“ASSOCIATION OF PHYSICAL AND MENTAL WELLBEING

WITH NOMOPHOBIA AMONG TEENAGERS IN SIALKOT”

In Fulfillment of the Requirement for the Degree

DOCTOR OF PHYSICAL THERAPY (DPT)

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Dr Zainab Naeem

DEPARTMENT OF PHYSICAL THERAPY

ISLAM COLLEGE OF PHYSICAL THERAPY (ICPT)

Session (2016-2021)
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 ACKNOWLEDGEMENTS

Foremost acknowledgment is for Almighty ALLAH, who created the universe and
bestowed the mankind with knowledge and wisdom and for Prophet Muhammad
(PBUH) whose blessings enable us to recognize what we don’t know and to recognize
our abilities to work hard. It is difficult to state our gratitude to the honorable our
Principal Dr. Muhammad Junaid Malik our supervisor Dr. Zainab Naeem and
all respected faculty members of the Department of Physical Therapy who guided
and motivated me to complete this research work. I am extremely thankful to the
participants for their kind and encouraging behavior. Their participation indeed made
this report worthy. I pay thanks to our parents and family members for their
unconditional support throughout our lives and for their sincere prayers. At the end, I
am thankful to each and every person who supported and guided me during this study.

Aqsa Batool

Fatima Tahir

Amina Khalid

Mahur Amin

Aqsa shakeel

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 TABLE OF CONTENTS
Certificate of Originality of Research Work.................................................................................... iii
RESEARCH COMPLETION CERTIFICATE........................................................................................... iv
Declaration..................................................................................................................................... v
ACKNOWLEDGEMENTS................................................................................................................. vii
LIST OF TABLES............................................................................................................................ x
LIST OF FIGURES............................................................................................................................. xi
LIST OF ABBREVIATION.................................................................................................................. xii
ABSTRACT..................................................................................................................................... xiii
Background:................................................................................................................................. xiii
Materials & Methods:................................................................................................................... xiii
Results:........................................................................................................................................ xiii
Conclusion:.................................................................................................................................. xiii
Keywords:.................................................................................................................................... xiii
1. INTRODUCTION........................................................................................................................... 1
1.1: Definition and Other terminologies.................................................................................. 1
1.2: Prevalence:...................................................................................................................... 3
1.3: Disease of 21st century:................................................................................................... 3
1.4: Physical Symptoms of Nomophobia:................................................................................ 4
1.5: Psychiatric symptoms of Nomophobia:............................................................................5
1.6: Use and Misuse of smart phones:.................................................................................... 6
1.7: Advantages and Disadvantages:....................................................................................... 7
1.8: Phantom Vibration Syndrome:......................................................................................... 7
1.9: Over Connection Syndrome:............................................................................................ 7
2. LITERATURE REVIEW................................................................................................................... 9
2.1: Rationale:....................................................................................................................... 12
2.2: Objective:....................................................................................................................... 13
3. MATERIALS AND METHODS...................................................................................................... 14
 Research Design:............................................................................................................ 14
 Study Settings:................................................................................................................ 14
 Study Duration:.............................................................................................................. 14
 Sample Size:................................................................................................................... 14
 Sampling technique:....................................................................................................... 14
 Selection criteria:........................................................................................................... 14
3.1: Data collection procedures:........................................................................................... 15
3.2: Method used for data analysis:...................................................................................... 15
3.3: Data collection tools:..................................................................................................... 15
4. RESULTS.................................................................................................................................... 17
5.DISCUSSION............................................................................................................................... 40
6.CONCLUSION............................................................................................................................. 43
7.LIMITATIONS.............................................................................................................................. 43
8. RECOMMENDATION................................................................................................................. 44
9. REFRENCES............................................................................................................................... 45

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10. APPENDIX................................................................................................................................ 47
10.1:Consent Form................................................................................................................ 47
10.2: IRB & EC Letter............................................................................................................. 48
10.3: Data collection permission letter.................................................................................49
10.4: Data collection tools Questionnaires .......................53

