Determinants of Healthcare Workers’ Willingness to Engage in Emerging Infectious Disease Surveillance: A Structural Equation Modeling Study in Indonesia

Background Emerging infectious diseases (EIDs) pose a threat to Indonesia, where high population mobility, decentralised health systems, and geographic complexity increase the risk of emergence and international spread. Effective EID surveillance relies on the engagement of frontline healthcare workers, which is shaped not only by individual willingness but also by training, system capacity, and community context.. Methods A cross-sectional study was conducted among 349 healthcare workers in primary healthcare centers in Bali Province, Indonesia. Data were collected using a structured questionnaire measuring cognitive readiness, attitudinal and behavioral preparedness, capacity building and training, perceived system constraints, community engagement and trust, and willingness to engage in EID surveillance. Summed construct scores were used for analysis. Structural equation modeling (SEM) with robust maximum likelihood estimation to examine direct and indirect relationships among constructs, including the mediating role of capacity building and training. Results Community engagement and trust, reflecting healthcare workers’ perceptions of community collaboration and trust in the surveillance system, showed the strongest direct association with willingness of hcws? to engage in EID surveillance (β = 0.326, p < 0.001), followed by cognitive readiness (β = 0.186, p = 0.003), perceived system constraints (β = 0.166, p < 0.001), and capacity building and training (β = 0.099, p = 0.047). Attitudinal and behavioral preparedness, reflecting perceptions of facility preparedness and resource availability, was not significantly associated with willingness. Cognitive readiness demonstrated a small indirect effect on willingness through capacity building and training (β = 0.046, p = 0.053), with a significant total effect (β = 0.232, p < 0.001). The model explained 37.3% of the variance in willingness and showed acceptable model fit. Conclusion Willingness to engage in EID surveillance among Indonesian healthcare workers is shaped by an interplay of knowledge, training, perceived system constraints, and community engagement. Strengthening surveillance preparedness therefore requires integrated strategies that link cognitive readiness to practical capacity building, address system-level barriers, and foster trust and collaboration with communities.