Internet usage among medical students: prevalence, addiction and health issues

INTRODUCTION

Internet has become the backbone of modern society since coming into existence from the last century. Its use is rapidly escalating, with technology becoming cheaper and more accessible. India’s share of Internet users has shown an exponential rise over the last decade due to the reliance for work, study, and leisure activity.¹ Recent advancements in the technological world have paved the way for the Internet to be an appropriate tool for individuals and families to communicate. Online social networking and Internet communication is current trend among both adolescents and young adults.²

Internet has helped the student community to share ideas, search for knowledge, lecture notes, experiences, perform many routine activities like purchasing tickets, ordering books, banking, video calling and other entertainment activities. Moreover, it’s a platform where they can gain access to any information on any event within seconds, can watch live telecasts, read the latest updates on any subject without spending money.³ The internet can easily hook individuals onto social media. 22% of teenagers log on to their favourite social media site nearly half a dozen times per day. This has augmented the appearance of conditions such as face book depression. Social media is now impacting lives with equal severity as with events occurring in the real world. Medical students are also affected by internet addiction. Though they often spend majority of their time either in class or studying, the time for any real entertainment and person-to-person interaction is very limited due to the hectic medical curriculum.⁴

Excessive use of the Internet has been termed by researchers by use of varied terminologies such as compulsive internet use, problematic internet use, pathological internet use, and IA.^5-8 In 1995, the term “internet addiction” was proposed by Dr. Ivan Goldberg for pathological compulsive internet use.⁹ The term IA describes it as an individual's inability to control his or her own use of the Internet causing disturbances and impairment in fulfilment of work, social and personal commitments.^7,10 Dr Kimberley Young in the Internet Addiction Test developed by her, linked excessive internet use most closely to pathological gambling, a disorder of impulse control in DSM IV and adapted the DSM IV criteria to relate to internet use. According to her, various types of internet addiction are cyber-sexual addiction, cyber-relationship addiction, net compulsions, information overload, and computer addiction. Young initially developed 8-question Internet Addiction Diagnostic Questionnaire (DQ) based on DSM IV. Later, she included 12 new items in addition to the 8 items to formulate an Internet Addiction Test (IAT). This the only available test whose psychometric properties have been tested.⁹

Although the internet has become a must need for a medical student, time is being wasted from a medical student's educational experience due to misuse of social media. Research is beneficial to identify possible addiction due to usage of technology on a daily basis.⁴ This study was undertaken with the objective of determining the prevalence of internet usage, addiction among medical students and to find out the characteristics.

METHODS

A cross sectional study was carried out among the medical students of a tertiary care teaching hospital of North Kerala from December 2016 to May 2017. Sample size was calculated to be 81, considering prevalence as 58.87% taking allowable error at 20% and assuming 20% non-response rate.¹¹ However, sample size was raised to increase the accuracy. Ethical clearance was obtained from the institutional ethical committee.

Purpose of the study was explained to all the participants and informed consent was taken from them. Students who were not willing to participate were excluded from the study. Finally, 227 students filled out and returned the questionnaires.

Study tool

A self-administered questionnaire was used which included questions pertaining to sociodemographic status, attitude, practice based and The Internet Addiction Test (IAT; Young, 1998) was used.^9,11,13,14 The predesigned, validated pretested questionnaire contained the questions pertaining to socio-demographic characteristics, attitude, practice, IAT questions. Participants filled all the IAT items on a 6-point Likert measure: 0-does not apply, 1-Rarely, 2-Occasionally, 3-Frequently, 4-Often, 5-Always. Internet addiction was assessed by scores from 0 to 5 for each question. Based on scoring they were graded as follows.

0 – 19: no addiction

20 – 49: average online user (mild addiction)

50 – 79: experiencing occasional and frequent problems (moderate addiction)

80 – 100: internet usage is causing significant problems in the life (severe addiction)

Statistical analysis

Data collected was coded, entered in Microsoft Excel and analysed using Statistical package for social sciences (SPSS) 16. Quantitative variables are presented as Mean, Standard deviation. Qualitative variables are presented as proportions.

