Introduction
A crisis is characterized as a significant event or situation that disrupts the normal operations of individuals or organizations, necessitating immediate action to mitigate its consequences. Such events may encompass violent incidents, conflicts, or widespread acute disease outbreaks.Reference Wang and Gupta 1 , Reference Yousuf, Jabbar and Ullah 2 Within health care systems, a crisis is defined as a period of pronounced difficulty, risk, or uncertainty, often precipitated by unforeseen events that disrupt standard operational frameworks.Reference Emami, Lorenzoni and Turchetti 3 For instance, pandemics place considerable strain on health care systems by depleting resources and escalating service demands, thereby compromising care quality.Reference Biel, Grondys and Androniceanu 4 Crises may also restrict access to health care services, exacerbate health disparities, and increase workloads and stress among health care professionals, potentially leading to burnout and workforce shortages.Reference López Bastida 5 , Reference Gifford, van de Baan and Westra 6 These challenges underscore the critical need for effective mobilization of health care personnel during crises.
Health care facilities play a pivotal role in crisis management by serving as foundational pillars of health security. Effective crisis response requires proactive engagement in preventive planning, resource allocation (including space, personnel, equipment, and budget), and preparedness for managing infectious disease outbreaks.Reference Mahmoudjanlou, Mahmoudi and Jahani 7 Hospitals and health care centers must maintain operational flexibility to sustain routine services while addressing sudden disasters, minimizing harm, and ensuring continuity of care.Reference Khorram-Manesh and Burkle 8 These responsibilities highlight the indispensable function of health care providers in navigating crises effectively.
In Iran, the frequent occurrence of natural disasters, such as earthquakes, floods, droughts, and fires, emphasizes the importance of robust crisis preparedness within the health system and society at large.Reference Mohammadpour, Sadeghkhani and Bastani 9 –Reference Hosseinighousheh, Arefi and Pouya 11 Floods, often resulting from heavy rainfall and unsustainable urban development, destructive earthquakes, and chronic droughts recurrently challenge the country’s health and emergency response systems.Reference Ardalan, Rajaei and Masoumi 12 –Reference Seddighi and Seddighi 15 These events necessitate comprehensive strategies to enhance resilience and response capacity.
Research demonstrates that strategic crisis management improves patient health outcomes, reduces costs, and enhances satisfaction, particularly in managing chronic diseases.Reference Holman 16 Key strategies include triaging access to acute care for lower-risk patients to optimize resource allocation, empowering health care workers to make resource-optimization decisions, reallocating personnel to address shortages, and encouraging voluntary participation of health care staff.Reference Butler, Webster and Diekema 17 –Reference Najafi, Khabaz Mafinejad and Abbaszadeh 20 The latter was particularly critical during the COVID-19 pandemic, where voluntary contributions significantly bolstered response efforts.Reference Najafi, Khabaz Mafinejad and Abbaszadeh 20
Voluntary participation in health care crises often involves individuals contributing their time and expertise without financial compensation, driven by altruism or professional duty.Reference Bailey and Kaplan 21 , Reference Newbigging, Mohan and Rees 22 Studies emphasize the importance of volunteer engagement in crisis management, identifying organizational structure, training, and effective communication as key facilitators.Reference Bailey and Kaplan 21 , Reference Jannat, Khorasani-Zavareh and Allahbakhshi 23 During the COVID-19 pandemic, supportive factors included collegial support, access to protective equipment, altruism, and a sense of professional responsibility.Reference Najafi, Khabaz Mafinejad and Abbaszadeh 20 Conversely, barriers included fears of infection, anxiety, insufficient information, fatigue, lack of support, poor organizational structures, interpersonal conflicts, financial constraints, and personal concerns such as family obligations and fears of isolation.Reference Karami, Nikbakht Nasrabadi and Torabizadeh 24
Several studies have investigated factors influencing voluntary participation during crises. A 2025 qualitative study in Iran identified inadequate risk perception, psychological trauma, and weak social capital as key barriers to community engagement in managing health emergencies, emphasizing the importance of collaboration among policymakers and local leaders to build resilience.Reference Mahmodi, Farrokhi and Hosseini 25 A 2024 study on volunteers assisting hospitalized COVID‑19 patients found main challenges such as poor recruitment systems, organizational inefficiency, mistrust, clinical risks, conflicting commitments, lack of financial and family support, isolation, and fatigue, highlighting the need for supportive policies.Reference Karami, Nikbakht Nasrabadi and Torabizadeh 24 Similarly, a 2023 study among health care professionals revealed that demographic features, altruism, professional duty, and team support facilitated participation, while fear, anxiety, and limited knowledge served as deterrents.Reference Najafi, Khabaz Mafinejad and Abbaszadeh 20
Despite existing research on barriers and facilitators to voluntary participation in health care crises, further exploration of these factors is warranted to inform stakeholders, including policymakers and health system managers. Incorporating these insights into crisis management planning can enhance volunteer engagement, thereby improving the efficiency and effectiveness of health organizations during crises. Such efforts are critical for strengthening health system resilience and ensuring robust responses to future challenges.
