Abstract
BACKGROUND:
Text Neck Syndrome (TNS) is a common issue in the neck. The emergence of such issues makes it more pressing to offer ergonomic training to prevent their consequences. The present study aimed to compare training through the lecture and Self-Study methods awareness and attitudes about the TNS.
MATERIALS AND METHODS:
The study was conducted on 94 female high-school students in 2021, and a quasi-experimental methodology was implemented. The participants were randomly divided into a lecture method and a self-study group. A researcher-made questionnaire was utilized for data collection to measure the participants’ attitudes and awareness. The data were analyzed according to descriptive and inferential statistics.
RESULT:
The findings showed that the mean post-test scores of the participants’ awareness in the lecture method and self-study groups were 8.74 and 5.83, respectively, and a significant increase was observed in the post-test scores of the lecture method group. However, no significant difference was observed between the pre-test and post-test attitude scores of the two groups.
CONCLUSION:
As training by the use of the lecture method in a webinar format has the characteristics of a traditional and online educational simultaneously, it offers an advantage that can be utilized in educational institutions as a complementary (or even an independent) method. Moreover, the experts in medical informational sciences need to accompany training groups as they are responsible to select and prepare credible content materials for audiences.
Keywords: Attitude, awareness, ergonomics, Isfahan, lecture method, self-study, students, text neck syndrome, TNS
Introduction
Changes in lifestyles and the advancement of new electronic devices have been among the indispensable factors in human life over the past few decades.[1] The social restrictions imposed during the COVID-19 pandemic and the introduction of quarantines caused many people to stay more at home and rely more than ever on using the internet and electronic devices.[2] Perhaps electronic devices were utilized by schools and universities as peripheral grounds before the coronavirus outbreak, but the pandemic prompted such institutions and, consequently, students to use them more seriously.[3] Statistics show that around 77% of the world’s population has personal cell phones.[4] The excessive use of such devices in the long-term perspective results in the emergence of serious issues, particularly in the neck and shoulders, and this can lead to the improper formation of the musculoskeletal system and the loss of one’s quality of life due to the malleability of youngsters’ (children’s) bodies.[5,6] The presence of children in social media to carry out the smallest daily affairs and their unawareness of the proper use of electronic devices, particularly cell phones, in various modes make people – more remarkably children – remain in improper conditions for hours, and this quickens the complications like neck pain, backache, and wrist pain.[7,8,9,10]
Musculoskeletal ailments and problems are among the commonest health issues that cause pain and uneasiness in people, particularly in their workplaces.[11] Out of the plethora of musculoskeletal issues, neck pain is considered a complicated health problem in modern societies. The origins of neck pains could be any of the building blocks of the area, including ligaments, intervertebral discs, muscles, or joints.[12] has ranked neck pain as the eighth cause of pain and uneasiness in people aged 15-19.[12] TNS is a prevalent issue that emerges due to the inappropriate use of smartphones and can bring about pain and numbness in one’s neck.[13,14] The term “Text Neck Syndrome” is used to describe symptoms like neck pain and injured muscles that emerge due to the repeated and excessive use of cell phones in inappropriate postures.[4,15] Various studies have been conducted to investigate the topic, and some of them have found that a significant relationship exists between the long-term and inappropriate use of smartphones and pain in one’s neck, body, and wrists.[2,16,17,18] Moreover, Masoumi found that significant differences existed between the conditions of the upper body and shoulders of the short-term and long-term users of cell phones.[19] The results of other studies showed the prevalence of TNS and the texting thumb among the users of mobile phones, particularly long-term users.[20,21]
Offering training programs to prevent the emergence of issues related to the incorrect ergonomics of the neck is not only important for students and their families, but it is necessary for the health system to reduce healthcare expenditures and can be more convenient than treatments. Numerous studies have compared and investigated the effects of various teaching methods on people’s awareness and attitudes. Habibzadeh et al.[22] compared the virtual and traditional teaching methods and observed a significant difference between the post-test scores of the two groups. Then, they suggested that virtual education should be utilized as a complementary, or even an alternative, methodology. The results of Najafi Ghezeljeh and Hassanian indicated the effectiveness of virtual education in enhancing the participants’ awareness and attitudes.[23,24] Moreover, the findings of Bartlett and Mansouri showed that the effectiveness of the hybrid teaching methodology on people’s skills and learning far exceeded other methods.[25,26]
The lecture method (via the webinar format) and the self-study method were selected to be investigated in the present study. The population consisted of female high school students. The reason for selecting them concerned some of the characteristics of women’s skeletons, their delicate structures, and issues related to hormones, which increased the probability of musculoskeletal issues in them.[2,27,28] The present study aimed to compare the effects of the lecture and self-study methods on students’ awareness and attitudes about TNS.
