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Background: Mobile Information and Communication Technologies have led to the rise in dependence on smartphones worldwide and nomophobia (NMP) which is the fear of being out of mobile phone contact.
Objectives: The objectives of the study were to assess smartphones usage among the medical students, to estimate the prevalence of NMP, it's gradation and it's association of different variables with grade of NMP.
Methods: A community-based, analytical cross-sectional study was conducted among medical students selected by the systematic random sampling technique. A questionnaire comprising smartphone ownership/usage variables and questions on NMP Questionnaire was used.
Results: Female students (70.9%) were more compared to males (29.1%). Majority (44.7%) were in the age group of 19–20 years. 52.4% of them had received ≤3 E-mails/day. 56.4% of them had installed ≤20 apps in their smart phones in their smartphones. Sixty-eight percent of them had installed ≤3 newer apps in last month. The prevalence of NMP was found to be 100% with the maximum (63.1%) having moderate grade of NMP. It was found that the associations of the community, possession of smartphone, average monthly mobile phone bill including internet usage, and number of E-mails sent per day with the difference in the grade of NMP were found to be statistically significant, (P = 0.04), (P = 0.04), (P = 0.01), and (P = 0.04), respectively.
Conclusions: The high prevalence of NMP can be attributed to the use of smartphones for online classes due to the COVID-19 pandemic.
Keywords: Medical students, nomophobia, smartphones
| Introduction | |  |
Human beings have made tremendous advancements in technology since history, to make their life easier and convenient. Information and Communication Technologies (ICTs) are one such advancement of which notably mobile ICT has become popular because of the decreasing cost of smartphones, technology, and greater adoption by the people.
This has led to rise in dependence on smartphones worldwide[1],[2],[3] and nomophobia (NMP).[4]
NMP or no mobile phobia is the fear of being out of mobile phone contact. It was first coined during a study conducted in 2008 by the UK Postoffice to investigate anxieties mobile phone users suffer.[5] NMP is a disorder of contemporary digital and virtual society and refers to discomfort, anxiety, nervousness, or anguish caused by being out of contact with a mobile phone. It has been proposed to be included in the new Diagnostic and Statistical Manual of Mental Disorders V.[6]
Sharma et al.[7] in her study on medical students reported that 75% of them had NMP and 83% experienced panic attacks on their inability to use their mobiles. Similar studies were done by Dixit et al.[8] in Indore and Pavithra et al.[9] in Bengaluru on medical students.
In a recent study by Dasgupta et al.[10] among medical students in North Bengal Medical College, Siliguri, West Bengal, the prevalence of NMP was found to be 42.6%.
Majority of college-going students from various socio-economic backgrounds are affected by the increasing use of smartphones in their day-to-day life.
Although there were some studies on NMP in India, there were very few studies on the same among medical students in Andhra Pradesh. Therefore, the present study was conducted to assess smartphones usage, to estimate the prevalence of NMP, it's gradation and its association of different variables with grade of NMP among the students of a medical college in Andhra Pradesh.
METHODS
A community-based analytical, cross-sectional study was conducted in a private medical college in North Andhra Pradesh from August 16 to October 15, 2021 for a period of 2 months. The study subjects were undergraduate medical students. Using the prevalence of 42.6% rounded off to 43% (based on previous study),[10] absolute precision of 10% and confidence interval of 95%, the sample size using the formula, n ≥ Z2pq/l2 was estimated to be 94.157 (rounded off to 94). With a 10% nonresponse rate, the final sample size derived was 103.
Students who possessed and used a smartphone for at least 1 year were included and students who were unwilling to participate, sick and absent during the study period were excluded from the study population.
Prior to the conduct of the study, permission from the Institutional Ethical Committee (IEC) was taken. Written informed consent was taken from the study subjects after explaining the nature, purpose, and conduct of the study. The students were briefed about the purpose of the study the questionnaire. The total number of students enrolled for MBBS course spread in all professionals was enumerated. They constituted 570 in number and constitute the sampling universe. After applying the inclusion and exclusion criteria, the accessible population constituted 515 in number. The study population was selected by the systematic random sampling technique. The sample size estimated earlier was 103. The sampling interval obtained was 5. The number 2 was chosen randomly between 1 and 5. Hence, the first student selected was no. 2, followed by 7th, 12th, and 17th and so on till the sample size of 103 students was obtained.
The data were collected by a pretested and predesigned questionnaire in English comprising background characteristics of study subjects, smartphone ownership/usage variables and questions on nomophobia questionnaire (NMP-Q)[3] were used. NMP-Q is a validated questionnaire specifically developed by Yildrim and Correia and used by many authors for their studies.
