Impact of nomophobia: A nondrug addiction among students of physiotherapy course using an online cross-sectional survey

Abstract

Background:

Smartphone addiction is known as nomophobia (NMP) which is a fear of not using mobile phone. More researches are available regarding NMP among the students of various professions. However, till date, to the best of our knowledge, there is no literature available on the impact of NMP on the academic performance among students pursuing physiotherapy course (SPPC).

Aim:

To determine the impact of NMP among SPPC.

Materials and Methods:

An online cross-sectional survey was conducted by using Google Form platform utilizing validated NMP questionnaires (NMP-Q). A self-reported questionnaire regarding demographic data, information regarding smartphone use, last academic performance, and presence of musculoskeletal disorders was collected. A total of 157 students participated in this survey. Google Form automatically analyzed the collected data.

Results:

The mean age of students was 22.2 ± 3.2 years; among them, 42.9% were male and 57.1% were female. Nearly 45% of students have been using smartphone for >5 years and 54% students have musculoskeletal disorders during their prolonged smartphone use. The mean NMP score with 95% confidence interval was 77.6 (72.96–82.15). There exists an inverse relation between the NMP scores (NMPS) and student's academic performance and no significant difference between NMP scores, P = 0.152.

Conclusion:

NMP among the SPPC have been established. There might be a negative impact between NMP and academic performance.

INTRODUCTION

Smartphone addiction is a well-known phenomenon nowadays, and it is termed as nomophobia (NMP).[1] NMP is a fear of without being using mobile phone and refers to anxiety, discomfort, and nervousness.[2,3] In the last decade, technological development in mobile phone changes the way of easy access and share information. By using smartphone, ones can access the Internet and through it can use their daily needs.[4] Due to the increasing demand and decreasing cost, dependency of mobile phone is raising worldwide.[2] In 2018, 2.53 billion smartphones have been in use worldwide, and the number is increasing day by day.[5] According to the Telecom Regulatory Authority of India, 1186.8 million (Total Indian population is 1339.2 million) subscribers use mobile phone in June 2017.[6]

NMP is considered the disorder of the 21^st century.[7] A study conducted at West Bengal in India among medical and engineering students had shown that 42.6% of medical students and 44.6% of engineering students are nomophobic.[2] Another study in the United Kingdom conducted in 2008 among smartphone users reported that 53% of users are suffered from NMP.[8]

NMP has been affecting the mental status of smartphone users and it is diagnosed as a mental disorder.[9] A study showed that musculoskeletal problems termed text neck syndrome and text thumb are associated with smartphone users.[10] Sharma et al. concluded that 75% of medical students had NMP and, when they are unable to access mobile phone, they experienced panic attack.[11]

Few researches are available regarding the impact of NMP among students pursuing medical,[2,11,12,13] dental,[14] engineering, and nursing courses.[15,16,17] However, till date, to the best of our knowledge, there is no literature available on the impact of NMP on the academic performance among the students pursuing physiotherapy course (SPPC). Hence, we have drafted this study to determine the impact of NMP on education among SPPC. The study hypothesized that NMP would have a negative impact on the academic performance of SPPC.

MATERIALS AND METHODS

The study protocol was approved by the student project committee, and the study was conducted in accordance with the guideline of Helsinki declaration 2013. The study strictly adhered to the National Ethical Guidelines for Biomedical and Health Research involving Human Participants- Indian Council of Medical Research guidelines (Revised 2017) and conducted during September 2017 and October 2017. The required sample size for this cross-sectional online survey was estimated using the formula for estimating proportion: n = Zα² P (1 − P)/d²; where Zα =1.96; P = 90% (response rate for online survey >90%);[18] and d = 5%. Thus, the minimum required sample required for this study was estimated to be 139. Anticipating 10% with incomplete forms, we have targeted the final minimal required sample size to be 153. The survey was advertised through face-to-face interaction during their class hours and interested students were identified to make sampling frame. The required sample of SPPC was recruited by simple random sampling. Sampling frame was made by listing of all potential participants totaling 476 SPPC, in the age group between 18 and 25 years from physiotherapy college of a recognized university from North India and were selected by a random number generator (an application tool in the statistical software, Statistical Package for Social Sciences [IBM SPSS version 22.0 (IBM Corp., Armonk, NY, USA)]). By this, a total of 157 SPPC were enrolled in this study from the recognized department of physiotherapy.

The enrolled students’ WhatsApp (an android-based messaging mobile application) contact details were obtained, and a link for the survey was sent to them after their college hours. The link (https://docs.google.com/forms/d/1ErZq7xw5_8vLGakqnqjA53hXg5cvmt3JUsDIGyrzwpU/edit?usp=drivesdk&chromeless=1) included the project description, demographic details, validated NMP questionnaire (NMP-Q) containing age, gender, year of study, course, E-mail address, and information about smartphone use that consist of the duration and purpose of smartphone use in Google Forms. Attempting the survey questionnaires was considered as providing consent for participating in this study. The validity of NMP-Q was already established by Yildirim and Correia in 2015.[3]

NMP-Q consists of twenty items addressing four factors of NMP: (a) Not being able to communicate, (b) Losing connectedness, (c) Not being able to access information, and (d) Giving up convenience. All items are rated using a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree).[3] The academic performance was assessed by the percentage of marks in the last academic examination, and daily activity limitations were assessed by the presence of pain in the neck, shoulder, elbow, or hand. It took approximately 10 min to complete the survey. Reminder WhatsApp message was sent to them if not responded within 48 h by monitoring the status of the number of responders recorded in the Google Form. By this, we have attained the required sample size within 2 weeks. We have not sent through E-mail as it was not the first option to reach a large number of college students. Online survey was selected as it is easily accessible, less expensive, and time saving. Google Form automatically analyzes data.

