{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:40:53Z","timestamp":1791420053499,"version":"4.3.3"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006249","name":"Donghua University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006249","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>This study explores the strategic and deliberate usage of ambiguity in Chinese public health policy as a governmental instrument.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>By analyzing 128 official public policy documents and 30 participant interviews as primary evidence, this study developed a three-tier coding instrument to capture the underlying categorizations, strategic functions, and behavioral responses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and discussion<\/jats:title><jats:p>The findings of this study indicate that ambiguity, categorized into five types\u2014\u201c<jats:italic>Elasticating<\/jats:italic>,\u201d \u201c<jats:italic>Generalizing<\/jats:italic>,\u201d \u201c<jats:italic>Overloading<\/jats:italic>,\u201d \u201c<jats:italic>Substituting<\/jats:italic>,\u201d and \u201c<jats:italic>Intensifying<\/jats:italic>\u201d\u2014with \u201c<jats:italic>Elasticating<\/jats:italic>\u201d being the most predominant, facilitated the diffusion of accountability, the shifting of responsibility, and the flexibility of interpretation. This research makes a significant contribution to the field of public health governance by redefining policy ambiguity as a complex, integrated mechanism of problem-solving that is rooted in the behavioral, institutional, and bureaucratic contexts of public health operations in China, rather than as a systematic failure.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1666193","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T05:37:45Z","timestamp":1761025065000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Toward a framework of ambiguity: a qualitative understanding of healthcare policy design and governance mechanism in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuanbo","family":"Qi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aijun","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panpan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4324\/9780429041754-1","article-title":"Ambiguities and contradictions: issues in China\u2019s changing political communication","volume-title":"China\u2019s media, media\u2019s China","author":"Lee","year":"2019"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1017\/S0305741023000826","article-title":"Ambiguity and clarity in China\u2019s adaptive policy communication","volume":"257","author":"Ang","year":"2024","journal-title":"China Q"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1332\/030557310x519650","article-title":"Institutional constraints and practical problems in deliberative and participatory policy making","volume":"39","author":"Hoppe","year":"2011","journal-title":"Policy Polit"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1111\/gove.12692","article-title":"Serving quarreling masters: frontline workers and policy implementation under pressure","volume":"36","author":"Hinterleitner","year":"2023","journal-title":"Governance"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1080\/23812346.2016.1277507","article-title":"The art of political ambiguity: top\u2013down intergovernmental information asymmetry in China","volume":"2","author":"Zhan","year":"2017","journal-title":"J Chin Gov"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1017\/S0305741012000860","article-title":"Local energy efficiency policy implementation in China: bridging the gap between national priorities and local interests","volume":"211","author":"Kostka","year":"2012","journal-title":"China Q"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4324\/9781315091693-1","article-title":"Implementation and participation in China\u2019s local environmental politics: challenges and innovations","volume-title":"Local environmental politics in China","author":"Kostka","year":"2017"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1111\/psj.12130","article-title":"Political commitment, policy ambiguity, and corporate environmental practices","volume":"46","author":"Liu","year":"2018","journal-title":"Policy Stud J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1080\/23812346.2020.1809272","article-title":"Strategic ambiguity in policy formulation: exploring the function of the term \u201ctownship and village enterprises\u201d in China\u2019s industrial ownership reforms","volume":"6","author":"Dai","year":"2021","journal-title":"J Chin Gov"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1080\/23812346.2020.1809312","article-title":"Ambiguity and conflict in pension policies implementation: evidence from China","volume":"7","author":"Guo","year":"2022","journal-title":"J Chin Gov"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1080\/10670564.2019.1580432","article-title":"Institutional ambiguity in primary and preventive care: reforming village health services in 21st century China","volume":"28","author":"M\u00fcller","year":"2019","journal-title":"J Contemp China"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1007\/s11096-020-01053-w","article-title":"Role ambiguity and role conflict and their influence on responsibility of clinical pharmacists in China","volume":"42","author":"Li","year":"2020","journal-title":"Int J Clin Pharm"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1080\/02673037.2019.1648774","article-title":"The end of \u2018toleration\u2019? 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