Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 21, 2025
Open Peer Review Period: Jun 23, 2025 - Aug 18, 2025
Date Accepted: Sep 23, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited.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.
Optimising Digital Health Education for Knee Arthroplasty: Effects of Multimedia Modalities and Learning Motivation from a Cognitive Load Perspective
ABSTRACT
Background:
Effective preoperative digital health education (DHE) for patients undergoing knee arthroplasty (KA) requires optimising cognitive load and learning performance, particularly among older adults with age-related cognitive limitations. Although multimedia modalities and learning motivation are recognised as influential factors, their combined effects and underlying cognitive mechanisms remain insufficiently explored in KA education.
Objective:
This study aims to explore how learning motivation influences cognitive load and learning performance across different modalities (text, text-graphic composite, and video-based) in the preoperative health education of KA.
Methods:
A 2×3 factorial experiment was conducted with 62 KA patients stratified by learning motivation (high vs. low). Participants engaged with DHE materials in three modalities (text, text-graphic composite and video-based). Cognitive load was assessed using subjective measures (NASA-TLX) and objective eye-tracking metrics (average fixation duration, number of fixation points, duration before the first fixation). Learning performance was evaluated via knowledge retention and transfer tests. Data were analyzed using general linear models, Two-way ANOVA analyzing and Pearson correlations.
Results:
High-motivation learners exhibited significantly lower cognitive load (NASA-TLX: F= 37.625, p < 0.001) and superior learning performance (F= 34.000, p < 0.001) compared to low motivation patients. Video-based materials induced the lowest cognitive load, while text-graphic composites promoted deeper learning despite higher load. Cognitive load negatively correlated with learning performance (r = -0.32, p< 0.001). Eye-tracking revealed that high-motivation learners adapted attention strategies across modalities, whereas low-motivation learners struggled with extraneous load in text-graphic formats.
Conclusions:
Learning motivation and multimedia modality interact to influence cognitive load and learning effectiveness in preoperative DHE for KA patients. Video-based materials support cognitive efficiency, while text-graphic composites may benefit motivated learners by enhancing germane load. To optimise patient education outcomes, DHE should incorporate motivational scaffolding, adaptive modality matching, and real-time cognitive load monitoring.
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Copyright
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