Assessment of Nomophobia and Development of an Educational Booklet Among Nursing Students

Abstract
Background: Nomophobia, defined as the fear or anxiety of being without access to a mobile phone, has emerged as a significant behavioral concern among college students, particularly those enrolled in professional courses such as nursing. Excessive smartphone dependence can adversely affect academic performance, mental health, sleep patterns and social functioning.

Objective: The present study aimed to assess the level of nomophobia among nursing college students and to develop an informational booklet for the prevention and management of nomophobia.

Methods: A quantitative, descriptive research design was adopted for the study. A total of 130 nursing students aged 18-25 years were selected using a probability stratified sampling technique from a nursing college in Jammu. Data were collected using a standardized Nomophobia Questionnaire (NMP-Q). Descriptive and inferential statistics were employed to analyze the data.

Results: The findings revealed a high prevalence of nomophobia among the participants. The majority of students (57.69%) exhibited a moderate level of nomophobia, while 22.31% demonstrated severe nomophobia. Mild nomophobia was observed in 19.23% of students and only 0.77% reported no nomophobia. Significant associations were found between nomophobia levels and selected variables such as educational level, duration of mobile phone use and primary reasons for mobile phone usage.

Keywords: Nomophobia, Nursing students, Smartphone use, Descriptive study, Informational booklet

1. Introduction

The rapid global diffusion of smartphones has produced new patterns of social interaction and behaviour and with them, new forms of psychological stress. One such emerging phenomenon is nomophobia, defined broadly as the fear or anxiety experienced when an individual is without access to a mobile phone or mobile phone connectivity. Nomophobia captures worries about losing contact, running out of battery, lack of signal or being unable to access information and social connections via a smartphone¹. In today’s world, cell phone technology has introduced a new sense of speed and connectivity into social life, making data and communication technologies indispensable². While their integration has improved efficiency and simplified daily activities, offering numerous benefits to humankind, it has also led to emerging challenges. Among these are issues related to excessive use and addiction, contributing to the growing prevalence of mental health problems such as nomophobia¹. The younger generation, particularly individuals under 25 years of age, represents the largest group of mobile phone users. Students in professional institutions, including medical colleges, use mobile phones extensively, making them especially vulnerable to the negative consequences of excessive mobile phone use³. Although not currently a formal psychiatric diagnosis, nomophobia has been widely studied as a contributor to anxiety, sleep disturbance, reduced attention and poorer academic functioning among adolescents and young adults’ populations with especially high smartphone dependence. Several narrative reviews and empirical studies report that problematic smartphone attachment is associated with increased perceived stress, distraction during learning and disrupted sleep hygiene, all of which are relevant to students in health professions⁴. Nomophobia is characterized by the distress and fear individuals experience when they are unable to communicate, access information or remain connected through their mobile devices, reflecting a generation increasingly dependent on a single technological tool⁵.

Measurement of nomophobia in research most commonly uses the Nomophobia Questionnaire (NMP-Q), a psychometrically evaluated self-report scale that identifies multiple dimensions of phone-related anxiety (e.g., not being able to communicate, losing connectedness, inability to access information and giving up convenience). The NMP-Q has been translated and validated in multiple languages and cultural contexts, making it suitable for cross-sectional descriptive studies among student populations⁶. Nursing students are a particularly important group to investigate. As future healthcare providers they must sustain attention, manage stress and adhere to clinical responsibilities where uninterrupted focus is essential; yet studies focused specifically on nursing cohorts show notable prevalence of nomophobia and links to academic difficulties and poorer sleep. Understanding the level of nomophobia in nursing colleges therefore has both educational and patient-safety implications and can inform the design of targeted informational and self- management interventions⁷.

A systematic review of the literature published in 2021 revealed a wide global variation in the prevalence and severity of nomophobia across population-based surveys. Depending on the level of severity, the proportion of individuals identified as being at risk of nomophobia ranged from 13% to 79%, indicating substantial heterogeneity across studies and populations⁸. The same review highlighted considerable disparities between countries. Furthermore, studies focusing on university students worldwide have reported prevalence rates ranging from as low as 6% to as high as 73%, underscoring the global inconsistency in nomophobia prevalence. These findings were further supported by a comprehensive review published in January 2023, which emphasized significant cross-cultural differences in nomophobia among young adults and university students⁹.

Nursing students are among the most frequent users of internet-based social media platforms, often engaging with them in ways that may negatively affect multiple aspects of their lives. Social media addiction is characterized by a compulsive urge to repeatedly check and use social networking sites, excessive cognitive and emotional investment in online interactions and an imbalanced allocation of time and energy toward social media. Such problematic usage patterns can disrupt essential life domains, including interpersonal relationships, academic performance, clinical responsibilities and overall psychological well-being¹⁰. Furthermore, nursing students primarily rely on smartphones for online activities such as internet browsing, video streaming and social media engagement, with their usage largely driven by the desire to remain continuously informed and socially connected across multiple platforms¹¹.

