Coronavirus disease-2019 (COVID-19) has placed a significant burden on the global healthcare system, prompting the World Health Organization (WHO) to declare it a pandemic on 11 March 2020 [1]. Various public health responses like travel restrictions, physical distancing, quarantining, social isolation, and contact tracing were used to control the pandemic [2]. Despite various public health responses strategies to halt the pandemic, challenges like shortage of resources including financing, personal protective equipment (PPE), and respiratory devices were creating the obstacle, especially in low-income countries [3,4]. Besides these, another important barrier was the lack of health care personnel [4].
For every 1000 people, WHO recommends a minimum of 2.28 health care personnel (doctors, nurses, and midwives) [5,6]. As per World Health Statistics 2018, for every 1000 people, there were 0.8 physicians and 2.1 nurses and midwives in India while 0.6 physicians and 2.0 nurses and midwives in Nepal [6,7]. So, South Asian countries including India and Nepal were already short of healthcare personnel before the pandemic began, and this shortfall was more evident with the emergence of the COVID-19 pandemic, increasing the work burden for the healthcare personnel. Thus, the recruitment of healthcare personnel and other human resources is crucial to fight the pandemic [8]. Medical students, being more oriented to medical situations are one of the alternatives for assisting overworked health professionals. During the influenza pandemic in 1918, medical students were involved in patient care to aid the medical personnel [9]. As a result, medical students serving as volunteers might be a vital response to the COVID-19 pandemic.
So, the primary objective of this study was to evaluate the medical and nursing students’ willingness to volunteer during the COVID-19 pandemic. The secondary objectives of this study were to determine the students’ risk perception and attitudes towards volunteering, to assess the students’ reasons for volunteering, and to know the areas where medical and nursing students are willing to volunteer during the COVID-19 pandemic.
2. Methods
2.1. Study design and setting
We conducted a descriptive cross-sectional study among the undergraduate medical and nursing students of the Nepalese Army Institute of Health Sciences (NAIHS), Kathmandu, Nepal. We used the proportionate stratified random sampling method. The study participants were selected randomly using the computer random number generator maintaining an equal proportion of students from both medical and nursing groups of students and each year within the groups and an equal proportion of males and females in each year. The questionnaire was emailed to the participants and the responses were collected from 8th July to 29th July 2021 via Google forms.
2.2. Population and study sample
The sample size for the study was calculated using Cochran’s formula:
Sample size (n) = z2 x (p x q)/e2
= 3.8416 x (0.5 x 0.5)/0.0025
= 385
where,
z= confidence interval at 95%, z: 1.96
p= prevalence taken as 50%; q= 1-p;
e= margin of error, 5%
Total undergraduate medical and nursing students in NAIHS (N) = 790 (540 from MBBS and 250 from nursing)
Adjusted sample size (n’) = n/ [1+ {(n-1)/N}]
= 385/ [1+ (384/790)]
= 259
Upon dividing this minimum sample size between two strata proportionately, we allocated 68.4% sample size for MBBS stratum (i.e. 177 students) and 31.6% sample size for nursing stratum (i.e. 82 students).
Considering 10% as a non-response rate, the required sample size became 288 (197 for the MBBS group and 91 for the nursing group). The questionnaire was emailed to 288 participants (197 from MBBS and 91 from Nursing), among which only 261 responded giving a response rate of 90.62%.
2.3. Study instrument
We used a self-administered questionnaire containing 30 items. It contained 8 items for demographic details and history, 5 items for risk perception, 12 items for attitude towards volunteering, and 5 items for willingness test. The questionnaire was developed after the extensive literature review in the English language and was pre-tested among 5% of the study sample, modified accordingly, and then emailed to the study participants.
2.4. Statistical analysis
The data collected via the Google forms were extracted to the Google sheets, cleaned in Microsoft Excel, and then imported and analyzed using SPSS (Statistical Package for Social Sciences) version 16. We used the Kolmogorov-Smirnov (K-S) test and the Shapiro-Wilk test to assess the normality of the data distribution. The data distribution was normal if the significant value of the test is greater than 0.05 and non-normal if the value is below 0.05. Our data were non-normal so we used non-parametric tests using the median and Inter-Quartile Range (IQR) as a measure of central tendency and dispersion respectively. Spearman’s rho was used to check the correlation between all possible non-categorical variables. A Pearson’s Chi-square test was used to check the association between different categorical variables and willingness to volunteer. The variables that had an association with willingness to volunteer (at p <0.05) were included in binomial logistic regression analysis. To find an association between different categorical variables and continuous variables like risk perception and attitude towards volunteering, Mann Whitney U test, and Kruskal Wallis One Way ANOVA were used, depending upon the number of categories in the categorical variables.
2.5. Ethical consideration
The Institutional Review Committee of NAIHS approved the study with reference number 432. All the participants were informed about the study and its objectives during the time of data collection. A consent form was incorporated into the questionnaire itself. So, all the participants filling the form are understood to have provided consent to participate in the study.
3. Results
3.1. Socio-demographic characteristics
A total of 261 valid responses were obtained from 288 randomly selected participants; with a response rate of 90.6%. The mean (SD) age of the respondents was 22.31 (2.01) years, ranging from 18 to 30 years. Majority of the participants were females (n= 152, 58.2%). Out of the valid respondents, 179 (68.6%) were pursuing education in medicine (MBBS) and 82 (31.4%) were in nursing. Among the 179 participants studying medicine, 109 (60.9%) were in the clinical years (third, fourth, and fifth years). Only 68 (26.1%) of 261 respondents were studying from scholarship and among them, 25 (37%) had a scholarship from the Ministry of Education (MoE); the rest of them being funded fully or partially by the Nepalese Army or other institutions. Interestingly, 92 (35.2%) participants reported having experience of volunteering in healthcare services and 83 (31.8%) participants had witnessed COVID-19 infection in them or any of their family members. However, a substantial number of respondents (n= 219, 83.9%) were fully vaccinated against COVID-19 by the time of data collection (Table 1).