Methods
This qualitative and exploratory study was conducted in 2025 at public health care centers in the east of Iran, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.Reference Tong, Sainsbury and Craig 26
Research Question
The research question was jointly formulated by the authors as: “What are the barriers and facilitators of voluntary participation by healthcare personnel in providing healthcare services during crises?” This question aimed to identify the factors that promote or hinder health care workers’ willingness to engage voluntarily in emergency response activities during crises.
Data Collection
Several unstructured interviews were conducted with a sample from the target population. These interviews resembled informal conversations rather than formal sessions, with no predetermined questions or strict structure, allowing free-flowing dialogue to explore topics in depth. Open, unstructured interviews are typically used to gather rich information, especially on sensitive or complex subjects.Reference Jamshed 27 , Reference Bergelson, Tracy and Takacs 28 The interviews were conducted face-to-face by a trained researcher using a voice-recording app. After briefly explaining the study’s purpose, the interviewer began with a broad question about facilitators and challenges to voluntary participation in health services during crises, such as: “What factors have influenced your participation or non-participation in voluntary health care services during crises?” Each interview lasted at least 30 minutes, allowing participants to express their views freely. Subsequently, one researcher transcribed the data, documenting participant characteristics including gender, age, occupation, work history, type of crises encountered, and barriers and facilitators to volunteering. To ensure data accuracy and reduce bias, a second researcher reviewed the entire data collection process. This approach provided comprehensive qualitative data for analysis.
Sample Size and Sampling Method
The sample size for the study was increased until data saturation was achieved. In this regard, the repetition of data across three consecutive rounds of interviews was considered the threshold for data saturation. Stratified sampling was employed to ensure a representative sample of the population under investigation. This technique involves dividing the population into distinct strata based on specific characteristics and indices within the community.Reference Suresh, Thomas and Suresh 29 For this study, the population was divided into 2 strata: clinical and paramedical. Purposeful sampling was then applied to select participants from each stratum. Additionally, snowball sampling was used to facilitate access to experts with prior crisis participation experience, who referred other knowledgeable individuals.Reference Kennedy-Shaffer, Qiu and Hanage 30 The clinical stratum included the public hospitals and clinics affiliated with a medical university located in the region affiliated with the study, while public health networks and centers under the same university constituted the paramedical stratum.
Inclusion criteria:
For all participants:
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• A history of voluntary involvement in providing health services during crises such as pandemics or natural disasters (fires, earthquakes, etc.).
For the clinical stratum:
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• Employed as physicians or nurses.
For the paramedical stratum:
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• Technicians in health services corresponding to environmental health, occupational health and safety, public health, or disease control.
Exclusion criteria:
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• Lack of voluntary participation during crisis.
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• Unwillingness to participate in face-to-face interviews.
Data Analysis
The data analysis for the study was conducted following the qualitative thematic analysis approach outlined by Braun and Clarke. This method involved 6 phases: familiarization with the data, coding, searching for themes, reviewing themes, defining and naming themes, and producing the final report.Reference Braun and Clarke 31 Initially, 2 authors independently familiarized themselves with the collected data. They then collaboratively coded the data in accordance with the study’s objectives and organized the codes into themes. The identified themes were thoroughly reviewed, defined, and named. To ensure the validity of the thematic analysis and minimize bias, a third author reviewed and approved the entire process. In cases of disagreement, all 3 authors engaged in discussions to resolve discrepancies and reach consensus.
Ethical Standards
This study was conducted in accordance with established ethical standards for qualitative research. All study data were sought to be securely maintained for a minimum of 1 year following publication. Additionally, all research activities were carried out by investigators with no conflicts of interest related to the study topic. In line with ethical guidelines, it was ensured that no personally identifiable information about participants was disclosed and that all data were treated with strict confidentiality. Furthermore, informed consent was obtained from all participants prior to inclusion in the study, with explicit assurance that they retained the right to withdraw from the study at any time without consequence. This study received ethical approval from the Birjand University of Medical Sciences Ethics Committee (Ethical Code: IR.BUMS.REC.1404.193).
Results
The results of the study are presented in the following sections. First, the demographic characteristics of the study participants are reported. Subsequently, the findings of the thematic analysis are presented.