RESULTS

A cross sectional study was conducted among 227 MBBS students. Majority of students 166 (73%) belonged to 20-22 years age group. Mean age of the sample was 20yrs. Majority 64 (28.2%) students were hailing from Kozhikode. There were students from all districts of Kerala. (Figure 1)

The study sample of 227 participants comprised mostly of females,174 (76.7%). Their age ranged from 17 to 24 years with mean age, 20 years. Majority166 (73.1%) were 20-22 years and hailing from rural areas. Most 221 (97.4%) were hostellers. Education of parents -120 (52.9%) of fathers,103 (45.4%) of mothers were graduates. Most of the fathers were either employed within the state or abroad with 11 (4.8%) availing pension and a few10 (4.4%) being unemployed. Most 152 (67%) of the mothers were homemakers. (Table 1).

Of the total 227 participants, most of the study population initiated internet use between the ages of between ages of 16 and 18 years 89 (39%) and 35 (16%) had the first use of the Internet between 8 -12 years. Most commonly used gadget was mobile phone 180 (79.3%). 7.5% students are using all the three gadgets.

*Many used multiple gadgets for many purposes, 7.5% used all the three types of gadgets. ^$Multiple health problems

Among the study population, majority of students 89.4% students were using their personal gadgets.

Majority 180 (79.3%) spent below Rs 200 per month for internet use. Average expenditure was Rs 164.56 per month. Our study revealed that 196 (86.3%) students were using internet for educational purposes only135 (59.5%) students were using internet for entertainment 189 (83.2%) were using for socialising. Among the study population, 215 (94.7%) spent up to 60 minutes for academic purposes. Average time spend for academic purposes was 32. 34 minutes. Average time spent for nonacademic purposes was 96.04min. Among the study population only 57 (25 %) 42 had no health issues. Majority 102 (44%) had headaches, 40 (17.6%) students were having sleep disturbances. 29 (15%) students were facing other problems like anxiety, stress, visual difficulties and backache. (Table 2).

Our study revealed that 93(41%) students were having no addiction. Prevalence of internet addiction among medical students was 59% (mild, moderate, severe) with severe addiction being 0.8%. (Table 3).

DISCUSSION

Age

In our study, majority of students 166 (73%) belonged to 20-22 years age group which is similar to a study among 2776 undergraduates from a recognized university in South India aged 18–21 years.¹² Mean age was 20 years almost similar to a study among college students in Mumbai in which the mean age was 16.82 years.₉

Gender

Of the total 227 participants, most of the study population were females similar to a study.^9,12,17 But in a study at Chandigarh, males (58.7%) outnumbered females (41.3%).¹⁵ Higher proportion of girls in this sample was in accordance with gender distribution in general in the teaching institution.

Age of initiation into internet

As seen in our study age of first internet use was between 8 -12 years in 35 (16%) and between the ages of 16 -18 years in 89 (39%).This is similar to study among 2776 undergraduates from a recognized university in South India, 35.50% initiated internet use between the ages of 10 -15 years and more than half of the study samples 52.0% had the first use of the internet between ages of 16-18 years.¹²

Gadget used

Most commonly used gadget was mobile phone 180 (79.3%),128 (56%) used only mobile phone for internet access 7 (3.1%) used only laptop 39 (17.2%) students are using only computers 4.8% students are using both mobile phones and laptops,10.6% students are using both mobile phones and computers,0.4% are using both laptops and computers and 7.5% students are using all the three gadgets. Among the study population, majority of students were utilizing their personal gadgets for internet purposes 89.4% students were using their personal gadgets 4% students were utilizing internet café.1.8% were using internet by other means like gadgets of their parents, 4% were using personal gadgets and internet café and 0.8% were utilizing all the three means of sites. In a study in Iran, 98% were Internet users of whom 81.4% had access to the Internet through computers and 18.6% through both computers and cell phones.¹⁷

Money spent

In majority 180 (79.3%) money spent was below Rs 200 per month for internet use. Average expenditure was Rs 164.56 per month.

