Blended learning vs traditional teaching: The potential of a novel teaching strategy in nursing education - a systematic review and meta-analysis

The primary goal of this analysis is to determine the effectiveness of blended learning versus traditional face-to-face teaching in nursing education from the three aspects of knowledge, skills and satisfaction. With the rapid development of health care, traditional teaching has been unable to meet the learning needs of nursing education. With the development of Internet technology, blended learning seems to be a new available choice to solve the current predicament. However, the effectiveness of blended learning is still controversial. In addition, most studies have primarily evaluated the teaching effect unilaterally. Systematic review and meta-analysis. We searched PubMed, Embase, Web of Science, CINAHL and the Cochrane Library for publications in English from inception to April 2021. Two researchers independently screened the eligibility of each publication and extracted the data. The Cochrane risk-of-bias tool and the MINORS (methodological items for non-randomized studies) were used to evaluate the quality of the studies. The statistical heterogeneity was analyzed by the meta-regression and subgroup analysis. Publication bias was assessed by Egger's test. The search strategy identified a total of 3682 potentially relevant articles. We finally included 13 randomized controlled trials (RCTs) and 12 quasi-experimental studies (QRs), with a total of 2706 nursing students. The meta-analysis results showed that blended learning is more effective than traditional teaching in terms of knowledge, skill performance and learning satisfaction (SMD=0.64, z = 3.237, p = 0.001; SMD = 0.37, z = 2.58, p = 0.010; SMD = 0.32, z = 2.347, p = 0.019). Egger's test showed no significant publication bias. In addition, sensitivity analysis suggested that the results are relatively reliable. Through subgroup analysis and meta regression, we found that although the heterogeneity could not be significantly reduced or eliminated, the publication year, the study design and the duration of the intervention time and the number of items in the intervention may be the potential factors affecting heterogeneity of knowledge and learning satisfaction. The research results showed that blended learning may be an effective teaching strategy and appears to have excellent long-term developmental potential. Although its initial construction may require specific investment to improve the teaching resources and standardize the design of blended learning, in the long term, this new teaching stra