key: cord-0686483-rn8f4wz0
authors: Kabir, H.; Tonmon, T. T.; Hasan, M. K.; Mitra, D. K.
title: Association between preference and e-learning readiness among the Bangladeshi female nursing students in the Covid-19 pandemic: a cross-sectional study
date: 2021-06-27
journal: nan
DOI: 10.1101/2021.06.20.21259188
sha: f7e4630c1c92175a1b990e886f943bd26c629bc6
doc_id: 686483
cord_uid: rn8f4wz0

The COVID-19 pandemic jeopardized the traditional academic learning calendars due to the closing of all educational institutions across the globe. To keep up with the flow of learning most of the educational institutions shifted toward e-learning. However, the questions of the students e-learning preference for various sub-domains of e-learning readiness did not identify, particularly among the female nursing students for a developing country like Bangladesh, where those domains pose serious challenges. A cross-sectional study was conducted among the female nursing students perceived e-learning readiness in sub-domains of readiness; availability of technology, use of technology, self-confidence, and acceptance. About 237 nursing students were recruited, who have enrolled in e-learning at least the last 30 days of the participation. A multivariable linear regression model was fitted to find the association between students preference and the perceived e-learning readiness with demographic and e-learning related factors. The findings of the study revealed that more than half of the students, 56.54% (n=134) did not prefer e-learning. The students did not prefer e-learning compared to prefer group has significantly less availability of technology ({beta} = -3.01, 95% CI: -4.46, -1.56), less use of technology ({beta} = -3.08, 95% CI: -5.11, -1.06), less self-confidence ({beta} = -4.50, 95% CI: -7.02, -1.98), and less acceptance ({beta} = -5.96, 95% CI: -7.76, -4.16). The age, degree, residence, parents highest education, having a single room, having any eye problems significantly associated with the variation of availability of technology, use of technology, self-confidence, and acceptance for e-learning. The outcomes of the study could be helpful while developing an effective and productive e-learning infrastructure regarding the preparedness of nursing colleges for the continuation of academia in any adverse circumstances like the COVID-19 pandemic.

contents of it, which are quality, social distancing for emergency health occurrences, time flexibility, and cost-effectiveness [4] . In nursing, e-learning, when were accessible through hospital websites for the nurses, allowed them to widen their knowledge and skills by taking their necessary courses as the service deliverance heavily depends on their enriched cognizance.

Besides, available nursing care information through the hospital websites implement the healthcare organizations to renovate professional and personal growth among the nursing community [5] . The widely evident term e-learning facilitated the nursing learning system since the 1960s, according to the findings of the CAL (Computer-assisted learning) studies in the nursing literature where debates were persistent about the consolidated skill accretion of the nurses and the proficiency of conventional teaching methods within the clinical environment [6] . Ironically, e-learning had a greater drop-out rate than the traditional delivered education, despite the advantages, in accordance with another study findings, due to the lacking in computer competency, browser handling, unavailability of adequate technologies, and nursing students' acceptancy towards it [7] . Elearning concentrates on three parts enormously which includes the appropriate words used for the presentations, in particular, the networking medium used for it and the pedagogic motive to bring constructive changes in people's lore [8] . This system of learning continued to grow with the growing interest of both faculty and pupils apart from the technical support upliftment with helping in courseware delivery [9] . These online course delivery models can be both coeval and nonsynchronous [10] . Regardless of the models, e-learning was adhered to globally as the timely educational plan of action to adopt during the COVID-19 pandemic situation in medical and nursing education due to the ongoing quarantined period [11]- [12] .

Though, dissensions are present regarding the e-learning educational system, by making sure the accessibility, affordability, and flexibility of this systems' teaching disquisition from both the disseminators' and receivers' sides, the learning capacity of the students can be developed for lifelong study purposes [13] . The learning process should be utilized in accordance with the learners' necessity and capacity to accommodate, assess and contemplate the instructors' recitation [14] .

Students should be prioritized to be trained to perform well while using the web-based educational method [12] . Although, it was found in a study that despite the training, e-learning could be depressive and stressful for visually impaired students [15] . To avoid these problems, specifications and standards using contents present in the LMS (Learning Management System) need to be created and accessed for the disabled people to access all the information given and . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted June 27, 2021. ; https://doi.org/10.1101/2021.06.20.21259188 doi: medRxiv preprint overcome the sufferings [16] . It was observed in studies that the quality of the training programs needs to be improved and to develop the learning experience of the nursing students, training on generalized caregiving skills, knowledge, and self-efficacy of mental health should be provided [17] . From a different point of view, in several studies, gender differences played some roles in perceiving e-learning. Perceived usage experience and the intention to learn, the benefit of technology-based learning were found slightly dominating among the males rather than the females [18].