Materials and Method
Study design and setting
The present study utilized a quasi-experimental methodology to investigate female high school students studying mathematics, empirical sciences, and humanities in Isfahan, Iran, in 2021.
Study participants and sampling
After obtaining the required certificates, 94 students were selected based on literature reviews using the stratified random sampling technique and were randomly divided into a lecture group (47 students) and a self-study group (47 students). Based on similar studies and as the goal was just comparing two types of interventions, the control group hadn’t been considered.
Data collection tool and technique
The examinees were briefed about the goals of the study and, then, they participated in the study voluntarily. The data were collected using a researcher-made questionnaire that was filled out by the examinees of the two groups on two occasions. The validity of the questionnaire was confirmed by a panel of experts in the field of physiotherapy, medical information sciences, and occupational health specialist, while its reliability was determined 0.763 using Cronbach’s Alpha. The electronic form of the questionnaire was sent to the examinees of the two groups electronically before starting the intervention. After filling out the questionnaire, one group received 2 three-hour training workshops in the form of webinars (in SkyRoom). The lectures were given by one of the researchers and a physiotherapy specialist. The other group received the educational content via WhatsApp. The provided content included educational items like films and images, scientific texts, animations, and GIFs that had a set of information about the anatomy of the musculoskeletal system, relevant ailments, particularly TNS, and methods to prevent and treat them. These items have been extracted from scientific credible content, prepared by experts in this area. The questionnaire was handed over once more to the participants one month after carrying out the intervention, and their levels of awareness and attitudes were measured. The collected data were analyzed in terms of descriptive and inferential statistics using SPSS26. The spread of the coronavirus and the lack of in-person and complete access to students were two major limitations of the study.
Ethical consideration
The office staff of the school contacted the parents, obtained their consent for the participation of the students in the research, and cooperated with the research team.
Result
The results of the independent-samples t-test on the pre-test scores showed that the two groups with two methods had no significant differences in terms of their awareness and attitudes about TNS.
The results of the independent-samples t-test to compare the post-test awareness scores of the two groups showed that a significant difference existed between the awareness scores of the two groups (P < 0.000), and the awareness scores of the lecture group were significantly above that of the self-study group [Table 1]. Moreover, the results of the independent-samples t-test [Table 2] to compare the post-test attitude scores of the two groups showed that no significant difference existed between the attitudes of the two groups after the intervention.
Table 1.
A comparison of the mean awareness scores of the students before and after the intervention
| Result | Self-study method |
Lecture method |
Group Time | ||
|---|---|---|---|---|---|
| Standard deviation | Average | Standard deviation | Average | ||
| t=0.31, P=0/75 | 2.08 | 6.46 | 1.82 | 6.34 | Before intervention |
| t=4.94, P<0/000 | 2.33 | 5.83 | 2.75 | 8.74 | After intervention |
| t=1.3, P=0/19 | t=4/67, P<0/000 | Result | |||
Table 2.
A comparison of the mean attitude scores of the students before and after the intervention
| Result | Self-study method |
Lecture method |
Group Time | ||
|---|---|---|---|---|---|
| Standard deviation | Average | Standard deviation | Average | ||
| t=0.4, P=0/69 | 0.48 | 3.73 | 0.71 | 3.68 | Before intervention |
| t=1.11, P=0/27 | 0.51 | 3.90 | 0.34 | 3.79 | After intervention |
| t=1.49, P=0/13 | t=0.87, P=0/38 | Result | |||
The results of the dependent-samples t-test to compare the mean pre-test and post-test scores of the awareness of the lecture group showed that the awareness of the group significantly increased in the post-test [Table 1], but no significant difference was observed between the pre-test and post-test mean scores of the group in terms of attitudes [Table 2]. The results of the paired-sample t-test to compare the mean awareness and attitude scores of the self-study group showed that no significant difference could be detected between their pre-test and post-test scores according to their awareness and attitudes [Tables 1 and 2].
