et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), thereby confirming convergent validity. The significance of each item was supported by Critical Ratios (CR\u0026thinsp;\u0026gt;\u0026thinsp;2) and p-values below 0.05. Construct Reliability (CR\u0026thinsp;\u0026ge;\u0026thinsp;0.70) and Average Variance Extracted (AVE\u0026thinsp;\u0026ge;\u0026thinsp;0.50) further indicate the robustness of the latent constructs (Sekaran \u0026amp; Bougie, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasurement Model Summary\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTraining Effectiveness (TE): Comprised of additional knowledge (0.84), memory retention (0.85), and practical application (0.87). CR\u0026thinsp;=\u0026thinsp;0.94; AVE\u0026thinsp;=\u0026thinsp;0.84.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKnowledge Management (KM): Assessed through knowledge use (0.84), knowledge sharing (0.89), and reflection (0.86). One item (identification) was excluded from analysis. CR\u0026thinsp;=\u0026thinsp;0.97; AVE\u0026thinsp;=\u0026thinsp;0.95.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEmployee Capacity (EC): Represented by cooperation (0.82), commitment (0.87), involvement (0.73), and Capacity building (0.78). CR\u0026thinsp;=\u0026thinsp;0.98; AVE\u0026thinsp;=\u0026thinsp;0.95.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHealth Worker Performance (HWP): measured via availability (0.76), productivity (0.86), and use of competence (0.83). One item (Responsiveness) was excluded from the analysis. CR\u0026thinsp;=\u0026thinsp;0.97; AVE\u0026thinsp;=\u0026thinsp;0.95.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eModel Fit and Structural Validation\u003c/h2\u003e\u003cp\u003eCFA and structural model assessment demonstrated a strong fit with the observed data (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The fit indices reported were CMIN/DF\u0026thinsp;=\u0026thinsp;1.96, GFI\u0026thinsp;=\u0026thinsp;0.92, RMSEA\u0026thinsp;=\u0026thinsp;0.07, TLI\u0026thinsp;=\u0026thinsp;0.96, NFI\u0026thinsp;=\u0026thinsp;0.94, CFI\u0026thinsp;=\u0026thinsp;0.97, PNFI\u0026thinsp;=\u0026thinsp;0.73, and PGFI\u0026thinsp;=\u0026thinsp;0.61 indicating an acceptable and well-fitting model (Ferdinand, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Hair et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e[Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Structural Equation Model]\u003c/h2\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003eHypothesis Testing\u003c/h2\u003e\u003cp\u003eAll the proposed hypotheses (H1\u0026ndash;H7) were supported. Standardized regression weights were significant (t-values\u0026thinsp;\u0026gt;\u0026thinsp;1.96), and p-values were below 0.05, confirming the statistical significance across all direct paths (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Structural Model Results and Hypothesis Testing\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"629\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothesis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized estimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6318%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3078%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCritical Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003eH1: Training Effectiveness \u0026rarr; Knowledge Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9698%;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6318%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3078%;\"\u003e\n \u003cp\u003e10.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003eSupported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003eH2: Training Effectiveness \u0026rarr; Employee Capacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9698%;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6318%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3078%;\"\u003e\n \u003cp\u003e3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003eSupported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003eH3: Training Effectiveness \u0026rarr; Health Worker Performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9698%;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6318%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3078%;\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003eSupported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003eH4: Knowledge Management\u0026nbsp;\u0026agrave;\u0026nbsp;Employee Capacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9698%;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6318%;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3078%;\"\u003e\n \u003cp\u003e6.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003eSupported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003eH5: Employee Capacity \u0026rarr; Health Worker Performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.9698%;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6318%;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.3078%;\"\u003e\n \u003cp\u003e6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003eSupported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003eH6: Training Effectiveness \u0026rarr; Knowledge Management \u0026rarr; Employee Capacity \u0026rarr; Health Worker Performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 32.9094%;\"\u003e\n \u003cp\u003eestimates/bootstrap (two tailed significance-BC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003eSupported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.5914%;\"\u003e\n \u003cp\u003eH7: Knowledge Management \u0026rarr; Employee Capacity \u0026rarr; Health Worker Performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5803%;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 32.9094%;\"\u003e\n \u003cp\u003eestimates/bootstrap (two tailed significance-BC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.26709%;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6518%;\"\u003e\n \u003cp\u003eSupported\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: *** (Significant at Level p\u0026lt; 0.01)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e: Authors\u0026rsquo; own work, based on survey data (2024).