Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

Prof. Somashekhar Nimbalkar

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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
On Sep 2018

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
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Calcutta National Medical College & Hospital , Kolkata

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Best regards,
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : LC29 - LC33 Full Version

A Multisite Survey of E-learning Readiness and Academic Performance among Nursing Students in Saudi Arabia

Published: October 1, 2022 | DOI:
Adnan Innab, Naji Alqahtani, Ghareeb Bahari, Alkadi Alshammari, Ali Kerari, Mohammad K Alharbi

1. Assistant Professor, Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia. 2. Assistant Professor, Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia. 3. Assistant Professor, Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia. 4. Assistant Professor, Department of Community, Psychiatric, and Mental Health Nursing, College of Nursing, King Saud University, Riyadh, Saudi Arabia. 5. Assistant Professor, Department of Medical Surgical Nursing, College of Nursing, King Saud University, Riyadh, Saudi Arabia. 6. Assistant Professor, Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia.

Correspondence Address :
Adnan Innab,
Assistant Professor, Department of Nursing Administration and Education Department at College of Nursing, King Saud University, Riyadh, Saudi Arabia.


Introduction: Determining students’ readiness for e-learning is critical to implementing more effective education and performance. Nursing education in Saudi Arabia continues to struggle with a shortage of technical tools to enable teaching and acquiring critical nursing skills.

Aim: To assess the level of e-learning readiness and academic performance and their association in nursing students and to determine the factors associated with e-learning readiness and academic performance.

Materials and Methods: A cross-sectional, multisite study was conducted on a convenience sample of nursing students (N=139) attending nursing programs from multiple public and private universities in Saudi Arabia. A structured questionnaire was used for data collection from May 2020 to August 2020. Multivariate analyses were run using Statistical Package for Social Sciences (SPSS).

Results: The mean age of the study participants was 27.3±6.34 years. The total average of e-learning readiness was 4.16 (SD=0.54). Bivariate analyses showed that age was associated with both e-learning readiness (r=0.175, p=0.03) and academic performance (r=0.341, p<0.001). Employment status, level of education, and previous experience with e-learning displayed significant association with e-learning readiness (p<0.05). In multivariate analyses, only previous experience with e-learning had positive influence on students e-learning readiness (β=0.188, p<0.05). Technology access subscale (β=0.206, p<0.05) and level of education (β=0.323, p<0.05) had both positive impacts on students’ academic performance.

Conclusion: The e-learning readiness score was high among the nursing students, especially if they were employed or had previous experience with it. Access to technology improved students’ academic performance. The current e-learning mechanism may need some developments in order to meet students’ different needs.


Education, Experience, Technology, Virtual learning

Electronic learning (e-learning) has become an effective educational delivery method over the past two decades. This strategy is a useful tool for enhancing teaching and learning quality, thus improving academic performance (1). The benefits of e-learning include increased accessibility of information, interactive learning, innovative teaching, self directed learning, enhanced data searches via hyperlinks, availability of help when needed, promotion of internet use, and building responsibility and self confidence (2),(3). It is also cost effective for organisations that adopt e-learning by reducing operation costs (4). Although e-learning has become increasingly common in nursing education, the extent of its use varies across programs and countries (3),(5). In Saudi Arabia, for example, the government has promoted the use of technology in many aspects, including education, as one of the main objectives for the National Transformational Program, ‘Vision 2030’ (6). The use of e-learning among Saudi students might help enhance their academic performance.

A number of researchers surveyed students to assess their perceptions toward e-learning in nursing education. Ramos- Morcillo AJ et al., conducted a study on nursing students from two public Spanish universities and discovered that they were hesitant to use e-learning (7). Another study in Philippines found that nursing students lacked computer literacy and had negative attitudes about e-learning (8). Since the shift to e-learning may complicate students’ learning, assessing students’ readiness to use e-learning would contribute to a rich education in academic contexts (1). Further, it may be simple to deliver remote nursing information, but teaching necessary nursing skills online might be more complex.

Previous researchers have also looked into the impact of face-to-face and blended learning on nursing students’ academic achievement (9),(10). In a quasi-experimental study, the researchers assessed the influence of blended learning (hybrid e-learning with face-to-face) on the academic performance of nursing students (10). There was a substantial difference between the experimental and control groups, implying that e-learning improves students’ academic performance. However, because their sample was limited to individuals enrolled in a one-semester course, the generalisability of their findings may be limited. In another study, the researchers surveyed nursing students and concluded that nursing students believed that practical skills were best learned in practical settings (11).

