Enhancing Ghanaian Sign Language Acquisition in Nursing Students: A Web-Based Approach

This research examined the perceived effectiveness of a web-based application designed for nursing students to learn Ghanaian Sign Language. The study employed a descriptive survey design, utilising an online questionnaire deployed through the Kobo Toolbox application. The sample size for the study comprised of 133 student nurses selected through proportionate stratified sampling. The findings generally found the web-based application effective in learning Ghanaian Sign Language. They found the application’s navigation and interface user-friendly and visually appealing. The student nurses also asserted the Ghanaian Sign Language videos within the application were accurate and usable, enhancing the learning experience. However, students indicated challenges relating to the application loading times, data consumption, and the lack of an offline mode for the application. In light of these findings, it is recommended that the web-based application in Ghanaian Sign Language include technical optimisation, integrate an offline mode, and provide settings for data usage.

Background

Communication is fundamental to human existence as it enables people to share ideas, express feelings, exchange information, and build social bonds (Barseliet al., 2019). Communication may take different forms, including written, spoken, or non-verbal modes. Communication is typically initiated by the sender who encodes the message. Encoding is the process of converting information into a format that can be easily transmitted and understood by the recipient (Xieet al., 2022). The message is then transmitted through a medium, and decoded by the recipient based on his/her experiences prejudices, attitudes, beliefs, cultural orientation, and other similar factors. Decoding by the intended recipient involves receiving and interpreting the encoded message (Luet al., 2023).

Ghanaian Sign Language (GSL) is the main form of communication used by Deaf people in Ghana. Information is communicated through the visual-manual modality in the GSL language. Deaf people in Ghana are able to effectively communicate with hearing people who are proficient in GSL, thus, closing the social interaction and communication gap (Izzah & Suciati, 2014).

The Nursing and Midwifery Council (NMC) of Ghana introduced GSL as a dedicated, audit course in the curriculum for training students. The course content was centred on the rudiments of sign language, deaf culture, approaches to learning fingerspelling and numbers as well as the common complaints and diseases of patients. The maximum time for lesson delivery in the different nursing institutions is 2 hours and is held once every week. In teaching GSL, teachers demonstrate hand shapes, palm orientation, movement, location, facial expressions, and body gestures are demonstrated within a limited timeframe. However, this conventional method may fall short of providing nursing students with a comprehensive understanding of sign language concepts. Moreover, the provision of textbooks and other text-based materials on sign language, while a common practice, falls short of affording students ample time to acquire the necessary GSL skills for effective communication (Joyet al., 2022). In contrast, the utilization of computer and mobile applications presents a more flexible and accessible alternative, allowing users to engage in second language studies at their convenience (Yanget al., 2020).

Studies by Shaoet al. (2020), Izzah and Suciati (2014) as well as Rosell-Aguilar (2017), established that a clear and intuitive application design, with well-organized menu structures, recognizable icons, and visual cues, was found to significantly enhance students’ navigation experiences. While web-based applications offer convenience and flexibility for learning and instruction purposes, they also present several challenges. A study Norman and Skinner (2006) found that technical issues such as slow loading times, poor connectivity, and limited functionality can hinder the overall learning experience.

In general education, educational videos improve students’ understanding, knowledge retention, and information recall (Brame, 2016; Haagsmanet al., 2020). The visual and auditory cues in videos aid in explaining complex concepts, making web-based learning an effective instructional tool in both domains. Similarly, in sign language education, the use of videos enhances learners’ comprehension of sign language, grammar, and vocabulary (Joze & Koller, 2020; Rosell-Aguilar, 2017). Noetelet al. (2021) opined that video tutorials and interactive lessons offer learners valuable practice opportunities and learners can observe the hand movements, facial expressions, and body language of signers, allowing them to learn and practice sign language skills dynamically and engagingly.

Purpose

The purpose of the study is to ascertain the perceived effectiveness of a web-based application designed to teach nursing students Ghanaian Sign Language.

Method

Study Design

The study utilized a descriptive survey research design to explore nursing students’ perceived effectiveness of a web-based application for learning GSL.

