A mixed-method study on prevalence, associated factors, and perception of nomophobia among undergraduate students of a medical college in Nagpur, India

INTRODUCTION

Smartphones have revolutionized modern life by enhancing communication, learning, and access to information. However, this increased reliance has introduced a new set of psychological challenges, one of which is nomophobia an abbreviation for "no mobile phone phobia".¹ Nomophobia refers to the discomfort, anxiety, or nervousness caused by being out of contact with a mobile phone. It is not currently recognized in major psychiatric classification systems, but its prevalence is rising, especially among adolescents and young adults who are highly dependent on smartphones for both academic and social purposes.² Though not formally included in the DSM-5, nomophobia is increasingly recognized as a form of behavioural addiction associated with negative emotional and physiological responses, such as anxiety, elevated heart rate, sweating, and even panic attacks.³

A systematic review and meta-analysis of 28 studies involving over 11,300 university students across eight countries revealed that 56% had moderate and 17% severe nomophobia, with prevalence rates remarkably consistent across genders and disciplines. This highlights that nomophobia is a global issue among young adults.⁴

India, being the second-largest smartphone market globally, is particularly vulnerable. Affordable smartphones, low-cost internet, and digital academic platforms have contributed to increased dependence among college students, especially in medical education, where information overload and stress are common. Factors associated with nomophobia include gender, duration of daily phone use, emotional dependency, and academic stress, though findings on gender remain inconsistent. Moreover, nomophobia correlates with poor sleep, decreased academic performance, social instability, and reduced life satisfaction. The behavioural paradox of smartphones are that they are both empowering and enslaving underscores their complex role in psychological well-being.⁵

Several studies have reported high prevalence rates of nomophobia in medical colleges across India. A study in Bhopal by Sethia et al found that 61.5% of students had moderate nomophobia.⁶ Similarly, Jilisha et al reported high dependence on smartphones among Puducherry college students, with major impacts on mental health, academic performance, and social interaction.⁷ Given this background, the current study aimed to estimate the prevalence, identify associated factors, and explore perceptions related to nomophobia among undergraduate students at a medical college in Nagpur using a mixed-method approach.

METHODS

A mixed method study was conducted in the Government Medical College, Nagpur among undergraduate medical students from month of October 2024 to December 2024.

Inclusion criteria

Quantitative

Students who had been using a mobile phone for a minimum of six months were eligible to participate.

Qualitative

students who are having severe nomophobia.

Exclusion criteria

Students were excluded from the study if they did not own a mobile phone or if they declined to give informed consent.

Sample size

The sample size for the quantitative component was calculated based on a prior study by Sethia et al. (2018)6, which reported a 61.5% prevalence of moderate nomophobia. Using an absolute precision of 5% and a 95% confidence level, the required sample size was determined to be 365 which was calculated using the Open Epi (Version 3.01).

Data collection method

Quantitative

For the quantitative part, a cross-sectional study was conducted among undergraduate medical students, from first year to final year. The participants are allocated through convenience sampling.

Data collection was done through a pretested, semi-structured, self-administered questionnaire, which captured sociodemographic variables, smartphone usage patterns, and symptoms of nomophobia using the 20-item nomophobia questionnaire (NMP-Q). The NMP-Q employs a Likert scale and categorizes nomophobia severity into mild, moderate, and severe based on total scores.

Qualitative

For the qualitative component, in-depth interviews (IDIs) were conducted among a purposive subsample of six students identified with severe nomophobia scores who also consented to be interviewed. Interviews were conducted in a private, distraction-free setting, and continued until data saturation was reached. Each IDI was audio-recorded with participant consent. The coding process involved familiarization with the data, generation of initial codes, and identification of emergent themes, which included perceptions about smartphone usage, facilitating and controlling factors for usage, and manifestations of smartphone dependency. Triangulation of qualitative insights with quantitative findings enriched the contextual understanding of nomophobic behavior in this young adult population.

Ethical approval was obtained from the institutional review board prior to data collection, and written informed consent was taken from all participants.

By adopting a mixed-methods framework, the study aimed not only to quantify the extent of nomophobia but also to gain insight into students lived experiences and perceptions through qualitative inquiry.

Data analysis

Quantitative

The quantitative data was entered in Microsoft excel and analyzed using SPSS software. Chi square test was used to assess the association between nomophobia and other variables. A p-value < 0.05 was considered statistically significant.