Implementing e-learning may be difficult since it can be influenced by students’ readiness to use it, e-content accessibility, previous e-learning experience, and learners’ learning styles (12),(13). Learners’ attitudes toward e-learning can influence their willingness to use it (1). Students also need to be mentally and physically prepared to participate in online classes and achieve better performance. Determining students’ readiness for e-learning is critical to implementing more effective education and performance. Research on such area in Saudi Arabia is lacking, which could lead to ineffective use of e-learning in nursing education. Thus, this study was conducted to determine factors associated with students’ academic performance.

Material and Methods

A cross-sectional, multisite study was conducted on undergraduate and graduate nursing students attending different nursing programs in Saudi Arabia. The data were collected between May and August 2020. In Saudi Arabia, there are two types of education supervised by the Ministry of Education: public and private. The government subsidizes public education and students are entitled to free access to a variety of electronic applications used in education. In private education programs, however, most services, including technological programs, require students to pay annual or quarterly fees (14),(15). The study protocol was approved by a Public University’s Ethics Committee (#KSU-HE-20-187) and was conducted in accordance with the Declaration of Helsinki. The permission to use the instrument was obtained from the copyright holder. Informed consent was obtained from all the participants.

Inclusion and Exclusion criteria: The study was conducted on a convenience sample of nursing students from different nursing colleges undertaking their undergraduate and graduate educations. Nursing interns who have already graduated from the nursing program and no longer use e-learning for academic purposes were excluded. Administrators and faculty members were also excluded from the study because the final findings were primarily designed to benefit nursing students’ learning and education.

Sample size calculation: The G*Power (Heinrich-Heine-Universität, Du¨sseldorf, Germany) tool was used to run a power analysis and estimate the required sample size. Under a significance level of 0.05, a power value of 0.80, an effect size of 0.15, and eight predictors, a minimum sample of 108 participants was needed to run statistical analyses (16).

Study Procedure

Data collection: The survey was a self-administered online questionnaire powered by an online secure platform. The web based survey was sent openly through social media websites (e.g., Twitter, Facebook, WhatsApp, and university emails). The survey link was also emailed to nurse instructors to share with students. To ensure that the surveys were filled by eligible participants, the invitation link displayed the inclusion criteria. Responses from participants who did not meet the inclusion criteria were excluded.

Measurement: The sample characteristics form contained five variables (age, gender, employment status, level of education, and previous experience with e-learning). Students’ academic performance was measured using their self-reported current Grade Point Average (GPA). E-learning readiness was measured using the Arabic version of students’ readiness for e-learning (16),(17). The original e-learning readiness was provided in English. However, it was translated into the Arabic Language as the participants of this study were Arabic speakers (16). The translation was done using the forward and backward translation process. Two bilingual translators translated the instrument independently and then it was sent to nursing faculty members to assure the accuracy and validation of the instrument. The readability of the instrument was done through sending the surveys to 10 nursing students. After the translation, the Cronbach’s alpha of the Arabic version of e-learning readiness scale ranged from 0.62 to 0.83 (16).

Readiness for e-learning scale: The scale was a self-assessment tool that measures students’ readiness for e-learning. This instrument was originally developed by Watkins et al. and consisted of 27 items and six subscales (technology access, online skills and relationships, motivation, online audio/video, internet discussion, and importance to your success) (17). Participants indicated their degree of agreement using a 5-point Likert scale response rated from 1 (strongly disagree) to 5 (strongly agree); the total scores ranged from 27 to 135, with higher scores indicating a higher level of readiness. Cronbach’s alpha for the subscales ranged from 0.7 to 0.9 (17). This self-assessment tool is reliable and valid and has been tested in different cultural groups (17),(18).

Statistical Analysis

Collected data were analysed using SPSS (version 26) (IBM Corp., Armonk, NY, USA). Descriptive statistics and double-checking of the files were used to fix any issues associated with data entry imported from the online secure platform. Mean imputations were utilized to handle missing data, which provided less than 3% missing data. Frequencies and percentages were calculated to demonstrate sample characteristics. The study variables were described using central tendency and dispersion measures for each subscale. Pearson’s product correlations were run to assess bivariate associations between continuous variables; age, e-learning readiness, and academic performance. Independent sample t-tests were conducted to explore the mean differences in e-learning readiness and academic performance by the sample characteristic. Finally, two multiple linear regression models were built to determine factors associated with e-learning readiness from the sample characteristics and the influence of e-learning readiness subscales on academic performance while controlling for the sample characteristics. Level of significance was set at p<0.05.