In Brazil, the nursing web-based education was seen more practiced for the research projects of the universities linked with the nursing area [1]. In a study of Canada, Cognitive Load Theory (CLT) was used among the nursing students to limit the idiosyncratic load on their memory capacity [10] . Whereas, in a Bangladeshi study observing the challenges in continuing the elearning, it was found that electronic and networking support is still not well built to manage the cost and accessibility affordable regardless of the regions and socioeconomic backgrounds of the country people [19] . Another study was seen bringing up the rural perspective of Bangladesh regarding e-learning where relevant online learning tools were used to deliver the lessons to evolve the predominant rural Bangladeshi learners into skilled personnel [20] . E-Learning is a fast-networking virtual process causing students to be more independent to change the conventional phenomena of the course-instructor-centered education into a student-centered learning process [18] . Virtual academic learning procedures are seen adopted worldwide including our neighboring countries bringing a transformation regardless of the variety of educational sectors [19] .

In Bangladesh, very few studies were found investigating the barriers on its way to cope with the e-learning methods, also which were not directly reporting the current situation of the female nursing students' readiness towards the e-learning system along with their preference for this reason. Recent pandemic has taught us to be prepared for all the time, especially to be skilled and efficient enough to continue the educational and professional activities virtually in case of emergencies. Therefore, our study intended to investigate the association between the preference and subdomain of e-learning readiness among the Bangladeshi female nursing students with the hope to contribute in the educational system development to find newer tactics to deal with the found barriers in the steps of enlightening our knowledge.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted June 27, 2021. ; https://doi.org/10.1101/2021.06.20.21259188 doi: medRxiv preprint 2. Methodology:

A cross-sectional study was conducted between December 26, 2020, and January 11, 2021.

The study participants were all undergraduate female nursing students who were enrolled with elearning during the last 30 days of the study period in Bangladesh.

Data were collected online by using "Google Form", posting the questionnaire link on nursing students' social media groups (Facebook, Messenger, and WhatsApp) during the school closing period in Bangladesh due to the COVID-19 pandemic. Out of 252 responses, a total 237 of completed responses were recruited for the final analysis.

The questionnaire included an item on whether the students were willing to participate in the study, an item on perhaps the students prefer e-learning, the demographic, e-learning related characteristics, and a perceived e-learning readiness questionnaire. The first part of the questionnaire included an item on students' willingness to participate in the study. The second part consisted of the e-learning related factors (prefer e-learning, device use, having a single room, and having any eye problems) and the demographic information (age, type of institution, degree, residence, and parent's highest education). The preference of e-learning was accessed by binary (yes and no) response a single item. Having any eye problems has defined in the study; the student could not stay on screen for a longer time. However, the third part of the questionnaire consisted perceived e-learning readiness questionnaire.

The readiness of e-learning can be accessed by using 39 items of the perceived e-learning readiness questionnaire (score range: [21], [22] . The items of the questionnaire were responded to a five-point Likert scale of 1 for "strongly disagree" and 5 for "strongly agree". The questionnaire mostly focused on five baseline subdomains of e-learning; availability of technology (6 items), use . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 27, 2021. ; https://doi.org/10.1101/2021.06.20.21259188 doi: medRxiv preprint of technology 11 items), self-confidence (12 items), acceptance (7 items), and training (3 items).

In our study, we considered the first four subdomains of the readiness questionnaire (total 36 items). The probable score range of the four subdomains was 36 to 180, wherein our study the range was found 36 to 177. This 36 items questionnaire showed excellent reliability and validity in our study (Cronbach alpha= 0.94). None of the reliability coefficients (Cronbach alpha) of the subdomains was found less than 0.77 in this study are presented in table 3.

Descriptive statistics were performed for the demographic, e-learning related characteristics, and perceived e-learning readiness score. The score of the perceived e-learning readiness questionnaire was presented by mean, median, standard deviation (SD), and interquartile range (IQR). The reliability coefficient (Cronbach alpha) was calculated for the perceived e-learning readiness questionnaire. A multivariable linear regression model was fitted to find the association between students' e-learning preference and perceived e-learning readiness and with the demographic and other e-learning related characteristics. The p-value <0.05 was considered statistically significant at a 95% confident interval. Data were analyzed by using statistical software STATA-16.