Nursing students must develop healthy technology-use habits and effective coping strategies to mitigate the negative consequences associated with nomophobia, particularly in light of the growing reliance on smartphones within healthcare settings. Smartphones are increasingly used for clinical communication, electronic documentation, medication reference and rapid access to medical information, making them an essential yet potentially problematic tool in nursing education and practice¹². Excessive or uncontrolled smartphone use, however, has been linked to heightened stress, anxiety, reduced attention and impaired well- being among nursing students¹³. Incorporating digital literacy education and mindfulness-based training into nursing curricula may support students in achieving a healthier balance between professional technology use and personal well-being. Such educational interventions can enhance self-regulation, promote responsible smartphone use and reduce the risk of nomophobia and technology-related stress¹⁴. The mobile technology industry has undergone rapid growth and continuous innovation since the introduction of the first smartphone in 2007, with significant technological advancements reshaping the sector and profoundly transforming the ways individuals communicate, access information and utilize mobile technologies in everyday life¹⁵.

Nursing students, who require high levels of concentration, clinical competence and emotional stability, may be adversely affected by uncontrolled mobile phone use. Assessing the level of nomophobia among nursing college students is therefore essential to understand the magnitude of this problem. The findings of the present study will help identify the extent of nomophobia and provide a basis for developing an informational booklet aimed at creating awareness, promoting healthy mobile phone usage and supporting students in maintaining a balanced academic and personal life.

2. Methodology of the Study
The present study adopted a quantitative research approach with a descriptive, non-experimental research design to assess the level of nomophobia among nursing students. The study was conducted at Stephens College of Nursing Jammu. The population comprised nursing students, with the target population including students aged 18 to 25 years studying at the selected college. The accessible population consisted of nursing students within the same age group who were available during the period of data collection. A probability stratified sampling technique was used to select the participants. The sample included 130 nursing students aged 18 to 25 years. Students who were present during data collection, willing to participate and owned mobile phones were included in the study, while those who were absent or unwilling to participate were excluded. The systematic representation of the research methodology used in the study are shown in (Figure 1).


Figure 1: Systematic Representation of Research Methodology.

2.1. Selection and development of the tool
A data collection tool refers to the instrument used to gather information relevant to the research objectives. In the present study, a standardized questionnaire was employed to measure nomophobia among participants. The Nomophobia Questionnaire (NMP-Q) is a standardized instrument consisting of 20 items. Each item is rated on a 7-point Likert scale, ranging from 1 (strongly disagree) to 7 (strongly agree). The total score on the NMP-Q ranges from a minimum of 20 to a maximum of 140, with higher scores indicating greater levels of nomophobia.

The NMP-Q score is interpreted to indicate the level of nomophobia, ranging from absence to severe, with higher scores reflecting greater severity. Scores of 20 indicate no nomophobia, scores between 21 and 59 indicate mild nomophobia, scores between 60 and 99 indicate moderate nomophobia and scores between 100 and 140 indicate severe nomophobia. The validity of the tool was confirmed through expert opinions regarding its relevance. The tool was reviewed by experts in the nursing field and modifications were made to the sociodemographic variables based on their valuable suggestions.

2.2. Data analysis and interpretation
The overall analysis reveals that the respondents are predominantly young undergraduate students, with females forming a substantially larger proportion of the sample. Most participants fall within the 20–21 years age group and are primarily enrolled in B.Sc. programs. The sample demonstrates an almost equal representation of students from rural and urban areas. The majority of respondents own a single mobile phone and belong to middle- to higher-income families. Parental occupation data indicate that most parents are employed, particularly in the government sector. Overall, the study population reflects a relatively stable socio-economic background with sufficient access to educational and technological resources.

(Table 1) presents the socio-demographic profile of the respondents based on variables such as age, gender, educational level, residential area, number of mobile phones owned, economic status and parental occupation. The analysis and interpretation are detailed below.

The largest proportion of respondents (48.46%) belongs to the 20-21 years age group, indicating that the majority are in early adulthood. This is followed by respondents aged 22-23 years (26.92%) and 18–19 years (23.85%). Only a negligible percentage (0.77%) falls within the 24 years and above category, suggesting that the sample is largely concentrated within a narrow youth age range.

