Iowa Mental Health Needs Assessment for the Public Health Workforce

1 Background

In response to the sustained impact of the pandemic on the workforce on the mental health of public health workers, highlighted in the alarming CDC report, public health practitioners in Iowa were invited to take a survey about the effects of COVID-19 on their overall mental health and well-being. This page presents the results of that survey. This information will be used to understand the challenges faced by the public health workforce in Iowa and to inform efforts to support workers.

The survey is a collaboration of the Institute for Public Health Practice (IPHP) at the University of Iowa College of Public Health and Iowa Public Health Association (IPHA). Please contact Kathleen May with any questions.

2 Workplace characteristics

2.1 Workplace type

2.1.1 Figure

Q: “Please specify your work setting”

2.1.2 Frequencies

Characteristic	N = 3611
Job Title
Local Public Health Agency - Government based	149 (45%)
Local Public Health Agency - Hospital based	20 (6.0%)
Other Local Public Health Agency	20 (6.0%)
State Health Agency - Central Office	67 (20%)
State Health Agency - Local or Regional Office	5 (1.5%)
Other State Agency, not Health	5 (1.5%)
Other County Agency, not Health	4 (1.2%)
Other City Agency, not Health	0 (0%)
Hospital or Health Care Clinic, other than Public Health Agency	13 (3.9%)
Nonprofit Organization	17 (5.1%)
Independent Consultant	1 (0.3%)
Private Industry	6 (1.8%)
Retired	2 (0.6%)
Other	22 (6.6%)
Unknown	30
1 n (%)

2.2 Workforce size

2.2.1 Figure

Q: “How many employees in this work setting are dedicated to public health?”

2.2.2 Frequencies

Characteristic	N = 361
How many employees in this work setting are dedicated to public health?
Median (IQR)	22 (7, 51)
Mean	388
Range	0, 35,000
Unknown	78

2.3 Supervisory status

2.3.1 Figure

Q: “What is your supervisory status?”

2.3.2 Frequencies

Characteristic	N = 3611
Supervisory status
Non-supervisor	215 (65%)
Supervisor	52 (16%)
Manager	28 (8.5%)
Executive	35 (11%)
Unknown	31
1 n (%)

2.4 Population served

2.4.1 Figure

Q: “What population setting does your organization serve?”

2.4.2 Frequencies

Characteristic	N = 3611
What population setting does your organization serve?
Rural (less than 2,500 people)	68 (21%)
Micropolitan (10,000-49,999 people)	84 (26%)
Urban (50,000 or more people)	173 (53%)
Unknown	36
1 n (%)

2.5 Region

2.5.1 Figure

Q: “In which Iowa local public health services region do you work?”

2.5.2 Frequencies

Characteristic	N = 3611
In which Iowa local public health services region do you work?
Region 1	89 (27%)
Region 2	21 (6.5%)
Region 3	10 (3.1%)
Region 4	14 (4.3%)
Region 5	25 (7.7%)
Region 6	93 (29%)
Statewide	72 (22%)
Outside Iowa	1 (0.3%)
Unknown	36
1 n (%)

3 Respondent Demographics

3.1 Age

3.1.1 Figure

3.1.2 Frequencies

Characteristic	N = 3611
Age
18-24	10 (3.2%)
25-34	62 (20%)
35-44	84 (27%)
45-54	77 (25%)
55-64	64 (21%)
65 & older	13 (4.2%)
Unknown	51
1 n (%)

3.2 Education

3.2.1 Figure

Q: “Please indicate the highest degree you have attained”

3.2.2 Frequencies

Characteristic	N = 3611
Highest degree attained
High School or equivalent	13 (4.0%)
Associate’s degree in nursing	32 (9.9%)
Other Associate degree	29 (9.0%)
BS/BA	83 (26%)
BSN	38 (12%)
BSPH	0 (0%)
Other baccalaureate degree	6 (1.9%)
MA/MS	25 (7.7%)
MBA	3 (0.9%)
MHSA	0 (0%)
MPA	8 (2.5%)
MPP	2 (0.6%)
MPH	44 (14%)
MSN	12 (3.7%)
MSW	7 (2.2%)
Other Masters degree	6 (1.9%)
DDS/DMD	0 (0%)
DrPH/PhD/ScD/Other public health doctorate	6 (1.9%)
DNP	0 (0%)
DVM/VMD	0 (0%)
JD	0 (0%)
MD/DO or international equivalent	2 (0.6%)
PharmD	3 (0.9%)
PhD/ScD/Other non-public health doctorate	5 (1.5%)
Unknown	37
1 n (%)

3.3 Race

3.3.1 Figure

Q: “Please select the racial category or categories with which you most identify”

3.3.2 Frequencies

Characteristic	N = 3611
Race
White	298 (96%)
Black or African American	4 (1.3%)
American Indian or Alaska Native	1 (0.3%)
Asian	3 (1.0%)
Native Hawaiian or Pacific Islander	0 (0%)
Two or more races	3 (1.0%)
Unknown	52
1 n (%)

3.4 Hispanic ethnicity

3.4.1 Figure

Q: “Do you identify as Hispanic or Latinx?”

