Evaluating Community Capability to Prevent and Control COVID-19 Pandemic in Shenyang, China: An Empirical Study Based on a Modified Framework of Community Readiness Model

Abstract

Community plays a crucial role in the successful prevention and control of the COVID-19 pandemic in China. However, evaluation of community capability to fight against COVID-19 is rarely reported. The present study provides a first attempt to assess community capability to combat COVID-19 in Shenyang, the capital city of Liaoning province in Northeast China, based on a modified framework of a community readiness model. We conducted semi-structured interviews with ninety key informants from fifteen randomly selected urban communities to collect the data. The empirical results indicate that the overall level of community capability for epidemic prevention and control in Shenyang was at the stage of preparation. The specific levels of the fifteen communities ranged from the stages of preplanning to preparation to initiation. Concerning the level of each dimension, community knowledge about the issue, leadership, and community attachment exhibited significant disparities between communities, while there were slight differences among communities on community efforts, community knowledge of efforts, and community resources. In addition, leadership demonstrated the highest overall level among all the six dimensions, followed by community attachment and community knowledge of efforts. Community resources displayed the lowest level, followed by community efforts. This study not only extends the application of the modified community readiness model to evaluate community capability of epidemic prevention in the Chinese community context, but also offers practical implications for enhancing Chinese communities’ capabilities to deal with various future public health emergencies.

Full text

Citation: Zhang, X.; Liu, X.; Wang, L.
Evaluating Community Capability to
Prevent and Control COVID-19
Pandemic in Shenyang, China: An
Empirical Study Based on a Modified
Framework of Community Readiness
Model. Int. J. Environ. Res. Public
Health 2023,20, 3996. https://
doi.org/10.3390/ijerph20053996
Academic Editor: Paul B. Tchounwou
Received: 13 November 2022
Revised: 16 February 2023
Accepted: 21 February 2023
Published: 23 February 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
International Journal of
Environmental Research
and Public Health
Article
Evaluating Community Capability to Prevent and Control
COVID-19 Pandemic in Shenyang, China: An Empirical Study
Based on a Modified Framework of Community
Readiness Model
Xiaojie Zhang 1, * , Xiaoyu Liu 1and Lili Wang 2
1Department of Public Administration, School of Humanities & Law, Northeastern University,
Shenyang 110169, China
2Party School of Weihai Municipal Committee of Communist Party of China, Weihai 264213, China
*Correspondence: zhangxiaojie@mail.neu.edu.cn; Tel.: +86-151-4004-9065
Abstract:
Community plays a crucial role in the successful prevention and control of the COVID-19
pandemic in China. However, evaluation of community capability to fight against COVID-19 is
rarely reported. The present study provides a first attempt to assess community capability to combat
COVID-19 in Shenyang, the capital city of Liaoning province in Northeast China, based on a modi-
fied framework of a community readiness model. We conducted semi-structured interviews with
ninety key informants from fifteen randomly selected urban communities to collect the data. The
empirical results indicate that the overall level of community capability for epidemic prevention
and control in Shenyang was at the stage of preparation. The specific levels of the fifteen commu-
nities ranged from the stages of preplanning to preparation to initiation. Concerning the level of
each dimension, community knowledge about the issue, leadership, and community attachment
exhibited significant disparities between communities, while there were slight differences among
communities on community efforts, community knowledge of efforts, and community resources. In
addition, leadership demonstrated the highest overall level among all the six dimensions, followed
by community attachment and community knowledge of efforts. Community resources displayed
the lowest level, followed by community efforts. This study not only extends the application of the
modified community readiness model to evaluate community capability of epidemic prevention
in the Chinese community context, but also offers practical implications for enhancing Chinese
communities’ capabilities to deal with various future public health emergencies.
Keywords:
community capability; COVID-19; community readiness model; community attach-
ment; China
1. Introduction
The coronavirus disease 2019 (COVID-19) pandemic, which first broke out at the end
of 2019 in China [
1
], was called a “public health emergency of international concern” by the
World Health Organization because of its high infection and mortality rate [
2
]. It has caused
global social disruption and economic recession and continues to pose a major threat to
public health. As of 2 December 2022, over 639 million people have been infected; of these,
6.6 million deaths, an unprecedented rate of spread around the world [
3
]. While the losses
of the pandemic are numerous, many countries are still struggling to prevent and control
the COVID-19 disease. China was the first country to identify and report a confirmed case,
and it has effectively controlled the wide spreading of the pandemic through strict and
effective measures since the first outbreak of COVID-19 in Wuhan of China up until the
Chinese government deregulated the epidemic control in December 2022. The number
of deaths due to the infection of COVID-19 is fewer than 32,000 in China since the first
outbreak of the pandemic [4].
Int. J. Environ. Res. Public Health 2023,20, 3996. https://doi.org/10.3390/ijerph20053996 https://www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2023,20, 3996 2 of 19
During the process of the COVID-19 prevention and control in China, communities
played a crucial role in implementing government policy, mobilizing public participation,
and providing public service. For example, communities set up checkpoints at the entrances
of the blockaded communities and provided the necessities of life for residents [
5
,
6
], helped
organize and conducted large-scale community-based biotechnology testing of COVID-
19, offered medical assistance, provided isolation rooms for suspected cases or those
who came from the epidemic areas, disinfected public spaces regularly, recruited and
trained volunteers, disseminated anti-epidemic knowledge, and provided psychological
counseling [
7
]. A few studies have shown that these measures taken by communities
effectively reduced the risk of the COVID-19 outbreaks [
8
–
11
]. However, the performance
of communities in the pandemic prevention and control varies widely in China. Some
communities can provide efficient and effective preventive services while others cannot.
Some communities have offered sufficient and satisfactory residents’ demand-oriented
services while other counterparts have not. The variation of the performance is mainly
due to the different levels of communities’ preventive and controlling capabilities [
12
].
As a result, the main questions that this research addresses are (i) How can community
capability be evaluated in China? and (ii) What are the levels of community capability for
epidemic prevention and control in China?
Community capability, also called community capacity [
13
], refers to the residents’
ability to collectively affect community opportunities [
14
]. According to George et al.,
community capacity refers to the combined influence of a community’s social systems
and collective resources, which is generally applied to address community problems and
broaden community opportunities [
15
]. Since the community is not a passive recipient of
outside influences but an active initiator in the effort to achieve specific goals [16], Chavis
emphasized more the initiative in the defining process. Chavis identified community
capacity as “the ability to develop, mobilize, and use resources to manage change” [
17
].
With the emphasis on community capacity increasing, assessing community capability has
emerged rapidly from the fields of community participation and development in recent
years. Brock et al. maintained that the development of capability assessment allows the
community to understand its strengths and room for further improvement [18].
Previous research has addressed a few assessment frameworks that are used directly
or adapted slightly in evaluating community capability. For example, the NSW Health
Capacity Building Framework is frequently used to evaluate community capacity in public
health management [
19
,
20
]. The framework provides a guide for enhancing the capability
of the community system to improve health [
21
]. Goodman et al. constructed a ten-
dimension evaluative framework of the community capacity, and subsequent studies
further verified the validity of some dimensions and also highlighted the importance of
others, such as cultivation of leadership [
22
,
23
]. Liu constructed an evaluation index based
on Chinese communities’ characteristics, which involves six dimensions, i.e., community
participation, community consciousness, horizontal and vertical interaction, leadership,
problem assessment ability, and resource mobilization ability [
24
]. Lee also developed a
six-dimension scale for assessing community capacity. It is comprised of leadership and
organization, administrative management, resource mobilization, residents’ participation,
collaborative work and network, and public relations and initiatives [25].
It is clear that there are some common indices within those evaluative frameworks.
They are community leaders who can initiate mobilization, partnerships of community
connectedness and concern, the availability of and access to internal and external resources,
and linkages and networks that can facilitate collective action [
26
]. Most of these common
indices are incorporated in the community readiness model (hereafter CRM), which is
based on structured interview guidelines and scoring systems. The model is widely used
to evaluate communities’ preventive ability in drug and alcohol, intimate partner violence,
childhood obesity, cardiovascular disease, HIV/AIDS, and cancer prevention
[27–30]
,
demonstrating high validity and wide applicability. Furthermore, the CRM can help
theorists and practitioners have a deep understanding of community capability from the

