Perceptions of chiropractic students on digital literacy skills at a South African university: A cross-sectional study Open Access

Previously, teaching and learning in higher education took place primarily through direct, face-to-face interaction between lecturers and students. However, the rise of digital computing technology, the internet, and the World Wide Web¹  in the 4th Industrial Revolution dramatically transformed the higher education landscape by empowering students to access a wealth of information from a variety of online sources, supplementing their learning beyond traditional methods.²  Despite the availability of online learning technologies, their formal integration into educational institutions was steady and incremental;³  however, face-to-face instruction remained the dominant approach in South Africa.¹  This change occurred abruptly in March 2000 with the rise in the coronavirus disease (COVID-19) infection rate in South Africa as this forced universities across the country to swiftly transition from face-to-face instruction to full online learning, ensuring the continuation of academic activities.⁴ 

The transition at this time was critical, requiring the rapid development of alternate models and strategies to accommodate distance teaching and learning. Teachers were forced to switch to online teaching without prior training and planning.³  Subsequently, students were expected to access and learn from uploaded curriculum content, attend online lectures and tutorials, and upload assignments. During this time, South African students were also faced with other difficulties affecting online learning, including a lack of adequate technological devices, network connectivity issues, and load shedding.¹  This change was unprecedented, lasting a period of 4 months; both teachers and students were ill prepared for the circumstances brought about by the pandemic.^3,4  From August 2000, as COVID-19 restrictions subsided, the University of Johannesburg (UJ) allowed only 50% of students to attend in-person practical components during lecture time with the continuance of 100% online theory lectures. As COVID-19 restrictions ceased, lectures were resumed with an 80% contact component for both theory and practical lectures and a 20% online component.

Students of today have been referred to as a generation of digital natives, born from 2001 to the present day,⁵  their existence being entwined with computers, gaming, mobile phones, TV,⁶  and the internet.⁷  These individuals have been exposed to digital technology since their birth, and this has played an integral part in their lives. Because of this unbounded exposure to modern-day advancements, one may assume that these individuals possess expert skills in both technology and digital information usage.⁸  Previous claims have been made that the generation of digital natives are inherently technology savvy, thinking and behaving differently because of their intrinsic and natural use of technology.⁷  The educational technology community though, through research, has shown that digital natives are not an evidenced-based stereotype and that the portrayal of their technology needs or abilities are not deemed particularly accurate.⁷  Whereas this cohort of students may be more comfortable in technology-driven environments and in using digital devices to interact on social media (SM), there is modest evidence to support that these skills favorably compare with high levels of digital literacy.^8,9  Whereas the assumption of digital natives may be made of students in more developed countries, South African students in the same age group do not necessarily share the same traits. This generation shows stark divisions within South Africa itself in their access to information and communication technologies. Many students live in more remote areas where internet access is poor, financial constraints to purchase computers is present, and a language divide exists.¹⁰ 

Digital literacy lays emphasis on the cognitive and technical process of learning to comprehensively use the different aspects of technology.⁷  Variation exists in defining digital literacy and categorizing its interrelated literacies and skills sets; the following descriptions compose the interrelated literacies used in this study. Information literacy (IL) includes the ability to search for, evaluate, organize, and document online information, using online tools, websites, and SM. Information communications and technology literacy (ICTL) includes understanding the implications of digital information usage and using online platforms to present one’s ideas and oneself. Information communication and technology utilization (ICTU) highlights the responsible use and delivery of digital information, and media literacy (ML) recognizes the use of different technological tools to find, record, and create digital information.^11,12  It is essential that students possess the necessary literacy skills to navigate the ever-changing digital terrain.

Educational institutions play a facilitating role in conveying appropriate digital skills to the future workforce.¹³  Reconstruction of academic curricula, together with the integration of technology, is vital to ensuring that educational content aligns with the persistent demands of a technologically focused society.¹⁴  The continual development and inclusion of digitally enhanced tools and programs requires the health care workforce, including chiropractors, to adapt to and maintain high levels of digital proficiency.¹⁵ 

By understanding the digital literacy skills of the chiropractic students, we can identify gaps in the perception of their knowledge as well as the extent to which their digital literacy education requires modification.

A cross-sectional, quantitative, and exploratory study was carried out, using a self-administered online anonymous questionnaire.

The participants involved (n = 242) in the study were 1st to 4th year bachelor of health sciences (BHSc) (n = 174) and 1st to 2nd year master of health sciences (MHSc) (n = 68) chiropractic students enrolled in the department of chiropractic at the UJ, Doornfontein campus, South Africa. The inclusion criteria were students, 18 years or older, who were registered for the BHSc or MHSc chiropractic degree.