Demographics of Participants
As presented in Table 1, the study sample consisted of 14 health care professionals who had engaged in crisis response efforts, primarily during the COVID-19 pandemic, with additional experience in natural disasters, armed conflict, and Crimean-Congo Hemorrhagic Fever (CCHF). The cohort was predominantly male (n = 9, 64%), with female participants accounting for 36% (n = 5), reflecting either the gender composition within these professions or the recruitment dynamics for crisis deployment. Participants’ ages ranged from 32 to 47 years, with a mean age of 41.5 years (SD ≈ 4.5), representing a largely mid-career group with substantial professional expertise and probable prior exposure to emergency situations. The sample encompassed a variety of health care roles, including nurses (n = 3), physicians (n = 3), vaccination or disease prevention technicians (n = 3), and health care or health service technicians (n = 5), thus capturing perspectives from both frontline clinical and operational support staff. Participants’ professional experience ranged from 5 to 22 years, with an average of 16.5 years (SD ≈ 5.1), indicating considerable familiarity with routine health care delivery as well as crisis management. All participants reported involvement in COVID-19 response efforts, while subsets had prior experience with natural disasters (n = 4) or CCHF (n = 1), providing a diverse understanding of both pandemic-specific and broader emergency response contexts.
Demographic characteristics of the study participants
Table 1. Long description
The table consists of six columns: Participant, Gender, Age, Profession, Working experience (years), and Crises experienced.
* Participant 1: Male, 45, Disease prevention technician, 20 years, C O V I D-19.
* Participant 2: Male, 42, Nurse, 20 years, C O V I D-19 and natural disasters.
* Participant 3: Male, 41, Vaccination technician, 15 years, C O V I D-19.
* Participant 4: Female, 39, Vaccination technician, 15 years, C O V I D-19.
* Participant 5: Female, 45, Nurse, 22 years, C C H F and C O V I D-19.
* Participant 6: Female, 42, Health care technician, 12 years, C O V I D-19.
* Participant 7: Male, 47, Nurse, 20 years, C O V I D-19 and natural disasters.
* Participant 8: Male, 35, Health care education technician, 10 years, C O V I D-19.
* Participant 9: Male, 32, Physician, 5 years, C O V I D-19.
* Participant 10: Male, 47, Physician, 19 years, C O V I D-19.
* Participant 11: Female, 46, Physician, 16 years, C O V I D-19.
* Participant 12: Male, 45, Health service technician, 20 years, C O V I D-19 and natural disasters.
* Participant 13: Male, 37, Health service technician, 15 years, C O V I D-19 and natural disasters.
* Participant 14: Male, 35, Health service technician, 10 years, C O V I D-19.
Thematic Analysis
Table 2 displays the findings of the thematic analysis. The data were systematically categorized into 2 primary mega-themes: barriers and facilitators. The content corresponding to each of the mega-themes is presented below.
Thematic analysis of the study data
Table 2. Long description
The table is organized into three columns: Mega theme, Theme, and Sub-theme.
1. Mega theme: Barriers
- Theme: Physical, Psychological, and Emotional Challenges. Sub-themes: Fatigue, Stress, Fear, Social stigma.
- Theme: Organizational Issues. Sub-themes: Lack of support, Unsafe environment, Lack of resources, Gradual shift from voluntary toward compulsion, Shortage of personnel and increased workload, Mismanagement, Lack of commitment from authorities, Bureaucracy, Appointment of inexperienced individuals, Lack of managerial presence during a crisis, Lack of effective communication and mutual respect, Lack of proper rewards, Professional discrimination and excessive hierarchy, Autocracy, Temporary employment, Unclear roles/responsibilities, Gap between doctors and other personnel, Nepotism, Political interference, Unfair promotions.
- Theme: Financial and Material Constraints. Sub-themes: Low and delayed payment, Unfair payment system, Lack of financial transparency.
- Theme: Family, Social, and Cultural Concerns. Sub-themes: Family opposition, Separation from family and children, Self-interest in participation, Neglect and undervaluation by the media and society, Cultural issues.
2. Mega theme: Facilitators
- Theme: Intrinsic Motivation, Values, and Characteristics. Sub-themes: Altruism, Moral duty, Religious commitment, Preference for busy and challenging environments, Professional responsibility.
- Theme: Cultural, Social, and Family Support. Sub-themes: Family encouragement, Peer support, Cultural norms.
- Theme: Organizational Support and Leadership. Sub-themes: Supportive managers, Appreciation, Transparency and honesty in promises, Collaboration with N G O s and philanthropists, Fair policies.
- Theme: Experience and Skills. Sub-themes: Crisis experience, Training, Professional competence.
- Theme: Material and Financial Incentives. Sub-themes: Financial reward, Career growth, Protective equipment.
