Evidence map›Paper›PMID 41013614›Full record

ArticleBMC nursing2025

Neonatal nurses' e-health literacy and technology‑mediated clinical practice: a cross-sectional analysis of digital health competencies and practice patterns.

Osama Mohamed Elsayed Ramadan, Nadia Bassuoni Elsharkawy, Alaa Hussain Hafiz, Nouran Essam Katooa, Areej Abunar, Dena Marwan A Attallah, Mashael Dewan, Majed Mowanes Alruwaili, Abeer Nuwayfi Alruwaili, Afrah Madyan Alshammari and 3 more

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Article in BMC nursing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Osama Mohamed Elsayed RamadanDepartment of Maternal and Child Health Nursing, College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia. omramadan@ju.edu.sa.ORCID https://orcid.org/0000-0002-9616-8590
Nadia Bassuoni ElsharkawyDepartment of Maternal and Child Health Nursing, College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia.
Alaa Hussain HafizMaternity and Child Health Department, Faculty of Nursing, King Abdulaziz University, Jeddah, 24123, Saudi Arabia.
Nouran Essam KatooaMaternity and Child Health Department, Faculty of Nursing, King Abdulaziz University, Jeddah, 24123, Saudi Arabia.
Areej AbunarMaternity and Child Health Department, Faculty of Nursing, King Abdulaziz University, Jeddah, 24123, Saudi Arabia.
Dena Marwan A AttallahNursing Department- Nursing Program, Fakeeh College for Medical Sciences, Jeddah, 21461, Saudi Arabia.
Mashael DewanDepartment of Adult Health Nursing, Dr. Sulaiman Al Habib College for Knowledge, Riyadh, Saudi Arabia.
Majed Mowanes AlruwailiDepartment of Nursing Administration and Education, College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia.
Abeer Nuwayfi AlruwailiDepartment of Nursing Administration and Education, College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia.
Afrah Madyan AlshammariDepartment of Maternal and Child Health Nursing, College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia.
Nourah AlsadaanDepartment of Nursing Administration and Education, College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia.
Enas Mahrous AbdelazizDepartment of Psychiatric Mental Health Nursing, College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia.
Lareen Magdi El-Sayed Abo-SeifDepartment of Pediatric Nursing, Faculty of Nursing, Suez Canal University, Ismailia, 41522, Egypt.

Funding

This work was funded by the Deanship of Graduate Studies and Scientific Research at Jouf University under grant No. (DGSSR-2025-01-01140).
6 · The paper itself

Abstract

backgroundDigital transformation in Level III NICUs demands advanced e‑health literacy, yet evidence tying these competencies to observable nurse behaviors and safety endpoints remains scarce.

objectiveTo examine associations between NICU nurses’ e-health literacy levels and their technology-mediated clinical practice patterns through a comprehensive analysis of digital health competencies and observable care delivery behaviors.

methodsA cross-sectional, multi-site study was conducted with 95 nurses from four Al-Jouf Health Cluster NICUs in Saudi Arabia. Data triangulation combined validated scales (eHEALS, TIGER), structured observations of short care episodes, and a 30-day EHR audit. Hierarchical regression and structural equation modeling were employed to examine the direct, mediated, and moderated relationships among literacy domains, alert-response performance, and system optimization behaviors.

resultsSystems Integration competency showed the strongest associations with technology-mediated care (β = -0.62 for alert response time, β = 0.67 for system optimization, p < 0.001). Nurses in the highest e-health literacy tertile demonstrated 43% faster alert responses (26.3-second improvement, 95% CI [22.1, 30.5]) and superior system optimization behaviors (Cohen’s d = 2.05, 95% CI [1.62, 2.48]). Technology Acceptance Model constructs mediated 35–38% of e-health literacy-clinical outcome relationships. Trust in Technology (β = -0.21, p < 0.01) and Motivation to Use (β = 0.23, p < 0.01) significantly moderated these associations. SEM demonstrated an excellent fit (CFI = 0.961, RMSEA = 0.049). Prior informatics training was associated with enhanced performance across all outcomes (Cohen’s d = 0.58–0.67).

conclusionsE-health literacy competencies, particularly Systems Integration capabilities, are strongly associated with effective technology-mediated clinical practice in NICUs. These digital competencies relate to critical patient safety indicators, including alert response efficiency and system optimization behaviors. The cross-sectional design limits causal inferences; longitudinal research is needed to establish whether improving e-health literacy leads to enhanced clinical performance. CLINICAL TRIAL NUMBER: Not applicable.

Indexed as

Clinical practice patternsDigital health competenciesE-health literacyNeonatal nursingPatient safetyTechnology acceptance

Identifiers

PMID41013614
PMCPMC12465202

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.