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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 27-37

A cross-sectional online survey of an impact of COVID-19 lockdown on smartphone addiction and nomophobia among undergraduate health sciences students of a rural tertiary health-care center from Maharashtra, India


1 Department of Psychiatry, Jawaharlal Nehru Medical College, Sawangi, Wardha, India
2 Department of Psychiatry, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, Gujarat, India
3 Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Sawangi, Wardha, India
4 Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi, Wardha, India
5 Department of Biochemistry, Shalinitai Meghe Hospital and Research Centre, Datta Meghe Medical College, Nagpur, Maharashtra, India

Date of Submission04-Apr-2021
Date of Decision10-May-2021
Date of Acceptance10-Jun-2021
Date of Web Publication05-Aug-2021

Correspondence Address:
Dr. Ajinkya Sureshrao Ghogare
Assistant Professor, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_38_21

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  Abstract 


Introduction: Increased use of smartphones can lead to smartphone addiction and “no-mobile-phone-phobia” known as nomophobia. During an ongoing coronavirus disease 2019 (COVID-19) lockdown, to tackle an issue of boredom, many people including undergraduate health sciences students (HSSs) are using smartphones, leading to an increased risk of smartphone addiction and nomophobia. During lockdown, many universities have shifted the mode of learning to e-classes by using an internet-based technology on smartphones, which may contribute to increased exposure to smartphones, leading to an increased risk of smartphone addiction among students. Objective: To assess an impact of COVID-19 lockdown on smartphone addiction and severity of nomophobia among UG HSSs. Materials and Methods: The present study was conducted at a rural tertiary health-care center in Maharashtra state of India with a sample size of 412. Smartphone Addiction Scale–Short Version was used to assess smartphone addiction and Nomophobia Questionnaire was used to assess nomophobia. Results: Majority (69.7%) reported inability to concentrate on studies at home due to increased use of smartphone during the COVID-19 lockdown. Boredom (32.8%) was the most bothering thing during lockdown, and to tackle it, 55.8% reported of using smartphone. 97.6% had nomophobia and 45.1% had smartphone addiction. There was increase in the prevalence of smartphone addiction and nomophobia during the COVID-19 lockdown as compared to the prevalence from studies which were conducted in the pre-COVID-19 lockdown period. Conclusion: Appropriate measures should be taken by health sciences universities and authorities to address an issue of smartphone addiction and nomophobia so that students can concentrate on their studies at home during the COVID-19 lockdown.

Keywords: Coronavirus disease 2019 lockdown, nomophobia, smartphone addiction


How to cite this article:
Ghogare AS, Aloney SA, Vankar GK, Bele AW, Patil PS, Ambad RS. A cross-sectional online survey of an impact of COVID-19 lockdown on smartphone addiction and nomophobia among undergraduate health sciences students of a rural tertiary health-care center from Maharashtra, India. Ann Indian Psychiatry 2022;6:27-37

How to cite this URL:
Ghogare AS, Aloney SA, Vankar GK, Bele AW, Patil PS, Ambad RS. A cross-sectional online survey of an impact of COVID-19 lockdown on smartphone addiction and nomophobia among undergraduate health sciences students of a rural tertiary health-care center from Maharashtra, India. Ann Indian Psychiatry [serial online] 2022 [cited 2022 Aug 9];6:27-37. Available from: https://www.anip.co.in/text.asp?2022/6/1/27/323187




  Introduction Top


Background

Without social life, it will be very difficult for human beings to survive and remain mentally healthy. Smartphones have played a major role in establishing and maintaining the social connectivity between the humans even from far distance. Smartphones have become one of the most important integral parts of human life including that of college students because of various functions served by them. Research has shown that smartphones have played a role in making the people socially more active, helped them in their profession, helped them in updating their general knowledge, and helped them in establishing their social identity through use of various applications such as Facebook, Twitter, Instagram, WhatsApp, and Gmail.[1]

Increased use of smartphones over a period of time in recent years due to invention of newer smartphones with newer features has led to the concern about smartphones becoming a part of behavioral addiction among the current generation of college students. The present generation including health sciences students (HSSs) have grown up with the use of the Internet on smartphones. Hence, the present generation of students are preferring interacting with each other on online social platforms than engaging in interpersonal communication in real-life situations.[2] A mixed-methods study of systematic review and meta-analysis from India had observed the prevalence of smartphone addiction in the range of 39%–44%.[3] Theoretically, the definition of addiction includes severe harm, impairment or negative consequences and psychological features such as craving, salience, loss of control, physical dependence, psychological dependence, tolerance, and withdrawal that leads to persistence of addictive behavior.[4]

