Awareness and Level of Digital Literacy among Paramedical Students | ||
| Health Education and Health Promotion | ||
| Article 10, Volume 13, Issue 2, 2025, Pages 265-272 PDF (981.27 K) | ||
| DOI: 10.58209/hehp.13.2.265 | ||
| Authors | ||
| R. Norouzi Aval1; Kh. Kimiafar* 2; M. Sarbaz2; S.F. Mousavi Baigi1 | ||
| 1“Department of Health Information Technology, Faculty of Paramedical and Rehabilitation Sciences” and “Student Research Committee”, Mashhad University of Medical Sciences, Mashhad, Iran | ||
| 2Department of Health Information Technology, Faculty of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran | ||
| Abstract | ||
| Aims: Digital literacy is a set of skills that enables individuals to effectively use digital technologies for learning, communication, and knowledge creation. Therefore, the aim of this study was to investigate the level of awareness and digital literacy among paramedical students. Instrument & Methods: This cross-sectional study on students enrolled in the School of Paramedical Sciences and Rehabilitation at Mashhad University of Medical Sciences during the 2024 academic year was conducted from October 2024 to February 2025. Data were collected using a previously developed questionnaire by Aydınlar et al. in 2024. This questionnaire consisted of 31 questions and focused on topics, including demographic data, familiarity with programming, opinions on digital literacy, software, hardware, networks, ethics, security, artificial intelligence, and knowledge interest. The face validity of the questionnaire was assessed by faculty members, and its reliability was measured using the test-retest method. SPSS 26 software was used to analyze the data. Findings: A total of 105 students responded to the survey. Sixty percent of the students were female, and 40% were male. Overall, more than half of the participants (51.4%) believed that digital literacy training was necessary but optional. In contrast, 30.5% stated that digital literacy training was necessary and mandatory. The domains of “interest-knowledge, artificial intelligence, network, ethics, and hardware” had the highest average scores, while the domains of “software and security” had the lowest averages. When examining the relationship between digital literacy domains and gender, the scores of men in the domain of “software and multimedia” were significantly higher than those of women (p-value=0.021). Conclusion: There are both strengths and gaps in digital literacy among paramedical students and they have moderate to high competency in several key areas, particularly in artificial intelligence awareness, networking, hardware, and ethical considerations. | ||
| Keywords | ||
| Digital literacy; Awareness; Students; Education | ||
| Full Text | ||
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Introduction In recent decades, the rapid advancement of digital technologies has fundamentally transformed education, communication, and healthcare [1]. Almost all devices used in daily life are digital, so the 21st century is often referred to as the digital age [2, 3]. The term “digital literacy” was first introduced by Gilster [4], and it refers to the ability to effectively and critically navigate, evaluate, and create information using digital technologies. It combines the concept of “digital,” which refers to the symbolic representation of data, and “literacy,” which involves the capacity to understand, write coherently, and think critically about the written word [5]. The American Library Association defines digital literacy as the ability to use information and communication technology to find, understand, evaluate, create, and communicate digital information [6]. The infrastructure in the healthcare sector is also rapidly digitizing, significantly improving the quality of diagnosis, follow-up, and treatment processes for patients [7, 8]. Digital literacy is essential for medical students to effectively access and interpret data, analyze medical images, and use technology to improve patient care. Additionally, it helps them understand the ethical implications of using technology in healthcare and its potential risks [9, 10]. In an era where artificial intelligence (AI) has become prevalent across many fields, it is vital that students pursuing medical sciences possess foundational knowledge of AI and that this technology is integrated into their educational programs [11]. ChatGPT, one of the most widely used AI tools, is increasingly considered a practical online teaching assistant due to its immediate and accessible responses [12, 13]. In Hamburg, Germany, digital health was included as an optional course in the medical curriculum. A survey evaluating the course revealed high overall satisfaction, demonstrating students’ positive reception of digital literacy education [14]. Another study in Germany created separate modules in medical schools to teach digital skills, focusing on digital challenges in medical applications, further highlighting the importance of digital literacy in medical education [15]. In 2024, Aydınlar et al. conducted a study to assess the digital literacy and awareness of health science students at their university. The results emphasized the need to evaluate students’ computer skills across different areas and recommended the creation of educational environments that strengthen digital knowledge [16]. Overall, familiarity with digital skills has become a basic requirement