Perceived Effectiveness and Barriers Influencing Blended Learning Implementation in Nursing Education: A Mixed Methods Study in Buea, Cameroon

Abstract

Background: Despite growing recognition of blended learning benefits in nursing education, implementation in resource-constrained African contexts faces substantial barriers. Understanding perceived effectiveness and implementation challenges is essential for successful adoption in Cameroonian nursing schools.
Methods: A mixed-method study was conducted from December 2023 to July 2024 in three nursing institutions in Buea, Cameroon. The quantitative component recruited 385 nursing students and 90 instructors using multi-stage sampling, while the qualitative component involved purposive sampling of 12 class delegates. Structured questionnaires assessed perceived effectiveness and barriers, while semi-structured interviews explored implementation experiences. Data were analyzed using SPSS version 27 for quantitative analysis and thematic analysis for qualitative data. Chi-square tests determined associations between variables at p<0.05 significance.
Results: Among students, 373 (96.9%) perceived blended learning as effective for enhancing flexibility, 367 (95.3%) for improving access to learning materials, and 354 (91.9%) for developing technology skills. However, only 12(3.1%) perceived blended learning as effective for replacing face-to-face clinical instruction. Major barriers included internet connectivity issues (reported by 89.6% of students and 92.2% of instructors), electricity supply challenges (78.4% students, 85.6% instructors), inadequate technological resources (81.3% students, 88.9% instructors), insufficient technological literacy (63.6% students, 71.1% instructors), and instructor unwillingness to adopt new methods (52.7% students, 43.3% instructors). Qualitative findings revealed four major themes: infrastructure deficiencies, pedagogical concerns, resource limitations, and resistance to change. Chi-square analysis showed significant associations between perceived effectiveness and academic level (p=0.018), prior technology experience (p=0.003), and institutional affiliation (p=0.029).
Conclusion: While nursing students and instructors perceive blended learning as effective for enhancing flexibility and resource access, substantial barriers related to infrastructure, resources, and human capacity impede implementation. Successful blended learning adoption in Cameroonian nursing education requires comprehensive interventions addressing technological infrastructure, faculty development, resource provision, and institutional support systems.