Psychometric behavioural correlates of problematic smart phone usage among medical students in Bengaluru

 

Nalini V Mallya^1*, Sunil Kumar D R²

 

{¹Assistant Professor, Department of Physiology} {²Professor and Head, Department of Community Medicine}

Akash Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, INDIA.

Email: nalinimallya@gmail.com

 

Abstract               Background: Smartphones have penetrated the information fabric of India quite rapidly in the 21^st century. Medical students have been so increasingly attracted to smartphones that reports of smartphone addiction have started surfacing as a problem akin to substance abuse. Objectives: To estimate the prevalence of problematic smart phone usage among medical students and to study the psychometric behavioural correlates of problematic smart phone usage using PUMP scale. Materials and Methods: A cross sectional, exploratory study design was used to conduct the study among first year medical students of a private medical college in rural Bengaluru. Data was collected using pretested questionnaire and analysed using SPSS software (version 24).Results: In this study, the total prevalence of problematic smart phone usage was 42.6% (64). Among males, prevalence was higher 46.42% compared to females 40.42%. PUMP scale had a Mean±SD of 57.56 ± 11.6 and the scores ranged from 36 to 87. Majority of the study subjects 60.3% agreed that they spent longer time than intended with the smartphones. Many students 40.3% felt that they spent too much time with smartphone. A significant association between self- addiction and PUMP score (p<0.0001) was observed. A significant association was also seen between relationship status and mean PUMP score (p<0.0001). Conclusion: The present study showed a staggering prevalence rate for problematic usage of smartphones among first year medical students. Although a higher prevalence of problematic smartphone usage was found among males compared to females, the gap was not significantly wide. Majority of the students reported not getting addicted to smartphones while close to half the study population was in problematic smartphone usage category. If unrecognized, problematic smartphone usage could have far reaching implications on medical students and society at large.

Key Words: Behavioural correlates, Medical students, Problematic usage, Psychometric, Smartphone.

 

INTRODUCTION

Smartphone has become a household name in India due to its vast applications in day to day life. The user friendly features and applications or apps have made smartphones the most popular gadgets in the electronic goods consumer market^1,2,3,4. Globally, younger generation in the age group of 25-34 comprises about 62% of smartphone users^5,6 The adolescent age group in India is the main driving force for the excess production of smartphones in Indian market. There has been an increase in smartphone usage in the adolescent age group from 5% to 25% between 2012 and 2014^5,6. The rate of smartphone usage is over 90% in urban India^5,6 Thus an upward trend in smartphone usage at a rapid rate has been the hallmark of 21^st century. Smartphone allows the users to communicate and multitask anywhere and anytime. With this, smartphones have become constant companions of their users. Public domain such as print and digital media are filled with articles and reports on cell phone addiction. The term addiction is often overused in the society. Smartphone users have shown a tendency towards addiction as per studies conducted by Kim and Flanagan^7,8.There is accumulating evidence from various research settings all over the world about problematic usage of smartphones and its psychophysiological implications^8,9. Literature survey supplies ample scientific evidence regarding the disengaging effects of excessive smartphone usage in a medical school campus¹⁰.The psychometrics of addiction and its correlates still appear to be controversial among clinicians and researchers. The present study was undertaken to explore the psychometric behavioural correlates of problematic smartphone usage.

 

MATERIALS AND METHODS

A cross sectional, exploratory study was conducted among the first year medical students of a private medical college in Bengaluru. Since the college has an annual intake capacity of 150 students, sample size for the study was 150. All the students in a batch of 150 were willing to be a part of the study and informed consent was taken. Ethical clearance was obtained from institutional ethical committee for the study.

