The Journal of Continuing Education in Nursing

Original Article 

Chinese Nurses' Preferences for and Attitudes About e-Learning in Continuing Education: A Correlational Study

Weijie Xing, PhD, RN; Linjun Ao, BN; Huiting Xiao, BN; Liang Liang, PhD

Abstract

Background:

This study aimed to examine nurses' preferences for and attitudes toward e-learning, identify factors that motivated or discouraged their e-learning participation, and also find the relationship between the nurse's attitude and their characteristics.

Method:

A total of 534 RNs from eight hospitals in Shanghai were recruited. Data were collected using a questionnaire that consisted of e-learning experiences, barriers, motivating factors, learning preferences, and attitudes toward e-learning.

Results:

Flexibility was the most important motivating factor and lack of time was the most common barrier to their participating in e-learning. Participants who had no e-learning experiences reported more barriers about lack of familiarity with e-learning and e-learning platforms. Nearly half of the participants exhibited positive attitudes toward e-learning. Regression analysis identified that nurses who were married, used computers frequently, and worked in rural hospitals were associated with more positive attitudes toward e-learning.

Conclusion:

Nurse educators and managers could provide more opportunities for nurses to increase their familiarity with online education technology and develop more high-quality online courses to meet nurses' learning needs. [J Contin Educ Nurs. 2020;51(2):87–96.]

Abstract

Background:

This study aimed to examine nurses' preferences for and attitudes toward e-learning, identify factors that motivated or discouraged their e-learning participation, and also find the relationship between the nurse's attitude and their characteristics.

Method:

A total of 534 RNs from eight hospitals in Shanghai were recruited. Data were collected using a questionnaire that consisted of e-learning experiences, barriers, motivating factors, learning preferences, and attitudes toward e-learning.

Results:

Flexibility was the most important motivating factor and lack of time was the most common barrier to their participating in e-learning. Participants who had no e-learning experiences reported more barriers about lack of familiarity with e-learning and e-learning platforms. Nearly half of the participants exhibited positive attitudes toward e-learning. Regression analysis identified that nurses who were married, used computers frequently, and worked in rural hospitals were associated with more positive attitudes toward e-learning.

Conclusion:

Nurse educators and managers could provide more opportunities for nurses to increase their familiarity with online education technology and develop more high-quality online courses to meet nurses' learning needs. [J Contin Educ Nurs. 2020;51(2):87–96.]

Health professionals in both developed and developing countries are required to undertake continuing education to sustain current qualifications and adapt to great changes in their work environments (Karaman, 2011). Continuing nursing education has been defined as “a life-long professional development process which takes place after the completion of the pre-registration nurse education program. It consists of planned learning experiences which are designed to augment the knowledge, skills and attitudes of registered nurses for the enhancement of nursing practice, patient/client care, education, administration and research” (Gallagher, 2007, p. 467). Continuing education can be divided into the degree/certificate courses and nondegree/certificate courses (with or without credits). Regardless of the forms, the final outcome of continuing education is the improved provision of the quality of nursing to the clients (Lachance, 2014). As degree/certificate courses were usually provided by university, this study focused the methods to improve nurses' participation in nondegree/certificate courses.

In many countries including China, continuing education has been considered as a mandatory requirement to enhance the quality of nursing care (Ni et al., 2014). However, traditional education methods, which involve face-to-face classes, could be inaccessible for nurses because of lack of time, energy, learning opportunities or support from organizations, and location factors (Chong, Sellick, Francis, & Abdullah, 2011). In addition, there are shortages of nursing education facilities in many lowand middle-income countries, and large, well-established nursing schools are expected to provide or share learning resources with newly created schools and frontline nurses (Frehywot et al., 2013). Consequently, innovative educational methods are required to provide opportunities to increase the accessibility and availability of nursing education.

The use of digital technology and social networking has increased rapidly and has been incorporated into teaching in higher education in last two decades (Button, Harrington, & Belan, 2014). Because of the application of this technology, e-learning, also referred to as online learning, has been introduced to nursing curricula in many countries. E-learning has been described as a dynamic, innovative, rich means of providing learning opportunities and is associated mainly with activities involving the simultaneous use of computers and interactive networks (Lahti, Hätönen, & Välimäki, 2014). In this study, e-learning was defined as online or local network-based learning. The learning content was successively delivered through the internet or intranet connections. It may or may not have interaction between teachers and students. Relative to traditional educational methods, e-learning has demonstrated advantages, including flexibility, accessibility, convenience, and cost-effectiveness, that provide nurses with additional opportunities to engage in continuing education (Kokol, Blazun, Micetić-Turk, & Abbott, 2006).

