Effectiveness of a Theory- and Web-Based Adaptive Implementation Intervention on Nurses' and Nursing Students' Intentions to Provide Brief Counseling: Protocol for a Randomized Controlled Trial

Development and Design of E_MOTIV: A Theory-Based Adaptive E-Learning Program to Support Nurses' Provision of Brief Behavior Change Counseling

Brief counseling, when provided by adequately trained nurses, can motivate and support patient health behavior change. However, numerous barriers can impede nurses' capability and motivation to provide brief counseling. Theory-based interventions, as well as information and communication technologies, can support evidence-based practice by addressing these barriers. The purpose of this study was to document the development process of the E_MOTIV asynchronous, theory-based, adaptive e-learning program aimed at supporting nurses' provision of brief counseling for smoking cessation, healthy eating, and medication adherence. Development followed French's stepwise theory- and evidence-based approach: (1) identifying who needs to do what, differently, that is, provision of brief counseling in acute care settings by nurses; (2) identifying determinants of the provision of brief counseling; (3) identifying which intervention components and mode(s) of delivery could address determinants; and (4) developing and evaluating the program. The resulting E_MOTIV program, guided by the Theory of Planned Behavior, Cognitive Load Theory, and the concept of engagement, is unique in its adaptive functionality-personalizing program content and sequence to each learners' beliefs, motivation, and learning preferences. E_MOTIV is one of the first adaptive e-learning programs developed to support nurses' practice, and this study offers key insights for future work in the field.

A theory-based adaptive E-learning program aimed at increasing intentions to provide brief behavior change counseling: Randomized controlled trial

BACKGROUND

Unhealthy behaviors are significant contributors to non-communicable diseases. Nurses can support patient health behavior change by providing brief behavior change counseling. However, training programs in brief counseling are generally not personalized, or adapted, to the barriers and theoretical determinants of its provision in clinical practice.

OBJECTIVE

This study aimed to evaluate the effectiveness of the E_MOTIV_A theory-based adaptive e-learning program on nurses' and nursing students' intentions to provide brief counseling for smoking, unhealthy eating habits and medication nonadherence.

DESIGN AND METHODS

A randomized controlled trial was conducted with nurses and nursing students in Canada. Experimental group participants were allocated to the E_MOTIV_A theory-based adaptive e-learning program. Control group participants were allocated to the E_MOTIV_B knowledge-based standardized e-learning program. E_MOTIV_A was designed to influence the constructs of the Theory of Planned Behavior (e.g., attitude, subjective norms) in relation to brief counseling. Outcomes were improvement in intention to provide brief counseling, improvement in other Theory of Planned Behavior variables, as well as cognitive load and engagement related to e-learning.

RESULTS

A total of 102 participants were randomized to the experimental (n = 51) and control (n = 51) groups. End of study questionnaires were completed by 27 experimental group and 38 control group participants. Analyses indicated no significant differences between groups in the change of scores for intention to provide brief counseling. However, while not significant, the change of score was greater in the experimental group (10.22 ± 3.34 versus 9.04 ± 2.80; p = 0.787). Scores in both groups improved significantly for attitude, subjective norms, perceived behavioral control, behavioral beliefs, and control beliefs. However, there were no statistically significant differences between groups for these variables as well as for cognitive load and engagement.

CONCLUSIONS

Both e-learning programs had a similar positive effect on nurses' and nursing students' intentions to provide brief counseling and on Theory of Planned Behavior variables.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN32603572; http://www.isrctn.com/ISRCTN32603572.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/18894; https://doi.org/10.2196/18894.

A Meta-Analysis of the Effect of Paper Versus Digital Reading on Reading Comprehension in Health Professional Education

Objective. Despite a rise in the use of digital education in health professional education (HPE), little is known about the comparative effectiveness of paper-based reading and its digital alternative on reading comprehension. The objectives of this study were to identify, appraise, and synthesize the evidence regarding the effect of how media is read on reading comprehension in the context of HPE.Methods. Observational, quasi-experimental, and experimental studies published before April 16, 2021, were included if they compared the effectiveness of paper-based vs digital-based reading on reading comprehension among HPE students, trainees, and residents. Random-effects meta-analyses were performed using standardized mean differences.Results. From a pool of 2,208 references, we identified and included 10 controlled studies that had collectively enrolled 817 participants. Meta-analyses revealed a slight but nonsignificant advantage to students reading paper-based HPE texts rather than digital text (standardized mean difference, -0.08; 95% CI -0.28 to 0.12). Subgroup analyses revealed that students reading HPE-related texts had better reading comprehension when reading text on paper rather than digitally (SMD =  -0.36; 95% CI -0.69 to -0.03). Heterogeneity was low in all analyses. The quality of evidence was low because of risks of bias across studies.Summary. Current evidence suggests little to no difference in students' comprehension when reading HPE texts on paper vs digitally. However, we observed effects favoring reading paper-based texts when texts relevant to the students' professional discipline were considered. Rigorous studies are needed to confirm this finding and to evaluate new means of boosting reading comprehension among students in HPE programs.