Insights from the front line: Uplifting stories of the COVID-19 pandemic through the eyes of the public health workforce in Iowa

Heidi Haines¹Amanda Sursely¹Hahn Pham¹Rylee Beltran¹Daniel K Sewell¹Lina Tucker Reinders²Natoshia Askelson¹Sarah Dixon³Kaitlin Emrich⁴Christine Estle⁵Michelle Lewis⁶Edith Parker¹Jimmy Reyes⁷Laurie Walkner¹Kelly Wells Sittig⁸Rima A Afifi^1*

• ¹College of Public Health, The University of Iowa, Iowa City, United States
• ²Iowa Public Health Association, Des Moines, United States
• ³Iowa Primary Care Association, Des Moines, United States
• ⁴Black Hawk County Public Health, Waterloo, United States
• ⁵Jefferson County Public Health, Fairfield, United States
• ⁶Siouxland District Health Department, Sioux City, United States
• ⁷University of Northern Iowa, Cedar Falls, Iowa, United States
• ⁸Iowa Cancer Consortium, North Liberty, United States

Introduction: SARS-coV-2 was declared a pandemic in March 2020. Studies have characterized some of the negative impact of the pandemic on public health workers (PHW), but few have explored the strength and coping strategies used. Our study documents the experiences of PHW in Iowa during the pandemic. Methods: We used an innovative mixed methods data collection tool, SenseMaker® to gather stories from PHW in Iowa between March-July 2022. Participants provided additional data about their story via structured follow-up questions. We conducted descriptive analyses of the quantitative questions. A qualitative thematic and sentiment analysis was applied to all stories. Results: The final sample size was 163 stories. PHW who submitted stories identified as mostly white (93.9%), and women (83.4%). Respondents were most likely to feel that in the story they told: the ability to act was out of their control; the strongest influence was from political considerations; decisions were made out of necessity; they wished for more focus on evidence-based public health. PHW were most likely to described their emotional state at the height of the pandemic as frustration (61%), uncertainty (55%), and helplessness (50%). Those who felt in control were more likely to express positive emotions. Qualitative thematic analysis of these stories revealed 8 themes, highlighting facilitators (e.g. strong partnerships and collaborations) and barriers (e.g. politicization and controversial government response) to effective pandemic response. Discussion: The stories PHW shared powerfully illustrate the context of the pandemic in Iowa, a state that spent the least time under high stringency policies.