Abstract
Background
The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally.
Methods
An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations.
Results
A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working part-time [Adjusted Odds Ratio 1.53 (95% Confidence Intervals 1.15–2.02)], having an academic appointment [2.45 (1.78–3.27)], having multiple co-morbidities [1.86 (1.41–2.48)], perceived burnout [1.99 (1.54–2.56)] and moderate to very high level of psychological distress [1.68 (1.18–2.39)]. Perceived burnout was associated with being female [1.35 (1.12–1.63)], having multiple co-morbidities [1.53 (1.20–1.97)], perceived job insecurity [1.99 (1.55–2.57)], and moderate to very high levels of psychological distress [3.23 (2.42–4.30)]. Staff with multiple co-morbidities [1.46 (1.11–1.92)], mental health issues [2.73 (1.79–4.15)], perceived job insecurity [1.61 (1.13–2.30)], and perceived burnout [3.22 (2.41–4.31)] were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69–4.19)] were more likely to have medium to high resilient coping.
Conclusions
Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.
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Background
During the pandemic, government restrictions greatly affected higher education (HE) institutions, altering teaching delivery and learning modalities. Face-to-face classes were cancelled, and delivery shifted to online with tight deadlines and limited support. These abrupt changes were particularly challenging for staff and students in practical and lab-oriented courses [1]. The work-related demands combined with job insecurity stemming from significant financial losses in HE institutions globally, affected the wellbeing of staff [2]. HE staff, like others, faced public health mandates, including social isolation, working from home, managing home-schooling children or caring for relatives with COVID-19 [3]. These factors compounded work-related stress.
Staff working at HE institutions had always been exposed to varied sources and types of work-related stresses impacting on their health and wellbeing. During the post-pandemic era, HE institutions and staff faced further challenges globally. The most recent Australian National Tertiary Education Union’s four-year survey data (2020–23) with over 6,200 staff showed the reporting of poor work environments, poor psychosocial safety, high levels of burnout, extreme tiredness, anxiety, or depression [4]. In addition, HE institutions of many developed countries like Australia and UK had significant financial impact, primarily due to loss of international students, which they tried to recover by adopting a number of cost-saving strategies such as organisational restructure, reducing staff costs including redundancies, early retirements, terminations, and reducing non-salary expenditures following the pandemic period [5]. Such changes also impacted on the remaining staff, who got increased workload, complexities in their role impacting on their heath and wellbeing.
The impact of COVID-19 on HE staff varied globally due to diverse political, cultural, environmental, and geographical factors, and differing national responses to the pandemic. Numerous studies have explored the impact of COVID-19 on HE students [6], however, very few have examined the health and wellbeing of staff who managed and supported students directly. Within the environment of financial losses with resultant cost-recovery approaches at HE institutions in the post-pandemic period, staff are concerned of their own job security besides adopting with increased work demand and performance expectations leading to work-stress [5]. Prior evidence indicates that work-related stress derives from teaching stress, research stress and administrative stress leading to emotional burnout [7]. Being resilient is one of the key strategies to overcome negative impacts on mental health, which has been shown effective amongst students during the pandemic adopting new learning environments [8]. Therefore, it’s also important to examine the coping strategies of staff dealing with the changed environment at HE institutions. No evidence-based evaluations of psychological factors affecting HE staff in various countries exist. Therefore, this multi-country study aimed to assess the psychological wellbeing and profession-related stress of staff across diverse global HE institutions.
We aimed to assess job insecurity, burnout, psychological distress, and coping among staff at HE institutions in 16 countries during the post-pandemic period. This exploratory study may inform post-pandemic health and wellbeing, and guide future interventions and policies to enhance wellbeing and reduce stress and burnout for this population.
Methods
Study design and settings
A cross-sectional study involving 16 countries was conducted from May to August 2023 using Qualtrics (QualtricsXM is a licensed data collection software). The countries included Australia, Mainland China, Hong Kong (China), Indonesia, Kuwait, Malaysia, Oman, Pakistan, Palestine, Saudi Arabia, South Africa, Taiwan (China), Turkey, the United Arab Emirates (UAE), Mexico, and the United Kingdom (UK).
Study population
Inclusion criteria
All staff from 18 higher education institutions from those 16 countries, regardless of employment status or role, were invited to participate. Countries and institutions were selected based on the existing research collaboration of the first author (MAR).