Study Period: December 2017- April 2018

Study Tools: A pretested questionnaire was used and it consisted of two segments. First segment included the demographic details such as age, sex, area of residence and relationship status. Data regarding age of smartphone and self-reported smartphone addiction based on an operational definition (>5hrs of smartphone usage per day) were collected. All these parameters were grouped into study factors so as to evaluate the association between these factors and problematic smartphone usage. The second segment consisted of PUMP ¹¹(problematic use of mobile phones) questionnaire which was used to assess psychometric correlates of smart phone usage such as impulsive use, mounting tension, dependence, loss of control and denial. The scale is based on DSM–IV criteria¹² for substance use disorders and review of available modalities assessing consequences of overuse of internet. It has an excellent internal consistency (Cronbach’s alpha= 0.94). The questionnaire consisted of 20 items and were answered on a 5 point Likert scale ranging from strongly disagree to strongly agree. The scores ranged from 20 to 100. Higher scores indicated problematic use of mobile phones. In the present study, scores greater than mean were categorized as problematic usage.

Data collection and analysis: Data was entered in MS Excel, analysed using SPSS version 24.Descriptive statistics (percentage, mean, standard deviation, range) were used to summarize baseline characteristics of the study subjects. Socio-demographic variables were denoted by frequency tables. The prevalence of problematic smart phone usage was described in terms of percentage. An association between two categorical variables was analysed by using Chi-square test and Fisher`s exact test and p<0.05 was considered as statistically significant.

 

RESULTS

150 students from I MBBS constituted the study population. Among the study population, majority were females 62.6% (94) and males were 37.3% (56). The age group was 18-20 yrs in 98% (147) and only 2% (3) were above 20 yrs of age. Most of the students were from rural area 60.6% (91) and about 39.3% (59) were from urban area. A large number of students were not in a committed relationship 84.6% (127) and only 15.3% (23) were committed(Table 1).In this study, PUMP scale had a mean score of 57.56 with a standard deviation of 11.6 and the scores ranged from 36 to 87. Scores above 57.56 were categorized as problematic usage. The total prevalence of problematic smart phone usage in our study was 42.6% (64). Among males, the prevalence was higher 46.42% (26) compared to females 40.42% (38) (Table 2). In the study, the possibility of an association between study factors such as age, sex, area of residence, relationship status, age of smartphone, the awareness of one’s addiction and the mean PUMP score was evaluated. Majority of the students were using newer smart phones78.7% (118).Most of the students were not committed into a long term relationship 84.7% (127). Self-addiction to smartphones was reported by a minority of students 28% (42). It has been found that there was a significant association between self- addiction and PUMP score (p<0.0001). A significant association was also seen between relationship status and mean PUMP score

(p<0.0001).Rest of the factors were not statistically significant (Table 3).The study also explored the psychometric behavioural correlates of PUMP scale such as 1)tolerance, 2)withdrawal, 3) longer time than intended,4)great deal of time spent,5) craving,6)activities given up or reduced,7) use despite physical or psychological problems,8) failure to fulfil role obligations,9) use in physically hazardous situations,10) used espite social or interpersonal problem. It was observed that 17% felt less satisfied when they cut down the time spent with the smartphone (tolerance). 38.3% agreed that they had emotional swings when they stopped using phone(withdrawal). Majority of the study subjects 60.3% agreed that they spent longer time than intended with the phone which kept them away from doing other important things. Lot of students 40.3% felt that they themselves and people around them pointed out that they spent too much time with the smartphone. Some 31.6% had a craving for phone when they were not using it. About 43.6% agreed that they would ignore interacting with people or postpone academic work due to smartphones. Failure to catch up with sleep was reported by 48.3% of the study population. Failure to fulfil their role obligations was reported by 29% of the students. A small number of students 22% reported having got into trouble such as accidents while using smartphones. Relationship issues with family and friends have been reported by 30% of the students (Table 4).Among the correlates since usage of smart phone for longer time than intended was more than others, it was analysed based on gender for association with agree, neutral and disagree components. Among males, ‘agree’ was less 51.8%(29) in comparison to females 74.5%(70) and among the ‘disagree’, males were more 28.6%(16) compared to females 10.6%(10).This association was significant statistically(p value-0.008)(Table-5).

