International Journal of Interactive Mobile Technologies (iJIM) – eISSN: 1865-7923 – Vol  17 No  13 (2023) Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference among Omani Nursing Students? https://doi.org/10.3991/ijim.v17i13.39409 Anitha Nesa Thanka1, Jansirani Natarajan2, Mickael Antoine Joseph2() 1 Adult Health and Critical Care Department, Sultan Qaboos University, Muscat, Oman 2 Fundamentals and Administration Department, Sultan Qaboos University, Muscat, Oman mickaelj@squ.edu.om, mickaelantoinejoseph@gmail.com Abstract—With the growing popularity of technology among millennial nursing students and the shift in publishers' focus toward electronic textbooks (e- books), there is a need to understand students' perceptions, preferences, and sat- isfaction related to e-books in nursing education, particularly in Oman, a country in the Gulf region with a lack of studies on this subject. This study examined the perceived usefulness, challenges, and satisfaction with e-books compared to printed textbooks, among Omani nursing students. A descriptive cross-sectional design was employed, and data were collected from a convenience sample of 77 students who used e-books in a community health nursing course. A valid and reliable survey was administered during the fall 2020 semester. The findings re- vealed that despite identifying more challenges associated with printed text- books, the majority of students (74%) preferred them to e-books. Additionally, 71.4% of students reported a low level of satisfaction with e-books. Female stu- dents demonstrated a higher preference for printed textbooks and lower satisfac- tion with e-books compared to male participants. These results highlight the need to address students' concerns and preferences when implementing e-books in nursing education. This study contributes to the understanding of nursing stu- dents' preferences and satisfaction with e-books, as well as the gender differences observed in this context. Further research is needed to investigate interventions to improve the adoption and effectiveness of e-books in nursing education. Keywords—electronic books, textbooks, nursing students, preference, satisfac- tion, Oman 1 Introduction The internet has transformed the lives of students worldwide. It has changed the ways in which they communicate and socialize with others, and most importantly, it has enormously affected their learning [1]. The internet has also affected students’ read- ing patterns and with widespread advancement in technology, has led to changes in their university textbooks and wider academic lives [2]. Electronic books, commonly known as e-books, have gained substantial interest recently, due to the many potential iJIM ‒ Vol. 17, No. 13, 2023 133 https://doi.org/10.3991/ijim.v17i13.39409 mailto:mickaelj@squ.edu.om Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… benefits they have over printed textbooks [3]. E-books can be defined as the electronic version of printed textbooks which can be read on a computer or any other electronic device [4]. E-books are easily accessible, flexible (they can be used at any time), dy- namic, and cheaper than their printed counterparts [5]. Although there is evidence that other forms of technological advancement have helped to enhance students’ learning outcomes, engagement with lectures, and their level of satisfaction with their learning environment [6], the benefits of using e-books have not yet been extensively investi- gated. Numerous learning theories emphasize the potential benefits of using electronic mul- timedia for education. In our study, we followed two prominent learning theories: the Multimedia Learning Theory and the Technology Acceptance Model. The Multimedia Learning Theory, developed by Mayer and colleagues [7], posit that using both visual and auditory channels for learning is essential. This theory implies that e-books may offer multimedia learning opportunities, as they can embed videos and interactive ele- ments within the electronic versions of the books. This has the potential to impact stu- dents’ preferences and satisfaction. Furthermore, the Technology Acceptance Model aims to investigate users’ acceptance of technology based on perceived ease of use and perceived usefulness. This model could help explain whether gender differences exist in the acceptance of e-books versus printed textbooks [8]. The pandemic has made the use of electronic devices a necessity. Since then, e- learning has become increasingly essential, and many universities that already had an e-learning platform, but did not use it before the pandemic, saw a significant increase in its use during the pandemic [9]. Moreover, many new e-learning tools have been developed to help teachers better understand their students' strengths and weaknesses, evaluate lessons, improve the educational process, and assess their own performance [10]. During the COVID-19 pandemic, the use of e-books became necessary due to the closures of universities and libraries worldwide, signifying how beneficial e-books can be for the continuation of education in uncertain times such as a pandemic. Probably one of the most major benefits of e-books is their lower cost compared to printed textbooks [5]. Another important feature that could interest students, is their convenience. Students can access e-books remotely, from the comfort of their home, they can annotate, add documents, and copy and paste sentences into their notes, and searching for a key word has never been easier [11]. These annotative capabilities are one of the best features of e-books. Moreover, e-books are easy to carry–students do not have to hold heavy books when they can carry their e-book in their pocket [12]. The last notable benefits