for 21st-century students in light of advancements in the digital world. However, the digital literacy skills that students possess before entering university do not always translate into effective and purposeful use to support their learning [17]. Studies have shown that students’ proficiency with basic digital tools, such as Microsoft Office, Word, PowerPoint, and Excel, is often lower than expected [18]. Administrators, teaching staff, and students need time to grasp the meaning and significance of digital literacy, which varies based on their roles, disciplines, and institutional priorities. Given the limited research in this field within Iran, this study aimed to investigate digital literacy awareness and levels among students at the Faculty of Paramedical Sciences and Rehabilitation at Mashhad University of Medical Sciences. Instrument and Methods Study design This cross-sectional quantitative study was conducted from October 2024 to February 2025. All ethical principles in research were observed according to the Helsinki Declaration [19]. In this regard, students were informed about the objectives, methods, possible benefits, and potential risks of the research, as well as any discomfort that may result. Participation was voluntary, and informed consent was obtained from all participants. As an incentive for participation, the objectives of the study were explained at the beginning of the questionnaire, and participants were informed that they would receive general feedback on the results upon completion of the study. All personal information was kept confidential and anonymized for research purposes only. Sample size The study population included all students enrolled in the School of Paramedical Sciences and Rehabilitation at Mashhad University of Medical Sciences during the 2024 academic year. These students were from eight disciplines, including health information technology, laboratory sciences, optometry, radiology, speech therapy, occupational therapy, physiotherapy, and social work, and were studying at the undergraduate, master’s, and doctoral levels. Stratified proportional sampling was employed; students were first categorized by discipline and academic level, and then a proportionate sample was selected from each stratum based on Cochran’s formula (with a confidence level of 95% and α=0.05). The initial sample size was 87; however, to enhance accuracy and generalizability, a total of 105 participants were ultimately included.  Z=The value of the statistic equivalent to the area under the standard normal curve P and q=The frequency ratio of the desired attribute in the target population d=Effect size or precision Inclusion criteria included all students actively enrolled at the School of Paramedical Sciences and Rehabilitation at the time of the study. Exclusion criteria comprised transfer or visiting students from other universities, students on academic leave during data collection, international students, and those unwilling to participate. Participation was entirely voluntary and based on informed consent. Participants were assured that their information would remain confidential and be used solely for research purposes. Data collection A pre-designed standard questionnaire by Aydınlar et al. [16] was used to assess the level of awareness and digital literacy of paramedical students. The face validity of the questionnaire was reviewed by five faculty members, and after incorporating their suggestions, the final version was approved. Its reliability was assessed using the test-retest method with a ten-day interval (Cronbach’s alpha: 78%). This questionnaire contained 31 questions, including multiple-choice questions, five-point Likert scale items, and one open-ended question. It focused on 11 general topics, including demographic data (age, gender, field of study, level of education, and semester), level of familiarity with programming, the respondent’s opinion on digital literacy education for paramedical students, software and multimedia, hardware, networks, ethics, security, AI, knowledge-interest, and one open-ended question to examine student opinions and suggestions (Table 1). The questionnaire was designed electronically, and an email with the survey link was sent to eligible students willing to participate. Two reminder emails were sent at one-week intervals. Participation was voluntary, and responses were anonymous. Table 1. The questionnaire used to evaluate digital literacy in seven domains  Statistical analysis SPSS 26 was used to analyze the data. Descriptive data were examined using frequency and percentage, while continuous parameters were characterized by their mean and standard deviation. Chi-square tests, t-tests, and the Spearman correlation coefficient were used to analyze the relationships between categorical parameters, with a p-value of 0.05 applied to determine the level of statistical significance. Findings A total of 105 students from various paramedical fields responded to the questionnaire. Sixty percent of the students were female, and 40% were male. Their mean age was 23.04±2.15 years. The frequency of the fields of study was as follows: health information technology (23, 21.9%), laboratory science (13, 12.4%), optometry (10, 9.5%), radiology (10, 9.5%), speech therapy (14, 13.3%), occupational therapy (10, 9.5%), social work (16, 15.2%), and physiotherapy (9, 8.6%). Health information technology accounted for 21.9% of the