Local Public Health Professionals Report Five Lessons Learned During the COVID Pandemic: The Results of Guided Reflection
It’s critical to evaluate the experiences of public health professionals during disease outbreaks. Evaluation enhances healthcare delivery, strengthens accountability from exiting institutions, and reduces health disparities across communities.
Our research, titled “Qualitative Analysis of a Roundtable Exercise: ‘Reflecting on the COVID-19 Experience of Public Health Professionals,'” aimed to understand the experiences of public health professionals and community leaders during the pandemic. While public health professionals were serving on the frontline during the height of the COVID-19 pandemic, they were not viewed the same as medical frontline workers. Our research allows those public health professionals’ voices to be heard. With diverse backgrounds in academia and the medical field, our team 
quantified and considered various factors that shaped these experiences. Our objectives were to describe these experiences, discuss the effectiveness of guided reflection exercises, and provide lessons learned for future pandemic preparedness.
We conducted a focus group study at a Midwestern state public health professional meeting. In total, forty-eight public health professionals self-selected to participate in the study. During focus sessions participants were randomly assigned and divided into 9 groups where they answered a series of questions about their experiences during the pandemic. We analyzed their responses to the questions into five key themes.
What did our findings tell us about the experiences of public health professionals?
The five key themes that emerged from our analysis were: Communication, Leadership and Collaboration, Data Management, Community Relationships, and Resources and Planning.
Communication
Participant responses revealed inconsistent communication of health information between state government and health officials, deviating from national recommendations during the pandemic. State health offices utilized public news, press conferences, official releases, and national recommendations for communication. Participants acknowledged that “messaging and communication were confusing and not consistent.” The challenges were worsened by a “lack of honest communication,” resulting in an “over-exaggeration of positivity information” benefiting certain individuals. Participants noted the governor’s office prioritizing meetings with mayors, excluding local public health officials. They highlighted communication difficulties between state health officials and local public health, with “non-medical leaders making decisions.” Participants stressed the importance of “public health experts initiating proactive education and open conversations” to enhance communication.
Leadership and Collaboration
Some participants felt that “non-medical leadership was making decisions for the state.” The consequences of this led to “downplaying the pandemic” and communities faced the burden of decision making on their own during the pandemic. And yet, collaboration between local health departments and community professionals was reported to be strong.
Data Management
Participants faced challenges in collecting, presenting, and sharing COVID-19 data. Poor data quality at the local level hindered data collection. Lack of transparency at the state level in presenting data was also noted. Some participants mentioned that state health officials reported data accurately but had flawed interpretation, while others found their data presentation clear.
Community Relationships
Participants said relationships between local public health, hospitals, clinics, and long-term care facilities were “strong and supportive,” practically and emotionally. Respondents emphasized the “sharing of PPE and collaborating to offer mass vaccination sites” as examples. Participants also experienced grief and personal loss indicating “loss of friends, family, and loss of career.” The experiences gave rise to concerns which several participants noted “about the public wanting to take away public health authority and reduce the impact of public health activities and laws.” Being in a rural region also complicated community relationships as participants pointed out “In rural communities it is hard to go against the flow because of the contrary people, and they knew where you lived, and made threats against you.”
Resources and Planning
Participants recalled a shortage of personal protective equipment (PPE) and testing tools greatly limited COVID-19 public health responses. Some recalled “local plans were ignored at the state level” and called for “updated policies and procedures.” Participants recalled that “No emergency operations plan has been developed that even came close for this scope of a pandemic.” We asked questions about how to improve planning in future and participants suggested, “Doing after action reports and lessons learned as a best tool to move forward.”
What lessons did we learn and how can we apply them to future pandemic preparedness activities?
The implications of our findings are critical in pandemic preparedness activities because they show the diverse nature of conflicts faced by public health professionals. The recommendations below may be used to improve preparedness efforts in future:
- Leadership: Governmental, civic, and health system leaders must accept responsibility in communication and decision making in their respective positions, under the common goal of serving the public, and with coordination and support from federal, state, and local authorities.
- Collaboration: An increased capacity for health information must be prioritized along with increasing funding and staffing in small county health districts. Collaborations must include American Indian communities who faced loss and hardship during this period.
- Communication: The public deserves to be kept informed about decisions that will affect them, and to provide input to those decisions. This will increase support for the decisions made. All must work to communicate reliable, consistent, and easy-to-understand public health information.
More information
For more information related to our findings, please review our article titled “Qualitative Analysis of a Roundtable Exercise: ‘Reflecting on the COVID-19 Experience of Public Health Professionals,'” in the Journal of Public Health Management and Practice.
Recommended Reading:
- Zemmel DJ, Kulik PKG, Leider JP, Power LE. Public health workforce development during and beyond the COVID-19 pandemic: findings from a qualitative training needs assessment. J Public Health Manag Pract. 2022;28(5 suppl 5):S263–S270.
- Schismenos S, Smith AA, Stevens GJ, Emmanouloudis D. Failure to lead on COVID-19: what went wrong with the United States? Intern J Public Leadersh. 2021;17(1):39–53.
- Walpola R, Lucas C. Reflective practice: the essential competency for health systems and healthcare practitioners during the COVID-19 pandemic. Reflective Pract. 2021;22(2):143–146.
- Strand MA, Omobosinuola S, Hohman A, Jansen R, Sidhu S. and McDonough S. Evaluating the Association of Face Covering Mandates on COVID-19 Severity by State. Journal of Primary Care and Community Health, 2022;13:1-8. Open Access.
- Strand MA, Bratberg J, Eukel H, Hardy M, Williams C. Community Pharmacists’ Contributions to Disease Management During COVID-19. Preventing Chronic Disease, Pharmacy and Public Health special collection, 2020;17:200317.
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Mark A. Strand, PhD, is professor in the School of Pharmacy and the Masters of Public Health Program at North Dakota State University. Dr. Strand’s research interests include the epidemiology of chronic diseases, in particular opioid use disorder; and models of collaboration between local public health and the broader health system.
Savita Sidhu is a recent graduate of North Dakota State University with a Masters of Public Health Epidemiology degree. She assisted faculty in COVID-19 research which assessed North Dakota’s pandemic preparedness strategies. She has served at both the North Dakota and Minnesota Departments of Health.
Rick Jansen, PhD, is a biostatistician in the Masonic Cancer Center at the University of Minnesota and in the Center for Biobehavioral Research for Sanford Research. His research areas of interests include identifying modifiable risk factors for disease and developing and applying integrative omics analyses.
Adam Hohman, DNP, FNP-BC, is an Assistant Professor of Practice at North Dakota State University and practices in the emergency department at Essentia Health. His research areas of interests include emergency preparedness and global health.
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Stephen McDonough, MD, worked as a pediatrician in North Dakota for forty years including fifteen years in senior positions at the North Dakota Department of Health.
Honored to give voice to local public health professionals through this publication. Please share with other local public health professionals who served nobly during COVID.