are that research has shown that e-books can optimize reading time, as students can study whenever they want, including on their way to and from the uni- versity and that reading an e-book is fun and engaging [12, 13]. Although they are convenient and cost-effective, studies have shown that e-books can pose some challenges to students. While e-books can be read on smartphones, some students complain that the small size of a phone’s screen can make reading difficult, especially in combination with a phone’s limited system for navigating the text. Addi- tionally, some students feel disoriented when reading an e-book on a screen [3], and the limited battery life of current smartphones poses a challenge for the wider adoption of e-books [14]. Therefore, often students feel compelled to buy e-book readers which 134 https://www.i-jim.org Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… have a bigger screen, better lighting, and a better navigation system, but are more ex- pensive. This negates the advantage of e-books being cheaper than printed textbooks. Results to date are conflicting on whether students prefer e-books or printed text- books. On the one hand, Lim and Hew [14] have found that the use of an e-book by tertiary level diploma students of the life science and engineering fields was perceived positively and increased students’ engagement. Other studies have also found that stu- dents’ level of satisfaction with e-books is generally very high, and this is due to the better availability and easy access of e-books [15, 16]. Shelburne [17] has argued that the increased use of e-books in higher education is affecting students’ perceptions and attitudes, and that students find e-books superior to printed textbooks. On the other hand, students have also complained that e-books do not allow them to assess the length of paragraphs and that it is difficult to read tables and graphics in an e-book format [18]. Students have also complained about spending long hours staring at screens when reading e-books and reported issues arising from long screen times [19]. According to a study by Gregory [20], 66% of students preferred a printed textbook over an e-book, whereas only 44% had a positive attitude towards both types of books. Currently, most e-books are merely the same version as the traditional book, which is instead read online, limiting the potential benefits of the electronic version. Gender differences have been studied in relation to the acceptance of e-books [21]. For example, research has shown that females tend to prefer printed books while males are more inclined to use e-books [22]. This difference may be attributed to the fact that males are generally more technologically savvy than females [21]. A study conducted in the United States also found that men are more likely to select e-books, while women are more likely to choose printed textbooks. However, regarding satisfaction, useful- ness, and ease of use of e-books, there is no significant difference between genders [23]. Conversely, a study from South Africa revealed that gender has no effect on the inten- tion to use e-books [24]. On the other hand, a study from Libya found that females are more confident in using e-books than males [25]. The findings of various studies on the comparative effectiveness of e-books and printed textbooks, as well as the potential impact of gender, have been inconclusive. Consequently, further research is required to investigate these questions more thor- oughly. Also, many these challenges have only been observed for students in Western cultures and it remains worthy to investigate whether students in other regions, such as Omani nursing students, face the same challenges. Most studies to date have been con- ducted in the West in regions such as the United States and Europe [14], making a study in Oman, a non-Western culture, of obvious value. There is a lack of research on the preference, challenges, and satisfaction of using e-books among nursing students in the Gulf region, specifically in Oman. Additionally, there is a gap in research on gender differences in the preference, challenges, and satisfaction of using e-books compared to printed textbooks among nursing students in Oman. Therefore, this study aims to fill these gaps in the literature by investigating the preferences, challenges, and satisfaction levels of using e-books compared to printed textbooks among Omani nursing students, and exploring potential gender differences in these areas. To the best of our knowledge, this is the first study on the preference, challenges, and satisfaction of using e-books in the Gulf region along with gender differences. iJIM ‒ Vol. 17, No. 13, 2023 135 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… Our research addressed the following questions: What are the preferences of nursing students regarding e-books versus printed textbooks? What challenges do Omani nurs- ing students face when using e-books as opposed to printed textbooks? How satisfied are Omani nursing students with e-books in comparison to printed textbooks? Lastly, are there any gender differences in the preferences, challenges, and satisfaction levels of Omani nursing students when using e-books versus printed textbooks? 2 Methods 2.1 Study design To address our research questions related to the preference, challenges, and satisfac- tion of nursing students with e-books and printed textbooks, we have chosen to use a cross-sectional descriptive study design. We believe that a cross-sectional design is the most appropriate approach for our study because it enables us to gather data from a sample of nursing students and analyze their responses. Additionally, the descriptive nature of our study design allows us to provide a clear understanding of the preference, challenges, and satisfaction of nursing students, as well as any potential gender differ- ences in their experiences. In summary, a cross-sectional descriptive study design will enable us to answer our research questions and provide valuable recommendations for the use of e-books in nursing education. 