Barriers
The barriers to voluntary participation among health care personnel were categorized under 4 major themes: Physical, Psychological and Emotional Challenges; Organizational Issues; Financial and Material Constraints; and Family, Social, and Cultural Concerns.
Physical, psychological, and emotional challenges. This theme comprised 4 sub-themes: fatigue, stress, fear, and social stigma.
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• Fatigue: Health care personnel frequently reported extreme exhaustion due to long working hours. This was described as a significant barrier hindering the voluntary participation of health care personnel during crises. In this regard, 1 participant stated:
Sometimes I was really out of energy. Around four or five in the afternoon, I’d only just get home to eat lunch. After resting for about an hour, I would head back out again …
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• Stress: The high-pressure environment intensified stress levels, making the work environment even more challenging. A participant described:
Our stress and headaches made our work even harder ….
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• Fear: Fear of diverse issues such as falling ill or contracting an infection emerged as a significant deterrent, particularly during the early stages of crises like COVID-19. One participant noted:
When COVID first emerged, many of us were afraid of getting sick ourselves …
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• Social stigma: Frontline workers faced social discrimination and suspicion. As a participant explained:
Everyone was saying that since I’m on the front lines of fighting COVID, I must have the virus …
Organizational issues. This theme consisted of 17 sub-themes: lack of support, unsafe environment, lack of resources, gradual shift from voluntary toward compulsion, shortage of personnel and increased workload, mismanagement, lack of commitment from authorities, bureaucracy, appointment of inexperienced individuals, lack of managerial presence during a crisis, lack of effective communication and mutual respect, lack of proper rewards, professional discrimination and excessive hierarchy, autocracy, temporary employment, unclear roles/responsibilities, gap between doctors and other personnel, nepotism, political interference, and unfair promotions.
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• Lack of support: Participants expressed disappointment with officials who failed to follow through on their promises. In this regard, 1 participant stated:
The officials made promises that they never kept … the managers were extensively looking for flaws … they said we had not done enough …
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• Unsafe environment: Exposure to infection posed a severe risk. A participant stated:
In medical terms, our immunity hadn’t become strong yet, and the virus was in a condition where it could infect us at any moment …
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• Lack of resources: Scarcity of basic supplies such as personal protective equipment was a common barrier among the participants. In this regard, 1 participant narrated:
In many places, we didn’t even have basic personal protective equipment. That was probably the main issue …
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• Gradual shift from voluntary toward compulsion: With the passage of time, voluntary roles increasingly became mandatory. This was presented to hinder voluntary participation. One participant stated:
Over time, they said we have to come at this hour … it moved away from being voluntary …
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• Shortage of personnel and increased workload: Staff shortages led to overtime and added stress. One participant stated:
During crises, we truly face a lack of staff … we are forced to work overtime and take on extra shifts …
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• Mismanagement: Ineffective leadership was highlighted as demotivating for voluntary participants. In this regard, a participant stated:
The manager is ineffective and unable to solve any problems … If someone lacks competence, why should they hold a managerial position?
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• Lack of commitment from authorities: Participants noted that authorities often failed to act responsibly. In this regard, a participant stated:
The authorities are not committed and do not do their duties …
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• Bureaucracy: Administrative processes were cumbersome. A participant stated:
If you want your contract to be renewed, you have to go there and get a signature … This isn’t the right way to handle the renewal of a volunteer’s employment …
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• Appointment of inexperienced individuals: Unqualified personnel hindered team efficiency, leading to lower desire for voluntary participation during crisis. A participant stated:
The person appointed as a matron in a center … doesn’t even have a two-digit number of years of experience.
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• Lack of managerial presence during a crisis: Leaders were absent during critical periods, which was presented as a significant barrier. In this regard, a participant stated:
Only in the end, the senior officials show up just to have their photo taken …
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• Lack of effective communication and mutual respect: Effective communication was identified as crucial. One participant stated:
Communication is fundamental. If you haven’t established a connection with your staff, how can you expect anyone to help you during a crisis?
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• Lack of proper rewards: Inadequate recognition discouraged staff. One participant stated:
They gave us a piece of paper as a reward … this is not proper …
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• Professional discrimination and excessive hierarchy: Hierarchical pressure undermined collaboration. A participant stated:
For that senior manager, everyone stood up to show admiration, while for an ordinary lady, pointing out every flaw …
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• Autocracy: Fear of speaking up prevented proactive participation. One participant stated:
In this system, even the senior staff are afraid and don’t speak up …
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• Temporary employment: Short-term contracts lowered motivation. In this regard, 1 participant stated:
I’ve been here for a year and a half, maybe two at most, and then I’ll leave … I have no motivation to continue working… and you speak of voluntary work?!
