The Effectiveness of Web-enhanced Self-
directed Learning in Promoting Information
Literacy of Nursing Students in Taiwan
by
Tsai Ling-Chun
RN, BSN, MN
A thesis submitted in fulfilment of the requirements of the degree of
Doctor of Philosophy
to the School of Nursing and Midwifery, Faculty of Health, Griffith University
Abstract
Background and Purpose:
It has become imperative for health professionals to have
information literacy, including database searching skills, to enable them to practise
contemporary quality patient care, and developing information literacy requires
computer literacy and self-directed learning (SDL). More than the half of the current
nursing workforce in Taiwan graduate from an Associate Degree in Nursing (ADN)
program, but the effectiveness of integrating e-learning to promote the information
literacy and SDL of students in the ADN program is unclear. This study investigated
whether a researcher-developed web-enhanced education intervention guided by
Knowles’ Adult Learning Theory (KALT) would improve Taiwanese ADN students’
online searching knowledge, skills, self-efficacy, and self-directed learning. The 10-
week intervention comprised a self-paced online learning package, an online forum, a
face-to-face tutorial, and an optional weekly drop-in session.
Method:
A mixed methods intervention design was used with focus groups, following
pre and post-test questionnaires. A total of 142 ADN students were recruited and
allocated to the experimental group (
n
= 69), or the control group which simply
received face-to-face instruction (
n
= 73) using cluster randomisation. The learning
outcomes were measured using an online searching knowledge test (OSKT) and
online searching skills test (OSST) developed by the researcher, the Online Searching
Skills Self-efficacy Inventory (OSSI), and the Self-Directed Learning Readiness Scale
for Nursing Education (SDLRSNE). The level of significance was set with an α of .05.
Four semi-structured questions were used to guide the focus group discussions in
Chinese. Comments made in the focus groups were recorded and fully transcribed,
then analysed using free-form coding with translation into English. Participants’
responses were thematically analysed guided by the five research questions.
Triangulation was achieved with the convergence of findings from the two separate
data sources.
Results and Implications:
At baseline there was no statistically significant difference
between the experimental and control groups regarding their demographic,
background, or the outcome variables (their OSKT, OSST, OSSI, and SDLRSNE
scores). After the intervention, the OSSI scores of the experimental group were
statistically significantly higher than those in the control group (t = 2.19, p = .027).
Focus group data supported the quantitative results and clearly indicated that the
experimental group participants benefited from the self-paced additional online
learning materials in combination with timely feedback via the online forum. The
web-enhanced approach offered learning support that closely matched participants’
learning needs, although there was no statistically significant difference between the
OSKT, OSST, and SDL scores of the control group and the experimental group.
Control group participants reported feeling information overload. They remarked on
the lack of hands-on exercise during their short face-to-face instruction session, and
commented negatively on group discussion when teachers were not present, and on
previous e-learning experiences involving limited teacher-student interaction. In
contrast, the experimental group participants reported that the intervention supported
development of their online searching skills and promoted learning engagement and
time management skills.
This study provides empirical evidence of the usefulness of KALT for guiding the use
of online teaching strategies to develop the information literacy of Taiwanese nursing
students. The findings support Knowles’ assumptions that adults prefer problem-
solving and life-related learning based on their previous experience. The researcher
recommends that information literacy education be started at the earliest stage of the
ADN program in order to better prepare students for evidence-based practice.
Ongoing facilitation by teaching staff should assist ADN students engaging in
experiential learning in the area of information literacy to enhance students’ positive
learning experiences and outcomes, particularly when project-based group
assignments are used.
Conclusion:
This study indicates that a web-enhanced learner-focused approach,
informed by KALT, can support students’ online searching self-efficacy. An online
forum with timely feedback from lecturers is more likely to encourage students’ SDL
and learning satisfaction, and to closely match their learning needs. As a result, group
assignments can be adopted by more courses for developing ADN students’ required
knowledge, skills, and attitudes. It is recommended that teaching strategies informed
by KALT be used in more courses within ADN programs to develop the students’
information literacy and SDL, and thereby help adequately prepare them for evidence-
based nursing practice.