2.2 Setting and participants In Fall 2020, Wolters Kluwer publisher began offering electronic versions of nursing textbooks with enhanced features, such as screen-reading, book marking, highlighting, searching, note taking and enhanced navigation. These e-books were available for download from the Wolters Kluwer website and could be installed on laptops or mobile devices using a specific code for each book. The nursing program at the College of Nursing at Sultan Qaboos University conducted a trial of these new e-books for com- munity health nursing students in the Fall 2020 semester, as students had previously used only printed textbooks. Students in this course were given the opportunity to use e-books for this community course while continuing to use printed textbooks for other courses, making them a convenient sample for this study. Participants were chosen be- cause they were enrolled in the community health nursing course, and no incentives were provided for participation. A total of 95 students were approached for the study, and 77 students completed the survey (81% response rate) to assess their preferences regarding the usefulness, challenges, and satisfaction with e-books. 2.3 Data collection and procedures The College of Nursing at Sultan Qaboos University is a prestigious nursing college that offers undergraduate and postgraduate nursing programs. The undergraduate nurs- 136 https://www.i-jim.org Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… ing program consists of nine semesters and includes courses totaling 130 credits. Nurs- ing students from across Oman are trained at the college and enjoy free access to its resources and facilities. During the COVID-19 pandemic, the college piloted the use of e-books among un- dergraduate nursing students to assess their preferences based on the usefulness, chal- lenges, and satisfaction with e-books versus paper textbooks. Based on the findings, decisions will be taken to use e-books for other nursing courses. For the Fall 2020 se- mester, students in the Community Health Nursing course were provided with the e- book version of "Community Health Nursing" (3rd edition, 2019, by Rosanna F. De- Marco and Judith Healey-Walsh, ISBN: 9781975111694, published by Wolters Kluwer). These students became the study participants. For this study, we adopted a survey by Silas Marques de Oliveira in 2012, with the author’s permission, and modified it to suit our cultural context [26]. The survey has two parts. Part 1 is an online self-reporting survey that includes demographic charac- teristics of the nursing students, such as age, gender, cumulative grade point average (GPA), and the number of credits registered. Part 2 consists of statements on the per- ceptions of usefulness (22 items) and challenges (3 items) of using e-books versus printed textbooks. Responses were rated on a 3-point Likert scale (1 - e-book is better, 2 - printed book is better, 3 – both are the same). Satisfaction with e-books was meas- ured with 7 items, using a 5-point Likert scale (1 - strongly disagree, 2 - disagree, 3 - neutral, 4 - agree, 5 - strongly agree). The minimum score is 7, and the maximum score is 35. A score of 7 to 21 indicates a low level of satisfaction, while a score above 21 indicates a high level of satisfaction. The Cronbach's alpha of our study population was 0.806, indicating high levels of reliability. After obtaining approval from the College Research and Ethics Committee, we sought permission from the course coordinator to access the students' email addresses. We provided students with an informed consent form and a Google Form link to the survey, after explaining the purpose of the study, as well as the confidentiality and an- onymity of the survey. We assured nursing students that participation was voluntary and that they could withdraw from the study at any time. We also informed them that their participation would not affect their course grades in any way. Once the students completed and submitted the online surveys, the data was stored in a password-protected computer to ensure confidentiality and data security. 2.4 Statistical analysis After cleaning the data, we conducted data analysis using IBM SPSS software ver- sion 23. Descriptive statistics, including frequency, percentage, mean, and standard de- viation, were used to summarize the data. We used the chi-square test to understand the students' preferences and to identify differences in perceptions between nursing stu- dents and their demographic variables. iJIM ‒ Vol. 17, No. 13, 2023 137 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… 2.5 Ethical consideration We obtained ethical approval for this study from the College Research and Ethics Committee at the College of Nursing. To ensure the privacy of nursing students, all personal identifiers were kept anonymous. We provided detailed information about the research purpose and methods before collecting data and approached potential partici- pants through emails. To further protect their privacy, we used coding to avoid identi- fying participants by name. All data were saved in password-protected files on a computer that was also pass- word-protected to ensure data security. 