“Beating Your Head Against the Wall”: Burnout on the Rise Among Local Health Department Communication Officials

Abstract

The COVID-19 pandemic posed unprecedented challenges for frontline healthcare professionals globally. Despite the varied challenges encountered by frontline healthcare professionals, the difficulties faced by public health communication officials in particular has remained an underexplored area of research. This study examined the specific challenges experienced by communication officials during the COVID-19 pandemic in the United States. A qualitative research design was used to conduct in-depth interviews with communication officials working in local health departments (LHDs) in 2022. A total of 14 participants were recruited through purposive sampling, coupled with a data saturation strategy, from LHDs situated in Kansas, Missouri, and Oklahoma. Thematic analysis revealed 3 key themes: (1) main challenges faced by LHDs during the COVID-19 pandemic, (2) challenges related to information dissemination on social media, and (3) burnout experienced by communication officials. This study's findings suggest that communication officials should be provided with the necessary resources and training to effectively handle misinformation, toxic behaviors, and bullying on social media while prioritizing their mental health. In addition, federal, state, and local health agencies should provide timely, clear, and accurate information to address the challenges faced by communication officials in their bid to disseminate information effectively.

Introduction

Inarguably, the COVID-19 pandemic presented an unprecedented environment for healthcare professionals. Early research examining the challenges and issues faced by health agencies and healthcare workers suggests that since the World Health Organization declared the pandemic a global health emergency, healthcare workers have encountered several challenges. These challenges include a scarcity of personal protective equipment; contraction of the virus; physical and emotional exhaustion; adaptation to frequently changing policies, information, and guidelines; heightened levels of anxiety and stress; understaffing; an inclination to express more negative emotions than positive ones; politicization of the pandemic; burnout; and public pressure to provide timely and accurate information.^1-14

A majority of the research conducted early in the pandemic focused on nurses, medical doctors, and healthcare workers employed in hospitals and emergency settings. These studies have provided valuable insights about the prevalence of burnout experience among nurses, doctors, and other healthcare professionals, both before and during the pandemic, which was attributable to factors such as heavy workload, chronic fatigue, work-life balance, depression, and stress.^15-18 Another stream of research suggests that healthcare professionals have faced considerable challenges with the proliferation of misinformation and politicization of the virus and vaccines.^19-22 The COVID-19 pandemic has proven that public health measures, such as mandating vaccination and face masking, have been challenged and questioned not only by the general public but also by elected officials.^2,23 Consequently, a concerning science and health communication landscape has emerged, where misinformation has proliferated, vaccination skepticism has increased, and the role of communication officials (such as social media managers, public relations officers, public information officers, risk communicators, crisis communication experts, community health coordinators) has become even more challenging.^19,24 Yet, we have a limited understanding of the challenges faced by communication officials responsible for managing the flow of information during pandemics, particularly those who leverage social media platforms. This population plays a critical role during times of crisis by disseminating information via social media platforms.²⁵

This study aims to address the gap by exploring the main challenges faced by local health departments (LHDs), specific challenges in information dissemination on social media, and factors contributing to burnout among communication officials in LHDs during the pandemic. In this study, semistructured interviews were conducted with communication officials from LHDs in Kansas, Missouri, and Oklahoma. The findings from this study contribute to our understanding of the broader role played by communication officials and social media in the context of a global health crisis in 2 significant ways: (1) it examines the experiences of communication officials who use social media to disseminate accurate information to the community while facing toxicity and negativity that impact their work, and (2) it highlights the need for communication officials to receive adequate resources and support to effectively address challenges such as online trolling, misinformation and disinformation, and toxicity from social media users. In addition, it emphasizes the importance of federal, state, and local health agencies developing interventions to address the mental health issues and burnout experienced by communication officials, while also fostering resilience within the community health workforce.

Methods

Semistructured interviews were conducted to investigate the challenges faced by communication officials from 14 LHDs during the COVID-19 pandemic and their impact on communication with local audiences. This study used a purposive sampling approach^26,27 to gather in-depth and detailed information from communication officials responsible for creating and posting content on their respective LHD Facebook pages. This study aimed to empower participants, encouraging them to share and discuss any themes relevant to their experience managing social media platforms during the COVID-19 pandemic. Prior to data collection, approval was obtained from the University of Kansas Institutional Review Board (00148289).