Keywords:
learning methods; computer-assisted instruction; self-directed learning;
nursing education; information literacy.
Statement of originality
This work has not previously been submitted for a degree or diploma in any university.
To the best of my knowledge and belief, the thesis contains no materials previously
published or written by another person except where due reference is made in the
thesis itself.
Table of contents
Abstract ... i
Statement of originality ... iv
Glossary ... x
List of abbreviations ... xii
Dissemination of study results... xiii
Acknowledgements ... xiv
Chapter 1: Introduction... 1
1.1 Background ... 1
1.1.1 The integration of e-learning into higher education ... 2
1.1.2 Self-directed learning ... 5
1.1.3 Information literacy... 6
1.1.4 Associate Degree in Nursing students in Taiwan... 8
1.1.5 Knowles’ Adult Learning Theory and Problem-Based Learning ... 11
1.2 The significance of this current research ... 12
1.3 Research purpose and objectives ... 15
Overview of project ... 15
1.3.1 Research questions ... 16
1.4 Structure of the thesis ... 16
Chapter 2: Literature review... 18
2.1 Background ... 18
2.1.1 Searching strategy ... 22
2.2 Nursing students’ readiness for information literacy ... 25
2.2.1 Quality of information & evidence-based nursing practice ... 25
2.2.2 Information resources used & online searching self-efficacy ... 26
2.2.3 Educational needs and challenges for online searching skills... 28
2.3 Matching teaching methods with learning needs ... 31
2.3.1 Technology-enhanced learning ... 31
2.3.2 Advantages of a web-enhanced approach ... 35
2.3.3 Methods matching students’ information literacy education needs ... 36
2.4 How learners become self-directed learners ... 44
2.4.1 Matching learners’ needs with preparation for SDL ... 44
2.4.2 The importance of facilitation during SDL ... 45
2.4.3 Other factors influencing learners’ self-directed learning... 46
2.5 Summary ... 50
Chapter 3: Theoretical framework... 53
3.1 Knowles’ Adult Learning Theory ... 53
3.2 Criticism of Knowles' Adult Learning Theory ... 56
3.3 A critical review of the use of Knowles' assumptions in guiding nursing education . 59 3.3.1 Method/Searching strategy... 60
3.3.2 Implications for nursing education and research... 73
3.4 Conceptual framework of the current research ... 74
Chapter 4: Methodology... 77
4.1 Design ... 78
4.2 Setting ... 83
4.3 Sample ... 84
4.4 Description of questionnaire ... 87
4.4.1 Section1: Demographic and background items ... 88
4.4.2 Section2: Tests used in the study ... 89
4.4.3 Section 3: Online Searching Self-efficacy Inventory... 96
4.4.4 Section 4: Self-Directed Learning Readiness Scale for Nursing Education ... 98
4.5 Usual instruction ... 99
4.6 The intervention ... 100
4.6.1 Aim of and background to the intervention ... 100
4.6.2 Theoretical foundation of the intervention ... 102
4.6.3 Components of the intervention ... 103
4.6.4 Intervention fidelity... 109
4.7 The implementation of the intervention... 110
4.8 Data collection procedure ... 112
4.9 Data analysis ... 114
4.9.1 Quantitative data analysis ... 114
4.9.2 Qualitative data analysis ... 116
4.9.3 Trustworthiness of qualitative data ... 118
4.10 Ethical considerations ... 119
4.11 Summary ... 120
Chapter 5: Results... 122
5.1 Sample response rate ... 122
5.2 Backgrounds of participants ... 124
5.3 Results... 134
5.4.2 Research question 2... 140 5.4.3 Research question 3... 145 5.4.4 Research question 4... 147 5.4.5 Research question 5... 150 5.4 Summary ... 173 Chapter 6: Discussion... 175
6.1 Participants’ readiness for information literacy ... 175
6.1.1 Online searching knowledge and skills ... 175
6.1.2 Online searching self-efficacy... 177
6.1.3 Participants’ information literacy weaknesses ... 180
6.2 Matching participants’ learning needs ... 184
6.2.1 Promoting participants’ online searching self-efficacy... 185
6.2.2 The significance of online searching self-efficacy... 188