Int. J. Environ. Res. Public Health 2023,20, 3996 3 of 19
perspective of group dynamics [
31
]. The application of the key informant method inherent
in the model contributes to better knowledge of the practical progress of the targeted
intervention programs in the communities. In addition, the model provides an easily
operationalized measurement tool for scholars and accurate intervention strategies for
policymakers to push the community to change.
With regard to studies assessing community readiness for COVID-19 prevention,
Adane et al. evaluated community readiness level for COVID-19 pandemic prevention
in the Awi Zone of northwest Ethiopia by employing four evaluative criteria including
residents’ knowledge, vulnerability perception, attitude, and practice towards prevention
measures [
32
]. Bumyut et al. used the CRM to estimate the community readiness for
implementation of the Safety and Health Administration for COVID-19 prevention in the
tourism community of Southern Thailand [33].
Previous studies focused mainly on the establishment of evaluation frameworks and
the adoption of those frameworks to assess community capability of mobilizing and taking
action to prevent chronic disease, serious disease, addictive behavior, domestic violence,
and health promotion. Very few studies evaluated community capability to deal with the
worldwide COVID-19 epidemic [
33
]. As far as we know, no studies have been published to
evaluate community ability to deal with public health emergencies including COVID-19 in
China. Therefore, the main purpose of this study is to estimate community capability to
prevent and control the COVID-19 pandemic in China by employing a modified framework
of the widely used CRM.
2. A Modified Framework of the CRM
The CRM was originally developed by the Tri-Ethnic Center for Prevention Research
at Colorado State University to measure a community’s level of readiness to implement a
prevention program [
34
,
35
]. The aim of constructing this theoretical model is to identify
whether a local prevention program can be effectively and successfully carried out and
supported by a community, and to offer strategies to help communities’ mobilization for
better changes. The original CRM includes five dimensions of readiness: (a) community
efforts, (b) community knowledge of the efforts, (c) leadership, (d) community knowledge
about the problem, and (e) funding for community efforts [
35
,
36
]. In the subsequent devel-
opment of the theory, the fifth dimension “funding for community efforts” was changed
to “resources for community efforts”, in order to incorporate other important resources
besides money, including people, time, space, and other factors that also influence commu-
nity efforts. A sixth dimension called community climate, which refers to characterization
of a community, was also added according to the suggestions of community members,
who participated in a workshop where the model was presented. These dimensions cover
a variety of aspects that can help guide a community in moving their readiness levels
forward [29].
The CRM divides community readiness level into nine stages that range from “commu-
nity tolerance or no awareness of the issue” to “a high level of community ownership”. The
nine stages of readiness are (a) community tolerance or no awareness, (b) denial/resistance,
(c) vague awareness, (d) preplanning, (e) preparation, (f) initiation, (g) institutionaliza-
tion or stabilization, (h) confirmation/expansion, and (i) professionalization [
27
,
34
]. The
specific definition of each stage, which can also be used as an “anchored statement” to
evaluate community readiness level, is shown in Table 1. Specifically, stage 1 to stage 9
represents a continuum of low to high level of community readiness to implement a specific
program. Stage 1, which corresponds to the anchored scales score of 1, means the lowest
level, while stage 9 corresponding to the scales number of 9 means the highest level. Once
the stage of community readiness is identified, intervention strategies can be formulated
and implemented to raise levels of community readiness [37].

Int. J. Environ. Res. Public Health 2023,20, 3996 4 of 19
Table 1. Stages of community readiness/capability.
Stage of Readiness Description Scores Capability Level
Stage1 Community tolerance Communities and leaders have no awareness of the
problem (or it may truly not be an issue). 1 Low
Stage2 Denial/Resistance Few residents recognize that the issue is a concern, but
there is little recognition that it might be occurring locally. 2
. . . . . .
. . . . . .
Stage3 Vague awareness The majority feel that there is a local concern, but there is
no immediate motivation to do anything about it. 3
Stage4 Preplanning There is clear recognition that something must be done,
but no efforts or specific plan has been done. 4
Stage5 Preparation
Active leaders begin planning in earnest, community
climate offers modest support of efforts, various
community resources are ready to put into use.
5
Stage6 Initiation Activities are underway, and active community members
begin to participate in the plan. 6
Stage7 Institutionalization/
Stabilization
Activities are supported by administrators or community
policymakers, resources, personnel and policies are
fully equipped.
7
Stage8 Confirmation/
expansion
With good results from the efforts, the community is prone
to scale up its efforts and evaluate the project experience. 8
Stage9 Professionalization
The community has sophisticated understanding of the
problem, highly trained staff are in place. Effective
evaluation can be done during this stage.
9 High
Adapted from Edwards et al. (2000) [35].
Since the creation of the CRM, it has been extensively used to identify the level of
community readiness to develop and implement prevention and treatment programs for ad-
dressing a variety of problems ranging from environmental problems such as air and water
pollution, litter, and recycling; health and nutritional problems such as obesity, cancer, drug
and alcohol abuse, cardiovascular disease, and sexually transmitted diseases; to social prob-
lems such as violence, transportation safety, poverty, and homelessness
[27,29,30,35,38–41]
.
The wide application of this model demonstrates its appropriateness, effectiveness, and
high diagnostic power in determining the stages of community readiness and enhancing
its level to deal with a wide range of problems. As community readiness is often used
interchangeably with community capability [
23
], and CRM has been shown to be a very ef-
fective tool for building community capability [
42
], we chose to adopt the CRM to evaluate
community capability to prevent and control the COVID-19 pandemic in China. We also
used community readiness and community capability in the same sense.
With the continuously extended application of the CRM, it has evolved over time and
became a flexible organic system that can be adapted to new and different problems [
36
].
According to Kostadinov et al. [
43
], in order to better tailor the model to the subject area
and particular community, scholars make both minor modifications, including modifying
the methodology and interview scripts, and substantial changes, including removing or
adding the core questions, changing dimensions, adding new dimensions, and altering
existing dimensions. For example, Apriningsih et al. examined the school readiness for
the implementation of a school-based Weekly Iron Folic Acid Supplementation Program
by integrating the social ecological model into the CRM [
44
]. York et al. substituted a new
political climate dimension for the knowledge of existing efforts dimension [
45
]. Jason
et al. divided the community climate dimension into town climate and police department
climate, in order to reflect the differences between two sections of the community [
46
].
Gansefort et al. combined the community efforts and the community knowledge of the
efforts into one single dimension [
47
]. Bumyut et al. removed the community efforts
dimension when evaluating the community readiness for effective implementation of
COVID-19 prevention measures [
33
]. Liu et al. also removed community efforts in assessing
community readiness for disseminating evidence-based physical activity programs to older
adults [48].

Int. J. Environ. Res. Public Health 2023,20, 3996 5 of 19
The studies mentioned above indicate that modifications to the CRM are widely
accepted and employed to make the model better fit the community, the subject area, and
the particular issue. Just as Jumper-Thurman et al. addressed, “the model is a research-
based tool” [
49
]. In this study, we substitute community attachment for the community
climate dimension to better tailor the model to the Chinese community and the COVID-19
pandemic issue. The community climate is originally defined as the level of community
support for specific programs, such as the opportunities, policies, services or staffs, and so
on [
50
]. In its subsequent application to measure community readiness, it mainly refers
to community attitudes [
51
] and is defined as prevailing attitudes within the community
concerning the issue [
28
]. The measuring questions of community climate focus mainly
on community members’ attitudes toward the issue, the primary obstacles to community
efforts, community members’ support on efforts to address the issue, and the circumstance
in which community members tolerate the issue. Most of the measures are similar to
the measures of community knowledge of efforts, resources, and community knowledge,
especially in the Chinese context. For example, measurements of community members’
support and the primary obstacles can be covered by the measures of resources, and the
measurement of community attitudes can be substituted by the measures of community
knowledge. Therefore, we remove the dimension of community climate.
Simultaneously, we add the community attachment dimension. Community attach-
ment refers to the feeling of being part of a group that is a source of security and a kind of
emotional connection with the community [
52
]. Attachment also implies that this sense
of belonging is positively evaluated, and that one is happy and proud to belong to the
community and will take on more responsibility in the community [
53
]. Community attach-
ment significantly impacts residents’ participation in community activities of improving its
members’ well-being and addressing social needs and other urban issues [
54
]. A number
of prior studies have demonstrated the importance of community attachment in explaining
community participation and satisfaction [
55
–
59
]. For example, community attachment or
the sense of community has been shown to significantly predict residents’ involvement in
substance abuse prevention activities [
60
]. Since community participation is an essential
element of community capability, the community attachment is thus added, in order to
enhance the applicability, appropriateness, and explanatory power of the CRM to evaluate
community capability to prevent and control the COVID-19 pandemic in China.
3. Materials and Methods
3.1. Design and Sample
In this study, community refers to the jurisdiction of the community neighborhood
committees. To assess the level of community capability for COVID-19 prevention and
control in China, we selected two communities randomly in each of the nine administrative
districts in Shenyang, the capital city of Liaoning Province in Northeast China. The reasons
why we chose the city of Shenyang as the targeted research area were as follows.
First of all, Shenyang is the most important central city in Northeast China. It has
a population of 9.118 million and is classified as a mega-city region by the Central Peo-
ple’s Government of China. Conducting a case study of Shenyang could provide some
community governance experiences and intervention strategies to enhance community
capability to cope with various public health emergencies to other similar mega-cities.
Secondly, Shenyang has experienced several serious outbreaks of the COVID-19 pandemic
since 2020 and the communities in the city have made tremendous efforts in effectively
fighting against the epidemic. Therefore, the communities in Shenyang are representative
in the implementation of epidemic prevention and control programs. Evaluating the com-
munity capability in Shenyang may contribute to a better understanding of a variety of
strengths and weaknesses of the communities and their readiness to prevent and control
the epidemics.
After choosing the targeted research communities, we adopted the qualitative ap-
proach to assess the community capability level of the prevention and control of COVID-19.