Exclusion criteria
Participants who completed the survey in under 1 min or over 60 min were excluded to prevent information bias.
Sampling
Population and stress varied across countries. To ensure adequate statistical power, a minimum sample size of 385 was established for each participating organisation, despite variations in population size and stress prevalence.
Data collection
An online-based questionnaire was developed using a licensed Qualtrics platform hosted by Federation University Australia. Ethics approval was obtained from Federation University Australia, the Australian Catholic University, and corresponding organisations in each participating country. (See the appendix for details).
Given the global multicultural nature of participation, participants could select their preferred language on the first screen. The languages were Arabic, Bhasa Indonesia, Chinese (Traditional and Modern), English, Spanish and Turkish. The Plain Language Information Statement (PLIS), consent form and survey were translated and back-translated from the English version. Lead investigators conducted pilot testing in UAE (Arabic), Indonesia (Bahasa Indonesia), China, Hong Kong and Taiwan (Traditional and Modern Chinese), Mexico (Spanish), and Turkey (Turkish). The second screen of the survey included the PLIS and consent form, affirming anonymity and voluntary participation. Only consenting participants could proceed to the next screen to access the survey questions.
Email invitations containing the online survey link were distributed to all staff in the participating organisations through the assistance of the lead investigator from each organisation. The first reminder email was sent three weeks after the initial email, followed by a second reminder three weeks later.
Study tool
A structured survey based on a previous global study led by the first author (MAR) was used [9]. Participants completed a 31-item survey consisting of items on countries/regions, socio-demographic factors (age, gender, highest level of education, work experience duration, living arrangement), profession details (job and appointment type, level, employment status), self-reported health conditions, and behavioural risk factors (smoking, alcohol consumption, physical activity), COVID-19 related experiences (positive tests, long-COVID symptoms, vaccination status), work-related concerns (job insecurity, burnout), psychological impact (mental health perception, distress), coping strategies, and physical health indicators (blood pressure, lipid profile, blood sugar, healthcare visits).
Variables were measured using validated and reliable tools: (1) job insecurity, with the 4-item Job Insecurity Scale (JIS) [10], (2) burnout with a single-item perceived burnout question [11], (3) psychological distress with the 10-item Kessler Psychological Distress Scale (K-10) [12, 13], and (4) coping with the 4-item Brief Resilient Coping Scale (BRCS) [14]. The estimated completion time for the survey was 20 min.
Data analyses
Data were analysed using STATA v.18. Continuous variables (age, years of experience, total scores for each outcome measure were presented as mean and standard deviations. Categorical variables underwent further inferential analyses. The JIS total scores were dichotomised into no job insecurity (1–3) and perceived job insecurity (4–5) [10] [6]. Perceived burnout scores categorised as no burnout (1–4) and perceived burnout (5–7) [11] [7]. Psychological distress scores were categorised as low (10–15) and moderate to very high (16–50) [12, 13] [8, 9]. Coping was categorised as low (4–13) and medium to high (14–20) based on the BRCS scoring [14,15,16].
Univariate analyses determined associations between outcomes and factor variables, yielding odds ratios (ORs) and 95% confidence intervals (CIs).. Multivariate logistic regression along with stepwise variable selection analysis was performed to investigate the controlled effect of factors such as age, sex, highest academic qualification, smoking, alcohol intake, country of residence, type and level of appointment, employment status and comorbid conditions on job insecurity, perceived burnout, psychological distress and resilient coping. Variables with a cut off value of p < 0.05 were identified from the initial chi-squared tests, which were included as potential confounders in the multivariate analyses. Similar approaches have been widely supported as a methodological concept in statistical analysis [17]. For country-wise comparisons, the reference country was selected based on the lowest prevalence of perceived job insecurity, perceived burnout, moderate to very high psychological distress, and medium to high resilience coping. Other countries and areas were organised chronologically by prevalence (lowest to highest) for each outcome before conducting the multivariate analyses. To deal with missing values, actual responses received for each variable were considered and reported accordingly as proportions in the descriptive analyses; actual responses were used for inferential analyses. We also performed a sensitivity analysis excluding the missing values and a multiple imputation technique was also conducted. We did not observe any changes in the effect estimates.
