Smartphone Addiction among Nursing and Health Students

Fandro Armando Tasijawa*, Devita Madiuw, Vanny Leutualy

Universitas Kristen Indonesia Maluku; Ot Pattimaipau st. Talake, Ambon City, 97115 Moluccas Province, Indonesia

*Corresponding Author’s Email: fandrotasidjawa@gmail.com

ABSTRACT

Background: Smartphones are integral to human life and are in great demand by young people to communicate, use various applications, study, watch, and play games, browse the internet, and listen to music. However, for most people, the cumulative daily time spent on smartphones is quite long. This review aimed to analyze the risks of smartphone addiction among health students. Methods: This study was conducted by searching four electronic databases, ProQuest, CINAHL EBSCO, PubMed, and Science Direct, from 2016 to 2022. The keywords used were “Smartphone Addiction” AND “Medical” OR “Nursing” OR “Psychology” OR "Health." Results: Of the 923 articles screened, 25 met the inclusion criteria. The results showed that 15.6%–81.1% of nursing and health students were addicted to smartphones, having an average use of five hours daily. Conclusion: Nursing and health students have the potential to become addicted to smartphones, with an impact on psychology (e.g., stress, anxiety, depression, and neuroticism), sleep disorders, and general health. Therefore, the need for interventions from various parties, such as students, families, universities, and health workers, through psychoeducation and self-management for nursing and health students is necessary.

Keywords: Health Students; Medical; Nursing; Smartphone Addiction

INTRODUCTION

Global data indicate that smartphone use has rapidly increased. Andrews et al. (2015) reported that approximately two billion people worldwide use smartphones. However, in 2020, Newzoo reported a rapid increase, with 3.6 billion smartphone users, namely in China (953.55 million), India (492.78 million), America (273.76 million), and Indonesia (170.4 million). Thus, the number of smartphone users has continued to increase (Newzoo, 2020).

In the era of Industry Revolution 4.0 and Society 5.0, smartphones have become integral to human life. The improved smartphone features available at competitive prices allow most people to use them. Smartphones increase the ease of communicating, searching for learning references, obtaining quick access to videos, games, and music for entertainment, and working through Zoom meetings, Facebook, and Google Meets (Tasijawa, 2022).

Smartphones have both beneficial and adverse effects on users. Consequently, excessive smartphone use has attracted the attention of researchers in education, sociology, and psychiatry. Several studies have reported smartphone addiction among adolescents. For example, research by Albursan et al. (2019) in the Middle East revealed that adolescents in Jordan showed higher smartphone addiction (59.8%) than those in Sudan, Yemen, and Saudi Arabia. Lopez-Fernandez (2017) reported excessive smartphone use rates of 12.5% in Belgium and 21.5% in Spain. Other studies have shown that smartphone addiction is significantly related to an increase in psychological disorders among students (e.g., fatigue, stress, and emotions), academic performance, relationships with others, and self-regulation (Bolle, 2014; Gökçearslan et al., 2016; Kim et al., 2017; Seo et al., 2016). So, future studies including a broader range of universities in future studies will enhance the understanding of the connection between social media addiction and academic performance in nursing students, with consideration for various variables to better evaluate the relationship and the need for further research to unveil fundamental frameworks between the two factors (Fauzi et al., 2021).

The primary symptom of smartphone use is that separation from smartphones leads to an increase in anxiety, even when given access to the internet. The fundamental reason for using a smartphone is to stay in touch with friends; however, smartphone use is also a symbol of one’s status (i.e., people who use smartphones are considered more affluent and educated) and a valuable tool to reach out for emergencies, entertainment, mobility, and maintaining one’s personal life (Balakrishnan & Raj, 2012; Körmendi et al., 2016). Cassidy (2006) reported that smartphone use among teenagers is considered a positive addiction, not a negative one, because of the social impact of its use; for example, it can improve self-image through an increase in social status, especially with a specific or the latest model (Cassidy, 2006; Körmendi et al., 2016).

Previous studies suggest that adolescents are at risk for smartphone addiction. However, further research is required to understand this phenomenon. The current review could address these gaps. Therefore, this exploration would help determine whether health students are addicted to smartphones.

METHODOLOGY

The method used in this study is a literature review following the PRISMA checklist. The authors searched the EBSCO, Science Direct, PubMed, and ProQuest electronic databases in December 2022 to minimize potential publication bias and then conducted a follow-up search across the three databases between 2016 and 2022.