Participant Recruitment Process

Eligible LHDs were chosen based on their presence in the most populous counties in each state. This was defined as having active engagement on social media platforms, active content posting, comparable numbers of COVID-19 cases during the study period, and a department size with about 2 to 3 individuals responsible for social media management. The author conducted a thorough examination of each LHD's website and sent inquiries to identify the relevant communication officials who actively posted content and addressed audience queries on social media platforms. Only those LHD communication officials who were directly involved in creating, posting, and updating content for their respective social media accounts were deemed eligible for this study. Of the 25 LHDs contacted, 14 communication officials (each from a different LHD) agreed to participate and were interviewed. Thematic saturation of data was reached after 14 interviews.

After the communication officials agreed to participate in the study, they were sent an email with information about the study and a consent form. Arrangements were then made to conduct the interviews online using the Zoom platform.

Interview Guide

An interview guide for this research was developed based on prior studies in the field and the specific research questions of the study.^22,28-31 The interviews were designed to be extensive, detailed, and conducted in a conversational style, following Mishler's³² approach, which emphasizes treating respondents as research “collaborators.” Each interview in this research began with introductory questions related to the participants' current job title and the duration of their tenure in the department, followed by questions directly related to their job and political environment (see Supplemental Material: Interview Guide, www.liebertpub.com/doi/suppl/10.1089/hs.2023.0002). Guiding questions were supported by additional prompts or probes to encourage participants to provide further details or elaborate on their responses to the main topics, particularly if they digressed from the main point.³³ Toward the end of the interview, additional demographic information was gathered from the participants, including their age, gender, education, official designation, and experience related to social media content management. Social media content management refers to a set of tools and processes used to create, edit, organize, and publish digital content on social media platforms. It is an important component of websites, blogs, and other online platforms, which simplifies the process of content creation and maintenance, allowing people and organizations to efficiently manage their online presence.

Data Collection

The interviews were conducted online between February 2, 2022, and April 24, 2022. Participant identities were anonymized by assigning each interviewee a number. All interviews were recorded on Zoom and transcribed in their entirety. Transcripts were then subjected to open coding using Dedoose version 4.12 (Dedoose, Los Angeles, CA) to facilitate the identification of recurring themes and concepts within the data.

Data Analysis

The author used the constant comparison technique for qualitative data analysis based on grounded theory^34,35 to develop codes and organize themes related to the main challenges faced by LHDs, the issues encountered by communication officials in disseminating information, and their experiences of burnout. The constant comparison technique involves several phases: (1) data familiarization, (2) initial coding, (3) comparison, (4) development of categories, (5) refinement, and (6) saturation.³⁵ In the first phase, the author familiarized himself with the data during the interview process and transcription, and by taking notes on how participants expressed their views. During the second phase, initial coding was generated using Dedoose, with the author coding various participants' responses to the same question. These codes were shared with the participants to verify their accuracy and to ensure the author captured the essence of their responses effectively. It is important to note that only 8 participants replied to the email requesting them to review the results at this stage. In the third phase, the author compared participant responses to identify similarities and differences, while supervised by 2 qualitative researchers from the author's institution. This supervision functioned as secondary coding to review all codes and verify patterns and themes. The comparison process was applied to each participant's response. During the fourth phase, broad categories were created and illustrative names were given to those categories. During the fifth refinement stage, the author collaborated with the qualitative researchers, who were well acquainted with the project, to ensure the quality of coding. Finally, in the sixth stage, saturation of themes was achieved after coding responses from the 14 participants. This process proved valuable in generating more focused and comprehensive themes. The iterative process of coding and constant comparison allowed for the construction of tightly fitting, focused themes that aligned well with the data.³⁶ Data coding was initially done in chronological order during data collection, using Dedoose version 4.12.

Results

The final study population comprised 8 female, 5 male, and 1 nonbinary participants (Table 1). The interviewees were strategic communicators, community information coordinators, communication officers, public information officers, risk communicators, crisis communication experts, and COVID-19 communication specialists with work experience ranging from less than 2 years to 10 years. The participant responses generated the following 3 key themes: (1) main challenges faced by LHDs during the COVID-19 pandemic, (2) challenges related to information dissemination on social media, and (3) burnout among communication officials (Table 2). Each theme is described in detail next.