A pilot study was carried out on 5 postgraduate chiropractic (1st and 2nd year MHSc) students as suggested by the statistical department that assisted with the study design. The researcher sent an information letter and a consent form as well as an adapted digital literacy questionnaire to these 5 students via Google Forms (Google LLC). The 5 students were tasked with verifying the ease of use of all 3 documents. Feedback suggested that the checkboxes in the questionnaire be changed to multiple choice questions to ensure that only 1 answer could be selected per question instead of multiple answers; this provided more decisive answers. These changes were implemented to the questionnaire. The results from these students were excluded from the final outcomes of the study.

The researcher then personally introduced the research to each year of study in the total chiropractic cohort; the students were given the opportunity to ask questions. The 3 documents were subsequently sent to the respective chiropractic students via a link on WhatsApp (Facebook Inc) via each year of study’s class representative. Data collection was conducted between February 27, 2023, and April 9, 2023. The 3 documents were sent a total of 3 times to maximize the number of respondents.

This study used an adapted version of the original valid and reliable questionnaire from the study “Digital Literacy Skills of Undergraduate Students in Nigerian Universities.”¹¹  Certain questions were transposed to incorporate ICTU as a measure of digital literacy.¹⁶  The adapted questionnaire (Supplementary File 1, available online accompanying this article) consisted of a Likert-style design using a numerical rating scale ranging from 1, which was strongly disagree, to 5, which was strongly agree. Forty-one questions were provided, including demographics (age, sex, and year of study) and student self-perceptions on 4 aspects of digital literacy skills: (1) IL, (2) ICTL, (3) ICTU, and (4) ML.

The data were retrieved from the completed questionnaires; subsequently, it was analyzed using the 28th version of the IBM SPSS statistics software (IBM Corp).

Frequency tables were used to analyze demographics, and custom tables, means, and standard deviations were used to analyze Likert-type response questions. Independent t tests helped to determine whether the perceptions of males and females were statistically different over the 4 constructs. One-way analysis of variance tests were used to assess if there were any statistically significant differences in digital literacy skills across the age groups and years of study. Furthermore, confirmatory factor analysis and Cronbach alpha tests were used to assess the internal consistency of the questionnaire. The data was subsequently stored in a password-protected document in the UJ data repository; this is for a period of 5 years.

The following permissions were granted from the relevant UJ departments and persons prior to the commencement of the study: Faculty of Health Sciences Higher Degrees Committee (HDC-01-101- 2022), Research Ethics Committee (REC-1840-2022), the head of the Chiropractic Department, and authors of the original digital literacy questionnaire.¹¹  The research participants remained anonymous throughout the study; each participant was, however, required to give consent prior to commencing the questionnaire. There were no direct risks or benefits to the participants. The consideration was that the information acquired from this study could highlight the perceived level of digital literacy skills of the chiropractic students at the UJ, consequently assisting the Department of Chiropractic, Faculty of Health Sciences, and the UJ to develop new ideas on how to use, mature, and enhance the learners’ digital literacy skills.

The questionnaire was distributed to (n = 242) chiropractic students at the UJ; the final response rate was 58% (n = 141). Demographic characteristics of age, sex, and year of study of the sample population are represented in Table 1. Most participants were aged between 18 and 24 years and were of the female sex. The biggest response for year of study came from the 1st year MHSc students.

Table 2 indicates the responses of each construct for digital literacy and year of study, that is, frequency count, mean and standard deviation, minimums/maximums, and 95% confidence levels from the means. Tables 3–6 demonstrates the frequency, percentage, mean, and standard deviation for each of the individual questions for each construct of the questionnaire as well as each construct’s overall mean and standard deviation value. For interpretation in this study, the 2 upper scales and 2 lower scales were merged to form agree and disagree, respectively; this allowed for better interpretation of the results.

When considering the interrelated literacies that contribute to the complexity of the digital literacy paradigm, the total cohort of chiropractic students at the UJ exhibited high levels of agreement in both their perceived IL and perceived ML levels overall. In contrast, lower levels of agreement were identified in both their overall perceived ICTL and ICTU levels.

There was no statistical significance identified between sex and digital literacy constructs: IL (0.872), ICTL (0.779), ICTU (0.984), and ML (0.411). Using Eta-squared, small effect sizes were identified: IL (0.017), ICTL (0.056), and ICTU (0.000). A large effect size was found for ML (0.486). No statistical significance was identified between age and digital literacy constructs: IL (0.442), ICTL (0.410), ICTU (0.963), and ML (0.427). Using Eta-squared, small effect sizes were identified: IL (0.011), ITCL (0.012), ICTU (0.000), and ML (0.012). The following values were identified between the 4 constructs and year of study: IL (0.040), ICTL (0.333), ICTU (0.545), and ML (0.513). Statistical significance was identified between the year of study and information literacy only. Using Eta-squared, small effect sizes were identified: IL (0.081), ITCL (0.041), ICTU (0.029), and ML (0.030).

