Development of a competency framework for public health nurses in China: A modified Delphi study

Background Public health nurses play a pivotal role in primary public health services, yet China lacks a systematic, context-specific competency framework to support workforce development. This study aimed to develop a competency framework for public health nurses in China to guide capacity-building initiatives. Methods A preliminary competency framework was constructed based on a literature review, job analysis, and semi-structured interviews with 22 frontline practitioners and comprised six domains, 16 subdomains, and 52 competencies. A two-round Delphi survey was then conducted with 21 experts from multiple regions with expertise in community nursing, public health, primary care medicine, and nursing education and related specialties. Consensus was defined as a mean importance rating ≥4.0 (5-point Likert scale) and a coefficient of variation ≤0.25. The Delphi consultation process was characterized by expert engagement, the expert authority coefficient, and the coordination of expert opinions. Finally, the Analytic Hierarchy Process was applied to determine the relative weights of the agreed-upon items at each level. Results Across the two Delphi rounds, the response rates were 95.45% and 100%, the expert authority coefficient was 0.90, and Kendall’s coefficients of concordance were 0.156 and 0.171, respectively (both P < 0.001). The final competency framework comprised six domains, 16 subdomains, and 46 competencies. All Analytic Hierarchy Process judgment matrices showed acceptable consistency (CR < 0.10). Health education and health promotion was assigned the highest weight (0.280) among the domains. Conclusion The resulting competency framework demonstrates methodological rigor, a comprehensive structure, and contextual relevance. It provides theoretical and practical implications for competency-based education, workforce development, and the professionalization of public health nursing in China.