Smartphone addiction among medical students in Bisha, Saudi Arabia.

CONTEXT: Smartphones are quickly becoming the most pervasive technological device on the planet. AIMS: This study aims to assess smartphone addiction and the factors associated with it among medical students. SETTINGS AND
DESIGN: This study was carried out in Bisha, Saudi Arabia, following a cross-sectional study design. METHODS AND MATERIAL: The data collection tool comprised a self-administered questionnaire. The validated Problematic Use of Mobile Phones (PUMP) scale was used. The PUMP score was calculated by summing up the scores for the individual questions such that higher scores indicate higher levels of addiction. STATISTICAL ANALYSIS USED: Pearson's correlation coefficient was applied to observe the linear relationship between the PUMP scale total score and the quantitative study variables.
RESULTS: The mean total PUMP score was 61.55, with a standard deviation of 13.16. The correlation coefficient between daily hours of smartphone usage and total PUMP score was 0.39, with a statistically significant P value (P < 0.0001). The correlation coefficient between smartphone use for games and total PUMP score was 0.19, with a statistically significant P value (P = 0.009). The correlation coefficient between GPA scores and total PUMP scores was -0.21, with a statistically significant P value (P = 0.003).
CONCLUSIONS: There is a high prevalence of smartphone addiction among medical students in Bisha city. There is a significant positive correlation between daily hours of smartphone usage and total PUMP score. Playing games on smartphones is significantly associated with smartphone addiction. There is a significant negative correlation relation between GPA score and total PUMP score. Copyright:

Introduction

Smartphones are rapidly turning into the most inescapable mechanical gadget on earth. The World Health Organization (WHO) defined addiction as the ceaseless utilization of something for alleviation or incitement, which frequently causes longings when it is missing.[1] Unreasonable utilization of cell phones in manners that hinder regular every day activity is considered as smartphone addiction.[2]

According to the WHO, uncontrolled use of electronic devices has reached the magnitude of a public health problem in a growing number of countries.[3] In addition, practice of primary care physicians can be adversely affected by the excessive use of mobile phones.[4]

For students, numerous studies suggest that smartphone addiction might have a negative impact on academic performance.[567] Other studies found students’ sleeping behavior significantly affected by smartphone addiction.[8910] However, some others found no association between smartphone addiction and academic performance.[111213]

This study aims to assess smartphone addiction and the factors associated with it among medical students. The main study objectives are:

Exploring the prevalence of smartphone addiction among medical students.

Identifying factors associated with smartphone addiction among medical students.

Assessing the implications of smartphone addiction on academic scores of medical students.

Subjects and Methods

This study followed a cross-sectional study design. The study was conducted on medical students in Bisha, Saudi Arabia. The data collection tool comprised a self-administered questionnaire, designed by the researcher after reviewing relevant literature.

The questionnaire was split into three sections. The first section included the sociodemographic data of participants, along with data about substances usage and academic grade point average (GPA) score. The second section contained details about smartphone usage like duration and purpose of usage. The third section included the validated Problematic Use of Mobile Phones (PUMP) scale.

The PUMP scale is a 20-item questionnaire that assesses mobile phone use based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth-Edition (DSM-5) criteria for substance use disorder.[14] It demonstrates a single factor structure, with excellent internal consistency. It also displays convergent validity when compared to existing measures of smartphone dependency and self-reported feelings of addiction to the smartphone.[5]

Each PUMP scale question followed a five-point Likert scale quintet. The five ordered response levels ranged from strongly agree to strongly disagree as shown in Table 1.

Table 1

The five ordered response levels and their scores

The statement	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Score	1	2	3	4	5

The PUMP score was calculated by summing up the scores for the individual questions such that higher scores indicated higher levels of addiction, with a minimum of 20 and a maximum of 100.

The GPA variable was used to measure the academic scores of participants.

The target population for this study constituted all male students registered and regularly attending college of medicine in Bisha, Saudi Arabia, for the academic year of 2019–2020. The inclusion criterion for the study was all male medical students from all academic levels agreeing to participate in the study. The questionnaire was disseminated during the week from December 22nd to December 26th, 2019.

Prior to data collection, an ethical and institutional approval was obtained December 19, 2019.

An informed consent was provided to all participants. The first page of the questionnaire comprised full information on the nature of the study objectives. In addition, participation in the study was completely voluntary. All responses were anonymous, collected data were kept fully confidential and were used only for research purposes.