The keyword combination used in the search was: “Smartphone Addiction” AND “Medical” OR “Nursing” OR “Psychology” OR “Health”. The inclusion criteria for the literature review were studies that: (1) only selected a sample of students in the Faculty of Health Sciences with excessive smartphone use; (2) used any research design but had to be original research rather than systematic reviews, meta-analyses, or any other review type; and (3) were from any country but were written in English.

RESULTS

The search identified 923 articles; however, after checking for duplications, 119 articles were found, leaving 804. The researcher then selected papers that required more full-text; 129 articles were found, resulting in 675 articles. Subsequently, the researchers screened the abstracts of each article, ultimately excluding 650. Finally, 25 papers were reviewed. The selection flow is shown in Figure 1.

Figure 1: Article Selection Process

Table 1: Results of Article Reviews

SAS (Smartphone Addiction Scale), SAS-SV (Short version of the Smartphone Addiction Scale), NMP-Q (Nomophobia questionnaire), TCI (Temperament and Character Inventory), PMPAS (Persian version of the Mobile Phone Addiction Scale), SF-12 (short-form 12 questionnaires), PSQI (Pittsburgh Sleep Quality Index), ESS (Epworth Sleepiness Scale), FS (Flourishing Scale), YDQI (Young Diagnostic Questionnaire for Internet Addiction), CSS (Communication Skills Scale), MPAS (Mobile Phone Addiction Scale), GICC (Global Interpersonal Communication Competence Scale), CASI (Computer Assisted Self-Interviews), SCS (Self-Control Scale), DLSC (Daily Life Stress Scale), GICC (Global Interpersonal Communication Competence Scale), CPOSQ (Cell Phone Overuse Scale Questionnaire), SNAQ (Social network addiction questionnaire), YIAQ (Yang Internet Addiction Questionnaire), GAD-7 (Generalized Anxiety Disorder-7 item Scale), IPASN (Instrument of Professional Attitude for Student Nurse), ASES (Academic Self-efficacy Scale), ABS (Academic Burnout Scale), General Health Questionnaire (GHQ-12), Depression Anxiety Scales (DASS-21), modified USM Personality Inventory (USMaP-i)

DISCUSSION

Previous research has examined excessive smartphone use among nursing and health students. The review findings indicated that studies have been conducted in Spain (Aguilera-Manrique et al., 2018; Gutiérrez-Puertas et al., 2019), Pakistan (Javaid et al., 2019), Saudi Arabia (Alhazmi et al., 2018; Alkhateeb et al., 2020; Venkatesh et al., 2016), Iran (Miri et al., 2019; Mohammadi et al., 2018), Oman (Siddiqi et al., 2017), India (Bartwal & Nath, 2020; Basu et al., 2018; Dhamija et al., 2021; Jahagirdar et al., 2021), Thailand (Boonluksiri, 2018; Tangmunkongvorakul et al., 2019), Turkey (Cerit et al., 2018), China (Chen et al., 2017; Song et al., 2022; Wang et al., 2021; Zhou et al., 2022), the United States (Brubaker & Beverly, 2020), South Korea (Sok et al., 2019), Malaysia (Lei et al., 2020), and Indonesia (Hanafi et al., 2019). The studies’ samples included students of medicine, dentistry, nursing, physiotherapy, and other health sciences. The most widely used instrument to assess smartphone addiction in the review was the Smartphone Addiction Scale (SAS).

Prevalence of Smartphone Users and Addiction among Nursing and Health Students

Mohammadi et al. (2018) reported that smartphone use among most students was regular, with only 15.6% having high or excessive rates of use. Basu et al. (2018) also reported that 93.6% of the Indian medical students in the study were smartphone users, and 39.9% were addicted to smartphones. The rates reported in another study were higher; 75% of students experienced moderate or severe smartphone addiction, with higher smartphone addiction scores among single and younger students (p<.001) (Miri et al., 2019).

Tangmunkongvorakul et al. (2019) found that smartphone addiction among women was 58.7% (Tangmunkongvorakul et al., 2019), differing from a study that showed that men (93) had higher total Smartphone Addiction Scale scores than women (89) (Alhazmi et al., 2018). Similarly, another study reported that the prevalence of smartphone addiction was 30.3% for men and 29.3% for women (Chen et al., 2017), and another indicated that 63.8% of male students were addicted to smartphones compared to 39.3% of female students (Javaid et al., 2019). However, one study found no significant gender differences in smartphone addiction (Basu et al., 2018).

