The subjects of this study were healthcare professionals working in township health centers of China during the COVID-19 pandemic, and each of them read a statement describing the purpose of the survey and consented to engage in this survey. Before the formal survey, we conducted a pilot test in Weifang, Shandong Province, in September 2021 using simple random sampling. In total, 200 questionnaires were distributed and 186 valid questionnaires were collected, with a valid response rate of 93.00%. In the pilot test, the mean age of healthcare professionals in township health centers was 38.43 years old, 51.08% were women, and the Cronbach’s Alpha of the questionnaire was 0.977. In addition, the data collected from the pilot test were analyzed by Exploratory Factor Analysis (EFA), and four common factors were extracted (consistent with our prespecified four factors of individual resilience, organizational resilience, perceived social support, and job performance), the cumulative variance contribution was 67.555%, the factors loading ranged from 0.502 to 0.870, and the structural validity of the questionnaire was good. A formal cross-sectional survey with the stratified random sampling method to collect data on subjects was conducted in December 2021 in Shandong Province, which is an economically developed region in eastern China, and has 16 prefecture-level cities (a prefecture-level city is an administrative level below a province and above a county). First, three prefecture-level cities were selected in Shandong Province to represent economically developed cities, economically moderate cities, and economically underdeveloped cities. Then, three counties were randomly selected in each prefecture-level city, and four to six townships were selected in each county depending on the population size. Generally, there is one township health center in a township, and we sampled around 30 healthcare professionals for the anonymous self-administered questionnaire survey in each township health center. After removing invalid questionnaires with missing data that could not be supplemented and logical errors that could not be corrected, a total of 1,266 valid questionnaires were collected, with a valid response rate of 97.38%.

First, descriptive analysis with frequencies and percentages was performed to describe the demographic characteristics of participants in this survey. Then, student’s t-test (t-test) and analysis of variance (ANOVA) were used to examine statistical differences across subgroups of demographic characteristics in scores on individual resilience, organizational resilience, perceived social support, and job performance. Pearson correlation analysis was conducted to estimate the correlations among these variables. IBM SPSS Statistics 21.0 was used for the above analyses. Finally, hypothesized relationships among individual resilience, organizational resilience, perceived social support, and job performance were validated with Structural Equation Modeling (SEM) on AMOS 21.0, using a bias-corrected bootstrap 95% confidence interval (CI) to further evaluate the significance of total, direct, and indirect effects (not including 0, significant). Additionally, fit indices of SRMR, RMSEA, AGFI, CFI, and TLI were proposed to assess model adequacy. We determined an acceptable fit using the conventional cut-off criteria of SRMR < 0.08, RMSEA < 0.08, AGFI > 0.90, CFI > 0.90, and TLI > 0.90 (Deng et al., 2018; Heiss et al., 2020). The significance level for all tests was determined as p < 0.05.

To control the data quality, the following steps were taken. In the study design stage, a formal questionnaire was formed by interpreting the relevant literature and using a pilot test. In the field research stage, the investigators were trained before the formal survey to ensure that they had a thorough understanding of the aim and content of the study. In the process of the formal survey, we assigned three to five specially trained investigators to each survey site. At least one investigator reviewed the quality of each questionnaire after it was completed. The investigators manually checked each item of the completed questionnaire to avoid omissions, mistakes, and logical errors. For example, if a healthcare professional’s age was 25 years old and his/her working tenure was written as 20 years, the investigator would re-interview the participant and ask him/her to correct it on the spot if there was a filling error, or if the same value was selected for all answers to the measured variables in the questionnaire, the investigator would ask the participant to reconfirm the accuracy of the answers. In the data collation and analysis stage, the questionnaires checked and passed were coded uniformly, and there was double-entry of data to control the quality.

Among the 1,266 healthcare professionals in township health centers who participated in this survey, most were females (70.62%) and married (83.33%). The mean age of these participants was 37.20 ± 9.20 years (ranging from 20 to 73 years old), and the majority of participants were in the age groups of 31–40 years (33.33%) and 41–50 years (34.52%). Most participants had a bachelor’s degree or higher (57.66%) and earned CNY 20,001–60,000 per year (64.61%). Nearly one-third (32.86%) of the participants have been working for more than 20 years. The majority of participants (58.29%) reported having worked 48 h or less per week. The specific information on demographic characteristics was shown in Table 1.

The means of total scores for individual resilience, organizational resilience, perceived social support, and job performance among the 1,266 participants in this study were 101.67 ± 14.29, 51.29 ± 7.88, 49.10 ± 8.37, and 37.97 ± 5.22, respectively. The means of total scores for each dimension of the variables were detailed in Table 2.

Participants in different age groups, marital statuses and weekly working hours reported different scores for individual resilience and perceived social support. Participants who were older, married, and had shorter weekly working hours had higher scores for individual resilience and perceived social support. Meanwhile, those with moderate annual incomes had a higher organizational resilience score. Participants who were older, married, held bachelor’s degrees or above, had high annual incomes, and have been working over 20 years had a higher score for job performance. The different scores across subgroups of demographic characteristics were shown in Table 3.