Int. J. Environ. Res. Public Health 2023,20, 3996 6 of 19
Key informants’ interview and anchor scoring method were both used to obtain the re-
search data and identify the accurate capability level, the details of which are displayed in
Sections 3.2 and 3.3.
3.2. Data Collection
The CRM is used to evaluate a community’s level of readiness through a semi-
structured interview of key informants. Key informants are formal and informal com-
munity leaders or decisionmakers who can provide comprehensive and informed opinions
about various problems in the community. They represent different sectors of communities
and have extensive experience of working with their communities. The criteria of key
informant selection in this study are as follows: (1) at least one year of work experience
in the community neighborhood committees or living in the community for more than
three years; (2) deeply involved in the COVID-19 prevention and control; and (3) willing
to participate in the study. Six key informants in each community were selected. Finally,
ninety key informants from fifteen communities, including Communist Party of China com-
munity neighborhood committee secretaries, community workers, community volunteers,
and community elites, were interviewed to acquire the qualitative research data. These
interviewees had the best understanding of what happened in the communities and what
the communities had done to prevent and control the COVID-19 pandemic.
To ensure the quality of the interview, we developed the final interview outline based
on the instructions of the Tri-Ethnic Center, and we also conducted some pre-interviews to
modify the outline to make it more suitable to the Chinese community context and more
comprehensible for the key informants. The final modified interview outline is shown in
Table 2.
Table 2. Interview outline.
A. Existing Community Efforts and B. Community Knowledge of the Efforts
Q1: What efforts are currently available in your community that relate to combating the COVID-19 epidemic? For example, rules,
regulations, programs and so on. Please explain.
Q2: How long have these policies or rules been operating in your community?
Q3: Who are served by these efforts?
Q4: How are these efforts implemented?
Q5: Do you know what emergency infrastructure has been built or planned to be constructed in your community? Can you give
an example?
Q6: If a person does not follow the relevant policies about COVID-19 prevention and control, will he or she be punished?
Q7: Is there a need to expand existing efforts about the COVID-19 prevention and control? If no, why not?
Q8: How are existing efforts viewed by the community members?
Q9: Are there plans to expand or develop new activities to fight against COVID-19?
Q10: Using a scale from 1 to 10, how aware are people in the community of these efforts, with one being no awareness and ten
being very aware? Please explain.
C. Leadership
Q11: Do you know who the leaders in your community are?
Q12: Who or which group is mainly responsible for epidemic prevention and control?
Q13: Are there some informal leaders whose opinions are respected or some influential people who were contacted when the
COVID-19 broke? Explain how they become “leaders”?
Q14: Do the leaders attach great importance to the prevention and control of the COVID-19 epidemic?
Q15: Are these leaders in your community involved in formulating and implementing prevention measures? Please explain how
and what measures they are involved in?
Q16: Are there any community organizations involved in the COVID-19 prevention and control?
Q17: Using a scale from 1 to 10, how much of a concern is the issue of COVID-19 prevention and control to the leadership in your
community, with one being not at all and ten being of great concern? Please explain.

Int. J. Environ. Res. Public Health 2023,20, 3996 7 of 19
Table 2. Cont.
D. Community Knowledge about the Issue
Q18: What public health emergencies have you experienced or learned about, and can you give some examples?
Q19: Do you know who is more vulnerable to the COVID-19 epidemic?
Q20: Do you know the symptoms of the COVID-19 epidemic?
Q21: Do you know the impact of the COVID-19 epidemic on our life and productivity?
Q22: Has your community set up some channels to understand and prevent the COVID-19?
Q23: Is there information available on the extent of the COVID-19 epidemic spreading? If yes, from whom?
Q24: Do the authorities release any information about the COVID-19 outbreak? Is it timely?
Q25: Using a scale from 1 to 10, how much do community members know about COVID-19 in your community, with one being not
at all and ten being a lot? Please explain.
E. Community Resources
Q26: Do you know the source of community funds that are mainly invested in the prevention and control of COVID-19?
Q27: When COVID-19 broke out, how did the community obtain relief goods, funds, or professional relief talents? Is the
community taking full advantage of them?
Q28: What resources has the community invested in combating COVID-19?
Q29: What is the community’s attitude about supporting prevention efforts with either people, money, time, or space?
Q30: What is the level of expertise and training among those working toward prevention of the COVID-19 epidemic?
Q31: Whom would an individual infected with COVID-19 turn to first for help, and why?
F. Community Attachment
Q32: What is the size of your community? How long have you worked (lived) in it? Are you satisfied with the current community
efforts to prevent and control COVID-19?
Q33: Do most community members participate in one or more non-governmental organizations or clubs?
Q34: Are there any nongovernment organizational volunteers involved in the prevention and control of the COVID-19 epidemic?
Q35: When community members are in trouble, do they turn to their communities for help?
Q36: Have you ever made suggestions to community neighborhood committees to improve the community capability level of
COVID-19 prevention and control?
Q37: Are community members cooperating well in the fight against the COVID-19 epidemic?
Q38: Do community members actively participate in the community volunteer service for epidemic prevention and control?
Q39: What are the factors that affect the participation or cooperative behaviors of the community members?
Q40: Using a scale from 1 to 10, please score how close the connection is between community members and the community, with
one being not at all and ten being very close.
The semi-structured interviews with the community key informants were conducted
from April to June in 2022. Due to the COVID-19 pandemic, all the interviews were
conducted by telephone separately. At the beginning of the formal interview, we ensured
that all interviewees had a full understanding of the purpose and process of the research,
and we also informed all interviewees that the interview was confidential. Moreover, we
obtained the electronic signatures of the interview participants on the informed consent
form for the use of the research data. Finally, each interview lasted for about thirty to
forty-five minutes, and the interviews were fully audio-taped and transcribed verbatim for
subsequent analysis.
3.3. Data Analysis
Firstly, according to the instructions given by the Tri-Ethnic Center, anchor scoring
method was used to evaluate the specific capability level of different communities. Since
the statements of the anchor rating scale were rooted in the Western community context,
the contextual differences between China and the West may lead to biased evaluation to a
certain extent. Thus, we adjusted the anchor sentences according to experts’ advice, the pre-
surveys, and Chinese language expressions. For the newly added dimension of community
attachment, we developed the anchor sentences based on the studies of Castañeda et al.
and Foster-Fishman [
61
,
62
], and the instructions of scoring dimensions by the Tri-Ethnic
Center. The final anchor rating scale is shown in Table 3.

Int. J. Environ. Res. Public Health 2023,20, 3996 8 of 19
Table 3. Anchor rating scale.
A. Existing Community Efforts
1. No awareness of the need for efforts to combat the COVID-19 epidemic in any capacity.
2. No efforts to prevent and control the COVID-19 epidemic. For example, plans, policies, etc.
3. A few individuals recognize the need to initiate some types of efforts, but there is no immediate motivation to do anything.
4. Some community members have met and begun a discussion of developing community efforts to combat the
COVID-19 epidemic.
5. Policies and contingency items responding to the COVID-19 emergency have been put on the agenda, and community workers
are also being trained.
6. Policies and resources are being prepared and the COVID-19 emergency response programs are being implemented.
7. Some plans, policies, emergency management programs have been in operation for several months and will continue to operate,
but no new programs are expected.
8. Several different plans, policies, emergency management programs are running in the community with a wide range. New
efforts are being developed based on evaluation data.
9. The community evaluates the effectiveness of different plans, policies and emergency management projects, and makes
continuous improvements based on the evaluation results.
B. Community Knowledge of the Efforts
1. Community has no knowledge of the need for efforts to prevent and control the COVID-19 epidemic.
2. Community has no knowledge about efforts to prevent and control the COVID-19 epidemic.
3. A few community members heard about the COVID-19 emergency contingency plans, policies, emergency management
programs, but have no real information on what they do and how.
4. Some leaders actively seek information about the plans, policies and emergency management programs of the COVID-19
prevention and control.
5. The community members have general knowledge of the COVID-19 emergency management plans, policies and projects, the
leaders and the people involved.
6. An increasing number of community members have knowledge of local efforts and are trying to increase the knowledge of the
general community about these efforts.
7. There is evidence that the community has specific knowledge of local efforts in the process of COVID-19 prevention and control,
including contacting persons, training of staff, clients involved, etc.
8. Most community members have an in-depth understanding of the community emergency management plans, policies and
projects, and have professional knowledge about the COVID-19 emergency.
9. Community has knowledge about program evaluation data on how well the different local efforts are working and their benefits
and limitations.
C. Leadership
1. Leadership has no awareness about the problem of COVID-19 epidemic.
2. Leadership believes that COVID-19 epidemic is not a problem in our community.
3. Leader(s) recognize(s) the need to do something to prevent and control the COVID-19 epidemic.
4. There are identifiable leaders who start trying to do something, such as a meeting to discuss the COVID-19 epidemic prevention
and control.
5. Leaders are part of a committee or group that addresses the prevention and control of the COVID-19 epidemic.
6. Plans for preventing and controlling the COVID-19 epidemic are running and supported by the committee leaders, but there is
lack of cooperation.
7. Community leaders are strong supporters of plans for preventing the COVID-19 epidemic and are considering resources
available for self-sufficiency.
8. Community leaders support a variety of emergency response programs, with staff well-trained, community leaders and
volunteers actively involved. Independent assessment teams are running.
9. Leaders are continually reviewing evaluation results of the efforts and are modifying support accordingly.

