|Year : 2020 | Volume
| Issue : 3 | Page : 1094-1100
Nomophobia among medical residents
Hala M Shaheen1, Salwa A Alkorma2, Safa H Alkalash1
1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Menoufia Governorate, Ministry of Health, Menoufia, Egypt
|Date of Submission||18-Jan-2020|
|Date of Decision||23-Feb-2020|
|Date of Acceptance||27-Feb-2020|
|Date of Web Publication||30-Sep-2020|
Safa H Alkalash
Shebin El-Kom, Menoufia
Source of Support: None, Conflict of Interest: None
To assess the prevalence and severity of nomophobia among medical residents in Menoufia University Hospitals and to assess its relation with anxiety, doctor–patient relationship, and residents' specialty/subspecialty.
Nomophobia is an abbreviation for 'no-mobile-phone phobia,' which describes anxiety experienced by mobile phone users in its absence; it is the fear of becoming technologically incommunicable. This fear is characterized by physical, psychological, and cognitive symptoms in the context of stress or danger.
Patients and methods
A descriptive cross-sectional study was conducted on 221 medical residents in Menoufia University Hospitals in the frame of 13 months. They were assessed through predesigned questionnaires to determine the prevalence and severity of nomophobia and anxiety. Doctor–patient relationship was observed through Kalamazoo checklist.
Prevalence of both nomophobia and anxiety was 100% among the studied group. More than half of the participants had moderate nomophobia and ~ 73% of the participants had mild anxiety. There was a positive moderate correlation between anxiety and nomophobia (r = 0.51), as increasing the severity of anxiety was associated with increasing in severity of nomophobia. Relation between nomophobia and anxiety was significant positive regarding doctor–patient relationship (P < 0.001), whereas a strong negative correlation regarding good doctor–patient relationship (r=−0.37) was detected. There was a highly statistically significant relationship between nomophobia severity and the residents' specialty, as 40% severely nomophobic residents were surgeons and 58.3% of them were gynecologists and obstetricians.
Prevalence of nomophobia was 100% among medical residents in Menoufia University Hospitals. Approximately half of the studied residents who had a poor doctor–patient relationships had severe nomophobia. Specialty of medical residents had effect on nomophobia severity.
Keywords: anxiety, doctor–patient relationship, medical, nomophobia, residents, specialty
|How to cite this article:|
Shaheen HM, Alkorma SA, Alkalash SH. Nomophobia among medical residents. Menoufia Med J 2020;33:1094-100
| Introduction|| |
Nomophobia is a neologism derived from the combination of 'no mobile,' 'phone,' and 'phobia' . It is considered a modern age phobia introduced to human lives as a byproduct of the interaction between people, mobile information, and communication technologies, especially smart phones . Nomophobia is a form of behavioral addiction toward mobile phones and manifested as symptoms of psychological as well as physical dependency . The characteristics of nomophobia vary and could include regular use of mobile phone, anxiety or nervousness in case of inability to access mobile phone or mobile network, repeated checking of the mobile screen notifications, sleeping with mobile device by bed, and preference for mobile interaction opposed to face-to-face confrontation . The complexity of this condition is very challenging to the patients' family members as well as for the physicians, as nomophobia shares common clinical symptoms with other disorders, and some mental disorders can precipitate nomophobia and vice versa. That is why nomophobia should be distinguished from other causes of anxiety . Prevalence of nomophobia among medical students in Indian studies was 99.8  and 71.39% . No previous studies were conducted in Egypt regarding this issue among medical residents, so the aim of this study was to assess the prevalence and severity of nomophobia among medical residents in Menoufia University Hospitals and to assess its relation to anxiety and doctor–patient relationship.
| Patients and Methods|| |
This study was a descriptive cross-sectional study; it was conducted on the first of October 2018 till the end of November 2019. Sample size was calculated by using EPI-INFO 7 (Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (USA). based on prevalence of nomophobia among medical doctors from previous literature (99.8%) . It was performed on all registered medical residents during the period of the study, which was 221 medical residents [114 (51.6%) male and 107 (48.4%) female residents]. After illustration of the study objectives, they were encouraged to give informed consent to participate. They were asked about the history of psychiatric diseases, alcohol, drug addiction, and history of psychotherapy, and no one was excluded from the study.
Data were collected by interviewing the residents. They were asked about their personal demographic data (marital status, resident's specialty, and subspecialty). For assessment of anxiety and nomophobia, they were assessed by two questionnaires and one checklist. Both questionnaires were fulfilled at the same session taking about 10 min.
- Nomophobia questionnaire: it was used for diagnosis and assessment of severity of nomophobia, validated by Yildirim and Correia . The questionnaire involved 20 items in a seven-point Likert scale, ranging from total disagreement (scored as 1) to total agreement (scored as 7). Total score is ranging from 20 to 140, with higher score corresponding to greater nomophobia severity, as the mild level achieve score greater than 20 and less than 60, moderate level when score is greater than or equal to 60 and less than 100 and the severe level achieves score greater than or equal to 100, whereas score 20 indicated absence of nomophobia
- Anxiety scale: the seven-item Generalized Anxiety Disorder Scale-7, the validated version by Spitzer et al. , was used, which is a self-report scale for screening, diagnosis, and severity assessment of anxiety disorder in the past 2 weeks.
