A qualitative analysis of frontline workers’ experiences with public health protocols and communications during the COVID-19 pandemic and perspectives for future public health practice

Frontline workers (FWs) faced substantial challenges during the COVID-19 pandemic, including higher risks of occupational exposure to SARS-CoV-2 despite rapidly evolving public health recommendations about how to reduce these risks. FWs in many industries, such as education, meatpacking, manufacturing, and agricultural production, were also more likely to have delayed access to personal protective equipment and vaccines compared to FWs in large healthcare organizations, leading to an increased infection risk in this population. Research examining FWs’ experiences during the COVID-19 pandemic may offer insight into occupational protections for future public health emergencies. A qualitative thematic analysis was conducted using more than 2500 free-text responses from 703 FWs participating in a community-engaged survey in the Midwestern United States from May 2022 to July 2022, coinciding with a period of transition from the acute pandemic crisis of 2020–2021 to management of its longer-term impacts. Responses were submitted in English or Spanish. At least two trained researchers independently coded each response, using an a priori codebook that was refined iteratively to incorporate emerging concepts. Participants represented a range of frontline occupations, with the largest group working in education, childcare, or school administration (28.3%). Major themes across FWs’ responses included health communication, occupational challenges, and protective measures. For health communication, workers described the impact of misinformation and communication barriers during the COVID-19 pandemic, noting how politically polarized health messaging and inaccurate information created confusion, distrust, and difficulty making informed decisions regarding one’s health. Occupational challenges included inadequate workplace policies, financial strain, and difficulties incorporating infection protections in the occupational setting. FWs’ views about protective measures varied but included perceptions of efficacy, ease of use, social stigma, and feasibility. FWs reported that inconsistent health messaging, insufficient workplace support, and barriers to use of protective measures had influenced their decisions and experiences. Their accounts align with broader research suggesting that misinformation, inconsistent reports about COVID-19 protections, politically influenced health messaging, and restrictive workplace policies increased vulnerability to infection among FWs. This study gives insight into public health practices that should be addressed when preparing for future epidemics and pandemics.