Int. J. Environ. Res. Public Health 2023,20, 3996 9 of 19
Table 3. Cont.
D. Community Knowledge about the Issue
1. Few community members consider the COVID-19 epidemic to be a problem or that it would cause problems.
2. Only a few community members have some knowledge about COVID-19, while many community members have
misconceptions about the epidemic.
3. A few community members have basic knowledge of the COVID-19 epidemic and recognize that some people here may be
affected by the epidemic.
4. Some community members have basic knowledge (causes, consequences, signs and symptoms) and recognize that the COVID-19
epidemic occurred locally, but access to information is lacking.
5. Some community members have basic knowledge of COVID-19. General information on COVID-19 is available.
6. A majority of community members have basic knowledge of COVID-19, including modes of transmission, means of prevention,
understanding of high-risk groups and behaviors. Specific local data on COVID-19 is available.
7. Community members have knowledge of, and access to, detailed information about local prevalence of COVID-19.
8. Community members have substantial knowledge about the prevalence, causes, risk factors and consequences of the
COVID-19 epidemic.
9. There is detailed information on local and national changes about the COVID-19 epidemic; and community members know a lot
about the effectiveness of local prevention measures.
E. Community Resources
1. There are no resources available for the prevention and control of the COVID-19 epidemic.
2. There are very limited resources available that could be used for the COVID-19 prevention and control. There is no action to
allocate these resources to the preventive efforts.
3. There are some resources that could be used for the COVID-19 prevention and control. There is little action to allocate these
resources to the preventive efforts.
4. There are some resources (individuals, organizations, and/or space) identified that could be used for the COVID-19 prevention
and control. Some community members or leaders have looked into or are looking into using these resources to prevent and control
COVID-19.
5. The various resources needed to prevent and control the COVID-19 epidemic are known. Some community members or leaders
are actively working to secure these resources, and funding proposals have been prepared, submitted and may be approved.
6. New resources have been obtained and/or allocated to support further efforts to fight COVID-19.
7. Much of the support comes from local sources, but they are uncertain and unsustainable. Community members and leaders are
beginning to look at continuing efforts by accessing additional resources.
8. Diversified resources and funds are secured and efforts are expected to be ongoing. There is additional support for further
preventive efforts.
9. There is continuous and secure support for programs and activities related to the COVID-19 prevention and control, and there
are substantial resources for trying new preventive efforts.
F. Community Attachment
1. Community members feel no attachment with their community.
2. Very few community members feel attached to their community. Most community members think that preventing and
controlling the COVID-19 epidemic is of non-relevance with them.
3. A few community members feel attached to their community and have a sense of responsibility to participate in the COVID-19
prevention and control but think that “there is nothing we can do”.
4. A few community members feel attached to their community and think that they should do something together to combat
COVID-19, but don’t know what to do.
5. Some community members get close connections with their community, and they are planning to be united to combat the
COVID-19 epidemic.
6. Some community members have close connections with their community and make some cooperative efforts to combat
COVID-19.
7. Some community members feel highly attached to their community. They make cooperative efforts through a variety of channels
to fight against the COVID-19 pandemic.
8. The majority of community members feel attached to their community. They trust the community leaders and devote cooperative
efforts to support the COVID-19 pandemic prevention and control.
9. The majority of community members feel highly attached to their community. They have high sense of responsibility to
participate and actively involved themselves in the cooperative efforts to fight against the COVID-19 epidemic. Community
members and leaders trust and understand each other.
Secondly, two raters analyzed and scored the qualitative data obtained from the
interviews of the 90 key informants independently based on the modified anchoring rating
scale (see Table 3). As the anchored scales define each dimension by using a 9-point

Int. J. Environ. Res. Public Health 2023,20, 3996 10 of 19
rating scale, with 1 representing the lowest levels of capability for that dimension and 9
representing the highest levels of capability, the raters finally scored each interview from 1
to 9 for the 6 dimensions, respectively. In order to ensure the reliability of the rating process,
discussions of the items or phrases were made when disagreement occurred, and a third
rater was invited to repeat the scoring until reaching a consensus.
Finally, we summed the consensual scores of the six key informants in every com-
munity and averaged them to calculate a final score for each dimension. The overall
capability level of a community was determined by calculating the average scores of the
six dimensions, and the overall level of each dimension for all communities under study
was obtained by averaging the dimensional score of every individual community. All the
averages were rounded down to generate whole numbers, which were used to identify the
overall as well as specific dimensional levels of community capability.
4. Results
4.1. Sample Characteristics
The majority of the key informants were female (N = 52), accounting for about 58% of
the total 90 interviewees. As for occupation, about 40% of the respondents (N = 37) were
secretaries of the community neighborhood committees, who were regarded as the formal
or official heads of the urban communities in China. The second largest number of the
respondents were the volunteers in COVID-19 prevention (N = 24). There were also 18
community elites and 11 medical workers participating in the interviews. Moreover, the
age of most of the respondents was 30 to 50 years, with the oldest being 54 years old. More
than 50% of the key informants have lived in their communities for more than 5 years.
4.2. Overall Level of Community Capability
Figure 1and Table 4show the final community capability scores and levels of each
dimension, respectively. On the whole, we found that the average capability score (ACS)
of the total 15 communities was 4.97, which means that the overall level of community
capabilities to prevent and control the COVID-19 pandemic in the city of Shenyang was
located at the stage of preparation. Furthermore, the capability scores of the 15 communities
ranged from 4.28 to 5.61, which indicates that their levels were mainly distributed in the
stages of preparation, preplanning, and initiation.
Int. J. Environ. Res. Public Health 2023, 20, x FOR PEER REVIEW 11 of 20
Figure 1. Community capability level.
Table 4. Community readiness scores.
Community Knowledge
of Issues Efforts Knowledge
of Efforts Leadership Resources Attachment Average Stage
A 5.67 4.67 5.83 6.67 4.83 5.50 5.53 Initiation
B 5.17 4.67 5.50 5.67 4.67 5.83 5.25 Preparation
C 4.50 4.50 5.17 5.50 5.00 5.83 5.08 Preparation
D 4.83 5.33 5.67 6.83 5.00 6.00 5.61 Initiation
E 4.50 3.83 4.83 5.83 4.00 4.50 4.58 Preparation
F 4.33 4.33 5.17 5.00 4.17 5.33 4.72 Preparation
G 6.00 4.83 5.50 6.83 4.67 5.67 5.58 Initiation
H 4.17 4.50 5.00 6.17 4.33 5.17 4.89 Preparation
I 3.67 4.33 4.83 5.33 3.83 4.50 4.42 Preplanning
J 3.67 3.83 4.50 5.17 3.67 4.83 4.28 Preplanning
K 4.67 4.50 5.00 5.67 4.17 5.00 4.83 Preparation
L 4.50 4.17 4.50 4.83 4.33 4.33 4.44 Preplanning
M 6.00 4.33 4.83 5.83 3.83 4.50 4.89 Preparation
N 6.67 4.33 5.17 6.67 4.83 5.50 5.53 Initiation
O 4.67 4.33 4.83 5.83 4.00 5.50 4.86 Preparation
Average 4.87 4.43 5.09 5.86 4.36 5.20 4.97 Preparation
Specifically, 26.67% of the evaluated communities were in the initiation stage, which
demonstrates that a quarter of the communities in the city had taken some measures or
considerable efforts to control and prevent the pandemic, and some active community
members began to participate in the relevant programs. About 20% of the communities
stayed in the preplanning stage, which means that there was recognition of the serious-
ness of the COVID-19 pandemic and the need to take some actions, but there were no
concrete plans about how to control and prevent it. Moreover, no efforts or specific plans
had been made to deal with the epidemic. More than 50% of the communities were found
in the preparation stage, indicating that more than half of the communities were planning
to solve the problem, which means that active leaders began to take some actions or for-
mulate some schemes to fight against the disease and various resources were ready to put
into use.
4.3. Overall Average Level of Each Dimension
Figure 2 displays visually the average scores for each dimension of the community
readiness. Leadership, with an average score of 5.86, received the highest score among all
Figure 1. Community capability level.

Int. J. Environ. Res. Public Health 2023,20, 3996 11 of 19
Table 4. Community readiness scores.
Community Knowledge
of Issues Efforts Knowledge
of Efforts Leadership Resources Attachment Average Stage
A 5.67 4.67 5.83 6.67 4.83 5.50 5.53 Initiation
B 5.17 4.67 5.50 5.67 4.67 5.83 5.25 Preparation
C 4.50 4.50 5.17 5.50 5.00 5.83 5.08 Preparation
D 4.83 5.33 5.67 6.83 5.00 6.00 5.61 Initiation
E 4.50 3.83 4.83 5.83 4.00 4.50 4.58 Preparation
F 4.33 4.33 5.17 5.00 4.17 5.33 4.72 Preparation
G 6.00 4.83 5.50 6.83 4.67 5.67 5.58 Initiation
H 4.17 4.50 5.00 6.17 4.33 5.17 4.89 Preparation
I 3.67 4.33 4.83 5.33 3.83 4.50 4.42 Preplanning
J 3.67 3.83 4.50 5.17 3.67 4.83 4.28 Preplanning
K 4.67 4.50 5.00 5.67 4.17 5.00 4.83 Preparation
L 4.50 4.17 4.50 4.83 4.33 4.33 4.44 Preplanning
M 6.00 4.33 4.83 5.83 3.83 4.50 4.89 Preparation
N 6.67 4.33 5.17 6.67 4.83 5.50 5.53 Initiation
O 4.67 4.33 4.83 5.83 4.00 5.50 4.86 Preparation
Average 4.87 4.43 5.09 5.86 4.36 5.20 4.97 Preparation
Specifically, 26.67% of the evaluated communities were in the initiation stage, which
demonstrates that a quarter of the communities in the city had taken some measures or
considerable efforts to control and prevent the pandemic, and some active community
members began to participate in the relevant programs. About 20% of the communities
stayed in the preplanning stage, which means that there was recognition of the seriousness
of the COVID-19 pandemic and the need to take some actions, but there were no concrete
plans about how to control and prevent it. Moreover, no efforts or specific plans had been
made to deal with the epidemic. More than 50% of the communities were found in the
preparation stage, indicating that more than half of the communities were planning to solve
the problem, which means that active leaders began to take some actions or formulate some
schemes to fight against the disease and various resources were ready to put into use.
4.3. Overall Average Level of Each Dimension
Figure 2displays visually the average scores for each dimension of the community
readiness. Leadership, with an average score of 5.86, received the highest score among
all the six dimensions. This puts leadership in the stage of initiation, demonstrating that
the community leaders were actively running and supporting plans for combating the
COVID-19 epidemic. This result was easily understood in the Chinese context because
the whole country from the head of the state to the head of the communities all attached
great importance to the prevention and control of the COVID-19 pandemic. Community
attachment had the second highest mean score (5.20) of all the dimensions, placing it at
the stage of preparation. This means that some community members felt that they had the
responsibility to participate in the fight against the COVID-19 pandemic and tried best to
make their contributions. Community knowledge of efforts and community knowledge
about the issue received average scores of 5.09 and 4.87, respectively, both of which are in the
stage of preparation. The evaluation results indicate that general information on COVID-19
was available in the communities and some community members had basic knowledge
of the pandemic. In addition, the community members also had general knowledge of
the plans, policies, emergency management projects of COVID-19 prevention and control,
and the leaders and the people involved in combatting the pandemic. The overall average
scores of community resources (4.36) and community efforts (4.43) were the lowest among
all dimensions, indicating the preplanning stage. The results demonstrate that most of the
evaluated communities were facing the dilemma of insufficient resources and inadequate
efforts in the prevention and control of COVID-19.