The content validity is there as the questions cover the full range of the issues or problems being measured. The face validity is also present as the questions in the research instrument have a logical link with the objectives. Reliability in the pilot study by the authors Yildrim and Correia demonstrated that NMP-Q held a good internal consistency or reliability with a Cronbach's alpha value of 0.918. The questionnaire is thus appropriate for the use in the study. NMP-Q had 20 items addressing the four factors of NMP: (1) Not being able to communicate, (2) losing connectedness, (3) not being able to access information, and (4) Giving up convenience. All 20 items in NMP-Q were rated using a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Total score was calculated by summing up responses to each item, resulting in a NMP score ranging from 20 to 140. NMP-Q scores are interpreted as follows: An NMP-Q score of 20 indicating the “absence of NMP;” score ≥20 and <60 corresponding to a “mild level of NMP;” score ≥60 and <100 corresponding to a “moderate level of NMP;” and a score ≥100 corresponding to a “severe NMP.”[3] Potential sources of bias can be sampling bias, nonresponse bias, and reporting bias. Sampling bias was avoided by the proper inclusion and exclusion criteria and also by proper sampling technique. Nonresponse bias was avoided by taking extra 10% of the sample size. Reporting bias was avoided by putting frankly the results that have originated from the study by including both significant and nonsignificant results. The data collected were entered into MS Excel spreadsheets and were analyzed using the SPSS software version 22 (Statistical Package for Social Sciences, IBM Corporation, Armonk, New York, United States of America).[11] Descriptive statistics such as percentages, mean with standard deviation or median with inter quartile range (IQR) depending on the nature of distribution was done. The Chi-square test for the association was done and P < 0.05 was considered as statistically significant.
The research proposal for the ICMR-STS-2020 was approved by the Institutional Ethics Committee, Rc.No: GVPHCMT/IEC/03082020/01.
| Results | | |
[Table 1] shows the distribution of the study population according to socio-demographic variables. Out of 103 medical students, males constituted 29.1% and females 70.9%. Majority (44.7%) students were found in the age group of 19–20 years. The mean age of males was estimated to be 20.77 ± 1.92 years and females 20.11 ± 1.51 years. 90.4% of the students were Hindus, and most 52.4% of the medical students hailed from general community. 88.3% of the medical students belonged to the nuclear family and most (68.9%) of the medical students had ≤4 family members. 50.5% of the medical students' family had total monthly income ≤Rs. 50,000 and 52.4% of the total medical students had ≤Rs. 1000 pocket money per month. First year medical students constituted 24.3% while 2nd year, third year and fourth year students each constituted 25.2%. 73.88% of the medical students came from their homes to the medical colleges. | Table 1: Distribution of study population according to sociodemographic variables (n=103)
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[Table 2] shows the distribution of the study population according to smartphone ownership and usage. 84.5% of the medical students were in possession of at least 1 smart phone and 82.5% of them had a latest phone worth more than Rs. 10,000. 97.1% of the medical students possessed a mobile internet data plan. 56.3% of them had an average monthly mobile phone bill more than or equal to Rs. 200. 37.9% of medical students had other gadgets also other than smartphone while the rest 62.1% had only smartphone. 60.2% of them spent more than 4 h per day average time using smartphone. 69.9% of the medical students made ≤3 phone calls per day. Median number of phone calls made per day was 3.0 with IQR 2.0. 59.2% of them received ≤3 phone calls per day. Median number of phone calls received per day was 3.0 with IQR 3.0. 52.4% of the medical students had sent ≤10 text messages per day. Median number of text messages sent per day was 10.0 with IQR 44.0. 57.3% of the medical students had received ≤20 text messages per day. Median number of text messages received per day was 20.0 with IQR 45.0. About 69.9% of the medical students did not send any E-mail per day while the rest 30.1% had sent more than or equal to 1 E-mail per day. Median number of E-mails sent per day was 0.0 with IQR 1.0. About 52.4% of the medical students had received ≤3 E-mail per day. The median number of E-mails received per day was 3.0 with IQR 5. 54.4% of the medical students had installed ≤20 apps. The median number of apps installed in smartphone was 20.0 with IQR 27.0. | Table 2: Distribution of study population according to smartphone ownership and usage (n=103)
