ABSTRACT
Background:
Social networking sites (SNS) are widely used by millions of people. Excess use of social media leads to addiction which is controlling lives of young generation leading to harmful effect on their physical, mental and social well-being.
Aim and Objective:
To find the prevalence of social media addiction among government and private medical college students across Punjab and uncover the ill effects of social media addiction on physical and mental health, relationships etc.
Materials and Methods:
In this cross-sectional study, 717 students were included by convenience sampling technique. A reliable and validated questionnaire of previous studies was used along with self-designed questionnaire. Data were collected in Google forms and analyzed in MS Excel.
Results:
Out of total 717 students, majority (46.30%) of the students were using internet for 4–6 hours per day. Overall prevalence of addiction among MBBS students was found to be 8.64%. In physical health, sleep deprivation leading loss of concentration was the major health issue. Mood alterations due to chats of social media found to be significantly more in females than male students. Also, 64.15% of students agreed to have negative effect of social media on their academic performances.
Conclusion:
Many students were self-described addicts, and addiction was felt more by government college students. In this study, it was found that social media addiction leads to many physical and mental health issues like sleep deprivation which leads to harmful effects on their academics as well as make them prone to many noncommunicable diseases.
Keywords: Addiction, medical students, social media
Introduction
Social networking sites and applications like Instagram, Facebook, Snapchat, WhatsApp, etc., widely used by millions of people worldwide to communicate with one another. It is used to share their opinions, photos, videos, upload status, comment, and like each other’s pictures. It is a modern day means of communication and has become a major source of entertainment in recent years. As we know, excess of everything is bad, social media is good means of communication only if used wisely and in a controlled manner. Social media addiction is a behavioral addiction characterized as being anxious about social media leading to an uncontrollable urge to access social media, and spend excessive time and effort which impairs other essential things in life.[1]
In India, very few studies have been conducted on this issue. This study will highlight the prevalence of social media addiction and its ill effects on MBBS students using a validated and reliable “Social media addiction scale” developed by Arslan and Kirik.[2,3]
Social networking sites allow an easy way to communicate worldwide by allowing people to share ideas, feelings, beliefs, content and experiences of their lives.[4] Nowadays, among the young generation, most popular used social networking sites are Instagram, Snapchat, Telegram, Facebook, Twitter, Skype, and WhatsApp, etc., Nowadays, social networks and the virtual world are dominated by students. Its excessive usage can have both positive and negative impact on their health, social relationships and academic performances.[5] Overuse of social networking can lead to addiction which can have negative consequences at the individual and social levels.[6] Thus, it is a new form of soft addiction.
A study by Andreassen CS[7] defined SNS addiction as being overly concerned about SNSs, being driven by a strong motivation to use SNSs, and devoting excessive time and effort to SNSs that it impairs other social activities, studies, job, interpersonal relationships, psychological health and well-being.
The present study is aimed to know the prevalence of social media addiction among MBBS students of Punjab to compare of social media addiction among MBBS students of different colleges of Punjab and to identify and uncover the ill effects of social media addiction on their studies, physical and mental health, relationship, etc.
Materials and Methods
Study area: The study was conducted in different medical colleges of Punjab.
Study design: The study was designed as an online cross-sectional study targeting students enrolled in medical colleges of Punjab.
Study population: It included MBBS students across Punjab from first to final year of their MBBS course. Their contact information was collected either from institute’s administrative office or through direct and indirect interactions. A total of 720 students were e-mailed or texted or were contacted through WhatsApp link of the online survey form. The weblink was kept “live” (to accept responses) for 2 months. Respondents were asked to respond within above mentioned time frame. Weekly reminders were sent via e-mail and text messages until responses were obtained. Survey was exclusively distributed to our target audience. Any personal or sensitive information was not required of participants.
Inclusion criteria: The MBBS students from first to final year who filled the form and students who have electronic gadgets (mobile, laptop, tablet), etc., with internet connection.
Exclusion criteria: Those who were not willing to participate.