Int. J. Environ. Res. Public Health 2023,20, 3996 12 of 19
Int. J. Environ. Res. Public Health 2023, 20, x FOR PEER REVIEW 12 of 20
the six dimensions. This puts leadership in the stage of initiation, demonstrating that the
community leaders were actively running and supporting plans for combating the
COVID-19 epidemic. This result was easily understood in the Chinese context because the
whole country from the head of the state to the head of the communities all attached great
importance to the prevention and control of the COVID-19 pandemic. Community attach-
ment had the second highest mean score (5.20) of all the dimensions, placing it at the stage
of preparation. This means that some community members felt that they had the respon-
sibility to participate in the fight against the COVID-19 pandemic and tried best to make
their contributions. Community knowledge of efforts and community knowledge about
the issue received average scores of 5.09 and 4.87, respectively, both of which are in the
stage of preparation. The evaluation results indicate that general information on COVID-
19 was available in the communities and some community members had basic knowledge
of the pandemic. In addition, the community members also had general knowledge of the
plans, policies, emergency management projects of COVID-19 prevention and control,
and the leaders and the people involved in combatting the pandemic. The overall average
scores of community resources (4.36) and community efforts (4.43) were the lowest among
all dimensions, indicating the preplanning stage. The results demonstrate that most of the
evaluated communities were facing the dilemma of insufficient resources and inadequate
efforts in the prevention and control of COVID-19.
Figure 2. Community capability level of each dimension.
4.4. Specific Levels of Each Dimension for the Communities
First, regarding the dimension of community knowledge about the issue, seven com-
munities were at the stage of preparation, three communities were at the initiation stage,
while one community was at the institutionalization stage. The remaining four communi-
ties were at the preplanning stage. The assessment results reveal that there was a signifi-
cant difference between the communities in the level of knowledge about COVID-19. Ac-
cording to the interviews, members in some communities were well informed about
COVID-19 and had some information about its causes and consequences through com-
munities’ bulletin boards, WeChat groups, and government notices. However, residents
in other communities were ill-informed. As a leader from community F said, “the public-
ity of COVID-19 was inadequate, especially in communities with large aging population,
they don’t use the smartphones or internet”.
Figure 2. Community capability level of each dimension.
4.4. Specific Levels of Each Dimension for the Communities
First, regarding the dimension of community knowledge about the issue, seven com-
munities were at the stage of preparation, three communities were at the initiation stage,
while one community was at the institutionalization stage. The remaining four communi-
ties were at the preplanning stage. The assessment results reveal that there was a significant
difference between the communities in the level of knowledge about COVID-19. According
to the interviews, members in some communities were well informed about COVID-19 and
had some information about its causes and consequences through communities’ bulletin
boards, WeChat groups, and government notices. However, residents in other communities
were ill-informed. As a leader from community F said, “the publicity of COVID-19 was
inadequate, especially in communities with large aging population, they don’t use the
smartphones or internet”.
Second, in terms of community efforts, about half of the communities were at the
stage of preparation while the other half were at the preplanning stage, which showed that
there were no significant differences in the communities’ efforts, including preparing health
emergency schemes, making emergency exercises, popularizing knowledge of tackling
public health emergencies, and improving infrastructure construction, to prevent and
control the COVID-19 pandemic. Nonetheless, some community efforts were irregular
and temporary. As an informant of community G addressed in the interview, “In fact,
emergency exercise is not often made and equipment is inadequate, especially for pandemic
prevention and control”. In addition, most of the key informants interviewed noted that
the lack of grant funding and experts were barriers for communities to make efforts.
Third, concerning the community knowledge of efforts, the levels of this dimension
for all communities assessed were higher than that of the community efforts. Eleven com-
munities were at the level of preparation and four communities were at the initiation stage,
indicating that there were slight disparities in the communities’ level of knowledge of
efforts. The evaluative result also means that community members in most of the communi-
ties had general knowledge of the efforts but lacked specific knowledge as well as in-depth
understanding of the local efforts. Some key informants described the difficulties to acquire
official and up-to-date information regarding the specific plans, policies, and emergency
management programs of the COVID-19 prevention and control. As an informant from
community L suggested, “further information of the efforts should be widely disseminated
in the communities”.

Int. J. Environ. Res. Public Health 2023,20, 3996 13 of 19
Fourth, regarding the dimension of leadership, four communities were at the level of
institutionalization, seven communities were at the stage of initiation, and the remaining
four were at the preparation level. The evaluative results revealed that almost all the
communities had a higher level of leadership than their level on the five other dimensions.
The reason for this result might be that the leadership was very identifiable in the Chinese
community context. They were composed of leaders in the community neighborhood
committees, community self-government organizations, professional service organizations,
and intermediary agencies. They made great efforts on preventing and controlling COVID-
19. Most of the key informants interviewed stated that community leaders provided direct
and enormous support in the prevention and control of COVID-19, such as distributing
resources quickly, organizing staff orderly, and serving the residents wholeheartedly.
Fifth, with respect to the community resources, six communities stayed at the stage of
preparation, while nine communities remained in the preplanning stage. The empirical
results show that most of the communities had the lowest level of resources among all the
dimensions. A possible explanation might be that China had the largest population and
the Chinese government attached greatest importance to the prevention and control of the
pandemic, which required a great many of financial, human, material, and many other
resources to control the spread of COVID-19. In contrast, the various resources needed
for preventing the COVID-19 emergency were limited. According to the interviews, the
government appropriation and donations from the Red Cross Society were not sufficient to
meet financial requirements. The number of community volunteers was also insufficient,
with less than 30 volunteers in some communities.
Finally, regarding the dimension of community attachment, four communities were at
a higher level of initiation, eight communities were at a medium level of preparation, and
three communities were at a lower level of preplanning. The analytical results disclose a
big difference in the level of various communities’ attachment. Furthermore, the level of
community attachment for most of the communities was higher than the overall level of
the community capability, which illustrates the higher level of community attachment than
other dimensions. This result corresponded to the fact of Chinese community members’
high sense of participation and high level of involvement in the pandemic prevention
and control.
5. Discussion
This study applied a modified framework of the CRM for the first time to evaluate
community capability to prevent and control the COVID-19 epidemic in the Chinese
context. The assessment results demonstrate that the overall capability levels of all the
communities evaluated in this research were at the stages of preplanning, preparation, or
initiation, which can be together called the “intermediate stages” group in the spectrum
of the readiness model, according to Kelly et al. [
63
]. Apart from identifying the overall
level of each community’s capability, we also assessed and presented the levels of the six
different dimensions, on which community capability was based. The research findings of
the present study not only have important theoretical contributions but also show some
practical implications to inform policymakers in promoting community capabilities in the
prevention and control of COVID-19 and other epidemics.
Firstly, the CRM has been widely used to assess community readiness levels in different
countries, such as Australia, the USA, the UK, and other European countries [37,40,47,64].
This study contributed to prior studies by employing the model in the Chinese community
context. Moreover, previous research adopting the CRM mainly focused on evaluating
community readiness of general prevention programs, such as drug and alcohol [
65
],
obesity [
66
], violence [
67
], and healthy lifestyles [
68
]. To the best of our knowledge, only
Adane et al. used the model to assess the level of community readiness for COVID-19
pandemic prevention, which they assessed in the Awi Zone of northwest Ethiopia [
32
].
Thus, our study also helps to extend the application of the CRM to the evaluation of
community capability in the prevention of a public health emergency.