LIST OF TABLES

xiv
Sr. No TABLES Pg No

4.1 Demographics 17

4.2 Prevalence of Nomophobia 22

4.3 Prevalence of Depression 23

4.4 Prevalence of Anxiety 24

4.5 Prevalence of Stress 25

4.6 Level of activity in participants 26

4.7 Association of Nomophobia and IPAQ 27

4.8 Association between Nomophobia and gender of 28

participants

4.9 Association between Nomophobia and age of 30

participants

4.10 Association between Nomophobia and duration of using 32

smartphone devices

4.11 Association between Nomophobia and depression 34

4.12 Association between Nomophobia and Anxiety 36

4.13 Association between Nomophobia and stress 38

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 LIST OF FIGURES

Sr. No Name of figures Pg No.

4.1 Gender of participants 18

4.2 Age of participants 19

4.3 BMI of participants 20

4.4 Duration of using smart-devices daily 21

4.5 Prevalence of Nomophobia 22

4.6 Prevalence of depression 23

4.7 Prevalence of anxiety 24

4.8 Prevalence of stress 25

4.9 Level of activity in participants 26

4.10 Association between Nomophobia and gender of 29

participants

4.11 Association between Nomophobia and age of 31

participants

4.12 Association between Nomophobia and duration of 33

using smartphone devices

4.13 Association between Nomophobia and depression 35

4.14 Association between Nomophobia and anxiety 37

4.15 Association between Nomophobia and stress 39

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 LIST OF ABBREVIATION

Serial Abbreviation Description

1 NMP-Q No Mobile Phone Questionnaire

2 DASS-21 Depression Anxiety Stress Scale-21

3 IPAQ International Physical Activity Questionnaire

4 SPSS Statistical package for Social Sciences

5 BMI Body Mass Index

6 EMR Electro Magnetic Radiation

7 CNS Central Nervous System

8 INE Identifiant National Élève

9 UK United Kingdom

10 DSM-V Fifth edition of Diagnostic and Statistical

Manual of Mental Disorders

11 CI Confidence Interval

12 IRB & EC Institutional Review Board and Ethical

Committee

13 SNS Social Networking Service

14 MP Mobile Phone

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 ABSTRACT

Background:

The term Nomophobia or NO Mobile Phone Phobia is used to describe a

psychological condition when people have a fear of being detached from mobile
phone connectivity. The objective of this study was to find association of physical and
mental well-being with Nomophobia among teenagers in Sialkot.

Materials & Methods:

An observational study was conducted among the students from different schools in
Sialkot. The data was collected using a non-probability convenient sampling
technique via three questionnaires DASS-21, NMP-Q, and IPAQ. The data was
collected from 380 teenagers who met the inclusion criteria. Data was analyzed
through SPSS-21 software.

Results:
Out of 380 participants, majority were between the age group of 16-18 years (62.1%)
The prevalence of Nomophobia was 98%. and 71.6% of participants were females.
Moderate Nomophobia affects people who use their phones for more than 3 hours
every day (50.5%).as the p-value is less than 0.05 so the results are significant. Out of
the total, 22.6% of participant who exhibits low IPAQ values had moderate
Nomophobia(p>0.05) there was a non-significant association between Nomophobia
and physical activity level, and 12.6% of the participants have the extremely severe
depression with moderate Nomophobia (p>0.05).
Conclusion:
It is concluded that Nomophobia affects most commonly the 16–18-year age group of
teenagers. Moderate Nomophobia affected more females than males. Those using cell
phones less than three hours per day and those had severe depression were more prone
to have moderate Nomophobia. Those teenagers who had a high level of
Nomophobia, exhibit low physical activity or IPAQ score.
Keywords:
Nomophobia, Teenagers, Anxiety, Depression, Stress, International Activity Level,
IPAQ