Qualitative

The In-depth interview (IDI) was recorded digitally, and transcripts were translated back into English. The encoded transcripts were analysed using the ATLAS.ti 8.0 trial package computer program by ATLAS.ti Scientific Software Development GmbH, Berlin, Germany. Employing a content analysis approach, we initially identified recurring codes and generated open codes through content analysis. Next, we conducted axial coding to categorize similar open codes under subthemes. Finally, through constant comparison analysis across different subthemes, we derived major themes, which served as a framework for identifying associated factors and perceptions regarding nomophobia.

RESULTS

A total of 365 undergraduate MBBS students from first to final year participated in the study. The analysis was divided into quantitative and qualitative components.

Table 1 summarizes the sociodemographic characteristics of the participants. The majority were in the age group of 18–22 years, with the mean age ±SD of 19.48±1.03 years. Most students resided in hostels or rented accommodations, while a smaller proportion lived at home. Gender distribution was fairly even, and most students reported belonging to middle socioeconomic status.

Table 2 outlines the smartphone usage characteristics of participants. A significant number of students reported using their smartphones for more than 4–6 hours per day, and the most common purpose of usage was social networking and entertainment. More than half the students acknowledged checking their phones multiple times per hour, often without any specific reason. A substantial proportion admitted to checking their phones immediately after waking up, and many reported perceived health effects such as eye strain, headache, and disturbed sleep. Furthermore, around 38% believed that smartphone overuse negatively affected their academic performance.

Figure 1 depicted the prevalence of nomophobia among the study population. It revealed that Moderate nomophobia was the most common, seen in 63% of students, mild nomophobia in 23% and severe in 3%. 11% of the participants had no nomophobia.

Table 3 presented the association of various factors with nomophobia levels. Statistically significant associations were found between nomophobia and the place of residence, age group, and primary purpose of smartphone use. Students residing in hostels showed higher nomophobia levels, likely due to fewer social controls and increased unsupervised access to the internet. Additionally, students using smartphones primarily for social media or leisure (rather than academics or communication) were more prone to moderate and severe nomophobia.

Table 4 presents the thematic analysis of the qualitative data. Thematic content analysis revealed four core themes:

Perceived necessity

Students widely considered smartphones crucial for academic activities such as accessing notes, diagrams, e-books, and coordinating study groups or clinical postings. Beyond academics, phones were integrated into their daily routines as planners, alarms, and task reminders, making them integral to both academic and personal functioning.

Emotional attachment

Many students reported a strong emotional dependence on their smartphones. Feelings of anxiety, unease, or incompleteness were common when separated from their devices. Fear of missing out on social interactions or updates contributed to compulsive checking behaviors, even in the absence of notifications.

Awareness of overuse

Despite recognizing the benefits, students were aware of excessive and often unintentional use. Many described how short phone use would turn into extended periods of scrolling, especially on social media. This led to distraction from studies, guilt, and frustration over lost time and productivity.

Control vs. dependence

Participants frequently described failed attempts to limit usage through app restrictions or uninstalling platforms. A recurring theme was the perceived lack of control, with some acknowledging habitual or addictive behavior. Efforts at self-regulation were often short-lived, reflecting internal struggles with digital dependency.

Emerging technology-related nomophobia

A newer pattern of reliance emerged around AI tools like ChatGPT. Students expressed growing dependence on such platforms for academic help and admitted to feeling lost without them. This reflects a shifting dimension of nomophobia from device attachment to dependence on digital content and intelligent tools.

DISCUSSION

The study found that 63% of the students exhibited moderate nomophobia, 23% had mild nomophobia, 3% had severe nomophobia, and 11% showed no nomophobia. These findings align closely with previous research in India, such as Sethia et al who reported a 61.5% prevalence of moderate nomophobia among medical students in Bhopal, with 6.1% having severe nomophobia.⁶ Similarly, Devi et al found 99.56% prevalence of nomophobia among medical students in Bhopal, with 55.65% moderate and 20% severe cases, indicating a slightly higher burden of severe nomophobia compared to our study.⁸ Globally, Marcos Kubrusly et al reported a 99.7% prevalence among Brazilian medical students, with 64.5% at moderate or severe levels, and Anusuya et al noted a 99% prevalence in Chennai, with 56.3% moderate and 17.5% severe nomophobia.^9,12 The consistency of moderate nomophobia prevalence across these studies underscores its widespread presence among medical students, likely driven by their reliance on smartphones for academic and social purposes. The lower prevalence of severe nomophobia in our study (3%) compared to other studies may reflect regional differences in smartphone usage patterns or access to digital infrastructure.

