A medium-sized accredited public university located in southeastern Minnesota has been offering an introductory undergraduate mathematics course with a consistent curriculum in two instructional formats: face-to-face and blended. Previously the course was offered only through a face-to-face instructional format while currently, it is only offered in a blended instructional format. This case study explored the influence that the method of instruction had on student achievement on common assessments, how a blended instruction course design impacted the attitude of students, and the amount of knowledge acquired in a blended instruction environment. A blended course is one taught by combining teacher-centered face-to-face instructional elements with online learning components and online course management tools. In more general terms, blended instruction is a term used to describe instruction or training events or activities where online learning, in its various forms, is combined with more traditional forms of instruction such as "classroom" learning. The terms "hybrid" and "mixed mode" are references to the same type of instruction and therefore used synonymously. An instrument developed by Martha Tapia and George Marsh measured changes in attitude toward mathematics related to a blended instructional course design. While one area of interest was the level of procedural knowledge acquired in a blended instructional environment versus that of a face-to-face setting, an additional interest was student comprehension beyond procedural knowledge. This study noted applications of the common knowledge students used to demonstrate their comprehension and sense-making ability. In order to evaluate the additional level of understanding, this study asked questions of students enrolled in a blended instructional environment via a series of interviews as well as observing classroom activities designed to allow for further exploration of content and demonstration of knowledge beyond that allowed for in a face-to-face setting. Results from this study indicated a statistically significant difference in comparing final course grades and final examination grades of the students enrolled in the blended instruction designed course versus the face-to-face lecture courses while the instructor was held constant. Students were less anxious working on assigned problems and assessments as they familiarized themselves with the design and instructional strategies. In addition, students were more engaged in discussions as the semester progressed, and students experienced the benefits of communicating with group members. The results also indicate that students enrolled in a blended instruction course perceive that the classroom environment promotes interactions, and they are involved in classroom discussions and activities. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]