A total of 139 surveys were completed. The age of participants ranged from 18 to 42 years, with an average of 27.3 years (SD=6.34). The majority of the sample (N=88, 63.3%) were male, employed (N = 70, 50.36%), and enrolled in undergraduate nursing programs (N=78, 56.1%). The academic performance of sampled students was high, with an average of 4.1 (SD=0.60). The majority of the participants (N=101, 72.7%) had previous experience with e-learning (Table/Fig 1).

The total average of e-learning readiness was 4.16 (SD=0.54). The average score for all subscales was high; nevertheless, the average score for ‘importance to your success’ was highest (M=4.42, SD=0.58). The lowest average score was for the motivation subscale (M=3.47, SD=1.08). More details on each subscale are shown (Table/Fig 2).

(Table/Fig 3) Displays the correlation matrix. There was a positive, significant relationship between students’ age and e-learning readiness (r=0.175, p=0.03). Age was also positively, moderately correlated with academic performance (r=0.341, p<0.001). Regarding e-learning readiness subscales and their association with academic performance, only technology access subscale was moderately correlated with academic performance (r=0.257, p<0.01). Other associations are presented in the correlation matrix.

In addition, (Table/Fig 4) shows mean differences in e-learning readiness and academic performance by the sample characteristics. Among the sample characteristics, employment status (p=0.013), level of education (p=0.03), and previous experience with e-learning (p=0.03) displayed significant differences in e-learning readiness mean. Employment status (p<0.001) and level of education (p<0.001) had significant differences on students’ academic performance.

In regression analyses (Table/Fig 5), only previous experience with e-learning explained 9% of variance in e-learning readiness (p<0.05) in the multiple linear regression analysis. Among the variables entered in the model, only previous experience with e-learning had positively influence on students e-learning readiness (βb=0.188, p<0.05). In addition, the multiple linear regression analysis model explained 29.5% of the variance in academic performance (p<0.001). Among the six e-learning subscales, only technology access and online audio/video subscales were significantly influencing academic performance. Technology access subscale had a positive impact on students’ academic performance (βb=0.206, p<0.05). However, online audio/video negatively influenced their academic performance (βb=-0.257, p<0.05). From the sample characteristics, only level of education was associated with academic performance (βb=0.323, p<0.05).


An initial objective of the current study was to assess the level of readiness of nursing students from different levels in terms of e-learning readiness in academic settings. Overall, the study indicated that nursing students perceived e-learning to be an essential and motivational source for education and learning. Readiness for e-learning was reported to be an effective tool for students’ success. However, inconsistent findings were reported in different countries, where it was found that nursing students did not prefer or lack the technological and equipment for e-learning (19),(20),(21). Yet, the study findings were consistent with a previous study in Saudi Arabia. It was reported that Saudi female nursing students in a suburban university were ready for e-learning. Similar to the findings of this study, Ali WGM found that motivation for e-learning had the lowest average score among the variables (18). However, the author reported the highest average score for technology, which contrasts with the findings of this study, where importance for success had the highest average score. This difference between this study and study done by Ali WGM might be due to differences in the sample. For instance, the sample of this study included graduate students who were employed and might have perceived technology as one of the aspects required to be successful in the workplace.

In bivariate analyses, age was found in a significant association with both e-learning readiness and academic performance. In particular, older individuals were more ready to use technology and had higher academic performance than their younger colleagues. This is supported by Vaportzis E et al., findings of a qualitative study that reported older people to be eager to adopt new technology and were ready to use it (21). However, other researchers found that younger people tend to use technology more than older, which can improve their skills, readiness, and approval of other e-learning technologies (22). With regards to academic performance, though a significant relationship was reported between age and academic performance, this finding contradicts Imlach A-R et al., who demonstrated a completely different finding, highlighting the need for further conclusive research on this area (20).

The present study also showed that students who were employed, attending graduate level classes, or had previous experience with e-learning, had higher e-learning readiness scores than their counterparts. Employed students or graduate level students had also higher academic performance compared to non-employed or undergraduate students, respectively. For employed individuals, e-learning was more flexible and suitable with respect to time and location because it helps balance work, studying, and family tasks (23). Previous experience with e-learning did not influence their academic performance despite that previous researchers reported that having previous experience with online platforms is crucial for positive learning outcomes (24).

In regression analysis, the relationships between sample characteristics and perceived e-learning readiness were examined. The results confirmed the bivariate association between previous experience with e-learning and e-learning readiness. Participants who had previous e-learning experience were more willing to use e-learning compared to their counterparts. They were also more committed to the e-learning strategy. A similar finding was reported in an Austrian study that measured the level of computer skills and the number of students having difficulty with, or opposed to, e-learning (22). Unlike the present study, which targets nursing students with different academic levels, Link TM and Marz R included only first year medical students, which may limit the generalisability of their findings (22). Future studies designed to familiarise both educators and students with the effectiveness of new developed educational tools are needed.