For assessment of the doctor–patient relationship, they were observed during their clinical practice in outpatient clinic using Kalamazoo Essential Elements Communication (KCS) checklist. The KCS-Adapted instrument was minimally modified at Harvard Medical School by Rider using global ratings on a Likert scale for the KCS competencies. Response was observed as follows: poor, fair, good, very good, and excellent .
After obtaining informed consent from patients, this checklist was fulfilled by the researcher in clinic through observing the doctor–patient relationship from onset of patient entry till leaving clinic. It was done four times in four separate occasions, with 1 week a part between each visit and recording it. It took less than 20 min in each time.
A pilot study was performed on 20 residents (not included in the final results of the study) from the total residents (241) to evaluate the adequacy and the relevance of the validated study tools, and it resulted in modifications applied on some items of the doctor–patient relationship checklist to be easily applicable to the participants. Data of those 20 residents were excluded from the study.
Data were collected, tabulated, and statically analyzed via Statistical Package for the Social Sciences (version 20; SPSS Inc., Chicago, Illinois, USA). Descriptive analysis of nomophobia and anxiety severity indices was calculated according to their predefined scoring system. For the doctor–patient relationship, the median of responses was calculated for each observation to give the total index. The significance of the relations was calculated by χ2 test and Spearman correlation coefficient was calculated to measure the direction (positive/negative) and strength (weak–moderate–strong) of the relation between the variables (nomophobia, anxiety, and doctor–patient relationship). P value less than 0.05 was considered significant and P value less than 0.001 was considered highly significant.
Regarding ethical consideration, an approval from the ethical committee of Faculty of Medicine, Menoufia University, was obtained. Administrative approval from the general manager of Menoufia University Hospitals was taken. Participants were informed about the aims and benefits of the study. Written consent was taken from patients to observe the residents' relationship with them in the clinic. Questionnaires used were anonymous, and confidentiality of the data was assured.
| Results|| |
The prevalence of both nomophobia and anxiety was 100% among medical residents in Menoufia University Hospitals. Overall, 54.8% of participants had moderate nomophobia and 27.1% had severe nomophobia, whereas 18.1% had mild nomophobia [Figure 1]. Among the studied residents, 73% had mild anxiety, whereas ~15% had severe anxiety [Figure 2]. It was found that there was a statistically significant relation between nomophobia severity and sex of the participants, as severe nomophobia was more among females (35.5%), whereas mild and moderate nomophobia was higher in males [Table 1]. Nomophobia was significantly higher among residents who frequently checked their mobile phones, had phantom ring sensation, and checked their smart phones during staying in bed for sleeping. For example, among those who check their mobile each 5 min, 53.8% had moderate nomophobia, whereas for those who check their mobile every 20 min, 75% had mild nomophobia [Table 2]. There was a positive moderate correlation between anxiety and nomophobia (r = 0.51), as residents who had severe anxiety had severe nomophobia [Table 3]. A significant relation between nomophobia and doctor–patient relationship was found. There was a negative moderate relation (r=−0.37), as 49% of residents who were in a poor relation with their patients, had severe nomophobia, whereas only 21.4% of residents who were in a good relation with their patients had severe nomophobia [Table 4]. There was a highly statistically significant relationship between nomophobia severity and the residents' specialty, as 40% of residents with surgical specialties had severe nomophobia, whereas only about 4% of residents with medical specialty had severe nomophobia. Moreover, a significant relation between nomophobia severity and residents' subspecialty was found, as 58.3% of residents who were working in gynecology and obstetrics had severe nomophobia, whereas ~10% of residents who were working in internal medicine – psychiatric had severe nomophobia [Table 5].
|Table 2: Relation between different levels of nomophobia and phone habits|
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|Table 4: Relation between nomophobia, anxiety, and doctor-patient relationship|
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| Discussion|| |
This descriptive cross-sectional study represents the prevalence and severity of nomophobia among medical residents in Menoufia University Hospitals and assesses its relation with anxiety, doctor–patient relationship, and residents' specialty/subspecialty. It included all registered medical residents during the study and included 114 (51.6%) male and 107 (48.4%) female residents. All participants had nomophobia in agreement with the result of an Indian study that was conducted by Sethia et al. , which showed that prevalence of nomophobia was 99.8%, as all participants had some degree of nomophobia and only one participant was not suffering from nomophobia. Moreover, this result is in line with a Turkish study that was performed by Ayar et al.  and revealed that prevalence of nomophobia was 97%. An American study done by Cain and Malcom  found 99.5% of the sample reported nomophobia, and in China, a study performed by Ma and Liu  found 82.9% of the sample grouped as nomophobia. In France, a study conducted by Tavolacci et al.  reported ~73% had nomophobia.
