Currently accepted at: JMIR Research Protocols
Date Submitted: Jul 2, 2026
Date Accepted: Oct 23, 2026
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/106108
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Study Protocol with Pilot Testing for a Cross-Sectional Study: Cloud-Based Nursing Documentation Usability and Nurses’ Digital Literacy and Their Impact on Nursing Care Quality—The Mediating Role of Workflow Efficiency
ABSTRACT
Background:
Healthcare systems are rapidly moving toward digital solutions, including cloud-based nursing documentation systems. While these systems aim to improve care, their success depends on usability and nurses’ digital literacy. However, it remains unclear how these factors influence nursing care quality and whether workflow efficiency mediates this relationship.
Objective:
This study aims to examine the effect of cloud-based system usability and nurses’ digital literacy on nursing care quality, and to test whether workflow efficiency acts as a mediating factor.
Methods:
A correlational cross-sectional design will be used. Data will be collected from 350 nurses working in three hospitals in the Hail Health Cluster, Saudi Arabia, using stratified random sampling. A structured questionnaire will include the System Usability Scale (SUS), eHealth Literacy Questionnaire (eHLQ), Workflow Efficiency Instrument, and Quality of Nursing Care Scale (QNCS). A pilot study was conducted with 45 nurses to assess feasibility and instrument performance, not to test study hypotheses. The pilot confirmed the questionnaire was practical (completion time 30–35 minutes), with missing data <5%, no item deletion, and acceptable reliability: SUS (α = 0.77), eHLQ (α = 0.82), Workflow Efficiency (α = 0.79), and QNCS (α = 0.72). Data will be analyzed using Structural Equation Modeling (SEM) to examine direct and indirect relationships. Ethical approval was secured from the ethical committee of Lincoln University College (Ref. No.: LUC/DVCECA/26022026/033) on February 26, 2026.
Results:
The study was funded in January 2026. The enrollment of participants started on March 18, 2026, and the required sample (n = 350) enrollment was completed in May 2026. Data analysis will begin after completion of data collection, and results are expected to be submitted for publication in August 2026. The main study findings will provide evidence on the relationships between system usability, digital literacy, workflow efficiency, and nursing care quality.
Conclusions:
The pilot confirmed the feasibility and reliability of the tools. The main study will provide evidence on the relationships between system usability, digital literacy, workflow efficiency, and nursing care quality. Findings are expected to guide healthcare administrators in optimizing system design, training, and workflows to enhance nursing practice and patient outcomes, supporting the digital transformation goals of Saudi Vision 2030. Clinical Trial: No registration is required, and it has no intervention
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.