Abstract
BACKGROUND: Blended learning is being increasingly adopted in higher education in China; however, ensuring high learning satisfaction remains a challenge. Understanding the interplay among students' technology perceptions, skills, and engagement is crucial for optimizing this mode of learning. This study investigated the structural relationships between perceived usefulness, digital literacy, learning engagement, and learning satisfaction among medical students in China. METHOD: A cross-sectional survey was conducted with 292 undergraduate medical students randomly selected from four universities in Guangxi, China. Data were analyzed using SPSS and partial least squares structural equation modeling (PLS-SEM). RESULTS: Perceived usefulness exerted an extremely strong direct effect on learning satisfaction and a moderate indirect effect through engagement. Digital literacy strongly predicted engagement and exhibited a small direct association with satisfaction. Engagement exerted a small to moderate effect on satisfaction and partially mediated both relationships. The model explains 73.1% of the variance in satisfaction. Importance-performance analysis showed that perceived usefulness was both highly important and well-performing, while digital literacy showed moderate importance but consistently high performance. Learning engagement showed relatively lower importance and performance. CONCLUSION: Perceived usefulness is central to medical students' satisfaction with blended learning, whereas digital literacy contributes primarily to fostering stronger learning engagement. Targeted efforts to build students' digital competencies and demonstrate the academic and clinical value of blended courses may help improve blended medical education in comparable settings.