Although smartphone addiction has not been mentioned in the Diagnostic and Statistical Manual of Mental disorders 5th edition (DSM–5)[5] and International Classification of Diseases 10th edition Diagnostic Criteria for Research (ICD–10–DCR),[6] it has been evident in the literature that smartphone addiction has lot of similarities with substance use disorders which is a term given in DSM–5[7],[8],[9] and with substance dependence syndrome which is a term given in ICD–10–DCR.[6],[10],[11],[12] These similarities especially involve behavioral changes such as compulsive behavior to use smartphone persistently, functional impairment due to an increased use of smartphone like inability to concentrate on study, withdrawal symptoms when access to smartphone is restricted in the form of anxiety, restlessness, irritability, insomnia, etc., and development of tolerance, i.e. increased need of spending time on using the smartphone to obtain previous level of pleasure after using smartphone.[7]

Novel coronavirus disease 2019 (COVID-19) had emerged in December 2019 from Wuhan city of China.[13] Since then, it is spreading rapidly and has captured an attention of whole world.[14],[15] In March 2020, the World Health Organization had declared COVID-19 as a pandemic amid its rapid global spread.[16] Since March 25, 2020, there is an ongoing countrywide lockdown in India to prevent the spread of COVID-19.

The lockdown period is having two sides. One important side is that it is very important in preventing and slowing the community transmission of coronavirus, but at the same time other side being perceived by the people as socially isolating and being lost in touch from the world. Although lockdown and social isolation have helped in achieving the goal of reducing the transmission of COVID-19 infection through reduced access to friends, family, and other social support systems, it has instilled the feeling of loneliness that has increased the mental health issues such as anxiety and depression.[17] Factors such as being socially isolated from the peers or the family members and being requested by the colleges as well as universities to attend multiple internet-based e-classes over a prolonged period of time every day in order to prevent an academic loss, the students are unknowingly getting exposed to an increased use of smartphones. It may lead to an increased risk of development of smartphone addiction among HSSs which may manifest later on in the form of NOMOPHOBIA (NO Mobile PHone PhoBIA) or in other way increased use of smartphones may lead to the development of nomophobia which may be followed by the development of smartphone addiction. Nomophobia is defined on the basis of Diagnostic and Statistical Manual of Mental Disorders fourth edition and is defined as a “phobia for a particular/specific things.”[18] The term nomophobia is used to describe the psychological condition when people have a fear of being detached from their smartphone connectivity. A study had observed that 66% of the smartphone users were suffering from nomophobia, with a higher rate among young people in an age group of 18–24 years old, and more prevalent among women than men.[19] Another study had observed that 42.6% of university students were suffering from nomophobia.[20]

There are many studies available regarding the psychological impact of COVID-19 on mental health status of general public, patients, and health-care workers (HCWs).[21],[22],[23],[24],[25],[26],[27],[28],[29] Apart from the psychological impacts, COVID-19 had caused adverse effects on the physical health.[25]

Rationale for the study

It has been evident in available literature that HSSs were exposed to stressors during virus outbreak, but this group was often overlooked.[30] The continuous spread of COVID-19 globally and strict lockdown measures have delayed the reopening of health sciences colleges and universities across the globe including India. Hence, the students are using their smartphones to attend their e-classes to prevent their academic loss. It may lead to an increased risk of smartphone addiction among HSSs. Smartphone addiction acts as a way of escapism from internal problems like boredom and sense of social isolation, as well as external problems like academic loss and future related worries that are secondary to COVID-19 lockdown. During the current COVID-19 lockdown, there has been increased in mental health issues like depression, anxiety and stress among many including HSSs.[28],[29],[31]

But no detailed literature is available regarding an assessment of relationship between smartphone addiction and nomophobia, and whether there has been an effect of COVID-19 lockdown on smartphone addiction and severity of nomophobia among undergraduate (UG) HSSs.

The research gap exists between the previous studies and present study, as in the previous studies, the relationship between smartphone addiction and nomophobia was not assessed.[2],[3],[4],[19],[20],[32] The present study had focused on bridging that gap of assessing the relationship between smartphone addiction and nomophobia. “Whether their exists an association between smartphone addiction and nomophobia as well as whether their exists an impact of COVID-19 lockdown on smartphone addiction and Nomophobia?” reflected the research question of this study.