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Structural Model Results and Hypothesis Testing]\u003c/h2\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003eMediation Analysis\u003c/h2\u003e\u003cp\u003eBootstrapping procedures were applied to test the mediating mechanisms, which is a robust technique suitable for moderate sample sizes and non-normal data distributions (Mattila, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Preacher \u0026amp; Hayes, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eH6: Training Effectiveness positively influences Health Worker Performance through the sequential mediation of Knowledge Management and Employee Capacity (p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eH7: Knowledge Management influences Health Worker Performance through Employee Capacity (p\u0026thinsp;=\u0026thinsp;0.011).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThese mediation results affirm the principles of Human Capital Theory (Bontis et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Mayo, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), emphasizing that training impacts performance most effectively when cultivating knowledge application and organizational capacity. Moreover, in the post-pandemic context, these findings underscore the strategic role of intangible assets such as knowledge management systems and employee development processes in sustaining public sector performance during and after periods of crisis (Ahsan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eTraining Effectiveness and Knowledge Management (H1)\u003c/h2\u003e\u003cp\u003eThis study demonstrates that training effectiveness significantly enhances knowledge management (β\u0026thinsp;=\u0026thinsp;0.76; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among KM indicators, knowledge sharing (0.89), reflection (0.86), and knowledge use (0.84) emerged as the strongest dimensions, highlighting the role of training in cultivating not only knowledge acquisition but also its integration and dissemination.\u003c/p\u003e\u003cp\u003eFrom the lens of Human Capital Theory (HCT), training is a key investment that builds employees\u0026rsquo; cognitive and behavioral capacities, aligning with organizational goals (Auerbach \u0026amp; Green, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Bontis et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). As supported by Tamsah, Ilyas, et al., (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), effective training enhances employees\u0026rsquo; ability to remember, apply, and expand knowledge\u0026mdash;three foundational elements for strong KM systems.\u003c/p\u003e\u003cp\u003eThis finding aligns with Giovanelli et al. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who emphasize that training strengthens both knowledge and ability. Specifically, the ability to practice, as emphasized by Aryee et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), is particularly relevant for health professionals operating in dynamic service environments. However, not all knowledge dimensions contribute equally\u0026mdash;this study excluded knowledge identification due to weak measurement loading, which corroborates (Chakma et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who argue that knowledge must be actionable to influence performance.\u003c/p\u003e\u003cp\u003eRecent literature reinforces these results. KM-based training has improved clinical behavior (Ahsan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), academic performance (Vyas, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and healthcare sustainability (Alboliteeh et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Across industries, KM and training are interdependent levers for enhancing organizational capability (Alharbi \u0026amp; Aloud, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Lehyani, Zouari, Ghorbel, \u0026amp; Tollenaere, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023), further validating the strategic role of training in developing human capital through knowledge optimization.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eTraining Effectiveness and Employee Capacity (H2)\u003c/h2\u003e\u003cp\u003eThe analysis confirms a significant positive effect of training effectiveness on employee capacity (β\u0026thinsp;=\u0026thinsp;0.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among capacity indicators, employee commitment (0.87), cooperation (0.82), capacity-building initiative (0.78), and involvement (0.73) emerged as core dimensions. These reflect the human capital components developed through effective training.\u003c/p\u003e\u003cp\u003eAligned with Human Capital Theory, training enhances not only skills but also psychological readiness and workplace engagement (Auerbach \u0026amp; Green, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Leoni, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Effective training enables practical skill application, reinforces memory, and introduces new knowledge, which collectively foster employees\u0026rsquo; initiative, participation, and teamwork (Aryee et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs prior studies suggest, training contributes to higher commitment and collaboration by increasing self-confidence and morale, particularly in dynamic environments requiring adaptability (Chen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kengia et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This supports the argument that training is not merely a tool for knowledge transfer, but a strategic lever for strengthening employee capacity as a key organizational resource (Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tamsah, Ilyas, et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, competency-based training fosters workforce flexibility and readiness, which are vital for enhancing individual and collective performance, especially in healthcare and public service sectors (Cometto et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Conti et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Therefore, employee capacity can be seen as the manifestation of accumulated human capital shaped by strategic learning interventions.