Data analysis

Normality of the collected data was analyzed by Kolmogorov–Smirnov test. As the data follow normal distribution, we have expressed the central tendency and dispersion of the data as mean with 95% confidence interval (CI) and used parametric test, ANOVA for the comparison of mean NMP score across various levels of academic performance. Descriptive statistics were expressed in percentage. For all the analyses, the levels of significance were set at 0.05 to minimize Type 1 error. The above statistical analysis was performed using the statistical software, IBM SPSS version 22.0 (IBM Corp., Armonk, NY, USA).

RESULTS

A total of 157 SPPC participated in this study. Four students participated more than required sample size, n = 153. However, we have not omitted the four survey details. There was no incomplete form as every question might be interesting to the students. The mean age of students was 22.2 ± 3.2 years; among them, 42.9% were male and 57.1% were female, 32% of students had postgraduate education, 13% were interns, 10% were final-year students, 19% were 3^rd-year students, 9% were 2^nd-year students, and 17% were 1^st-year students. The total duration of smartphone use is displayed in Figures 1 and 2 which highlight the use of smartphone other than calling purpose. Nearly 54% of the SPAHS reported having musculoskeletal problem (neck pain/shoulder pain/thumb pain/wrist pain, etc.) due to prolonged smartphone use, which might have an impact on daily activities. The mean NMP score with 95% CI was 77.6 (72.96–82.15). The NMP scores (NMPS) along with their academic performance among SPPC are displayed in Table 1. There exists no statistically significant difference (P = 0.152) among NMPS with the corresponding academic performance levels which included the four levels of <50%, 50–60%, 60–70%, and >70% marks in the last academic performance.

Figure 1.

Total duration of smartphone use

Figure 2.

Duration of smartphone use other than calling purpose

Table 1.

Academic performance with the corresponding mean nomophobia score among the students pursuing allied health courses

DISCUSSION

NMP is relatively a newer trend and has different aspects. Spending more time on mobiles, fear of low battery, feeling anxious at the thought of losing handset, sleeping with mobile, and unlocking the screen frequently are some of the symptoms of NMP.[1,19,20] Our study results demonstrated that there was no significant difference between academic performance and NMP in NMP group (P = 0.152). However, there was an inverse relationship between NMP score and academic performance. As NMP score increases, academic performance decreases and vice versa. Mendoza and Mcdonough reported that NMP on students have a larger impact on attending lectures.[21]

Mobile phone users’ health education strategies are affected severely as Dongre et al. reported that increased mobile phone usage causes lack of sleep and eyestrain.[22] The present study also shows that 54% of mobile phone users had pain. The prevalence rate of NMP varies from 17.8% among medical students by Dixit et al.[12] and 75% by Sharma et al.,[11] and there was a female preponderance.[11,23] Higher age negatively affects mobile phone usages and younger age individuals are more likely to use mobile phone.[24,25,26] Shah and Seth found a positive correlation between smartphone addiction and neck pain (r = 0.671) that matched with our study as 54% of population reported pain and it can cause discomfort in the activities of daily living.[10] King et al. found that mobile phone usage in panic disorder significantly increases anxiety, fear, perception, tachycardia, and respiratory alteration.[1]

NMP affects academic performance and daily activities among SPPC. Mobile phone addiction has been an emerging problem of the modern era and one of the biggest nondrug addictions. The inappropriate use of mobile phone is a symptom but not a problem; hence, we can modify it by recognizing the growing trends of inappropriate use of mobile phone among college students. Smartphones have become more popular due to advancement in internet connectivity with high-speed internet by various competitive service providers. Regular and constant use of smartphone has therefore awoken concerns about its addiction potential. According to the American Psychiatric Association, internet gaming/social media use is categorized as a nonsubstance-related addictive disorder and considered as mental illness.[27]

This study had few limitations. The generalizability of the results to SPPC might be affected as we have recruited the students from single university. Moreover, the students from physiotherapy colleges were recruited by the convenience sampling method that might have led to some degrees of selection bias. We have not assessed other mental health issues such as depression, anxiety disorder, and stress disorder, which could influence academic performance among these students. Nevertheless, this was the first study to estimate the impact of NMP among SPPC. We used a very simple and easy questionnaire that can be used in the future among students pursuing other courses.

With the help of NMP-Q, the impact of NMP on academic performance and the prevalence of musculoskeletal problem can be assessed. The present study would be helpful to highlight the SPPC about the alarming rise of NMP and its negative consequences. Thereby, this study would pave the way for controlled and proper use of mobile phones among students. Future studies should be conducted in establishing the correlation of NMP with risk factors such as academic performance, depression, anxiety disorder, and stress disorder among students pursuing other college courses.

CONCLUSION

NMP among students pursuing physiotherapy course have been established. There might be a negative impact between NMP and academic performance. However, it should be confirmed by correlation analysis in future studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.