Study Population

The study involved nursing students in the 3rd year of the diploma program and the 2nd year of the certificate program at the College of Community Health Nursing, Winneba, in the Central Region of Ghana. These two distinct groups were chosen because they had received some exposure to the basics of GSL. The study population is presented in Table I.

Table I. Study Population of Nursing Students

Programme of study	Male f (%)	Female f (%)	Total (%)
Registered Public Health Nursing (Diploma)	23 (27)	63 (73)	86 (100)
Registered Nursing Assistant Preventives (Certificate)	33 (29)	81 (71)	114 (100)
Total	56 (28)	144 (72)	200 (100)

Sample Size Determination

The sample size (n) for nursing students was determined based on the precision method as follows:

$$\begin{array}{r}n=\frac{N}{(1+N{e}^2)}\end{array}$$

where:

N is the proportion of nursing students who have been introduced to GSL,

e is the precision level.

$$\begin{array}{r}n=\frac{200}{(1+200\times {0.05}^2)}=133\end{array}$$

Sampling Technique

A proportionate stratified sampling approach was employed in selecting 133 nursing students (96 females; and 37 males) from the study population. The strata were based on the sex of respondents to ensure that the sample was highly representative of the study population.

Building the Web-based Application

The development of a web-based application for learning Ghanaian Sign Language (GSL) utilized the Agile methodology for its iterative approach and improved developer-user communication (Wuttkeet al., 2022). The application, designed for Android and iOS platforms, leveraged Node.js and React Native for their portability and robust libraries. MongoDB, a NoSQL database system, supported the backend with its cross-platform capabilities and schema flexibility. Additionally, the Hygraph Content Management System (HCMS) was employed to handle Graphic Interchange Format uploads, offering efficient content federation (Singhet al., 2021). These tools ensured a versatile, scalable solution tailored to GSL learning needs.

Field Data Collection Process

After obtaining approval from the University of Education, Winneba’s Institutional Review Board (IRB), the Department of Special Education provided an introductory letter for the researchers that facilitated access to respondents and institutional authorities. Informed consent was obtained from respondents, emphasizing voluntary participation and the right to withdraw at any stage.

Data collection began with the creation of a WhatsApp group made up of the researcher and respondents to maintain communication. Respondents received the URL for the GSL application and participated in a five-day face-to-face training session to enhance their application usage skills. Over two months, they engaged with the application flexibly, employing preferred learning styles. Quizzes integrated into the application enabled self-assessment of their progress.

After six weeks, a built-in questionnaire URL was activated to collect respondents’ feedback on aspects like navigation, interface, video content, and challenges faced during the application’s use. This systematic approach ensured respondent familiarity with the tool and facilitated comprehensive feedback.

Data Management and Analysis

Stata version 15 was applied in analysing data in this current study. Likert scale responses were treated as ordinal data due to their hierarchical nature with unknown difference between different data points (Sullivan & Artino, 2013). Data preparation included thorough cleaning, accurate labeling, and formatting. The dataset’s structure was examined using the describe command. Core analyses involved generating frequency tables via the tabulate command, with column percentages providing additional insights. Results were exported for reference using the out-sheet command, ensuring transparency.

The Pearson Chi-squared test of association was applied to investigate significant relationships between gender and respondents’ experiences with the application’s navigation, interface, and perceptions of video accuracy. To facilitate this analysis, Likert scale responses were dichotomized (agree/disagree).

Results

Demographic Characteristics of Respondents

The characteristics of the participant for the study is presented in Table II.

Table II. Demographic Characteristics of Respondents

Demographic	Male f (%)	Female f (%)	Total n (%)
Gender	34 (27)	90 (73)	124 (100)
Age (Years)
18–21	12 (35)	24 (27)	36 (29)
22–24	6 (18)	43 (48)	49 (40)
25–28	16 (47)	23 (25)	39 (31)
Level of students
Level 200	12 (35)	40 (44)	52 (42)
Level 300	22 (65)	50 (56)	72 (58)
Programme
Public Health Nursing	22 (35)	50 (44)	52 (42)
Community Nursing	12 (65)	40 (56)	72 (58)
Means of accessing the web-based application
Smartphone	23 (68)	81 (90)	104 (84)
Tablet	1 (3)	1 (1)	2 (2)
Tablet and Smartphone	10 (29)	8 (9)	18 (14)
Frequency of application usage
Used rarely (less than thrice a month)	7 (21)	27 (30)	34 (27)
Used occasionally (a few times a month)	13 (38)	28 (31)	41 (33)
Used regularly (a few times a week)	5 (15)	27 (30)	32 (26)
Used daily	9 (26)	8 (9)	17 (14)
Experiences with GSL Instruction
Face to Face	34 (100)	90 (100)	124 (100)
Web-based application	–	–	–