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 CHAPTER 1

1. INTRODUCTION

1.1: Definition and Other terminologies

Nomophobia which literally means "fear of being without a mobile phone". Mobile
phones have become so popular for unwinding as a result of the advent of a plethora
of applications that they are now being viewed as a distraction and addiction by
people of all ages, particularly school and college students(1).
The classification of Nomophobia is in dispute because it is a new measurement.
Similarly, the concept of "Nomophobia" is complicated and deserves to be explored
further. Nomophobia, like other phobias, behavioral addictions, and mental illnesses,
has some overlap. As a result, the terms phobia and addiction are often interchanged
when describing the condition. Phobias are irrational or extreme fears that, at worst,
cause a strong desire to avoid a situation and, at best, cause a strong desire to confront
it, terrifying endurance challenge. A cellphone can be used to connect, learn, belong,
and communicate. It is reductive and pathologizing to label the fear of being without
this conduit a phobia. To score highly on the Nomophobia scale, mobile phone use
should be avoided or treated(2).
The discomfort, anxiety, and anxiousness generated by smart phone dependency is
known as Nomophobia. People with Nomophobia have traits like "never turning off
the phone,""repeatedly checking for missed texts and calls,""carrying their phone
everywhere,""indulging in it at inappropriate times," and "deliberately missing face-
to-face conversation." When their phone connection breaks or is otherwise unusable,
Nomophobics may have physical side effects such as 'panic attacks, "shortness of

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breath,' 'trembling, "sweating,' 'accelerated heart rate,' 'pain in the hand joints, neck
and back pain,' and so on(3).
Anxiety is a lifetime affliction."Nomophobia," or the dread of losing communication
with one's cell phone, is a new addition to the list of stressors. This condition is
known as Nomophobia, which is a catchy combination for "no mobile." phone" and
"phone addiction" are two terms that come to mind while discussing mobile phones.
It's the end the outcome of technological advancements that enable connectivity.
Nomophobia is a fear that causes discomfort, anxiety, tension, or misery by not
having access to a mobile phone. From the moment they wake up, many people's
phones have become an extension of their ears until they fall asleep in a second. The
mobile phone is both empowering and devastating at the same time(4).
Almost everyone has been affected by these changes, regardless of age. When it
comes to the use of technology and its possibilities, however, teenagers are the most
vulnerable and influence able group. "Digital technology has become very important
among teen audiences and is part of their daily practices in various areas such as
family, school, and friends," write Vidales-Bolaos and Sábada-Chalezquer (2017, p.
20). Its use gives users with immediate benefits such as peer connection in real time, a
sense of belonging, and the capacity to receive comments and share information,
among other things. As a result, the mobile phone has become a vital instrument for
the social, personal, and professional development of adolescents. A thorough
investigation of the smartphone's propensity to evoke good emotions such as
independence, freedom, and constant connectivity. Beyond these virtual settings, the
smartphone's excessive, reliant, and problematic use as a medium of access and
mediator between youth and social networks has contributed to its reliant, problematic
use. When teenagers "enter adolescence, their network of friends and classmates is
seen as the primary source of information..." When teenagers get older, "their
membership in and knowledge of social media is what is assimilated, shared, and
expanded, based on what their peers do or prefer," according to the study (Bian
&Leung, 2015, p. 59). Parents and teachers appear to be outside the personal universe

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of teenagers in this context. Teenagers spend the most time on their smartphones
watching videos and surfing the Internet. For young people, social networks are now
an obvious source of communication and socialisation, affecting their relationships to
the point of addiction. It is vital, according to Guedes et al., to explore the physical
and psychological hazards linked with the use of the Internet and social networks,
such as their excessive and inappropriate usage, which is one of the most alarming
issues that must be thoroughly examined. Aside from these virtual worlds, the study
looks into the use and abuse of smartphones as a means of access and a mediator
between youth and social networks. (5).
1.2: Prevalence:
Nomophobia is a 21st-century disorder caused by new technologies [emerging
information and communication technologies and their apps] and devices, according
to King, Valença, and Nardi (2010). Nomophobia was reported to affect 53 percent of
mobile phone users in the United Kingdom (UK) in 2008.It was also higher among
male users (58%) than female users (48%) (Mail Online, 2008). In 2012, however, it
increased from 53% to 66%, with women experiencing higher levels of Nomophobia
(70%) than their male counterparts (61%) users. It shows that women are more
vulnerable to Nomophobia than men who express feelings of loneliness. When they
are unable to use or lose their mobile phones, they experience anxiety (SecurEnvoy,
2012). Its prevalence was discovered to be higher (77%) of people(6).

