JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic placed unprecedented demands on nurses and midwives worldwide, exacerbating existing workforce shortages and contributing to high rates of mental health issues and altered labor market dynamics. Nurses and midwives in low- and middle-income countries remain underrepresented in the literature and thus, there is little data to determine differences and similarities in the impact of pandemic response implementation with high-income countries.

Objective:

To describe and compare the impact of pandemic response implementation across countries and contexts on the global nursing and midwifery workforce who worked and delivered care between March 2020 and December 2023.

Methods:

A pragmatic design guides this multinational, online, descriptive study. Eligible participants are nurses and midwives who cared for at least one suspected or confirmed COVID-19 patient in the designated period. Country teams use opt-in convenience and network sampling, targeting n=300 per country, or n=60 for small island states. The self-administered 79-question instrument, hosted on Qualtrics XM software and available in 27 languages, was developed with country teams. It includes 8 open-ended free-text questions; 46 questions examining the impact of pandemic response implementation on mental health, career mobility, economics, and occupational exposures; and 25 demographic questions. After pilot testing, data collection took place between July 2022 and June 2026. Summative content analysis combined with natural language processing techniques analyzed the qualitative data. Descriptive and bivariate analyses analyze quantitative responses. Cross-country comparative analyses of quantitative data use funnel plots with binomial control limits to compare country responses and can accommodate unequal sample sizes. Psychometric evaluation of instruments developed and tested in this study is planned. Funding for the study was provided by the PI’s university, with ethics approval obtained in May of 2020.

Results:

At the conclusion of data collection in June of 2026, 23,000+ nurses and midwives from 108 countries engaged with the study's online instrument, with 14,000+ completing more than 50% of all the questions. Descriptive analyses of partial samples are published as well as the pilot tests of the methodology. The analyses specified here will use the complete dataset and are underway, with the first multinational analyses expected in 2027. Country teams will lead analyses specific to their country.

Conclusions:

Upon completion, the study will identify the common and unique factors that influenced pandemic response implementation relative to nurses and midwives during the COVID-19 pandemic, from low-resource to high-resource settings. It will produce some of the first occupational estimates of the participants’ mental health symptoms and how they cope with them. Data may provide insights into current labor market dynamics resulting from the pandemic. Finally, the study will provide data that can inform country-level preparation to meet Articles 4, 6, 7, and 9 of the WHO pandemic agreement. Clinical Trial: Not applicable.