Many studies have reported that e-learning in continuing education produced positive outcomes in the aspects of learning achievement, desire, and satisfaction. A systematic review that included 2,491 nurses and nursing students showed that there were no significant differences between traditional learning and e-learning in the outcomes regarding knowledge, skills, or learning satisfaction (Lahti et al., 2014). Another review of 6,750 students in health professions showed that students who participated in e-learning exhibited equal knowledge and greater satisfaction relative to students who participated in traditional classroom learning (George et al., 2014). Therefore, e-learning displayed its potential benefits in learning and offers nurses a supplementary continuing education method.

However, successful delivery of e-learning programs requires preassessment of learners' attitudes and needs. The critical factors influencing learners' satisfaction in e-learning have been shown to include learners' characteristics, computer skills, perceived usefulness, e-learning course flexibility and quality, and attitudes toward e-learning (Sun, Tsai, Finger, Chen, & Yeh, 2008). Positive attitudes were found to improve learning efficacy, motivation, and learning outcomes (Karaman, 2011). Knowledge regarding learners' preferences could provide information for use in designing general e-learning courses (Paechter & Maier, 2010). Therefore, an understanding of learners' preferences and perceptions of e-learning could facilitate the design and development of a successful e-learning program.

In 2018, there were approximately four million RNs in China. Almost 70% of nurses held junior college degrees or above, and the remaining had a primary diploma (National Health Commission, 2019). To cope with the challenges in a rapidly changing health care context, nursing education plays a critical role in preparing nurse graduates to meet the health needs of China's growing population (Wang, Whitehead, & Bayes, 2016). Furthermore, Chinese nurses recognize the necessity, importance, and helpfulness of continuing education in enhancing their knowledge and skills (Ni et al., 2014). However, Chinese nurses face barriers to continuing education participation, including lack of time, shortage of opportunity, work commitments, worry of cost, insufficiency of the learning programs, and unequal distribution of resources among health care facilities (Ni et al., 2014; Xiao, 2010). Therefore, e-learning could be a more accessible and effective method of continuing education for nurses in China, as it may require less consideration of limitations involving the workforce, time restrictions, or financial support.

On the basis of a multicenter survey of RNs working in hospitals, the study aimed to ascertain Chinese nurses' attitudes toward e-learning in continuing education and explore associated factors, to identify their preferences for e-learning courses, and to explore the motivating factors for and barriers to participation in e-learning. The result of this study will assist nurse educators and managers to design and implement effective e-learning courses to fulfill nurses' continuing education requirements.

Method

Design

This study was a multicenter, cross-sectional, descriptive and correlational survey, conducted via an anonymous self-reported questionnaire. The survey was hosted by So-jump, a commercial, Web-based survey-delivery service.

Population

A total of 550 RNs were recruited from eight hospitals in Shanghai, China. Sample size was estimated according to an investigation of Malaysian nurses (Chong et al., 2016). Sampling was systematic and divided into two phases. In the first phase, a total of eight hospitals was selected conveniently, with one hospital from each of the eight main regions in Shanghai; in the second phase, staff identification numbers of nurses were inputted into Excel®, and the requested number of participants was randomly selected from each hospital by Excel RAND function.