Sample size: A sample size of 720 has been calculated using (Daniel, 1999) sample size formulae as under n = Z2 pq/d2, where Z = table value of Z at 95% level of significance = 1.96; P = 0.5 (50% assumed to take highest possible sample size); q = 1-p = 1- 0.5 = 0.5; d = accepted deviation = taken as 4%. Assuming the nonresponse rate of 20%, study sample size is 720 students.
Sampling technique: Estimating population size of 5000–6000 MBBS students in Punjab, it was estimated that data from 600 conveniently selected students would have to be collected to answer this question with 4% margin of error (acceptable deviation) and at 95% confidence level. Assuming further a nonresponse rate of 20%, the recruitment target was kept at 720, out of which 717 responses were obtained.
Study tools: An online survey form which was well structured, reliable and validated was used; web based questionnaire of “Social Networking Status Scale”, developed by Arslan and Kırık[2] with additional self-designed questions prepared on google form was circulated among students. These were used in the research, and the data were collected. “Social Networking Status Scale”, which was used, had 25 questions and grading was done with Likert’s scale (1-Strongly disagree, 2-Disagree, 3-Neutral, 4-Agree, and 5-Strongly agree), where higher the score indicates more is the addiction levels. Minimum score for the validated questionnaire was 25, and the maximum was 125. Whereas the self-designed questionnaire which contained 12 questions was used to get more information and Chi-square test was applied to find out whether the difference was significant or not. There were total 37 questions (25 from the validated scale +12 from self-designed questionnaire) that were used to analyse the prevalence of addiction levels and also compare between students of government and private colleges.
Study period: March 2021–May 2021
Ethical consideration: The project was duly approved beforehand by the Institutional Ethics Committee and the Research Committee. Informed consent was taken online in a separate consent section which was followed by the questionnaire section of the same form and all those who were willing to participate filled the form. All personal data collected from students were kept confidential.
Data analysis: Data were analyzed using Google documents responses by the students and using MS excel. The data were anonymized in MS Excel spreadsheet by the author.
Result
A total of 717 students took part in the study. Out of them, 223 (31.01%) were from government colleges, while 494 (68.89%) were from private colleges. There were 59.80% female and 40.02% male students. The mean age of the students was 20.07 years (with standard deviation 1.44 years), and the range was 17–24 years.
Table 1 shows that most of the students (97.77%) used internet for more than an hour daily. Most common usage was 4–6 hours per day. The daily internet usage was significantly different among male and female students.
Table 1.
Time spent on internet daily in men and women
| 7 h or more | 4-6 h | 1-3 h | <1 h | Nil | Grand total | |
|---|---|---|---|---|---|---|
| Female | 61 | 216 | 144 | 7 | 1 | 429 |
| Male | 65 | 116 | 99 | 7 | 1 | 288 |
| Grand total | 126 | 332 | 243 | 14 | 2 | 717 |
| P | 0.0235 | |||||
| Chi Square | 11.289 |
Figure 1 shows that only 2.93% students did not check social media accounts on daily basis. Social media usage was most common for 6–10 times per day (34.17%), whereas 16.05% students were checking social media always.
Figure 1.
Showing number of times students checking social media account on daily basis
Figure 2 shows that initially when students started using social media, the main purpose was “to stay updated with friends and current life” (70.01%) followed by “to pass free time and for entertainment” (64.08%). The same trend is being observed for the current usage that is 71.07% and 68.08%, respectively. However, social media for educational purposes was found to be increased from 34.00% to 47.08% (increased by 13.08%). This shows social media is commonly used as a source of entertainment, which later on may lead to addiction.
Figure 2.
Change in trends of social media usage
It is evident from Figure 3 that sleep deprivation leading to loss of concentration (46.03%) was highlighted as the most common physical health issue among students, followed by eye pain or strain (43.00%) when using social media during the day. Weight gain (39.04%) was also prevalent issue among students that were raised up. Other physical issues faced by students were headache (28.00%) followed by neck pain (21.02%).
Figure 3.
