# Multimodal interprofessional education vs. digital learning: enhancing Mpox preparedness in Saudi nursing students

## TL;DR

A multimodal education approach improved Saudi nursing students' Mpox preparedness more effectively than digital-only learning.

## Contribution

Demonstrated that combining digital learning with interprofessional workshops enhances Mpox knowledge and preparedness in nursing students.

## Key findings

- Multimodal education led to significantly greater improvements in knowledge, confidence, and attitudes compared to digital-only learning.
- Effect sizes were medium to large, with sustained knowledge gains at 4-month follow-up.
- Ceiling effects were observed in PPE and hand hygiene subdomains, indicating high baseline proficiency.

## Abstract

The monkeypox (Mpox) outbreak, declared a global health emergency, underscores the urgent need for healthcare workforce preparedness. Nursing students represent a critical frontline group but often lack structured training in emerging infectious disease response. This study aimed to evaluate the effectiveness of a multimodal interprofessional educational intervention, compared with digital-only learning, in enhancing measured knowledge and self-reported preparedness outcomes related to Mpox among Saudi nursing students. The intervention was theoretically grounded in the Health Belief Model (HBM), which guided confidence-building and attitude modification, and Kolb’s Experiential Learning Theory (ELT), which informed the design of interactive workshops to facilitate concrete experience, reflective observation, abstract conceptualization, and active experimentation.

A quasi-experimental design with propensity score matching was employed, involving 480 undergraduate nursing students from six Saudi universities. Participants were allocated to either a digital learning-only control group or a multimodal intervention group that combined digital modules with interprofessional workshops. Propensity score matching (PSM) was conducted using age, gender, academic year, cumulative GPA, prior infectious disease training, geographic region, and baseline outcome scores to achieve covariate balance (all standardized mean differences < 0.10). Post-matching balance is detailed in Table 1. Validated instruments assessed Mpox knowledge (objectively measured), confidence, attitudes, and self-reported clinical practices. The Mpox Knowledge Assessment Questionnaire was adapted from validated instruments previously used in infectious disease education research, with modifications to reflect current Mpox-specific epidemiology and clinical guidelines. Content validity was established through expert review by infectious disease specialists and nursing educators (Content Validity Index = 0.94). Data were analyzed using descriptive statistics and robust comparative analyses, with sensitivity testing to account for non-normal data distributions.

Students in the multimodal intervention group demonstrated significantly greater improvements across all outcome measures compared to the digital-only group (p < 0.01). Knowledge gains were sustained at 4-month follow-up, while confidence, attitudes, and self-reported practice scores showed moderate to large between-group effect sizes. Specifically, Cohen’s d effect sizes were interpreted as medium for knowledge (d = 0.62), large for confidence (d = 0.78), medium for attitudes (d = 0.58), and medium for self-reported practices (d = 0.65), based on established benchmarks for educational interventions. Observed effect magnitudes were interpreted conservatively, considering baseline knowledge gaps and potential ceiling effects in selected measures. Ceiling effects were particularly noted in hand hygiene and personal protective equipment (PPE) subdomain scores, where post-test means approached 88% of maximum possible scores.

A multimodal interprofessional educational approach combining digital learning with experiential workshops resulted in superior improvements in nursing students’ Mpox preparedness, particularly for applied knowledge, self-efficacy, and perceived readiness. These findings support integrating interprofessional experiential learning into nursing curricula to strengthen preparedness for emerging infectious disease threats.