{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T22:53:09Z","timestamp":1785365589636,"version":"3.55.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":54,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"the National Education Science Planning Project","award":["CLA210281"],"award-info":[{"award-number":["CLA210281"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare-Associated Infection (HAI) prevention is a crucial competency in nursing education but is often taught through didactic lectures with limited application. This study evaluated the effectiveness of combining the Bridge-in, Objective, Pre-assessment, Participatory Learning, Post-assessment, and Summary (BOPPPS) model with Case-Based Learning (CBL) for HAI education using a non-equivalent control group design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A quasi-experimental study with a historical control group was conducted over three consecutive academic years (2023\u20132025). Second-year nursing undergraduates enrolled in an elective HAI module participated. The 2023 cohort (control group,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921) received traditional lecture-based learning (LBL). The 2024 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918) and 2025 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925) cohorts (intervention group, total\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200943) received instruction redesigned using the BOPPPS framework with CBL. Knowledge acquisition was assessed via identical pre- and post-course tests, analyzed using analysis of covariance (ANCOVA) with pre-test scores as covariates. Post-course perceptions were measured using an 8-dimension, 5-point Likert-scale questionnaire. Data were analyzed following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines adapted for educational interventions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were comparable (pre-test score: LBL\u2009=\u200954.00\u2009\u00b1\u20096.49 vs. BOPPPS-CBL\u2009=\u200952.30\u2009\u00b1\u20097.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.360, Cohen\u2019s d\u2009=\u20090.17). ANCOVA revealed that the BOPPPS-CBL group achieved significantly higher post-test scores after adjusting for baseline differences (adjusted mean\u2009=\u200987.19 vs. 73.61; mean difference\u2009=\u200913.58, 95% CI: 11.14\u201316.03, F(1,61)\u2009=\u2009123.46,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, partial eta-squared\u2009=\u20090.669). Within-group improvements were significant for both conditions (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The intervention group reported significantly higher scores across all seven positive perception dimensions (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 after Bonferroni correction), including self-directed learning (4.07\u2009\u00b1\u20090.80 vs. 3.19\u2009\u00b1\u20090.68, Cohen\u2019s d\u2009=\u20091.15) and teacher-student interaction (3.98\u2009\u00b1\u20090.80 vs. 2.76\u2009\u00b1\u20090.94, Cohen\u2019s d\u2009=\u20091.43). Notably, they also reported higher perceived learning burden (3.98\u2009\u00b1\u20090.86 vs. 2.29\u2009\u00b1\u20090.96,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, Cohen\u2019s d\u2009=\u20091.90). Sensitivity analyses showed consistent intervention effects across the 2024 and 2025 cohorts (cohort-by-interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.737). Qualitative feedback highlighted enhanced knowledge application and autonomous learning skills.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The BOPPPS-CBL model appears to be effective in enhancing HAI knowledge acquisition and fostering positive learning engagement among undergraduate nursing students. The increased perceived cognitive effort may represent \u2018productive cognitive engagement\u2019 rather than \u2018productive germane load\u2019. This structured, active learning strategy offers a promising approach for teaching critical infection control competencies, though resource implications and design limitations warrant consideration. Institutions adopting this model should ensure rigorous case design and faculty development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-026-09428-9","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T02:55:54Z","timestamp":1779504954000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of the BOPPPS model combined with case-based learning on knowledge acquisition and learning engagement in undergraduate nursing students: a multi-cohort quasi-experimental study"],"prefix":"10.1186","volume":"26","author":[{"given":"Yuda","family":"Fei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaning","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"issue":"8","key":"9428_CR1","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1016\/S1473-3099(22)00459-5","volume":"22","author":"VS Balakrishnan","year":"2022","unstructured":"Balakrishnan VS. 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An exemption from full ethical review and informed consent was granted under Article 39 of the Measures for the Ethical Review of Biomedical Research Involving Humans (National Health Commission of the People\u2019s Republic of China, 2016), which permits the use of de-identified retrospective data for educational quality improvement research posing no more than minimal risk. Nevertheless, all participants (students and faculty) were informed that anonymized data from routine educational evaluations would be used for research purposes, and no objections were raised regarding publication. This process constitutes informed notification and implied consent.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not Applicable. This manuscript does not contain any identifying images, personal details, or clinical information that could compromise participant anonymity. All data presented are aggregated and de-identified.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1165"}}