Effectiveness of Interactive Digital Textbooks on Learning Outcomes Among Nursing Students: A Systematic Review and Meta-Analysis

Background: Interactive digital textbooks (IDTs) combine multimedia, interactivity, embedded assessment, and immediate feedback within a unified learning resource. These features may support technology-enhanced, learner-centered nursing education. Objective: To determine whether IDTs improve nursing students’ knowledge, skills, learning motivation, and competence compared with traditional or noninteractive educational approaches. Methods: This was a systematic review and meta-analysis. PubMed, MEDLINE, the Cochrane Library, Ovid MEDLINE, databases accessed through EBSCOhost, Scopus, Web of Science Core Collection, ScienceDirect, China National Knowledge Infrastructure, Wanfang Data, and China VIP Journal Database were searched from inception through August 1, 2026; reference lists were also screened. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated using random-effects models. Risk of bias was assessed with RoB 2 for randomized controlled trials and RoBANS for nonrandomized studies. Subgroup analyses were conducted by study design, and sensitivity analyses were performed by excluding outliers. Results: Eight studies (4 randomized controlled trials and 4 quasi-experimental studies; 579 participants) were included. IDTs improved knowledge (5 studies; SMD, 0.59; 95% CI 0.23-0.95), skills (4 studies; SMD, 0.73; 95% CI 0.19-1.27), and learning motivation or competence (6 studies; SMD, 1.00; 95% CI 0.45-1.55). Knowledge and motivation findings remained robust in sensitivity analyses, whereas the effect on skills was nonsignificant in the randomized controlled trial (RCT)-only analysis. Heterogeneity was moderate to high. Conclusions: IDTs appear to improve knowledge acquisition and learning motivation in nursing education. Effects on skills and competence are promising but less certain because of heterogeneity, variation in outcome measures, and the limited number of randomized trials. Well-designed, adequately powered trials using standardized outcomes and longer follow-up are needed.