Objective of the study

Therefore, we conducted this study with the primary objective of assessment of an impact of COVID-19 lockdown on smartphone addiction and nomophobia among UG HSSs of Medical, Dental, Ayurveda, Physiotherapy, Nursing and Pharmacy faculties of a rural tertiary health care center from Maharashtra state of India.

Prespecified hypothesis of the study

Based on previous study findings,[19],[20],[33] we hypothesized that UG HSSs with smartphone addiction tend to have higher levels of nomophobia.


  Materials and Methods Top


Study design

Present study was the cross-sectional internet based (www.surveymonkey.com) online survey.

Study setting, location, and relevant dates

The present study was conducted by the department of Psychiatry of a rural tertiary health care center from Maharashtra state of India over a period of 10 days from May 8, 2020 to May 17, 2020 through a predesigned questionnaire.

Eligibility criteria for the study participants, and sources and methods of selection of the study participants

Inclusion/eligibility criteria adopted for the present study were participants in an age group of 18–25 years, those who were well versed in English language and those who belonged to UG HSSs student's category. Under UG HSSs category, we included students of Medical (Bachelor of Medicine and Bachelor of Surgery [MBBS]), Dental (Bachelor of Dental Surgery), Ayurveda (Bachelor of Ayurvedic Medicine and Surgery), Physiotherapy (Bachelor of Physiotherapy), Nursing (Bachelor of Nursing Sciences) and Pharmacy (Bachelor of Pharmacy) faculties. Exclusion criteria adopted for the present study were those who did not wish to participate in the study and those who did not belonged to above-mentioned faculties of UG HSSs category. Identity of every participant was strictly kept anonymous. Before starting the survey, all study participants were provided with details of time taken to complete the survey, nature of the survey and information that filling in survey implies provision of informed consent by the participants. Survey questionnaire was circulated by using WhatsApp to UG HSSs. Data were collected from study participants by using the purposive sampling method.

Data sources/measurement

Present survey was in English language. In the survey, we have used two scales named – Smartphone Addiction Scale–Short Version (SAS–SV) and Nomophobia Questionnaire (NMP–Q). SAS–SV is a 10-item self-report scale that measures the smartphone addiction.[34] The study participants have to respond on a 6-point Likert scale ranging from “strongly disagree” to “strongly agree.” The total score of SAS–SV ranges from 10 to 60. Higher score indicates higher risk of smartphone addiction. Cutoff values ≥31 and ≥33 for male and female participants were used, respectively, for assessment of the smartphone addiction.[34] Internal consistency and concurrent validity of SAS–SV were verified by a study with Cronbach's alpha of 0.911. In boys, sensitivity and specificity values were 0.867 and 0.893, respectively. In girls, sensitivity and specificity values were 0.875 and 0.886, respectively. The same study had observed that SAS–SV had good reliability and validity for assessment of smartphone addiction.[34]

NMP–Q is a 20-item self–report scale developed by Yildirim and Correia.[35] NMP–Q consists of four factors such as not being able to communicate, losing connectedness, not being able to access information and giving up convenience. This four factor structure among 20 item instrument was supported in an exploratory factor analysis which had shown an excellent Cronbach's alpha across entire NMP–Q (α =0.95) and for four factors, the alpha were 0.94, 0.87, 0.83 and 0.81 respectively. Yildirim and Correia conclude that NMP–Q had good internal consistency and fair reliability.[35]

Apart from SAS–SV and NMP–Q scales, a set of COVID-19 lockdown-related common worries and concerns among UG HSSs were formulated and used. Those worries and concerns related to COVID-19 lockdown included worry related to future on a scale of 1–5 where “1” indicates less worry and “5” indicates highest level of worry, worry about contracting COVID-19 to self, worry about contracting COVID-19 by family member (s), worry related to academic loss due to COVID-19 lockdown, worry related to concentrating on their studies at home, change in smartphone use during COVID-19 lockdown, time spent on smartphone use every day during COVID-19 lockdown, eye strain due to increased smartphone use during COVID-19 lockdown, change in internet use during COVID-19 lockdown, most bothering thing during COVID-19 lockdown, sleep pattern affected during COVID-19 lockdown, common time–pass activity during COVID-19 lockdown, most common purpose for smartphone use during COVID-19 lockdown, parental criticism due to excessive smartphone use during COVID-19 lockdown, monthly expenditure on internet use during COVID-19 lockdown and having an extra smartphone.