A study conducted in India by Jahagirdar et al. (2021) reported that the prevalence of smartphone addiction among medical students was 81.1%. Findings from the same country indicated that 33.3% of women and 46.1% of men experienced smartphone addiction (Chatterjee & Kar, 2021), with a prevalence of 52% (Dhamija et al., 2021). Lei et al. (2020) also reported that 40.6% of medical students in Malaysia experienced smartphone addiction, with men having higher rates of addiction than women. However, Alkhateeb et al. (2020) found that the prevalence of sex addiction was higher in women than in men (p<.001). These findings are concerning for medical students because of the increased risk of smartphone addiction; thus, health students must be aware of and assess the status of their smartphone addiction and provide corrective interventions. These findings also indicated no gender differences (men vs. women) in experiencing smartphone addiction. A study emphasizes the importance of identifying smartphone usage patterns and addiction risks to prevent associated health problems, motivating educators to promote responsible smartphone practices and mitigate psychological and health issues (Machado, Pai, & Kotian, 2023).

How Long is Duration of Smartphone Use for Nursing and Health Students?

The duration of smartphone use among health students varied. Tangmunkongvorakul et al. (2019) revealed that 366 (45.8%) of 800 students from three disciplines (i.e., health, science and technology, humanities, and social sciences) spent at least five hours daily on their smartphones. Similarly, among the 189 medical students in a study conducted in Oman who reported their smartphone use, 50% used the internet for more than 4 hours daily (Siddiqi et al. 2017). Other findings demonstrated a significant association between the duration of daily cell phone use and smartphone addiction (p<.02) (Alhazmi et al. 2018), with 66 students having scores indicating smartphone addiction, including 24 (55.8%) using their smartphones more than 5 hours daily, 17 (34.7%) using them 4-5 hours daily, and 13 (27.7%) using them. They reported that it could be used for 2–5 hours. Three hours a day, 12 students (28.6%) used it less than 2 hours a day (Alhazmi et al., 2018).

Javaid found that 30% of physiotherapy doctoral program students used smartphones for 6 hours per day (Javaid et al., 2019). Further, 27.7% reported opening their smartphone 21–50 times daily, while 8.6% used their smartphone less than five times a day. After waking up, 50.9% of the students used smartphones within 5 minutes, while only 12.3% used them after more than 60 minutes. The average daily usage time of smartphones was 7.83 hours (SD = 4.03), the highest of all findings in the review (Hanafi et al., 2019).

What do Nursing and Health Students Access Through their Smartphones?

Healthy students’ use of smartphones has two purposes: academic and entertainment. The percentage of students accessing smartphones for academic purposes, such as scientific information and news, was relatively high (80.99%) (Mohammadi et al., 2018). Many educational materials are available online, and students may feel more comfortable using smartphones than laptops or desktop computers (Alhazmi et al., 2018). However, another study in India with 388 medical students revealed that smartphone use for academic purposes was relatively low (46.6%) compared to accessing it for entertainment (Basu et al., 2018). Similarly, during college, 85% of students reported leaving their cell phones “on,” 65% sent messages, 20% even played games, and 7% received or made calls (Siddiqi et al., 2017).

According to Hanafi et al., smartphone use for entertainment is associated with harmful coping mechanisms that reduce depression and anxiety and increase the risk of smartphone addiction (Hanafi et al., 2019). Students access entertainment through smartphones, such as social media (64.8%) and group messaging (66.1%) (Basu et al., 2018). Mohammadi also reported that the level of smartphone addiction for accessing social networks is relatively high, including communication with friends (94.39%), entertainment and fun (71.65%), and sharing movies and photos (48.59%) (Mohammadi et al., 2018). Boonluksiri (2018) revealed that smartphones were primarily used for communication with family and friends (93.1%), listening to music, browsing the internet or social media, and spending time (40.4%). Additionally, they spent time when they were bored (91.4%), alone (86%), and waiting for someone (74.1%). (Boonluksiri, 2018).

Is there an Impact of Excessive Smartphone Use on Nursing and Health Students’?

Excessive smartphone use was significantly associated with psychological problems (e.g., stress, anxiety, and burnout), sleep disturbances, and poor eye health. For example, a study from Thailand among 800 college students revealed that excessive smartphone use had higher rates of psychological problems than those who did not use smartphones excessively (B = 1.60; p<.001) (Tangmunkongvorakul et al., 2019). Psychological issues occur because of the reduction in face-to-face interactions and the tendency to feel that social relationships are less supportive and contribute to happiness (Tangmunkongvorakul et al., 2019).