Instrument

Participants completed a self-report questionnaire, which consisted of four parts. The first part of survey was developed by the authors and pertained to demographic characteristics of participants. The section was a 10-item questionnaire, consisting of sex, age, marital status, number of children, household income, work experience, educational level, hospital type, job position, and average weekly computer use (excluding work-related computer use, such as handling doctor's orders and taking nursing records). The second part, including 19 items, examined the experience of e-learning, as well as factors that motivated or impeded e-learning participation, using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). This section was designed based on the study by Chong et al. (2016) and modified according to local context. Two factors were supplemented—namely, less impact on work and lack of interest in the courses, and the words “Web board” were modified into “e-learning platform.” The results of this study showed good reliability of the second part, with a Cronbach's alpha of .89. The third part with six items was developed by the authors and pertained to e-learning preferences such as those for facilities, places, times, course content, course duration, and interaction style. This section was reviewed by five experts and tested by 24 nurses, and then the wording was modified to achieve good readability and content validity. The fourth part pertained to nurses' attitudes toward e-learning, which were measured using a 28-item scale that was designed by Chong et al. (2016) and included six subdomains, with four, seven, five, seven, two, and three items, respectively, pertaining to computer use, interaction with facilitators and other students, convenience and flexibility, a positive learning experience, access to knowledge, and improvement of nursing care. Participants' responses were provided using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Subscale scores were summed to provide a total score between 28 and 140, and a score of 100 or higher indicates a positive attitude toward e-learning. We obtained the original author's permission to use the questionnaire, and one of the researchers translated it into Chinese. Two other Chinese nursing researchers with experience of working overseas compared the translated Chinese version with the original scale and revised it until consensus was reached. Five experts in online teaching, nursing education, and questionnaire design reviewed the Chinese version of the scale, and the overall content validity index value was .96. The results of a pilot study including 24 nurses from eight hospitals indicated that the scale demonstrated satisfactory reliability, with a Cronbach's alpha of .93. Overall, 63 items were measured in the whole questionnaire, and it is estimated that participants could complete the survey within 10 to 15 minutes.

Data Collection Procedure

The protocol of the study was approved by the institutional review board in the university with which the authors were affiliated and each hospital authority. The principle researcher communicated with nurse directors at each hospital and explained the purpose of the study. Randomly selected nurses were invited in the survey and received verbal and written information about the purpose of the study. In addition, they were informed of their rights to withdraw participation at any time and advised that both the questionnaire and data were anonymous. An online survey platform was used to improve efficiency and quality. It is a secure data platform, and only authorized researchers with the password can assess the data. Questionnaires were entered into the survey platform. In addition, each response was screened by using exclusion criteria including missing items, completion time of less than 300 seconds, and logical contradiction. Then, a response link and corresponding verification code were created and provided to participants. Participants entered the verification code to complete the questionnaire via mobile telephone or computer. In order to reduce survey fatigue, different background colors were set in different parts of questionnaire, and a progress bar was displayed to show a visible percentage of survey completion.

Statistical Analysis

SPSS® version 22.0 was used to conduct data analysis. Descriptive statistics, including means, standard deviations, proportions, and frequencies were calculated for each study variable. Chi-square tests and logistic regressions were performed to identify associations between nurses' attitudes and their demographic characteristics.

Results

Demographic and Background Characteristics

A total of 534 nurses completed the questionnaire (response rate = 97.1%). Table 1 shows their demographic and background characteristics. The average age of the 534 nurses was 29.71 years (SD = 6.0), and 99.1% of them were women. More than half (56.4%, n = 301) of the participants were married. The percentages of nurses working in urban hospitals and rural hospitals were 57.5% and 42.5%, respectively. The average length of participants' work experience was 8.09 years (SD = 6.46). Approximately half (53.6%, n = 286) of the participants held a diploma in nursing (a 3-year prenursing registration program), and 82% (n = 438) were front line nurses. With regard to computer use, almost 40% of participants spent 2 to 5 hours per week using a computer.

Participants' Demographic Characteristics (N = 534)

Table 1:

Participants' Demographic Characteristics (N = 534)

E-Learning Experience and Factors That Motivated or Discouraged E-Learning Participation

Among the 534 nurses, 53% (n = 283) had participated in e-learning activities, of which 87.3% (n = 247) involved self-directed online learning and no communication with tutors or other students, and 12.7% (n = 36) involved interactive online learning. The most important motivating factor for e-learning participation was its flexibility with respect to time and location (mean score = 4.37), followed by the provision of the opportunity to broaden one's horizons via diversity and current knowledge (mean score = 4.32). With respect to the factors that discouraged e-learning participation, the most frequently mentioned barrier was lack of time (mean score = 4.43), followed by lack of interest in the courses (mean score = 3.90). Other motivating and discouraging factors are presented in Table 2. The ranking of barriers was similar between nurses who had e-learning experiences and those who had no such experience. However, nurses who had no e-learning experience reported higher level of barrier related to lack of familiarity with e-learning and e-learning platform (t = 1.969, p = .050).

