Bilingual Simulated Electronic Health Record to Advance Nursing Students’ Digital Competence in Low-Resource Cambodian Healthcare: Quasi-Experimental Study

Background: Digital health competence, particularly proficiency in electronic health records, is crucial for nursing practice globally but faces challenges in low-resource settings. Cambodian nursing students encounter linguistic barriers due to limited English proficiency and lack of bilingual digital training tools. This study evaluates a novel bilingual simulated electronic health record platform designed to improve digital health competencies among Cambodian nursing students. Methods: A quasi-experimental design with pre- and post-intervention assessments was conducted among first-year nursing students at three Cambodian institutions. Survey instruments were developed, validated, and administered in both Khmer and English. Reliability of survey scales was evaluated using Cronbach's alpha. Data were analyzed using the Shapiro-Wilk test for normality, descriptive statistics (medians and interquartile ranges), the Mann-Whitney U test for group comparisons, and the Hodges-Lehmann estimator for median difference estimation. Results: A total of 584 students completed the pre-intervention survey, and 291 completed the post-intervention survey. The majority preferred using the platform in Khmer or a combination of Khmer and English. Self-perceived competence in electronic health record knowledge improved significantly post-intervention (p < 0.001). Students reported increased confidence and readiness for workplace digital health tasks. Challenges included technical issues, limited computer literacy, and language difficulties; however, bilingual support mitigated language barriers. Nearly all participants recommended the platform for future cohorts. Conclusions: The bilingual simulated electronic health record platform effectively enhanced digital health competencies and confidence among Cambodian nursing students. Language accessibility and mobile compatibility were critical to the platform's success in this low-resource, multilingual setting. Integrating bilingual digital health education and addressing infrastructural barriers can better prepare nursing students for clinical practice in contexts with limited English proficiency and digital resources.