Discussion
The present study aimed to compare the effects of lecture teaching and self-study methods on female high school students’ awareness and attitudes about TNS. The results showed that no significant difference existed between the awareness and attitudes of the two groups in their pre-test scores. The findings of the study indicated that a significant difference existed between the post-test awareness scores of the two groups after carrying out the intervention, and the lecture group showed more awareness compared to the self-study group. This was in line with Hemmatipour, Nikjou, and Lak who found a significant increase in the awareness of experimental groups after carrying out interventions.[29,30,31] Moreover, the finding was in line with the findings of Najafi Ghezeljeh et al.[23] who observed the significant influence of the use of virtual social networks on their examinees’ awareness. In a study conducted by Mottaghi and Najimi[32] the significant influence of computer-assisted teaching over the lecture (traditional) method was illustrated. The present study used the lecture method in a webinar format to combine the advantages of computer-assisted teaching and the lecture method; in other words, the electronic content materials were presented on the internet, and it was possible for the learners and trainers to communicate with each other and ask/answer questions (instructiveness). This was the strength of the present study and, somehow, made it similar to the study by Mottaghi. In another study, Khoshnoudifar observed that the effectiveness and satisfaction rates of flipped classes significantly exceeded that of traditional ones.[33] But the results of Hakami showed no significant differences between the knowledge and the skills of the participants being trained by the traditional and virtual methods, and the two methods were introduced as alternatives.[34] The findings of the present study were in line with the findings of Lee et al.[35] who found no significant differences between the beliefs of the participants being trained by mobile applications and the ones receiving traditional education. On the other hand, the study by Alaa and Younis[36] indicated the significant influence of ergonomic intervention on dentistry students’ attitudes. In addition, in the study by Najafi Ghezeljeh et al.,[23] attitude scores increased after holding 34 sessions in a messaging application (Telegram), and this contradicted the findings of the present study. The lengthier duration of the study compared to the present study, the deep-rootedness of attitudes and the inclusion of cognitive and emotional components in attitudes could justify the observed incongruence. In general, attitudes are late-yielding, resist changes, and can be modified only under pressure. Thus, it can be argued that changing attitudes is a very complicated matter.[37] Unlike the findings of the present study, Komasi compared the in-person method and teaching via social networks in the field of social studies and found significant differences between the pre-test and post-test scores of the participants’ attitudes.[38] It seems that the field of medical sciences, in comparison with social sciences, has a more empirical and practical nature, and consolidating its educational materials needs more practice. Perhaps this is the reason for the different in observations above.
Limitation and recommendation
The limitation of this research was mainly COVID-19, If there was no pandemic limit and the training was done face-to-face, the comparison results could be stronger. It is recommended for future studies to compare more methods of training students, and also more healthy subjects.
Conclusion
The findings of the present study and the significance of students’ knowledge, attitudes, and performance concerning TNS emphasized the necessity of holding training courses in the field. Moreover, the lecture method (in a webinar format) can be used to present educational materials more conveniently and easily due to the characteristics of the method and the examinees’ favorable attitudes toward it. The lecture method (webinar) can be utilized as an independent educational method and have a significant impact on students’ learning and academic achievement. On the other hand, specialists in the field of medical information sciences need to offer credible and up-to-date information under the supervision of health specialists to play a remarkable role in enhancing the quality of students’ health and, consequently, improving the quality of teaching in educational environments such as schools. It is recommended that educational institutions have a close relationships with these teams to train students and inform their parents to prevent health problems and improve their lifestyle.
Financial support and sponsorship
This project was supported financially by Isfahan University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
We would like to appreciate the cooperation of all students and high school office staff who participated in this study. The ethical code of this research (IR.MUI.NUREMA.REC.1400.057) has been given by the Isfahan University of Medical Sciences vice chancellor for research and technology.