Table 1.

Participant and Interview Characteristics

Interviewee	Gender	Education	Experience in the Field	Interview Length
1	Male	Bachelor's degree	1.2 years	48 min.
2	Female	Bachelor's degree	10.0 years	64 min.
3	Female	Master's degree	7.0 years	37 min.
4	Female	Bachelor's degree	4.8 years	55 min.
5	Female	Bachelor's degree	3.0 years	58 min.
6	Male	Master's degree	10.0 years	40 min.
7	Male	Bachelor's degree	9.0 years	56 min.
8	Male	Bachelor's degree	2.0 years	51 min.
9	Female	Master's degree	2.0 years	57 min.
10	Female	Master's degree	2.1 years	50 min.
11	Female	Bachelor's degree	2.6 years	41 min.
12	Male	Bachelor's degree	2.5 years	57 min.
13	Female	Bachelor's degree	2.0 years	51 min.
14	Nonbinary	Bachelor's degree	1.5 years	51 min.

Table 2.

Overview of Themes, Subthemes, and Comment Count

Themes	Subthemes	Comment Count
Main challenges faced by local health departments during the COVID-19 pandemic	Lack of resources	19
	Understaffing	21
	Less flexible schedules	19
	Lack of funding and shortage of medical supplies	15
Challenges related to information dissemination on social media	Multilanguage translation	17
	Verification of social media pages	8
	Negativity and hostility on social media	24
Burnout among communication officials	Stepping away from work for a while	21
	Leaving the public health industry	16
	COVID-19-related fatigue and stress	23

Main Challenges Faced by LHDs During the COVID-19 Pandemic

LHD communication officials highlighted key challenges they faced during the early phase of the COVID-19 pandemic. These included lack of resources, staff shortages, limited testing supplies, inadequate funding from state and federal governments, bureaucratic obstacles in the health department, longer working hours and limited flexibility in work schedules, and hostility and negativity from local communities online and offline.

Regarding inadequate resources and support for LHDs during the pandemic, interviewees noted that, in general, both large and small LHDs faced similar challenges and barriers. However, in some cases, smaller LHDs faced more pronounced and varied difficulties in terms of resource availability and dealing with COVID-19 cases compared with their larger counterparts. One participant from a larger LHD said:

I think every LHD has the same problem—lack of resources. Comparatively, we have more access to resources than some smaller health departments. I have a colleague who works in a small LHD and [they] told me that they were having more issues dealing with COVID-19 than us, not just in terms of [COVID-19] cases but resources. (Interviewee 6)

Specifically, several participants emphasized that the lack of funding and understaffing remained the biggest challenge they faced in carrying out their duties throughout the pandemic. For example, a participant noted:

Initially it was funding. Then, we didn't have enough staff to keep up with contact tracing at the time. We didn't have enough funding to hire additional staff to do that, or to have additional health providers to do testing. (Interviewee 10)

In addition to staff shortages and lack of resources, participants also noted that their efforts to respond effectively to the crisis were hampered by bureaucratic processes from the federal to the state level. As a participant expressed:

There was not enough testing going on or accessible to the community. You know vaccines and how we do things. The FDA [US Food and Drug Administration] and the CDC [US Centers for Disease Control and Prevention] first have to approve things, and then that trickles down to the Kansas Department of Health. Then, us [LHDs] and then our doctors or deputy helped everybody to decide on how we were going to move forward. So, I feel like that hierarchy and bureaucracy sometimes can slow down the process because we have to wait for every step to be on board. (Interviewee 11)

Another participant highlighted inconsistencies in the supply chain and the lack of clear guidelines regarding the phases of vaccine rollout. This led to confusion among communication officials who were tasked with guiding the general public on where to get tested, purchase masks, and receive vaccinations.

Obviously, when the vaccine rollout happened, it was kind of a 24/7, because there [were] a lot of people that were getting confused about vaccination and want[ed] to know what phase they were in. And the phase [was] being controlled by the state, which was out of our control. And, like, trying to help people get it [the vaccine]—and then in the beginning it was so hard to get. (Interviewee 4)

Overall, the general challenges discussed under this theme encompass long working hours, staff shortages, funding limitations, bureaucratic hurdles, and irregularities in the supply chain of testing, masks, and vaccination. This resulted in frustration among healthcare professionals and the public.

