(Special Issue) Effectiveness Analysis of a Digitally Assisted Teaching Module on Spiritual Health Care Competency for Middle-Aged and Older Long-Term Care Workers in Taiwan
Author: Chia-Chen Chang (Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei City, Taiwan), Chen-Yin Tung (Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei City, Taiwan), Yuh-Wei Seng (Department of Senior Welfare and Health Promotion, College of Lohas Design, St. John’s University, New Taipei City, Taiwan), Pin-Hsien Li (Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei City, Taiwan), Jia-Ni Wu (Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei City, Taiwan), Hsiao-Fen Lo (Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei City, Taiwan), Wei-Hsiang Huang (Department of Early Childhood Care and Education, University of Kang, Ning, Taipei City, Taiwan), Ching YI Chen (Ai Shin Home Care Co., Ltd. Affiliated Taipei City Private Ai Shin Home Long-Term Care Institution), Han Chiang Fu (Ai Shin Home Care Co., Ltd. Affiliated Taipei City Private Ai Shin Home Long-Term Care Institution), Jaw-Shiun Tsai (Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan; Department of Family Medicine; Jin-Shan Branch, National Taiwan University Hospital, Taipei, Taiwan)
Vol.&No.：Vol. 70, No. 4
Date：December 2025
Pages：91-120
DOI：https://doi.org/10.6209/JORIES.202512_70(4).0004
Abstract：
Introduction
As societies around the world enter the era of population aging, long-term care (LTC) services have become an essential pillar of social welfare and healthcare systems. In Taiwan, the proportion of older adults aged 65 and above has surpassed 20%, categorizing the country as a super-aged society. Among LTC professionals, middle-aged and older care workers play a critical role in the daily care and emotional support of older adults. However, while most LTC training programs emphasize physical and psychological caregiving, the spiritual dimension of health remains under-addressed. Spiritual health, defined as the capacity to find meaning, hope, and connection, is essential for holistic well-being, especially among older adults. Despite its significance, spiritual care is often overlooked in formal training programs, and many care workers feel inadequately prepared to provide such support. Purpose This study aimed to develop, implement, and evaluate a digital-assisted teaching module that focuses on enhancing the spiritual care competencies of middle-aged and older LTC workers. The rationale for adopting a digital approach lies in the growing need for flexible and scalable educational interventions, particularly during and after the COVID-19 pandemic when in-person training was limited. Moreover, digital learning tools offer the potential to tailor content to learners’ pace, context, and preferences– features that are especially important for adult learners who may face barriers in traditional classroom settings. This study contributes to the field by addressing the following key questions: (1) Can a digital-assisted teaching module improve spiritual care competencies among middle-aged and older LTC workers? (2) How does age moderate the effectiveness of such an intervention? (3) Which domains of spiritual care competence benefit the most from digital learning?
Methods
A randomized controlled trial was conducted between September and November 2024 at a long-term care institution in northern Taiwan. Forty LTC workers aged 45 and above were recruited through purposive sampling and randomly assigned to either the experimental group (n = 20) or the control group (n = 20). The experimental group received a digital-assisted teaching module specifically designed to improve spiritual care competencies. The control group did not receive any intervention during the study period. The module was constructed based on a review of existing literature and tailored to the practical needs of middle-aged and older learners. It consisted of interactive video scenarios, self-assessment activities, and reflective learning components. Expert validity review yielded a content validity index of 0.81, indicating strong content relevance and appropriateness. The intervention lasted four weeks, with learners engaging in self-paced activities that included thematic learning units: spiritual care attitudes, assessment, care implementation, resource integration, and quality improvement. Participants completed the 27-item Spiritual Care Competency Assessment Questionnaire at three time points: pretest, posttest, and delayed posttest (four weeks after the intervention). Data were analyzed using repeated-measures ANOVA to examine within-group and between-group effects over time. Generalized Estimating Equations (GEE) were also employed to explore the moderating role of age and the long-term impact of the module.
Results
Participants in the experimental group showed statistically significant improvements across multiple domains of spiritual care competence. Repeated-measures ANOVA revealed significant group-by-time interaction effects in the domains of spiritual care skills (F = 19.39, p < .01), assessment (F = 12.63, p < .01), resource integration (F = 8.15, p < .01), and quality improvement (F = 7.06, p = .01). The overall competency score also demonstrated a significant interaction effect (F = 12.81, p < .01), indicating that the experimental group improved more over time than the control group. Although the attitude domain did not show a significant interaction effect (F = 2.67, p = .11), a main effect of time was observed (F = 6.95, p = .01), suggesting that participants became more open to spiritual care practices regardless of group assignment. GEE analysis confirmed these findings and provided further insights into age-related effects. Notably, age was a significant predictor of improvement in caring attitude (B = 0.55, p =.014) and care skills (B = 0.67, p = .028). This suggests that older participants may have been more receptive to the values and practical guidance offered in the module, possibly due to their accumulated life experiences and empathy toward the spiritual needs of care recipients. Additionally, significant effects were found for resource integration at both the posttest (B = 31.95, 95% CI: 1.22-62.68, p = .042) and delayed posttest (B = 40.94, 95% CI: 1.20-80.69, p = .043), indicating sustained learning impact. The discussion of findings points to several practical and theoretical implications. First, integrating spiritual care education into LTC training is not only feasible but also effective, especially when digital tools are used to simulate real-world caregiving scenarios. Second, the findings highlight the necessity of age-sensitive instructional design in adult education. Tailoring content and delivery for middle-aged and older learners– including slower pacing, meaningful examples, and values-based reflections– can enhance engagement and retention. Lastly, the sustained effects observed at follow-up suggest that digital learning, when properly designed, can promote not only knowledge acquisition but also long-term behavioral and attitudinal change.
Conclusion
This study provides empirical evidence that a digital-assisted teaching module can significantly enhance the spiritual care competencies of middle-aged and older long-term care workers. The results also suggest that older learners benefit even more from such interventions, emphasizing the importance of age-appropriate instructional design. By integrating real-world practice, reflective learning, and flexible digital delivery, the module proved effective in improving both short-term and sustained learning outcomes. These findings have important implications for the design of continuing education programs in long-term care. Policymakers and training institutions are encouraged to adopt digital, scalable, and personalized learning approaches to strengthen holistic care practices in aging societies. Future research could extend this work by comparing different digital formats, exploring cost-effectiveness, or adapting the module for use in interdisciplinary teams, including nurses, social workers, and chaplains.
Keywords：middle-aged and older adults, long-term care education, digital-assisted learning, randomized controlled trial, spiritual care competency