3 Results Overall, 77 participants were included in this study. The mean age of the participants was 22.01 ± 0.925 years, and the majority (81.8%) were female. Most participants (50.6%) had a cumulative GPA between 2 and 3 and had registered for 13.66 ± 1.971 credits for the semester. Demographic characteristics of the participants are presented in Table 1. Table 1. Demographic characteristics of the participants Demographic Characteristics Categories Frequency Percentage Gender Male 14 18.2 Female 63 81.8 CGPA* Below 2 1 1.3 2-3 39 50.6 3.1-3.5 34 44.2 3.6-4 3 3.9 Age Mean=22.01 SD=.925 Number of credits registered Mean=13.66 SD=1.971 * cGPA: cumulative Grade Point Average To address the research questions concerning nursing students' preferences for e- books or printed textbooks, Table 2 displays the participants' preferences based on the books' usefulness. The participants reported that printed textbooks were useful in the following aspects: providing a good learning experience (70.1%), easy to maintain at- tention and concentration (77.9%), ease of reading (64.9%), pleasure of reading (68.8%), ease of marking a place (59.7%), ability to highlight (49.4%), tangibility (able to touch and feel) (76.6%), and ease of organizing (50.6%). In contrast, students pre- ferred e-books for their possibility to share (62.3%), ease of making copies (64.9), quick referencing (64.9%), and searching capabilities (66.2%). 138 https://www.i-jim.org Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… Table 2. Preference of e-books versus print textbooks based on the usefulness SN Factors or Features of Usefulness E Books are Better Print Books are Better They are same Chi- Square P Value N (%) N (%) N (%) 1 Provides a good learning experience 12 (15.6) 54 (70.1) 11 (14.3) 46.935 .000 2 Easy to maintain attention and con-centration 9 (11.7) 60 (77.9) 8 (10.4) 68.909 .000 3 Ease of reading 14 (18.2) 50 (64.9) 13 (16.9) 34.623 .000 4 Pleasure of reading 12 (15.6) 53 (68.8) 12 (15.6) 43.662 .000 5 Ease of marking a place 22 (28.6) 46 (59.7) 9 (11.7) 27.455 .000 6 Up-to-date 39 (50.6) 19 (24.7) 19 (24.7) 10.39 .006 7 Available everywhere 41 (53.2) 23 (29.9) 13 (16.9) 15.688 .000 8 Flexibility 33 (42.9) 32 (41.6) 12 (15.6) 10.935 .004 9 24/7 accessibility 30 (39) 26 (33.8) 21 (27.3) 1.584 .453 10 Ability to Highlight 18 (23.4) 38 (49.4) 21 (27.3) 9.065 .011 11 Clear graphics and images 24 (31.2) 21 (27.3) 32 (41.6) 2.519 .284 12 Tangibility (able to touch and feel) 8 (10.4) 59 (76.6) 10 (13) 65.013 .000 13 Easy to use multiple documents at once 30 (39) 29 (37.7) 18 (23.4) 3.455 .178 14 Easy to organize 19 (24.7) 39 (50.6) 19 (24.7) 10.39 .006 15 Possibility to share 48 (62.3) 13 (16.9) 16 (20.8) 29.325 .000 16 Ease of making copies 50 (64.9) 15 (19.5) 12 (15.6) 34.779 .000 17 Portability/Transportability 38 (49.4) 25 (32.5) 14 (18.2) 11.247 .004 18 Quick reference 50 (64.9) 16 (20.8) 11 (14.3) 35.091 .000 19 Convenience 26 (33.8) 31 (40.3) 20 (26) 2.364 .307 20 Ease of navigation/Browsing 37 (48.1) 24 (31.2) 16 (20.8) 8.753 .013 21 Space/Storage capability 37 (48.1) 27 (35.1) 13 (16.9) 11.325 .003 22 Searching capabilities 51 (66.2) 14 (18.2) 12 (15.6) 37.584 .000 To address the research questions about the challenges faced by nursing students when comparing e-books and printed textbooks, Table 3 indicates that 54.5% of partic- ipants reported experiencing eyestrain or discomfort with e-books, while 48.1% men- tioned navigation and reading aloud facilities as challenges associated with printed text- books. Table 3. Challenges faced with e-books and printed textbooks SN Challenges Faced E-Books Print Books They are same Chi- Square P Value No (%) No (%) No (%) 1 Discomfort/difficulty reading from the screen/eye strain 42(54.5) 29(37.7) 6(7.8) 25.896 .000 2 Pages take too long to navigate/ too slow 24(31.2) 37(48.1) 16(20.8) 8.753 .013 3 No facility to have the text read out loud 25(32.5) 37(48.1) 15(19.5) 9.455 .009 iJIM ‒ Vol. 17, No. 13, 2023 139 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… In addressing the research questions about nursing students' satisfaction with e- books, Figure 1 reveals that the majority (71.4%) of participants had a low level of satisfaction with e-books. Fig. 1. Satisfaction with e-books To understand whether gender has a difference in satisfaction levels for e-books, the chi-square analysis was conducted between satisfaction and demographic variables. The results showed that females had lower satisfaction levels with e-books compared to male participants, which was significant at χ²(1) = 6.844, p = .009 (Table 4). Table 4. Difference in satisfaction with e-books based on gender Demographic charac- teristics Category Satisfaction Chi square value P value Low satisfaction (Up to 21) Good satisfaction (above 21) Gender Male 6 (10.9%) 8 (36.4%) 6.844 0.009 Female 49 (89.1%) 14 (63.6%) Significant differences were reported between male and female nursing students re- garding their preference of books based on usefulness, and the chi-square analysis is presented in Table 5. Male students preferred e-books more than female students in many aspects, such as providing a good learning experience (42.9% vs. 9.5%, respec- tively), availability everywhere (85.7% vs. 46%), flexibility (78.6% vs. 34.9%), 24/7 accessibility (71.4% vs. 31.7%), ability to highlight (57.1% vs. 15.9%), tangibility (35.7% vs. 4.8%), easy to use multiple documents at once (71.4% vs. 31.7%), easy to organize (57.1% vs. 17.5%), possibility to share (92.9% vs. 55.6%), ease of making copies (92.9% vs. 58.7%), portability (85.7% vs. 41.3%), quick referencing (92.9% vs. 71.4% 28.6% 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 Percentage of Students Low satisfaction (upto 21) Good satisfaction (above 21) 140 https://www.i-jim.org Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… 58.7%), and convenience (78.6% vs. 23.8%). Female students reported that printed textbooks