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eTraining Effectiveness and Health Worker Performance (H3)\u003c/h2\u003e\u003cp\u003eThe findings indicate a significant and positive relationship between training effectiveness and health worker performance (β\u0026thinsp;=\u0026thinsp;0.32; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The strongest contributors to training effectiveness were ability to practice (0.87), ability to remember (0.85), and acquisition of new knowledge (0.84). For health worker performance, productivity was the most dominant indicator (0.86), followed by competence utilization (0.83), and availability (0.76). These results affirm that effective training enhances readiness and productivity\u0026mdash;key attributes of high-performing health systems (Mwansisya et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sheffel et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGrounded in Human Capital Theory, training develops workers\u0026rsquo; competencies that drive performance in dynamic service contexts (Auerbach \u0026amp; Green, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). As human capital is enhanced through practical skills and knowledge application, employees become more productive, and confident to organizational needs (Adhvaryu et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Chen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Effective training also fosters adaptive capacity, allowing staff to adjust to changing demands, thus boosting overall health service delivery (Alolayyan \u0026amp; Alyahya, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Kengia et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, learning outcomes from structured training\u0026mdash;such as motivation, engagement, and behavioral reinforcement\u0026mdash;are essential mechanisms for sustaining high performance (Aryee et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This suggests that beyond technical instruction, training serves as a motivational engine for behavior change and performance enhancement within healthcare systems (Cometto et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Conti et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge Management and Employee Capacity (H4)\u003c/h2\u003e\u003cp\u003eThis study confirms that knowledge management (KM) has a positive and significant effect on employee capacity (β\u0026thinsp;=\u0026thinsp;0.61; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among KM dimensions, knowledge sharing, reflection, and application substantially contribute to strengthening employee commitment, cooperation, involvement, and capacity-building initiatives. These findings are consistent with prior studies demonstrating that KM improves employee competence and engagement (Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, \u0026amp; Tollenaere, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnder the lens of Human Capital Theory, KM functions as a strategic mechanism to accumulate, organize, and apply knowledge, thereby enhancing individual and organizational value (Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Employees who actively utilize and share knowledge are more likely to demonstrate proactive behaviors, including higher involvement and initiative, as knowledge becomes embedded in daily tasks (Afshari et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; El-Jardali et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This supports the premise that effective KM contributes directly to the development of organizational human capital and improves workforce adaptability in dynamic environments (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Alharbi \u0026amp; Aloud, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn line with HCT, KM-driven learning processes strengthen individual readiness and self-development\u0026mdash;key components of capacity enhancement in modern, knowledge-based institutions (Obeng et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Shaikh et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eEmployee Capacity and Health Worker Performance (H5)\u003c/h2\u003e\u003cp\u003eThe findings reveal a significant positive relationship between employee capacity and health worker performance (β\u0026thinsp;=\u0026thinsp;0.65; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Employees with higher levels of commitment, cooperation, involvement, and capacity-building initiatives tend to demonstrate greater productivity, competence utilization, and work readiness. This supports prior evidence that employee capacity is a critical determinant of performance outcomes (Chen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFrom a Human Capital Theory perspective, employee capacity represents the embodiment of accumulated skills, motivation, and knowledge, which translate into improved task execution and adaptability (Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Leoni, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Enhanced commitment and cooperation foster higher engagement and collaboration, while initiative and involvement support problem-solving and responsiveness\u0026mdash;key to healthcare delivery effectiveness (Conti et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Deussom et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These findings align with research indicating that capacity development facilitates performance improvisation and helps employees prioritize tasks in complex environments (Afshari et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Alolayyan \u0026amp; Alyahya, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAs organizations face dynamic challenges, fostering human capital through capacity strengthening becomes imperative to ensure sustainable improvements in health worker productivity and system responsiveness (Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eTraining Effectiveness and Health Worker Performance through Knowledge Management and Employee Capacity (H6)\u003c/h2\u003e\u003cp\u003eThe study confirms that knowledge management and employee capacity significantly mediate the effect of training effectiveness on health worker performance (β\u0026thinsp;=\u0026thinsp;0.40; p\u0026thinsp;=\u0026thinsp;0.003). This indicates that training outcomes translate into performance improvements when newly acquired knowledge is effectively applied (Alharbi \u0026amp; Aloud, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Aryee et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ngusie et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDrawing from Human Capital Theory, effective training enhances individual skills and knowledge, while KM structures provide the mechanisms for retention, reflection, and application\u0026mdash;thus reinforcing behavior change and performance (Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023). Knowledge management acts as a guidance system that enables knowledge to be embedded into practice, aligning with the learning motivation process theory, where reinforcement and application are essential for behavioral improvement (Afshari et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe mediating role of KM is further supported by self-efficacy theory, which highlights the importance of context-specific reinforcement. Health workers with strong self-efficacy, shaped by structured KM and capacity-building initiatives, are more resilient and goal-oriented (Chen et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Smythe et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This aligns with recent evidence that organizational learning structures improve health system responsiveness (Cometto et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile training directly contributes to performance (Giovanelli et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), its impact is significantly strengthened when mediated by KM and employee capacity. This addresses prior concerns that training alone may not improve performance (Al Badi et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Cavalcante de Oliveira et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), emphasizing the strategic importance of knowledge-driven human capital development.