High satisfaction with interactive e-books among Egyptian nursing students, study finds

Nursing students in Egypt report high satisfaction and strong academic self-efficacy when learning with interactive e-books, but their experience is linked to academic performance, prior training and reliable access to technology, according to a mixed-methods study published in BMC Nursing. The research surveyed 500 undergraduate nursing students at Capital University, Egypt, combining quantitative measures of satisfaction and self-efficacy with thematic analysis of students' reported challenges. The quantitative strand used validated instruments to measure satisfaction with interactive e-books and academic self-efficacy.

Descriptive results showed that 72.2 percent of students reported high levels of satisfaction, while 63 percent reported high self-efficacy. Correlation analysis revealed a strong positive association between the two measures, suggesting that students who felt more confident in their academic abilities also tended to rate their digital learning experience more favorably. The authors note that this is an association, not proof that one variable causes the other.

To identify what predicts these outcomes, the team ran multiple linear regression models for satisfaction and self-efficacy separately. Academic performance, measured by grade point average, emerged as a significant predictor of both: β = 0.185 for satisfaction and β = 0.198 for self-efficacy, both with p < 0.001. Prior training was also significant, with β = 0.142 for satisfaction (p = 0.014) and β = 0.155 for self-efficacy (p = 0.005).

Age and academic level were additionally significant predictors across both models, indicating that where students sit in their program and how old they are shape how they experience e-book-based learning. Gender, by contrast, was not a statistically significant predictor in either model, with p values above 0.05. The regression models explained a moderate proportion of the variance in both outcomes, which the researchers interpret as evidence that satisfaction and self-efficacy in technology-enhanced learning are multifactorial.

Digital tools alone, in other words, do not determine how students respond; academic preparedness, training history and personal circumstances all play measurable roles. The qualitative strand added texture to these numbers. Using semi-structured questionnaires analyzed thematically, the researchers identified recurring barriers to effective e-book use: technical limitations, difficulties navigating digital content, limited access to devices and internet connectivity, cognitive overload, and insufficient digital literacy.

The findings arrive amid accelerating digital transformation in nursing education. Interactive e-books are described in the study as innovative resources that promote engagement, flexibility and active learning. Yet the authors note that evidence regarding their effectiveness in enhancing nursing students' satisfaction and academic self-efficacy, and the challenges affecting their use, remains limited, which they cite as the motivation for assessing both outcomes alongside the challenges students face in real academic settings.

The study's design carries important caveats. It was conducted at a single institution in Egypt, so the results may not generalize to nursing programs in other countries or educational systems. The cross-sectional, correlational approach cannot establish causal direction: it remains possible that higher-performing students gravitate toward and enjoy digital tools, rather than the tools themselves boosting performance or confidence.

Self-reported satisfaction and self-efficacy also depend on students' own assessments rather than objective measures of learning gains. Even so, the practical implications are concrete. The authors conclude that interactive e-books can enhance nursing students' satisfaction and self-efficacy, but that their effectiveness depends on students' academic preparedness, technological accessibility and system design.

Addressing the identified barriers and strengthening digital readiness are described as essential for optimizing the integration of interactive e-books in nursing education. As nursing schools continue to adopt digital platforms, this study suggests the transition will depend on preparation and access as much as on the technology itself. The researchers call for addressing these challenges directly so that the benefits of interactive e-books reach all students, not only those already digitally fluent.

Subject of Research: Nursing students' satisfaction, academic self-efficacy and challenges in using interactive e-books in digital nursing education

Article Title: Digital transformation in nursing education: students’ satisfaction, academic self-efficacy, and challenges with interactive e-books

Article References: Mekdad, A. K., Kotp, M. H., Elauoty, R. M., Basyouny, H. A. A., Ismail, H. A., Hafez, A. A., Hamed, A. E. M., Aly, M. A., & shaaban Attia, A. (2026). Digital transformation in nursing education: students’ satisfaction, academic self-efficacy, and challenges with interactive e-books. BMC Nursing. https://doi.org/10.1186/s12912-026-05357-6

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05357-6

Keywords: nursing education, interactive e-books, digital transformation, academic self-efficacy, student satisfaction, mixed methods, Egypt, digital literacy, regression analysis, undergraduate nursing students, Digital, transformation