Gender distribution shows a clear dominance of female respondents (76.15%) compared to males (23.85%), indicating higher female participation in the study. With regard to educational level, most respondents are enrolled in B.Sc. third year (40.77%), followed by B.Sc. first semester students (35.38%). B.Sc. fourth semester students account for 17.69%, while B.Sc. second semester students represent the smallest group (6.15%). This pattern reflects greater participation from students in the advanced stages of their undergraduate studies.

The residential background of respondents is almost evenly split, with 50.77% from rural areas and 49.23% from urban areas, ensuring balanced representation. In terms of mobile phone ownership, a large majority (82.31%) reported owning one mobile phone, while 12.31% own two phones and only 5.38% possess more than two devices. This suggests moderate and adequate access to mobile technology among the respondents.

Regarding economic status, most respondents (43.31%) belong to families with a monthly income exceeding ◻30,000. Equal proportions (28.35% each) fall within the ◻10,000- 20,000- and ◻20,000-30,000-income categories, indicating that a significant portion of the sample comes from middle- to higher-income households.

Parental occupation data reveal that more than half of the respondents’ parents are government employees (51.97%), followed by private sector employees (26.77%). About 21.26% reported parental unemployment. This highlights the predominance of stable government employment among parents.

In summary, the respondents are largely young female undergraduate students from B.Sc. programs, with balanced rural and urban representation. Most belong to middle- to upper- income families, own a single mobile phone and have parents primarily employed in the government sector. This socio- demographic profile provides a clear and relevant context for interpreting the findings of the study.

2.3. Statement on frequency distribution of demographic variables
The frequency distribution of demographic variables provides a comprehensive overview of the characteristics of the respondents included in the study (Figure 2). The gender-wise distribution indicates that a large majority of the respondents are female (76.15%), while males constitute 23.85% of the total sample. This shows a higher participation of female students in the study. Age-wise classification reveals that most respondents belong to the 20-21 years age group (48.46%), followed by 22-23 years (26.92%) and 18-19 years (23.85%). Only a very small proportion of respondents are aged 24 years and above (0.77%), indicating that the sample largely consists of young adults.

Table 1: Frequency and percentage distribution of study subjects according to demographic variables.

Regarding residential area, the distribution is almost balanced, with slightly more respondents from rural areas (50.77%) compared to urban areas (49.23%). This suggests adequate representation of both rural and urban backgrounds. In terms of educational level, the majority of respondents are pursuing undergraduate studies. A significant proportion are in B.Sc. 3rd year (40.77%), followed by B.Sc. 1st semester (35.38%). Smaller percentages are observed in B.Sc. 4th semester (17.69%) and B.Sc. 2nd semester (6.15%). This indicates that most respondents are in the middle stages of their academic programs.

Parental occupation data shows that government employment is the most common category (51.97%), followed by private employment (26.77%), while 21.26% of parents are unemployed. This reflects a relatively stable occupational background for a large portion of the respondents. The economic status of families further supports this finding, as the highest proportion of respondents belong to the income group of more than 30,000 (43.31%). The remaining respondents are equally distributed between the income groups of 20,000-30,000 and 10,000-20,000 (28.35% each).

With respect to mobile phone ownership, the majority of respondents own one mobile phone (82.31%), indicating widespread access to communication technology. A smaller proportion own two phones (12.31%), while only 5.38% own more than two devices. Overall, the demographic profile suggests that the respondents are predominantly young, female undergraduate students with moderate to stable socioeconomic backgrounds and good access to digital resources.


Figure 2: Bar diagram showing frequency percentage distribution according to the demographic variables of study subject.

2.4. Nomophobia levels among participants
The present findings reveal a notable prevalence of nomophobia among the study participants, with varying levels of severity observed. As shown in the (Table 2), the majority of respondents fell within the moderate nomophobia category, accounting for 57.69% of the total sample. This indicates that more than half of the participants experience a considerable level of discomfort or anxiety when separated from their mobile phones, suggesting a strong dependence on mobile technology in daily life.

In addition, 22.31% of the participants were classified as having severe nomophobia, reflecting a high level of psychological distress related to the inability to access or use their mobile devices. This substantial proportion highlights a potential risk for negative behavioral and emotional consequences, including increased stress, reduced concentration and impaired social interactions.

Meanwhile, 19.23% of the respondents exhibited mild nomophobia, indicating occasional or manageable anxiety related to mobile phone unavailability. Only 0.77% of participants were found to be absent of nomophobia, demonstrating that complete independence from mobile phones is extremely rare within the sample.

Overall, the findings underscore the widespread nature of nomophobia, with the majority of participants experiencing moderate to severe levels. These results emphasize the need for increased awareness, preventive strategies and interventions aimed at promoting healthier mobile phone usage behaviors.

Table 2: The Scores of Nomophobia Levels among Study Subjects.