Optimizing cognitive load in digital nursing education: the role of pre-academic performance and material modalities

Li, Yawen; Yan, Chuchu; Ye, Han; Liu, Mengnan; Xiang, Leyuan; Lu, Haiying; Shan, Yawei · 2026 · DOAJ

DOI: 10.1186/s12909-026-09230-7

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Summary

This study investigates how pre-academic performance and digital learning material modalities influence cognitive load and learning outcomes in nursing education. Motivated by the rapid expansion of digital learning and the lack of psychophysiological evidence regarding aptitude-by-modality interactions, the research aims to optimize instructional design by understanding how students with varying academic preparedness process different types of multimedia content. The authors hypothesize that both learner expertise and material format significantly impact cognitive engagement and performance. The researchers conducted a 2 × 3 factorial psychobehavioral experiment involving 58 undergraduate nursing students, stratified into high and low pre-academic performance groups based on cumulative GPA. Participants were exposed to three digital material modalities: text-only, text-graphic composite, and video-based. To capture both subjective and objective cognitive states, the study utilized the NASA Task Load Index (NASA-TLX) for subjective load assessment and eye-tracking technology to measure oculometric indices such as total fixation duration. Learning performance was evaluated through achievement scores and a novel metric, knowledge acquisition efficiency, defined as the ratio of achievement scores to total fixation duration. Statistical analysis employed two-way analysis of covariance (ANCOVA) with covariates for demographic differences and self-efficacy, alongside Pearson correlation analyses. Results from the 55 valid cases revealed that learners with high pre-academic performance experienced significantly lower subjective cognitive load and achieved superior learning performance compared to their low-performance counterparts. Conversely, low-performance learners suffered from cognitive overload, particularly when engaging with text-based materials. Among the modalities, video-based materials induced the lowest cognitive load across all knowledge modules. However, text-graphic composites achieved optimal learning efficiency despite imposing moderate cognitive load, suggesting a balance between effort and outcome. Notably, no significant interaction effects were observed between pre-academic performance and material modality, indicating that the effects of learner aptitude and material type were additive rather than interactive. The findings underscore that lower perceived cognitive load does not automatically equate to more effective learning, highlighting the need for instructional strategies that align material modality with individual cognitive characteristics. The study concludes that a cognitive-material alignment framework, integrating knowledge typology and dynamic adaptation mechanisms, is essential for preventing cognitive overload in at-risk learners. By demonstrating that text-graphic composites offer high efficiency and videos reduce load, the research provides evidence-based recommendations for designing digital nursing curricula that accommodate diverse learner aptitudes.

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• mental demand