Effect of Multimedia E-Book Use on the Information Literacy of Nursing Students and Health Communication in Student-Led Large- and Small-Group Community Health Education Sessions
Round 1
Reviewer 1 Report
Congratulations to the authors on presenting an interesting research article. The background, methodology and results presentation enable the reader to understand the purpose of the research project, the data collected and analysed, robustness of the deductions and suitably thorough discussion.
The main question addressed by the research can be deduced from lines 113 - 115 "We posited that the real-time interactions, convenience, flexibility, multimodal inter faces, and automated information processing provided by interactive digital media and other recent technological advancements can extend the range and flexibility of intervention options in preventive medicine." From this sentence my deduction indicates the research question is: Can e-books, with their many interactive functions, assist nurses in engaging patients to improve the purpose of preventive care strategies?
The topic is relelvant as this is a new context for nurse/patient interface and an investigation into application of this technology not currently evident within this context. As such, unless I have missed it, this research addresses a gap in existing research on the benefits of the application of e-books for improvements in peventive approaches to medical care.
This article adds an insight into broader understanding of positive and practical approaches to adopting the specific IT in a particular context. The evidence-based approach provides reassurance that there is substance to the benefits that can be achieved in applying this technology in this context.
The researchers have undertaken a rigorous approach to data collection and analysis. Whilst there is no clear control group for comparison, in my opinion, the content from lines 420 to 428 sufficiently explains context for exploring the technology, defining the scope for the investigation and assessing the benefits as a result of change in the workplace.
Conclusions are unambiguous, articulate and address the intended question.
Broad range of references from different global sources that include, as far as can be determined, current knowledge in the field to support assertions, develop arguments and align theory and practice through the review and discussion.
The following very minor issues were identified for correction:
Figure 2 - contrast of some of the diagram makes reading difficult; suggest that a revised version checked for accessibility for those with visual impairments is undertaken.
At lines 332 and 462 the [ ] for citations 30 and 41 respectively are missing.
Author Response
Thank you for Reviewer affirmation and suggestions. This study aims to explore whether interactive e-book features improve nurse-patient interaction for better preventive healthcare. We have revised the unclear parts of Fig. 2. Experimental process and the citation brackets for [30] and [41].
Reviewer 2 Report
This is a highly original and interesting piece of research on an effective and easy to implement intervention to improve health literacy. It is well sourced and the research questions, analyses, and results are presented in a clear manner. There is a modest amount of proofreading to be done in terms of extra or missing words and small errors such subject/verb disagreement (The Abstract is in particular need of attention in this regard). However, I do think the manuscript is generally ready to move forward.
Author Response
Thank you for your affirmation and suggestions. I reviewed and revised the research content and abstract accordingly.
Reviewer 3 Report
Dear authors,
Please find my comments in the attached files.
Comments for author File: 
Comments.pdf
Author Response
Thank you for the reviewer's suggestions. Upon reviewing the article, we realized that the English was not used correctly. I revised the article by changing "phases" to "groups" to improve clarity and made adjustments to the figures for better readability.
Reviewer 4 Report
Overall: The subject and focus of the study is very interesting and deserves a broader audience with respect to how technology can be used in the medical educational field. The paper needs major revisions, especially with respect to English grammar and clarification of ideas in the abstract, additional information in the introduction, and more information and clarification in the materials and methods section.
Abstract: There are multiple sentences in the abstract that need editing for grammar.
For example, line 13-14 should read: “This study analyzed a group of nursing students who applied multimedia health education e-books [or e-books on health education] to different groups of varying sizes to explore the efficacy of implementing (digital) communication and literacy in the nursing industry.
Another example is line 18-19 where the term “steps” is confusing. Was the sample group divided into groups or was the entire group subject to three separate steps of a program? This could be improved to read: “Thirty-two junior nursing students at the college level were divided into three groups, each subject to a 3-week internship.”
Significance and data should be described in numerical terms with actual p values if appropriate.
The Abstract mentions “values greater than 4” but does not say to what “4” refers with regards to measurements or comparison values.