participants, while the participation rates in the other seven disciplines varied, ranging from 8.6% to 15.2%. The largest number of students participating in the study (24.8%) were in their third year of study. More than half of the participants (51.4%) believed that digital literacy training was necessary but optional for paramedical students. In contrast, 30.5% stated that digital literacy training is necessary and mandatory for paramedical students, while only 19 students (18.1%) believed that digital literacy training was unnecessary. Additionally, 32.4% of students had not received any training in programming. Twelve percent of students had learned programming at university, and 4.8% had trained independently (Table 2). Table 2. Frequency of demographic features of participants (N=105)  A significant difference was found between the average responses obtained in the two gender groups (male and female) (p-value=0.004). Additionally, no significant difference was observed between the average responses regarding the necessity of learning digital literacy for paramedical students in the two gender groups (p-value=0.955; Table 3). Table 3. The results of t-tests between genders  Comparison of domains in digital literacy The average scores in the domains of digital literacy ranged from 3 to 4 on a five-point Likert scale, which indicated a relatively favorable state of knowledge and awareness in digital literacy, but there was still room for improvement in some areas. The areas of “interest-knowledge, AI, network, ethics, and hardware,” which had the highest average scores (3.688, 3.682, 3.682, 3.682, 3.682), indicated greater awareness in these areas. Conversely, the areas of “software and multimedia” and “security” had the lowest average scores (3.38 and 3.55), indicating that these areas required more attention to increase student awareness. The scores of males in the “software and multimedia” area were significantly higher than those of females (p-value=0.021). There was no significant difference in the remaining areas (Table 4). Table 4. Comparison of scores between genders  Spearman correlation tests were conducted between the various domains of digital literacy, academic fields, and gender. A significant and negative relationship was observed between gender and the software and multimedia area (r=-0.272, p=0.0049), which indicated that gender may affect the level of software skills. Other domains, including security (p=0.0791) and hardware (p = 0.0894), showed weak correlations with gender that were not statistically significant. A significant relationship was also observed between the field and the hardware area (r=-0.232, p=0.0171), which indicated that students from different fields may have differences in hardware and multimedia knowledge. The relationships between the field and the other domains were also not significant. An analysis of gender differences in the domains of digital literacy was also conducted among different academic fields (Figure 1).  Figure 1. Comparison of mean scores in domains according to field and gender Health information technology students exhibited the highest level of knowledge in the software and multimedia domain, while social work and occupational therapy students demonstrated the lowest level of knowledge. In most majors, male students had higher scores than female students; however, the difference was smaller in some majors, such as optometry and radiology. Familiarity with hardware skills was greater among health information technology and laboratory science students than in other majors. Social work and speech therapy majors showed the lowest level of knowledge in the hardware domain. In most majors, male students performed better, but in laboratory science, the difference between male and female students appeared to be smaller. When examining the level of students’ awareness in the field of networking, students in health information technology and laboratory sciences showed the highest level of awareness, indicating a strong need in these fields to be familiar with network systems and databases. In contrast, students in social work and occupational therapy reported the lowest level of awareness. In this area, the gender gap between male and female students was significant in most fields. Compared to other fields, the gender difference in the ethics area was smaller. The fields of social work and speech therapy exhibited the highest level of awareness regarding issues related to ethics in research. In the security area, students in health information technology and laboratory sciences had the highest level of awareness because these fields require the protection of patient data. In contrast, the fields of social work and optometry showed the lowest level of awareness. The gender gap in this area was significant, with male students performing better in most fields. Health information technology students demonstrated the highest level of proficiency in AI, which is attributed to the widespread use of AI in medical data analysis and e-health systems. Laboratory science and radiology majors also received relatively high scores in this area. Social work and speech therapy majors showed the lowest level of proficiency in AI, indicating that AI applications in these fields are not very common from the students’ perspective. Generally, male students performed better in this area than female students. Health information technology, laboratory