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• Unclear roles/responsibilities: Confusion over responsibilities reduced efficiency. One participant stated:
Each hall had a separate person in charge … sometimes it caused confusion …
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• Gap between doctors and other personnel: Hierarchical divisions hindered teamwork. A participant stated:
The system has created a divide between the doctoral and nursing professions …
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• Nepotism: Favoritism discouraged fair participation. One participant stated:
Corruption and nepotism are evident everywhere … To get any position, you need the right connections. This is causing us to lose our motivation for volunteering during crises.
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• Political interference: Politics negatively impacted staffing decisions, hindering voluntary participation. One participant stated:
Because political interests get involved … a politician steps in behind the scenes … These actions completely discourage people and leave no motivation for voluntary participation.
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• Unfair promotions: Inequity in promotions undermined morale among the health care personnel. One participant stated:
Some people get promoted for no reason, while I, who have worked for 20 years, have never been promoted. Do you think anyone would still feel motivated to volunteer under these circumstances?
Financial and material constraints. This theme had 3 sub-themes: low and delayed payment, unfair payment system, and lack of financial transparency.
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• Low and delayed payment: Delayed and insufficient compensation discouraged volunteers. One participant stated:
They finally paid the overtime, but a month late … and it’s only around half of what they were supposed to give.
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• Unfair payment system: Inequitable accounting of work reduced motivation. A participant stated:
Administering a vaccine is considered one service, but a young caregiver’s 16 services are counted as one …
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• Lack of financial transparency: Perceived corruption created distrust among the health care personnel. One participant stated:
Nothing was transparent … I suspect they are embezzling …
Family, social, and cultural concerns. This theme comprised 5 sub-themes: family opposition, separation from family and children, self-interest in participation, neglect and undervaluation by the media and society, and cultural issues.
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• Family opposition: Family concerns could prevent voluntary participation. One participant stated:
The family’s opinion is important … Without their consent, a person cannot feel at ease. For example, a spouse may oppose their partner’s voluntary participation.
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• Separation from family and children: Distance from loved ones was emotionally challenging for the voluntary participants. One participant stated:
Being away from my spouse and children, which is the most important part of life, was very difficult …
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• Self-interest in participation: Personal gain influenced decisions for voluntary participants. A participant stated:
Everyone works for their own benefit …
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• Neglect and undervaluation by the media and society: Lack of societal recognition demotivated staff for voluntary participation. One participant stated:
Working somewhere voluntarily and realizing that it makes no difference for the media and the society at all … it completely destroys your motivation …
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• Cultural issues: Cultural norms influenced employees’ voluntary participation. One participant stated:
Sometimes people wait for a few others to take the lead before they step forward; otherwise, they don’t participate. Someone has to start, and once a group of people gets involved, others will follow.
Facilitators
The facilitators that encourage voluntary participation were categorized under 5 major themes: Intrinsic Motivation, Values, and Characteristics; Cultural, Social, and Family Support; Organizational Support and Leadership; Experience and Skills; and Material and Financial Incentives.
Intrinsic motivation, values, and characteristics. This theme included 5 sub-themes: altruism, moral duty, religious commitment, preference for busy and challenging environments, and professional responsibility.
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• Altruism: Participants highlighted the natural human desire to help. One participant stated:
It’s simply human nature and altruism that drive voluntary participation. Whether now or ten years from now, people will still take part. It has always been this way, and it will continue to be … humans are human.
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• Moral duty: Sense of duty inspired engagement. A participant stated:
It was a matter of passion and the moral duty we have toward the people.
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• Religious commitment: Faith and spiritual beliefs encouraged participation. One participant stated:
Religion and the matter of faith … “Because I believe in the afterlife and the reward that God gives, I do this work.” Clearly, it has an impact …
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• Preference for busy and challenging environments: Some staff preferred dynamic work, hence tempting for voluntary participation during crises. In this regard, a participant stated:
I am genuinely willing to work in a busy center with challenging circumstances …
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• Professional responsibility: Accountability motivated sustained participation. One participant stated:
The issue of professional responsibility was very important; it made me feel personally accountable. During the COVID vaccination campaign, we sometimes started distributing vaccines as early as 8 a.m., and at the end of the day, we wouldn’t finish until 9 or 10 p.m.
Cultural, social, and family support. This theme had 3 sub-themes: family encouragement, peer support, and cultural norms.
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• Family encouragement: Family support could initiate participation. In this regard, 1 participant stated:
Sometimes a person participates even without being part of the organization because they are encouraged by their family … My father told me … “You go and assist.”
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• Peer support: Collegial support made voluntary work appealing. A participant stated:
Support by the individuals within a single unit is very important, as it makes the work environment more appealing for voluntary participation.
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• Cultural norms: Cultural upbringing shaped voluntary behavior. One participant stated:
The issue of culture can also influence voluntary participation. I was raised this way from childhood—whenever someone needed help, I would step in immediately.