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eKnowledge Management and Health Worker Performance through Employee Capacity (H7)\u003c/h2\u003e\u003cp\u003eThe findings demonstrate that employee capacity significantly mediates the relationship between knowledge management and health worker performance, with an indirect effect of 0.54 (p\u0026thinsp;=\u0026thinsp;0.011). This indicates that knowledge management has a stronger impact on performance when channeled through enhanced employee capacity.\u003c/p\u003e\u003cp\u003eThis result confirms that the contribution of employee capacity as a lever between KM and performance exceeds that of direct training effects. Employees may not immediately exhibit improved performance after training; instead, training often first builds capacity\u0026mdash;through increased commitment, cooperation, initiative, and involvement\u0026mdash;which then leads to sustainable performance gains, especially when supported by effective KM systems (Al-Husseini, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Karsikas et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lehyani, Zouari, Ghorbel, Tollenaere, et al., 2023).\u003c/p\u003e\u003cp\u003eAligned with Human Capital Theory, this relationship affirms that investments in knowledge resources enhance intangible assets, such as employee capacity, which subsequently strengthen organizational performance (Bontis et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mayo, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). These findings also support the idea that performance improvement, particularly in healthcare settings, depends on how well knowledge is internalized, shared, and applied across roles (Abbate et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ahsan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; El-Jardali et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThus, optimizing KM is not only about managing information but also about strategically developing human capital to amplify capacity and performance\u0026mdash;particularly relevant during disruptive periods like the pandemic.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eTheoretical and Managerial Implications\u003c/h2\u003e\u003cp\u003eThis study confirms that human resource development (HRD) plays a pivotal role in enhancing organizational resilience, particularly during crisis periods such as the COVID-19 pandemic. Effective training improves employee capacity, which in turn strengthens performance under uncertainty (Adhvaryu et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Vyas, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFrom a theoretical standpoint, the findings reinforce Human Capital Theory (HCT) by demonstrating that training not only enhances individual productivity but also builds intangible assets such as knowledge management capabilities and employee capacity (Bontis et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Gerhart \u0026amp; Feng, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These assets serve as mediators that drive sustainable performance improvements across organizational levels (Memon et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Shahzad et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eManagerially, this study highlights the necessity of training programs that go beyond knowledge transmission. Training must foster retention, application, and reflective practice to improve both knowledge management processes and employee capacity (Ahsan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Akther \u0026amp; Rahman, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Health organizations, in particular, should prioritize structured and competency-based training models to equip employees with adaptive capabilities needed in dynamic healthcare environments (Alt et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mwansisya et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn sum, effective training serves as a foundational mechanism for building human capital that translates into higher organizational performance\u0026mdash;especially when supported by strong knowledge management systems and employee development strategies.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study has provided empirical evidence that structured training human resource development is instrumental in improving health worker performance, especially in times of crisis, such as during the COVID-19 pandemic. The results indicate that training effectiveness has both direct and indirect effects, the latter channeling through improved knowledge management and employee capacity. In this study, the mediating mechanisms were found to have a more pronounced contribution than the direct influence of training.\u003c/p\u003e\u003cp\u003eThis finding therefore suggests that training interventions should not be perceived as a stand-alone solution; rather, their effective output is a greater percentage when enforced with organizational systems that enhance knowledge sharing and capacity development. This pathway suggests that improvements in performance often come protractedly. First, there is an enhancement of knowledge processes, capacity building, and later manifest behavior and performance outcomes.\u003c/p\u003e\u003cp\u003eFrom a larger perspective, these insights demand a more strategic approach to workforce development in public health institutions. The study suggests that the design of training programs aligned with knowledge utilization goals and capacity priorities could offer a more sustainable route to achieving long-term resilience in the health system. Therefore, this study is expected to add value to the understanding of how interventions based on training intersect with organizational learning and capacity dynamics to enhance the delivery of public services.