were useful in the majority of aspects. There were no significant differences reported with other demographic characteristics of the participants. Moreover, there were no significant differences between the challenges of using e-books and printed textbooks and any of the demographic variables. Table 5. Preferences of e-books versus printed textbooks based on gender SN Factors or Features of Usefulness Gender E-Books are Better Print Books are Better They are same Chi- Square P Value N (%) N (%) N (%) 1 Provides a good learning experience Male 6 (42.9) 6 (42.9) 2 (14.3) 9.981 .007 Female 6 (9.5) 48 (76.2) 9 (14.3) 2 Available everywhere Male 12 (85.7) 0 (0) 2 (14.3) 8.567 .014 Female 29 (46) 23 (36.5) 11 (17.5) 3 Flexibility Male 11 (78.6) 1 (7.1) 2 (14.3) 9.988 .007 Female 22 (34.9) 31 (49.2) 10 (15.9) 4 24/7 accessibility Male 10 (71.4) 1 (7.1) 3 (21.4) 8.436 .015 Female 20 (31.7) 25 (39.7) 18 (28.6) 5 Ability to Highlight Male 8(57.1) 3 (21.4) 3 (21.4) 11.263 .004 Female 10 (15.9) 35 (55.6) 18 (28.6) 6 Tangibility (able to touch and feel) Male 5 (35.7) 8 (57.1) 1 (7.1) 11.86 .003 Female 3 (4.8) 5 (81) 9 (14.9) 7 Easy to use multiple documents at once Male 10 (71.4) 3 (21.4) 1 (7.1) 7.756 .021 Female 20 (31.7) 26 (41.3) 17 (27) 8 Easy to organize Male 8 (57.1) 4 (28.6) 2 (14.3) 9.705 .008 Female 11 (17.5) 35 (55.6) 17 (27) 9 Possibility to share Male 13 (92.9) 0 (0) 1 (7.1) 6.977 .031 Female 35 (55.6) 13 (20.6) 15 (23.8) 10 Ease of making copies Male 13 (92.9) 0 (0) 1 (7.1) 6.17 .046 Female 37 (58.7) 15 (23.8) 11 (17.5) 11 Portability/ Transport-ability Male 12 (85.7) 2 (14.3) 0 (0) 9.438 .009 Female 26 (41.3) 23 (36.5) 14 (22.2) 12 Quick reference Male 13 (92.9) 0 (0) 1 (7.1) 6.221 .045 Female 37 (58.7) 16 (25.4) 10 (15.9) 13 Convenience Male 11 (78.6) 2 (14.3) 1 (7.1) 15.377 .000 Female 15 (23.8) 29 (46.0) 19 (30.2) 4 Discussion This study was conducted with the aim of exploring the perceptions and preferences of Omani nursing students regarding e-books and printed textbooks, which have not been extensively explored in previous research. The study results revealed that, in gen- eral, Omani nursing students exhibited a greater preference for and satisfaction with iJIM ‒ Vol. 17, No. 13, 2023 141 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… printed textbooks rather than e-books. Furthermore, our findings highlighted a gender difference, with female students tending to prefer printed textbooks, while male stu- dents favored e-books. More specifically, nursing students preferred printed textbooks for specific useful features, such as providing a good learning experience, maintaining attention and con- centration, ease and pleasure of reading, ease of marking and highlighting, tangibility and easy organization. This preference for printed textbooks is consistent with findings from previous studies, which have also reported that printed textbooks are still relevant and preferred by students at various academic levels [27-29]. However, students who preferred printed textbooks also felt that they were easier on their eyes and reduced strain and eye fatigue, which is consistent with studies that have linked increased screen time to eye fatigue [30]. Moreover, nursing students reported experiencing fewer dis- tractions and increased concentration when using printed textbooks, which is in line with the finding of two studies reporting a higher likelihood of multitasking and dis- tractions when using digital devices for learning [30, 31]. In this study, nursing students preferred e-books for their up –to-date content, avail- ability, flexibility, ease of sharing, easy copying, portability, quick referencing, and ease of storage. The easy portability of e-books makes them particularly useful. These findings are consistent with other recent studies, which have reported similar ad- vantages of e-books, particularly in terms of convenience, availability, and ease of ac- cessing information [30, 32, 33]. One study even found that the use of e-books led to improved student learning outcomes [34]. Some studies have reported that students who had perceived higher levels of expectations, usefulness and enjoyment or playfulness had higher satisfaction with e-books and expressed the intention to continue using them [35, 36]. To improve student satisfaction and engagement, considering these findings, nursing faculty can provide additional attractive and interactive features like highlight- ing, note-taking, creating flashcards as a pre-preparation for case study discussions in the classroom. Educating students and faculty about the various features of e-books can also increase their satisfaction [5, 37]. As today's tech-savvy generation Z higher edu- cation students find e-book technology familiar, which may encourage those who oth- erwise don't enjoy reading, it is essential to make e-books in nursing more tech-savvy and better suited for the fast-paced modern world. In this study, e-books were intro- duced in the community health nursing course; however, many interesting pictures, videos, and other features could not be included, leading to lower levels of student sat- isfaction. Therefore, before concluding about nursing students' preferences for e-books compared to printed textbooks, educators and administrators should consider introduc- ing e-books in other courses, such as anatomy and physiology, pathophysiology, and adult health nursing. Further research is necessary to identify the relationship between e-books and various factors such as the nature of the course, self-efficacy, technical experience, learning styles, and self-directed learning of the learner. Additionally, re- search studies comparing the learning outcomes and retention of knowledge between printed and