A longitudinal cross-sectional study of changes in working attitude among primary healthcare workers across the major COVID-19 outbreaks in China

Primary health care workers play a vital role in both routine health services and responses to public health emergencies. This study aims to examine long-term changes in work attitudes and burnout among primary health care workers during the years after COVID-19 breakout in Jinan, China. We conducted repeated cross-sectional surveys of primary health care workers in selected districts of Jinan in August 2020, 2023, 2024, and 2025. Standardised questionnaires measured job satisfaction, organisational commitment, and burnout. A total of 5,535 workers were included across four survey waves. Regression models were used to examine changes over time and associated factors. Principal component analysis was used to identify underlying vulnerability profiles. Matched subsamples were used to compare changes within the same workers across the 2023–2024, 2024–2025, and 2023–2025 periods. Here we show that recovery in work attitudes is partial and uneven. Job satisfaction declines in 2023, partly recovers in 2024, and decreases again in 2025, remaining below the 2020 level. Organisational commitment increases from 2020 to 2024 but shows a slight decline in 2025. Burnout remains a persistent concern, with depersonalisation and emotional exhaustion worsening by 2025. Severe coronavirus disease 2019 infection and newly recruited public health roles are associated with less favourable changes. These findings show that the effects of pandemic-related stress continue beyond the acute crisis. Sustained mental health support, stronger organisational resources, and long-term workforce policies are needed to protect primary health care workers and support resilient health systems. Primary healthcare workers play a key role in both everyday care and public health emergencies. We wanted to understand how their work attitudes changed during and after the COVID-19 pandemic. We studied primary healthcare workers in Jinan, China, using surveys carried out in 2020, 2023, 2024, and 2025. We measured job satisfaction, organisational commitment, and burnout. We found that job satisfaction fell after the major COVID-19 wave, improved slightly, and then fell again in 2025. Organisational commitment generally increased, although it declined slightly in 2025. Burnout remained an important problem, and some parts of burnout became worse over time. These findings show that the end of the acute pandemic did not mean full recovery for healthcare workers. Long-term support, better working conditions, and stronger management systems are still needed. Wang et al. survey primary healthcare workers in China across four waves from 2020 to 2025 to track changes in job satisfaction, organisational commitment, and burnout. Job satisfaction recovers only partly, organisational commitment peaks and then dips slightly, and burnout remains substantial, worsening in some dimensions by 2025.