Physical problems faced by students
42.05% (more than 2/5th of the students) of students agreed that sometimes chat affected their moods. 5.05% of students said the chats always had an impact on their mood, while 8.09% denied from any effect of chats on their mood. The difference between male and female students is highly significant (P < 0.01), whereas this difference is not significant between government and private colleges. 43.06% of students feel being addicted to social media. This population tends to be more than 3/7th of the total students which is worrisome. Government medical college students (54.07%) felt more addicted to social media than private college students (38.06%). These data are highly significant (P < 0.01), but there is no significant difference between male and female students.
It is evident from Table 2 that 8.64% of students were found to be addicted to social media. Government college students (12.10%) were found to be more addicted than private college students (7.08%), which was found to be nonsignificant. Male students (10.76%) were more addicted to social media than female students (7.22%), which was not significant. 66.81% of students were on high risk of addiction or near addiction. Hence, this study targets the addicted and the population at high risk, so that we can find the ways to help them to decrease social media usage.
Table 2.
Classification of social media users according to the score
| Score | Government | Private | Males | Females | |
|---|---|---|---|---|---|
| Below normal users of social media | 25-50 (1.11%) | 01 (0.44%) | 07 (1.41%) | 05 (1.73%) | 03 (0.69%) |
| Normal users | 51-75 (22.45%) | 46 (20.62%) | 115 (23.27%) | 64 (22.22%) | 97 (22.61%) |
| Users at Risk of addiction | 76-100 (66.81%) | 149 (66.81%) | 337 (68.21%) | 188 (65.27%) | 298 (69.46%) |
| Users Addicted to social media | 101-125 (8.64%) | 27 (12.10%) | 35 (7.08%) | 31 (10.76%) | 31 (7.22%) |
More than half of students (57.03%) deleted their social media account at least once. Out of total, 51.04% of men and 38.09% of women never deleted their accounts. This difference is highly significant. Even there is significant difference among students of government and private colleges.
As seen in the Table 3, 18.08% of students agreed to get external help (approximately 1/5th of total students). There were 25.11% government college students and 11.01% private college students who felt the need for external help; this difference is highly significant. Difference between male and female students was found to be nonsignificant.
Table 3.
If students need external help in government and private college students to get rid of social media addiction
| No | Yes | Grand Total | |
|---|---|---|---|
| Government | 167 (74.88%) | 56 (25.11%) | 223 |
| Private | 415 (84.00%) | 79 (15.90%) | 494 |
| Grand Total | 582 (81.17%) | 135 (18.82%) | 717 |
| P | 0.00383 | ||
| Chi square | 8.362 |
It was found that 38.09% of the total students feel irritated when they are told to decrease the time spent on social media by their parents. This difference between government and private students is highly significant. There is a gap between the acceptance rate of government and private college students. There was no significant difference observed between male and female students.
Table 4 shows that more than half of the total students (52.71%) agreed that they postpone their studies because of social media. 63.68% of government college students and 47.77% of private college students post pone their studies because of social media. This difference is highly significant, which is not observed between male and female students.
Table 4.
Students postponing studies because of social media
| No | Yes | Grand Total | |
|---|---|---|---|
| Government | 81 (36.32%) | 142 (63.67%) | 223 |
| Private | 258 (52.26%) | 236 (47.77%) | 494 |
| Grand Total | 339 (47.28%) | 378 (52.71%) | 717 |
| P | 0.00008 | ||
| Chi square | 15.591 |
As seen in Figure 4, it was agreed by 64.15% of students that social media usage has decreased their productivity, and they could have performed well in exams if they would have decreased its usage. 75.78% of students from government colleges and 58.90% from private college accepted that there is decrease in their productivity because of social media. This was found to be highly significant. However, the difference among male and female students was not significant.
Figure 4.
Students accepting that social media has decreased their productivity in government and private colleges
Discussion
In our study, there were 59.8% female and 40.2% male students, similar to the study conducted by Azizi S.M. et al.[8] in Iranian medical students where 55.3% were females and the 45.7% were males. The results were a bit different from a cross-sectional survey conducted at Tofail University of Kenitra,[9] which showed that 68.30% were men and 22.70% were women and also with the study conducted in Qassim University[10] in Saudi Arabia where male students were 57.90% and female students were 42.10%.