Lei et al. (2020) examined 574 medical students and found that smartphone addiction could affect psychological health (i.e., stress, anxiety, and depression) and neuroticism. Wang et al. (2021) revealed that managing negative emotions was essential for overcoming smartphone addiction. In addition, excessive smartphone use can contribute to sleep disturbances and an inability to concentrate (Basu et al., 2018; Boonluksiri, 2018).

Another study reported that out of 89 medical students in Thailand, 77.5% had sleep problems, 43.6% slept in class, and 70.8% of all college students reported excessive smartphone use at bedtime (Boonluksiri, 2018). Moreover, the reported sleep quality among the medical students in India in Chatterje and Kar’s (2021) study was relatively low (63.4%), as was their reported poor health (62.1%). Thus, smartphone addiction appears to be detrimental to general health and medical students’ sleep quality.

Siddiqi reported that 70% of college students did not turn off their cell phones at bedtime, 33% kept them under their pillows, and 60% on their bedside tables (Siddiqi et al., 2017). Further, 90% of the students knew that electromagnetic cell phone waves can cause health problems (Siddiqi et al., 2017). Additionally, a significant relationship was observed between mental health issues and smartphone addiction (r =0.35, p<0.001) (Miri et al., 2019).

Other studies have reported an increase in nomophobia owing to smartphone addiction. Nomophobia is a new term used to describe feelings of restlessness, anxiety, and discomfort caused by not using smartphones. For example, Aguilera-Manrique research in Spain with 304 Academy students who were conducting practical work in the clinic revealed a positive correlation between smartphone use and nomophobia (p =0.04) and comfort using smartphones (p =0.027) (Aguilera-Manrique et al., 2018). This study showed that students felt discomfort when unable to use their smartphones and wanted to operate them immediately.

Gutiérrez-Puertas’s study of Spanish and Portuguese nursing students had high nomophobia scores (Gutiérrez-Puertas et al., 2019). However, Portuguese students reported higher anxiety (54.7%) than Spanish students (35.4%) when their smartphone batteries ran out (Gutiérrez- Puertas et al., 2019). Medical students also reported exhibiting distinct nomophobia: 15.5% experienced mild nomophobia, 67.2% had an average level, and 17.3% experienced severe nomophobia (Boonluksiri, 2018). The nomophobia factor’s highest score (4.54) was reported when individuals could not communicate or communicate via a smartphone (Boonluksiri, 2018).

Health students were highly dependent on smartphones during the COVID-19 pandemic, which could be viewed as a dependence on smartphones for online learning, a potential risk factor for smartphone addiction. Research by Song et al. (2022) during the COVID-19 pandemic with a sample of 666 medical students revealed that anxiety was significantly related to excessive smartphone use, and smartphone addiction directly impacted pressure due to sleep disturbances. Thus, there are two sound effects of being anxious regarding smartphone use; however, excessive smartphone use affects sleep disturbances. These findings have implications for health programs emphasizing students’ sleep and mental health.

Zhou et al. (2022) also revealed that during the COVID-19 pandemic, 44.26% of a sample of 1445 nursing students experienced academic burnout, with smartphone addiction being a determining factor. Thus, strategies for improving professional attitudes and academic self- efficacy can prevent and alleviate academic burnout. Another study with 385 osteopathic medical students revealed that smartphone addiction could have a significant impact on emotional exhaustion (2.3%), depersonalization was relatively high (17.4%), and low self- actualization was reported by 80.5% of the medical students (Chatterjee & Kar, 2021). They also reported poor sleep quality and high stress (p<0.001). These findings suggest that health education is essential for assisting with students’ mental health and burnout prevention.

Additionally, the study by Jahagirdar et al. (2021) found smartphone addiction resulted in eye strain (67.9%), blurred vision (31.4%), and tingling in the palms and auditory (30.9%). Problems with eye health are notable because 80% of students in this study reported having to use a cell phone before going to bed. Another study shows the prevalence of smartphone addiction among Chinese nursing postgraduates. The study reveal relationships with loneliness, perceived stress, resilience, and sense of security, and identify influencing factors and predictors of smartphone addiction in this population. (Liu et al., 2023).