Organizational support and leadership. This theme had 5 sub-themes: supportive managers, appreciation, transparency and honesty in promises, collaboration with non-governmental organizations (NGOs) and philanthropists, and fair policies.
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• Supportive managers: Leadership presence inspired volunteers. In this regard, 1 participant stated:
Support from managers can be very influential. I have observed that when managers take the lead in voluntary participation, their staff are immediately encouraged to get involved as well.
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• Appreciation: Recognition increased motivation. One participant stated:
When an employee’s voluntary work is recognized by their manager, it is likely to encourage continued voluntary participation in the long term.
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• Transparency and honesty in promises: Trust in management facilitated engagement. One participant stated:
Managers should act in a way that employees can see their honesty in their behavior; this is very important …
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• Collaboration with NGOs and philanthropists: External partnerships provided tangible support. One participant stated:
We were connected with the head of the Relief Committee … they gave gift cards, which was very impactful …
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• Fair policies: Equitable resource distribution encouraged participation. In this regard, a participant stated:
Resources need to be distributed fairly to encourage people—especially when it comes to fairly sharing rewards among employees.
Experience and skills. This theme comprised three sub-themes: crisis experience, training, and professional competence.
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• Crisis experience: Past experiences improved confidence. One participant stated:
After years of experiencing different situations, I’ve come to this viewpoint.
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• Training: Specialized training enhanced readiness. A participant stated:
There is a need for specialized professional training for voluntary participants in each unit … for example, at the start of every month, putting together a team crisis plan.
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• Professional competence: Skilled personnel were more likely to participate. One participant stated:
If a person is capable and skilled, it’s much easier for them to get involved during crises, which demand expertise and know-how.
Material and financial incentives. This theme has 3 sub-themes: financial reward, career growth, and protective equipment.
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• Financial reward: Monetary incentives promoted participation. A participant stated:
I can’t deny that financial rewards work. When voluntary participation comes with financial incentives, it definitely encourages some people to join in.
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• Career growth: Advancement opportunities motivated engagement. One participant stated:
It’s more motivating if they offer us a higher position or role … We could be encouraged by saying, “If we do this, this will happen.”
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• Protective equipment: Safety provision encouraged staff and family participation. One participant stated:
The most effective thing is to supply equipment for people—and occasionally for their families too—to keep them safe.
Limitations
This study had a limitation. The study population was restricted to individuals working in a limited region within a single country, which may affect the generalizability of the findings. Future research could expand this work by conducting similar studies in other regions and countries to provide broader insights.
Discussion
Based on the study findings, Organizational Issues constituted the most frequently reported group of barriers to the voluntary participation of health care personnel during crises. Conversely, Intrinsic Motivation, Values, and Personal Characteristics emerged as the most commonly cited group of facilitators. These results highlighted the substantial influence that both organizational factors and individual intrinsic attributes exert on the decision of health care personnel to engage voluntarily during critical situations.
The finding that organizational challenges constitute a substantial barrier to the voluntary participation of health care personnel during crises aligns with prior research. Existing literature indicates that ineffective organizational structures impede the enrollment of volunteers. In this regard, management-related problems—such as unmet basic needs, bureaucratic constraints, supply shortages, and ambiguous role definitions—further deter health care personnel from engaging in disaster response efforts.Reference Yanik and Ediz 32 While these barriers were frequently reported throughout the data, as outlined in the study findings, our research also identified several additional organizational challenges. These included insufficient support, limited managerial presence during crises, ineffective communication and lack of mutual respect, professional discrimination and rigid hierarchical structures, autocratic leadership practices, temporary employment arrangements, nepotism, political interference, and, notably, a pronounced gap between physicians and other health care personnel. In this regard, the literature indicates that the Iranian health care system appears to be highly autocratic and predominantly physician-centered.Reference Mehrabi, Madanipour and Ahmadnia 33 , Reference Nakhaee and Nasiri 34 This dynamic is described as extending to the point where elements of paternalism are evident, whereby individuals tend to refrain from participating in decisions made by physicians.Reference Khosravi, Shamsi Gooshki and Ravangard 35 , Reference Khosravi, Shojaei and Kavosi 36