References
- 1.Jahanimoghadam F, Abdolalizadeh M. Ergonomics, musculoskeletal disorders, and computer work. J Health Biomed Inform. 2016;3:145–54. [Google Scholar]
- 2.Budianto P, Kirana DH, Hafizhan M, Putra SE, Mirawati DK, Prabaningtyas HR. The effect of duration gadget uses during COVID-19 pandemic on neck pain, neck disability, and sleep quality. Int J Public Health Sci. 2022;11:581–8. [Google Scholar]
- 3.Surkhali B, Garbuja CK. Virtual Learning during COVID-19 Pandemic: Pros and Cons. J Lumbini Med College. 2020;8:2. [Google Scholar]
- 4.Chitale N, Jawade S, Jain D. Effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in subjects with text neck syndrome. J Pharm Res Int. 2021;33:536–42. [Google Scholar]
- 5.Rafieepour A, Rafieepour E, Sadeghian M. Effectiveness of ergonomics training in decreasing the risk of musculoskeletal disorders based on rapid upper limb assessment among computer operators. J Ergon. 2015;3:25–32. [Google Scholar]
- 6.Khorasani J, Tavafian SS, Zarei F. Effect of educational intervention based on the ergonomic principles of working with computers in promoting behaviors preventing musculoskeletal disorders among health care providers. Int J Musculoskelet Pain Prev. 2019;4:192–201. [Google Scholar]
- 7.Pooriayevali M. Computer ergonomics. Selected Management Monthly. 2012;13:92. [Google Scholar]
- 8.Taieb-Maimon M, Cwikel J, Shapira B, Orenstein I. The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers. Appl Ergon. 2012;43:376–85. doi: 10.1016/j.apergo.2011.05.015. [DOI] [PubMed] [Google Scholar]
- 9.Karimi M. Ergonomic complications of using computers by children. Occup Med Q J. 2012;3:56–62. [Google Scholar]
- 10.Hajiomid K, Hekmat Shoar R, Taban E, Faghih M, Yazdani Avval M, Shokri S. Effects of an ergonomic training program on the reduction of musculoskeletal disorders. J Sabzevar Univ Med Sci. 2016;23:58–65. [Google Scholar]
- 11.Shakerian M, Rismanchian M, Khalili P, Torki A. Effect of physical activity on musculoskeletal discomforts among handicraft workers. J Educ Health Promotion. 2016;5:8. doi: 10.4103/2277-9531.184546. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.David D, Giannini C, Chiarelli F, Mohn A. Text neck syndrome in children and adolescents. Int J Environ Res Public Health. 2021;18:1565. doi: 10.3390/ijerph18041565. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Al-Gharabawi B. Text neck syndrome: A new concern for physical therapists worldwide”. EC Orthopaedics. 2017;8:89–91. [Google Scholar]
- 14.Neupane S, Ali U, Mathew A. Text neck syndrome-systematic review. Imp J Interdiscip Res. 2017;3:141–8. [Google Scholar]
- 15.Ahmadi H, Yalfani A, Gholami Borujeni B. Musculoskeletal disorders associated with text neck syndrome: A systematic review. Feyz J Kashan Univ Med Sci. 2020;24:237–45. [Google Scholar]
- 16.Ng KC, Wu LH, Lam HY, Lam LK, Nip PY, Ng CM, et al. The relationships between mobile phone use and depressive symptoms, bodily pain, and daytime sleepiness in Hong Kong secondary school students. Addict Behav. 2020;101:105975. doi: 10.1016/j.addbeh.2019.04.033. [DOI] [PubMed] [Google Scholar]
- 17.Al-Hadidi F, Bsisu I, AlRyalat SA, Al-Zu’bi B, Bsisu R, Hamdan M, et al. Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PLoS One. 2019;14:e217231. doi: 10.1371/journal.pone.0217231. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Alsalameh AM, Harisi MJ, Alduayji MA, Almutham AA, Mahmood FM. Evaluating the relationship between smartphone addiction/overuse and musculoskeletal pain among medical students at Qassim University. J Fam Med Prim Care. 2019;8:2953–9. doi: 10.4103/jfmpc.jfmpc_665_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Masoumi AS, Akoochakian M. The effect of duration of smartphone use on head and shoulders posture of young adults aged 20-35 years. Iran J Ergon. 2019;7:62–71. [Google Scholar]
- 20.Chaudary AA, Aslam F, Asghar AR, Bashir H, Awais A, Riaz CZ, et al. Frequency of text neck syndrome in medical students due to excessive usage of electronic devices. J Pak Orthop Assoc. 2019;31:79–82. [Google Scholar]
- 21.Ahmed S, Akter R, Pokhrel N, Samuel AJ. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: A cross-sectional survey study. J Public Health. 2021 Apr;29:411–6. [Google Scholar]
