Interactive e-books and traditional education show comparable effectiveness for foundational cancer sleep management nurse training

PURPOSE: Sleep disturbances affect approximately 60% of cancer patients, with significant impacts on quality of life and treatment outcomes. While Brief Behavioral Treatment for Insomnia (BBTI) offers evidence-based management, implementation requires foundational training for oncology nurses. This study compared interactive e-books with traditional education for cancer sleep management training. The purpose of this study was to evaluate knowledge acquisition, confidence enhancement, and learning satisfaction between formats, and examine confidence as a mediator. METHODS: Cluster randomized controlled trial with 142 clinical nurses from nine wards assigned to interactive e-book (n = 75) or traditional education (n = 67) groups. Outcomes assessed at baseline and one-week post-intervention using validated instruments (Cronbach's α = 0.862-0.980). Structural equation modeling examined mediation effects, controlling for baseline differences. RESULTS: Both groups showed significant confidence improvements (e-book: d = 0.51; traditional: d = 0.36) with no between-group difference (p = 0.263). Knowledge gains were modest and non-significant in both groups. Learning satisfaction was high in both groups (83% vs. 81% of maximum score, p = 0.365). Confidence significantly mediated the knowledge-satisfaction relationship (indirect effect = 0.051, 95% CI [0.006-0.096]), accounting for 24.5% of the total effect. Feasibility indicators were favorable with 100% retention. CONCLUSIONS: Interactive e-books and traditional methods showed comparable effectiveness for foundational BBTI training. Limited knowledge gains suggest brief theoretical instruction alone is insufficient, supporting multi-component training programs. Confidence emerged as a key mediator, indicating educational programs should incorporate explicit confidence-building strategies. Interactive e-books offer scalable alternatives when traditional training is impractical.