Overall, 124 nursing students (90 females: and 34 males) completed the survey, yielding a response rate of 93.2%. The mean age was 23.4 years (SD = 2.2 years), with the modal age range of respondents being 22–24 years. It is worth noting that 42% of respondents were second-year nursing students whereas 58% of the respondents were third-year nursing students. Most students (68% of males, and 90% of females) used smartphones for GSL learning. Notably, all respondents reported experiencing face-to-face instruction during GSL lessons. On application usage, the majority of respondents (33%) occasionally used the application to learn GSL.

Research Question 1: Nursing Students’ Experiences with the Navigation and Interface of a Web-Based Application in Enhancing Learning in GSL

The experiences of nursing students on the navigation and interface of the web-based application are presented in Table III.

Table III. Findings Related to Nursing Students’ Experiences with the Navigation and Interface of a Web-Based Application in Enhancing Learning in GSL

Statement	Strongly agree f (%)	Agree n f (%)	Disagree f (%)	Strongly disagree f (%)	Total n (%)
1. The navigation tabs in the web-based application were not visible and responsive.	–	8 (6)	85 (69)	31 (25)	124 (100)
2. The alphabets and the numbers in the web-based application were in a sequential order	116 (93.5)	7 (6)	–	1 (1)	124 (100)
3. The interface of the application is well-designed	70 (56)	52 (42)	2 (2)	–	124 (100)
4. The colours used for the interface of the web-based application are not contrasting	8 (6)	15 (12)	73 (59)	28 (23)	124 (100)
5. The web-based application provided interactive features that helped you engage with the course content	57 (46)	67 (54)	–	–	124 (100)
6. The texts in the web-based application were not legible	1 (1)	1 (1)	87 (70)	35 (28)	124 (100)
7. The instructions provided within the web-based application are clear and understandable	118 (95)	6 (5)	–	–	124 (100)
8. The application effectively adapts to different devices and screen sizes	36 (29)	57 (46)	31 (25)	–	124 (100)
9. I am satisfied with the navigation and interface of the application	57 (46)	67 (54)	–	–	124 (100)

As depicted in Table III, up to 116 (93.5%) of respondents found the navigation tabs of the web-based application visible and responsive. Again, a significant majority of respondents (99.5%) agreed that the alphabets and numbers in the web-based application were in sequential order, contributing to a better learning experience. The majority of respondents, 122 representing, 98.4% of respondents were of the view that the interface of the web-based application was well-designed, potentially enhancing the learning experience. While most respondents (81.5%) found the colours contrasting, a notable portion (18.5%) disagreed, indicating potential issues with colour contrast. All respondents believed the web-based application provided interactive features that enabled them to engage with the content. Up to 122 (98.4%) believed the texts used in the web-based application were legible. All respondents were of the view the web-based application displayed clear instructions. A quarter (31) of all respondents were of the opinion that the web-based application did not effectively adapt to different devices and screen sizes. Respondents were generally satisfied with the navigation and interface of the web-based application. Overall, students had positive experiences with the web-based application, but concerns about colour contrast, text legibility, and device adaptability to different devices and screens suggest areas for improvement.

Research Question 2: Nursing Students’ Perceptions of the Accuracy and Usability of GSL Videos in the Web-Based Application

The perceptions of nursing students on the accuracy and usability of videos in the web-based application are summarised in Table IV.