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[Table 3] shows the distribution of the study population according to the grade of NMP. All the 103 medical students were found to be having some or other grade or degree of NMP and prevalence of NMP was found to be 100%. About 23.3% medical students were found to be suffering from mild NMP, while 63.1% and 13.6% were seen to be suffering from moderate and severe NMP, respectively. Out of the 103 medical students suffering from NMP, 70.9% were females and. 29.1% were males. | Table 3: Distribution of the study population according to grade of nomophobia (n=103)
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[Table 4] shows the association of sociodemographic variables of the study population with grade of NMP. The association of the community of the medical students with the difference in the grade of NMP in the medical students was found to be statistically significant (P = 0.04). | Table 4: Association of sociodemographic variable of the study population with grade of nomophobia
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[Table 5] shows the association of smartphone ownership and usage variables of study population with grade of NMP. The association of possession of smartphone by medical students with the difference in the grade of NMP in medical students was found to be statistically significant (P = 0.045). The association of average monthly mobile phone bill including internet usage of medical students with the difference in the grade of NMP in medical students was found to be statistically significant (P = 0.01). Similarly, the association of number of E-mails sent per day using smartphone by medical students with the difference in the grade of NMP in medical students was found to be statistically significant (P = 0.04). | Table 5: Association of smartphone ownership and usage variables of the study population with grade of nomophobia
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| Discussion | | |
In the present study, there was more proportion of female students (70.9%) compared to male students (29.1%) thus showing a female preponderance. Similar observations were noted in the studies by Sharma et al.,[7] Kumari et al.,[12] Sethia et al.,[13] Rupani et al.,[14] Choudhury et al.,[15] and Thapa et al.[16] Studies by Dixit et al.,[8] Pavithra et al.,[9] Dasgupta et al.,[10] and Kariya et al.[17] showed a male preponderance. Majority (44.7%) of the students were found in the age group of 19–20 years. Dixit et al.,[8] Sethia et al.,[13] and Choudhury et al.[15] made similar observations in their studies. Studies by Sharma et al.,[7] Dasgupta et al.,[10] Thapa et al.[16] and Thapa et al.,[18] however, noted different observations. Mean age of the research participants in the present study was 20.30 ± 1.66 years of which age in males was 20.77 ± 1.92 years and females was 20.11 ± 1.51 years. Rupani et al.[14] reported that the mean age of the medical students was 20.25 ± 1.2 years. This was found to differ with the observations in the studies by Pavithra et al.,[9] Dasgupta et al.,[10] Bivin et al.,[19] Kumari et al.,[12] Thapa et al.,[16] and Thapa et al.[18] 87.4% of the medical students were Hindus which was similar to that of the study by Choudhury et al.[15] in which Hindus constituted 88.1%. 88.3% of the medical students belonged to nuclear family, 6.8% of them to joint family, and 4.9% of them belonged to three generation family. This was found to be consistent with the observations in a study by Rupani et al.[14] where the majority (78%) of the medical students belonged to the nuclear family, 17.3% to joint family and 4.7% to three generation family. Studies by Thapa et al.[16] and Thapa et al.[18] reported similar findings. It was observed in the current study that medical students from all professional years participated. Kumari et al.,[12] Sethia et al.,[13] Dasgupta et al.,[10] and Thapa et al.[18] in their studies also observed that medical students from all years participated. However, in studies by Sharma et al.,[7] Kariya et al.,[17] Rupani et al.,[14] and Choudhury et al.,[15] students from selected years only participated. Majority (73.88%) of the medical students in the present study came from their homes to the medical college, while 23.2% were staying in hostel and 3.9% were staying as paying guest in flats or houses in the city. Pavithra et al.[9] in their study where majority (59.5%) were day scholars and the rest 40.5% were residing in the hostels. Dixit et al.[8] in their study noted 46% of the study population were day scholars and the rest 54% were hostellers. Studies by Dasgupta et al.[10] and Choudhury et al.[15] also reported different observations.
