Implementation of the Digital Health Approach to Support Learning for Health Students Based on Bloom’s Taxonomy: A Systematic Review

1. Search Strategy

The study utilized Medical Subject Headings (MeSH) keywords to identify relevant studies [6]. The study conducted an extensive literature search across PubMed, Science Direct, ERIC, and Scopus using the search terms “digital AND (health OR medical) AND (education OR health professional OR training).” Inclusion criteria comprised publications between 2013 and 2023, open full-text availability, and English language. Exclusion criteria excluded studies unrelated to medicine, nursing, or the health professions, as well as non-journal article types such as reviews, books, conference papers, and letters.

2. Eligibility Criteria

The study utilized the PICO model to select experimental studies (Table 1). The PICO process is a method used in evidence-based practice to formulate and answer a clinical question that pertains to a specific patient problem and is relevant to the evidence found in the literature [7].

Table 1

Application of the PICO framework in this study

Descriptive studies that focused on digital approaches and method development were also evaluated and selected. Initially, this study was aimed at students and health practitioners engaged in health services. However, to widen the scope of the search, the criteria for participants were broadened to include collaborators of healthcare professionals, covering studies involving health-related students, healthcare professionals, and individuals employed in health-related fields.

3. Study Collection

Collected studies were organized by converting references into RIS format using the Zotero reference management tool, which helped eliminate duplicates. The initial search results were subjected to title and abstract screening, independently conducted by two authors (A.R.S. and K.P.). Subsequently, full texts of potentially eligible studies were downloaded and further screened according to the study’s eligibility criteria. In instances of uncertainty or disagreement between two authors (A.R.S. and K.P.), the author S.C.B. provided consensus guidance. The use of Zotero facilitated efficient data management for the citation writing process.

4. Quality Appraisal of the Studies

The methodologies of the selected articles were critically assessed for quality by two independent reviewers (K.P. and A.R.S.) using the Joanna Briggs Institute’s critical appraisal tool. Any disagreements were addressed and resolved with the assistance of a third reviewer (S.C.B.). Details of the critical appraisal are available in Supplementary Table S1.

5. Data Extraction and Analysis

Data extraction utilized a table that listed the author (year), study design, country, subjects/participants, intervention, sample size, and outcome. The researchers recorded all topics related to digital health education or healthcare workers found in the papers. Qualitative content analysis was performed using the Atlas Ti 8th version qualitative analysis tool. Data analysis adhered to the guidelines outlined in the Cochrane Collaboration Handbook for Systematic Reviews to minimize researcher bias in systematic reviews [8].

The initial search across four databases yielded 259,930 articles. Of these, 253,810 were excluded based on the inclusion and exclusion criteria applied by each database’s filter tool, as illustrated in Figure 1. After removing 65 duplicates, 6,055 articles were manually screened using their titles and abstracts according to the eligibility criteria. Subsequently, the researchers conducted a complete screening of all articles that met these requirements. A total of 140 articles were subjected to full-paper reading to evaluate their methodological quality and eligibility. Ultimately, 26 studies were selected for data extraction and synthesis.

Figure 1

Preferred Reporting Items in Systematic Reviews and Meta-Analyses flow diagram of study selection.

1. General Characteristics (Characteristics of Sources of Evidence)

The largest number of studies (12; representing 46,2%) originated from Europe. Most of these studies (nine papers) were published in 2022. Table 2 provides an overview of the types of studies included in the research [2–4,9–31]. The majority were quasi-experimental (13 papers), followed by qualitative studies (five papers), randomized control trials (five papers), and cross-sectional studies (two papers).

Table 2

Characteristics of the included studies

Table 2 summarizes studies conducted in various countries involving medical students, nurses, and other health professions. The search results from this article indicate that a variety of learning media are utilized in the educational process, including e-learning platforms, digital education programs, virtual simulations, digital games, workshops, and web-based platforms. These findings are considered in the development of learning media for health information management education, aimed at improving students’ understanding of the material before they engage in practical fieldwork.

2. Study Participants

As shown in Table 1, the target training groups can be divided into three categories: (1) students in health professions, (2) healthcare professionals, and (3) both students and healthcare professionals. The majority of the studies (n = 15; 57.7%) targeted student groups. Nine studies (34.6%) involved healthcare professionals. Two studies (7.7%) included both students and healthcare professionals.

