Perceived Effects, Opportunities, and Challenges of Adapting Computer-Based Testing (CBT) in Nursing Education in Nigeria: A Mixed-Methods Study

Background: Nursing education in Nigeria is increasingly shifting from paper-based examinations to Computer-Based Testing (CBT), although adoption remains inconsistent across institutions. Objective: This study examined CBT adoption, its perceived effects on student performance, and the experiences of teaching staff and students in nursing institutions across Nigeria. Methods: A mixed-methods convergent triangulation design was used. Quantitative data were collected from 320 teaching staff and 1,005 students, while qualitative data were obtained through 12 key informant interviews. Data were analysed using descriptive statistics, one-sample t-tests, ANOVA, and thematic analysis. Results: CBT adoption was moderate but statistically significant (mean = 3.21; t(319) = 12.35, p < 0.001). Major challenges included internet connectivity (mean = 2.85), technical support (mean = 2.65), and transition from paper-based examinations (mean = 2.59). Teaching staff perceived positive effects on student performance, with an overall mean score of 3.76 and item scores ranging from 3.47 to 3.85. Students reported positive perceptions of convenience (mean = 3.92), fairness and reliability (mean = 3.93), and confidence (mean = 3.90). However, stress related to time and technical challenges remained evident (means = 2.47–2.57). Perceptions differed significantly by age group (p = 0.002), but not by gender or academic level. Qualitative findings identified five themes covering adoption practices, perceived benefits, student engagement, implementation barriers, and mitigation strategies. Conclusion: CBT was generally perceived favourably, but infrastructural limitations, inadequate technical support, and digital preparedness remain important challenges. Strengthening ICT infrastructure, training, and technical support may improve implementation.