The Ethical Review Broad of the Faculty of Life Science, North South University, Bangladesh approved this study. The reference number is 2021/OR-NSU/IRB/0601. The aim and objective of the study were explained on the first page of the questionnaire and the respondents who were willing to participate were only considered as respondents of this study.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 27, 2021. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 27, 2021. ; https://doi.org/10.1101/2021.06.20.21259188 doi: medRxiv preprint enrolled from private institutions and most of the students 71.73% (n=170) were from the diploma in nursing degree. More than half of the participants about 59% (n=141) were from the rural areas of Bangladesh. In terms of parents' highest education, about 54% (n=128) had higher secondary certificates (H.S.C.) education, 28.69% (n=68) had primary, and only 17.30% (n=41) bachelor's & above. Interestingly, only 2.53% (n=6) of the student participated in e-learning using the personal computer, and the majority of the participants 63% (n=149) had no single room for elearning. However, around 42% (n=101) of the respondents reported having any eye problems. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The results of the study showed that among all the participants, more than half of the students did 30 not prefer e-learning. When we tried to figure out the factors may affect this prevalence, it was 31 observed that less acceptance and lack of self-confidence are two of the reasons significantly 32 associated with not to prefer the e-learning among the female nursing students, along with that,

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The copyright holder for this preprint this version posted June 27, 2021. lack of technology usage and its' non-availability was also found strongly associated with the non-34 preference. Having said that, age differences, degree variation, residency, not having a single room 35 while having online classes, and having any eye problems are also evidently associated with the 36 non-preference among the female nursing students.

The results of this cross-sectional study are consistent with earlier reports showing the effects of a 

To digitalize Bangladesh, the internet-based education system is expanding country-wide, but 52 overseeing the access to the information and the programs, lagging behind the female nursing 53 students of the nation to be more familiar with the system, which could be causing the lackings in 54 preparing themselves to prefer the e-learning system more enthusiastically. A study conducted in 55 Vienna also reported similar problems with e-learning adaptation, likewise in our study, we found 56

[25].

The results of this study showed that students aged more than 22 years were found more inclined 58 to prefer e-learning as they were more confident and had the technological support more available 59 compared to the younger age group students, wherewith slight inconsistency, H. Pillay et al.,

(2007) reported in his study conducted in Australia that students more than 40 years were with less 61 self-efficacy and technological support pointing out the younger age groups less than 25 years 62 possess higher capability on both of these constructs [26] . From our country's perspective, it could 63 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted June 27, 2021. ; https://doi.org/10.1101/2021.06.20.21259188 doi: medRxiv preprint be explained as the more the students become experienced and exposed to this newer technology 64 adaptation, they tend to use more of it and hence have it more available rather than the younger citizens.

In this study, the association was found significant between educational degree variation and the 67 lack of readiness among the female nursing students into all the subdomains except for use of This study also suggested that the lack of readness for e-learning is also to some extent significantly 86 associated with the residency of the female nursing students. In a similar study conducted in India,

T. Muthuprasad et al., (2020) reported that the majority of the students living in a rural setting are 88 associated significantly with the lack of readiness due to unavailability and self-efficacy was 89 another study also found the residency to be a potential factor [32] . The advancement of technology 90 and availability of it, with the speed it has reached the urban areas, did not find reaching in rural 91 settings comparing that speed where the students studying from a rural setting perceiving online 92 education are not being privileged with available technical support and thus not enough confident 93 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) However, having an eye problems showed significant association with having lack of availability 98 of technology and being less acceptant towards the e-learning preparedness in our study, whereas 99 a study addressing the problem faced by the disadvantaged people similarly showed that e-learning 

106 Very few studies were found conducting the effectiveness of the e-learning for the Bangladeshi 107 students, where no such studies were found specifically investigating the efficacy of this method 108 among the female nursing students of Bangladesh so far which is a strength of this study. However, 109 a study was found reporting the effectiveness of online learning, the study considered a limited 110 number of variables where the factors affecting the readiness for e-learning system were not 111 covered with a wide range of variables.

Although a readiness evaluation is important, this research only highlighted the four aspects of 113 readiness addressing the availability of technology, use of technology, self-confidence, and 114 acceptance. As it was a cross-sectional study, the study could not investigate the range of its 115 variables over a large group of female nursing students. Hence, it is recommended for future 116 research to assess the various other readiness factors (sociological, environmental, human 117 resource, financial, and content) on a larger scale study to report how ready the female nursing 118 students of Bangladesh are to implement e-learning.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted June 27, 2021. ; https://doi.org/10.1101/2021.06.20.21259188 doi: medRxiv preprint 6. Conclusion: 120 To reduce the spread of COVID-19, the closing of academic institutions as well as the installation among Lebanese university students during COVID-19 quarantine," Nurs. Forum, vol. 56,

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