science, and radiology students displayed the highest level of interest in knowledge. This finding suggests that students in these majors are more aware of digital technologies and are likely to work more with technological tools. In contrast, social work and speech therapy students exhibited the lowest level of interest-knowledge, which may be due to the lower focus of these majors on technology. The gender gap in this area was smaller than in other skills, but male students still had higher scores in most majors. Discussion This study aimed to investigate digital literacy awareness and levels among students at the Faculty of Paramedical Sciences and Rehabilitation at Mashhad University of Medical Sciences. In the digital age, and with the rapid advancement of technology, digital literacy has become one of the basic and essential skills for individuals in various societies [20]. However, the level of knowledge and mastery of individuals in different areas of digital literacy can vary, necessitating a detailed and targeted study. This study attempted to use statistical tools to assess the status of students’ digital literacy in various areas and to identify existing strengths and weaknesses, thereby taking a step toward improving related training and planning. There was a noticeable gender gap in prior exposure to programming, with female students being less likely to have received formal training. This aligns with global trends reported in previous research, which highlight persistent challenges in achieving equal access to digital education opportunities [21]. While some studies suggest that early-stage performance in coding may not differ significantly between genders, more advanced competencies tend to show male-dominated outcomes. These findings underscore the need for more inclusive training strategies that empower all students, particularly women, to engage confidently with coding and digital technologies [22]. Although female students had received less prior training in programming than male students, their views on the importance of digital literacy education were equivalent to those of male students. No significant difference was observed between gender and students’ perceptions of digital literacy, indicating a shared belief in the necessity of digital literacy education among students. Students demonstrated the strongest familiarity in areas, such as wireless connectivity, responsible citation practices, and the use of online platforms for accessing medical information. Chereka et al. indicated that 67.4% of health science students use the Internet for health information, reflecting a high reliance on digital resources for health-related queries [23]. This suggests a baseline competence in practical digital skills commonly used in academic settings. However, deeper technical aspects, including problem-solving with technology and familiarity with programming languages, emerged as areas requiring targeted educational support. Lazaridou et al. [24] investigated the level of medical students’ knowledge of the rules and ethics of scientific writing and reported that medical students’ knowledge of publication ethics is relatively good. However, many medical students have limited knowledge of the ethical principles of scientific publication, indicating a need for further training in this area. In general, it can be said that incorporating training related to publication ethics into the curricula of medical students is important and necessary to prevent unethical behavior in future research. The lowest frequency of knowledge regarding various components of digital literacy is related to the components “I know how to solve technical problems that arise while working with the technologies in use,” “I am familiar with computer languages, such as Python, C++, and Visual Basic,” and “I can easily communicate with others through platforms, such as Zoom, Microsoft Meeting, and Outlook.” Studies show that a lack of awareness in these areas can lead to reduced productivity in educational and professional environments. Therefore, to improve this situation, it is essential to integrate training related to digital technologies into university curricula [25]. For example, Barteit et al. found that 70% of medical students use learning management systems, such as Moodle or Blackboard; however, many of them lack the skills to troubleshoot technical issues [26]. Additionally, Krishnamurthy and Shetteppanavar aimed to determine the level of literacy in the use of digital resources by female students. They revealed that the Google search engine is the most commonly used search engine among students, with most respondents (68.83%) being aware of the use of the Google Scholar search engine, followed by ResearchGate, Twitter, Slideshare, and Academic.edu databases, respectively. Among these, LinkedIn, SciSpace, and Research ID had the least usage among academic social networking sites [27]. Although overall digital literacy levels were relatively high, a closer look revealed domain-specific differences across genders. Male students tended to score higher in software-related competencies, while other domains, such as hardware and network skills, showed more balanced performance. Momayyezi et al. indicated that the average computer literacy of male students is higher than that of female students [28]. Conversely, another study showed that in the online education method, the satisfaction and