3. Digital Education Methods

In our analysis of the studies, we categorized the digital education approaches into three types: platform-based, tools-based, and training-based (Table 3). The majority of the studies employed a platform-based system (n = 12; 46.2%), followed by eight studies (30.7%) that adopted a tools-based approach, and six studies (23.1%) that implemented a training-based approach.

Table 3

Final studies analyzed

Research employing a platform-based approach typically focused on cognitive (knowledge and perception), affective (attitude, satisfaction, and motivation), and psychomotor (performance and self-confidence) aspects. In contrast, education adopts a training-based approach, targeting cognitive (practical knowledge and skills), affective (attitudes and satisfaction), and psychomotor (practical skills and interests) aspects. According to the analysis of articles presented in Table 3, education that utilizes a tool-based approach generally explores cognitive (knowledge and understanding), affective (attitude, motivation, and perception), and psychomotor (confidence in study performance, experience, and usability) aspects. It is essential for health information management students to acquire the necessary knowledge to meet cognitive, affective, and psychomotor competencies.

4. Content and Material

The studies varied in their content and material, leading us to categorize them based on their objectives and target audiences: curriculum-targeted and clinical-targeted. Seventeen studies (65.4%) were curriculum-targeted, focusing on educational materials (No. 1,4,6,7,9,10,13,15–17,20,22–26 in Table 3). Conversely, clinical-targeted studies, comprising 34.6%, were designed to enhance the skills of healthcare workers in their daily practice (No. 2,3,8,11,12,14,18,19,21 in Table 3).

5. Study Outcomes

All study outcomes were categorized according to Bloom’s taxonomy domains as cognitive, affective, and psychomotor. Out of the 26 studies sampled, 22 (84.6%) pertained to the cognitive domain, 20 (76.9%) addressed the affective domain, and 12 (46.1%) involved the psychomotor domain.

1. Cognitive

Undergraduate health information programs equip students to deliver systematic healthcare services through the analysis of needs, system design, and plan implementation [9,10]. A platform-based approach is advised to strengthen skills in theory and methodology. This recommendation is supported by studies that demonstrated enhanced understanding following virtual simulations and digital modules [2].

The platform-based approach also had several positive impacts, including enhanced computer proficiency and better preparation of doctors for clinical roles [11]. Additionally, it has improved digital literacy [12] and significantly increased the knowledge of health workers [13]. These findings demonstrate the relevance of this approach in enhancing student knowledge and skills in health information management.

Implementing a platform-based approach for health information management students requires addressing complex subjects such as medical terminology, data security, procedure development, and programming logic. This necessitates the use of systematic and flexible learning tools. Online education presents additional challenges in promoting independent communication and establishing precise conditions for interaction [14]. Furthermore, the stages of the cognitive domain in Bloom’s taxonomy—comprehension, application, synthesis, and analysis—are difficult to achieve [5].

Simultaneously, simulations and quizzes should be employed to enhance health digital literacy. Clinical simulations enhance knowledge, enabling students to apply what they have learned and evaluate their competence [15]. Learning modules increase skill accuracy and lead to improved test outcomes, demonstrating effective knowledge transfer [16,17]. An app has been found to act as an additional resource, augmenting understanding [15]. Digital courses and training have a positive effect on students’ academic performance and learning experiences [18].

The findings of this study suggest that tool-based approaches can enhance the cognition of health information management students. These approaches include clinical case simulations, role-play, anatomy, pathology, disease coding, software coding, and health financing simulations [1]. Apps should be interactive and user-friendly, incorporating question-and-answer content, games, quizzes, and opportunities for discussion. Proper dissemination of information and education on how to use the app is essential for addressing technical and personal issues, thereby enhancing the e-learning experience for health information management students [1].

All of the studies that employed a training approach consistently showed a positive correlation with increased knowledge among both health workers and students. Training in information and communication technology (ICT) and eHealth significantly improved self-rated and ICT knowledge among health surveillance assistants (HSAs) and senior HSAs. Telehealth training also boosted nurses’ learning and self-efficacy [19]. In addition, exercises such as using medical information and web resources can improve students’ skills in finding quality internet resources, answering health questions, and utilizing health information, thereby improving their health literacy scores [20]. This training equipped medical students with practical skills and a deeper understanding of technologies applicable to clinical practice, including the use of artificial intelligence (AI) in clinical decision systems [21]. Workshops like NUWA (National Union of Real-World Gynecologic Oncology Research & Patient Management) expanded medical students’ knowledge of extensive data and professionalism [22]. Furthermore, a coding workshop that utilized Arduino Nano as a teaching tool significantly improved student literacy in health-related technology [23].