Majority (84.5%) of the research participants had 1 smart phone with them followed by 8.7% having twosmartphones and 6.8% having three smartphones. Sharma et al.[7] noted similar observations where majority (62%) of the respondents had 1 smartphone followed by 34% having 2 smartphones and 4% having more than two smartphones. Studies by Dasgupta et al.,[10] Bivin et al.,[19] Kariya et al.,[17] and Kumari et al.[12] also reported similar findings. Majority (52.4%) of the medical students were in possession of smartphone for more than 2 years. Bivin et al.[19] and Thapa et al.[16] noted similar observations in the study. However, Dasgupta et al.[10] differed with that of finding in the present study. 82.5% of the medical students had a smartphone worth more than or equal to Rs. 10,000 which was similar to the findings in the study by Dasgupta et al.[10] 97.1% of the research participants in the current study had a mobile internet data plan. Dasgupta et al.[10] also reported in their study that 88% of the medical students had a mobile internet plan. Studies by Kariya et al.,[17] Kumari et al.[12] and Rupani et al.[14] noted similar findings. 56.3% of the medical students had average monthly mobile phone bill including internet usage, more than or equal to Rs. 200. Kariya et al.[17] noted in their study that 87.7% of the medical students spent Rs. 125–150 per month for recharge of their mobile phones. Dixit et al.[8] observed that 44% of the students spent Rs. 250–500 per month for their mobile recharge. Studies by Pavithra et al.,[9] Rupani et al.,[14] and Thapa et al.[18] also contradicted with the observation of the present study. Only 37.9% of the medical students in the present study had other gadgets. Dasgupta et al.[10] noted that 51.2% of the research participants had other gadgets. About 60.2% of the medical students in the current study spent more than 4 h per day using smartphone while the rest (39.8%) spent ≤4 h per day. Kumari et al.[12] also noted that 63.8% of the medical students spent more than or equal to 4 h per day on their smartphone. Pavithra et al.[9] differed in their observation where majority (48%) spent 1–3 h per day on their mobile phones. Studies by Dasgupta et al.,[10] Sethia et al.,[13] Thapa et al.,[16] Kiriya et al.,[17] and Thapa et al.,[18] also reported contradictory findings. It was noted that majority (69.9%) of the study subjects had made ≤3 calls per day. Median number of calls made per day was 3.0 with IQR 2.0. This was consistent with the observation in the study by Thapa et al.[18] where the majority (57.6%) made 1–5 calls per day. 59.2% received ≤3 phone calls per day in the present study. Median number of calls received per day was 3.0 with IQR 3.0. This differed with the observation in the study made by Dasgupta et al.[10] where the median number of calls received per day was 5.0 with IQR 7.0. 52.4% of the medical students sent ≤10 text messages per day with median number of text messages being 10.0 with IQR 44.0. However Dasgupta et al.[10] noted in their study that the median number of text messages sent per day was 3.0 with IQR 20.0. Contradictory observations were also reported in other studies.[16],[18] 57.3% of the respondents in the present study received ≤20 text messages per day with the median number of messages being 20.0 with IQR 45.0. Dasgupta et al.[10] noted that the median number of text messages received per day was 7.0 with IQR 28.0. 52.4% of the study subjects received ≤3 E-mails per day with the median number of E-mails received per day being 3.0 with IQR 5.0. This contradicted with the findings in the study by Dasgupta et al.[10] where the median number of E-mails received per day was 2.0 with IQR 8.0. 54.4% of the medical students had installed ≤20 apps in their smartphones with the median number of apps installed being 20.0 with IQR 27.0. Dasgupta et al.[10] reported similar findings where the median number of apps installed was 20.0 with IQR 35.0. 68% of the medical students in the current study had installed ≤3 newer apps in last month with the median number of newer apps installed in last month being 3.0 with IQR 4.0. This was consistent to the finding in the study by Dasgupta et al.[10] where the median number of newer apps installed in last month was 2.0 with IQR 4.0. All the medical students were seen to be suffering from some grade or degree of NMP. The prevalence of NMP estimated was thus 100%, with majority (63.1%) of them having moderate NMP, followed by 23.3% having mild NMP and 13.6% having severe NMP. The cent prevalence as evidenced in the study could be due to the COVID pandemic where all the educational institutions were shut down and students were taught all the subjects online as mandated by the National Medical Council and State medical universities. This invariably made them otherwise increasingly dependent on their smartphones which were easy to carry and convenient to use. Sethia et al.[13] in their study also noted the high prevalence of NMP (99.8%) with moderate NMP being 61.5%, followed by mild NMP (32.5%), severe NMP (6.15%), and no NMP (0.2%). Kanmani et al.[20] also observed a high prevalence (98.8%) of NMP in their study. This was contradictory to the prevalence of NMP noted in the studies by Sharma et al.[7] (73%), Dixit et al.[8] (18.5%), Pavithra et al.[9] (39.5%), Dasgupta et al.[10] (42.6%), Bivin et al.[19] (23%), Kumari et al.[12] (91.8%) and Rupani et al.[14] (92%). The wide range of NMP among the medical students can be attributed to sue of different study tools used to assess NMP and estimate its prevalence. The generalizability of the results of the present study is there as the external validity is present. This was possible as the sample chosen was representative of the target population, i.e., the medical students. The research can be applied to the real world of medical students.