Int. J. Environ. Res. Public Health 2023,20, 3996 14 of 19
Secondly, the CRM was modified in this study by substituting community attach-
ment for the community climate dimension, in order to improve the appropriateness and
applicability of the model in the context of Chinese community. Community attachment
mainly refers to community members’ sense of belonging to their community. In other
words, it emphasizes the emotional ties that community residents have to their communi-
ties. The final results illustrate that community attachment demonstrated a higher level
than other dimensions of community capability except leadership. According to the in-
terviews with key informants, the emotional and psychological ties between the residents
and their community could activate residents’ willingness to devote various resources and
take positive actions to support relevant programs in the prevention and control of the
COVID-19 epidemic. This result was consistent with the findings of Peterson and Reid [
69
].
In addition, we refined a community readiness evaluation index to make it suitable for the
assessment of Chinese community capability based on the anchor rating scale developed
by the Tri-Ethnic Center, which provides guidance for the operationalization of the CRM in
the Chinese context and promotes the application of the model in a wider range of subject
areas and issues in China [70].
Thirdly, the number of evaluated communities in most previous studies was less than
ten, and one third of prior studies focused on only one community [
36
]. This research
made further contributions by assessing both the overall capability level of the fifteen
communities as a whole and the individual level of capabilities for each community.
Moreover, the average level of each dimension in the modified model was also reported
for the fifteen communities, demonstrating the overall stages of the six dimensions. Thus,
this study provides a comprehensive evaluation of community capabilities, by not only
regarding the fifteen communities as a geographically larger community, namely the urban
city, but also focusing on the different levels of capabilities to prevent and control COVID-19
between each individual community.
Fourthly, the analytical results of this study indicate that leadership is located at the
highest level among all the six dimensions to measure community capability of preventing
and controlling the COVID-19 pandemic in China. This result corresponds with the findings
of Coroiu et al. [
71
] and Kostadinov et al. [
72
]. However, some previous studies found
that the dimension of community efforts received the highest scores in both Western
settings, such as the UK and the USA, and in the Middle East context, such as Iran [
73
].
A possible explanation for the different results may be that community leaders in China
played an irreplaceable and vitally important role in the process of combating COVID-19,
through following the leadership of the Communist Party of China, implementing epidemic
prevention and control policy promulgated by the government, and mobilizing community
residents to participate. They had authority, resources, and personal influence, which were
all critical to improve the community capability level.
Fifthly, community resources and community efforts received the lowest scores in
this evaluation, which demonstrates that these two dimensions could be regarded as the
biggest weaknesses of the communities in the process of combating COVID-19 in China.
Just as some scholars said, “resources are vital to any health intervention program’s success
and they serve as potential indicator of future sustainability of the effort” [
74
]. According
to the interviews with the key informants, relevant resources, including people, money,
equipment, time, and space, were all insufficient to effectively deal with the pandemic.
Specifically, limited financial support was a significant barrier when implementing some
prevention programs. Infrastructures such as isolation space and hospital beds were in
critical shortage, especially in the old and remote communities. There was also a huge
shortage of medical workers and professional nursing staff. The finding that community
resources were at the lowest level of capability conformed with existing research that
inadequate budgets and expertise, and the underfunding of public health, were major
and well-known problems [
75
–
77
]. Community effort was found to be the second lowest
dimension, which contradicted prior studies on ordinary community prevention programs.
The different results might be explained by the characteristics of health emergencies,

Int. J. Environ. Res. Public Health 2023,20, 3996 15 of 19
including suddenness, complexity, and harmfulness, which usually made it difficult for
communities to devote enough effort.
Finally, the evaluative results of this study also provided some important guiding
suggestions and precise intervention strategies to promote the community capability of
coping with COVID-19 and various other health emergencies to a higher level. As the results
reveal, the levels of the community capability to prevent and control COVID-19 in Shenyang
of China were in the stages of preplanning, preparation, and initiation. Therefore, we put
forward a few policy suggestions based on the Tri-Ethnic Center Community Readiness
Handbook and the evaluative results of the six dimensions for each community. Specifically,
for the communities at the stage of preplanning, community members’ awareness of the
various impacts of COVID-19 should be continuously enhanced through different forms
of media; the engagement of various formal and informal community leaders in the
preventive efforts should be increased via mobilization; and the emotional connection
between residents and their communities should be reinforced through the provision of
diversified forms of daily care and services and volunteer platforms.
For the communities at the stage of preparation, more local data about COVID-19
should be collected and made available for community residents; community key leaders
and influential people should be motivated to mobilize community residents to provide
more supports for the prevention and control of the pandemic; the effectiveness of preven-
tive policies and programs should be evaluated; and community surveys and public forums
should be conducted to solicit new preventive strategies from community leaders and
community members. For the communities at the stage of initiation, professional in-service
training of the prevention and control of the pandemic should be conducted; publicity
efforts regarding the COVID-19 prevention should be further promoted; the progress of the
epidemic prevention and control should be continuously updated; evaluation of the various
preventive efforts should be increased; interviews with community members should be
conducted to obtain their comments about improving the prevention strategies; and more
resources including money and people should be invested.
6. Conclusions
This study evaluated the community capability to prevent and control the COVID-19
pandemic in Shenyang, the capital city of Liaoning province in Northeast China. The evalu-
ation adopted a modified framework of a CRM by removing the dimension of community
climate and adding a new dimension of community attachment. The assessment results
demonstrate that the overall level of community capability in the pandemic prevention
and control in the city of Shenyang was at the stage of preparation. The specific levels
of the selected fifteen communities ranged from the stages of preplanning to preparation
to initiation, showing a moderate level of difference. Regarding the level of each dimen-
sion, the levels of community knowledge about the issue, leadership, and community
attachment exhibit significant disparities among different communities, while the levels
of community efforts, community knowledge of efforts, and community resources show
slight differences. In addition, leadership shows the highest overall level among all the
six dimensions, followed by community attachment and community knowledge of efforts.
Community resources present the lowest level, closely followed by community efforts.
Although this study has important theoretical contributions as well as practical impli-
cations, there are still some limitations that need to be emphasized. The most important
limitation is that the evaluation of the community capability levels relied on the interviews
with key informants, mainly including community neighborhood committee leaders, com-
munity workers, and community elites, who might overstate their roles and performance
and underestimate the performance of others. Future studies could include a broader range
of community informants. We also suggest that a combination of qualitative and quanti-
tative approaches be used in future community capability assessment, in order to reduce
the impact of subjectivity inherent in the key informant interviews. Another limitation is
that the evaluative result of the overall level of community capability in Shenyang might

Int. J. Environ. Res. Public Health 2023,20, 3996 16 of 19
be biased due to the limited number of selected communities and the lower administra-
tive level of key informants in this research. It is suggested that more different types of
communities be included in future analysis. Moreover, community key informants at a
higher administrative level, including the sub-district, urban district, and the city, could be
incorporated to obtain a better understanding of the overall level of community capability
in the city. A third limitation of this study lies in its failure to analyze the impact of China’s
COVID-19 policy on community capabilities to deal with public health crises. While policy
formulation and implementation are crucial in strengthening community capacity, the
influencing mechanism of the policies is worth further exploration. The last limitation
is that the present study estimates the overall average level of community capability in
Shenyang by randomly selecting 15 communities at the jurisdictional level of community
neighborhood committee, rather than focusing on a single community. Although this
research design has some theoretical contributions, it fails to analyze the specific character-
istics of individual communities. An in-depth case study to evaluate a single community
might provide more targeted intervention strategies for policymakers to enhance the level
of community capability to manage public health emergencies.
Author Contributions:
Conceptualization, X.Z. and X.L.; methodology, X.Z., X.L. and L.W.; investi-
gation, X.Z., X.L. and L.W.; data curation, X.L. and L.W.; formal analysis, X.Z. and L.W.; writing—
original draft, X.Z., X.L. and L.W.; writing—review and editing, X.Z. and X.L.; supervision, X.Z.;
project administration, X.Z.; funding acquisition, X.Z. All authors have read and agreed to the
published version of the manuscript.
Funding: This work was supported by Liaoning Social Science Fund [grant number L20BZZ002].
Institutional Review Board Statement:
The study was conducted in accordance with the Declaration
of Helsinki, and the protocol was approved by the institutional review board (or ethics committee)
of the School of Humanities and Law at Northeastern University on 7 March 2022. (approval
code: 2022001).
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement:
Data may be obtained from the corresponding author upon the consent
of all the interviewees.
Acknowledgments:
The authors wish to express gratitude to Liju Hu for her help in data collection.
The authors wish to thank Edward T. Jennings Jr. for his language edits on the manuscript. The
authors also wish to thank all the participants of the interviews, and the reviewers and editors of the
International Journal of Environmental Research and Public Health for their constructive comments
and suggestions.
Conflicts of Interest: The authors declare no conflict of interest.
References
1.
Wang, C.; Horby, P.W.; Hayden, F.G.; Gao, G.F. A novel coronavirus outbreak of global health concern. Lancet
2020
,395, 470–473.
[CrossRef]
2.
Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-nCoV). Statement on the Second Meeting of the
International Health Regulations (2005). Available online: https://www.who.int/news-room/detail/30-01-2020-statement-on-
the-second-meeting-of- the-international-health-regulations-(2005)-emergency-committee- regarding-the-outbreak-of-novel-
coronavirus-(2019-ncov) (accessed on 28 August 2022).
3. WHO. Coronavirus Disease (COVID-19) Dashboard. Available online: https://covid19.who.int (accessed on 2 December 2022).
4.
WHO. Coronavirus Disease (COVID-19) Dashboard. Available online: https://covid19.who.int/region/wpro/country/cn
(accessed on 2 December 2022).
5.
Cheng, Y.; Yu, J.X.; Shen, Y.D.; Huang, B. Coproducing Responses to COVID-19 with Community-Based Organizations: Lessons
from Zhejiang Province, China. Public Adm. Rev. 2020,80, 866–873. [CrossRef]
6.
Peng, T.L.; Liu, X.H.; Ni, H.F.; Cui, Z.; Du, L. City lockdown and nationwide intensive community screening are effective in
controlling the COVID-19 epidemic: Analysis based on a modified SIR model. PLoS ONE 2020,15, e0238411. [CrossRef]
7.
Give Full Play to the Community’s Role in the Prevention and Control of the COVID-19. Available online: https://baijiahao.
baidu.com/s?id=1659465131838222492&wfr=spider&for=pc (accessed on 28 August 2022).