Table IV. Findings Related to Nursing Students’ Perceptions of the Accuracy and Usability of GSL Videos in the Web-Based Application

Statement	Strongly agree f (%)	Agree f (%)	Disagree f (%)	Strongly disagree f (%)	No response f (%)	Total n (%)
10. The Graphic Interchange Formats (GIFs) in the web-based application were not clear to see and follow	–	–	69 (56)	55 (44)	–	124 (100)
11. The GIFs provide ample time to learn Ghanaian Sign Language	93 (75)	30 (24)	1 (1)	–	–	124 (100)
12. The GIFs in the web-based application could not cover a sufficient range of nursing concepts and terminologies	29 (23)	27 (21)	63 (50)	8 (6)	–	124 (100)
13. The web-based application effectively teaches me the basics of Ghanaian Sign Language	105 (85)	19 (15)	–	–	–	124 (100)
14. The web-based application provided a personalised learning experience that was tailored to my learning needs and preferences	86 (69)	37 (30)	–	–	1 (1)	124 (100)
15. The text in the web-based application did not correspond with GIFs	–	–	34 (27)	90 (73)	–	124 (100)
16. I find the sign language videos provided in the application to be helpful and informative.	84 (68)	40 (32)	–	–	–	124 (100)
17. The interface of the application is user-friendly and intuitive for learning Ghanaian Sign Language.	70 (56)	54 (44)	–	–	–	124 (100)
18. The application accurately represents and explains signs and concepts.	58 (47)	66 (53)	–	–	–	124 (100)

All the respondents found the GIFs in the web-based application clear and easy to follow. Again, the vast majority of respondents (99%) of respondents affirmed that the GIFs provided ample learning time. While a majority of respondents (50%) believed the GIFs in the web-based application covered a sufficient range of nursing concepts, a notable portion (43%) that was not the case. All respondents agreed the web-based application effectively captured the basics of GSL. The vast majority (99.2%) offered a personalised learning experience. All respondents further affirmed there was synchronization between text and GIFs in the web-based application. Additionally, all respondents found the GSL videos helpful and informative. Furthermore, all respondents asserted the interface of the application was user-friendly and intuitive for learning GSL. All respondents believed the web-based application accurately represents and explains signs and concepts. In summary, nursing students displayed positive perceptions of the accuracy and usability of GSL videos in the web-based application, indicating its effectiveness in supporting GSL learning.

Research Question 3: Challenges Nursing Students Face When Using the Web-Based Application for Learning GSL

The challenges nursing students face when using the web-based application are presented in Table V.

Table V. Findings Related to Challenges Nursing Students Face when Using the Web-Based Application for Learning GSL

Statement	Strongly agree f (%)	Agree f (%)	Disagree f (%)	Strongly disagree f (%)	No response f (%)	Total n (%)
19. The GIFs in the web-based application were not loading as fast as I wanted.	33 (27)	50 (40)	37 (30)	4 (3)	–	124 (100)
20. The GIFs in the web-based application were small in size	2 (2)	5 (4)	96 (77)	20 (16)	1 (1)	124 (100)
21. The navigation and interface of the web-based application were complex to follow	1 (1)	22 (18)	40 (32)	61 (49)	–	124 (100)
22. The web-based application was not compatible with my device	–	–	78 (63)	46 (37)	–	124 (100)
23. The web-based application consumed a lot much data	2 (2)	73 (59)	49 (39)	–	–	124 (100)
24. The web-based application did not support offline capability	112 (90)	11 (9)	–	1 (1)	–	124 (100)

The study identified key challenges faced by respondents in using a web-based application for learning GSL. A substantial portion expressed concern about the slow loading of GIFs (67%). While most respondents found GIF sizes adequate (93%), 6% were of the assertion that the GIFs were small in size. Less than a fifth (19%) of respondents believed the navigation and interface of the web-based application were complex. All respondents agreed on the application’s compatibility with their devices. Over 60% of respondents reported high data consumption, potentially impacting accessibility. Remarkably, 99% of respondents highlighted the absence of offline capability as a significant challenge. These findings underscore the need for improvements in GIF loading speed, size optimisation, navigation simplicity, data consumption, and the crucial addition of offline functionality to enhance the application’s usability for nursing students learning GSL.

Pearson Chi-Squared Test

Table VI presents the results of the chi-square test of independence between the gender of nursing students and their experiences and perceptions of the web-based application. The results revealed that female nursing students in particular had more positive experiences with the responsiveness and visibility of navigation tabs in the web-based application compared to their male counterparts. It was further revealed that female nursing students were likely to express that the web-based application covered a sufficient range of nursing concepts and terminologies compared to their male counterpart as presented in Table VI.