Individual resilience, organizational resilience, perceived social support, and job performance were correlated bilaterally. Individual resilience was positively related to organizational resilience (r = 0.619, p < 0.001), perceived social support (r = 0.634, p < 0.001), and job performance (r = 0.633, p < 0.001). Organizational resilience was positively related to perceived social support (r = 0.588, p < 0.001), and job performance (r = 0.438, p < 0.001). Perceived social support was positively related to job performance (r = 0.451, p < 0.001). More detailed correlation coefficients among the variables were presented in Table 4.

Figure 1 demonstrated the standardized path coefficients of the synthesized relationships among variables validated by SEM. The model shown in Figure 1 had a good fit (SRMR = 0.029, RMSEA = 0.074, AGFI = 0.922, CFI = 0.971, and TLI = 0.962). Table 5 with a bias-corrected bootstrap 95% CI presented the significance of the total, direct, and indirect effects. The path coefficients for all effects were significant. Organizational resilience [β = 0.409, 95% CI = (0.304, 0.495)] and perceived social support [β = 0.410, 95% CI = (0.323, 0.507)] had significant direct effects on individual resilience. Organizational resilience [β = 0.290, 95% CI = (0.222, 0.359)] and perceived social support [β = 0.291, 95% CI = (0.229, 0.371)] had significant indirect effects on job performance. Meanwhile, individual resilience [β = 0.709, 95% CI = (0.647, 0.759)] had significant direct effect on job performance.

This study was designed to explore the level of individual resilience of healthcare professionals in township health centers during the COVID-19 pandemic, and to analyze the relationships between individual resilience, organizational resilience, perceived social support, and job performance.

The score of the individual resilience for our collected sample was 101.67, showing a moderate level of resilience among healthcare professionals in township health centers during the COVID-19 pandemic, which was higher than the level of resilience reported in a study for primary care workers in Spain (Aragonès et al., 2022). Additionally, organizational resilience and perceived social support were positively associated with individual resilience, and individual resilience was positively associated with job performance, in line with the findings of previous studies (Hou et al., 2020; Riess, 2021; Shi et al., 2022). Moreover, the relationship between organizational resilience and job performance, and the relationship between perceived social support and job performance were both mediated by individual resilience.

Organizational resilience is related to the inherent and adaptive capabilities that enable organizations to detect threats, cope with disturbances, adapt and adjust to environmental changes, reduce organizational vulnerabilities to systemic risk environments, recover from adverse events, and even grow from them (Burnard and Bhamra, 2011; Jalil et al., 2021; Khalili et al., 2021). It can be understood from both static and dynamic perspectives, encompassing not only the capacity of organizations to proactively prevent risks, but also their capacity to cope with crises, bounce back from adversity, and survive in the long term (Zhang and Qi, 2021), which also has important implications for shaping individual resilience. The organizational resilience of the township health centers during the COVID-19 pandemic was at a moderate level, with a score of 51.29, and had a positive effect on individual resilience, which can be explained in the following ways.

First, resilient organizations are more likely to be taking steps before, during, and after crises to alleviate the psychological stress of healthcare professionals and enhance individual resilience (Young et al., 2021). Township health centers have been taking multiple steps during the COVID-19 pandemic to promote individual resilience by understanding the psychological status of primary healthcare professionals, monitoring individual stress responses, developing new support services and resources, rationalizing the working hours and rest times, and prioritizing individuals with special needs. Second, the organizational culture of resilience in township health centers can underpin the development of individual resilience among primary healthcare professionals. The features of leadership, effective communication, efficient policy implementation, empowerment, solidarity and cooperation, and altruism available in healthcare organizations during the COVID-19 pandemic have been noted to be associated with a culture of resilience at the organizational level, contributing to the resilience of individuals (Wu et al., 2020; Brown et al., 2021; Fleuren et al., 2021). Third, township health centers with resilience pay more attention to improving the work environment, such as through the provision of appropriate personal protective equipment and disinfection of hospital communal facilities, which alleviates anxiety about COVID-19 infection among primary healthcare professionals. The association between low anxiety levels and high resilience scores among healthcare professionals has been shown to be strong (Sakr et al., 2022).

Perceived social support is a subjective perception and assessment of the degree of support received from one’s external surroundings, such as family, friends, and significant others (Zimet et al., 1990). It allows for solving problems or regulating emotions arising from stressful events by providing tangible assistance (such as medical assistance, financial support, and useful information) or emotional values (such as empathy and belonging; Mo et al., 2020; Hofman et al., 2021). The perceived social support of healthcare professionals in township health centers during the COVID-19 pandemic was at a moderate level, with a score of 49.10, and perceived social support positively affected individual resilience, further explaining previous studies that found social support to be an important resource for healthcare professionals improving their ability to cope with stress during the COVID-19 pandemic (Aughterson et al., 2021).