Bias

It was an open and voluntary online survey which was carried out in English language among the study participants who were well versed in English language. They were not provided any incentives for participation in the survey. Participants could only fill survey once through a device, i.e. users with same IP address were not able to access the survey twice, thus preventing duplication of responses.

Study size

Sample/study size was calculated by using the sample size calculation formula for cross-sectional study with the help of OpenEpi software.[36] The formula was n = (DEFF × Np [1 − p])/(d2/Z2 1−α/2× [N − 1] + p × [1 − p]).[36] In this formula, “N” is population size (for finite population correction factor of fpc), “p” is hypothesized percentage frequency of outcome factor in the population, “d” is confidence limits as percentage of 100 (absolute ± %), “DEFF” is design effect (for cluster surveys – DEFF) and “n” is sample size for the study. In the present study, by considering population size of N = 1200 at P = 55%,[19] d = 5% and DEFF = 1, proposed sample size was 412. Total responses received were 550. Out of those 550, 138 responses were incomplete. So, we excluded those incomplete 138 responses. When the survey responses hit completely solved number of 412 (the number reached after 550 UG HSSs participated in the survey), the web based open e-survey link was closed for accepting further responses and analysis was carried out on required calculated sample size.

Statistical methods

Data from both scales were entered with the help of Microsoft Excel version 2010. Final data were analyzed with the help of SPSS statistical software version 15 (IBM, Chicago, IL, USA). Continuous data were presented as mean and standard deviation (SD), categorical data were presented as frequency and percentage. Chi-square and Fisher's exact tests were used to determine the level of significance. Pearson's test of correlation was used to test the correlation between presence of smartphone addiction and severity of nomophobia. Level of significance was set at 0.05.


  Results Top


Distribution of sociodemographic data among study participants

In the present study, as regards sociodemographic characteristics, majority of the study participants belonged to an age group of 18–21 years (71.1%), female gender (73.3%), Hindu religion (87.4%), nuclear family (71.4%), urban residence (70.9%), medical faculty (35.9%) and 1st year of education (48.3%). Mean age of study participants was 20.33 (1.73) years.

Distribution of coronavirus disease 2019 lockdown-related data among study participants

In the present study, as regards COVID-19 lockdown-related data, majority of UG HSSs (30.6%) had rated “5” regarding the future related worry due to COVID-19 lockdown, mild worry of contracting COVID-19 by self (45.6%), moderate worry of contracting COVID-19 by family member (s) (35.2%), moderate worry related to academic loss due to COVID-19 lockdown (43.4%), not able to concentrate on study due to excessive use of smartphone during COVID-19 lockdown (69.7%), moderate increase in smartphone use due to COVID-19 lockdown (40.5%), spending more than 3 h/day on using smartphone (64.1%), not having eye strain (74.8%), moderate increase in internet use (40.8%), boredom as the most bothering thing during COVID-19 lockdown (32.8%), sleeping less than usual due to excessive smartphone use during COVID-19 lockdown (53.9%), using smartphone as a common time–pass activity to tackle the boredom due to COVID-19 lockdown (55.8%), using Instagram application on smartphone (46.6%), facing parental criticism due to excessive smartphone use during COVID-19 lockdown (52.2%), spending up to Rs. 250/month on using internet (58.5%) and not having an extra smartphone (91.0%).

Distribution of smartphone addiction among study participants

In the present study, smartphone addiction was present in 45.1% of the UG HSSs according to SAS–SV scores. The mean score ± SD (range) of SAS–SV was 31.52 ± 9.67 (10–59).

Distribution of nomophobia and its severity among study participants

In the present study, nomophobia was present in 97.6% of the UG HSSs according to NMP–Q scores. Based on NMP–Q scores, out of those 97.6% study participants with nomophobia, 18.7% had mild, 61.4% had moderate and 17.5% had severe nomophobia. The mean score ± SD (range) of NMP–Q was 77.58 ± 24.59 (20–140).

