A cross-sectional study on the prevalence of nomophobia and its impacts on quality of life among medical students in Shimoga, Karnataka

INTRODUCTION

The smartphone, a recent progression in information technology, has not merely replaced cellular phones but also supplanted others due to its mobility and other integrative features. It has become an essential element of human beings.¹ Smartphones have become increasingly popular because of their multiple application such as accessibility to information, connectivity, workplace application, etc.²

The number of smartphone users globally is projected to be nearly 7.7 billion by 2027.³ Currently, smartphone penetration is about 71% in India.⁴ The highest penetration rate in the use of smartphones was for the age group of 18-24 years, and the time spent by Indians on smartphones was recorded as 40% at 4.6 hours.⁵

Nomophobia (portmanteau for no mobile and phobia) refers to discomfort, anxiety, nervousness, or anguish caused out of contact with a mobile phone.⁶ This term was coined by United Kingdom-based researchers who were assessing anxieties suffered by mobile users in 2008.² Researches by Bragazzi et al and Yildirim et al proposed to include nomophobia in diagnostic and statistical manual of disorders, 5^th edition (DSM-V).

Recently, the negative consequences of the problematic use of smartphones have increased. The usage of smartphones causes various psychological problems, such as low self-esteem, social phobia, and social anxiety.²

A systematic review conducted on the prevalence of nomophobia indicates that nomophobia is universally present.⁹ However, there is less evidence of its effect on the quality of life of potentially vulnerable populations like medical students. World Health Organization defines quality of life as a subjective evaluation of one's perception of their reality relative to their goals as observed through the lens of their culture and value systems.¹⁰

With this background, the present study aimed to estimate the prevalence of nomophobia and assess its impact on the quality of life of medical students of Shimoga Institute of Medical Sciences, Shimoga.

METHODS

A cross-sectional study was conducted among medical students of Shimoga Institute of Medical Sciences, Shimoga, Karnataka, India from January 2024 to April 2024. Medical students from phase I, phase II, phase III part I, and phase III part II who use smartphones were included in the study. The students who didn’t give informed written consent were excluded from the study. Ethical approval was obtained from the institutional ethics committee.

The sample size was calculated using Epi Info. Considering the prevalence of nomophobia among medical students 40.1%, absolute precision of 5%, 95% Confidence interval, and adjusted for population size, the minimum sample required was 229.¹¹ Considering the 10% non-response rate, the sample size increased to 250.

The list of all students from the first to the last phase was obtained from the academic section and given numbers from 1 to 600. Open Epi software was used to generate random numbers. Students selected by random numbers were approached and assessed the inclusion and exclusion criteria. Participants were provided with the self-administered questionnaire and the collected data.

The questionnaire had 3 parts- sociodemographic details, nomophobia questionnaire and sf 36 questionnaire. Nomophobia was assessed using the nomophobia questionnaire (NMP-Q), a pre-validated questionnaire with a Cronbach’s alpha of 0.95. NMP-Q is a 20-item self-reported questionnaire. It comprises four factors (factor 1: not being able to communicate, factor 2: losing connectedness, factor 3: not being able to access information, and factor 4: giving up convenience). A 7-point Likert scale ranging from 1 (Strongly disagree) to 7 (strongly agree) is used for each item, and the total score is calculated. Total score ranges from 20-140. The results were interpreted as follows- 20 (no nomophobia), 21-59 (mild nomophobia), 60-99 (moderate nomophobia), and 100-140 (severe nomophobia).⁸

Quality of life was assessed using the SF-36 questionnaire. It considers the following domains-Physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. The Cronbach’s alpha varied from 0.78 to 0.93 for each domain. Each domain is scored from 0 (worst possible health) to 100 (best health).^12,13

Data were tabulated in Microsoft Excel, and data analysis was done using SPSS v 21. Qualitative variables were expressed as frequencies and percentages. Quantitative variables were expressed as mean±standard deviation, or median (interquartile range, IQR). The relationship between the NMP-Q and SF-36 scores was assessed using the Spearman correlation coefficient.

RESULTS

The study included 250 medical students. The students’ median (IQR) age was 21 (19, 22). There were equal numbers of male and female students. Most participants (64%) had a permanent residence in an urban area (Table 1).

The mean smartphone usage duration among the students was 3.98±2.3 years. The mean time spent on the smartphone daily was 5.26±2.3 hours. The purpose of the use of smartphones among students is given in Table 2.

The mean score of nomophobia was 82.64±19.93. Table 3 shows the prevalence of nomophobia. Most of the participants had moderate nomophobia (69.6%). Considering the four factors of NMP-Q, the overall highest mean score was for “not being able to communicate” (4.63±1.31) and lowest for “losing connectedness” (3.61±1.39).

Quality of life was assessed using the SF-36 questionnaire. Table 4 shows the median scores with interquartile range (IQR) of 8 domains of the SF-36.

A correlation between the NMP-Q score and SF-36 scores was done (Table 5). There was a significant, weak, negative correlation between the nomophobia score and some domains of quality of life.

