Resilience among Rural Public Health Leaders during the COVID-19 Pandemic: A Hermeneutic Phenomenological Study.

PURPOSE: This study explored how rural public health leaders in Wisconsin experienced and sustained resilience during the COVID-19 pandemic, with particular attention to the role of relational connections across professional, personal, and community domains. METHODS: Using hermeneutic phenomenology, the study examined the lived experiences of rural county health officers and other supervisory leaders. Twenty semistructured interviews were conducted via Zoom between September and November 2023. Participants were purposively sampled from rural counties, as defined by the National Center for Health Statistics' Urban-Rural Classification Scheme. Interviews were recorded, transcribed, and thematically analyzed through iterative coding and synthesis. FINDINGS: Resilience was closely linked to the embeddedness of rural communities. Longstanding trust, shared history, and a sense of mutual responsibility strengthened leaders' resolve. At the same time, this closeness also increased feelings of scrutiny, blurred personal and professional boundaries, and exposed leaders and their families to hostility. Leaders relied on tightly knit staff teams, cross-jurisdictional peer networks, and supportive governing officials. CONCLUSIONS: In rural settings, resilience is co-constructed through community connections. Strengthening peer support and preparing governing bodies to lead with empathy are important for sustaining this workforce.