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and analyzed during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u0026nbsp;\u003c/strong\u003eThis study was reviewed and approved by the Institutional Review Board of the Research and Community Service Center (PPPM), STIE Amkop Makassar, Indonesia (Ethical Clearance No. 112/KomTik-PPPM/STIEAMKOP/IX/2024; approval date: 23 September 2024; certificate issued: 24 February 2025). The data were collected while the corresponding author was affiliated with STIE Amkop Makassar; therefore, ethical oversight for this project was provided by that institution. All procedures complied with relevant guidelines and regulations and adhered to ethical principles for research involving human participants. Although data collection occurred in March\u0026ndash;May 2024, the protocol later approved by the IRB is identical to the procedures applied during data collection and therefore covers the dataset gathered in that period.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e. All participants received an information sheet describing the study\u0026rsquo;s objectives, procedures, risks/benefits, confidentiality, and their rights as respondents. Written informed consent was obtained prior to participation during the data collection period (March\u0026ndash;May 2024). Participation was voluntary; no identifying information was recorded; confidentiality and anonymity were assured; and participants could withdraw at any time without consequence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAI Use Declaration:\u0026nbsp;\u003c/strong\u003eThe authors used generative AI tools (ChatGPT by OpenAI) exclusively for language enhancement and editing purposes. All conceptual content, interpretations, and final revisions are entirely based on the authors\u0026rsquo; intellectual contributions and have been verified for accuracy and originality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Institutional policy reference for research ethics and governance (PPPM STIE Amkop Makassar): https://ppm.stieamkop.ac.id/zg-content/uploads/19._standar_peneliti_penelitian.pdf\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eAbbate, S., Centobelli, P., Cerchione, R., Oropallo, E., \u0026amp; Riccio, E. (2023). Investigating Healthcare 4.0 Transition Through a Knowledge Management Perspective. \u003cem\u003eIEEE Transactions on Engineering Management\u003c/em\u003e, \u003cem\u003e70\u003c/em\u003e(9), 3297\u0026ndash;3310. https://doi.org/10.1109/tem.2022.3200889\u003c/p\u003e\n\u003cp\u003eAdhvaryu, A. 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The effectiveness of continuing education programmes for health worker s in rural and remote areas: a systematic review and meta-analysis. \u003cem\u003eRural and Remote Health\u003c/em\u003e. https://doi.org/10.22605/rrh8275\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"training effectiveness, knowledge management, employee capacity, health workforce, human capital development","lastPublishedDoi":"10.21203/rs.3.rs-7002902/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7002902/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe COVID-19 pandemic has exposed significant weaknesses in public health systems, particularly in terms of workforce preparedness and responsiveness. Among the many interventions to improve service quality, training remains a core element of human resource development; however, its direct impact on health worker performance remains controversial. Building on Human Capital Theory, this study investigates how training effectiveness contributes to health workers\u0026rsquo; performance through the mediating roles of knowledge management and employee capacity.\u003c/p\u003e\u003cp\u003eA quantitative survey was conducted among 202 health professionals in South Sulawesi, Indonesia, and data were analyzed using structural equation modeling (SEM; AMOS). The results indicate that effective training is positively associated with performance both directly and indirectly. Knowledge management and employee capacity served as complementary mediators, with the latter perceived as being more critical by respondents. Significant causal pathways were identified among training, knowledge management, capacity building, and overall performance.\u003c/p\u003e\u003cp\u003eThese findings underscore the importance of integrating knowledge-sharing mechanisms and capacity development into training frameworks, particularly in post-crisis recovery. This study offers insights into the strategic value of intangible assets for workforce resilience in developing countries\u0026rsquo; health systems and provides evidence to support more adaptive and learning-oriented HR policies in healthcare.\u003c/p\u003e","manuscriptTitle":"Overview of HR Development and Performance of Health Workers during the Covid-19 Pandemic: Studies on Health Workers in Indonesia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-27 12:09:06","doi":"10.21203/rs.3.rs-7002902/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-13T13:55:59+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"321198756102224319927005339173450075839","date":"2026-01-04T13:09:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T11:41:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322371944879655827069286259436441822626","date":"2025-12-17T06:43:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126194301138071280624965177396310100543","date":"2025-11-20T10:22:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-20T08:23:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-20T08:11:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-04T15:11:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-11T08:26:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2025-09-11T08:21:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1275db18-edab-40ea-97fa-167200691c3a","owner":[],"postedDate":"November 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":58565740,"name":"Health sciences/Health care"},{"id":58565741,"name":"Humanities/Health humanities"},{"id":58565742,"name":"Health sciences/Health occupations"}],"tags":[],"updatedAt":"2026-04-14T10:08:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-27 12:09:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7002902","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7002902","identity":"rs-7002902","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}