Association between socio–demographic as well as coronavirus disease 2019 lockdown-related data and smartphone addiction among study participants

[Table 1] shows that, among sociodemographic data, only rural residence was associated with smartphone addiction. Among COVID-19 lockdown related data, worry of contracting COVID-19 by family members, not able to concentrate in study at home due to increased smartphone use, increased smartphone use during lockdown, more than 3 h/day of smartphone use, presence of eye strain due to increased smartphone use, increased internet use on smartphone during COVID-19 lockdown, presence of bodyache as most bothering thing during COVID-19 lockdown, disturbance of sleep pattern and criticism from parents/family members regarding an increased smartphone use during COVID-19 lockdown were associated with smartphone addiction.
Table 1: Association between sociodemographic as well as coronavirus disease 2019 lockdown-related data and smartphone addiction among study participants (n = 412)

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Association between socio–demographic as well as coronavirus disease 2019 lockdown-related data and Nomophobia among study participants

[Table 2] shows that among sociodemographic data, only year of education factor was associated with presence of nomophobia. Among COVID-19 related data, spending above 3 h/day of time on smartphone use during COVID-19 lockdown, increased internet use during COVID-19 lockdown and increased eye strain due to increased smartphone use during COVID-19 lockdown were associated with the presence of nomophobia.
Table 2: Association between sociodemographic as well as coronavirus disease 2019-related data and no-mobile-phone-phobia (n=412)

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Assessment of relationship between smartphone addiction and Nomophobia among study participants

[Table 3] shows that, presence of smartphone addiction was associated with the severity of nomophobia. As the smartphone addiction developed, the severity of nomophobia also increased among the study participants.
Table 3: Relationship between smartphone addiction and severity of no-mobile-phone-phobia among study participants (n=412)

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  Discussion Top


Sociodemographic data among study participants

In the present study, majority of UG HSSs (71.1%) belonged to 18–21 years of age. The mean age of the study participants was 20.33 ± 1.73 years. Bhalerao et al. had also observed a similar finding with mean age of 19.28 ± 0.93 years.[33] Jain et al. had also observed a similar finding with mean age of 18.50 ± 0.80 years.[37] These studies reflected the fact that smartphone addiction and nomophobia are more common among younger students. In the present study, majority of UG HSSs (73.3%) belonged to female gender. Jain et al. had also found that majority of HSSs (70.91%) from their study were females.[37] Ahmed et al. had observed a similar finding with majority of HSSs (57.1%) belonging to female gender.[38] These findings might reflect that female HSSs were more interested and responsive towards participating in study than their male counterparts. It might also reflect on the fact that smartphone addiction and nomophobia were more prevalent in female students.[37],[38] In the present study, majority (71.4%) of UG HSSs belonged to nuclear family. Joint families obviously have more family members who might share various responsibilities among themselves to take care of a person suffering from any psychological problems which may include smartphone addiction and nomophobia. A study had found that 11% of study participants came from intact families living with biological parents, while 89% i.e. majority had some form of disruption in their family structures.[39] Thus family type plays an important role in management of health problems among sufferers which holds true for HSSs also. Familial dysfunction are more common among nuclear families due to lack of adequate supportive care. Kim et al. observed that family dysfunction was significantly associated with smartphone addiction.[40] In the present study, majority (70.9%) of HSSs belonged to urban area of residence. Jilisha et al. had also observed that majority (62.3%) of college students were from urban background.[41] Recent study from urban India had shown that there was 90% rate of rise of smartphone users from year 2012 to 2013 and there were 51 million smartphone users.[42] These findings suggest that maximum number of smartphone users are from urban areas of India and smartphone addiction is more prevalent among urban areas of India. In the present study, majority (35.9%) of UG HSSs belonged to medical (MBBS) faculty. In the present study, majority (48.3%) of UG HSSs were from first year of their academic course. Aguilera-Manrique et al. observed that majority (50.7%) of HSSs were from third year of their academic course which was in contrast to present study finding.[43] Such a difference in two study findings might be due to differences in selection criteria of study participants as Aguilera-Manrique et al. had carried out their study among HSSs who were from 3rd to 4th year of their academic course.[43]