Purpose of internet usage

Our study revealed that 196 (86.3%) students were using internet for educational purposes only 135 (59.5%) students were using internet for entertainment 189 (83.2%) were using for socialising. Majority (75%) of the respondents admitted using Social Networking Sites, whereas 20% used these sites for sharing academic and educational information.^16,20 Of the 200 students, nearly 84 (42%) students have started on social networking site during their I MBBS. One hundred thirty (65%) students have installed medical apps, while 70 (35%) students have not installed any medical apps which include Medscape, PGMED, USMLE and others.² The most common purpose of Internet use was educational for two-thirds of 312 participants (62.5%) at Chandigarh. The five most commonly endorsed items were as follows: the need to use the Internet everyday (53.8%), Internet use helping to overcome bad moods (50%), staying online longer than one originally intends to (43.3%), eating while surfing (24%), and physical activity going down since one has started using the Internet (22.1%).¹⁵

Time spent

Among the study population, 215 (94.7%) spent up to 60minutes for academic purposes. Average time spend for academic purposes was 32, 34 min. Out of the study population,134 (59%) spent about 100min for non-academic purposes. Average time spent for non-academic purposes was 96.04 min.The average time spent on social networking sites- 143 (71.5%) students spend more than 2 h and share social issues, personal issues, share jokes etc.2According to a study done among 312 participants at PGIMER, the average time spent in Internet use was 2.13 h (SD 1.98) daily, more than half (56.73%) was using Internet at least for 2 h/day.¹⁵ The mean hours spent on the Internet per week was less than 15 hours in 815 students (90%) and more than 15 hours in 91 (10%).¹⁷

Health issues

Among the study population thankfully 57 (25 %) had no health issues. But in majority head ache was the commonest health problem 102 (44%) followed by sleep disturbances in 40 (17.6%), back pain in 14 (6.1%). 29 (15%) students were facing other problems like anxiety, stress, visual difficulties. Those with excessive use internet had high scores on anxiety, depression, and anxiety depression was also seen in a study among college students.₉

Addiction

Our study revealed that 93 (41%) students were having no addiction, 113 (49.8%) students were average online users having only mild addiction, 19 (8.4%) students were experiencing occasional and frequent problems (moderate addiction) and for 2 (0.8%) severely addicted students was causing significant problems. The prevalence of IA in medical students was 56.81% (mild IA: 49.59%, moderate IA: 7.22%).¹ In a study among 987 college students in Mumbai, 74.5% were moderate (average) users and 0.7% were addicts.⁹ Among the 2776 university students, 831 (29.9%) met criterion on IAT for mild IA, 455 (16.4% ) for moderate addictive use, and 13 (0.5%) for severe IA.¹² When evaluated on ICD-10 substance dependence criteria and Young's IADQ separately, the prevalence of the ‘cases’ of Internet addiction came out to be 51.9 and 3.8%, respectively 1521% of the students were identified as problematic Internet users.¹⁷

Limitations

Self-reporting by participants may not reveal the true picture at times. One question was modified from Young’s questionnaire since it was culturally inappropriate.

CONCLUSION

This research provides an insight into the current trend among medical students and their affinity towards usage of the internet for academic and non-academic purposes. It also revealed that medical students are at increased risk for problematic internet use and to a lesser extent internet addiction. Health issues are an alarming concern which need to be addressed as a priority measure.

Recommendations

Students should be made aware the use of negative and positive impacts of the internet, internet addiction/problematic internet use focusing on developing a safe internet culture. Health and preventive measures should be instituted promptly early in life in order to curtail health problems in the long run. Ergonomically placed interventional strategies are pertinent as a primary level of prevention.