Several health information management courses, including clinical case practicum, health administration, and health statistics, require ongoing support [1]. It is recommended that digital training be implemented to enhance the quality of cognitive aspects in students.

2. Affective

Implementing a platform-based approach seems to correlate positively with the affective domain. In studies focused on curriculum, students expressed high satisfaction with peer-assisted learning through tablet-based case simulations [24] and virtual case simulations [9]. They also showed appreciation for digital learning methods, positively received anatomy courseware [25], and valued interactive digital microscopy for pathology education [26]. Furthermore, their confidence in their skills notably increased after completing the course [2]. In studies focusing on clinical practice, healthcare professionals reported increased confidence in patient care [4] and expressed satisfaction with digital education programs, which they found supportive in their work [13]. They also enjoyed the classroom experience and recommended it [27]. Despite the differences in content, all platform-based approaches showed a positive correlation with affective domains across both curriculum-based and clinical settings.

Studies showed a robust correlation between training methodologies and increased knowledge among health workers and students [23]. Students reported high levels of satisfaction with the learning environment and positive attitudes towards big data platforms following coding workshops [22]. They also showed enthusiasm for AI-CDSS programs and increased confidence in using technology [21]. Additionally, the training approach improved healthcare professionals’ telehealth and ICT skills, thereby boosting their self-efficacy and satisfaction [19].

The tools-based approach with curriculum-targeted content positively impacted student engagement and interest [18]. Nursing students, in particular, found the cancer survivor application highly beneficial [28]. Students expressed satisfaction and a positive attitude following their use of multimedia e-books [29] and a game application [15]. However, some studies encountered implementation challenges, and the impact on the curriculum was limited, showing no significant differences in student satisfaction with e-learning modules [30]. Students perceived digital health modules as inadequate [17]. In contrast, content specifically targeted at clinical applications markedly improved well-being, hope, and personhood. Among eight studies employing this approach, four reported positive outcomes on the curriculum, two showed insignificant results, and one study on a clinical target demonstrated a positive impact.

Studies have shown that platform-based training substantially improves the affective aspect, particularly for health students preparing for fieldwork or internships [30]. To further enhance this affective impact, it is crucial to address and reduce technical and personal issues through a tool-based approach.

3. Psychomotor

Twelve studies were conducted, of which only eight utilized a platform-based approach relevant to the psychomotor domain. An e-learning package resulted in improvements in both efficiency, as measured by task completion time, and accuracy, indicated by a reduced number of incorrect clicks [11]. Digital education focusing on self-harm in children and young people led to more positive attitudes towards its effectiveness and increased confidence across various practice areas [4]. The intelligent digital learning platform enabled learners to take control of their learning process and build a knowledge base [12]. Greater access to classrooms has been associated with a heightened interest in education [27].

The platform-based approach had a positive impact on the psychomotor aspects of students. Peer-assisted learning provided appropriate simulation content, fostering a safe learning environment for medical students and improving the retention of new concepts [25]. It also boosted students’ willingness to register as first responders [2]. While repetition of simulations led to improved scores, the effect was somewhat less pronounced for nursing students [9]. The clinical simulation stage strengthened the psychomotor domain, aiding participants in understanding and practicing essential skills [5].

In eight studies that employed a tools-based approach, only one addressed the psychomotor domain, demonstrating that students benefited from using apps to prepare for clinical practicum courses [28]. Among six studies that adopted a training-based approach, three focused on the curriculum and targeted student psychomotor outcomes. These included completing mini-projects in coding workshops [24] and acquiring practical clinical skills through programs such as AI-CDSS [21]. However, after completing a course on web tool usage, students still expressed uncertainties regarding the practical application of the health information they learned [20].

Articles on health education methods have been reviewed to inform health information management education. The limited availability of articles specifically focused on health information education constrains this research. Health information management benefits from methods that are platform-based, tool-based, and training-based, which positively affect cognitive and affective domains. However, the impact on the psychomotor domain still requires thorough evaluation. Platform-based methods are recommended to improve cognitive function through various learning activities such as questions and answers, games, discussions, virtual simulations, and quizzes related to health information management. Both platform-based approaches and training are advised for improving affective and psychomotor skills in students. The development of integrated digital learning systems is crucial for preparing students for advancements in the health system. This approach aligns with Bloom’s taxonomy, aiming to enhance learning outcomes and facilitate the transfer of skills.