Factors that Motivated or Discouraged e-Learning Participation (N = 534)

Table 2:

Factors that Motivated or Discouraged e-Learning Participation (N = 534)

E-Learning Preferences

With respect to e-learning preferences, 85.6% (n = 457) of participants preferred to use a mobile telephone or tablet, whereas only 31.5% (n = 168) preferred using a personal computer. Regarding locations for e-learning, 79% (n = 422) of participants preferred to engage in e-learning at home and 54.5% (n = 291) preferred the workplace. With respect to learning times, 69.1% (n = 369) of participants preferred learning on weekdays and 65.2% (n = 348) preferred learning in the evenings. Concerning course duration, 74.3% (n = 397) of participants expected to complete the course within 8 weeks. Regarding interaction style, 91.4% (n = 488) of participants preferred interaction with facilitators and other learners, whereas only 8.6% (n = 46) preferred self-learning and no interaction with others.

The most interesting topics in the e-learning course were as follows: nursing communication skills (mean score = 4.31), patient education (mean score = 4.27), specialty nursing (mean score = 4.19), nursing skills (mean score = 4.15), nursing informatics (mean score = 3.99), nursing education (mean score = 3.88), nursing management (mean score = 3.87), and nursing research and evidence-based nursing (mean score = 3.84).

Attitudes Toward E-Learning

Participants' mean attitude to e-learning scores ranged from 38 to 135 (M = 100.24, SD = 13.63). Among the 534 participants, 50.6% (n = 270) reported positive attitude scores (≥ 100) toward e-learning and 49.4% (264) reported less than positive scores, respectively. Scores for items pertaining to each of the subdomains of the scale by Chong et al. (2016), ranked from high to low, were as follows: access to knowledge (81.5), interaction with facilitators and other students (76.3), convenience and flexibility (75.4), improvement of nursing care (73.8), computer use (72.4), and a positive learning experience (71.4).

The results of the chi-squared tests showed that marital status, educational level, work experience, hospital type, position, and weekly computer use were significantly correlated with positive attitudes toward e-learning. However, sex, age, average monthly income, and experience with e-learning were not associated with nurses' attitudes toward e-learning. Table 3 presents the relationships between nurses' attitudes toward e-leaning and their characteristics.

Relationships Between Background Characteristics and Attitudes Toward e-Learning (N = 534)

Table 3:

Relationships Between Background Characteristics and Attitudes Toward e-Learning (N = 534)

Factors identified in univariate analysis was further examined by logistic regression analysis (Table 4). The result showed that married nurses reported more positive attitudes than unmarried nurses (odds ratio [OR], 1.795; 95% confidence interval [CI] [1.256, 2.564]). For hospital type, nurses who worked in rural facilities reported more positive attitudes compared with nurses who worked in urban hospitals (OR, 1.531; 95% CI [1.073, 2.184]). With regard to computer use, the more nurses used computer, the more positive attitudes they showed (OR, 1.411; 95% CI [1.189, 1.674]).

Predictors of Nurses' Positive Attitudes Toward e-Learning by Logistic Regressiona

Table 4:

Predictors of Nurses' Positive Attitudes Toward e-Learning by Logistic Regression

Discussion

The results of this correlational study revealed that nearly half of the nurses had the experience with e-learning as part of their continuing education. This proportion exceeded our expectations and is higher relative to those observed in other countries. For example, in studies conducted in the United Kingdom (McVeigh, 2009) and Malaysia (Chong et al., 2016), 43.5% and 17.7% of nurses, respectively, had participated in e-learning for their professional training. With the application of information technology, the free Web-based online learning program is introduced in the Chinese education system. The number of students enrolled in open online courses in China had exceeded 10 million at the end of 2016 (Ministry of Education of the People's Republic of China, 2016). Chinese learners, including nursing students, have changed their learning style from that of traditional face-to-face classroom-based learning to that involved in online courses. In addition, some leading hospitals have established online education platforms for staff training and patient education (Yang, Chen, Luan, & Liu, 2016; Yang, Zhang, Yang, & Guo, 2014). Therefore, Chinese nurses are familiar with this new learning approach and have experience with online learning.

The results also revealed that no matter whether nurses have e-learning experiences or not, the most important motivating factors for e-learning participation were flexibility in respect of time and location, the provision of the opportunity to broaden one's horizons via diversity and current knowledge, the fulfilment of work-related needs, cost-effectiveness, and the fulfillment of personal learning needs and interests. In a qualitative study conducted by Kataoka-Yahiro, Richardson, & Mobley (2011), one of the nurses stated, “with nurses doing mostly 12-hour shifts, you could not even get off work and take an evening class without rearranging your work” (p. 130). In other studies, the flexibility and diversity provided by the online learning environment were cited as important positive aspects of e-learning (Button et al., 2014), and accessibility, convenience, and cost minimization were identified as significant advantages of e-learning (Kimiloglu, Ozturan, & Kutlu, 2017).