Int. J. Environ. Res. Public Health 2023,20, 3996 17 of 19
8.
Cheng, Z.J.; Zhan, Z.; Xue, M.; Zheng, P.; Lyu, J.; Ma, J.; Zhang, X.D.; Luo, W.; Huang, H.; Zhang, Y. Public health measures and
the control of COVID-19 in China. Clin. Rev. Allergy Immunol. 2021,6, 1–16. [CrossRef] [PubMed]
9.
Chu, Z.; Cheng, M.; Song, M. What determines urban resilience against COVID-19: City size or governance capacity? Sustain.
Cities Soc. 2021,75, 103304. [CrossRef]
10.
Chen, H.; Shi, L.; Zhang, Y.; Wang, X.; Jiao, J.; Yang, M.; Sun, G. Comparison of public health containment measures of COVID-19
in China and India. Risk Manag. Health. Policy 2021,14, 3323–3332. [CrossRef] [PubMed]
11.
Xiao, J.; Hu, J.; He, G.; Liu, T.; Kang, M.; Rong, Z.; Lin, L.; Zhong, H.; Huang, Q.; Deng, A. The time-varying transmission
dynamics of COVID-19 and synchronous public health interventions in China. Int. J. Infect. Dis.
2021
,103, 617–623. [CrossRef]
[PubMed]
12.
Brosi, D.N.; Mays, G.P. Local Public Health System Capabilities and COVID-19 Death Rates. Public Health Rep.
2022
,137, 980–987.
[CrossRef]
13.
Veazie, M.A.; Teufel-Shone, N.I.; Silverman, G.S.; Connolly, A.M.; Warne, S.; King, B.F.; Lebowitz, M.D.; Meister, J.S. Building
community capacity in public health: The role of action-oriented partnerships. J. Public Health Manag. Pract.
2001
,7, 21–32.
[CrossRef]
14. Kusel, J. Assessing well-being in forest dependent communities. J. Sustain. Forest. 2001,13, 359–384. [CrossRef]
15.
George, A.S.; Scott, K.; Mehra, V.; Sriram, V. Synergies, strengths and challenges: Findings on community capability from a
systematic health systems research literature review. BMC Health Serv. Res. 2016,16, 47–59. [CrossRef]
16.
Beckley, T.M.; Martz, D.; Nadeau, S.; Wall, E.; Reimer, B. Multiple capacities, multiple outcomes: Delving deeper into the meaning
of community capacity. J. Rural Community Dev 2008,3, 56–75.
17.
Chavis, D.M. Building community capacity to prevent violence through coalitions and partnerships. J. Health Care Poor Underserved
1995,6, 234–245. [CrossRef]
18.
Brock, D.-J.P.; Estabrooks, P.A.; Maurer, H.M.; Hill, J.L.; Barlow, M.L.; Alexander, R.C.; Price, B.E.; Marshall, R.; Zoellner, J.M.
Building and Sustaining Community Capacity to Address Childhood Obesity: A Three-Year Mixed-Methods Case Study of a
Community-Academic Advisory Board. Fam. Community Health 2019,42, 62. [CrossRef] [PubMed]
19.
Millar, L.; Robertson, N.; Allender, S.; Nichols, M.; Bennett, C.; Swinburn, B. Increasing community capacity and decreasing
prevalence of overweight and obesity in a community based intervention among Australian adolescents. Prev. Med.
2013
,56,
379–384. [CrossRef]
20.
Horton, J.E.; MacLeod, M.L. The experience of capacity building among health education workers in the Yukon. Can. J. Public
Health 2008,99, 69–72. [CrossRef] [PubMed]
21.
van Herwerden, L.A.; Palermo, C.; Reidlinger, D.P. Capacity assessment in public health community interventions: A systematic
review. Health Prom. Int. 2019,34, e84–e93. [CrossRef] [PubMed]
22.
Lempa, M.; Goodman, R.M.; Rice, J.; Becker, A.B. Development of scales measuring the capacity of community-based initiatives.
Health Educ. Behav. 2008,35, 298–315. [CrossRef]
23.
Goodman, R.M.; Speers, M.A.; McLeroy, K.; Fawcett, S.; Kegler, M.; Parker, E.; Smith, S.R.; Sterling, T.D.; Wallerstein, N.
Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Educ. Behav.
1998
,25,
258–278. [CrossRef]
24.
Liu, J. Standard Structure of ‘Community Capacity’ in Urban: Exploratory Analysis Based on Overseas Empirical Research. Soc.
Constr. 2016,3, 75–84.
25.
Lee, Y.-j. Developing a scale of community capacity: Testing community organizations in Taiwan. Health Prom. Int.
2021
,36,
1521–1529. [CrossRef]
26.
Merzel, C.; Moon-Howard, J.; Dickerson, D.; Ramjohn, D.; VanDevanter, N. Making the connections: Community capacity for
tobacco control in an urban African American community. Am. J. Community Psychol. 2008,41, 74–88. [CrossRef]
27.
Islam, S.; Small, N.; Bryant, M.; Yang, T.; de Chavez, A.C.; Saville, F.; Dickerson, J. Addressing obesity in Roma communities: A
community readiness approach. Int. J. Hum. Rights Healthc. 2018,12, 79–90. [CrossRef]
28.
Findholt, N. Application of the community readiness model for childhood obesity prevention. Public Health Nurs.
2007
,24,
565–570. [CrossRef]
29.
Arambula Solomon, T.G.; Jones, D.; Laurila, K.; Ritchey, J.; Cordova-Marks, F.M.; Hunter, A.U.; Villanueva, B. Using the
Community Readiness Model to Assess American Indian Communities Readiness to Address Cancer Prevention and Control
Programs. J. Cancer Educ. 2021,38, 206–214. [CrossRef] [PubMed]
30.
Peercy, M.; Gray, J.; Thurman, P.J.; Plested, B. Community readiness: An effective model for tribal engagement in prevention of
cardiovascular disease. Fam. Community Health 2010,33, 238–247. [CrossRef] [PubMed]
31.
Lawsin, C.R.; Borrayo, E.A.; Edwards, R.; Belloso, C. Community readiness to promote Latinas’ participation in breast cancer
prevention clinical trials. Health Soc. Care Community 2007,15, 369–378. [CrossRef]
32.
Adane, D.; Yeshaneh, A.; Wassihun, B.; Gasheneit, A. Level of community readiness for the prevention of COVID-19 pandemic
and associated factors among residents of Awi Zone, Ethiopia: A community-based cross-sectional study. Risk Manag. Healthc.
Policy 2021,14, 1509. [CrossRef]
33.
Bumyut, A.; Thanapop, S.; Suwankhong, D. Exploring Readiness towards Effective Implementation of Safety and Health
Measures for COVID-19 Prevention in Nakhon-Si-Thammarat Community-Based Tourism of Southern Thailand. Int. J. Environ.
Res. Public Health 2022,19, 10049. [CrossRef]