To avoid potential type I errors arising from multiple comparisons, significance threshold can be minimised by adjusting the p-values [18]. Given the number of four dependent/outcome variables, significance threshold for multivariate analyses were adjusted accordingly (0.05/4 = 0.0125). Therefore, the cut-off of p < 0.01 was used as statistical significance for all findings of the multivariate analyses in this study.
Results
A total of 22,597 staff across 16 countries were invited via emails to participate, 2,353 (10%) responded. The response rate varied across countries, ranging from 70% (155 responses out of 220 staff) in Malaysia to 1% (47 responses out of 6,900 staff) in Saudi Arabia. (Table S.1) Details of socio-demographic data and characteristics of study population are presented in Table 1. The proportion of missing values did not exceed over 3% for our study variables. Most staff (n = 2,004, 85%) did not report job insecurity. However, 29% (n = 684) reported experiencing burnout. Twenty-three percent (n = 527) perceived their own mental health to be fair to poor. More than two-thirds of participants (n = 1,685, 73%) experienced moderate to very high levels of psychological distress, and 58% (n = 1,317) exhibited medium to high resilient coping. (Tables S.2, S.3, S.4).
Job insecurity
Univariate analyses showed associations between perceived job insecurity and several variables (Table 2). After adjusting for potential confounders, perceived job insecurity was associated with: academic appointments (teaching and/or research), part-time employment, multiple co-morbidities, perceived burnout, and moderate to very high levels of psychological distress. Staff having recent blood lipid profile checks and perceiving their mental health as good to excellent did not report job insecurity in their current positions.
Burnout
Table 3 shows the associations between perceived burnout and other variables. After adjusting for potential confounders, burnout was associated with being female, having multiple co-morbidities, perceived job insecurity, and moderate to very high psychological distress. Conversely, staff with positive COVID-19 tests, recent blood sugar checks, and perceived mental health as good to excellent were less likely to report burnout.
Psychological distress
Univariate analyses showed that moderate to very high psychological distress was associated with having single or multiple co-morbidities, mental health issues, smoking, perceived job insecurity and burnout (Table 4). Conversely, lower distress levels were reported by staff aged ≥ 60 years, holding Senior Lecturer/Assistant Professor or Professor appointments, perceiving good to excellent mental health, and reporting medium to high resilient coping.
Coping
Table 5 shows the factors associated with medium to high resilient coping. Staff with Bachelor and higher qualifications, Professor appointments, smoking, current alcohol use, recent blood lipid profile checks, and perceived good to excellent mental health were more likely to exhibit medium to high resilient coping. Conversely, staff in administration or leadership roles, with single co-morbidity, mental health issues, and moderate to very high psychological distress showed low resilient coping levels.
Country-wise findings
Country-wise analyses showed varied proportions of job insecurity, burnout, psychological distress, and coping across all 16 countries. Details are included in Table 6.
Discussion
This is the first large-scale cross-sectional global study examining the health and wellbeing of staff working in HE institutions during the post-pandemic period. The study assessed job insecurity, burnout, psychological distress, and coping difficulties amongst HE staff in 16 countries, and identified the sub-groups at high-risk of experiencing difficulties. This study was conducted within the post-pandemic environment, when the environment at HE institutions was a bit unstable with financial challenges and restructuring of operations, therefore, challenges faced by the staff during that period were extraordinary. Compared to the pre-pandemic and pandemic contexts, the impact was heightened during the post-pandemic period. Therefore, findings from this study add critical insights for relevant support policies for wellbeing of staff working at HE institutions which should be adopted in the strategic directions, so that the environment can be more productive, resilient and sustainable to face any future challenges.
Job insecurity
Job insecurity, a personal concern about future employment stability, is a growing concern in public and private universities [19, 20]. Financial pressures from pandemic-induced technological advancements, the complexities of teaching, research and societal contributions, underpin uncertainty about tenured employment [21, 22]. However, 85% of staff in this study did not perceive job insecurity, contrasting sharply with findings from a 2021 study of academics in Australian universities. In that study, 77% feared job loss, 50% were concerned about damaged career prospects, and 81% predicted increased casualisation [23]. Similar findings were reported in studies conducted elsewhere [24].