DISCUSSION

The usage of smartphones has become highly prevalent among youths, and it plays an integral part in daily living nowadays.¹⁴ The excessive use of mobile phones can be viewed as a behavioural addiction, and it has been considered to be similar to substance abuse.¹⁵

The present study aimed to estimate the prevalence of nomophobia and its impact on the quality of life among medical students. Data was collected from 250 medical students. The mean smartphone usage duration was four years, and the average time spent on mobile phones was 5 hours daily. The findings are similar to the study conducted by Bartwal and Nath on medical students, where the duration of smartphone usage was more than three years, and the average time spent on mobile phones was more than 3 hours.²

In the present study, mobile phones were used mainly for talking to family and friends, followed by the use of social media. A study conducted by Pavithra et al showed that mobile phones were used mainly for social networking.¹⁶ The usage pattern of mobile phones from the present study had similar findings of Bartwal and Nath.²

The mean NMP-Q score was higher than Ahmed et al in the present study.¹⁷ The prevalence of nomophobia varied in different studies. It may be due to the difference in the nomophobia assessment method or the difference in culture. In this study, 11.2% of medical students had mild nomophobia, 69.6% of them had moderate, and 18.8% of them had severe nomophobia. The findings were similar to the study conducted by Madhusudhan et al, where most participants had moderate nomophobia.¹⁸

In the present study, the highest mean score was for not being able to communicate among the four factors of the NMP-Q questionnaire. It can be attributed to the most common usage of smartphones among the participants for talking to family and friends and social media usage. This is similar to the study conducted by Bartwal and Nath.²

The present study has a significant negative correlation between multiple domains of quality of life and nomophobia. It can be inferred that nomophobia has a negative impact on emotional well-being and social functioning. It also causes limitations in daily activities due to emotional problems. It may be due to stress, anxiety, comparing life with peers, lack of in-person socialisation rather than virtual socialisation, loneliness, sleep disturbances, and fear of missing out.¹⁹

It has also been noted that nomophobia can affect physical health also negatively. In the present study, there was a negative correlation between nomophobia and fatigue and the role of limitation of activity due to physical health. It may be due to headaches, backache, and eye strain associated with excess usage of mobile phones. Similar findings were seen in the study by Daniyal et al.²⁰

The present study gives the prevalence of nomophobia among the population age group where smartphone penetration is high. The limitations are that the study is based on only one institution and cannot be generalised.

CONCLUSION

The prevalence of moderate nomophobia was high among medical students, and it had a negative impact on multiple physical and emotional domains of quality of life. It indicates that the problem has to be addressed. Awareness can be created about the various implications of problematic usage of mobile phones.

ACKNOWLEDGEMENTS

The authors acknowledge support from all faculties of the department of community medicine and the valuable participation of the medical students.

Funding: No funding sources

Conflict of interest: None declared

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

REFERENCES

1. 1. Lin Y. How does Nomophobia Impact Life Satisfaction? Exploring the Mediating Effect of Psychological Disorders. Selected Papers of the IRIS, Issue Nr 10 (2019). 2019;7.
2. 2. 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.
3. 3. Statista. Number of smartphone users in India in 2010 to 2023, with estimates until 2040. Available from: https://www.statista.com/statistics/467163/forecast-of-smartphone-users-in-india/. Accessed on 23 August 2024.
4. 4. Statista. Mobile communications in India- statistics and facts. Available from: https://www.statista.com/topics/5836/mobile-communications-in-india/. Accessed on 23 August 2024.
5. 5. Smartphone Users in India (Statistics and Facts)-2021. 2021. Available from: https://findly.in/smartphone-users-in-india-statistics/. Accessed on 23 August 2024.
6. 6. King AL, Valença AM, Nardi AE. Nomophobia: the mobile phone in panic disorder with agoraphobia: reducing phobias or worsening of dependence? Cogn Behav Neurol. 2010;23(1):52-4.
7. 7. Bragazzi NL, Puente GD. A proposal for including nomophobia in the new DSM-V. PRBM. 2014;7:155-60.
8. 8. Yildirim C, Correia AP. Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire. Comp Hum Behav. 2015;49:130-7.
9. 9. León-Mejía AC, Gutiérrez-Ortega M, Serrano-Pintado I, González-Cabrera J. A systematic review on nomophobia prevalence: Surfacing results and standard guidelines for future research. PLoS One. 2021;16(5):e0250509.
10. 10. Teoli D, Bhardwaj A. Quality of life. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing; 2023.
11. 11. Mengi A, Singh A, Gupta V. An institution-based study to assess the prevalence of Nomophobia and its related impact among medical students in Southern Haryana, India. J Fam Med Prim Care. 2020;9:2303-8.
12. 12. RAND. 36-Item Short Form Survey (SF-36) from the RAND Medical Outcomes Study. Available from: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html. Accessed on 20 August 2024.
13. 13. RAND. 36-Item Short Form Survey (SF-36) Scoring Instructions. Available from: https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/scoring.html. Accessed on 20 August 2024.
14. 14. Walsh SP, White KM, Cox S, Young RMcD. Keeping in constant touch: the predictors of young Australians’ mobile phone involvement. Comp Hum Behav. 2011;27(1):333-42.
15. 15. Aggarwal M, Grover S, Basu D. Mobile phone use by resident doctors: Tendency to addiction-like behaviour. German J Psychiatr. 2012;15:50-5.
16. 16. Pavithra MB, Suwarna M, Mahadeva Murthy TS. A study on nomophobia- mobile phone dependence, among students of a medical college in Bangalore. Nat J Community Med. 2015;6(3):340-4.
17. 17. Ahmed S, Pokhrel N, Roy S, Samuel AJ. Impact of nomophobia: A nondrug addiction among students of physiotherapy course using an online cross-sectional survey. Indian J Psychiatr. 2019;61(1):77-80.
18. 18. Muralidhar M, Sudarshan B, T.V S, Gopi A, Fernandes S. Nomophobia and its determinants among the students of a medical college in Kerala. Int J Med Sci Public Health. 2017;6:1046-9.
19. 19. Awasthi S, Kaur A, Solanki HK, Pamei G, Bhatt M. Smartphone use and the quality of life of medical students in the Kumaun Region, Uttarakhand. J Family Med Prim Care. 2020;9(8):4252-8.
20. 20. Daniyal M, Javaid SF, Hassan A, Khan MAB. The relationship between cellphone usage on the physical and mental well-being of university students: a cross-sectional study. Int J Environ Res Public Health. 2022;19(15):9352.