Table 1: Sociodemographic Variables of Study Population

 

Table 2: Prevalence of Problematic Smartphone Usage based on PUMP Score (Mean=57.56)

 

Table3: Association between study factors and mean PUMP score (mean=57.56)

Study factors	Response	Frequency	%	χ2
Age (in yrs)	<=20	147	98	p=0.721
	>20	3	2
Sex	Male	56	37.3	p=0.412
	Female	94	62.7
Residence	Urban	115	76.7	p=0.450
	Rural	35	23.3
Age of smartphone (in years)	<1	118	78.7	p=0.518
	> 1	22	14.7
Self-addiction	Yes	42	28	p<0.0001**
	No	108	72
Relationship status	Committed	23	15.3	p<0.0001**
	Non committed	127	84.7

*Chi-square test to test association between study factors and mean PUMP score, **statistically significant

Table 4: Psychometric behavioural correlates of PUMP scale in study population

 

Table 5: Association between problematic smartphone usage and 'longer time spent than intended’ based on gender.

*Statistically significant

DISCUSSION

In the present study, all the participants were using smartphones and all were first year medical students. This ensured uniformity of the cohort. The prevalence of problematic usage of smartphones was 42.6%. Considering that the students were first year medical students having voluminous subjects like anatomy, physiology and biochemistry to study in the given duration of 9 to 10 months, the observed prevalence rate has been found to be alarming. Prevalence rate was higher among males compared to females. Earlier studies with a different cohort have revealed that an average person in the age group of 20-45 yrs checks his phone every 6.30 min in a 16 hr waking cycle ¹³.Study by ChathothMavila et al among medical (MBBS) students in Mangalore revealed prevalence of internet addiction in 18.8% of students¹⁴.In our study, smartphone usage had no association with age, rural or urban belonging of the students.Although PUMP score has not been considered the gold standard to diagnose people with smartphone addiction, it helps in screening the study population for internet addiction based on DSM IV criteria¹².It is also useful in evaluating the psychometric correlates such as tolerance, withdrawal etc. The simple questionnaire format of PUMP scale¹¹ found a high response rate in our study. Since there was no cut off for addiction and as only higher scores were classified as problematic users in the original study on PUMP scale, the present study employed the mean PUMP score as cut off above which subjects were categorized as problematic users. The analysis of psychometric properties revealed that overall, the students agreed to have spent more time surfing the smartphone than intended. Sleep deprivation, decreasing interaction with people around and spending less time or giving up activities that they used to do before have also been reported by a majority of study population. This finding has been consistent with a study by Aggarwal et al which said excessive use of smartphones negatively impacted work performance and had negative health consequences among Indian resident doctors ^(15). The overbearing influence of smartphones with all the latest advancement in “app” technology adding to the fact that smartphones are made affordable, internet tariffs have been brought down have made smartphones, highly popular and must have gadgets with the student community. The above psychometric correlates which were earlier found in substance abusers are now reflected in smart phone userstoo¹⁶.The study of 200 adolescents in Korea also showed that abnormal usage of smartphone had significant problematic behaviours, somatic symptoms, attention deficits, aggression andthe youth that were more addicted to smartphone had more severe psychopathologies¹⁷.However some studies have revealed positive correlations between internet and academic outcome such as acquiring skills and enhancement of self-esteem^18,19.In the present study, there was a significant association between one‘s awareness of addiction and problematic smartphone usage. Since medical students get sensitized and exposed to clinical material pertaining to substance use disorders right from the early days of joining medical school, there seemed to be an increasing awareness towards a similar clinical entity called problematic mobile phone usage. There was also a significant association between relationship status and problematic smartphone usage. Increase in social networking “apps” and the ease of establishingvirtual connection whenever required seemed to have kept the students hooked to smartphones whether they form or break relationships.

 

CONCLUSION

The present study reiterates the fact that smartphone usage and application are here to stay despite their shortcomings. This fact is amply supported by the staggering prevalence rate for problematic usage of smartphones among first year medical students. Although males have a higher prevalence in this study compared to females, the gap is not significantly wide and in future it could only narrow down from what it is at present. Prolonged time spent with smartphones at the cost of sleep and fulfilling one’s role obligations was the most important observation among psychometric correlates in the study. Majority of the students had the impression that they were not addicted to smartphones while, close to half the study population was in problematic smartphone usage category. The cognizance of this burgeoning problem is yet to register in the minds of medical students. This problem if left unrecognized could have far reaching implications on medical students and society at large.

 

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