Int. J. Environ. Res. Public Health 2023,20, 3996 18 of 19
34.
Oetting, E.R.; Donnermeyer, J.F.; Plested, B.A.; Edwards, R.W.; Kelly, K.; Beauvais, F. Assessing community readiness for
prevention. Int. J. Addict. 1995,30, 659–683. [CrossRef]
35.
Edwards, R.W.; Jumper-Thurman, P.; Plested, B.A.; Oetting, E.R.; Swanson, L. Community readiness: Research to practice. J.
Community Psychol. 2000,28, 291–307. [CrossRef]
36.
Oetting, E.R.; Jumper-Thurman, P.; Plested, B.; Edwards, R.W. Community readiness and health services. Subst. Use Misuse
2001
,
36, 825–843. [CrossRef]
37.
Islam, S.; Small, N.; Bryant, M.; Bridges, S.; Hancock, N.; Dickerson, J. Assessing community readiness for early intervention
programmes to promote social and emotional health in children. Health Expect. 2019,22, 575–584. [CrossRef]
38.
Harris, K.J.; Brown, B.; Shankle, L.; Tryon, M.; Pedersen, M.; Panarella, S.K.; Swaney, G. Community readiness model for
prevention planning: Addressing childhood obesity in American Indian reservation communities. J. Racial Ethn. Health Disparities
2019,6, 1144–1156. [CrossRef]
39.
McCoy, H.V.; Malow, R.; Edwards, R.W.; Thurland, A.; Rosenberg, R. A strategy for improving community effectiveness of
HIV/AIDS intervention design: The Community Readiness Model in the Caribbean. Subst. Use Misuse
2007
,42, 1579–1592.
[CrossRef]
40.
Borrayo, E.A. Using a community readiness model to help overcome breast health disparities among US Latinas. Subst. Use
Misuse 2007,42, 603–619. [CrossRef] [PubMed]
41.
Kakefuda, I.; Stallones, L.; Gibbs, J. Readiness for community-based bicycle helmet use programs: A study using community-and
individual-level readiness models. J. Health Psychol. 2008,13, 639–643. [CrossRef]
42.
Thurman, P.J.; Vernon, I.S.; Plested, B. Advancing HIV/AIDS prevention among American Indians through capacity building and
the community readiness model. J. Public Health Manag. Pract. JPHMP 2007,13, S49–S54. [CrossRef]
43.
Kostadinov, I.; Daniel, M.; Stanley, L.; Gancia, A.; Cargo, M. A systematic review of community readiness tool applications:
Implications for reporting. Int. J. Environ. Res. Public. Health 2015,12, 3453–3468. [CrossRef] [PubMed]
44.
Apriningsih, A.; Madanijah, S.; Dwiriani, C.M.; Kolopaking, R.; Crosita, Y. School Readiness in Weekly Iron Folic Acid Supple-
mentation Program in Urban Area, West Java, Indonesia. Amerta Nutr. 2020,4, 290–298. [CrossRef]
45.
York, N.L.; Hahn, E.J.; Rayens, M.K.; Talbert, J. Community readiness for local smoke-free policy change. Am. J. Health Promot.
2008,23, 112–120. [CrossRef] [PubMed]
46.
Jason, L.A.; Pokorny, S.B.; Kunz, C.; Adams, M. Maintenance of community change: Enforcing youth access to tobacco laws. J.
Drug Educ. 2004,34, 105–119. [CrossRef]
47.
Gansefort, D.; Brand, T.; Princk, C.; Zeeb, H. Community readiness for the promotion of physical activity in older adults—A
cross-sectional comparison of rural and urban communities. Int. J. Environ. Res. Public Health
2018
,15, 453. [CrossRef] [PubMed]
48.
Liu, M.; Zhang, X.; Xiao, J.; Ge, F.; Tang, S.; Belza, B. Community readiness assessment for disseminating evidence-based
physical activity programs to older adults in Changsha, China: A case for Enhance
®
Fitness. Glob. Health Promot.
2020
,27, 59–67.
[CrossRef]
49.
Thurman, P.J.; Plested, B.A.; Edwards, R.W.; Foley, R.; Burnside, M. Community readiness: The journey to community healing. J.
Psychoact. Drugs 2003,35, 27–31. [CrossRef] [PubMed]
50.
Oswald, R.F.; Cuthbertson, C.; Lazarevic, V.; Goldberg, A.E. New developments in the field: Measuring community climate. J.
GLBT Fam. Studies 2010,6, 214–228. [CrossRef]
51.
Hildebrand, D.A.; Blevins, P.; Carl, L.; Brown, B.; Betts, N.M.; Poe, T. Use of community readiness model to develop and evaluate
a pilot culinary training program for school nutrition staff. J. Nutr. Educ. Behav. 2018,50, 118–124.e111. [CrossRef]
52. Newbrough, J.R.; Chavis, D.M. Psychological sense of community, I: Foreword. J. Community Psychol. 1986,14, 3–5. [CrossRef]
53.
Rothenbuhler, E.W.; Mullen, L.J.; DeLaurell, R.; Ryu, C.R. Communication, community attachment, and involvement. J. Mass
Commun. Q. 1996,73, 445–466. [CrossRef]
54.
Zanbar, L. Sense of belonging and commitment as mediators of the effect of community features on active involvement in the
community. City Community 2020,19, 617–637. [CrossRef]
55.
DeHoog, R.H.; Lowery, D.; Lyons, W.E. Citizen satisfaction with local governance: A test of individual, jurisdictional, and
city-specific explanations. J. Polit. 1990,52, 807–837. [CrossRef]
56.
Roch, C.H.; Poister, T.H. Citizens, accountability, and service satisfaction: The influence of expectations. Urban Aff. Rev.
2006
,41,
292–308. [CrossRef]
57. Theodori, G.L. Community attachment, satisfaction, and action. Community Dev. 2004,35, 73–86. [CrossRef]
58.
Theodori, G.L. Reexamining the associations among community attachment, community-oriented actions, and individual-level
constraints to involvement. Community Dev. 2018,49, 101–115. [CrossRef]
59.
Kim, D.J.; Salvacion, M.; Salehan, M.; Kim, D.W. An empirical study of community cohesiveness, community attachment, and
their roles in virtual community participation. Eur. J. Inform. Syst. 2022, 1–28. [CrossRef]
60.
Chilenski, S.M.; Greenberg, M.T.; Feinberg, M.E. Community readiness as a multidimensional construct. J. Community Psychol.
2007,35, 347–365. [CrossRef]
61.
Castañeda, S.F.; Holscher, J.; Mumman, M.K.; Salgado, H.; Keir, K.B.; Foster-Fishman, P.G.; Talavera, G.A. Dimensions of
community and organizational readiness for change. Prog. Community Health Partnersh. 2012,6, 219. [CrossRef] [PubMed]
62.
Foster-Fishman, P.G.; Cantillon, D.; Pierce, S.J.; Van Egeren, L.A. Building an active citizenry: The role of neighborhood problems,
readiness, and capacity for change. Am. J. Community Psychol. 2007,39, 91–106. [CrossRef] [PubMed]

Int. J. Environ. Res. Public Health 2023,20, 3996 19 of 19
63.
Kelly, K.J.; Edwards, R.W.; Comello, M.L.G.; Plested, B.A.; Thurman, P.J.; Slater, M.D. The community readiness model: A
complementary approach to social marketing. Mark. Theor. 2003,3, 411–426. [CrossRef]
64.
Puccetti, M.; Greville, H.; Robinson, M.; White, D.; Papertalk, L.; Thompson, S.C. Exploring readiness for change: Knowledge and
attitudes towards family violence among community members and service providers engaged in primary prevention in regional
Australia. Int. J. Environ. Res. Public Health 2019,16, 4215. [CrossRef] [PubMed]
65.
Paltzer, J.; Black, P.; Moberg, D.P. Evaluating community readiness to implement environmental and policy-based alcohol abuse
prevention strategies in Wisconsin. J. Alcohol Drug Educ. 2013,57, 27.
66.
Schröder, M.; Schnabel, M.; Hassel, H.; Babitsch, B. Application of the Community Readiness Model for childhood obesity
prevention: A scoping review. Health Prom. Int. 2022,37, daac120. [CrossRef] [PubMed]
67.
Shadowen, N.L.; Guerra, N.G.; Reyes Rodas, G.; Serrano-Berthet, R. Community readiness for youth violence prevention: A
comparative study in the US and Bolivia. Vulnerable Child Youth Stud. 2017,12, 117–129. [CrossRef]
68.
Schmader, B. Healthy Lifestyles Community Readiness Assessment: Co-Creating Initiatives with Communities and Examining Differences
in Sectors and Demographic Characteristics across Dimensions; University of Nebraska-Lincoln: Lincoln, NE, USA, 2020.
69.
Peterson, N.A.; Reid, R.J. Paths to psychological empowerment in an urban community: Sense of community and citizen
participation in substance abuse prevention activities. J. Community Psychol. 2003,31, 25–38. [CrossRef]
70.
Thurman, P.J.; Edwards, R.W.; Plested, B.A.; Oetting, E.R. Honoring the Differences: Using Community Readiness to Create
Culturally Valid Community Interventions. In Handbook of Racial and Ethnic Minority Psychology; Sage: Thousand Oaks, CA, USA,
2003; pp. 591–607.
71.
Coroiu, A.; Moran, C.; Campbell, T.; Geller, A.C. Barriers and facilitators of adherence to social distancing recommendations
during COVID-19 among a large international sample of adults. PLoS ONE 2020,15, e0239795. [CrossRef]
72.
Kostadinov, I.; Daniel, M.; Jones, M.; Cargo, M. Assessing change in perceived community leadership readiness in the Obesity
Prevention and Lifestyle program. Health Promot. J. Austr. 2016,27, 208–214. [CrossRef]
73.
Ghahremani, L.; Eskandari, E.; Nazari, M.; Karimi, M.; Khalan, Y.A. Developing strategies to improve the community readiness
level to prevent drug abuse in adolescents: Based on the community readiness model, Eghlid City, Iran, 2019. J. Community
Psychol. 2021,49, 1568–1578. [CrossRef] [PubMed]
74.
Nwagu, E.N.; Dibia, S.I.; Odo, A.N. Community Readiness for Drug Abuse Prevention in Two Rural Communities in Enugu
State, Nigeria. SAGE Open Nurs. 2020,6, 2377960820963758. [CrossRef]
75.
Gagne, M.-H.; Drapeau, S.; Clement, M.-E. Community readiness for child maltreatment prevention: The challenge of a brief
assessment. J. Prim. Prev. 2020,41, 299–316. [CrossRef]
76.
Marrast, L.; Himmelstein, D.U.; Woolhandler, S. Racial and ethnic disparities in mental health care for children and young adults:
A national study. Int. J. Health Serv. 2016,46, 810–824. [CrossRef]
77.
Ahmed, F.; Ahmad, G.; Paff, K.; Samkange-Zeeb, F.; Brand, T. A Cross-Sectional Community Readiness Assessment for
Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan. Int. J. Environ. Res. Public Health
2021
,
18, 1497. [CrossRef] [PubMed]
Disclaimer/Publisher’s Note:
The statements, opinions and data contained in all publications are solely those of the individual
author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to
people or property resulting from any ideas, methods, instructions or products referred to in the content.