This study adopted a descriptive cross-sectional design to assess perceived informatics competency and digital technology self-efficacy among undergraduate nursing students using an online self-assessment survey.

Voluntary participation in an electronic survey allowed for data collection from undergraduate nursing students at a university in Hail, covering students from the first to fourth years (levels 1‐4) of the Bachelor of Nursing program. The target population was all undergraduate nursing students enrolled in the Bachelor of Nursing program at the University of Hail during the 2024‐2025 academic year (levels 1‐4 and interns). The source population comprised all students with an active institutional email address on the official program mailing list at the time of data collection. Therefore, the accessible sampling frame consisted of this official mailing list of currently enrolled undergraduate nursing students, which was used to distribute a single open invitation to participate in the study.

Students were eligible if they (1) were currently enrolled as undergraduate nursing students in levels 1 to 4 at the University of Hail, (2) were able to read and understand English (the language of instruction), and (3) had an active institutional email account. Students on academic suspension, on long-term leave, or who had withdrawn from the program at the time of data collection were excluded from the study.

A convenience sampling approach was used in which all eligible students from the source population were invited to participate. This strategy was practical, cost-effective, and enabled the coverage of the broadest possible segment of the accessible student population. In this context, convenience sampling reflects all students who chose to respond to the open email invitation rather than a preselected subgroup. All invitations were distributed via the official undergraduate nursing program’s email list. Because the list is updated dynamically, the exact number of invitations sent could not be confirmed, but it approximately matched the total number of eligible students. The survey was conducted using Google Forms. A total of 260 students started the survey, of whom 93.5% (243/260) completed it and were included in the analysis. In total, 6.5% (n=17) of the responses were excluded due to substantial missing data (more than 20% of the items were unanswered). Because the total number of active student email accounts at the time of the survey could not be verified, the exact response rate could not be calculated. However, program records indicated that the mailing list approximately matched the total number of enrolled and eligible students.

For inferential analyses involving year level, only students in levels 1 to 4 were included, excluding interns because their internship year is structurally distinct from the numbered academic levels. To reduce potential selection bias, all eligible undergraduate nursing students on the institutional mailing list were invited to participate using the recruitment protocol described in the Data Collection section.

A priori power analysis indicated that at least 315 respondents were required to achieve 80% power at a 95% confidence level for medium effects in ANOVA, 2-tailed t tests, and regression analyses. Therefore, the final analytic sample of 243 respondents was underpowered for confirmatory inferential analyses but was considered adequate for descriptive and exploratory correlational analyses.

The questionnaire was divided into 3 sections to capture comprehensive participant information. The first section collected general demographic data, including age, sex, academic year, prior experience with electronic medical records, and self-assessed computer proficiency. These variables provided a contextual background for interpreting the findings in the subsequent sections.

The second section assessed participants’ informatics competency using the 21-item C-NICAS version 2 with permission from Kleib and Nagle [3]. This student-focused instrument has been adapted and validated for undergraduate nursing students across multiple international contexts, supporting its suitability for this population and enabling cross-study comparison. Originally developed and psychometrically validated among registered nurses in Alberta, Canada, the scale has also undergone cross-cultural validation, supporting its use in international benchmarking.

The C-NICAS includes 4 subscales: foundational information and communications technology (ICT) skills, information and knowledge management, professional responsibility and accountability, and use of ICTs in the delivery of care. These domains align with the core competencies relevant to the digital health ecosystem in Saudi Arabia. The instrument was administered in English, consistent with the language of instruction at the study site. Participants self-reported their competency using a 4-point Likert scale ranging from 1 (“not competent”) to 4 (“very competent”). The total scores ranged from 21 to 84 and were categorized into 4 levels: not competent (21-41), somewhat competent (42-62), competent (63-83), and very competent (84). The scale demonstrated strong internal consistency (Cronbach α=0.93 overall and 0.74‐0.89 for the subscales).

The final section measured digital technology self-efficacy using a revised 17-item version of the questionnaire by Hughes [16]. This scale complements the C-NICAS by assessing students’ confidence in their ability to use digital technology. Responses were recorded on a 4-point Likert scale ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). In total, 12 items were reverse coded, and 5 items (1, 7, 8, 11, and 16) were positively coded. The mean scores ranged from 1 to 4, with higher scores indicating greater self-efficacy. The scale demonstrated strong reliability, with the Cronbach α exceeding 0.90 in both the original study and the sample in this study.

Both informatics competency and digital technology self-efficacy were assessed using self-report measures. Although both instruments have strong psychometric properties, self-reported data may be subject to bias and inaccurate self-assessment, potentially leading to over- or underestimation of actual competency and confidence levels.

