Many Americans living in counties that flipped for or overwhelmingly supported Donald Trump during the 2016 election don’t believe the country is better off today under his leadership, according to a new poll from NBC News and the Wall Street Journal.

The poll, released Tuesday, focused on residents of the 438 counties in 15 states that went from blue to red in 2016, or voted overwhelmingly for Trump compared to 2012 Republican presidential nominee Mitt Romney.

Among those residents, 41 percent believe the country is worse off today than it was when Trump assumed the presidency. Additionally, 26 percent believe things in the country haven’t changed.

Thirty-two percent of residents in these “Trump counties” say the U.S. is better off today than before Trump became commander in chief.

The majority of residents, 53 percent, in counties that either flipped from Democrat to Republican in 2016 or saw a surge of support for Trump, don’t believe the president has a strong agenda for addressing the country’s top issues.

But the president enjoys a higher approval rating among residents of “Trump counties” than among the general voting population. Forty-eight percent of residents approve of the job Trump is doing as president, compared to 50 percent who disapprove.

Overall, 38 percent of voters said they are pleased with Trump’s job performance, compared to 58 percent who disapprove, according to an NBC News/Wall Street Journal poll published last month.

Residents of “Trump counties” are especially disappointed with how the president has improved America’s image worldwide, helped unite the country, boosted race relations, and improved the healthcare system.

Fifty-seven percent of voters in those counties are unhappy with how Trump has enhanced America’s image, and 60 percent are dissatisfied with how he has helped to unite the country. Additionally, just 37 percent of “Trump county” voters said they are satisfied with his efforts to improve race relations and improve the healthcare system.

“Trump counties” are located in Colorado, Florida, Georgia, Indiana, Iowa, Maine, Michigan, Minnesota, Missouri, New Hampshire, North Carolina, Ohio, Pennsylvania, Virginia, and Wisconsin.

The NBC News/Wall Street Journal poll surveyed 800 residents in “Trump Counties” from Nov. 1 to Nov. 4. The margin of error is plus or minus 3.46 percent.