Technology access and online audio/video subscales were significantly influencing students’ academic performance. The relationships were seen approximately moderate, which may be related to rapid shifting to online education. Access to technology was positively associated with students’ academic performance. Prior studies in other countries indicated that technology accessibility such as computers and internet connection enhanced academic performance (23),(25). It is worth noting that the literature lacks studies that look at the impact of nursing students’ access to technology on their academic performance and achievement, indicating that further research is needed in this field. However, the use of online audio/ video in e-learning influenced students’ academic performance negatively. Since e-learning implementation was sudden for nursing students in Saudi Arabia due to Coronavirus Disease-2019 (COVID-19), this could be related to the mere exposure effect. Therefore, educators should apply an internally hosted virtual classroom for courses in order to help students become familiar with technology and provide high-quality audio/video that can be linked to the content of classes. Based on that, more studies are needed to examine the impacts of using online audio/videos on nursing students’ academic performance. In addition, level of education had also a positive impact on academic performance in bivariate and multivariate analyses. Graduate students had higher academic performance compared to undergraduate nursing students. This could be related to the difference in emotional intelligence, self control, and resilience in older students, in upper level of education, compared to undergraduate students (26).


This study had some limitations. First, there may be a risk of sampling bias due the convenience sampling method, which might have made the results specific to the sample on which the study was conducted. In addition, this study targeted public and private colleges, but without further specifications. Finally, due to a lack of data that adequately reflects the various academic contexts, the researchers of this study did not examine the amount of disparities between study locations. In order to achieve more thorough data, future researchers should measure the similarities and differences between different programs. Despite these limitations, the current study contributed to enriching knowledge about the factors associated with e-learning readiness among nursing students.


In nursing, as in other specialties, online education makes courses available on digital platforms. This study showed that the total average of e-learning readiness was high. Many nursing students preferred e-learning, especially if they were employed or had previous experience with it. Being a graduate nursing student, employed and having previous experience with e-learning was significantly associated with e-learning readiness. Therefore, the current e-learning mechanism may need some developments in order to meet students’ different needs. Intervention studies on the students, faculty, or institution levels to promote the overall experience of e-learning are recommended. Future studies can help measure the effectiveness of online education over time.