Conversely, the main barriers that discouraged nurses from participating in e-learning in the current study were lack of time, lack of interest in the courses, and lack of knowledge regarding computers. These findings are consistent with those of previous studies (Chong et al., 2016; Kataoka-Yahiro et al., 2011; Kimiloglu et al., 2017). Lack of time was the main barrier reported by nurses, which could be directly associated with the serious shortage of nursing staff in China (Yun, Jie, & Anli, 2010). Lack of interest in the courses was the second most commonly reported barrier to e-learning participation. Although many sites and organizations offer health-related open courses for nurses, they are usually delivered in English, and there is a paucity of online resources to enhance nursing knowledge and skills delivered in the Chinese language (Swigart & Liang, 2016); therefore, additional online courses should be developed in Chinese to meet nurses' needs. We also found that nurses who had no e-learning experiences reported higher levels of barriers related to lack of familiarity with e-learning and e-learning platforms. Many studies have shown that computing facilities, computer skills, and information exerted significant effects on learners' success in e-learning engagement (Button et al., 2014; Moule, Ward, & Lockyer, 2010). Accordingly, organizational supports are required to improve nurses' activities of e-learning, including reducing nurses' daily workload to release more learning time, developing high-quality online courses to meet nurses' learning needs, and providing training to increase nurses' familiarity with online educational technology.

When asked about their preferred delivery platforms for e-learning, more than 85% of nurses preferred mobile telephones or tablets to personal computers. Internet access is required for e-learning; however, most nurses in developing countries lacked access to computers with Internet connections in workplaces (Chen, Yang, Tang, Huang, & Yu, 2008). Therefore, mobile devices provide nurses with highly accessible and convenient Internet connections, which allow them to learn whenever, wherever, and however they choose (Gikas & Grant, 2013). This indicated that nurse educators should develop e-learning courses for mobile devices rather than personal computers. With respect to the most preferred locations and times for e-learning, almost 80% of nurses preferred to learn at home on workday evenings. The reason for this finding could be that most of the nurses were women, and this would allow them to balance learning, work, and family commitments. When asked about the type of courses they preferred, most nurses selected short-term (<8 weeks), interactive (interaction with facilitators and other learners) courses, which indicated that online communication and discussion should be emphasized in e-learning course development. This indicated that it is important to prepare educators to be good e-learning instructors and to develop their skills to facilitate e-learning. With regard to interest in courses, nurses preferred practical course content, such as that involving nursing communication skills, patient education, specialty nursing, and nursing skills over methodological courses; one possible explanation for this finding is that most clinical nurses in China hold diplomas or continuing Bachelor of Science in Nursing degrees, and their main learning objective was to improve their clinical skills to fulfill work-related requirements.

The findings of the study showed that nearly half (50.6%) of the nurses exhibited positive attitudes toward e-learning. This is similar to the results of previous studies involving nurses (Chen et al., 2008; Chong et al., 2016; Karaman, 2011; Moule et al., 2010) and the global enthusiasm for continuing online learning (Allen & Seaman, 2016). Regarding the scores for items pertaining to each of the subdomains of the Chong et al. (2016) scale, nurses strongly agreed that online continuing nursing education provides access to knowledge (81.5), allows interaction with facilitators and other students (76.3), and is convenient and flexible (75.4). This finding is similar to those reported by Chong et al. (2016) and Karaman (2011) and reflects the advantages of online learning. In addition, accessibility, convenience, interaction and flexibility were evaluated as the most significant advantages of online learning in previous studies (Heidari & Galvin, 2002; Kokol et al., 2006). The findings of the current study indicated that e-learning in continuing education is compatible with nurses' needs, desires, and working conditions.

