How can local governments achieve effective early warning communication during public health emergencies? An fsQCA analysis of 15 cases in China

Public health emergencies are characterized by high uncertainty, rapid transmission, and wide social impacts, making effective early-warning communication a critical challenge for local governments. However, existing studies have primarily focused on the net effects of individual factors and have paid limited attention to how multiple technological, organizational, and environmental conditions jointly shape early warning communication effectiveness. Drawing on the TOE (Technology-organization-environment) framework, this study employs fsQCA (fuzzy-set qualitative comparative analysis) to examine 15 public health emergency cases in China and identify the configurational pathways leading to high early warning communication effectiveness. The findings reveal that no single factor constitutes a necessary condition for achieving high early warning communication effectiveness. Instead, effective early warning communication is associated with different combinations of technological, organizational, and environmental conditions. Three configurational pathways are identified: the Collaborative Empowerment Pathway, the Institutional Resilience Pathway, and the Pressure-Responsive Pathway. These pathways respectively highlight the joint role of organizational management capacity and information dissemination, the maintenance of effective communication despite limitations in technological and resource conditions, and the role of high social impact under constrained information dissemination conditions. The findings suggest that local governments should move beyond single-factor governance approaches and adopt contextualized governance strategies that flexibly combine technological, organizational, and environmental conditions according to local contexts, thereby enhancing the effectiveness of early warning communication and strengthening emergency response capacity.