Some studies reported that healthcare professionals were not fully prepared for emergencies, including the COVID-19 pandemic (Labrague et al., 2018; Labrague and De Los, 2021). Inadequate preparation can make it difficult for healthcare professionals to take on the physical and psychological stresses of a pandemic in a short period, showing vulnerability. Instrumental and informational support from significant others (such as leaders and experienced colleagues) in terms of emergency response methods, risk communication skills, and critical information findings can bridge gaps in crises preparedness for healthcare professionals and promote rational coping with and flexible adaptation to the COVID-19 pandemic and related events, which would enhance individual resilience among healthcare professionals in township health centers. Furthermore, given the fast spreading nature of COVID-19, healthcare professionals in township health centers have been forced to isolate themselves from family, friends and society, which left them feeling anxious and depressed. Emotional support from family and friends can promote positive emotions, increase confidence, alleviate anxiety and depression, and enhance hardiness and self-efficacy with individual resilience for them (Ortiz-Calvo et al., 2022; Shi et al., 2022). Additionally, work-life balance is an essential attribute of resilience (Cooper et al., 2020). Healthcare professionals in township health centers have put lots of effort into their work during the COVID-19 pandemic, with limited time allocated for family life. Family members can support healthcare professionals in achieving a work-life balance by sharing more family responsibilities, enabling primary healthcare professionals to improve their resilience.

Job performance of healthcare professionals, a key objective of organizational management, refers to their behavioral presentations and outcomes in healthcare work and is profoundly associated with individual resilience (Liu et al., 2019; Hoşgör and Yaman, 2022). The job performance of healthcare professionals in township health centers during the COVID-19 pandemic was at a moderate level, with a score of 37.97, and was affected by individual resilience.

Resilience protects individuals against various negative emotions and prevents poor psychological states such as stress, depression, and anxiety, thereby improving the professional skills and job engagement of primary healthcare professionals with a positive effect on job performance (Ojo et al., 2021; Yörük and Güler, 2021; Hoşgör and Yaman, 2022). Studies have also shown that resilient individuals are able to take control of themselves, thus avoiding transgressions in the workplace and contributing to increased productivity (Song, 2012). These viewpoints can serve to explain the positive relationship between the individual resilience and job performance of healthcare professionals in township health centers during the COVID-19 pandemic. Moreover, resilience is regarded as being related to a sense of coherence, which was defined as individuals having a dynamic feeling of confidence in being able to cope with stressful challenges (Streb et al., 2014). A strong sense of coherence enables individuals to mobilize the available resources for effective coping with stress and avoiding burnout (Levert et al., 2000), which plays a positive role in improving the job performance of healthcare professionals in township health centers. We also found that individual resilience mediated both the relationship between organizational resilience and job performance, and the relationship between perceived social support and job performance.

The individual resilience of healthcare professionals in township health centers requires long-term investment and sustained attention, rather than no longer valued as crises abate, and it should involve the joint efforts of individuals, organizations, health authorities, and society. Primary healthcare professionals have been required to acquire increased specialized knowledge and emergency management skills to adapt rapidly and cope rationally with the COVID-19 pandemic and related crisis events, and to learn from experiences in practice to improve their individual confidence and self-efficacy. Meanwhile, healthcare professionals are encouraged to relieve negative emotions through reflective journaling, thoughts sharing, and mindfulness training, to develop hardiness and promote individual resilience by accepting their limitations, finding meaningful objects in life, and learning to grow in life experiences (Bonanno, 2004).

Building organizational resilience and fostering the individual resilience of primary healthcare professionals should be a priority for healthcare organizations. Firstly, organizations should take the COVID-19 pandemic as an opportunity to improve the capacity to monitor and predict risks, develop emergency plans and conduct simulation exercises, and strengthen organizational teamwork, with the aim of crisis prevention and preparedness. Secondly, organizations are expected to bounce back rapidly from crises and achieve a new development stage. Thirdly, during a pandemic, organizations should develop the individual resilience of primary healthcare professionals at the organizational level by monitoring their health status, providing technical guidance, offering targeted support programs and creating an optimal working environment. Additionally, in the early stages of a pandemic, organizations need to redeploy staffing structures, form a flexible shift schedule, optimize the workflow, and guarantee adequate rest time for primary healthcare professionals (Johal et al., 2021), with a view to improving individual adaptation to the stressful environment, attending to their the mental state and enhancing resilience. What’s more, it is recommended that health authorities and society provide instrumental and emotional support for healthcare professionals during the pandemic to enhance resilience in terms of sharing information, stocking, providing adequate emergency supplies, and offering medical support and emotional value when necessary.

Although this study provides an important reference for enhancing the individual resilience of primary healthcare professionals during the COVID-19 pandemic, some limitations were noted. Firstly, the data in this study were from one province in eastern China, rather than being representative of the national situation, so we will consider taking one province in central China and one province in western China in a future study, to obtain a more comprehensive understanding of the resilience of healthcare professionals in township health centers during the COVID-19 pandemic. Secondly, several limitations were imposed by the nature of the study design. The cross-sectional survey meant that causal relationships between variables could not be proven, and the adoption of self-reported methods for collecting data implied that social desirability effects due to observation bias were unavoidable. In future studies, we will incorporate a combined qualitative and quantitative approach for the study design and the collection of sample data from multiple subjects. Finally, we expect to include more individual factors (such as demographic information, personal characteristics, and resources available to the individual) in the analysis of factors influencing individual resilience.