Significant associations were found between nomophobia and factors such as place of residence, age group, and primary purpose of smartphone use in current study. Students residing in hostels exhibited higher nomophobia levels, potentially due to fewer social controls and greater unsupervised internet access, a finding consistent with Jilisha et al who identified frequent smartphone usage and social networking as significant factors.⁷ The study also noted that students using smartphones primarily for social media or leisure, rather than academics, were more prone to moderate and severe nomophobia, corroborating Devi et al who reported a significant association between nomophobia and daily smartphone usage duration (p=0.000).⁸ Additionally, Anusuya GS et al found that severe nomophobia was linked to mobile usage exceeding five hours daily (p=0.013), aligning with our observation of increased nomophobia with prolonged leisure-based usage.¹⁰

Gender differences were not significant in our study, contrasting with Jilisha et al and Sharma M et al, who reported higher nomophobia among males.^7,11 These inconsistencies suggest that contextual factors, such as cultural norms or academic pressures, may influence gender-based differences in nomophobia prevalence.

The qualitative component, revealed five core themes: perception about smartphone usage, facilitating factors, controlling factors, nomophobia and addiction and emerging technology-related nomophobia. Students perceived smartphones as essential for daily life, providing stress relief, social belonging, and a sense of identity, yet expressed embarrassment when using non-smartphones, reflecting social pressures. Facilitating factors included internet availability and compulsive checking of notifications, consistent with Jilisha et al.’s findings of dependency and compulsive behaviour.⁷ Controlling factors, such as parental restrictions and awareness of overuse, were noted as mitigating nomophobia, aligning with Devi et al who highlighted usage duration as a modifiable factor.⁸

Students described anxiety, frustration, and loss of control when separated from their phones, with some interrupting tasks or returning home for forgotten devices, mirroring Jilisha et al observations of addiction-like behaviours.⁷ Theme of emerging technology-related nomophobia highlighted a growing dependence on AI tools like ChatGPT for academic assistance, with students reporting feelings of disorientation when unable to access these platforms. This finding extends Jilisha et al observations of dependency by suggesting that nomophobia is evolving beyond device attachment to include reliance on specific digital content and intelligent tools, reflecting the increasing integration of AI in educational settings.⁷

Limitations

The cross-sectional design limits the ability to establish causal relationships between associated factors and nomophobia. The use of convenience sampling may limit the generalizability of findings beyond the study setting. Self-reported data are subject to recall and social desirability bias

CONCLUSION

Nomophobia is highly prevalent among undergraduate medical students in this study, with the majority exhibiting moderate dependence and a smaller proportion having severe dependence. Younger students, those residing in hostels, and those using smartphones primarily for social networking were more likely to exhibit higher levels of nomophobia. Qualitative findings revealed that smartphones are perceived as indispensable for academic and personal tasks but are also a source of distraction, emotional dependence, and anxiety when unavailable. The emerging reliance on AI-based tools such as ChatGPT indicates a shift from device attachment towards dependence on specific digital platforms. These findings highlight the need for targeted interventions to promote healthy digital habits among medical students.

Recommendations

Implement structured digital well-being programs focusing on balanced smartphone use, time management, and awareness of the risks of overdependence.

Provide counseling and psychological support services for students exhibiting signs of smartphone overuse or dependency.

Develop institutional guidelines to regulate smartphone use during lectures, practical sessions, and clinical postings.

Encourage the use of offline academic resources such as printed study material, group discussions, and skill-based practical learning.

Involve parents and peers in promoting healthy usage patterns and in early identification of problematic use.

Undertake multicentric longitudinal and interventional studies to assess the long-term impact of nomophobia and the effectiveness of preventive strategies.