However, two Indian studies done by Prasad et al.  and Ramudu et al.  found the prevalence of nomophobia to be 41.8 and 22.3%, respectively, which are contrary to the current study results. The cause of this difference may be owing to different culture and nature of the studied groups.
The higher prevalence of nomophobia in the current study could be owing to all of participants in our study were medical residents, being in hospital full time and away from their family, so they use it to reach their families and friends . Moreover, it might be owing to their full-time work in the hospital and their dependence on smartphone in communication with their colleagues for patient care, making them more dependent on the mobile phone.
One of factors that increase susceptibility to develop nomophobia is the duration of smartphone ownership, as nomophobic behaviors develop with increased duration of smartphone usage . In our study, most participants (99.6%) had a smart phone for 5 years or more.
Dasgupta et al.  reported that younger individuals are at a higher risk of developing addiction-like behavior from their mobile phone usage, and this is totally in agreement with our study results, as mean age of the participants was 25.5 ± 1.3 years.
Regarding the severity of nomophobia in the current study, more than half of the participants had a moderate level of nomophobia, which is in agreement with a Turkish and an Indian studies performed by Deryakulu and Ursavaş  and Sethia et al. , which found 56.8 and 61.5% of the participants had a moderate level of nomophobia, respectively.
In the present study, 27% of the participants had a severe level of nomophobia, which is in agreement with a study in Saudi Arabia performed by Alahmari et al.  which found that 22.2% experienced severe nomophobia, whereas an Indian study conducted by Harish and Bharath  found 13.5% of participants had severe nomophobia.
This current study found that ~18% of participants had a mild level of nomophobia, which is in agreement with an American study performed by Cain and Malcom  which revealed that 24.5% had mild level of nomophobia. In contrary to the current study, an Indian study performed by Kanmani et al.  reported that 41.6% of participants had a mild level of nomophobia.
In the current study, severe nomophobia was found to be more among female residents (35.5%), and this is in agreement with Cain and Malcom , who concluded that nomophobia is more among female participants who are emotional and also have so many feminine applications.
According to the present study, anxiety prevalence was 100%, which is in agreement with an Egyptian study performed in Ain Shams University's Faculty of Medicine by Al-Sayed et al. , which indicated that 100% of the medical residents had anxiety. Moreover, in the USA, a study performed by Lever et al.  revealed that prevalence of anxiety was 92% among the sample population. Another studies performed in Saudi Arabia and Bahrain reported by Al Bahhawi et al.  and Mahroon et al.  found that 65.7 and 51% among the participants had anxiety, respectively.
It was different to the results of a study done in Tunisia by Marzouk et al.  which concluded that 43.6% of study group sample met the definite criteria for anxiety. From our point of view, this great difference between results of the current study and others may be related to differences in sample size and medical specialty of the participants.
Anxiety severity was classified in the current study into mild anxiety, which accounts 73% of sample, whereas an American study performed by Verma  reported that 37.9% of the participants experienced mild anxiety.
Severe anxiety in the current study was 15% among participants, which is in agreement with a study done in Alexandria by Ibrahim and Abdelreheem , which found 10.4% of participants had severe anxiety, whereas an Egyptian study performed in Ain Shams University's Faculty of Medicine by Al-Sayed et al.  indicated that 8.5% of the participants had severe symptoms.
In the current study, there was a significant relation between anxiety and specialty, as anxiety level was more in surgical specialties compared with medical specialties, which is contrary to the study presented by Dave et al. , which reported the prevalence of anxiety among resident doctors of an Indian teaching hospital was not statistically significant on comparing the surgical versus the nonsurgical branches.
According to the current study, 36.6% of medical resident participating in the study had anxiety, which is in agreement with a Tunisian study performed by Marzouk et al.  which found that 43.6% of Tunisian medical residents met the definite criteria for anxiety.
A positive moderate correlation between anxiety and nomophobia was stated by the current study, for example, all participants who had severe anxiety had also severe nomophobia, which is parallel to the study conducted by King et al. , which found that there is a relationship between the psychiatric disorders (generalized anxiety disorder 85%) with the abusive use of technologies, whereas in an Indian study performed by Veerapu et al. , there was a weak positive correlation between nomophobia and anxiety.
| Conclusion|| |
This study concluded that all medical residents in Menoufia University Hospitals had nomophobia and anxiety. Approximately half of them had moderate nomophobia whereas one-third of them had severe levels of nomophobia. Nearly all the participants had a smart phone for 5 years or more. Severe nomophobia was more among female residents. Doctor–patient relationship was poor with increased severity of nomophobia and anxiety and vice versa. Approximately half of the studied residents who were in a poor relation with their patients had severe nomophobia. The residents' specialty and subspecialty had an effect on nomophobia severity.
As in the present era smart phone is a necessity, we cannot ignore its use completely. Those who already have some degree of nomophobia should use smart phones more judicially. More studies should be conducted in a wide range to highlight risk factors for nomophobia, and also we recommend conduction of health educational program to limit this condition and its drawbacks.
The authors thank the medical residents and patients who accepted to participate in this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]