The limitation of the study was a true picture of the prevalence of NMP in the medical student community could not be ascertained as an extra-ordinary situation like COVID-19 pandemic played an important role in increased adoption of the smartphones thereby leading to NMP.
| Conclusions | | |
This study gave an estimate of the prevalence of NMP in the medical students which was 100%. Understanding the importance of social physical interactions and spending time with family, friends, colleagues at work place and joining a sports activity, book club or voluntary activity for a social cause will help in the reduction of time spent on smartphones and thereby NMP.
Acknowledgments
The authors would like to express their gratitude to medical students for their participation and co-operation extended during the conduct of the study. They also would like to acknowledge Mr. N. Hanumanth, Lecturer in Statistics for his guidance in data analysis.
Financial support and sponsorship
This research paper is as a result of research project approved and funded by Indian Council of Medical Research under Short Term Studentship (ICMR-STS-2020) with Reference Id: 2020-06674).
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | |
| 2. | Nikhita CS, Jadhav PR, Ajinkya SA. Prevalence of mobile phone dependence in secondary school adolescents. J Clin Diagn Res 2015;9:VC06-9.  |
| 3. | Yildirim C, Correia AP. Exploring the dimensions of nomophobia: Development and validation of a self- reported questionnaire. Comput Hum Behav 2015;49:130-7. |
| 4. | |
| 5. | |
| 6. | Bragazzi NL, Del Puente G. A proposal for including nomophobia in the new DSM-V. Psychol Res Behav Manag 2014;7:155-60. |
| 7. | Sharma N, Sharma P, Sharma N. Rising concern of nomophobia amongst Indian medical students. Int J Res Med Sci 2015;3:705-7. |
| 8. | Dixit S, Shukla H, Bhagwat A, Bindal A, Goyal A, Zaidi AK, et al. A study to evaluate mobile phone dependence among students of a medical college and associated hospital of central India. Indian J Community Med 2010;35:339-41. [ PUBMED] [Full text] |
| 9. | Pavithra MB, Suvarna M, Mahadeva Murthy TS. A study on nomophobia-mobile phone dependence among students of a medical college in Bangalore. Nat J Community Med 2015;6:340-4. |
| 10. | Dasgupta P, Bhattacherjee S, Dasgupta S, Roy JK, Mukherjee A, Biswas R. Nomophobic behaviors among smartphone using medical and engineering students in two colleges of West Bengal. Indian J Public Health 2017;61:199-204. [ PUBMED] [Full text] |
| 11. | IBM Corp. IBM SPSS Statistics for Windows. Ver. 22. Armonk, NY: IBM Corp.; 2013. |
| 12. | Kumari GK, Pasha MA, Fathima A. Prevalence of nomophobia and use of social networking sites and apps -a cross-sectional study among undergraduate medical students in SRMC, Nandyal. IOSR-JDMS 2019;18:31-4. |
| 13. | Sethia S, Melwani V, Melwani S, Priya A, Gupta M, Khan A. A study to assess the degree of nomophobia among the undergraduate students of a medical college in Bhopal. Int J Community Med Public Health 2018;5:2442-5. |
| 14. | Rupani MP, Khusali DP, Trivedi AV, Singh MP, Patel A, Vadodariya B, et al. Cross-sectional study on mobile phone involvement among medical students of a tertiary care teaching hospital of Western India. Natl J Community Med 2016;7:609-13. |
| 15. | Choudhury S, Saha I, Som TK, Ghose G, Patra M, Paul B. Mobile phone involvement and dependence among undergraduate medical students in a Medical College of West Bengal, India. J Educ Health Promot 2019;8:1. |
| 16. | Thapa K, Lama S, Pokharel R, Sigdel R, Rimal SP. Mobile phone dependence among undergraduate students of a medical college of Eastern Nepal: A descriptive cross-sectional study. JNMA J Nepal Med Assoc 2020;58:234-9. |
| 17. | Kariya VB, Ratanpara LC. Study the pattern of mobile phone usage in medical students. Ind J Anat Res 2019;7:6717-21. |
| 18. | Thapa K, Pokharel R, Sigdel R, Rimal SP. Pattern of mobile phone use among students of an institution. JNMA J Nepal Med Assoc 2018;56:522-6. |
| 19. | Bivin JB, Mathew P, Thulasi PC, Philip J. Nomophobia-do we really need to worry about? A cross-sectional study on nomophobia severity among male undergraduate students of health sciences. Rev Prog 2013;1:1-5. |
| 20. | Kanmani SA, Bhavani U, Margatham RS. Nomophobia – An insight into its psychological aspects in India. Int J Indian Psychol 2017;4:5-15. |
Correspondence Address:
Epari Ravi Kiran,
Department of Community Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjhs.mjhs_87_22
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5] |
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