The mean age of the participants was 20.07 years (with standard deviation 1.44 years), and the range from 17 to 24 years was found in our study, whereas the median age of the participants was 22 years in a survey conducted by Oumaima Alaika et al.[9] which is quite similar to our study, but the mean age of the participants was 25.48 ± 3.39 years in the study conducted by Seyyed Mohsen Azizi et al.,[8] among Iranian medical students, which is slightly higher than our study.
In our study, it was found that most of the students (97.77%) used internet for more than an hour daily. Most common usage was 4–6 hours per day (46.30%). The daily internet usage was significantly different among male and female students. In study conducted by Mehmet Ali Gazi,[11] it was found that 47.73% of participants used it for 4–6 hours per day which agrees with the present study. It was found that 37.05% of participants used social networking for 4–5 hours daily followed by 6 hours (31.3%) and 25% used it for 2–3 hours in study conducted by Oumaima Alaika et al.[9] In study conducted among medical students in Malaysia,[12] it was found that median time for internet use was 6.08 hours in addicts and 5.1 hours in nonaddicts out of which maximum usage of internet was for social media and entertainment purpose. Another study which was conducted by Endreddy A et al.[13] found that 81.99% of students used internet for 1–3 hours out of which maximum usage was for social media (59.07%) that was bit different than our study.
It was found that in our study, initially when students started using social media the main purpose was “to stay updated with friends and current life” (70.01%) followed by “to pass free time and entertainment” (64.08%). However, the trend of using social media for the educational purpose was found to be increased from 34.00% to 47.08%. This result was also found in a study conducted in Malaysia[12] where internet use for entertainment purpose (48.35%) was found more than education purpose (7.04%). In study conducted by M.Kolhar et al.,[14] it was found only 1% of the students used social media for academic purposes, and a majority of them (35–43%) used social media for nonacademic purposes.
In study conducted by Masthi NR et al.,[15] strain on eyes was found to be experienced by 38.04% of participants, neck pain by 30.07% and 26.01% students faced sleep deprivation. In a study conducted by Subathra V et al.,[16] 37% of students agreed that they lost sleep during late night chatting on social media. In another study conducted by M. Kolhar et al.[14] 68% of the students have social media as reason for late night sleep and causing sleep deprivation. In study conducted at Moroccan University,[9] 44.20% felt troubled sleeping because of social media effect. American Academy of Sleep Medicine recommends 7 to 9 hours of sleep which is hampered because of excessive social media usage especially in night as shown by our and previous studies. This effect on physical health and sleep disturbance on medical students due to excess social media usage can affect their professional conduct and skills.[17]
In our study, government college students (54.70%) felt more addiction to social media than private college students (38.60%). This difference was highly significant. Maybe government college students were more responsible for their behaviour and acceptance to addiction. This can be because the study timings of private colleges are longer than government colleges. Government college students have more free time in their routine; even the rules and regulations regarding mobile use during study hours in private college are stricter than government college students, so government college students felt more addicted. There was no significant difference between male and female students.
Overall, 8.64% of students were found to be social media addicts (as per the scale used) in which government college students (12.10%) were found to be more addicted than private college students (7.08%), but the difference was not significant; social media addiction was found to be more among male students (10.76%) than female students (7.22%) again the difference was found to be not significant. In Iranian study[8] on medical students, it was found that 70.60% of students were moderately addicted; the addiction in male students was significantly higher than females, the similar trend was also found in our study, but it was non-significant. In study conducted by Patil SD et al.[18] among medical students in Nagpur, the prevalence of internet addiction was 3.68% with male predominance. Masthi NR et al.[19] found that women (8.33%) were found to be more addicted to Facebook than men (6.12%) which is quite different from our results. In another study conducted by Masthi NR et al.,[20] on social media addiction between public and private high school students in Bangalore, overall social media addiction prevalence was found to be 19.96% with significantly high rates of self-reported addiction in private schools; 25% male students were addicted to social media than 15.03% female students.