Challenges Related to Information Dissemination on Social Media

With an increasing number of diverse populations within the study region, the selected LHDs have faced growing demands to address the healthcare needs of diverse communities. All study participants highlighted that a key challenge faced by LHDs was the translation of social media content into multiple languages. For example, a participant said:

[H]aving things in multilanguage is really challenging. So, having things translated, it takes a long time, and then someone has a question in a different language. Then, we have to translate the answer using online tools, so it might not be super accurate. (Interviewee 11)

This participant and others also noted that their LHDs encountered difficulties in getting translated messages approved for content boosting due to increasing concerns about misinformation during the pandemic. For example, Interviewee 11 reported that “Facebook would try to vet any misinformation post about the vaccine, so getting our flyers out or boosted would get rejected by Facebook's algorithm.”

Another participant emphasized that the challenge during the COVID-19 pandemic was not limited solely to translating messages into different languages, but equally challenging was the requirement for additional time and careful consideration to rephrase and reshape each message before disseminating it to the general public. The pandemic brought attention to the prevalence of negativity and hostility on social media, prompting communication officials to incorporate uplifting content to foster a sense of normalcy within their local communities. One participant expressed frustration over the need to distill lengthy documents into concise messages, which were sometimes difficult to comprehend, requiring people to ask follow-up questions to communication officials. Consequently, allocating sufficient time for both document perusal and content creation emerged as a major obstacle during the initial stages of the COVID-19 crisis. When facing staff shortages while racing against time, clarity of information often became compromised. One participant said, “Language accessibility is definitely a bigger challenge for us.” Another participant noted:

The general public is not going to understand that we are going to take the time to try to understand it. […] So, we need more of an hour, but preferably 4 hours. We can do it, then we may not have an effective message. (Interviewee 5)

Another challenge was that because COVID-19 was caused by a novel virus, communication officials were not previously aware of the virus. They experienced immense pressure from the community to share information regarding the disease and its causative agent. They constantly grappled with the rapidly evolving nature of information and the community's relentless demand for round-the-clock updates. As an interviewee described:

There's so much information and it's changing constantly. So, keeping up with that and getting that information out constantly, especially in the last 6 months […] What's the latest guidance is like I said: we are building the plane while we are flying. And that's been the hardest part […] is just trying to feed that beast and get that information out there. It's been hard listening to them attack our staff for just doing their jobs, […] just trying to keep up with the accurate information. (Interviewee 2)

Another participant highlighted the difficulty of providing information to a significant portion of the population who lacked a computer or internet literacy. This added another layer of complexity to their communication efforts. The participant (Interviewee 13) said, “Individuals who don't use social media or the internet. I think information was overly less accessible for folks that were not computer or digitally literate.”

In conclusion, the challenges associated with dissemination of information on social media platforms were far from simple and straightforward. In fact, more complexities contributed to the formidable challenges encountered during the evolving COVID-19 crisis, such as the need for multilanguage translation for a diverse population, hostility on social media platforms toward communication officials, social media algorithm miscalculations about what was fake versus what was not, lack of technological understanding among certain factions of the society, and the demand for constantly updated information about the virus in the age of social media.

Burnout Among Communication Officials

Frustration and feelings of burnout—stemming from various factors including negative interactions on social media during the pandemic—were frequently mentioned by the interviewees. All participants acknowledged experiencing moments when they desired a break, had no interest in dealing with social media, contemplated leaving the public health industry, or questioned the significance and importance of their work. A few individuals responsible for managing LHDs' social media communication even resigned from their positions due to the abundance of hateful comments, spam, and trolling. As a result, communication officials reported having experienced burnout. As a participant said:

I think we all had that [burnout] at some point in time. We took it [as] a priority of making our staff take breaks and back away. […] There were definitely times where you looked around and said, You need a break. (Interviewee 6)

The burnout experienced by communication officials emerged as one of the most important recurring themes in almost all of the responses. For instance, a participant said:

The first person in charge of my position [and] my social media no longer works here. She was done. She was like, I'm out. I would say that definitely. So, dealing with all the hate and anger we get on our page is just too much. It definitely affects you. [And] people are still so angry, or they are still questioning the vaccine and posting comments about it. It's like, get a life—just move on. I'm tired of it. (Interviewee 9)

Furthermore, excessive exposure to social media among communication officials during the COVID-19 pandemic contributed to feelings of burnout. Participants mentioned that repeatedly sharing the same information without knowing if it would truly make a difference in the community was a key factor that contributed to their burnout. Some participants emphasized the importance of having a supportive work environment, including the ability to take time off to address their mental health issues. Communication officials in LHDs recognized the importance of their work in safeguarding community health. However, they often faced lack of recognition and appreciation from community members for the value of their efforts. Finding a balance between mental health and professional responsibilities remained an ongoing process for interviewees. As an interviewee said:

I know that a lot of people do get burned out on it, as far as from a communication standpoint. I'm seeing a lot of the toxicity that goes on. Overall, I think, [the potential for] burnout is definitely a worthwhile consideration, not just for me and other communications people but also our department who actually puts data together for us that we share out. If we take a day off, people in the community will kind of freak out a little bit. (Interviewee 1)

One participant even contemplated leaving the industry and seeking a different job in marketing communication that would not involve social media. Communication officials not only experienced burnout but also provided explanations for why they felt this way and identified the underlying factors. As an interviewee noted:

Absolutely and I think it's just been a thing throughout the entire pandemic. […] We've dealt with people not trusting us or them believing that we don't have their best interest in mind. This definitely leads to burnout but [we're] just kind of learning tools to fight through it. (Interviewee 10)

Another participant aptly described the experience of sharing repetitive information online without knowing its impact as akin to “beating your head against the wall.” Despite the efforts of communication officials to disseminate credible and accurate information, people often aligned their ideologies with a particular political viewpoint, causing divisions and hindering the reception of useful health-related information. The participant described this as follows:

I think everyone's experiencing that fatigue. You feel like you're just kind of beating your head against the wall with, sending the same information […] everything has become so divided, you're either on this side or that side […] So, it is a bit frustrating and you're tired and you just are ready to talk about something else. I wouldn't be here if she [my supervisor] wasn't here. If we need to take a mental health day, we can step away and take a break, and she respects that and she recognizes that. (Interviewee 4)

Another participant candidly expressed her desire to leave the job, acknowledging the challenges of combating misinformation in the era of social media. She recognized that the task was far from easy, given the complexities and rapid spread of false information on various online platforms. She said:

Just the negativity, it's very stressful. I've thought about leaving the industry and just going to do some other kind of marketing communications job if it's not social media […] it's like the never-ending snowstorm for 2 years […] I don't know how to fix it [misinformation] anymore. It's not fun. (Interviewee 2)

One participant emphasized the substantial loss experienced by their communication division, revealing the formidable challenges encountered in recruiting and retaining staff for social media communication:

I lost my entire division. So, my entire division left, and I had to rehire all of my staff during the pandemic. And my longest tenured staff person now has been on board for just 2 years, and so we are trying to retain and onboard. (Interviewee 7)

One more participant expressed her feelings of frustration and burnout, as well as how to deal with it in the following quote:

When you're constantly receiving hostile emails and calls and comments, in person you just get very thick skinned and a little desensitized to it. So, it can be stressful, and it can make you frustrated at times. But I think over the years I've just learned. I assume that you're always going to have a segment like that. But […] those are the vocal minority; but then there's a large percentage of the viewers or the social media folks that don't feel that way that are not as vocal. So, that helps me keep focused on what I'm trying to do. (Interviewee 8)

To summarize, communication officials faced challenges in effectively reaching the public, leading some to consider a new career or leave due to social media's incivility and toxicity. Social media also presented challenges as users constantly sought updates, making it difficult for communication officials to address the unprecedented crisis of the COVID-19 pandemic. Despite these obstacles, participants continued to share relevant data and information with communities, aiming to empower individuals in making well-informed decisions about their health. While some communication officials managed to navigate the toxic and negative aspects of social media, most of them still grappled with strategies to maintain their mental wellbeing while continuing their work in the public health field.