Our findings may be explained by the post-pandemic period in 2023, during which cost-cutting measures, including extensive job redundancies, were implemented. HE institutions navigated organizational changes and moved forward[25, 26], as evidenced by a study of the impact of restructuring during the COVID-19 pandemic. The impact of COVID-related job insecurity, and the global financial crisis may have varied across sectors, such as hospitality or industry, compared to higher education.
Job insecurity was significantly associated with staff in research roles or with academic appointments (teaching and/or research). This is consistent with research identifying job insecurity as a direct stressor, particularly in research work [27]; and studies showing that higher levels of education could contribute to less job insecurity [28]. The findings might also be attributed to increased workloads, work demands, and high expectations around performance in HE institutions [29]. Part-time employment but not the duration of work (working ≥ 10 years) significant predicted job insecurity, and this finding is consistent with studies showing that job tenure significantly predicts job insecurity; although increasingly, universities are transitioning away from tenured positions [22].
A review showed that teachers with temporary contracts of < 3 months had the highest levels of depression and anxiety and fear of job loss [29]. Our study also showed that staff with multiple co-morbidities or mental health issues or moderate to high levels of psychological distress had higher levels of job insecurity. The emergence of COVID-19 had a significant effect on the psychological wellbeing of HE employees during the pandemic [21]. Perceived job insecurity has been linked to deterioration of health and well-being as it increases anxiety, worry, and depression [19, 27, 30]. Furthermore, perceived burnout was also associated with higher job insecurity in this study, consistent with prior research identifying job insecurity as a chronic stress reaction stemming from an inability to cope adaptively in stressful situations [31].
Burnout
Similar to previous research, one-third of staff reported perceived burnout, with women reporting higher levels than men [32, 33]. Explanations may include household responsibilities, parenting, unfulfilled motivations for research productivity, work-life balance challenges, and lack of support [33, 34].
Staff with leadership roles experienced higher levels of burnout. In a 2022 USA study of health sciences faculty, participants reported medium to high levels of burnout, and, like this study, most participants were women [34]. Contributing factors included campus closures, limited preparation for transitioning to new learning modalities, ongoing planning for reopening, government mandates, and additional workloads and responsibilities [33, 35, 36]. Further, a recent Australian university study (2023) of Nursing and Allied Health staff reported increased workload and burnout, and identified several contributing factors, including managing distressed students, online teaching, stepping into leadership roles, staff shortages, and sourcing placements [37].
Poor mental health among HE staff, especially among women has been highlighted previously with recommendations for realistic workload allocations, better performance indicators, long-term goal setting for academics and sustainable career pathways [32, 33].
Psychological distress
The present study showed that more than two-thirds of participants experienced moderate to very high levels of psychological distress. Although numerous studies have investigated mental health issues among university students, the exploration of psychological distress in HE institutions involving university administrative staff, academics, and other support personnel in the post-pandemic period is limited.
The scarcity of similar university staff-focused research globally constraints meaningful comparisons with previous studies. However, our study showed comparatively higher rates of psychological distress (73%) compared to other studies, which varied between 9%-54% [38,39,40]. A longitudinal study focusing on teachers and staff affiliated with a Japanese university reported a significant increase in psychological distress in 2021 compared to 2019 [41]. A study from a South African university showed that 28% of staff experienced psychological distress, with administrative and service staff experiencing higher distress compared to academic staff [42]. In contrast, the current study included all university staff (academics, researchers, administrative and other support staff) across different HE institutions globally.
In this study, psychological distress varied according to age and gender [40,41,42]. Younger staff were at risk of experiencing higher levels of psychological distress; a finding also supported by previous research where younger age was identified as a risk factor for mental health issues [38, 41]. Younger individuals may be more exposed to social media, potentially increasing their exposure to pandemic-related negative and misleading news, thereby exacerbating stress [16, 43]. Young people may also experience distress due to their inherent responsibility for social productivity and family maintenance [44].
Higher levels of psychological distress were experienced by women compared to men; similar findings have been reported in Italy [40], Japan [41], and South Africa [42]. Academic women faced more challenges during the pandemic, primarily because of the greater load in terms of household chores, family care responsibilities, and providing emotional support [45]. Further, both young adults and women experience higher levels of anxiety due to frequent exposed to unemployment and economic risks, leading to increased psychological distress [46].