e-book could be conducted in future. As we know, clinical instruction is moving towards a new direction, and the use of handheld digital devices with e-books can facilitate immediate referencing of diseases 142 https://www.i-jim.org Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… and management, as well as reviewing of skill videos, which could be a boon for to- day’s nursing students and educators. Further research can support this trend in curric- ulum decisions based on student learning outcomes. Our results also showed that gender significantly influenced preferences and satis- faction with e-books. Male students preferred e-books, while female students preferred printed textbooks. These findings are consistent with Gilbert and Fister [38] research, which found a striking gender gap, with twice as many males as females preferring e- books. Additionally, our results showed that female students had lower satisfaction with e-books compared to male students. Hao and Jackson [39] also found that male students exhibited higher levels of satisfaction with e-books than females. This could be proba- bly due to the fact that male students are believed to be more skilled in technology than female students [40, 41]. Previous research has also shown that e-books users are much more likely to be male students than females [42, 43]. The familiarity of using e-books could explain the gender discrepancy, and the previous experience of males using e- books could be significantly correlated with their preference and level of satisfaction with current e-book use [44]. Thus, nursing educators should recognize that gender might be an important factor to consider when using e-books in the classroom. 5 Conclusion Although the college aimed to provide students with e-books instead of printed text- books, the findings of this study do not support this trend. Students preferred both printed textbooks and e-books for their respective benefits but reported lower satisfac- tion and more challenges with e-books. These results contribute to the theoretical un- derstanding of students' perceptions, preferences, and satisfaction related to e-books in nursing education and gender differences, particularly in the context of Oman, a region with limited studies on this subject. This study has some limitations. The findings cannot be generalized as the partici- pants were selected from a single institution and a specific course. Future research should include a larger sample that represents all levels of the nursing program and multiple institutions. Furthermore, the gender differences observed in this study may be influenced by the fact that the majority of the study population was female. The results cannot be generalized since less than 20% of the population was male. Despite these limitations, the study highlights the importance of considering stu- dents’ preferences and gender when introducing e-books in nursing education. It also underscores the need for information literacy training on e-books' features and usage to enhance students' active learning using digital resources. In summary, caution must be exercised when introducing e-books in nursing educa- tion, considering the learning styles and levels of nursing students. Information literacy training on e-books’ features and usage is crucial for enhancing nursing students’ active learning using digital resources. For the time being, e-books and electronic journals could complement, but not replace, printed resources for student learning. iJIM ‒ Vol. 17, No. 13, 2023 143 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… 6 References [1] Makwanya, C., & Oni, O. (2019). E-Books Preference Compared to Print Books Based on Student Perceptions: A Case of University of Fort Hare Students. International Journal of Interactive Mobile Technologies (iJIM), 13(12): 236-245. https://doi.org/10.3991/ijim. v13i12.10840 [2] Weisberg, M. (2011). Student Attitudes and Behaviors Towards Digital Textbooks. Publish- ing Research Quarterly, 27(2), 188-196. https://doi.org/10.1007/s12109-011-9217-4 [3] Jeong, H. (2012). A comparison of the influence of electronic books and paper books on reading comprehension, eye fatigue, and perception. The Electronic Library, 30(3): 390- 408. https://doi.org/10.1108/02640471211241663 [4] Rickman, J. T., Von Holzen, R., Klute, P. G., & Tobin, T. (2009). A campus-wide e-textbook initiative. Educause Quarterly, 32 [5] Johnston, N., & Ferguson, N. (2020). University Students’ Engagement with Textbooks in Print and E-book Formats. Technical Services Quarterly, 37(1): 24-43. https://doi.org/ 10.1080/07317131.2019.1691760 [6] Karabatzaki, Z., Stathopoulou, A., Kokkalia, G., Dimitriou, E., Loukeri, P. I., Economou, A., & Drigas, A. (2018). Mobile Application Tools for Students in Secondary Education. An Evaluation Study. International Journal of Interactive Mobile Technologies (iJIM), 12(2): 142-161. https://doi.org/10.3991/ijim.v12i2.8158 [7] Mayer, R. E., & Moreno, R. (2003). Nine ways to reduce cognitive load in multimedia learn- ing. Educational psychologist, 38(1), 43-52. https://doi.org/10.1207/S15326985EP3801_6 [8] Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS quarterly, 319-340. https://doi.org/10.2307/249008 [9] Tzavara, A., Lavidas, K., Komis, V., Misirli, A., Karalis, T., & Papadakis, S. (2023). Using Personal Learning Environments before, during and after the Pandemic: The Case of “e- Me”. Education Sciences, 13(1), 87. https://doi.org/10.3390/educsci13010087 [10] Papadakis, A., Barianos, A., Kalogiannakis, M., Papadakis, S., & Vidakis, N. (2022). ARION: A Digital eLearning Educational Tool Library for Synchronization Composition & Orchestration of Learning Session Data. Applied Sciences, 12(17), 8722. https://doi.org/ 10.3390/app12178722 [11] Lam, P., Lam, J., & McNaught, C. (2010). How usable are eBooks in an mLearning envi- ronment? International Journal of Continuing Engineering Education and Life Long Learn- ing, 20(1): 6-20. https://doi.org/10.1504/IJCEELL.2010.031645 [12] Kiriakova, M., Okamoto, K. S., Zubarev, M., & Gross, G. (2010). Aiming at a moving target: Pilot testing eBook readers in an urban academic library. Computers in Libraries, 30(2): 20- 24. [13] Lam, P., Lam, S. L., Lam, J., & McNaught, C. (2009). Usability and usefulness of eBooks on PPCs: How students' opinions vary over time. Australasian journal of educational tech- nology, 25(1). https://doi.org/10.14742/ajet.1179 [14] Lim, E.