CONCLUSION

This review highlights the complexity of the information related to nursing and health students’ smartphone use. The findings of 25 articles showed that the prevalence of smartphone addiction ranged from 15.6% to 81.1%, with no gender differences. The reported duration of smartphone use averaged more than four hours per day for academic and entertainment purposes. Smartphone addiction in students was related to sleep disturbances, concentration problems, and nomophobia. Given the information obtained from this review, smartphone addiction was experienced by health students. Therefore, comprehensive research on the impact of excessive smartphone use among this population of students is recommended. However, long-term use of smartphones for work and academic purposes is not associated with smartphone addiction.

Further, these findings also have implications for Indonesia, a country with one of the highest rates of smartphone use among early childhood and adolescence, given the health impacts that can be experienced as adults. Healthcare professionals in community health centers should consider smartphone use interventions that could be offered during early childhood and adolescence. Thus, the observations from this review can be used to inform training and health education programs aimed at reducing the negative impacts of smartphones.

Conflicts of Interest

The authors declared no conflict of interest.

ACKNOWLEDGMENT

The authors are thankful to the institutional authority for completion of the work.

REFERENCES

Aguilera-Manrique, G., Márquez-Hernández, V. V, Alcaraz-Córdoba, T., Granados-Gámez, G., Gutiérrez-Puertas, V., & Gutiérrez-Puertas, L. (2018). The relationship between nomophobia and the distraction associated with smartphone use among nursing students in their clinical practicum. PloS One, 13(8), e0202953. https://doi.org/10.1371/journal.pone.0202953

Albursan, I. S., Al Qudah, M. F., Dutton, E., Hassan, E. M. A. H., Bakhiet, S. F. A., Alfnan, A. A., Aljomaa, S. S., & Hammad, H. I. (2019). National, Sex and Academic Discipline Difference in Smartphone Addiction: A Study of Students in Jordan, Saudi Arabia, Yemen and Sudan. Community Mental Health Journal, 55(5), 825–830. https://doi.org/10.1007/s10597- 019-00368-x

Alhazmi, A. A., Alzahrani, S. H., Baig, M., & Salawati, E. M. (2018). Prevalence and factors associated with smartphone addiction among medical students at King Abdulaziz University, Jeddah. Pakistan Journal of Medical Sciences, 34(4), 984. https://doi.org/10.12669/pjms.344.15294

Alkhateeb, A., Alboali, R., Alharbi, W., & Saleh, O. (2020). Smartphone addiction and its complications related to health and daily activities among university students in Saudi Arabia: A multicenter study. Journal of Family Medicine and Primary Care, 9(7), 3220. https://doi.org/10.4103/jfmpc.jfmpc122419

Andrews, S., Ellis, D. A., Shaw, H., & Piwek, L. (2015). Beyond self-report: Tools to compare estimated and real-world smartphone use. PloS One, 10(10), e0139004. https://doi.org/10.1371/journal.pone.0139004

Balakrishnan, V., & Raj, R. G. (2012). Exploring the relationship between urbanized Malaysian youth and their mobile phones: A quantitative approach. Telematics and Informatics, 29, 263– 272. https://doi.org/10.1016/j.tele.2011.11.001

Bartwal, J., & Nath, B. (2020). Evaluation of nomophobia among medical students using smartphone in north India. Medical Journal Armed Forces India, 6(4), 451-455. https://doi.org/10.1016/j.mjafi.2019.03.001

Basu, S., Garg, S., Singh, M. M., & Kohli, C. (2018). Addiction-like behavior associated with mobile phone usage among medical students in Delhi. Indian Journal of Psychological Medicine, 40(5), 446. https://doi.org/10.4103/IJPSYM.IJPSYM5918

Bolle, C. L. (2014). Who is a smartphone addict? The impact of personal factors and type of usage on smartphone addiction in a Dutch population. University of Twente. https://purl.utwente.nl/essays/66307 . Accessed on 1st December, 2022

Boonluksiri, P. (2018). Effect of smartphone overuse on sleep problems in medical students. Asia Pacific Scholar, 3 (2), 25–28. https://doi.org/10.29060/TAPS.2018-3-2/OA1039

Brubaker, J. R., & Beverly, E. A. (2020). Burnout, perceived stress, sleep quality, and smartphone use: a survey of osteopathic medical students. Journal of Osteopathic Medicine, 120(1), 6–17. https://doi.org/10.7556/jaoa.2020.004

