Internet and facebook addiction among Egyptian and Malaysian medical students: a comparative study, Tanta University, Egypt

INTRODUCTION

The internet is considered as the most effective tool in all areas of science, business, education, culture, and politics.¹ The total number of worldwide internet users was estimated as 1.2 billion in the year 2000 and jumped to be 3.17 billion in 2015.² According to the internet usage statistics, internet users are increasing in Egypt reaching about 54.6 % of the population in 2015, compared to 35.6% in 2012.^3,4 More than 80% of the Egyptian internet café clients are young people.⁵ Increasingly usage of computer technology and widespread dominance of the internet has faced many people particularly university students and extremely usage of it results in mental and psychological disorders.⁶ College students are believed to be at a high risk with a marked increase in their internet usage worldwide.⁷

The term ‘internet addiction’ was first introduced by Goldberg I in 1995 describe ‘pathological and compulsive use of internet’. Goel categorized this term as a subgroup of behavioral addictions.⁸ In addition, various psychological measures are available to assess the internet addiction which include: young internet addiction test (YIAT), problematic internet use questionnaire (PIUQ), compulsive internet use scale (CIUS), and chen internet addiction scale (CIAS).⁹

Facebook is a social networking service launched in February 2004; it reports more than 1 billion active users. It is particularly attractive to young adults and over half of member being in the age group of 18-34.^10,11 As of the third quarter of 2015, Facebook had 1.55 billion monthly active users with estimated 27million users in Egypt in November 2015. It has quickly become both a basic tool and a mirror for social interaction, personality identity and network building amongst university students.^4,12,13

There is no doubt that excessive use of facebook affects the real world interaction abilities and communication, while social skills gradually decrease. Facebook addiction is the new term invented by psychiatrists as its addiction will damage the sleeping habits, health and interest in studies and interaction abilities of real life.¹⁴

To our knowledge, in spite of numerous studies to discuss the issue of internet and facebook addiction among medical students were carried worldwide, scares studies were done in Egypt, so the objective of this study was to determine prevalence, associated factors and effects of internet and facebook addiction on medical students of Tanta faculty of medicine.

METHODS

This cross sectional was conducted in Tanta faculty of medicine, Tanta University, Egypt on Egyptian and Malaysian students in 4^th and 5^th grade; it was conducted from March through May, 2015 in the academic year 2014-2015. The study sample included all Malaysian students (N=300), and a non-probability sample was drawn from 4^th and 5^th grades Egyptian students (N=1900). The least sample size was calculated using Epi-Info version 7.1.5.2. Program of statistics using 5% confidence limits at 99% confidence level was 431 students. For better accuracy and validity and to cover any losses due to incomplete questionnaires, 600 Egyptian students were estimated to participate in the study.

Inclusion criteria

• • 4^th year medical students.
• • Both sexes.
• • Active internet user since at least 1 year
• • Willing to give consent and complete the questionnaire

Exclusion criteria

• • Not willing to give consent & complete the questionnaire
• • Not using internet

After end of data collection only 861 students (584 Egyptians and 277 Malaysians) met the inclusion criteria, gave the consent and completed the questionnaire with response rate 95.67%.

The study instrument for data collection consisted of a self- administered semi structured questionnaire with 2 sections;

Section I questions about internet and facebook use

• • Socio-demographic and academic data of the student (Nationality age sex residence family income grade of previous year).
• • Patterns of internet use (Internet access place (s), device (s), use years, daily hours, predominant time, and type of internet activity).
• • Patterns facebook use (Cause of use, effect of facebook on social life, effect on time that you used to spend with your friends and family, activity on facebook, effects of use and attempts to leave).
• • Adverse effects of using internet and facebook.

Section II young internet addiction test (YIAT)

Developed by Young K included 20 items, each of which is rated on a six point likert scale: rarely, occasionally, frequently, often, always, and does not apply.¹⁵ Total internet addiction test (IAT) scores were calculated and interpreted as follows; Total up the scores for each item. The higher your score, the greater level of addiction is.

• • 20-49 points: An average on-line user. May surf the Web a bit too long at times, but have control over your usage.
• • 50-79 points: Experiencing occasional or frequent problems because of the internet. Categorized as potential problematic internet users should consider their full impact on your life.
• • 80-100 points: Internet usage is causing significant problems in life, categorized as problematic internet users (PIU). Should elevate the impact of the Internet on life and address the problems directly caused by Internet usage.

Statistical analysis

The data were coded, tabulated and analyzed using statistical package for social sciences (SPSS), software version 22.0 (IBM SPSS statistics for windows, released 2011; IBM Corp., Armonk, New York, USA; SPSS Inc., Chicago, Illinois, USA). Qualitative data were expressed as numbers and percentages, and the chi-square test was applied to test the relationship between variables. Pearson’s correlation was applied to determine the relationship of the level of internet addiction and socio-demographic and academic characteristics of the students, and for the relationship of the level of internet addiction and the adverse and health effects of internet & facebook use. For each test, a p-value of less than 0.05 was considered statistically significant.