Mobile phones (MP), which were once the exclusive property of the wealthy in the
1990s, have now become a necessity for almost everyone from all walks of life, with
some statistics claiming that the number of subscribers has increased from 12.4
million in 1990 to 500 million in 2000 to 3.3 billion in 2008 and 5.3 billion at the end

of 2010. According to the 2019 Survey on Equipment and the use of Digitalization in

Households (INE, 2020), 89.7% of children in the previous three months, 92.9 percent
of those aged 10 to 15 had used a computer, and 66 percent had used the Internet. The

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use of a cell phone increases dramatically after the age of ten, reaching 94.8 percent
among 15-year-olds in Spain. (1).

1.3: Disease of 21st century:

Nomophobia is a disease of 21st century. Nomophobia is a new disorder that affects a
large number of people nowadays. Fascination with modern technology has a negative
beginning. Smartphone usage figures from LEFTRONIC for 2021 suggest that the
average person spends 2 hours and 51 minutes per day on their mobile device [5].
Furthermore, 22% of us check our phones every few minutes, while 51% of users
check their phones a few times per hour. Since the year 2000, children aged 15 to 18
have had limited access to these technologies due to their inability to acquire them,
despite aid and financial support from other sources, particularly parents. Following
the completion of a survey, it was discovered that 28% of the targeted demographic
(teenagers and youths) are employed, 11.8 percent are unemployed, and 58 percent
are students. They all have various engagements in terms of mobile phone usage, yet
there are certain similarities(7).

King, Valença, and Nardi (2010) described Nomophobia as a 21st-century disorder

brought on by new technologies [emerging information and communication
technologies]. Nomophobia is a 21st-century disorder that emerges as a result of new
technologies (King, Valenca, & Nardi, 2010). (Asensio Chico, Diaz Maldonado &
Garrote Moreno 2018). Nomophobia is a mental disorder that affects smartphone
users 2014, Del Puente According to studies, 37 percent of adults and 60 percent of
children are addicted to their smartphones. For children and adolescents (Sarwar &
Soomro, 2013). The group of people between the ages of 18 and 24 is the most at risk
for Nomophobia(8).

1.4: Physical Symptoms of Nomophobia:

Sleeplessness in young adults is associated to Nomophobia, but not to age, gender,
BMI, or mobile phone screen size, according to a recent study. Variables that may be
at play in the link between mobile device use and insomnia were examined in the

xxii
study. For example, the synthesis of melatonin, the master hormone that regulates the
circadian cycle, is disrupted by blue light from smartphones displays. According to a
recent research, 2 hours of exposure to shortwave blue light with a wavelength of
400–450 nanometers is adequate to suppress melatonin significantly. Melatonin levels
begin to recover quickly after 15 minutes of no exposure to artificial light(9).

Low-energy electromagnetic radiation (EMR) is received during mobile phone use,

according to Research. It appears to disrupt cellular structure and function changes in
the body that cause abnormal cell responses. Both the central nervous system (CNS)
and the auditory system(10).

Excessive use of mobile phones can cause a range of problems in addition to

providing various benefits. It can lead to social, physiological, and psychological
issues such electro-magnetic field radiation-related injuries, car accidents, and anxiety
about not being able to use new technologies. Nomophobia can lead to antisocial
behavior. Because they rely on their phones for social interaction and making friends.
It would be extremely difficult for them to make genuine friends in person as they
have done online (Razzaq, Samiha, & Anshari, 2018). There is a link between people
who develop Nomophobia and their fears of being unable to communicate, of losing
connectedness, of being alone, and of losing convenience(11).

1.5: Psychiatric symptoms of Nomophobia:

Nomophobia is regarded as a modern-day phobia (Argumosa-Villar et al.
2017). Other psychiatric disorders share clinical symptoms with it. When people are
without their mobile phones, they often experience anxiety, respiratory changes,
trembling, perspiration, agitation, disorientation, and tachycardia. Teens who are
Nomophobic or at risk of becoming Nomophobic typically participate in behaviours
such as spending too much time on their phones every day, checking their phones as
soon as they wake up in the morning, checking their phones more than 35 times per
day, and never turning their phones off. Some mental diseases, such as social anxiety
and panic disorder, may be exacerbated by psychological factors such as low self-

xxiii
esteem and self-efficacy, extrovert personality traits, impulsivity, and a sense of
urgency and desire. (12).