-L., & Hew, K. F. (2014). Students’ perceptions of the usefulness of an E-book with annotative and sharing capabilities as a tool for learning: a case study. Innovations in Edu- cation and Teaching International, 51(1): 34-45. https://doi.org/10.1080/14703297.2013. 771969 [15] Anuradha, K. T., & Usha, H. S. (2006). Use of e‐books in an academic and research envi- ronment. Program, 40(1): 48-62. https://doi.org/10.1108/00330330610646807 [16] Carlock, D. M., & Maughan Perry, A. (2008). Exploring faculty experiences with e‐books: a focus group. Library hi tech, 26(2): 244-254. https://doi.org/10.1108/07378830810880342 144 https://www.i-jim.org https://doi.org/10.3991/ijim.v13i12.10840 https://doi.org/10.3991/ijim.v13i12.10840 https://doi.org/10.1007/s12109-011-9217-4 https://doi.org/10.1108/02640471211241663 https://doi.org/10.1080/07317131.2019.1691760 https://doi.org/10.1080/07317131.2019.1691760 https://doi.org/10.3991/ijim.v12i2.8158 https://doi.org/10.1207/S15326985EP3801_6 https://doi.org/10.2307/249008 https://doi.org/10.3390/educsci13010087 https://doi.org/10.3390/app12178722 https://doi.org/10.3390/app12178722 https://doi.org/10.1504/IJCEELL.2010.031645 https://doi.org/10.14742/ajet.1179 https://doi.org/10.1080/14703297.2013.771969 https://doi.org/10.1080/14703297.2013.771969 https://doi.org/10.1108/00330330610646807 https://doi.org/10.1108/07378830810880342 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… [17] Shelburne, W. A. (2009). E-book usage in an academic library: User attitudes and behaviors. Library Collections, Acquisitions, and Technical Services, 33(2): 59-72. https://doi.org/ 10.1016/j.lcats.2009.04.002 [18] Eveland, W. P., & Dunwoody, S. (2001). User Control and Structural Isomorphism or Dis- orientation and Cognitive Load?: Learning From the Web Versus Print. Communication re- search, 28(1): 48-78. https://doi.org/10.1177/009365001028001002 [19] Levine-Clark, M. (2006). Electronic Book Usage: A Survey at the University of Denver. Supplementary Material." portal: Libraries and the Academy, 6(3): 285 - 299. https://doi.org/10.1353/pla.2006.0063 [20] Gregory, C. L. (2008). But I Want a Real Book : An Investigation of Undergraduates' Usage and Attitudes toward Electronic Books. Reference and User Services Quarterly, 47: 266- 273. https://doi.org/10.5860/rusq.47n3.266 [21] Srirahayu, D. P., Nurpratama, M. R., Handriana, T., & Hartini, S. (2022). Effect of gender, social influence, and emotional factors in usage of e-Books by Generation Z in Indonesia. Digital Library Perspectives, 38(3), 263-282. https://doi.org/10.1108/DLP-12-2020-0129 [22] Leitão, L., Amaro, S., Henriques, C., & Fonseca, P. (2018). Do consumers judge a book by its cover? A study of the factors that influence the purchasing of books. Journal of Retailing and Consumer Services, 42, 88-97. https://doi.org/10.1016/j.jretconser.2018.01.015 [23] Marston, S., Thrasher, E., & Ciampa, M. (2014). Does gender play a role in the acceptance of e-textbooks by students?. Research in Higher Education Journal, 23, 1. [24] Maduku, D. K. (2015). An empirical investigation of students' behavioural intention to use e-books. Management Dynamics: Journal of the Southern African Institute for Management Scientists, 24(3), 3-20. [25] Smeda, A., Shiratuddin, M. F., & Wong, K. W. (2017). Measuring the moderating influence of gender on the acceptance of e-book amongst mathematics and statistics students at uni- versities in Libya. Knowledge Management and E-Learning, 9(2), 177-199. https://doi.org/ 10.34105/j.kmel.2017.09.011 [26] De Oliveira, S. M. (2012). E‐textbooks usage by students at Andrews University: A study of attitudes, perceptions, and behaviors. Library management. https://doi.org/10.1108/ 01435121211279894 [27] Darsono, D., Winarno, W., & Slamet, S. T. (2018). The Need Textbook Writing of Chil- dren’s Story Based on Character Education. International Journal of Educational Research Review, 3: 1-8. https://doi.org/10.24331/ijere.391780 [28] Letchumanan, M., & Muniandy, B. (2016). How mathematics postgraduate students use mobile e-book? Library Hi Tech News, 33(7): 6-7. https://doi.org/10.1108/LHTN-02-2016- 0009 [29] Piramanayagam, S., & Seal, P. (2020). The Choice Between EBooks and Printed Books: A Study Among Hospitality and Tourism Educators and Learners. Library Philosophy and Practice. [30] Turner, K. L., & Chung, H. (2020). Transition to eBook Provision: A Commentary on the Preferences and Adoption of eBooks by Chemistry Undergraduates. Journal of Chemical Education, 97(5): 1221-1225. https://doi.org/10.1021/acs.jchemed.9b01157 [31] Daniel, D. B., & Woody, W. D. (2013). E-textbooks at what cost? Performance and use of electronic v. print texts. Computers & Education, 62: 18-23. https://doi.org/10.1016/ j.compedu.2012.10.016 [32] Casselden, B., & Pears, R. (2020). Higher education student pathways to ebook usage and engagement, and understanding: Highways and cul de sacs. Journal of Librarianship and Information Science, 52(2): 601-619. https://doi.org/10.1177/0961000619841429 iJIM ‒ Vol. 17, No. 