Ethical considerations

Official approvals were obtained from the ethics committee of the Tanta faculty of medicine. All the students were informed about the objectives of the study and verbal consents were obtained from them.

RESULTS

Socio-demographic and academic data of the respondents (Table 1)

The study included 861 students (484 Egyptian and 277 Malaysian), their mean age was 22.08±1.15 years. More than one half of both Egyptian and Malaysian students were urban residents. (56.3%, 54.5% respectively). Females represented higher percentage than males in both groups. Only minor percent (1.1%) of Malaysian students had failed the last year.

Patterns of internet use (Table 2) and (Figure 1)

Significantly higher percentage (70.8%) of Malaysian students reported use of internet for a duration more than 5 years (p=0.000). The majority of the students of both groups reported “home” as the most frequent place for internet access (85.8% and 89.2%), and the most commonly used device in both groups was the mobile phone with significantly higher percentage (92.4%) among Malaysian students (p=0.000). Malaysian students reported significantly longer durations of daily internet use (p=0.000). The afternoon and evening times were the most frequent times for internet use in both groups (76% and 79.1%).

Patterns and socio academic effects of facebook use (Table 3 and Figure 1-6)

Facebook was most frequently social media used by Egyptian students (93%), while other social media such as twitter, whatsapp, skype were more frequently used by Malaysian ones (96.4%). Only minor percentages (1.9%, 1.8%) of both groups reported use of facebook for more than 6 hours per day. Significantly higher percentage of Malaysian students (84.1%) reported internet use for studying issues (p=0.000). Contact with friends, relatives and social purposes were reported by the highest percentage of both groups as the main causes of facebook use.

* Statistically significant

χ² = 25.99, p = 0.000*, * statistically significant

χ² = 14.58, p = 0.001*, * statistically significant

* Statistically significant

χ² = 19.34, p = 0.000*, * statistically significant

χ² = 4.91, p = 0.179

More than one third (36.8%, 37.5%) of both groups reported that they are equally active on both facebook and real life. Nearly one half (49.3% of Egyptian students reported moderate effect of facebook on their social relations compared to only 39% of Malaysian ones with statistically significant difference (p=0.000). Significantly higher percentage of Egyptian students reported marked decrease in time they spend with their friends and family (p=0.000). Significantly higher percentage of Egyptian students reported feeling lethargic due to facebook use (p=0.000). Habitual use of facebook at late night was reported by 26.9% of Egyptian students compared to only 15.5% of Malaysian ones with statistically significant difference (p=0.000). More than 30% of both groups reported use of facebook during study hours or lectures. More than half students of both groups (52.6%, 57%) denied any negative effect of facebook use on their study. 29.5% of Egyptian students tried to quit facebook use but they failed to do that, compared to only 16.2% of Malaysian ones with statistically significant difference (p=0.000), while more than 40% of both groups are planning for future reduction of time spent on facebook use.

Adverse effects of internet and facebook use (Figure 7- 9)

The most commonly reported adverse effects were eye irritation, followed by headache then back pain. Among health related behaviors during internet & facebook usage; disturbance of sleep pattern, postponing meals and holding urine or defecation were the most frequently occurring ones. About 30% of students reported decrease in physical exercise and increase in body weight.

Internet addiction test (IAT) scores Figure (10-12 and Tables 4 and 5).

Near two thirds (64.1%) of the student were average internet users, while only minor percentage of them (2.7%) had problematic internet use. Male students showed higher percentage of problematic internet use (PIU) than females, however the differences were not statistically significant (p = 0.073, while the largest percent of them (64.1%) were average internet users. Significantly higher percent of Egyptian students had (PIU) than Malaysian ones (3.8%, 0.9% respectively), (p=0.000). Significant negative correlation was present between IAT scores and academic grades of the students; the higher the grade the lower the score, while significant positive correlation was present with the adverse health effects, the higher the score, the more frequent occurrence of adverse health effects.