An ethical recruitment plan was developed. Nursing students were invited through email, which contained an invitation letter, a survey link, an information sheet, and a consent statement. The invitation highlighted the purpose of the research, the importance of the study, and the possible implications of the study for nursing informatics research.

Reminder emails using a predetermined protocol were sent to encourage response; the first reminder was sent 24 to 48 hours after the initial email, followed by another one 3 to 7 days later, with a total of 3 to 5 reminders sent throughout the data collection period. Google Forms was used for the survey because of its accessibility and reasonable data storage capacity.

Data analysis was performed using SPSS (version 29.0; IBM Corp) and the Python software (Python Software Foundation). Item-level missing data were minimal (<5% for all variables). Continuous items with less than 5% of missing data were imputed using item-specific means and categorical variables using the mode. Given the low proportion of missing data, this approach was unlikely to bias the descriptive estimates, although it may have slightly attenuated the variance in the inferential analyses.

Statistical assumptions were assessed prior to the inferential analyses. Descriptive statistics, including measures of central tendency (mean, median, and mode) and variability (SD), were calculated for key variables, such as C-NICAS and digital technology self-efficacy scores. Inferential analyses included Pearson correlation to examine relationships among variables, independent-sample t tests, and one-way ANOVA to assess group differences.

Hierarchical multiple regression was conducted using 4 models to identify the predictors of informatics competency. Potential confounders (age, sex, academic level, prior informatics training, and previous EHR exposure) were included; however, given the underpowered sample and limited variables, residual and unmeasured confounding (eg, informal IT training or personal interest in technology) cannot be excluded.

The significance level was set at an α value of .05. Effect sizes were interpreted using the Cohen standards for correlations (small=0.10; medium=0.30; large=0.50), and F change statistics were used to assess changes in R² values across regression models. As the final sample was below the a priori target (N=243 vs 315), all inferential analyses should be considered exploratory and hypothesis generating rather than confirmatory.

Institutional review board approval from the University of Hail (H-2024-437) was obtained prior to data collection. Participation was entirely voluntary and no financial compensation was provided to the participants. All procedures were conducted in accordance with the ethical standards of the Research Ethics Committee and the 1964 Declaration of Helsinki and its subsequent amendments.

Informed consent was obtained from all students prior to accessing the online survey and questionnaire. Participation was entirely voluntary, and students had the right to withdraw at any time without adverse academic consequences. To preserve participants’ anonymity, no personal identifiers (such as names or email addresses) were collected through Google Forms, and the researchers did not link any responses to individual participants. The dataset was stored on a secure, password-protected server, and access was limited to the research team members.

This study posed an extremely low risk as it involved noninvasive procedures and presented no more than minimal risk to the participants. The participants’ normal coursework was not affected, and it was clearly stated that their decision to participate or not would have no impact on their academic status or their relationship with faculty members.

These results have significant implications for nursing education and policy in Saudi Arabia. Considering the moderate level of informatics competency, curricular reform is needed to align nursing students with the digital elements of Vision 2030. This can be achieved not only by viewing faculty as presenters of subject matter but also by emphasizing authentic learning experiences. This could be further aided by incorporating a specific informatics module or student engagement activities that rely on EHRs and digital health technologies, which have demonstrated successful clinical experiences in American and Canadian programs. Finally, it is of utmost importance to formalize partnerships between universities and practice settings to ensure that students have authentic experience with real-time informatics in practice settings. These initiatives could yield a digitally competent workforce that can use technology in patient care and contribute to health initiatives in the future.

This single-site survey found that undergraduate nursing students at the University of Hail showed noticeable gaps in informatics competency even though many reported moderate to high confidence in using digital technologies. This highlights the need to revisit the current curriculum considering Saudi Vision 2030 and its emphasis on digital health. The findings also suggest that being comfortable with everyday technology does not necessarily mean that students are prepared with the informatics skills required in clinical settings.

Students with prior exposure to informatics content or experience with EHRs generally demonstrated better competency levels. However, the study sample was smaller than originally planned, and the statistical analyses were not sufficiently powered. Therefore, any observed relationship, including the weak link between digital technology self-efficacy and informatics competency, should be interpreted with caution and considered exploratory.

It is also important to note that this study relied on a single-site convenience sample and self-reported data, both of which limit the generalizability of the findings. These factors may also lead to an overestimation of the actual competency levels. Therefore, the results are best understood as specific to this context rather than reflective of all nursing students in Saudi Arabia. Nevertheless, this study offers useful baseline information that can support local curriculum improvements and inform future research, particularly larger multisite or mixed methods studies aimed at strengthening nursing informatics education in the country.