Perceived Performance of Community Two Committees and Satisfaction with Urban Infectious Disease Governance: The Mediating Roles of Government Trust and Public Participation.

PURPOSE: The community two committees play a pivotal role in urban grassroots public health emergency governance. Situated within China's distinctive grassroots governance context, this study examines the associations among the perceived performance of community two committees, government trust, public participation, and satisfaction with urban infectious disease governance. PATIENTS AND METHODS: Using 2023 China Social Governance Survey data, 3182 participants were selected for cross-sectional analysis. We estimated stepwise regression models and tested mediation using the weighted least squares mean and variance adjusted estimator and bootstrap procedures. We conducted robustness tests using alternative variable specifications and propensity score matching, and assessed potential endogeneity using the Oster test, Rosenbaum bounds, and the Lewbel approach. RESULTS: Perceived performance of community two committees was positively associated with satisfaction with urban infectious disease governance (β = 0.158, 95% CI: 0.118-0.197). Government trust (β = 0.086, 95% CI: 0.068-0.104) and public participation (β = 0.031, 95% CI: 0.020-0.043) partially mediated this association, accounting for 29.20% and 10.40% of the total effect, respectively. In addition, a sequential indirect association through government trust and public participation was observed (β = 0.020, 95% CI: 0.013-0.027), accounting for 6.70% of the total effect. The robustness tests indicated that both the direct and indirect associations remained significant, while the sensitivity and supplementary endogeneity analyses suggested that the findings were not highly sensitive to omitted-variable bias or unobserved confounding. CONCLUSION: The study revealed that the perceived performance of community two committees was positively associated with satisfaction with urban infectious disease governance, with government trust and public participation sequentially mediating this association. Governments should strengthen the governance capacity of community two committees, improve transparency and responsiveness to foster public trust, and establish institutionalized channels for public participation in urban infectious disease governance.