The adapted questionnaire was assessed using the Cronbach alpha test. The following was reported: IL (0.862), ICTL (0.830), ICTU (0.840), and ML (0.844). The closer the Cronbach alpha coefficient is to 1.0, the greater the internal consistency of the items in the scale.¹⁷  According to George and Mallery,¹⁸  levels above .8 show good internal consistency; therefore, all 4 constructs were deemed reliable and internally consistent.¹⁷  Validity of the questionnaire was verified with confirmatory factor analysis (chi-square p-value): IL (0.252), ICTL (0.460), ICTU (0.051), and ML (0.058).

Age and sex comparisons to each of the 4 constructs showed no statistically significant differences in their responses; however, the trend in each of the digital literacy constructs showed total mean values were highest over all 4 constructs in the over 31+ age group. This trend shows that digital literacy may be perceived to improve as one matures. It may also highlight a bias that older students may perceive themselves as being more digitally literate. When comparing males and females, the mean values were almost identical throughout all 4 constructs. According to Becker,¹⁹  digital literacy skills are not defined by age or stereotype and rather by one’s interest in one’s readiness and ease in using digital tools.

Regarding the year of study, statistically significant differences were only identified when comparing the year of study to the information literacy construct. When considering the year of study among the chiropractic students, an overall increase in mean values was found in each of the 4 constructs identified in 1st to 3rd year BHSc students. Subsequent decreases were, however, evident in 4th year BHSc and 1st year MHSc students. A rise in mean values recurred in 2nd year MHSc chiropractic students. This trend reveals an interesting pattern. A study by Öncül²⁰  found that most students are more comfortable with basic search actions when using digital tools; however, they begin to struggle with the more advanced search and evaluation strategies such as when using Google Scholar or online library databases. The students also struggled with source search and evaluation strategies, including decision making on the relevance and reliability of information. They found that the students’ weakest skill category was regarding academic truthfulness, knowledge, awareness of and appropriate use of data. Their conclusion was that students require support in higher order skill levels of digital literacy.²⁰  It is, therefore, postulated that, until the 3rd year, the chiropractic students use more basic skills in all 4 of the constructs of digital literacy. Fourth year BHSc and 1st year MHSc students, however, require higher order skill levels of digital literacy as their focus shifts toward research and writing dissertations; at this stage, more advanced search options, citing, and referencing knowledge is then required.²¹  Once chiropractic students reach 2nd year MHSc, they may have acquired more advanced skills and, therefore, perceive themselves as more proficient.

As noted earlier, ML and IL demonstrated the highest overall mean values in the total chiropractic student cohort. The high levels in agreement in the ML skills may be due in part to the use of SM, an umbrella term describing a variety of online platforms, including social networks, blogs, social gaming, and photo and video sharing.²²  Although not all SM platforms are used for socialization, it is considered to be one of the most apparent commonalities of all types of SM.²²  Despite being used for community interactions, SM has become a significant feature in universities and higher education; it allows for an increased and more accessible interaction between staff, teachers, parents, and students and allows for active engagement with learning materials.²³  Sheeran and Cummings²⁴  suggest that students are frequent users of SM on more informal platforms versus more formal platforms attached to universities. A study conducted by Dlamini, Ncube, and Muchemwa²⁵  found that many students at a particular Zimbabwean university were using SM as an integral component of their daily university engagement. SM was used to complete online registrations, for university communication, to send and receive assignments, and for interacting with their peers.²⁵  In a study by Chatterjee and Kar,²⁶  inference is made that SM is being used frequently by average citizens across all socioeconomic classes, suggesting its convenience of use. It, therefore, makes sense that the chiropractic students are also able to make use of and perceive themselves as more proficient in types of ML usage.²⁶ 

IL has also shown increased mean values in the chiropractic student cohort. It is the area of digital literacy that has been given the most instruction and attention, and therefore, these findings may be accentuated. Accelerated by the onset of the COVID-19 pandemic, UJ, like other learning institutions, advanced meaningfully in the realm of digital literacy development. The library at the UJ previously offered voluntary contact (face-to-face) training to 1st year students in IL;²⁷  however, this has been integrated as a compulsory unit in the 1st year curriculum for the chiropractic students. The IL content includes navigation of the library system, prevention and consequences of plagiarism, and citing and utilization of information sources as well as using online search strategies.²²  IL is a continually evolving module, ultimately providing the students with a suitable baseline skill set.¹⁵  It is, therefore, understandable that the chiropractic students would be more confident in this particular area of digital literacy as they have received more directed learning in this regard. It is not only the 1st year students that receive this instruction; support training is provided online via the library portal as well as through the campus learning management system (LMS) to the rest of the chiropractic students and students of the university. Students can access this content in their own time. We can infer that institutional availability of these library-based resources may have played a significant role in these high levels of agreement, indicating the importance of these formal support structures on the student’s digital literacy skills. These results correlate with those by Adeoye and Adeoye,¹¹  which showed a high correlation between IL in undergraduate students.