The literature also had identified several additional barriers to the voluntary participation of health care personnel during crises, including insufficient financial support, prioritization of employment obligations, concerns regarding personal health, fear of contracting illness, and a lack of requisite skills or interest.Reference Susanti, Yudianto and Mulyana 37 , Reference AlOmar, AlShamlan and AlAmer 38 These findings were likewise supported by our study, which identified these factors as barriers to voluntary participation among individuals. Additionally, our research revealed several other impediments, including physical, psychological, and emotional difficulties, as well as family, social, and cultural concerns. In this regard, the existing literature also reports family-related barriers to health care personnel’s voluntary crisis participation, with family members opposing involvement due to fears of hospital-acquired infections and prioritization of household safety.Reference Karami, Nikbakht Nasrabadi and Torabizadeh 24 , Reference Houghton, Meskell and Delaney 39 It is reported that this concern boosted protocol adherence but deterred frontline roles, while disagreements forced volunteers to conceal participation for months, heightening emotional strain.Reference Houghton, Meskell and Delaney 39 , Reference Tekin, Glover and Greene 40
Consistent with existing literature, the present study demonstrated that financial constraints significantly influence voluntary participation among health care personnel during crises, functioning as both barriers and facilitators.Reference Karami, Nikbakht Nasrabadi and Torabizadeh 24 , Reference Alimehr and Hashjin 41 –Reference Strkljevic, Tiedemann and de Oliveira 44 Notably, these financial factors manifested more prominently among lower-tier health care roles, such as technicians and nurses, compared to higher-tier professionals like physicians. Specifically, nearly all of the technicians and nurses reported financial issues as determinants of their participation, whereas only 33% of physicians cited such concerns. This finding could be attributed to the tendency for professionals occupying lower levels of the health care hierarchy, such as nurses and technicians, to encounter greater financial challenges compared to higher-level roles, including physicians and policymakers.Reference Martin, Jones and Miller 45 –Reference Browne, Jenkins and Berlinger 47 This observation also aligns with Maslow’s hierarchy of needs, which conceptualizes human motivation as a 5-tiered pyramid, progressing from fundamental physiological needs at the base, followed by safety, social belonging, esteem, and culminating in self-actualization at the apex.Reference Hayre-Kwan, Quinn and Chu 48 , Reference Maslow 49
Our study findings indicated that intrinsic motivation, values, and personal characteristics constituted the most frequently reported category of facilitators. These encompassed altruism, moral duty, religious commitment, preference for busy and challenging environments, and professional responsibility. These factors were also aligned with findings from prior literature, which underscores their significant role in facilitating volunteer participation among health care personnel during crises.Reference Strkljevic, Tiedemann and de Oliveira 44 , Reference Umar, Samudra and Nashor 50 In this regard, nearly all of our study participants identified these intrinsic ethical factors as key influences on volunteer participation during crises.
The study findings revealed that physical, psychological, and emotional challenges constituted another prominent category of barriers impeding voluntary participation among health care personnel during crises. In this context, fatigue, stress, fear, and social stigma were frequently identified as key inhibitory factors. These findings aligned with the existing literature indicating that fatigue and psychological stress—stemming from excessive workloads, staff shortages, and prolonged exposure to crisis conditions—can discourage health care workers from volunteering by increasing the risk of burnout and reducing their functional capacity. Additionally, concerns about transmitting infections to family members, especially in the context of insufficient institutional support, further hinder their willingness to participate.Reference Sorokin, Kasyanov and Rukavishnikov 51 –Reference Daneshvar and Otterbach 53 Notably, nearly all nurses participating in our study identified workload, fatigue, or overwork as a major barrier to volunteer participation during crises. Moreover, it is noteworthy that nearly all nurses participating in our study identified family considerations—including distance from family, concerns for family health, and family influence on their decisions—as significant barriers to voluntary participation. This finding can be attributed to the particularly demanding nature of the nursing profession during crises. In this regard, the existing literature suggests that nurses are disproportionately susceptible to various vulnerabilities during crises, including the COVID-19 pandemic, compared with other health care professional groups.Reference Al Thobaity 54 –Reference Grinspun, Perry and Abu-Qamar 56 Moreover, all physicians and nurses (100%) who participated in our study identified psychological stress as a significant barrier to voluntary participation during crises, unlike other study participants. This disparity indicates that psychological stress is more prevalent among clinical curative professionals than paramedical preventive roles.