- 22.Habibzadeh H, Rahmani A, Rahimi B, Rezai SA, Aghakhani N, Hosseinzadegan F. Comparative study of virtual and traditional teaching methods on the interpretation of cardiac dysrhythmia in nursing students. J Educ Health Promot. 2019;8:202. doi: 10.4103/jehp.jehp_34_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Ghezeljeh TN, Aliha JM, Haghani H, Javadi N. Effect of education using the virtual social network on the knowledge and attitude of emergency nurses of disaster preparedness: A quasi-experiment study. Nurse Educ Today. 2019;73:88–93. doi: 10.1016/j.nedt.2018.12.001. [DOI] [PubMed] [Google Scholar]
- 24.Hasanian M, Karami N, Molavi vardanjani M, Tapak L. The effect of nurses’ virtual learning on knowledge and practice of observing X-Ray protection principles. Avicenna J Nurs Midwifery Care. 2020;28:46–56. [Google Scholar]
- 25.Bartlett AS, Smith N. The effect of a cardiovascular and pulmonary mobile application on student learning of assessment skills: A pilot study. Cardiopulm Phys Ther J. 2020;31:66–73. [Google Scholar]
- 26.Mansoori S, Salari Koohfini Z, Ghasemali M. A comparison between the effectiveness of E-learning and blended learning in industrial training. Interdiscip J Virtual Learn Med Sci. 2020;11:46–53. [Google Scholar]
- 27.Wolf JM, Cannada L, Van Heest AE, O’Connor MI, Ladd AL. Male and female differences in musculoskeletal disease. J Am Acad Orthop Surg. 2015;23:339–47. doi: 10.5435/JAAOS-D-14-00020. [DOI] [PubMed] [Google Scholar]
- 28.Taneja A. Effects of work-from-home use laptop or mobile phone causing text neck syndrome during the quarantine period COVID-19. Int J Sci Dev Res. 2021;2:54–7. [Google Scholar]
- 29.Nikjo P, Vizeshfar F, Zarifsanayee N. Comparison of the effect of training academic honesty using two workshop and virtual training methods on the knowledge and attitude of MS students. J Educ Health Promot. 2021;10:180. doi: 10.4103/jehp.jehp_1145_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Safari Z, Jahangirimehr A, Hemmatipour A, Arizavi Z. The effect of education using social networks on knowledge and performance of nursing students in regard to safe injections. J Mil Med. 2020;22:306–13. [Google Scholar]
- 31.Lak P, Noroozi M, Ehsanpoor S. Comparing the effect of methods of group education and education by multimedia compact disk on mothers’ knowledge and attitude about child sexual abuse. J Health Care. 2019;21:353–61. [Google Scholar]
- 32.Mottaghi P, Najimi A. Teaching medical students: Computer-based teaching versus traditional lecture. Iran J Med Educ. 2018;18:1–7. [Google Scholar]
- 33.Khoshnoodi Far M, Mohajerpour R, Rahimi E, Roshani D, Zarezadeh Y. Comparison between the effects of flipped class and traditional methods of instruction on satisfaction, active participation, and learning level in a continuous medical education course for general practitioners. Sci J Kurdistan Univ Med Sci. 2019;24:56–65. [Google Scholar]
- 34.Hakami Z. Comparison between virtual and traditional learning methods for orthodontic knowledge and skills in dental students: A quasi-experimental study. Healthcare (Basel) 2021;9:1092. doi: 10.3390/healthcare9091092. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Lee JE, Gao Z. Effects of the iPad and mobile application-integrated physical education on children’s physical activity and psychosocial beliefs. Phys Educ Sport Pedagogy. 2020;25:1–18. [Google Scholar]
- 36.Alaa E, Younis SH. Assessment of an ergonomics interventional educational program on knowledge, attitude, practice and behavior among a group of egyptian dental students. Egypt Dent J. 2020;66:623–32. [Google Scholar]
- 37.Karimi Aghdam S. A dialectical reading of dynamic systems theory: Transcending socialized cognition and cognized social dualism in L2 studies. Lang Sociocult Theo. 2016;3:55–82. [Google Scholar]
- 38.Komasi M, Aliabadi K, Zareii Zavaraki E. Comparing the method of teaching through social network and face training and its impact on the level of learning and retention of adult students in the social sciences. Bimonthly Educ Strategies Med Sci. 2019;11:25–32. [Google Scholar]