ACKNOWLEDGEMENTS

Authors are grateful to the respondents who participated in the study, Institutional Research and Ethical committees for their valuable support.

Funding: No funding sources

Conflict of interest: None declared

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

REFERENCES

1. 1. Shivam S, Chaudhari B, Chaudhury S, Saldanha D. Parenting style and personality correlates of internet addiction: A cross-sectional study. Med J DY Patil Vidyapeeth. 2021;14:143-54.
2. 2. Asaithambi A, Subramanian M, Venkatesan S, Elakkuvan P, Ponniah T, Ramanathan M et al. Knowledge, attitude, behaviour, and practice of study on assessment of social networking among students and its impact on them. Int J Med Sci Public Health. 2016;5:473-6.
3. 3. Saha SK. What are Medical Students Doing Online? - A Study in Kolkata, India. Arabian J Bus Manag Review. 2016;6:214.
4. 4. Lavadi R, Subramanian M, Panchaseelan M, Chintala L, Reddy L, Dhananjay M, et al. A study on internet addiction among medical students in a tertiary care hospital in Bangalore, India. Int J Community Med Public Health. 2021;8:2995-8.
5. 5. Meerkerk GJ, Van Den Eijnden RJ, Vermulst AA, Garretsen HF. The compulsive internet use scale (CIUS): Some psychometric properties. Cyberpsychol Behav. 2009;12:1-6.
6. 6. Caplan SE. Problematic internet use and psychosocial well-being: Development of a theory-based cognitive – Behavioral measurement instrument. Comput Hum Behav. 2002;18:553-75.
7. 7. Young KS. Internet addiction: The emergence of a new clinical disorder. Cyberpsychol. Behav. 1998;1:237-44.
8. 8. Huang C. Internet addiction: Stability and change. Eur J Psychol Educ. 2010;25:345-61.
9. 9. Goel D, Subramanyam A, Kamath R. A study on the prevalence of internet addiction and its association with psychopathology in Indian adolescents. Indian J Psychiatry. 2013;55(2):140-3.
10. 10. Chen K, Tarn JM, Han BT. Internet dependency: Its impact on online behavioural patterns in E-commerce. Hum Syst Manage. 2004;23:49-58.
11. 11. Chaudhari B, Menon P, Saldanha D, Tewari A, Bhattacharya L. Internet addiction and its determinants among medical students. Ind Psychiatry J. 2015;24(2):158-62.
12. 12. Anand N, Jain PA, Prabhu S. Prevalence of excessive internet use and its association with psychological distress among university students in South India. Ind Psychiatry J. 2018;27(1):131-40.
13. 13. Young KS. Caught in the Net: How to Recognize the Signs of Internet Addiction – And a Winning Strategy for Recovery. New York, United States: John Wiley & Sons. 1998.
14. 14. Widyanto L, McMurran M. The psychometric properties of the internet addiction test. Cyberpsychol Behav. 2004;7:443-50.
15. 15. Grover S, Chakraborty K, Basu D. Pattern of Internet use among professionals in India: Critical look at a surprising survey result. Ind Psychiatry J. 2010;19(2):94-100.
16. 16. Guraya SY. The usage of social networking sites by medical students for educational purposes: A meta-analysis and systematic review. North Am J Med Sci. 2016;8:268-78.
17. 17. Mazhari S. The prevalence of problematic internet use and the related factors in medical students, kerman, iran. Addict Health. 2012;4(3-4):87-94.
18. 18. Koronczai B, Urbán R, Kökönyei G. Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychol Behav Soc Netw. 2011;14(11):657-64.
19. 19. Canan F, Ataoglu A, Ozcetin A, Icmeli C. The association between Internet addiction and dissociation among Turkish college students. Compr Psychiatry. 2012;53(5):422-6.
20. 20. Ukeme Ekpedeme Umoh, Etuk Nssien Etuk. Students’ Involvement in Social Networking and Attitudes towards Its Integration into Teaching. International Education Studies. 2016;9:9.