Introduction:
Line 39-41 – These sentences should be combined
With regards to large and small groups, it would be beneficial to cite other sources or other studies that have looked at the efficacy of knowledge transfer based on group size. This would help support and justify the group sizes of the study. Additional information on other studies completed on education, especially education in the medical field, should also be included.
The introduction also mentions group sizes, but it is unclear as to whether these groups sizes should apply to the subject group sizes of the participants (nursing students) or the people they are teaching. It is also unclear if the focus is on teaching the nursing students or on whether the nursing students succeed at teaching others.
There is also a rather general stated hypothesis/goal (Line 113-116) but there should be a more specific hypothesis stated regarding the specific group and goal of the study.
Materials and Methods:
The description of participants should include ages, genders, and other relevant demographic information.
The design description should include more specifics as to what is included in “conventional” practices “innovative integrated technologies”
There is no description as to what was used to measure the subjective experiences involved. What was used to measure learning motivations or confidence. Was it the questionnaire mentioned in section 3.4.1? It’s unclear what was used to measure these values and also unclear as to what the questionnaire was measuring or its specific focus.
Results:
Since the methods and measures were unclear in the Materials section, the results are a little confusing since it is not clear as to where the results originated and what was used to create the numbers. The statistical analysis seems fine, but the origin of the numbers means that the results are confusing.
Discussion and Conclusion: These are well-written but since the previous sections are confusing, they need to be revised once the previous sections have been edited and more information presented.
Author Response
Thank you for Reviewer valuable suggestions, which I have incorporated into the revisions as per your recommendations.
Abstract:
- There are multiple sentences in the abstract that need editing for grammar.
A：Thank you for the reviewer's correction. I have revised the abstract accordingly.
- About the abstract mentions “values greater than 4”
A：We used the average values of the Likert five-point scale in this study and supplemented the research content in response to the reviewer's comments.
Introduction:
- Line 39-41 – These sentences should be combined.
A：We have combined the sentence of lines 39-41.
- The introduction also mentions group sizes, but it is unclear as to whether these groups sizes should apply to the subject group sizes of the participants (nursing students) or the people they are teaching. It is also unclear if the focus is on teaching the nursing students or on whether the nursing students succeed at teaching others.
A：This study aimed to investigate whether nursing students can successfully apply multimedia e-books to teach others, and to compare the health communication process in community education programs for both large and small groups. Furthermore, the study examined the differences in nursing students' perceived effectiveness in applying health communication and developing nursing informatics competencies.
- There is also a rather general stated hypothesis/goal (Line 113-116) but there should be a more specific hypothesis stated regarding the specific group and goal of the study.
A：This paragraph cites the study by Kim, K. J., Shin, D. H., & Yoon, H. (2017). Information tailoring and framing in wearable health communication. Information Processing & Management, 53(2), 351-358.Development of nursing information literacy. Revised for clarity based on review feedback.
Materials and Methods:
- The description of participants should include ages, genders, and other relevant demographic information.
A：Participant demographic information, including age and gender, has been added to the study as per the reviewer's suggestion.
- The design description should include more specifics as to what is included in “conventional” practices “innovative integrated technologies”
A："Conventional practices" and "innovative integrated technologies" have been added to the content in section of 3.2 Design.
- What was used to measure learning motivations or confidence?
A：After reviewing the article, we discovered that section 3.3 on learning motivations and instruments contained some erroneous research content. As a result, we have removed this section and its content from the article. We appreciate the feedback and apologize for any confusion this may have caused.
Results:
- Since the methods and measures were unclear in the Materials section, the results are a little confusing since it is not clear as to where the results originated and what was used to create the numbers. The statistical analysis seems fine, but the origin of the numbers means that the results are confusing.
A：Thanks to the review committee's suggestions, we have addressed the research limitations in the suggested order. Our data source was a questionnaire survey, which is detailed in section 3.3.1 Questionnaire.
Discussion and Conclusion:
- These are well-written but since the previous sections are confusing, they need to be revised once the previous sections have been edited and more information presented.
A：We appreciate the reviewer positive feedback, and we have made the necessary revisions to address the research limitations in the suggested order. Upon further review, we have also removed any erroneous content.