3.4.2 Frequencies

Characteristic	N = 3611
Hispanic or Latinx	5 (1.6%)
Unknown	47
1 n (%)

3.5 Gender

3.5.1 Figure

Q: “What is your gender identity?”

3.5.2 Frequencies

Characteristic	N = 3611
Gender identity
Male	27 (8.6%)
Female	285 (91%)
Non-binary	1 (0.3%)
Another gender	0 (0%)
Unknown	48
1 n (%)

3.6 LGBTQIA+ status

3.6.1 Figure

Q: “Do you identify as a member of the LGBTQIA+ community?”

3.6.2 Frequencies

Characteristic	N = 3611
LGBTQIA+ identifying	20 (6.4%)
Unknown	49
1 n (%)

4 Career goals/path

4.1 Considering a career change? (free response)

4.1.1 Yes (Top 100 words used)

Q: Since the pandemic, why have you re-evaluated your career path (e.g., leaving public health or current position, retiring, etc.)? Note: (2169 total words, stop-words (e.g., the, in) removed)

4.1.2 No (Top 100 words used)

Q: Since the pandemic, why have you not re-evaluated your career path (e.g., leaving public health or current position, retiring, etc.)? Note: Top 100 words of 64 total responses (570 total words, stop-words (the, in) removed)

4.1.3 Themes / number of mentions

Theme	Description	Mentions
Advancement	Mentions advancement or growth (whether they want it or not)	4
Better Pay and Benefits	Underpaid; Mental Health / Wellness policies; increase in pay; staying only for the benefits; loan forgiveness; attraction and retention; ability to use PTO	23
Connection Opportunities	Mental Health and Wellbeing resources, programming, etc.; safe place to talk; discounts	6
Consideration of or moving into Non-Public Health Field	Considering / thought about moving into a non-public health field; Moved into a non-public health field	28
Consideration of or moving into or within Public Health Field	Considering / thought about moving to something else within public health field; Moved into a public health field	17
Flexibility	ability to work from home; benefit of job; how to support workers from home	12
Alignment	what the alignment entails; lack of communication regarding alignment with little input from LPH	4
Inspired / Motivated into Public Health	Inspired to go into public health because of the pandemic; strengthening motivation for public health work	16
Lack of Communication	Lack of communication from leadership, between organizations, with public; not included in discussion at state	12
Lack of Impact / Fulfillment / Appreciation	Feelings of no impact on public, underappreciation from leaders and public, ineffectiveness; don't feel valued or appreciated	14
Lack of Life Work Balance	reasons for reconsidering career; high workload; no boundaries	11
Org / Supervisor Issues	internal agency issues with co-workers and/or supervisors; leadership decisions; lack of professional management; poor work environment	24
Political / Public Support	lack of political and/or public support; their support is essential; need to increase their awareness	23
Politicization of Public Health	Overemphasis of politics in public health; governor and state public health issues; cognitive dissonance between politics and science; working in govt public health less desirable	18
Retirement	Already retired; solidified retirement plans; early retirement	38
Stress / Burnout	stress, anxiety, burnout, trauma, PTSD, overworked; difficulty maintaining mental health; reasons for leaving public health	42
Supportive Work Environment	Mental Health and Wellbeing in the workplace in form of policies and supportive leadership; consistent communication, input, feedback; life work balance	23
Training	Learning opportunities mentioned as a need	32
Health Equity / Cultural Competency		2
Management / Leadership	Trainings specifically for leadership / management (directors, supervisors, boards of health, legislatives); communication, supporting staff	10
Mental Health_Wellness	Learning about coping, meditation, life / work balance, trauma, conflict resolution, burnout, talking about mental health challenges; workplace culture of mental health and wellness	8
Messaging		2
Team Building		6

5 Workforce Challenges

5.1 Resilience

5.1.1 Figure

Q: Please select the extent to which you agree or disagree with the statement Note: Agree = ‘Somewhat agree’ or ‘Strongly agree’; Disagree = ‘Somewhat disagree’ or ‘Strongly disagree’. Some items were “reverse-coded” for ease of comparison

