Abstract
BACKGROUND: Non-governmental organizations support state-based responses to health emergencies, including the COVID-19 pandemic. Their capacity to respond effectively to such emergencies depends on worker and volunteer willingness to engage in high-risk conditions. Some studies examine volunteer and salaried worker motivation to continue in high-risk situations, but offer limited insight into how workers themselves understand and act on workplace cultures, governance, risks, and care work, as well as their consequences for motivation to continue. This study investigated drivers of motivation to continue and appraisals of the value of care work among French Red Cross (FRC) personnel during the COVID-19 pandemic, 2020-2021. METHODS: We conducted online quantitative surveys and qualitative interviews. We used a novel analytical approach employing unsupervised clustering with BERTopic-a transformer-based language model-for analyzing open-text survey responses. This method, alongside descriptive statistics and multivariate analyses, illuminated underlying themes in participants' intentions to continue care work. Thematic analyses situated these intentions within broader discussions about FRC work culture and the value of care work during a pandemic. RESULTS: Analysis of responses from 2,460 online surveys and 40 online interviews revealed a decrease in the proportion of salaried workers expressing an intention to continue, whereas the proportion among volunteers remained stable across surveys conducted between June 2020 and June 2021. Multivariate analysis linked declining motivation to continue with heightened anxious state and increased motivation to continue with perceived readiness and in-person communication. Qualitative findings reframed our question about FRC actor motivation to continue. "Motivation to continue", whether declining or intensifying, reflected a rethinking of care work. For some, remote work sapped their care work of its value. Others perceived their labor to have high value and thus worked beyond their physical and emotional capacities. CONCLUSIONS: Although anxious state and risk perceptions influenced FRC actor motivation to continue during the COVID-19 pandemic, this motivation to continue must be understood in a context of changing values of voluntary and salaried care work that sustain the health and wellbeing of a population. Studies of future health emergencies could extend this reasearch to yield greater insight into sociocultural and political economic logics that sustain care work.