ACKNOWLEDGEMENTS

The author gratefully acknowledges the guidance and support of mentors and colleagues at the institution. Sincere appreciation is also extended to the members of the Institutional Ethics Committee for their valuable approval and diligent ethical oversight throughout the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Dabhi H, Satodiya V, Garg S. Goel R, Vala A. A cross-sectional study to know the prevalence, pattern, and contributing factors associated with nomophobia in medical students. International Journal of Research in Medical Sciences. 2024;12(7)2370–4.
2. 2. George G, Vincent J, George JB. A study on the prevalence of nomophobia and its associated factors among the medical students of a medical college in central Kerala. Int J Community Med Public Health. 2023;10:2224-7.
3. 3. Bhattacharya S, Bashar M, Srivastava A, Singh A. NOMOPHOBIA: No Mobile Phone Phobia. Journal of Family Medicine and Primary Care. 2019;8(4):1297–300.
4. 4. Tuco KG, Castro-Diaz SD, Soriano-Moreno DR, Benites-Zapata VA. Prevalence of Nomophobia in University Students: A Systematic Review and Meta-Analysis. Healthc Inform Res. 2023;29(1):40-53.
5. 5. Bartwal J, Nath B. Evaluation of nomophobia among medical students using smartphone in north India. Med J Armed Forces India. 2020;76(4):451-5.
6. 6. Sethia S, Melwani V, Melwani S, Priya A, Gupta M, Khan A. A study to assess the degree of nomophobia among the undergraduate students of a medical college in Bhopal.International Journal of Community Medicine and Public Health. 2018;5(6):2442–5.
7. 7. Jilisha G, Venkatachalam J, Menon V, Olickal JJ. Nomophobia: A mixed-methods study on prevalence, associated factors, and perception among college students in Puducherry, India. Indian Journal of Psychological Medicine. 2019;41(6):541–8.
8. 8. Devi KA, Thomas PE, Kumari P, Rani P, Sharma P, Kapoor M, et al. Prevalence and associated factors of nomophobia among undergraduate students of AIIMS Patna. Int J Med Res Rev. 2023;11(3):71-7.
9. 9. Kubrusly M, Silva PG, Vasconcelos GV, Leite ED, Santos PD, Rocha HA. Nomophobia among medical students and its association with depression, anxiety, stress and academic performance. Revista Brasileira de Educação Médica. 2021;45(03):e162.
10. 10. Anusuya Gs, Dinah H, Arumugam B, Karthik Rc, Annamalai R, Mani E. A Cross-sectional Study on Nomophobia among Undergraduate Medical Students in Chennai, India. Journal of Clinical & Diagnostic Research. 2021;15(12):1.
11. 11. Sharma M, Mathur DM, Jeenger J. Nomophobia and its relationship with depression, anxiety, and quality of life in adolescents. Industrial psychiatry journal. 2019;28(2):231-6.
12. 12. Chandak P, Singh D, Faye A. An exploratory study of nomophobia in post graduate residents of a teaching hospital in Central India. Int J Indian Psychol. 2017;4:48–56.
13. 13. Yildirim C, Correia AP. Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire. Comput Human Behav. 2015;49:130–7.
14. 14. Bivin JB, Mathew P, Thulasi PC, Philip J. Nomophobia - Do we really need to worry about? Rev Prog. 2013;1:1–5.
15. 15. Sharma N, Sharma P, Sharma N, Wavare RR. Rising concern of nomophobia amongst Indian medical students. Int J Res Med Sci. 2015;3:705–7.
16. 16. Gezgin DM, Cakir O, Yildirim S. The relationship between levels of nomophobia prevalence and internet addiction among high school students: The factors influencing Nomophobia. Int J Res Educ Sci. 2018;4:215–25.
17. 17. Aguilera-Manrique G, Marquez-Hernande V, Alcaraz-Cordoba T, Granados-Gamez G, Gutierrez-Puertas V, Gutierrez-Puertas L. The relationship between nomophobia and the distraction associated with smartphone use among nursing students in their clinical practicum. PLoS One. 2018;13:1–14.
18. 18. Lapointe L, Boudreau-Pinsonneault C, Vaghefi I. Is smartphone usage truly smart? A qualitative investigation of IT addictive behaviors. Proceedings of the Annual Hawaii International Conference on System Sciences. 2013:1063–72.
19. 19. Khan MM. Adverse effects of excessive mobile phone use. Int J Occup Med Environ Health. 2008;21:289–93.
20. 20. Argumosa-Villar L, Boada-Grau J, Vigil-Colet A. Exploratory investigation of theoretical predictors of nomophobia using the Mobile Phone Involvement Questionnaire (MPIQ) J Adolesc. 2017;56:127-35.
21. 21. Fullwood C, Quinn S, Kaye LK, Redding C. My virtual friend: A qualitative analysis of the attitudes and experiences of Smartphone users: Implications for Smartphone attachment. Pergamon: Computers in Human Behavior; 2017:75.
22. 22. King ALS, Valença AM, Silva ACO, Baczynski T, Carvalho MR, Nardi AE. Nomophobia: dependency on virtual environments or social phobia?. Comput Hum Behav. 2013;29:140-4.
23. 23. Kanmani A, Bhavani U, Maragatham RS. Nomophobia-an insight into its psychological aspects in India. Int JIndian Psychol. 2017;4:6-15.
24. 24. Lin CY, Griffiths MD, Pakpour AH. Psychometric evaluation of Persian Nomophobia questionnaire: differential item functioning and measurement invariance across gender. J Behav Addict. 2018;7:100-8.