Staff reporting any co-morbidity and mental health issues also had higher levels of psychological distress, and this finding was supported by recent studies showing an association between perceived poor mental health and higher levels of psychological distress [38, 42]. Another study reported an increase in psychological distress among staff with a history of psychiatric treatment [47].
Coping
Coping refers to cognitive and behavioural mechanisms that enhance resilience to stress. Strategies fall into higher order dimensions: adaptive/maladaptive, avoidant/approach, problem, emotional or avoidance-focused coping [48]. In our study over half the staff coped adaptively, with normal to high resilience scores on the BRCS. Similar results were reported in a large international sample during COVID-19 [9]. An Australian study also found that individuals with higher qualifications (i.e., bachelor’s degree) reported increased normal to high resilience scores [49]. This was attributed to enhanced critical thinking and problem-solving skills leading to the use of more adaptive coping strategies. Overall, cognitive reappraisal, social support and active coping are adaptive coping strategies used for managing stress and maintaining wellbeing. Emotion suppression has mixed effects [50]. Problem focused coping strategies such as seeking support, acceptance, exercise, and leisure activities are adaptive and link to increased wellbeing, while avoidance and emotion-focused coping are maladaptive and associated with lower levels of wellbeing [51,52,53,54].
Surprisingly, participants classified as normal/high resilient copers were more likely to smoke and consume alcohol, consistent with findings among academic staff in Malaysia and Saudi Arabi during the pandemic [51, 52]. Additionally, the resilient copers were more likely to report their mental health as excellent, consistent with previous findings among academics from the UAE [51] and Malaysia [52]. This supports the notion that adaptive problem focused coping strategies (normal/high resilience) are associated with enhanced mental health and wellbeing, while emotion focused coping strategies (low resilience) are more likely to be maladaptive and have an inverse relationship with mental health and wellbeing [55]. For example, an Australian study concluded that low resilient copers were associated with multiple comorbidities impairing their ability to adopt healthy behaviours over time [16].
Country-wise analyses
The impact of COVID-19 and issues around professional workloads had varying impacts on staff health and wellbeing across the participating countries. Nevertheless, some trends were observed in some countries. For example, participants from the two Australian HE institutions showed the highest prevalence of job insecurity which corresponded with the highest level of perceived burnout in their work settings.
COVID-19 affected Australian HE institutions substantially because of their diversity, complexity, financial challenges, and international dependence. With closures of international borders, universities faced decreased student returns in 2020, and reduced numbers in 2021 and 2022, resulting in substantial revenue loss and 17,300 job losses on campuses in 2020 [23]. This reduction in job security appears to be associated with increased burnout in the Australian HE sectors.
Regarding coping, our study found that Australia had the lowest prevalence of medium to high resilient coping, consistent with the recent global study showing similarly low resilience amongst community members [9]. This may be attributed to increased top-down management and loss of control leading to tight deadlines, elevated workloads, contributing to higher burnout, and a high prevalence of mental health issues, compounded by living in a region experiencing the world’s longest lockdown [56, 57]. Australian tertiary students experienced low wellbeing and resilience, increasing the risk of future mental illness [58]. However, a previous study showed higher resilience prevalence (57%) among Australian residents [16]. In our study, Mexican staff exhibited the highest medium to high resilient coping levels aligning with a previous study showing that over 60% of Mexican university staff reported medium to high resilience coping [59], along with strong community support and cultural norms. Another recent study among Mexican faculty members found a strong relationship between burnout and resilience, demonstrating that adaptive mechanisms were acquired over time [60].
Limitations
This multi-country study had limitations including uneven country representations due to some institutions having summer holidays during data collection. Mexico, the United Kingdom, and Australia contributed to 13–18% of the total participants, while other countries contributed 2–8%, potentially limiting country-wise analyses. Additionally, the study relied on self-reported data, potentially introducing recall bias or social desirability effects. Given the cross-sectional design, caution should be exercised when interpreting potential causal relationships between outcomes and other variables, as this represents an inherent limitation of the study design.
Differences in ethnicity, cultural backgrounds, public health policies, compliance with public health measures, and post-pandemic recovery stages across the 16 countries could have influenced the key issues investigated in this study. However, some of these variables were controlled during multivariate analysis. Despite these limitations, this global study was among the first to examine the health and wellbeing of staff at HE institutions worldwide. Collaboration between researchers ensured a substantial sample size with adequate power to enable robust examination of the aims and to provide valuable insights for developing psychological support strategies and interventions in HE institutions.
