Effects of caricature storyline audiovisual education on knowledge, attitudes, behavior, and preventive motivation regarding needlestick injuries among nursing interns: a mixed methods study

Despite existing preventive measures, nursing interns remain vulnerable to needlestick injuries (NSIs). Although animation-based education has been shown to be effective in other clinical contexts, its use in preventing NSIs remains underexplored. This study evaluated the effectiveness of the caricature-based audiovisual education model with a storyline in preventing NSIs and explored nursing interns’ perceptions of this intervention. A sequential mixed-methods design was used. A total of 260 nursing interns enrolled in junior college or undergraduate programmes were recruited after completing one to two months of clinical practice. All participants subsequently received the “caricature storyline-based audiovisual education”. Quantitative outcomes (NSI-related knowledge, attitudes, behaviors, preventive motivation) were assessed using validated scales at baseline, immediately after the intervention, and at the 3-month follow-up. Additionally, a subsample of 49 participants participated in ethnographic observations and semi-structured interviews. Quantitative data were analysed using repeated‑measures ANOVA, while qualitative data were analysed using thematic analysis. Repeated-measures ANOVA revealed significant main effects of time for knowledge, attitudes, behaviors, and preventive motivation (all p < 0.001, partial η² = 0.968–0.992). Corrected post-hoc tests showed that all four scores significantly increased from pre-test to both the post-test and the 3-month follow-up (all p < 0.001). Knowledge and attitude scores remained stable between post-test and follow-up ( p = 0.473 and p = 0.541, respectively), whereas behaviors and preventive motivation scores continued to rise significantly over the same period (both p < 0.001). Only six NSIs were reported during the follow-up period. Qualitative feedback from 49 participants yielded four themes and six subthemes. The caricature storyline-based audiovisual education model improved nursing interns’ knowledge, attitudes, behaviors, and motivation regarding NSI prevention, and some improvements were maintained or increased over the 3-month follow-up period. The intervention may also support the standardisation of clinical practice and help reduce the occurrence of NSIs. Most nursing interns rated the intervention positively, suggesting that it could be considered for other healthcare disciplines.