Discussion

This study analyzed the challenges faced by communication officials in LHDs during the COVID-19 pandemic. Prior studies in public health and health communication suggest that healthcare professionals encountered several substantial difficulties throughout the pandemic.²⁹ For instance, although a 2021 study³⁷ conducted by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health suggests that the majority of Americans acknowledge the crucial role of public health agencies in maintaining the nation's health, another survey presents a contrasting view. The survey, conducted by the New York Times, reveals that public health agencies have experienced employee losses, legislative limitations on LHDs' powers, ongoing concerns about funding, and instances where staff members have felt insecure due to death threats received via calls and social media.³⁸

Sadly, the findings of this study align with those of the New York Times survey and several other studies.^4,29,31,39 Participants in this study noted various challenges that they encountered during the pandemic, including being trolled on social media, being understaffed, facing limited testing supplies, dealing with inadequate funding, having inflexible work schedules, and experiencing hostile environments on social media platforms. In the past, scholars have extensively studied the challenges faced by healthcare workers during the COVID-19 pandemic and have established that these workers have experienced depression, health concerns, burnout, workplace safety worries, demoralization, harassment, abuse, and even violent attacks.^6,29,40 It is important to note, however, that communication officials who are responsible for managing social media for their respective LHDs face challenges specific to social media communication. Highlighting the distinct difficulties faced by these officials in their role is the most important contribution of this study.

This study also examined specific challenges related to information dissemination on social media, including translating content into languages other than English; verifying social media pages; managing time effectively; dealing with evolving and sometimes conflicting information; navigating guidelines from federal, state, and local health agencies; and addressing low internet connectivity and low health literacy within the community. Participants acknowledged the difficulty of reaching individuals without social media presence or internet access, highlighting the major disadvantages faced by those without stable internet access or digital devices in our increasingly digital society.⁴¹ During crises, communication should be purposeful, recurrent, and iterative and health agencies should use multiple social media platforms for information dissemination.⁴² This research supported previous studies' findings that communication officials used multiple platforms to disseminate information and often posted the same content multiple times to reinforce the importance of COVID-19-related messages.

Finally, the findings also indicate that frustration and feelings of burnout among communication officials stemmed from various sociopsychological, technological, and political factors. For instance, participants noted moments when they desired a break and wished to avoid dealing with social media. These experiences of burnout were not solely due to the challenges posed by COVID-19 but were also influenced by the treatment they received on social media platforms. Participants shared negative encounters, expressing that when faced with hateful comments, they questioned their commitment to remaining in the public health field. These factors contributed considerably to the emotional toll experienced by communication officials in their roles. This aspect serves as the second most significant contribution of the study is emphasizing how toxicity, misinformation, negativity, and trolling on social media platforms have contributed to the burnout and poor mental health experienced by communication officials in LHDs. It sheds light on the detrimental impact of these factors on the wellbeing of these professionals, further highlighting the urgent need for supportive measures and interventions to address the challenges they face in their roles related to social media communication.^4,31,39

Undoubtedly, the issue of burnout among healthcare professionals has a longstanding history in public health scholarship.^4,18,43 For instance, Leider and colleagues⁴ examined the intentions of state and local public health agency staff to leave or retire in 2017 and tracked their actual separations through 2021. The findings suggested that nearly half of the employees in state and local public health agencies left their positions between 2017 and 2021. Among younger individuals, several key factors emerged as major contributors to their decision to leave the public health field, including low pay, limited opportunities for career advancement, work overload leading to burnout, job dissatisfaction, and high levels of stress. The present study found, however, that the pervasive presence of misinformation, online harassment, and negative public sentiment on social media platforms had a considerable impact on the wellbeing and job satisfaction of individuals in the public health field. These negative experiences added to the overall stress and burnout levels, further exacerbating the decision to leave the profession.