average scores of female students are higher than those of male students [29]. In general, it can be concluded that although there may be differences in the level of familiarity with and use of software and multimedia tools between female and male students, these differences vary depending on the context and type of technology, and a definitive conclusion cannot be drawn in this regard. Security awareness, though critical, appeared to be underdeveloped among participants. This resonates with research indicating that students often lack sufficient knowledge about data protection and cybersecurity best practices [30-32]. Meanwhile, high scores in AI awareness reflect a growing interest and recognition of its relevance in modern healthcare—a trend observed across multiple health education contexts [33]. Despite this, the formal integration of AI topics into curricula remains limited, indicating a potential area for development [34]. Students confidently explored the Internet to acquire new knowledge and interact with their peers through applications such as Skype and LinkedIn. Similarly, a cross-sectional study showed that health information technology students, due to the nature of their field and the availability of course units, use mobile phones for educational purposes more than students in other fields [35]. Additionally, in a study conducted by Lin using a questionnaire administered to first-year nursing students to assess their computer literacy levels, the highest score was obtained in the area of familiarity with the Internet [36]. It can also be said that the importance of being familiar with ethical issues in research is becoming more complex with the rapid development of technologies. For example, the results of a study conducted on Indian students indicate a lack of awareness among students about using different search strategies for efficient information retrieval, with only 43 respondents (55.84%) being aware of copyright issues [27]. Another study has revealed significant gaps in students’ knowledge and awareness regarding research ethics and the functioning of research ethics committees. Additionally, students who had a PhD or were familiar with research ethics exhibit a more positive attitude toward these issues [37]. This study has limitations that affect the interpretation of the results. The sample size of 105 represents a small proportion of eligible healthcare students, which may affect the generalizability and comparability of the results. Furthermore, the study focused on specific paramedic students at a single university, limiting the applicability of the findings to other universities or countries. Some important aspects of digital literacy may not have been covered in this study and require further investigation. Additionally, this study was cross-sectional and did not assess changes in digital literacy over time. It is recommended that research be conducted in larger and more diverse populations to enhance the accuracy and generalizability of the results. Longitudinal studies are also recommended to examine changes and trends in digital literacy over time. This study highlights both strengths and gaps in digital literacy among paramedical students. While female participants reported less prior exposure to computer skills and coding, their perception of the importance of digital literacy was comparable to that of male students. Overall, students exhibited moderate to high competency in several key areas, particularly in AI awareness, networking, hardware, and ethical considerations. Nonetheless, the relatively lower scores in software proficiency and cybersecurity indicated the need for more focused and practical training in these domains. To better prepare future healthcare professionals, educational institutions should consider integrating tailored digital literacy modules that address both technical skills and ethical responsibilities in digital environments. Conclusion There are both strengths and gaps in digital literacy among paramedical students and they have moderate to high competency in several key areas, particularly in AI awareness, networking, hardware, and ethical considerations. Acknowledgments: The authors stated that all information provided in this article could be shared. All authors have read and approved the final version of the manuscript. We also thank all students for their participation and cooperation in this project. Ethical Permissions: This study is based on a research project approved by Mashhad University of Medical Sciences (Ethics Code: IR.MUMS.FHMPM.REC.1403.144). All ethical principles in the research were observed according to the Helsinki Declaration. Students entered the study with informed consent after the research was explained. All information about individuals was used confidentially and without revealing their names. Conflicts of Interests: The authors declared no conflicts of interest. Authors' Contribution: Norouzi Aval R (First Author), Introduction Writer/Methodologist/Main Researcher (40%); Kimiafar Kh (Second Author), Methodologist/Discussion Writer/Statistical Analyst (40%); Sarbaz M (Third Author), Methodologist/Statistical Analyst (10%); Mousavi Baigi SF (Fourth Author), Assistant Researcher/Discussion Writer/Statistical Analyst (10%) Funding/Support: This project was supported by Mashhad University of Medical Sciences with grant number 4030663. | ||
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