Data entry and statistical analysis were done using the Statistical Package for the Social Sciences (SPSS, version 21). Frequency and percentage were applied for data description in case of categorical data, while mean and standard deviation were applied for description of quantitative variables. Pearson's correlation coefficient was applied to observe the linear relationship between the PUMP scale total score and the quantitative study variables. A P value of <0.05 was considered statistically significant.

The study was self-funded. Some participations were not complete, with frequent missing responses.

Results

Table 2 shows sociodemographic characteristics of participants. A total of 188 participated in this study. All participants were males. Sixty-eight participants (36.2%) aged 19 years old and below. Most participants aged 20–24 years old (61.7%, n = 116) and only four participants (2.1%) aged 25 years and older. Almost all participants were single (97.9%, n = 184), three were married (1.6%), and one was divorced (0.5%). Forty participants were from the first academic year (21.3%), 38 were from the second year (20.2%), 34 participants were from the third year (18.1%), 29 were from the fourth year (15.4%), 30 were from the fifth year (16.0%), and 17 participants were from the sixth year (9.0%).

Table 2

Socio-demographic characteristics of participants

Socio-demographic characteristics of participants	No	%	Correlation with total PUMP score (P)
Age group
> or equal 19	68	36.2	r = -0.07 (P=0.3)
20-24 years	116	61.7
> 25 years	4	2.1
Total	188	100.0
Gender
Males	188	100.0	-
Marital Status
Single	184	97.9	-
Married	3	1.6
Divorced	1	0.5
Academic Year
First	40	21.3	-
Second	38	20.2
Third	34	18.1
Fourth	29	15.4
Fifth	30	16.0
Sixth	17	9.0

Table 3 shows health characteristics of participants. Participants BMI data showed 79 in the healthy range (42.0%), 52 were overweight (27.7%), 42 were obese (22.3%), and 15 were underweight (8.0%). Most participants were not using any substances (80.32%, n = 151), 31 (16.49%) were smoking cigarettes and Shisha, and six were using substances like cannabis, Benzo, and others (3.19%).

Table 3

Health characteristics of participants

Health characteristics of participants	No.	%	Correlation with total PUMP score (P)
BMI
Underweight	15	8.0	r=0.03 (P=0.6)
Healthy	79	42.0
Overweight	52	27.7
Obese	42	22.3
Substances dependence
None	151	80.32	r=0.03 (P=0.6)
Cigarettes	26	13.83
Shisha	5	2.66
Cannabis	1	0.53
Benzo	1	0.53
Others	4	2.13

Table 4 shows participants’ duration of smartphone usage. Almost all participants have been using smartphones for more than 3 years (91.0%, n = 171). Sixty-one participants use their smartphones more than 5 h a day (32.4%). Eighty-two participants use their smartphones for 4–5 h daily (43.6%). Thirty-four participants use their smartphones for 2–3 h daily (18.1%). Eleven participants spend less than 2 h daily on their smartphones (5.9%). The correlation coefficient between daily hours of smartphone usage and total PUMP score was 0.39, with a statistically significant P value (P < 0.0001).

Table 4

Duration of Smartphone usage among participants

Smartphone usage among participants	No.	%	Correlation with total PUMP score (P)
Duration of smartphone usage in years
<1 year	5	2.7	r=-0.009 (P=0.9)
1-3 years	12	6.4
>3 years	171	91.0
Daily hours of Smartphone usage
<2 h	11	5.9	r=0.39 (P<0.0001)
2-3 h	34	18.1
4-5 h	82	43.6
>5 h	61	32.4

Table 5 shows the purpose of smartphone usage according to participants. 123 participants use their smartphones for academic purposes (65.4%). Almost all participants use their smartphone to access social media (91.5%, n = 172). Seventy-four participants play games on their smartphones (39.4%), and 35 utilize it for athletic purposes (18.6%). The correlation coefficient between smartphone use for games and total PUMP score was 0.19, with a statistically significant P value (P = 0.009).

Table 5

Purpose of Smartphone usage

Purpose of Smartphone usage	No.	%	Correlation with total PUMP score (P)
Academic	123	65.4	r=-0.04 (P=0.5)
Social media	172	91.5	r=0.05 (P=0.4)
Games	74	39.4	r=0.19 (P=0.009)
Athletic	35	18.6	r=-0.05 (P=0.9)
Other	27	14.4	r=-0.14 (P=0.8)

Table 6 shows participants’ distribution according to GPA. The mean total PUMP score was 61.55, with a standard deviation of 13.16. The correlation coefficient between GPA scores and total PUMP scores was -0.21, with a statistically significant P value (P = 0.003).