Regression analysis results demonstrated that nurses' positive attitudes toward e-learning were associated with their marital status, hospital types, and average weekly computer use. The proportion of married nurses with positive attitudes to e-learning was higher relative to that of unmarried nurses; this finding could have occurred because e-learning is flexible and exerts a low impact on family life. Furthermore, the results showed that attitudes differed significantly between nurses working in different locations. This finding could be explained by the limited access to traditional educational programs in rural areas (Hendrickx & Winters, 2017). Moreover, the results indicated that nurses' basic computer usage was positively correlated with the positivity of their attitudes toward e-learning. This finding agrees with those of previous studies (Chen et al., 2008; Chiu & Tsai, 2014; Chong et al., 2016; Karaman, 2011) and suggests that health care managers should endeavor to increase nurses' access to computers and implement targeted training programs to enhance nurses' familiarity with computer skills.

This is the first study to explore the preference and attitude of RNs toward e-learning in China. Findings of this study could assist nurse educators and managers to design and implement a successful e-learning program to fulfill nurses' continuing education requirements. However, despite these strengths, the study was subject to some limitations. First, although nearly half of clinical nurses surveyed 2would like to adopt e-learning as a continuing education approach, the other half of these nurses showed a less favorable attitude. Nurses thought the presentation of e-learning courses could be improved, making for a better learning experience and a more attractive means of learning. Second, the nurses were recruited from eight regions in Shanghai, the largest and most modernized city in China. Nurses' attitudes toward e-learning in continuing education could have been influenced by their work environments, economic status, and access to educational resources. Therefore, further studies should be conducted to ascertain attitudes toward e-learning in nurses from less developed areas such as towns, villages, rural areas, and smaller cities.

Conclusion

E-learning enhances the accessibility and flexibility of education and increases its potential for customization, which provides nurses with an alternative method of continuing education. The results of this correlational study showed that nearly a half of clinical nurses would like to participate in e-learning for future continuing education. However, there was also another half of nurses who showed a less favorable attitude, which may be related to unfamiliarity with computer use and unsatisfactory learning experience. Therefore, nurse educators and managers could provide more opportunities for nurses to increase their familiarity with online education technology and develop more high-quality online courses to meet nurses' learning needs.

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Participants' Demographic Characteristics (N = 534)

Variablen (%)
Sex
  Male5 (0.9)
  Female529 (99.1)
Age (years)
  ≤ 30342 (64)
  31 to 39162 (30.3)
  ≥ 4030 (5.6)
  Mean (SD)29.71 (6)
Marital status
  Married301 (56.4)
  Unmarried233 (43.6)
Educational level
  Diploma or advanced diploma286 (53.6)
  Continuing bachelor's program188 (35.2)
  Bachelor of Science and above60 (11.2)
Work experience (years)
  ≤ 5211 (39.5)
  6 to 9189 (35.4)
  ≥ 10134 (25.1)
  Mean (SD)8.09 (6.46)
Hospital type
  Urban307 (57.5)
  Rural227 (42.5)
Position
  Frontline nurse438 (82)
  Nurse educator53 (9.9)
  Nurse manager43 (8.1)
Average monthly income (RMB)
  ≤ 5,000134 (25.1)
  5,001 to 7,999240 (44.9)
  ≥ 8,000160 (30)
Average weekly computer use (hours)
  0 to 1111 (20.8)
  2 to 5210 (39.3)
  6 to 998 (18.4)
  > 10115 (21.5)

Factors that Motivated or Discouraged e-Learning Participation (N = 534)

VariableTotal, Mean (SD)Nurses With e-Learning Experience (n = 283)Nurses Without e-Learning Experience (n = 251)tp
Motivation factors
  1. Flexibility with respect to time and location4.37 (0.75)4.37 (0.75)4.37 (0.76)0.053.958
  2. The opportunity to broaden one's horizons via diversity and current knowledge4.32 (0.76)4.35 (0.73)4.30 (0.80)−0.772.440
  3. Fulfilment of work-related needs4.31 (0.76)4.34 (0.70)4.28 (0.83)−0.851.395
  4. Cost-effectiveness4.29 (0.79)4.28 (0.72)4.31 (0.79)0.403.687
  5. Fulfilment of personal learning needs and interests4.28 (0.76)4.35 (0.71)4.20 (0.82)−2.226.026
  6. Less impact on family life4.26 (0.84)4.29 (0.83)4.23 (0.86)−0.800.423
  7. Self-directed learning4.23 (0.72)4.28 (0.72)4.18 (0.74)−1.637.102
  8. Less impact on work4.20 (0.85)4.24 (0.83)4.15 (0.88)−1.252.211
  9. Achievement of lifelong learning4.10 (0.89)4.17 (0.83)4.02 (0.95)−1.883.060
Barriers
  1. Lack of time4.43 (0.71)4.46 (0.67)4.39 (0.76)−1.047.296
  2. Lack of interest in the courses3.90 (1.00)3.93 (1.00)3.88 (1.01)−0.519.604
  3. Lack of knowledge regarding computers/information and communication technology/network system3.57 (1.16)3.55 (1.17)3.59 (1.16)0.341.734
  4. Lack of support from supervisor3.50 (1.16)3.57 (1.14)3.42 (1.18)−1.492.136
  5. Lack of access to computer with an Internet connection3.36 (1.31)3.41 (1.30)3.30 (1.32)−0.971.332
  6. Lack of familiarity with e-learning and e-learning platform3.35 (1.19)3.25 (1.22)3.46 (1.16)1.969.050
  7. Lack of knowledge regarding searching for information on the Internet3.14 (1.25)3.09 (1.27)3.20 (1.22)1.065.287
  8. Lack of knowledge regarding uploading and downloading information3.07 (1.26)3.00 (1.27)3.15 (1.26)1.320.187
  9. Limited ability to send and receive e-mails or messages2.99 (1.26)2.98 (1.28)3.00 (1.24)0.125.901