5.1.2 Frequencies

Characteristic	N = 3611
I tend to bounce back quickly after hard times.
Strongly disagree	8 (2.2%)
Somewhat disagree	69 (19%)
Neither agree nor disagree	47 (13%)
Somewhat agree	191 (53%)
Strongly agree	46 (13%)
I have a hard time making it through stressful events.
Strongly disagree	43 (12%)
Somewhat disagree	141 (39%)
Neither agree nor disagree	61 (17%)
Somewhat agree	106 (29%)
Strongly agree	10 (2.8%)
It does not take me long to recover from a stressful event.
Strongly disagree	9 (2.5%)
Somewhat disagree	115 (32%)
Neither agree nor disagree	73 (20%)
Somewhat agree	133 (37%)
Strongly agree	31 (8.6%)
It is hard for me to snap back when something bad happens.
Strongly disagree	36 (10.0%)
Somewhat disagree	160 (44%)
Neither agree nor disagree	59 (16%)
Somewhat agree	98 (27%)
Strongly agree	8 (2.2%)
I usually come through difficult times with little trouble.
Strongly disagree	10 (2.8%)
Somewhat disagree	90 (25%)
Neither agree nor disagree	69 (19%)
Somewhat agree	155 (43%)
Strongly agree	37 (10%)
I tend to take a long time to get over set-backs in my life.
Strongly disagree	66 (18%)
Somewhat disagree	150 (42%)
Neither agree nor disagree	59 (16%)
Somewhat agree	72 (20%)
Strongly agree	14 (3.9%)
1 n (%)

5.2 Stressors

5.2.1 Figure

Q: How has COVID-19 and the possible intersecting issues below impacted your stress over the past nearly two years? Note: Low impact = ‘Not at all’, ‘Somewhat’, or ‘Moderately’; High impact = ‘Very’ or ‘Extremely’

5.2.2 Frequencies

Characteristic	N = 3611
COVID-19 pandemic
Not at all	5 (1.4%)
Somewhat	27 (7.5%)
Moderately	68 (19%)
Very	113 (31%)
Extremely	147 (41%)
NA	0 (0%)
Unknown	1
Life/work balance
Not at all	15 (4.2%)
Somewhat	42 (12%)
Moderately	82 (23%)
Very	108 (30%)
Extremely	112 (31%)
NA	0 (0%)
Unknown	2
Public perception of public health
Not at all	20 (5.6%)
Somewhat	42 (12%)
Moderately	77 (22%)
Very	105 (29%)
Extremely	114 (32%)
NA	0 (0%)
Unknown	3
Political perception of public health
Not at all	17 (4.8%)
Somewhat	36 (10%)
Moderately	43 (12%)
Very	95 (27%)
Extremely	166 (46%)
NA	0 (0%)
Unknown	4
Work environment
Not at all	24 (6.7%)
Somewhat	63 (18%)
Moderately	92 (26%)
Very	93 (26%)
Extremely	86 (24%)
NA	0 (0%)
Unknown	3
Mistrust of public health
Not at all	66 (19%)
Somewhat	64 (18%)
Moderately	62 (17%)
Very	75 (21%)
Extremely	89 (25%)
NA	0 (0%)
Unknown	5
Political / court rulings
Not at all	29 (8.2%)
Somewhat	75 (21%)
Moderately	68 (19%)
Very	83 (24%)
Extremely	97 (28%)
NA	0 (0%)
Unknown	9
Mental health stigma
Not at all	74 (21%)
Somewhat	99 (28%)
Moderately	74 (21%)
Very	54 (15%)
Extremely	57 (16%)
NA	0 (0%)
Unknown	3
Racial discrimination
Not at all	125 (37%)
Somewhat	65 (19%)
Moderately	51 (15%)
Very	62 (18%)
Extremely	37 (11%)
NA	0 (0%)
Unknown	21
Gender discrimination
Not at all	133 (39%)
Somewhat	85 (25%)
Moderately	59 (17%)
Very	38 (11%)
Extremely	30 (8.7%)
NA	0 (0%)
Unknown	16
LGBTQIA+ discrimination
Not at all	154 (46%)
Somewhat	78 (23%)
Moderately	49 (14%)
Very	35 (10%)
Extremely	22 (6.5%)
NA	0 (0%)
Unknown	23
Disability discrimination
Not at all	145 (43%)
Somewhat	87 (26%)
Moderately	47 (14%)
Very	34 (10%)
Extremely	24 (7.1%)
NA	0 (0%)
Unknown	24
Economic status
Not at all	95 (27%)
Somewhat	77 (22%)
Moderately	79 (22%)
Very	56 (16%)
Extremely	49 (14%)
NA	0 (0%)
Unknown	5
Other
Not at all	140 (67%)
Somewhat	10 (4.8%)
Moderately	14 (6.7%)
Very	13 (6.2%)
Extremely	32 (15%)
NA	0 (0%)
Unknown	152
1 n (%)

5.3 Workplace culture

5.3.1 Figure

Q: Please indicate your level of agreement with the following statements: Note: Agree = ‘Somewhat agree’ or ‘Strongly agree’; Disagree = ‘Somewhat disagree’ or ‘Strongly disagree’.