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Article History

Received: 4 October 2023

Accepted: 15 May 2025

First Online: 6 June 2025

Competing interests

: The authors declare no competing interests.

: The study received ethical approval from the Ethics Committee of the Nursing School of Porto, the institutional body responsible for reviewing research involving human participants. All procedures involving human subjects were carried out in line with the ethical standards established by the committee, the relevant national regulations, and the principles outlined in the Declaration of Helsinki and its subsequent amendments. Approval was formally granted on 16 July 2021, under the reference number ADHOC_907/2021. Importantly, while the questionnaire was made available earlier as part of the course’s pedagogical and evaluation components, this occurred in the context of the public health emergency caused by the COVID-19 pandemic, which required the urgent deployment of the training programme to support healthcare professionals. No data were accessed, processed, or analysed for research purposes prior to receiving formal approval from the Ethics Committee of the Nursing School of Porto. The approval covered the analysis of anonymized data provided voluntarily by participants enrolled in a massive open online course (MOOC) on healthcare practices during the COVID-19 pandemic. The ethical review specifically assessed the validity of the informed consent process, the adequacy of data protection measures, and the non-interventional nature of the study. The committee granted approval with full knowledge of the data collection timeline and confirmed that all procedures conformed to the ethical standards required for research involving human participants. Following the ethics committee approval, all participants were recontacted and explicitly invited to confirm their authorization for the use of their responses in the context of the approved research study. This additional step reinforced the validity of the consent obtained and ensured continued adherence to the principles of autonomy and transparency.

: Informed consent was obtained electronically from all participants prior to data collection. The process took place between 1 March and 31 October 2021, during enrolment in the MOOC. Before accessing the questionnaire, participants were required to read an information sheet and actively confirm their agreement by selecting a checkbox on the online consent form. This step was mandatory and integrated into the course platform, ensuring that no responses were collected without prior consent. The process was overseen by the principal investigator at the Nursing School of Porto, and consent was obtained exclusively from adult participants who had voluntarily registered for the course. Participants were clearly informed, both in the consent form and again at the start of the questionnaire, that their survey responses would be processed anonymously. Identifiable data were not linked to the questionnaire at any stage, and the research team ensured that all responses were stored and analysed independently of personal information, thereby preserving full anonymity at the level of data analysis. Participants were also informed of the study’s aims, the voluntary nature of participation, the procedures involved, and the intended use of the data for research and publication. They were advised of their right to withdraw from the study at any point, without any disadvantage or penalty. Confidentiality was guaranteed, and all data handling was carried out in accordance with applicable data protection legislation. Following ethics committee approval, all participants were recontacted and invited to reaffirm their authorization for the inclusion of their responses in the ethically approved research. This additional step reinforced the transparency of the consent process and ensured continued respect for participants’ autonomy. Given the non-interventional nature of the study and the clear assurance of anonymity and voluntary participation, no risks were foreseen for those who took part. The procedures for obtaining consent were carried out in line with the ethical principles set out in the Declaration of Helsinki, which highlights the participant’s right to be fully informed and to provide voluntary, informed consent prior to inclusion in any research.