The study’s findings identified organizational support and leadership as key facilitators of voluntary participation during crises, with supportive managers, appreciation, transparency in commitments, collaboration with NGOs and philanthropists, and fair policies cited as critical elements. Notably, nearly all participating nurses emphasized appreciation as a vital motivator, underscoring its role in encouraging nursing involvement. This finding was consistent with the existing literature indicating that nurses place a particularly high value on appreciation as a determinant of work engagement, job satisfaction, and performance.Reference Seitovirta, Lehtimäki and Vehviläinen-Julkunen 57 –Reference Kurucová, Čáp and Bóriková 59 This pattern was especially evident during the COVID-19 pandemic, when acknowledgment and recognition were shown to enhance nurses’ willingness to participate in frontline crisis response despite considerable occupational risks.Reference Luo, Feng and Zheng 60
Our study also identified the presence of prior experience and professional skills among health care personnel as an additional facilitator contributing to their willingness to volunteer during crises. This finding was also supported by the existing literature showing that health care personnel with prior clinical or volunteering experience demonstrate greater readiness to participate in crisis response. Previous skills and exposure enhance confidence, facilitate effective contributions in tasks such as triage and direct care, and are associated with higher engagement rates compared with inexperienced individuals.Reference Strkljevic, Tiedemann and de Oliveira 44 , Reference Umar, Samudra and Nashor 50 Conversely, some reports indicate that the desire to gain new experiences can also serve as a facilitator for health care personnel’s willingness to volunteer during crises.Reference Lee, Lee and Sang 61 , Reference Metzger, Nguyen and Le 62
Material and financial incentives emerged in our study as additional facilitators of volunteer participation. This was consistent with the existing evidence showing that financial compensation can increase willingness to engage in crisis response by offsetting perceived risks and burdens.Reference Bickman, Domenico and Byrne 63 Likewise, the provision of adequate protective equipment functions as an important non-financial incentive by reducing exposure risks and thereby encouraging frontline involvement.Reference Kiwanuka, Babirye and Kabwama 64 –Reference Willis-Shattuck, Bidwell and Thomas 66 This phenomenon was particularly pronounced among participants in clinical curative roles within the health care system, as most physicians and nurses reported it, in contrast to those in paramedical preventive domains.
The study has multiple implications for beneficiaries. Future researchers can build on these findings to conduct more precise investigations, particularly using quantitative approaches to assess and model the significance of each factor in evidence-based frameworks. The data can also inform health care policymakers and managers in designing strategic plans to effectively utilize volunteer personnel during crises. In this regard, our study provides foundational data for strategy development and implementation. Our study contributed some interesting insights to the literature, particularly regarding organizational factors. Specifically, it highlighted the negative impact of closed, autocratic, unfair, and non-transparent health care organizations in impeding volunteer participation, as observed in the Iranian health care system. While intrinsic motivation, personal values, and individual characteristics were the most frequently reported facilitators of volunteer participation, several other factors were also influential. Financial incentives were particularly important for personnel in lower levels of the health care hierarchy, such as paramedical and nursing roles. Workload, fatigue, and overwork emerged as major barriers, especially for nurses, whose roles are more demanding than those of other health care professions. Family considerations were also cited as significant, particularly for nurses. Psychological factors were more pronounced among clinical professionals compared to paramedical staff. Appreciation was another key facilitator, especially among nurses. These findings suggested that health care policymakers and managers should implement strategies that preserve family considerations, support the psychological well-being of clinical personnel, and recognize their contributions—particularly nurses—to enhance voluntary participation during crises. Additionally, attention to education, experience, and skills of health care personnel was identified as a facilitator, while financial incentives remain relevant for lower-level staff. The provision of adequate protective equipment was another important facilitator, especially for clinical staff, including physicians and nurses, compared to those in preventive paramedical roles. Overall, these insights can guide health care policymakers and managers in maintaining and optimizing the potential for voluntary service among personnel during crises.
Conclusions
Our study identified several groups of barriers and facilitators influencing health care personnel’s volunteer participation during crises. Among the barriers, organizational issues were the most frequently reported, whereas intrinsic motivation, personal values, and individual characteristics emerged as the most commonly cited facilitators. While many findings aligned with existing literature, our study also provided some interesting insights. Notably, organizational barriers—highlighting the negative impact of closed, autocratic, unfair, and non-transparent health care organizations—were particularly significant. These included the gradual shift from voluntary to compulsory participation, lack of commitment from authorities, absence of managerial presence during crises, ineffective communication and mutual respect, professional discrimination and excessive hierarchy, autocratic practices, temporary employment, unclear roles and responsibilities, gaps between physicians and other personnel, nepotism, political interference, and unfair promotion practices. Social and cultural barriers were also reported, including self-interest in participation, neglect and undervaluation by media and society, and other cultural factors, all of which impeded volunteer participation. Conversely, new facilitators identified in our study included transparency and honesty in promises and the implementation of fair policies, underscoring the importance of an open, committed, fair, and transparent organizational environment in promoting voluntary engagement.
Data availability statement
The research data is accessible through contacting the corresponding author of the study.
Acknowledgments
ChatGPT-5 was utilized in order to rewrite the text of the manuscript in terms of grammar and wording.
Author contribution
MK and SS contributed to the data collection. MK, SS, and MAS performed the data analysis; MK wrote the manuscript.
Funding statement
There is no funding regarding the research.
Competing interests
None.
Consent to participate
Informed consent was obtained from all of the study participants.
