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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.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"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\u2019s 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. 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