Conclusions
This study identified several key health and wellbeing issues experienced by the staff working at HE institutions across 16 countries in the post-pandemic era. Although job insecurity was not pronounced, many staff reported perceived burnout, experienced moderate to high levels of psychological distress, and reported low adaptive coping. These vulnerable staff need support and services, and awareness of the existing resources. Based on the findings, it may be necessary to implement targeted policies or practices to address psychological distress and burnout issues more effectively. HE institutions could promote resilience-building initiatives to enhance staff health and wellbeing. The study found no single staff group vulnerable to all four key issues which were often interrelated. Thus, tailored efforts within robust mental health support structures are essential, along with a strong emphasis on the importance of fostering organisation support.
Availability of data and materials
All data generated or analysed during this study are included in this published article.
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Acknowledgements
We would like to acknowledge the support from all the collaborators and individuals who supported us in collecting data from the participating countries. We would like to convey our gratitude to all the study participants, who contributed their valuable time during the crisis period of coronavirus pandemic and kindly participated in this global study.
Funding
We did not receive any funding for this research.
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Contributions
MAR was the lead investigator, who conceptualised the study and had the responsibility to coordinate with the study investigators for data collection in 16 countries. Data collection was coordinated by the respective country lead: MAR at Federation University Australia and LL at Australian Catholic University in Australia, QW in China, SYC in Hong Kong, SW in Indonesia, MH in Kuwait, KO in Malaysia, MGE in Mexico, TSAM at Oman College of Health Sciences and JA at Sultan Qaboos University in Sultanate of Oman, AA in Pakistan, NAL in Palestine, IM and IA in the Kingdom of Saudi Arabia, HN in South Africa, YLC in Taiwan, MFC in Turkey, BS in the United Arab Emirates, and RH in the United Kingdom. PD developed and managed online questionnaire in different languages at the Qualtrics platform and finalised the database for analyses. SMA and FS analysed the data; MAR interpreted data. MAR, PD, LL, MS, BB, BJ, PP, KF, AJ, SH and RP wrote different sections of the manuscript. All authors (including AL, DS, JP, SMSI, WC, WTC, NNTP, AH, GO, SSMAW, BSAR, SLC, OB, RP) provided critical feedback on narrative structure, methods or results. MAR finalised the manuscript and revised it critically for important intellectual content. All authors had full access to all the data in the study, accepted responsibility for its validity and had final responsibility for the decision to submit for publication.
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Ethics approval and consent to participate
Ethics approval was obtained from the Human Research Ethics Committee from each participating country: Australia (Federation University Australia, 2022/216 and Australian Catholic University, 2023-3101R), China (Shenzhen University, PN202300059), Hong Kong and Taiwan (The Chinese University of Hong Kong, SBRE-22–0556), Indonesia (Universitas Airlangga, 404/HRECC.FODM/IV/2023), Kuwait (Kuwait University, VDR/EC-353), Malaysia (Universiti Malaysia Terengganu, UMT/JKEPM/2023/135), Mexico (Universidad Anáhuac Querétaro, 2023/1108), Sultanate of Oman (Ministry of Health, MoH/DGPS/CSR/PROPOSAL_APPROVED/94/2020 and Sultan Qaboos University, CON/NF/2023/10), Pakistan (International Islamic University, IIUI/ORIC/2023), Palestine (Palestinian Health Research Council, PHRC/HC/1265/23), Kingdom of Saudi Arabia (Qassim University, 23–40-04), South Africa (University of Johannesburg, REC-1918–2023), Turkey (Kirklareli University, E-35523585–302.99–79933), United Arab Emirates (University of Sharjah, REC-23–03-29–02-F), United Kingdom (Northumbria University, 3584). Each study participant read the consent form along with plain language summary and ticked their informed consent in the online form prior to accessing the study questionnaire.
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Rahman, M.A., Das, P., Lam, L. et al. Health and wellbeing of staff working at higher education institutions globally during the post-COVID-19 pandemic period: evidence from a cross-sectional study. BMC Public Health 24, 1848 (2024). https://doi.org/10.1186/s12889-024-19365-1
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DOI: https://doi.org/10.1186/s12889-024-19365-1