Coronavirus disease 2019 lockdown-related data among study participants

In the present study, majority (30.6%) of HSSs had rated “5” on a scale of 1–5 regarding their future related worry due to ongoing COVID-19 lockdown where “1” indicated no worry and “5” indicates maximum or severe worry. Wong et al. had recorded mental distress caused by virus outbreak by a single item 11-point Likert scale where “0” was no distress and “10” meant very distressed. Majority of their respondents had scored “6.19.”[44] These ratings on Likert scales in present study and study conducted by Wong et al.[44] indicated a mean distress level secondary to viral disease outbreak among study participants. In the present study, majority (45.6%) of UG HSSs reported of having mild degree of worry regarding contracting COVID-19 to self. In the present study, majority (35.2%) had reported moderate degree of worry of contracting COVID-19 by family member (s). Wong et al. had observed that sources of stress among health sciences personnel like HCWs include feelings of vulnerability, loss of control and concerns about health of self, others and family, spread of the virus, changes in work and being isolated from loved ones.[44] Present study findings infer that sources of stress mentioned by Wong et al.[44] may hold true in case of HSSs also. Such sources of stress might lead to smartphone overuse leading to smartphone addiction and nomophobia. In the present study, majority (43.4%) of HSSs had reported moderate degree of worry related to academic loss due to COVID-19 lockdown. Finding supporting present study finding was observed by Al-Rabiaah et al. who stated that HSSs were exposed to stressors during virus outbreak because students had adverse effects on their academic achievement through increased avoidance of learning activities and reduced psychomotor concentration which had occurred during lockdown period.[30] In the present study, majority (69.7%) of HSSs reported that they were not able to concentrate on their studies at home due to an increased smartphone use due to COVID-19 lockdown. Another two studies had also observed a similar finding among HSSs that those who were having stronger smartphone addiction had shown higher risk of getting distracted during their studies and had reduced learning ability due to distraction.[45],[46] In a study conducted by Jilisha et al., 38.1% of students reported of perceived impairment in academic performance due to excessive smartphone use.[41] Thus, it was evident that development of smartphone addiction led to increased distractibility and decreased learning ability among HSSs. In the present study, boredom due to COVID-19 lockdown was the most bothering thing reported by majority (32.8%) of UG HSSs. To tackle COVID-19 lockdown-induced boredom, 40.5% had reported moderate increase in smartphone use, 40.8% had reported moderate increase in internet use on their smartphones and 55.8% had reported of using smartphone during COVID-19 lockdown as the most common activity to pass the time and to get relieved of boredom. Jilisha et al. had observed a similar finding that students considered smartphones to be an absolute necessity and an escape from boredom.[41] Students also found a sense of belongingness from smartphone use during period of boredom and they couldn't leave their smartphones manifesting as nomophobia.[41] So, socially isolating period like COVID-19 lockdown might be a predisposing factor for development of smartphone addiction and nomophobia because smartphones are being used as a way of dealing with boredom as well as for establishing social contacts in virtual mode. Hence, to prevent or tackle an issue of smartphone addiction and nomophobia, health sciences universities should create practical guidelines regarding use of smartphones by UG HSSs.

In the present study, majority (64.1%) of UG HSSs reported that they were spending more than 3 hours/day of time on using smartphone. Jilisha et al. had observed a similar finding that majority (52.1%) of students reported of spending 3–6 h/day on using their smartphones to cope with their sense of boredom.[41] On assessment of use of internet among UG HSSs, we found that majority (46.6%) had reported of using Instagram application for maintaining social contacts with peers. Skierkowski and Wood also observed a similar finding and concluded that Instagram was one of the most common applications used by smartphone users for recreational purpose and to maintain social contacts.[1] In the present study, 25.2% of UG HSSs had reported of having eye strain due to an increased smartphone use during COVID-19 lockdown. Finding similar to present study finding was reported by Jilisha et al. who found that 21.8% of the students had eye strain due to excessive smartphone use.[41] These findings support the role of ophthalmological interventions in cases of nomophobia and smartphone addiction. In the present study, majority (52.2%) of UG HSSs had reported of facing parental criticism due to an increased smartphone use during COVID-19 lockdown. Similar finding was noted by Jilisha et al. who also found that majority (51.5%) had faced criticism due to their increased smartphone use.[41] These findings imply that increased use of smartphone can have deleterious effects on interpersonal relationships. In the present study, majority (53.9%) of UG HSSs had reported of sleeping less than usual due to COVID-19 lockdown induced increased smartphone use. Dworak et al. had observed that problematic internet use over smartphones may affect sleep quality by reducing rapid eye movement sleep, slow–wave sleep and sleep efficiency.[47] Lemola et al. had also observed that smartphone use had deleterious effect on sleep pattern. They concluded that sleep latency was higher among smartphone addicts.[48] Pavithra et al. had observed that 93% of HSSs reported that they were keeping their smartphones with them even when they went to bed for sleep. They conclude that such maladaptive use of smartphones in night while going to sleep can lead to sleep disturbances because of exposure to bright light screen of smartphones.[49]