13, 2023 145 https://doi.org/10.1016/j.lcats.2009.04.002 https://doi.org/10.1016/j.lcats.2009.04.002 https://doi.org/10.1177/009365001028001002 https://doi.org/10.1353/pla.2006.0063 https://doi.org/10.5860/rusq.47n3.266 https://doi.org/10.1108/DLP-12-2020-0129 https://doi.org/10.1016/j.jretconser.2018.01.015 https://doi.org/10.34105/j.kmel.2017.09.011 https://doi.org/10.34105/j.kmel.2017.09.011 https://doi.org/10.1108/01435121211279894 https://doi.org/10.1108/01435121211279894 https://doi.org/10.24331/ijere.391780 https://doi.org/10.1108/LHTN-02-2016-0009 https://doi.org/10.1108/LHTN-02-2016-0009 https://doi.org/10.1021/acs.jchemed.9b01157 https://doi.org/10.1016/j.compedu.2012.10.016 https://doi.org/10.1016/j.compedu.2012.10.016 https://doi.org/10.1177/0961000619841429 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… [33] Ennis, R. H. (2018). Critical Thinking Across the Curriculum: A Vision. Topoi, 37(1): 165- 184. https://doi.org/10.1007/s11245-016-9401-4 [34] Budi Santoso, T. N., Siswandari, S., & Sawiji, H. (2018). The Effectiveness of eBook versus Printed Books in the Rural Schools in Indonesia at the Modern Learning Era. International Journal of Educational Research Review, 3(4): 77-84. https://doi.org/10.24331/ijere.453512 [35] Joo, Y. J., Park, S., & Shin, E. K. (2017). Students' expectation, satisfaction, and continuance intention to use digital textbooks. Computers in Human Behavior, 69: 83-90. https://doi.org/ 10.24331/ijere.453512 [36] Liu, H., Shao, M., Liu, X., & Zhao, L. (2021). Exploring the Influential Factors on Readers' Continuance Intentions of E-Book APPs: Personalization, Usefulness, Playfulness, and Sat- isfaction. Frontiers in psychology, 12: 640110-640110. https://doi.org/10.24331/ijere. 453512 [37] Mizrachi, D., Salaz, A. M., Kurbanoglu, S., Boustany, J., & on behalf of the, A. R. G. (2018). Academic reading format preferences and behaviors among university students worldwide: A comparative survey analysis. PLOS ONE, 13(5): e0197444. https://doi.org/10.1371/jour- nal.pone.0197444 [38] Gilbert, J., & Fister, B. (2015). The Perceived Impact of E-books on Student Reading Prac- tices: A Local Study. College & Research Libraries, 76(4): 469-489. https://doi.org/10.5860/ crl.76.4.469 [39] Hao, Y., & Jackson, K. (2014). Student satisfaction toward e-textbooks in higher education. Journal of Science & Technology Policy Management, 5(3): 231-246. https://doi.org/ 10.1108/JSTPM-04-2014-0016 [40] Tosun, N. (2014). A Study on Reading Printed Books or E-Books: Reasons for Student- Teachers Preferences. Turkish Online Journal of Educational Technology, 13: 21-28. [41] Bernik, A., Vusić, D., & Milkovic, M. (2019). Evaluation of gender differences based on knowledge adaptation in the field of gamification and computer science. International Jour- nal of Emerging Technologies in Learning (iJET) (Online), 14(8), 220. https://doi.org/ 10.3991/ijet.v14i08.9847 [42] Nicholas, D., Rowlands, I., Clark, D., Huntington, P., Jamali, H. R., & Ollé, C. (2008). UK scholarly e-book usage: a landmark survey. Aslib Proceedings: new information perspec- tives, 60(4): 311-334. https://doi.org/10.1108/00012530810887962 [43] Rowlands, I., Nicholas, D., Jamali, H. R., & Huntington, P. (2007). What do faculty and students really think about e‐books? Aslib Proceedings, 59(6): 489-511. https://doi.org/ 10.1108/00012530710839588 [44] Ismail, R., & Zainab, A. N. (2013). The Pattern of E-Book Use amongst Undergraduates an Malaysia: A Case of to Know is to Use. ArXiv, abs/1301.5400. 7 Authors Anitha Nesa Thanka, MSN, is a lecturer at the College of Nursing, Sultan Qaboos University in Muscat, Oman. She teaches courses in Adult Health, Critical Care, and Advanced Clinical practices. Her research interests span Nursing Education-related re- search and wound care, including topics such as split-thickness grafts for burns and intravenous site complications and management. Jansi Natarajan, MSN, PhD, serves as a lecturer at the College of Nursing, Sultan Qaboos University, Muscat, Oman. She teaches courses in adult health, critical care, and advanced clinical practices. Her research interests focus on quality of life in chronic 146 https://www.i-jim.org https://doi.org/10.1007/s11245-016-9401-4 https://doi.org/10.24331/ijere.453512 https://doi.org/10.24331/ijere.453512 https://doi.org/10.24331/ijere.453512 https://doi.org/10.24331/ijere.453512 https://doi.org/10.24331/ijere.453512 https://doi.org/10.1371/journal.pone.0197444 https://doi.org/10.1371/journal.pone.0197444 https://doi.org/10.5860/crl.76.4.469 https://doi.org/10.5860/crl.76.4.469 https://doi.org/10.1108/JSTPM-04-2014-0016 https://doi.org/10.1108/JSTPM-04-2014-0016 https://doi.org/10.3991/ijet.v14i08.9847 https://doi.org/10.3991/ijet.v14i08.9847 https://doi.org/10.1108/00012530810887962 https://doi.org/10.1108/00012530710839588 https://doi.org/10.1108/00012530710839588 Paper—Preference, Challenges, and Satisfaction with Using E-Books: Is There a Gender Difference… diseases and nursing education research, particularly in areas such as simulation and incivility among nursing students. Mickael Antoine Joseph, PhD, is an Assistant Professor at the College of Nursing, Sultan Qaboos University, Oman. He teaches biosciences courses such as anatomy, physiology, and pathophysiology for undergraduate nursing students. In addition to his teaching duties, he serves as the Assistant Dean for Training and Community Service. His research interests focus on nursing education and exploring effective strategies for teaching biosciences courses to undergraduate nursing students. Article submitted 2023-03-07. Resubmitted 2023-05-07. Final acceptance 2023-05-07. Final version pub- lished as submitted by the authors. iJIM ‒ Vol. 17, No. 13, 2023 147