Previous studies have explored factors that can contribute to burnout but have not specifically examined social media as a potential factor—a finding that this research reveals through the perspectives of communication officials. One participant aptly described that sharing information on social media is like “beating your head against the wall” due to the uncertainty of its impact and negative public interaction. Two other participants even contemplated leaving the public health field during the pandemic, feeling exhausted from combating health misinformation on social media. Previously, several studies have recommended strategies for healthcare workers and health agencies to combat health misinformation on social media and strategies to maintain good mental health, with evidence of their effectiveness.^{23,28,31,39,44-46} However, the findings of this study suggest that communication officials are not yet equipped to effectively tackle this challenge, primarily due to time constraints and the hostile environment prevalent on social media platforms. This aspect serves as the third most significant contribution of the study, highlighting the complex nature of misinformation and negativity on social media platforms and the challenges faced by communication officials in addressing this growing issue in health communication and public health. The findings shed light on the pressing need for comprehensive strategies, support systems, and resources to equip communication officials in their efforts to combat misinformation and foster positive health communication in the digital sphere.

Practical Implications of the Study

Drawing from the shared experiences of participants and the findings of prior studies, this research highlights valuable practical implications for the public health field. First, it is essential to provide communication officials with necessary resources (eg, guidelines on effectively using social media while prioritizing their mental health) and training (eg, online content management) to equip them with necessary skills and knowledge to handle both misinformation, as well as toxic behaviors and bullying encountered on social media. Second, this study underscores the importance of resource sharing for those responsible for enhancing community health, particularly communication officials. Recognizing the vital role played by these professionals, it is imperative to prioritize the dissemination of relevant resources that can be instrumental in supporting their efforts, such as resources from the Public Health Communications Collaborative and the Government Social Media Conference. These platforms offer valuable opportunities for knowledge sharing, networking, and professional development in the field of public health communication and social media. Third, communication officials face a plethora of challenges when it comes to disseminating information effectively. Thus, federal, state, and local health agencies should provide them with timely, clear, and accurate information. By ensuring a streamlined flow of information, these agencies can alleviate the burden on communication officials and enable them to manage information and address the information needs of the community more efficiently. Fourth, excessive use of social media and constant exposure to trolling and a toxic environment can impact the mental health of communication officials considerably. Therefore, it is essential to provide them with mental health resources (eg, therapy sessions, short breaks, mental health day). Fifth, it is anticipated that communication officials may encounter more severe disinformation campaigns in the future, potentially surpassing the challenges witnessed during the COVID-19 pandemic. As technology advances and mis/disinformation tactics evolve, it is crucial for communication officials to stay vigilant, adapt their strategies, and collaborate with relevant stakeholders to counteract the spread of false information effectively. Finally, these findings emphasize the importance of prioritizing the health and wellbeing of communication officials during health crises to prevent the prevalent feeling of burnout often experienced in the public health field.

Limitations and Future Research

This study has several limitations. First, the sample size of only 14 participants may restrict comprehensive understanding of communication officials' main challenges, their information-dissemination strategies, and their experience of burnout. Second, the study focused on both small and large LHDs located in Midwestern states, which have distinct political dynamics compared with the East or West Coast. Therefore, the challenges faced by these communication officials might differ from those encountered by communication officials in LHDs in other parts of the United States. Moreover, the generalizability of the findings beyond the scope of the sample population, which consisted solely of US communication officials, could be limited. It is important to note that this qualitative study did not establish a causal relationship between negativity on social media and the development of burnout. Although prior research has investigated the challenges faced by LHDs, this study is the first of its kind to focus on the hurdles encountered in information dissemination during a prolonged health crisis in the era of social media, as well as the burnout experienced by communication officials in the public health workforce. Future research should explore the specific social media platforms used by LHDs and explore the reasons behind their choices. Furthermore, investigating the perception of communication officials about the importance of fact-checking in public health and their strategies to address misinformation on social media would be fruitful avenues for future work.

Conclusion

This research explored the challenges faced by communication officials in LHDs during the COVID-19 pandemic and revealed that these officials faced hostility on social media and encountered staffing shortages, limited testing materials, funding constraints, and inflexible work schedules, which led to burnout and frustration. The study contributes to literature on social media use by LHDs, personal wellness in public health, crisis communication in the digital age, and burnout among communication officials. The qualitative analysis opens new avenues for researching communication officials in healthcare during public health crises, particularly regarding burnout.

Footnotes

Acknowledgments

The author expresses his heartfelt gratitude to the participants who dedicated their diligent work during the challenging COVID-19 response and generously contributed their time for the interviews. In addition, the author would like to thank his supervisor for her support of this research.

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