Table VI. Pearson Chi-Square Test of Independence Between Gender of Nursing Students and Their Experiences Related to Navigation as well as Perceptions Related to Accuracy and Usability of the Web-Based Application

Item		X2	df	P-value
1.	The navigation tabs in the web-based application were visible and responsive	25.6552	1	0.000
2.	The GIFs in the web-based application covered a sufficient range of nursing concepts and terminologies	7.2298	1	0.027
3.	The alphabets and the numbers in the web-based application were in a sequential order	3.0244	1	0.220
4.	The interface of the application is well-designed	0.7679	1	0.681
5.	The web-based application provided interactive features that helped you engage with the course content	1.7283	1	0.421
6.	The texts in the web-based application were not legible	0.7679	1	0.681
7.	The application effectively adapts to different devices and screen sizes	4.6194	1	0.099
8.	The GIFs provide ample time to learn Ghanaian Sign Language	3.0244	1	0.220

Discussion

Nursing students generally had positive experiences relative to navigation, interface, accuracy, and usability with the web-based application for learning GSL. Respondents asserting that the web-based application is user-friendly suggests they are comfortable using the application. As emphasised by Robleset al. (2023) efficient and user-friendly navigation experiences can significantly enhance student engagement, motivation, and learning outcomes. Again, the user-friendly and intuitive interface was crucial for promoting ease of use and navigation, allowing students to focus on content without distractions. It is informative to note that 94% of students found the navigation tabs visible and responsive, facilitating easy access to different sections of the application. The organised, sequential order of alphabets and numbers contributed to effective navigation, aligning with the findings of Izzah and Suciati (2014) as well as Rosell-Aguilar (2017) emphasising the significance of clear and visible application design for enhanced navigation experiences.

The majority of respondents considered the application’s interface well-designed and visually appealing, a crucial aspect for sustaining interest in the course content. Respondents further gave positive feedback on the use of contrasting colours, enhancing readability. The legibility of text within the application was deemed satisfactory by most respondents. The aforementioned findings, according to Shaoet al. (2020), enhances users’ satisfaction, motivation, and willingness to continue using the application. The presence of interactive features in the web-based application was highlighted as helpful for student engagement, emphasising the value of incorporating elements like quizzes and simulations for active learning and enhanced understanding of GSL. Additionally, clear and understandable instructions further supported the learning process, minimising confusion.

The study reveals that 97% of respondents held positive perceptions of the accuracy and usability of GSL videos in web-based applications. As affirmed by Rosell-Aguilar (2017) and Joze & Koller (2020), such videos enhance the learning and comprehension of sign language. Additionally, the findings of this current study indicated that respondents found GIFs in the application to be clear and comprehensible. Compared to text-based explanations, GIFs provide a more engaging and easily digestible way to learn, improving understanding, knowledge retention, and information recall (Brame, 2016; Haagsmanet al., 2020). The findings suggest that the videos effectively conveyed information in a visually digestible format, providing ample learning time and an appropriate pace for understanding concepts related to GSL. Notably, the GSL videos covered a sufficient range of nursing concepts, ensuring a comprehensive learning experience and catering to diverse learning needs. This mitigates the inadequacies associated with other traditional methods of teaching GSL including the challenges of covering sufficient concepts as espoused by Joyet al. (2022). The application’s perceived success in teaching the basics of GSL implies that the presented material was easily understandable, while the personalised learning experience reflects a tailored approach as espoused by Noetelet al. (2021).

The correspondence between text and GIFs enhanced the learning experience, emphasising the value of multimedia synergy. Importantly, the accurate representation of signs and concepts contributed to the positive reception among nursing students, aligning with Davidson and Piché (2017), who emphasised the importance of credibility in video information.

The findings of the study suggest that the web-based application effectively met nursing students’ expectations in terms of accuracy and usability. Positive feedback on clear GIFs, comprehensive coverage, personalised learning, user-friendly interface, and accurate representation highlights the efficacy of GSL videos in supporting respondents’ learning. These outcomes contribute to existing knowledge and underscore the significance of accurate and usable educational materials in GSL education.

