Heat adaptation in rural municipalities: A cross-sectional study in the Augsburg district, southern Germany

Extreme heat is an increasing public health challenge, yet heat adaptation in smaller and rural municipalities remains comparatively underexplored. This study assessed municipal heat adaptation, implementation barriers, perceptions of heat-related health impacts, and their relation to regional climate information in the Augsburg district, Southern Germany. A cross-sectional online survey was conducted among all 46 municipalities in the district between January and March 2025. Forty municipalities responded (87%), and 29 provided complete questionnaires (63% of the sampling frame). Survey data were analyzed primarily descriptively and supplemented by regional climate projections from the GERICS Climate Outlook. Perceived health impacts during the previous and next 10 years were additionally compared using a paired t -test and Wilcoxon signed-rank sensitivity analysis. Fourteen of 29 municipalities (48%) had no assigned responsibility for heat protection. Strategic approaches, including climate analyses and Heat Action Plans, were less established than several infrastructure-based measures. Financial and staffing constraints were among the most frequently reported barriers. Municipalities expected stronger heat-related health impacts over the next 10 years than during the previous decade (mean paired difference 0.655, 95% CI 0.422 to 0.889; p < 0.0001), while regional projections indicate increasing heat-related climatic hazards over subsequent decades. Descriptive patterns suggested lower strategic engagement among smaller municipalities. Given the small analytical sample and single-district design, municipality-size patterns should be interpreted as exploratory. The findings highlight the importance of translating regional climate information into locally applicable adaptation support. Clear responsibilities, accessible guidance, funding support, and capacity building may strengthen climate services and heat adaptation in resource-constrained municipalities.