Cassidy, S. (2006). Using social identity to explore the link between a decline in adolescent smoking and an increase in mobile phone use. Health Education, 106, 238–250. https://doi.org/10.1108/09654280610658578

Cerit, B., Çıtak Bilgin, N., & Ak, B. (2018). Relationship between smartphone addiction of nursing department students and their communication skills. Contemporary Nurse, 54(4–5), 532–542. https://doi.org/10.1080/10376178.2018.1448291

Chatterjee, S., & Kar, S. K. (2021). Smartphone addiction and quality of sleep among Indian medical students. Psychiatry, 84(2), 182–191.

https://doi.org/10.1080/00332747.2021.1907870

Chen, B., Liu, F., Ding, S., Ying, X., Wang, L., & Wen, Y. (2017). Gender differences in factors associated with smartphone addiction: a cross-sectional study among medical college students. BMC Psychiatry, 17(1), 341. https://doi.org/10.1186/s12888-017-1503-z

Dhamija, S., Shailaja, B., Chaudhari, B., Chaudhury, S., & Saldanha, D. (2021). Prevalence of smartphone addiction and its relation with sleep disturbance and low self-esteem among medical college students. Industrial Psychiatry Journal, 30(Suppl 1), S189. https://doi.org/10.4103/0972-6748.328813

Fauzi, R., Saaiddin, N. I., Ibrahim, N. S., & Abdullah, S. S. (2021). Effect of Social Media Addiction on Academic Performance among Nursing Students. The Malaysian Journal of Nursing (MJN), 13(1), 3-9. https://doi.org/10.31674/mjn.2021.v13i01.001

Gökçearslan, Ş., Mumcu, F. K., Haşlaman, T., & Çevik, Y. D. (2016). Modelling smartphone addiction: The role of smartphone usage, self-regulation, general self-efficacy and cyberloafing in university students. Computers in Human Behavior, 63, 639–649 https://doi.org/10.1016/j.chb.2016.05.091

Gutiérrez-Puertas, L., Márquez-Hernández, V. V, São-Romão-Preto, L., Granados-Gámez, G., Gutiérrez-Puertas, V., & Aguilera-Manrique, G. (2019). Comparative study of nomophobia among Spanish and Portuguese nursing students. Nurse Education in Practice, 34, 79–84. https://doi.org/10.1016/j.nepr.2018.11.010

Hanafi, E., Siste, K., Wiguna, T., Kusumadewi, I., & Nasrun, M. W. (2019). Temperament profile and its association with the vulnerability to smartphone addiction of medical students in Indonesia. BioRxiv, 536474. https://doi.org/10.1371/journal.pone.0212244

Jahagirdar, V., Rama, K., Soppari, P., & Kumar, M. V. (2021). Mobile phones: vital addiction or lethal addiction? mobile phone usage patterns and assessment of mobile addiction among undergraduate medical students in Telangana, India. Journal of Addiction, 2021, 1–6. https://doi.org/10.1155/2021/8750650

Javaid, A., Yasir, I., & Ahmed, F. (2019). Prevalence of smart phone use and smart phone addiction among Students of Doctor of Physiotherapy: A cross sectional study. Isra Medical Journal, 11(3), 180–183. https://www.imj.com.pk/wp-content/uploads/2019/07/13.-OA-759- Prevalence-of-smart-phone-use-and-smart-phone-addiction-among.pdf.

Kim, Y., Lee, N., & Lim, Y. (2017). Gender differences in the association of smartphone addiction with food group consumption among Korean adolescents. Public Health, 145, 132– 135. https://doi.org/10.1016/j.puhe.2016.12.026

Körmendi, A., Brutóczki, Z., Végh, B. P., & Székely, R. (2016). Smartphone use can be addictive? A case report. Journal of Behavioral Addictions, 5(3), 548–552. https://doi.org/10.1556/2006.5.2016.033

Lei, L. Y.-C., Ismail, M. A.-A., Mohammad, J. A.-M., & Yusoff, M. S. B. (2020). The relationship of smartphone addiction with psychological distress and neuroticism among university medical students. BMC Psychology, 8, 1–9. https://doi.org/10.1186/s40359-020- 00466-6

Liu, J., Yu, X., Kong, L., & Zhou, X. (2023). Prevalence and factors associated with smartphone addiction among nursing postgraduates during the COVID-19 pandemic: a multilevel study from China’s mainland. BMC Psychiatry, 23(1), 1-11. https://doi.org/10.1186/s12888-023-05369-5

