Income-Based Disparities in Perceived Benefits and Challenges of Virtual Global Health Activities During the COVID-19 Pandemic: Mixed Methods Analysis

Background: Global health activities (GHAs) can potentially reduce health disparities by facilitating resource sharing, promoting medical education and professional development worldwide, and enhancing collaboration among high-income countries (HICs) and low- and middle-income countries (LMICs). However, the COVID-19 pandemic disrupted in-person GHAs due to strict infection control and travel restrictions. To ensure the continuity of GHAs and further address health inequity, virtual GHAs (VGHAs) are gaining traction. Objective: Our research aimed to understand how people perceive the benefits and challenges of VGHAs, analyze and compare whether HIC and LMIC respondents have different perceptions of virtual and in-person GHAs, and summarize suggestions for improvement to inform the future development of VGHAs. Methods: We conducted a cross-sectional web-based survey during the COVID-19 pandemic in early 2022. Eligible participants were adult students, trainees, or professionals who participated in, created, taught, or facilitated GHAs. We thematically analyzed participants’ free-text responses regarding their perceptions of the benefits and challenges of virtual and in-person GHAs. The patterns differed depending on whether respondents were from HICs or LMICs; thus, we compared frequencies of each theme between the 2 groups. Results: A total of 154 respondents from 34 countries were included in the analysis. Key benefits of VGHAs were improved access to global health resources or content, reduced cost, easier scheduling and planning, expanded remote participation, and wider participation and reach. The themes that emerged as challenges of VGHAs included a lack of infrastructure to engage virtually, being less motivated and engaged, a lack of in-person and hands-on experience, and challenges with virtual communication and collaboration. LMIC respondents, compared to HIC counterparts, were more likely to identify reduced cost (26/67, 39% LMIC compared to 20/87, 23% HIC; χ²₁=4.5; P=.03) and expanding knowledge, experience, or skills (15/67, 22% LMIC compared to 8/87, 9% HIC; χ²₁=5.2; P=.02) as benefits of VGHAs, lack of infrastructure to engage virtually as a challenge of VGHAs (38/67, 57% LMIC compared to 31/87, 36% HIC; χ²₁=6.8; P=.009), and to suggest improving the content to be more interesting and relevant (6/67, 9% LMIC compared to 1/87, 1% HIC; χ²₁=5.3, P=.02). In contrast, HIC respondents were more likely to identify fostering continuity of relationship or activities (28/87, 32% HIC compared to 6/67, 9% LMIC; χ²₁=11.9; P<.001) as a benefit of VGHAs and being less engaged and motivated to participate virtually (43/87, 49% HIC compared to 19/67, 28% LMIC; χ²₁=7.0; P=.008) as a challenge of VGHAs. Conclusions: Our findings add to the existing literature by understanding how GHA participants from HICs and LMICs perceive the benefits and challenges of VGHAs differently. These data help elucidate what makes VGHAs acceptable to global health partners and suggest improvements to ensure partner needs are served equitably within the partnership.