Thapa P, Bhandari SL, Pathak S. Nursing students’ attitude on the practice of e-learning: A cross-sectional survey amid COVID-19 in Nepal. PloS One. 2021;16(6):01-17:e0253651. [crossref] [PubMed]
Mukhtar K, Javed K, Arooj M, Sethi A. Advantages, limitations and recommendations for online learning during COVID-19 pandemic era. Pak J Med Sci. 2020;36:S27-31. [crossref] [PubMed]
Voutilainen A, Saaranen T, Sormunen M. Conventional vs. e-learning in nursing education: A systematic review and meta-analysis. Nurse Educ Today [Internet]. 2017;50:97-103 [cited 2020 Apr 9]. Available from: https://linkinghub.elsevier. com/retrieve/pii/S0260691716303227. [crossref] [PubMed]
Yusuf N, Al-Banawi N. The impact of changing technology: The case of e-Learning. Contemp Issues Educ Res [Internet]. Clute Institute; 2013;6(2):173- 80. Available from: [cited 2021 Sep 6]. [crossref]
Yangoz ST. The use of e-learning program in nursing education. New Trends Issues Proc Humanit Soc Sci [Internet]. 2017;4(2):230-36. Available from: https:// [cited 2020 Apr 9]. [crossref]
AL-Dossary RN. The Saudi Arabian 2030 vision and the nursing profession: The way forward. Int Nurs Rev [Internet]. 2018;65(4):484-90 [cited 2021 Jul 31]. Available from: [crossref] [PubMed]
Ramos-Morcillo AJ, Fernandez-Salazar S, Ruzafa-Martinez M, Del-Pino-Casado R. Effectiveness of a brief, basic evidence-based practice course for clinical nurses. Worldviews Evid Based Nurs [Internet]. 2015;12(4):199-207. Available from: direct=true&db=rzh&AN=109826403&site=ehost-live [cited 2018 Feb 18]. [crossref] [PubMed]
Oducado RM, Estoque H. Online learning in nursing education during the COVID-19 pandemic: Stress, satisfaction, and academic performance. J Nurs Pract [Internet]. Kediri: Institut Ilmu Kesehatan STRADA Indonesia; 2021;4(2):143-53. Available from: [cited 2022 Jan 9]. [crossref]
El Refae GGA, Kaba A, Eletter S. The impact of demographic characteristics on academic performance: Face-to-face learning versus distance learning implemented to prevent the spread of COVID-19. Int Rev Res Open Distrib Learn [Internet]. 2021;22(1):91-110. Available from: irrodl/article/view/5031. [cited 2021 Oct 8]. [crossref]
Elfaki NK. Impact of e-learning vs traditional learning on student’s performance and attitude. Int J Med Res Health Sci. 2019;24(3):225-33.
Abbasi MS, Ahmed N, Sajjad B, Alshahrani A, Saeed S, Sarfaraz S, et al. E-Learning perception and satisfaction among health sciences students amid the COVID-19 pandemic. Work Read Mass. 2020;67(3):549-56. [crossref] [PubMed]
Engin M. Analysis of students’ online learning readiness based on their emotional intelligence level. Univers J Educ Res. 2017;5(12A):32-40. [PubMed]
Swaminathan N, Ravichandran L, Ramachandran S, Milanese S, Singaravelu R, Govindaraj P. Entry level nursing graduate students’ perception and readiness toward online component of blended learning: A mixed method study. J Educ Health Promot [Internet]. 2021;10(1):01-07 [cited 2021 Sep 6]. Available from:
Almalki M, FitzGerald G, Clark M. The nursing profession in Saudi Arabia: An overview. Int Nurs Rev. 2011;58:304-11. [crossref] [PubMed]
Aljohani KAS. Nursing education in Saudi Arabia: History and development. Cureus. 2020;12:e7874. [crossref]
Alqahtani N, Innab A, Bahari G. Virtual education during COVID-19: Exploring factors associated with e-learning satisfaction among saudi nursing students. Nurse Educ [Internet]. 2021;46(2): [cited 2022 Jul 29]. Available from: https:// Education_During_COVID_19__Exploring.27.aspx. [crossref] [PubMed]
Watkins R, Leigh D, Triner D. Assessing readiness for e-learning. Perform Improv Q [Internet]. 2004;17(4):66-79 [cited 2021 Sep 6]. Available from: http:// [crossref]
Ali WGM. Nursing students’ readiness for e-Learning experience. Gynecol Obstet [Internet]. 2016;(6):01-06 [cited 2020 Apr 9]. Available from: https:// 2161-0932-1000388.php?aid=75853.
Zalat MM, Hamed MS, Bolbol SA. The experiences, challenges, and acceptance of e-learning as a tool for teaching during the COVID-19 pandemic among university medical staff. PLOS ONE. Public Library of Science. 2021;16:01- 12:e0248758. [crossref] [PubMed]
Imlach AR, Ward DD, Stuart KE, Summers MJ, Valenzuela MJ, King AE, et al. Age is no barrier: Predictors of academic success in older learners. NPJ Sci Learn [Internet]. 2017;13(2):01-07. Available from: articles/s41539-017-0014-5. [cited 2021 Oct 8].
Vaportzis E, Giatsi Clausen M, Gow AJ. Older adults perceptions of technology and barriers to interacting with tablet computers: A focus group study. Front Psychol [Internet]. 2017;8:01-11. Available from: article/10.3389/fpsyg.2017.01687. [cited 2021 Oct 8]. [crossref] [PubMed]
Link TM, Marz R. Computer literacy and attitudes towards e-learning among first year medical students. BMC Med Educ [Internet]. 2006;34(6):01-08. [cited 2021 Sep 6]. Available from: [crossref] [PubMed]
Kharel P. Access to technology and student academic achievement: Empirical evidence from Nepal [Internet] [Capstone Project]. [Amherst, MA]: University of Massachusetts Amherst; 2018. Available from: cgi/viewcontent.cgi?article=1049&context=cppa_capstones [cited 2021 Oct 8].
Vogt MA, Schaffner BH. Evaluating interactive technology for an evolving case study on learning and satisfaction of graduate nursing students. Nurse Educ Pract. 2016;19:79-83. [crossref] [PubMed]
Fairlie RW. Academic achievement, technology and race: Experimental evidence. Econ Educ Rev. 2012;31(5):663-79. [crossref]
Mthimunye K, Daniels FM. Predictors of academic performance, success and retention amongst undergraduate nursing students: A systematic review. South Afr J High Educ. Higher Education South Africa (HESA); 2019;33(1):200-20. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/58107.17050

Date of Submission: May 30, 2022
Date of Peer Review: Jul 19, 2022
Date of Acceptance: Aug 17, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jun 17, 2022
• Manual Googling: Aug 09, 2022
• iThenticate Software: Aug 13, 2022 (22%)

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