Experiential and Structural Determinants of Communicable Disease Reporting Among Health Care Providers in Alameda County, California

Communicable disease reporting is essential for public health surveillance, yet underreporting is common. California Title 17 mandates that health care providers report >80 communicable diseases to local health departments, according to the patient's residence. We conducted a cross-sectional survey assessing health care provider knowledge, attitudes, and practices related to reporting requirements in Alameda County, California. Of 145 health care providers surveyed from April through June 2025, 127 (87.6%) were aware of Title 17 requirements and 105 (72.4%) had submitted at least 1 report. In multivariable logistic regression analysis using Firth penalized likelihood, the following were significantly associated with higher odds of reporting communicable diseases: having an awareness of reporting requirements versus no awareness (adjusted odds ratio [AOR] = 6.91; 95% CI, 1.21-58.36), having >10 years of clinical experience versus <5 years of clinical experience (11-20 years: AOR = 11.07 [95% CI, 2.30-64.68]; >20 years: AOR = 10.89 [95% CI, 2.28-62.59]), and having training in systems of institutional reporting versus no training (AOR = 5.37; 95% CI, 1.56-22.52). Misunderstanding reporting responsibility versus accurately identifying reporting responsibility was associated with lower odds of reporting communicable diseases. Improving clinician training, clarifying reporting expectations, and expanding electronic reporting systems may strengthen public health surveillance.