Lopez-Fernandez, O. (2017). Short version of the Smartphone Addiction Scale adapted to Spanish and French: Towards a cross-cultural research in problematic mobile phone use. Addictive Behaviors, 64, 275–280. https://doi.org/10.1016/j.addbeh.2015.11.013

Machado, J., Pai, R. R., & Kotian, R. R. (2023). The pattern of smartphone usage, smartphone addiction, and associated subjective health problems associated with smartphone use among undergraduate nursing students. Journal of Education and Health Promotion, 12. https://doi.org/10.4103/jehp.jehp98122

Miri, M., Tiyuri, A., Bahlgerdi, M., Miri, M., Miri, F., & Salehiniya, H. (2019). Mobile addiction and its relationship with quality of life in medical students. Clinical Epidemiology and Global Health. https://doi.org/10.1016/j.cegh.2019.08.004

Mohammadi, S., Valinejadi, A., Saman, J. A., Karimpour, H., Kaivanfar, M., Safaeipour, M., Mohammadi, A., & Kawyannejad, R. (2018). Assessment of addiction to internet, smartphone and social networks among students of medical sciences: A cross sectional study. Electronic Journal of General Medicine, 15(4). https://doi.org/10.29333/ejgm/85685

Newzoo. (2020). Top Countries by Smartphone Users. https://newzoo.com/insights/rankings/top-countries-by-smartphone-penetration-and-users.

Accessed on 28th December, 2022

Seo, D. G., Park, Y., Kim, M. K., & Park, J. (2016). Mobile phone dependency and its impacts on adolescents’ social and academic behaviors. Computers in Human Behavior, 63, 282–292. https://doi.org/10.1016/j.chb.2016.05.026

Siddiqi, N., Jahan, F., Moin, F., Al-Shehhi, F., & Al-Balushi, F. (2017). Excessive use of Mobile Phones by Medical Students: Should Precautions be Taken? Biomedical and Pharmacology Journal, 10(4), 1631–1638. https://doi.org/10.13005/bpj/1274

Sok, S. R., Seong, M. H., & Ryu, M. H. (2019). Differences of Self-Control, Daily Life Stress, and Communication Skills between Smartphone Addiction Risk Group and General Group in Korean Nursing Students. Psychiatric Quarterly, 90(1), 1–9. https://doi.org/10.1007/s11126- 018-9596-1

Song, Y., Sznajder, K., Cui, C., Yang, Y., Li, Y., & Yang, X. (2022). Anxiety and its relationship with sleep disturbance and problematic smartphone use among Chinese medical

students during COVID-19 home confinement—A structural equation model analysis. Journal of Affective Disorders, 296, 315–321. https://doi.org/10.1016/j.jad.2021.09.095

Tangmunkongvorakul, A., Musumari, P. M., Thongpibul, K., Srithanaviboonchai, K., Techasrivichien, T., Suguimoto, S. P., Ono-Kihara, M., & Kihara, M. (2019). Association of excessive smartphone use with psychological well-being among university students in Chiang Mai, Thailand. PloS One, 14(1), e0210294. https://doi.org/10.1371/journal.pone.0210294

Tasijawa, F. A. (2021). Website Innovation for Nursing Student Learning during the COVID-19 Pandemic. Philippine Journal of Nursing, 91(2), 99–101. https://www.pna-pjn.com/. Accessed on 11th June, 2023

Venkatesh, E., Al Jemal, M. Y., & Al Samani, A. S. (2016). Smart phone usage and addiction among dental students in Saudi Arabia: a cross sectional study. International Journal of Adolescent Medicine and Health, 31(1). https://doi.org/10.1515/ijamh-2016-0133

Wang, W., Mehmood, A., Li, P., Yang, Z., Niu, J., Chu, H., Qiao, Z., Qiu, X., Zhou, J., & Yang, Y. (2021). Perceived stress and smartphone addiction in medical college students: the mediating role of negative emotions and the moderating role of psychological capital. Frontiers in Psychology, 12, 660234. https://doi.org/10.3389/fpsyg.2021.660234

Zhou, Z., Liu, H., Zhang, D., Wei, H., Zhang, M., & Huang, A. (2022). Mediating effects of academic self-efficacy and smartphone addiction on the relationship between professional attitude and academic burnout in nursing students: A cross-sectional study. Nurse Education Today, 116, 105471. https://doi.org/10.1016/j.nedt.2022.105471