χ² = 5.45, p = 0.073

χ² = 38.52, p = 0.000*

*p < 0 .05, **p< 0.01

DISCUSSION

The Internet is extremely an important social and communications tool, and is changing our daily lives at home and at work. There is no doubt that some Internet users develop problematic behavior.¹⁶ Over past 5 years, social media sites like facebook have become a central, virtually unavoidable medium for social interaction, most of facebook users don’t realize the negative impact of social media on their life because they are already addicted to it.¹⁴

This study showed that the majority of the students had home internet access especially through their mobile phones (Table 1) which is similarly reported by Reda et al among a group of Egyptian adolescents.¹⁷

Lusk stated that one of the positive aspects of online communities is that youth can utilize them for academic assistance and support.¹⁸ In the current study, 72.1% of Egyptian students declared that they use internet for studying issues (Figure 1) which is similar to the results of Tayeeh who reported that 72.6% of students in his study use internet as a source of information.¹⁹

Among different types of social medias; the study participants reported Facebook as the most commonly used one (Figure 1), this finding is corresponding to that of Qingya et al, who stated that facebook is the most used social network by college students, followed by youtube and twitter. The majority of both Egyptian and Malaysian students reported that they use facebook keep in touch with friends and relatives (Figure 2) which was also found by Ellison and Lampe.^20,21

Daily use of Facebook was reported by 58% of Egyptian students and 72.6% of Malaysian ones, for duration of 1-2 hours (41.3%, 32.1%, respectively.) (Figure 3) which is in line with Farooqi et al who reported daily use in 64% of medical students in his study, and that about 40% used it around 1-2 hours.¹⁴

Every invention has its both negative and positive effects, same case was with Facebook that also has a negative impact on the life of human beings.²² Despite the name “Social networking”, large percentage of the study participants reported that its use has some negative effect on their social life with reduction of time that they spend with their families (Table 3).

Addiction to the Internet shares some of the negative aspects of substance addiction, and has been shown to lead to consequences such as school failure and family and relationship problems.²³ Widespread use of the Internet among the adolescents makes them feel alone, causes problematic behaviors, and leads to poor family and friends relationships.²⁴ Kamal and Mosallem also stated that problematic internet users (PIUs) cut themselves off from their family, friends, and social activities and choose to spend most of their time alone. Also students participated in Farooqi et al study claimed that facebook had ruined their social life and they spent less time with their loved ones.¹⁴

More than two thirds of Egyptian students who participated in this study reported negative impact of Facebook use on their study (Figure 4), which is in agreement with Qingya et al who stated that social networking is definitely affecting students’ efficiencies as well as their grades.²⁰

Addiction to facebook is one of the major complain of young generation.¹⁴ This fact was revealed via the results of this study, where considerable percentage of the students tried to reduce the time they spend using facebook and more than two fifths of them have a future plan to do this (Figure 5 and 6), however other two fifths reported that they will continue the same use which is an agreement with Farooqi et al, study in which most of users didn’t consider themselves as addicted of facebook and they responded with “I’ll keep using it in future life”.¹⁴

In the present study the most frequently reported adverse effects of internet and facebook use were headache, eye irritation and musculoskeletal pain (Figure 7, 8 and 9) these results were similarly reported by many other authors.^14,26,27

In the present research, problematic internet use or internet addiction was detected among 2.7% of the studied students (Figure 11). Middle Eastern prevalence of PIU varies between 1 and 12%.^28-30 Higher results (13.2%) were reported in a study held in Menofia University, Egypt.³¹ Variation in figures can be explained by the different criteria used to identify internet problematic use and/or addiction.¹⁷ Male students showed higher percentage of problematic internet use (PIU) than females (Figure 10). Similarly, Desouky and Reda, reported that the prevalence of PIU was higher among male students.³² These results also coincides with Saif, who said that "Based on popular stereotypes as well as on previous research, it was predicted that pathological internet users would more likely be males". However, Kyunghee et al stated that the prevalence of Internet addiction did not vary with gender.^31,33

In the present study significant negative correlation is present between IAT scores and academic grades of the students (Table 4) which is consistent with the fact that on-line users were becoming addicted to the internet in much the same way that others became addicted to drugs or alcohol, which resulted in academic, social, and occupational impairment.¹⁵

One of the limitations of this study it was a cross-sectional one that only showed the relation between internet and facebook addiction and some potential health hazards without being able to determine the causality among those variables, so cohort studies are recommended to confirm the causality. Also data collection was based on self-administered questionnaires which are prone to recall bias.

CONCLUSION

This study revealed considerable effects of facebook and internet use upon the social life of medical students. It also revealed that excessive facebook and internet use is associated with some adverse health effects commonly eye problems, musculoskeletal pains and other unhealthy behaviours. Medical students are at increased risk for problematic internet use, and to a lesser extent internet addiction. Students with higher IAT score were more prone have negative effects on their academic grades.

Recommendations (a) development of awareness about internet addiction disorder among the students and provision of an intervention of cognitive behavior therapy of those found with Internet addiction disorder; (b) college students need to make a better balanced relationship between internet and social media use versus their academic study and social life.

ACKNOWLEDGEMENTS

Authors would like to thanks to the all the students participants of the study, without them this study wouldn’t be completed.

Funding: No funding sources

Conflict of interest: None declared

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

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