This study, based on a survey of 9475 outbreak prevention and control staff, explored possible work difficulties in the early and middle stages of major outbreak prevention and control work, and found that the highest reporting rate was psychological distress (48.8%), the middle reporting rate was data processing difficulties (31.25%), communication and coordination difficulties (29.8%) and resource shortage (27.9%), and the lowest reporting rate was target audience difficulties (20.2%). A comparative analysis among different institutions found higher rates of resources shortage in primary-rural, higher rates of communication and coordination difficulties in CDC, and higher rates of target audience difficulties in primary-urban.
The mental health problems of outbreak prevention and control staff cannot be ignored. The psychological distress was found as the most serious in this study, with a reporting rate of nearly half (48.8%). And there was no variation among institutions, suggesting that despite the differences in the content of outbreak prevention and control work in different institutions, all faced high levels of psychological distress. Mental health problems of clinical staff in outbreak prevention and control have raised concern [7]. This study found that the mental health problems of epidemic prevention and control workers engaged in public health-related work are also of concern, and further explored their specific sources of distress, such as: being treated differently at work, feeling aggrieved at work, family members not understanding and worrying about routine work outside the epidemic. These psychological distresses directly affect epidemic prevention on the one hand, and pose mental health hazards to staff on the other. In the future, the comprehensive protection of epidemic prevention and control staff should be improved, and humanistic care should be strengthened so that they can work with peace of mind and efficiency [8]. In addition, the current psychological intervention for epidemic workers focuses on clinical health care staff, and the psychological relief and intervention for epidemic prevention and control staff cannot be ignored.
The problem of resources shortage in primary-rural is of concern. The resources shortage problem found in this study is serious (27.9% reporting rate) and the highest reporting rate in primary-rural, suggesting that resources allocation in primary-rural needs to be optimized in the early and middle stages of epidemic. Admittedly, the resources shortage in China occurred mainly in the early stage of epidemic. Because with the development of the epidemic, the capacity and transfer of epidemic prevention materials work in an orderly manner, which gradually ensure that China’s reserve materials are sufficient. Resources shortage was mainly manifested in insufficient emergency material reserves and the capacity of health emergency response teams needs to be improved. Government financial support for health emergencies should be increased and the allocation of resources for health emergencies optimized. Vulnerable areas with relatively insufficient financial support (e.g., the primary-rural identified in this study) are often the focus of health emergency work. The introduction, training and training of health emergency staff should be strengthened, and drills and training in on-site epidemiological investigation are important ways to improve health emergency response capacity [9].
Communication and coordination difficulties in CDC institutions need attention. The communication and coordination difficulties found in this study are serious (the reporting rate is 29.8%), and the highest reporting rate is found in CDC, suggesting that the reform of China's CDC institutions needs to pay attention to information communication and transportation coordination. As the core backbone of the public health network, the work of CDC institutions involves more communication and coordination. Communication and coordination difficulties are mainly manifested in unclear overtime incentive system and poor communication between and within departments, which will directly affect the implementation of epidemic prevention and control and its effectiveness. To address communication and coordination difficulties, we should put the staff overtime incentive performance programs [10] and the multi-departmental joint prevention and control mechanisms at different levels [11] into the construction of the emergency system for public health emergencies.
Difficulties of the target audiences in primary-urban were relatively prominent. The difficulties of working targets found in this study were relatively serious (the reporting rate is 20.2%), and the reporting rate is highest in primary-urban, suggesting that the focus of public education on public health in China should be on primary-urban. Difficulties of target audiences are mainly manifested in concerns about the reliability of the survey and the uncooperative, which will directly affect the effect of blocking the transmission route and protecting vulnerable groups in epidemic prevention and control. In order to address the difficulties of the target audiences, vigorous efforts should be made to promote community awareness of public health and emergency work, so that the community can understand the relevant work, reduce misunderstandings and promote prevention and control work. For key populations with a lower level of education, we should use appropriate methods to publicize and popularize core information on the prevention and control of infectious diseases, cultivate their good hygiene habits and healthy lifestyles, and raise the overall population's awareness of the prevention and control of infectious diseases [12].
There are limitations to this study. First, the multi-stage sampling according to geographic distribution and the severity of the epidemic may be subject to selection bias, leading to an increased risk of extrapolating the findings to other parts of the country. Second, this study used a self-administered questionnaire, which may be subject to reporting bias. Third, this study was a cross-sectional survey and it cannot yet be assumed that the work difficulties identified were only in the context of preventing and controlling the COVID-19 epidemic.