ArticleBMJ open2026
Perception of response governance and collaborative attitude of hospital infection outbreak and their association with perceived stress among healthcare workers: a cross-sectional study in North-Eastern China.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesHealthcare-acquired infection outbreaks impose significant psychological stress on healthcare workers, yet limited research has examined stress perception and protective factors during institutional-level outbreak scenarios. Grounded in the Job Demands-Resources model, this study examines the relationships among healthcare workers' perceptions of response governance, collaborative attitudes and perceived stress, and tests the moderating role of collaborative attitudes.
designA cross-sectional study was conducted using an online questionnaire from May to October 2025.
settingHealthcare workers from hospitals in North-Eastern China.
participants1017 valid healthcare workers, including clinicians, nurses, clinical technicians, administrative personnel, support staff and others with at least 1 year of continuous employment at the hospital. Purposive and snowball sampling were used.
main outcome measuresPerception of response governance collaborative attitude towards hospital infection outbreaks and perceived stress scores were assessed using validated self-report questionnaires.
resultsThe mean perceived stress score among study participants was 2.03 (SD=0.97, range 1-5), indicating low to moderate levels. However, 11.9% of individuals still experienced high stress levels. Perception of response governance showed a significant negative correlation with perceived stress (r=-0.224, p<0.001) and the collaborative attitude towards hospital infection outbreaks also showed a significant negative correlation with perceived stress (r=-0.305, p<0.001). Hierarchical multiple regression, after adjusting for demographic covariates, showed that perception of response governance (β=-0.400, p<0.001) and collaborative attitude (β=-0.210, p=0.008) negatively predicted perceived stress, thereby increasing model explanatory power by 10.2% (ΔR²=0.102, p<0.001). Interaction analysis revealed that the interaction term between perception of response governance and collaborative attitude significantly predicted perceived stress (β=-0.202, p=0.022). Simple slope tests indicated that at higher levels of collaborative attitude, the negative predictive effect of perception of response governance on perceived stress intensified (low level: simple slope=-0.247; high level: simple slope=-0.402). Additionally, years of service between 11 and 15 years (β=0.381, p=0.012) and prior experience in managing healthcare-associated infection outbreaks (β=0.468, p<0.001) were identified as risk factors for perceived stress.
conclusionWhile most healthcare workers reported low-to-moderate stress levels, identifiable high-risk subgroups remained. Given the cross-sectional design, causal inferences cannot be drawn; however, perceived governance and collaborative attitudes showed a synergistic moderating effect on perceived stress. Administrators should implement integrated interventions combining cognitive empowerment with collaborative support to strengthen organisational resilience.
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