Relationships Between Background Characteristics and Attitudes Toward e-Learning (N = 534)

VariablePositive Attitudea, n (%)Less Than Positive Attitudeb, n (%)χ2p
Sex
  Male1 (20)4 (80)1.89.170
  Female269 (50.9)260 (49.1)
Age (years)
  ≤ 30163 (47.7)179 (52.3)3.22.200
  31 to 3990 (55.6)72 (44.4)
  ≥ 4017 (56.7)13 (43.3)
Marital status
  Married170 (56.5)131 (43.5)9.66.002
  Unmarried100 (42.9)133 (57.1)
Educational level
  Diploma129 (45.1)157 (54.9)8.19.017
  Continuing bachelor's program110 (58.5)78 (41.5)
  Bachelor of Science and above31 (51.7)29 (48.3)
Work experience (years)
  ≤ 597 (46)114 (54)6.94.031
  6 to 992 (48.7)97 (51.3)
  ≥ 1080 (60.2)53 (39.8)
Hospital type
  Urban140 (45.6)167 (54.4)7.11.008
  Rural130 (57.3)97 (42.7)
Position
  Frontline nurse213 (48.6)225 (51.4)8.68.013
  Nurse educator26 (49.1)27 (50.9)
  Nurse manager31 (72.1)12 (27.9)
Average monthly income (RMB)
  ≤ 5,00063 (47)71 (53)1.64.441
  5,001 to 7,999120 (50)120 (50)
  ≥ 8,00087 (66.9)73 (56.1)
Average weekly computer use (hours)
  0 to 138 (34.2)73 (65.8)23.90<.001
  2 to 5103 (49)107 (51)
  6 to 966 (67.3)32 (32.7)
  > 1063 (54.8)52 (45.2)
E-learning experience
  Yes153 (54.1)130 (45.9)2.95.086
  No117 (46.6)134 (53.4)

Predictors of Nurses' Positive Attitudes Toward e-Learning by Logistic Regressiona

VariableβSEβ 'Wald χ2pOR [95% CI]
Marital status (unmarried versus married)0.5850.1820.29010.317.0011.795 [1.256, 2.564]
Hospital type (urban versus rural)0.4260.1810.2115.528.0191.531 [1.073, 2.184]
Average weekly computer use, hours (0 to 1, 2 to 5, 6 to 9, >10)0.3440.0870.35915.535<.0011.411 [1.189, 1.674]
Authors

Dr. Xing is Assistant Professor, Ms. Ao is Undergraduate Student, Ms. Xiao is Undergraduate Student, School of Nursing, and Dr. Liang is Radiologist, Attending Physician, and Master of Medicine, Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China. Dr. Liang is also Lecturer, School of Clinical Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.

This work was supported by the Fudan Nursing Foundation (grant no. FNF201520). The authors thank Dr. Mei Chan Chong for sharing the instrument used in the study, as well as all the nurses in eight hospitals who participated in the survey.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Liang Liang, PhD, Radiologist, Attending Physician, Master of Medicine, Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Road, Xuhui District, Shanghai, 200032, China; e-mail: liang.liang@zs-hospital.sh.cn.

Received: December 25, 2018
Accepted: September 04, 2019

10.3928/00220124-20200115-08

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