6.2.3 Matching participants’ learning needs using a technology-enhanced approach 189 6.3 Methods that nurture the participants’ self-directed learning ... 193
6.3.1 Participants’ readiness for self-directed learning ... 193
6.3.2 Factors that influence learners’ self-directed learning ... 195
6.3.3 Encouraging participants’ self-directed learning ... 198
6.4 Findings related to Knowles’ Adult Learning Theory ... 201
6.5 Summary ... 203
Chapter 7: Conclusion ... 207
7.1 Contribution of results ... 207
7.2 Future directions ... 212
7.1.1 Recommendations for nursing education ... 212
7.1.2 Recommendations for nursing research ... 213
7.1.3 Recommendations for nursing practice ... 213
7.3 Strengths and limitations ... 214
7.4 Summary ... 215
Appendices ... 217
Appendix 1: Research ethics approval ... 217
Appendix 2: Information sheet and consent form ... 219
Appendix 3: Permission to use questionnaires ... 228
Appendix 4: Research questionnaires ... 230
Appendix 5: Questionnaire translation ... 250
Appendix 6: Example from the online self-paced learning module ... 256
List of Tables
Table 1. Knowles’ assumptions about adult learners ... 55
Table 2. Articles included in this review ... 62
Table 3. Examples of the background Items ... 88
Table 4. I-CVI of the Online Searching Knowledge Test ... 90
Table 5. Percentage of Correct Answers for Individual Knowledge Items ... 92
Table 6. Final Online Searching Knowledge Test (16 items)... 93
Table 7. CVI of the Online Searching Skills Assessment Tool ... 96
Table 8. Four components of the Intervention (改成 Table 8.) ... 104
Table 9. Learning Objectives and Contents of the Self-paced Learning Modules ... 107
Table 10. Problem-Based Discussion Facilitation Guidelines... 108
Table 11. Phases of Free-Form Analysis ... 117
Table 12. Comparison of Mean Age between the Two Groups ... 125
Table 13. Number and Percentage Distribution of Gender of the Participants ... 126
Table 14. Participants’ Previous Databases Learning Experiences ... 129
Table 15. Databases Instruction Given in Hours ... 130
Table 16. E-Learning and Searching Competencies of Participants ... 133
Table 17. Mean scores of Online Searching Knowledge of Participants Pre-test and Post-test ... 135
Table 18. Example Questions for Each Area of the Online Searching Knowledge Test .... 136
Table 19. Knowledge Change of Participants ... 137
Table 20. Mean of Online Searching Skills of Participants at Pre-test and Post-test ... 141
Table 21. Proportion of Individual Skill Performed by Participants at Pre-test and Post-test ... 142
Table 22. Mean Scores of Self-Efficacy of Participants at Pre-test and Post-test ... 146
Table 23. Means of SDLRSNE between the Control and Experimental Groups at Pre-test and Post-test... 148
Table 24. Means of the Post-test Outcome Variables between the Control and Experimental Groups ... 151
Table 25. Correlation Coefficients amongst the Four Post-test Outcome Measures ... 152
Table 26. MANCOVA of the Post-test Outcome Variables between the Two Groups ... 154
Table 27. Comparisons the Post-test Outcome Variables between the Two Groups controlling the Covariates... 172
List of Figures
Figure 1. Nursing education in Taiwan with the Australian equivalence ... 11
Figure 2. Initial database search flowchart ... 24
Figure 3. Theoretical framework. ... 76
Figure 4. Study Design and Data Collection Procedure ... 82
Figure 5. Flow Chart of the Intervention ... 110
Figure 6. The Process of Integrating Problem-Based Learning into the Intervention ... 111
Figure 7. Flow Diagram of Participants’ Progress... 123
Figure 8. Knowledge Score before and after the Intervention with Estimated Marginal Means for Post-test ... 155
Figure 9. Skills Total Means before and after the Intervention with Estimated Marginal Means for Post-test ... 159
Figure 10. Self-efficacy Means before and after the Intervention with Estimated Marginal Means for Post-test ... 163
Figure 11. Plot of SDLRSNE total Means before and after the Intervention with Estimated Marginal Means for Post-test ... 166