This study then highlights gaps in chiropractic students perceived ICTL and ICTU abilities. Tables 5 and 6 show limited self-perceptions of the following concepts: legalities of using and sharing online material, searching and filtering through digital information, one’s digital identity and footprint, and writing online content. Whereas most learners, regardless of age, are capable of navigating the internet for general information, deficiencies are identified when using the internet for educational purposes, such as analyzing, evaluating, and creating digital information.²⁸  This is in contrast to the study by Adeoye and Adeoye,¹¹  which found confident levels in agreement regarding ICTL among undergraduate students. Digital literacy skills require both cognitive and technical skills to develop a learner’s ability to locate, use, and communicate information from more basic toward complex learning environments. Digital literacies are, therefore, multidimensional, often requiring the combination of simple literacies to form complex skill sets aimed to address more advanced problem solving.²⁰ 

It is, therefore, necessary to include ICTL and ICTU in the 1st year chiropractic digital literacy curriculum as well as make this support content available to all undergraduate and postgraduate university students on the UJ website; this information may then be accessed via the online library portal and the university’s LMS.²⁹  Although, currently, the digital literacy support content is not compulsory, it is advised that a more formalized structure be put in place to ensure that more chiropractic students access and make use of the uploaded content. Fourth year BHSc and 1st year MHSc chiropractic students would be the most targeted grouping, the suggestion being that these students may not be making adequate use of the digital literacy content that is being made available for them.

Digital literacy instruction has become an integral part of the UJ’s academic domain. Libraries provide fundamental support for teaching, learning, and research even being closely involved in the training of information digital competencies.^30,31  Library portals are also present from which students and staff may access books and textbooks online as well as databases and journal subscriptions to access research articles. The UJ also has a university-specific search engine accessed via the university website and the university’s LMS through which alternative training initiatives may be accessed.²⁹ 

Substantial change has transpired in many institutional sectors, including education,³⁰  and this has subsequently surged toward the use of technology and online learning; this is in response to an age characterized by rapid technological advancement.³¹  It is, therefore, essential for institutions to find ways to expand on their current digital literacy instruction models to include not only IL but to ensure that ML, ICTL, and ICTU are provided to undergraduate and postgraduate students. This will contribute to a more comprehensive educational environment aimed to effectively equip students with an array of literacy skills to enhance their competency levels required for facing the challenges of information management in today’s society.³² 

Digital literacy is a broad and complex subject, and digital literacy skills and competencies are crucial to the students’ academic success. Basic digital literacy skills may be present; however, these skills require refinement for more advanced tasks to support their learning.²⁰ 

The responses to certain questions may not have been completely accurate; certain questions or statements may have required more context to allow for better interpretation of the questions. More stringent standardization of digital literacy terms needs to be implemented to assist researchers in refining their future investigations. As this study was based on a small sample size, we cannot put these assumptions onto the general population. We also understand that this study was based only on the chiropractic students at UJ, and therefore, some measure of selection bias may have been present.

This study aimed to determine the perceptions of chiropractic students at the UJ on their levels of digital literacy. The chiropractic students perceived themselves proficient in IL and ML skills; however, a gap was identified in perceived ICTL and ICTU skills overall. It also highlighted a divide between the chiropractic students’ perceptions of their basic digital literacy skills and their higher order skill levels or more advanced digital literacy skills. The practical application of the study outcomes are to fill these gaps of ICTL and ICTU in both the 1st year curriculum and through the library online portal and university’s LMS for the rest of the undergraduate and postgraduate students. It is essential to convey this knowledge to 4th year BHSc and 1st year MHSc students who shift focus toward research implementation and dissertation writing to elevate their digital literacies to more advanced levels. This study lays a foundation for future studies in the field of digital competency relating to students and the difference between basic versus more advanced levels of digital literacy. This study will also bring about an awareness at departmental, faculty, and institutional levels at which change can be implemented.

This study was funded by the University of Johannesburg, Supervisor Linked Bursary. None of the authors of this article have any conflicts of interest.