Some other studies to find internet addiction were conducted like a study conducted by Salehi et al.,[21] among Iranian students in 2014 where prevalence of internet addiction was reported to be 5.02%. Internet addiction was found to be 10.08% in studies conducted by Ghamari et al.[22] In study conducted by Siomos et al.,[23] on Greek adolescent students where prevalence was 8.02% had similar results with our study. A study conducted in Malaysia[12] showed that prevalence of internet addiction was 36.09%, it also found that among the medical students 45.00% of male respondents and 32.00% of female respondents that were classified as internet addicts, and the difference was statistically significant (P = 0.009).
In our study approximately 1/5th of total participants (18.80%) felt the need for external help to get rid of social media addiction. The need for external help was felt by 25.11% of government and 11.01% of private college students, this difference was highly significant. In study conducted by Masthi NR et al.,[19] 6.00% of participant felt that they need help for Facebook addiction. This shows students want to get rid of social media as they realise social media addiction is a rising issue and need external help. This study can highlight the growth in acceptance of social media addiction and need for help to find ways to get rid of it.
In our study, 64.15% students accepted that social media usage has decreased their productivity and they could have performed well in exams if they would have decreased its usage. 75.80% of government and 58.20% of private college students accepted decreased productivity because of social media. This was found to be highly significant; the difference among male and female participants was not significant. In study carried by Subathra V et al., et al.,[16] more than half (57.00%) of the respondents’ grades are affected in college because of the amount of time they spend for chatting. In one Iranian study,[8] a negative and significant correlation was found between social networking addiction and academic performance (p ≤ 0.01, r = −0.210) of the students; which means that, an increase in the excessive use of social networks decreases the academic performance. In study conducted in Moroccan University[9] 44.02% students reported drop in productivity and demotivation as an effect of social media and 36.06% students agreed about negative impact of social media on studies and relationships. In study conducted in Khartoum University,[24] 73.08% users agree about negative effect of using the social networks on their personal academic performance. In study conducted by Masthi NR et al.,[19] it was found that 19.00% students agreed that their grades were affected because of amount of time spent on social media. In a study conducted in Oman,[25] almost 28.00% students agreed that SNS had negative impact on their academic work. This shows that students have started accepting the social media as a hindrance to their studies and making students perform sub-par in their studies. Urgent steps need to be taken before it’s too late for the developing population of the country especially in budding doctors.
This study will be very much relevant to primary care physicians as it highlights the growing issue of social media addiction among medical students and its ill effects such as mental health challenges and decreased academic performance. Understanding this problem enables primary care physicians to recognize, counsel, and address such behavioural health issues in young adults contributing to holistic patient care.
Conclusion
The prevalence of social media addiction among MBBS students across Punjab was found to be 8.64%. Many students were self-described addicts, and addiction was felt more by government college students. Government college students even wanted more of external help to get rid of this addiction. More than half of students tried to get rid of social media and out of which mostly were women. In this study, it was found that social media addiction leads to many physical and mental health issues like sleep deprivation which leads to harmful effects on their academics as well as make them prone to many noncommunicable diseases. This study highlights the negative effect of social media on academic performance of students, especially in government colleges. It can be concluded that MBBS students of government colleges are suffering more with social media addiction and its ill-effects. The help of experts should be provided to tackle this problem among the medical students, with slightly more focus on government colleges.
Recommendation
It is recommended to carry out few more similar studies across India to know the prevalence of social media addiction especially in medical and paramedical students as they are the frontline workers for the healthcare system of our country. As prevention is better than cure it is better to reduce addiction levels and finding the root causes that can be reduced which attracts the students for this addiction through future researches.
Author’s contribution
All authors have contributed equally.
Declaration of generative AI and AI assisted technologies in the writing process
The authors haven’t used any generative AI/AI assisted technologies in the writing process.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
This study was funded by Indian Council of Medical Research (ICMR) under Short Term Studentship (STS) program, Reference number- 2020-07445.
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