Table 6

Participants’ distribution according to GPA

GPA	No.	%	Correlation with total PUMP score (P)	Mean total PUMP score±SD
<2.7	35	18.6	-0.21 (0.003)	61.55±13.16
>2.7	153	81.4

Discussion

The current study results revealed a mean total PUMP score of 61.55, with a standard deviation of 13.16, most participants’ smartphone usage was at least 4 h and above per day (76%, n = 143), and a positive correlation was found between daily hours of smartphone usage and total PUMP score (r = 0.39), with a statistically significant P value (P < 0.0001).

It seems that high levels of smartphone addiction are not far from medical students and particularly in Bisha there is prevalence of high levels of smartphone addiction.

Medical students are spending considerable amount of time using their smartphone, which in turn increases their chances of developing overdependence. This overdependence can cause negative psychological, social, physical, and educational effects.[15]

These findings are in concordance with findings reported by Alosaimi et al. where the mean total PUMP score was 60.8 with a standard deviation of 14.9.[5] Another study by Iqbal et al. reported a mean total PUMP score of 56.33 and a standard deviation of 15.92.[16] Aljomaa et al. reported similar findings where using smartphone for more than 4 h a day had resulted in differences in participants’ smartphone addiction.[15]

Similar findings were also reported by Boumosleh and Jaalouk where excessive smartphone use was defined by 5 h or more, 49% (n = 331) reported using the smartphone more than 5 h.[17] Another study by Alhazmi et al. reported an overall prevalence of smartphone addiction of 36.5%, and a statistically significant relationship between daily hours of smartphone usage and smartphone addiction.[18]

The present study results showed that 39.4% (n = 74) used the smartphone to play games. In addition, a significant positive correlation between using smartphones for playing games and the total PUMP score was found (r = 0.19).

It seems that playing games on the smartphone is associated with smartphone addiction. Additionally, the WHO has raised public health concerns regarding excessive gaming and released Gaming Disorders (GD) and Hazardous gaming (HG) among its International Classification of Diseases 11th Revision (ICD-11) list.[192021]

These findings concur with Alosaimi et al.'s findings where 42% (n = 997) were reported to use smartphones for playing games.[5] A study by Liu et al. also revealed that smartphone gaming plays an important role in smartphone addiction.[22]

Furthermore, several studies reported that a negative relationship identified between cell phone use and academic performance is moderated by multitasking behavior including playing games.[2324]

In the current study, a negative correlation relationship was found significant between GPA and the total PUMP score (r = -0.21, P = 0.003). This is in concordance with a number of local studies.

Alosaimi et al. report 23.4% (n = 555) found their academic achievement adversely affected since they started using their smartphones.[5] Jamal et al. report similar findings where 13.3% (n = 16) of participants considered the use of smartphones as having a bad effect on their grade point average.[25]

Different findings were reported by Boumosleh and Jaalouk where smartphone addiction levels were found to be not significantly associated with GPA.[17] The same study also found lower GPA significantly associated with older age. However, in the present study no significant correlation was found between age and total PUMP score.

Difference in study setting and population may account for the difference in study results. In addition, several studies suggest that the GPA might not be an accurate representation of academic achievement.[2627] This could be the reason why findings of smartphone addiction and its association with GPA may differ.

Findings of the present study showed that most participants (65.4%, n = 123) used smartphones for academic purposes, however no significant correlation was found between using smartphones for academic purposes and total PUMP score.

These findings are in concordance with findings from a study by Haque et al. where most participants (66%, n = 152) used their smartphones for academic purposes, but no significant relation was found between hours of use and performance.[28]

In the current study, almost all participants use their smartphone to access social media (91.5%, n = 172).

Similar findings were reported by Alosaimi et al. where 94.7% (n = 2241) reported using smartphones for social networking.[5] Other findings by Jeong et al. report that social network use is a stronger predictor of smartphone addiction than game usage.[29]

In the current study, no significant correlation was found between using smartphones for accessing social media and total PUMP score. However, a positive correlation was found between daily hours of smartphone usage and the total PUMP score. Students might spend excess amount of time on social media which might contribute to their smartphone addiction.[30]

Therefore, findings of the current study can be concluded in the following conclusion.

Conclusion

There is a high prevalence of smartphone addiction among medical students in Bisha. There is a significant positive correlation between daily hours of smartphone usage and total PUMP score. Playing games on smartphones was found to be significantly associated with smartphone addiction. There is a significant negative correlation relation between GPA score and total PUMP score. Awareness programs for medical students and primary care physicians on the consequences of excessive use of smartphones are highly recommended. Further research in the field of smartphone addiction is needed for a better understanding to the disorder and its prevention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.