In the present study, majority (58.5%) of UG HSSs reported of spending up to Rupees 250/month on using internet on their smartphones. Pavithra et al. also reported a similar finding that majority (74.0%) of HSSs spent Rupees 300/month on internet use on their smartphones.[49] In the present study, 97.6% had nomophobia and 45.1% had smartphone addiction. A study from South India had shown that 46% of university students had smartphone addiction which was similar to the finding of present study from Central India.[32] These both studies from Central and South India had shown comparable results which might be due to similarity of the population selected and similar instrument (SAS–SV) being used to assess the smartphone addiction.[32] Another study from India which was a mixed method study of systematic review and meta-analysis, had observed that the prevalence of smartphone addiction was in a range of 39%–44% which was lesser than present study finding of 45.1%.[3] Although there was very little increase in the prevalence of smartphone addiction in the present study when compared to the finding of mixed method study from India,[3] it might be effect of COVID-19 lockdown that present study had an increased prevalence of smartphone addiction. Also it is worthy to note down that present study was conducted during an initial phase of COVID-19 lockdown and as the duration of lockdown progresses, there may be a further increase in the prevalence of smartphone addiction. The prevalence of smartphone addiction may reduce post COVID-19 lockdown once health sciences colleges and universities will re-open as students may become busy in their academic activities, and to assess it, carrying out prospective studies would be required. A study conducted by Market Analysis and Consumer Research Organization (MACRO) in Mumbai city of India had observed that 58% of the study participants had nomophobia which was much lesser than the prevalence of nomophobia of 97.6% in the present study.[50] This much higher prevalence of nomophobia in the present study might be due to an effect of COVID-19 lockdown and lower prevalence of Nomophobia in the study conducted by MACRO in Mumbai, India, was during pre-COVID-19 lockdown time.[50] This might suggest that once the period of post-COVID-19 lockdown will commence the HSSs will be busy in their academics as their colleges as well as universities will re-open which may result in the reduction of prevalence of nomophobia.

In the present study, among those 97.6% of UG HSSs with nomophobia, majority (73.1%) were females. In the present study, among those 45.1% of UG HSSs with smartphone addiction, majority (71.0%) were females. Studies by Aguilera-Manrique et al.,[43] Arpaci,[51] and Yildirim et al.[20] also showed the findings similar to present study finding that female college students exhibited higher levels of nomophobia and smartphone addiction than male college students.

In the present study, presence of smartphone addiction was associated with the severity of nomophobia. Results of the present study revealed that as smartphone addiction developed, severity of nomophobia also increased among UG HSSs. Aguilera-Manrique et al. had also observed a similar finding that there was correlation between smartphone use and nomophobia among HSSs.[43] Another study had found moderate correlation between smartphone use and the risk of developing nomophobia.[52]

Limitations of the present study

Due to cross-sectional study design, temporal assessment can't be done. As participants were questioned about details of use of smartphones, they might have answered in such a way as to portray themselves in a good light; hence, social desirability bias could be present. As the participants were questioned about their use of smartphone during the times of COVID-19 lockdown, there remains possibility of recall bias and subjective bias. Lastly, the study was conducted on the specific population of UG HSSs, thus limiting the generalizability of the results found.


  Conclusion Top


UG HSSs who had smartphone addiction, had high levels of nomophobia. So, appropriate measures should be taken by health sciences universities and authorities to modify the smartphone use by UG HSSs so that they can concentrate on their studies during COVID-19 lockdown.

Research quality and ethics statement

The authors of this manuscript declare that this scientific work complies with the reporting quality, formatting and reproducibility guidelines set forth by the EQUATOR Network. The authors also attest that this clinical investigation was determined to require Institutional Ethics Committee (IEC) review, and the corresponding protocol/approval number is– (DMIMS/IEC/2020/8709, dated May 6, 2020).

Acknowledgment

We sincerely thank all the study participants who participated in the study for their cooperation. We are also grateful to all the CORONA Warriors, i.e. HCWs and their supporting family members for their selfless and kind services to the humankind.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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