The study identified significant challenges faced by nursing students in using the web-based application for learning GSL. Issues related to loading speed, GIF size, data consumption, and the absence of offline capability were prominent problems associated with the application. Slow loading times, large GIF sizes, and data consumption concerns can lead to frustration and disrupt the learning experience. Again, users of the web-based application in areas with poor internet connectivity or limited data plans will be disadvantaged and unable to fully utilise the application.

In conclusion, the study highlighted nursing students’ positive experiences with a web-based application designed for learning Ghanaian Sign Language (GSL). The findings emphasised the application’s potential benefits, particularly in terms of a user-friendly interface, structured content, and effective GSL videos. Despite these positive aspects, some challenges related to the use of the web-based application were uncovered.

Conclusions

This current study delved into nursing students’ perceived effectiveness of a web-based application designed for learning GSL. The findings unveiled a positive outlook on the navigation and interface of the application. The majority of students appreciated its user-friendly design, with visible and responsive navigation tabs enhancing their ease of use. The structured arrangement of alphabets and numbers, along with an appealing design, contributed to a smooth and visually engaging learning experience. Most students acknowledged the effective interactive features and clear text readability, which facilitated their engagement with course content and comprehension.

Furthermore, students perceived the GSL videos in the web-based application as accurate and usable tools for learning. The GIFs effectively conveyed information, striking a balance between textual content and visual aids. The application catered for individual learning preferences and covered a broad range of nursing concepts. It was seen as a reliable resource that accurately represented GSL signs and concepts, thus contributing to students’ overall learning outcomes.

However, the study also highlighted certain challenges faced by nursing students. Slow loading times for GIFs and concerns about their size were noted, potentially impeding the learning experience. While most students found the interface user-friendly, a notable portion encountered navigation difficulties, indicating a need for refinements. Additionally, data consumption and the absence of offline capabilities emerged as significant issues, restricting accessibility for some students.

These findings collectively underscore the potential of web-based applications in enhancing language learning experiences for nursing students. Nevertheless, there is room for improvement in addressing technical challenges, optimising user interface, and enhancing accessibility. To maximize the effectiveness of such applications, developers, educators, and institutions must collaborate and refine the application’s technical performance and user experience. Ultimately, by addressing these challenges, nursing students can fully benefit from the advantages offered by innovative technology in their GSL learning journey.

Recommendations

Consistent with the first research question of this current study, it was revealed that nursing students generally had positive experiences with the navigation and interface of the web-based application. However, to improve the colour contrast of the web-based application applied in this current study, it is recommended a colour contrast analysis is done using tools such as Web Accessibility in Mind (WebAIM’s) Contrast Checker to ensure appropriate contrast ratios between text and background colours for both light and dark themes. Again, to improve the web-based application’s adaptability to different devices and screens, it is recommended frameworks such as Bootstrap or Foundation should be applied to automatically adjust the layout and content based on the user’s device and screen size. This should be followed by testing the web-based application on different devices and screens to ensure it is adapted for these devices and screens.

In line with the second research question underpinning this current study, nursing students largely found the web-based application accurate and usable. However, nearly a quarter of respondents asserted the web-based application did not cover sufficient terminologies relevant to nursing education. Thus, there is a need to conduct a comprehensive needs assessment with nursing students and professionals to identify essential nursing terminologies for inclusion in the web-based application.

Relative to the third research question, the study brought to light some challenges faced by the majority of nursing students in using the web-based application, particularly pertaining to the slow loading of GIFs and internet connectivity issues. In light of these issues, there is a need to invest in faster servers and optimisation of media file sizes of the web-based application to ensure a smoother and more efficient user experience. Again, it is crucial features including options for lower-resolution video streaming and a data-saving mode are incorporated into the web-based application so as to provide users with greater flexibility and control over their online learning experience.

Further research is needed to explore the underlying reasons for female nursing students having more positive experiences with the navigation and content of the web-based application compared to their male counterparts. This could involve conducting qualitative studies such as interviews or focus groups to gain deeper insights into student perspectives and experiences. The findings of these studies could then be incorporated into future education-related web-based applications to ensure these applications appeal to all sexes.