Rethinking the city resilience: COM-B model-based analysis of healthcare accessing behaviour changes affected by COVID-19

The global pandemic of COVID-19 has been influencing people's lives and the cities. Not only people's physical and mental health have been threatened, but also the city operation has been profoundly affected from different perspectives (e.g., social and economic) permanently. How cities can efficiently react and response to improve city resilience is an urgent issue to be addressed. The healthcare system as a vital part of the city systems is confronting intense pressure and many challenges under this emergent public health crisis of COVID-19, which might cause huge impacts on the whole city's operation. Also, human beings as the direct victims of this public health crisis, their behaviour changes impacts on the healthcare system and the city could have been inevitable but have been neglected. In this context, this paper intends to study the citizen healthcare accessing behaviours changes in the post-pandemic era, and to unearth their impacts on the healthcare system and the city operation. For this purpose, first, a framework of influential factors for healthcare accessing was established based on a bidirectional "capability, opportunity, motivation, and behaviour" (COM-B) model and the comprehensive literature review. In which, 43 factors that would influence citizen healthcare accessing behaviour were identified and classified. Thus, based on the proposed framework, two cases (i.e., UK and China) were analysed in depth and compared based on a questionnaire survey to evaluate the factor importance and relationships under different scenarios. And the most influential factors based on analysis results are classified into 12 aspects (e.g., healthcare capability, policy support, information updating etc.). Further, a novel behaviour-healthcare system-city model based on the COM-B model was developed to rethink and indicate the relationships among citizen behaviour, healthcare system and city operation. The research results can be used by policymakers and researchers to improve the city resilience by enabling immediate responses to city systems and citizens behaviours confronting city emergencies.