Adolescents use the Internet to escape emotions of loneliness, social conflicts, and
unsolvable challenges in their daily lives (Byun et al., 2009; Kran Esen, 2009). Many
young people use the Internet responsibly and following their goals, attempting to
avoid overuse. On the other side, some youngsters lack self-control and, as a result of
their excessive Internet use, may suffer difficulties in their academic and social lives.

Nonetheless, all definitions imply that: Nomophobia can be observed as a disorder

involving a fear of the unknown. The psychological symptoms of nomophobia include
the following: a pathological fear of being disconnected from technology;
Nomophobia is a behavioural addiction that affects people. Nomophobia is a phobia
that occurs in specific situations not just Smartphones, but all types of smartdevices
and new technologies that enable virtual reality. Personal computers, laptops, tablets,
and other forms of communication Smartphones, personal assistants, and the Internet
are all examples. Therefore, The "New Technologies Paradox" has been coined to
describe Nomophobia(13).

1.6: Use and Misuse of smart phones:

Aside from these virtual environments, the research community is worried about the
usage and misuse of smartphones as a mode of access and a link between youth and
social networks. According to Simó Sanz et al. (2017), young people are increasingly
feeling the need to use or keep their smartphone close to them in order to be calm, and
they are becoming agitated if they cannot use it, bringing us closer to addiction terms
like tolerance and withdrawal. As a result, young people and teenagers have become
too dependant on mobile devices due to the ease with which they can stay connected
at all times (Rojas-Jara, Henrquez, Sanhueza, Nez, Inostroza, Sols, & Contreras,
2018). When it comes to smartphones and young people. Young people, it is asserted,
are more likely to use social media and online messaging programmes to
communicate with their family and friends (Anshari et al., 2016). This situation has

xxiv
resulted in a surge in the popularity of social networking services, as well as an
increase in the number of young users. In addition to web access, social networks
services are thought to have been successful in increasing the widespread use of SNS
mobile applications by providing easier and faster access (Salehan & Neghban, 2013).
Using a smartphone to access the internet is also an undeniably popular and
widespread activity within and between younger people. One of the most important
features of smartphones is that they should be connected to the internet 24x7 for
various purposes such as accessing information via various applications(14).

1.7: Advantages and Disadvantages:

Many inventions have sprung from the technological revolution. Every technology,
however, has both advantages and disadvantages, and smartphones are no exception
(Ahmed, Ramzan, Qazi, & Jabeen, 2011). When people become addicted to using the
Internet or their smartphones, It can have a significant financial, physical,
psychological, and social impact on their lives (Young, 1998). Although the Internet
in general, and mobile-accessed Internet on smartphones in particular, have similar
features that contribute to the same type of addiction (Kwon et al., 2013),
smartphones have unique factors to consider, such as screen size (screen size),
applications, ubiquity, and time and space flexibility (Nielsen & Fjuk, 2010). The
enormous number of applications available stimulates the usage of smartphones and
tablets on a regular basis. (15).

1.8: Phantom Vibration Syndrome:

The majority of Nomophobics suffer from "Rinxiety," also known as "Phantom
Vibration Syndrome" or "Phantom Ringing," which refers to a false impression of
mobile phone ringing. Nomophobia has a negative impact on the mental health of
mobile phone users. As a result, it was suggested that Nomophobia be included in the
Diagnostic and Statistical Manual of Mental Disorders' fifth edition. (DSM-V) (10).

1.9: Over Connection Syndrome:

xxv
When a person has Nomophobia, he or she becomes concerned because he or she is
afraid of losing his or her cell phone. The "Over-Connection Syndrome" occurs when
people spend too much time on their phones and have fewer face-to-face contacts.
Another term for someone who avoids direct interactions by isolating themselves,
including mood disorders like depression, is "Techno-Stress" (16).

xxvi
 CHAPTER 2

2. LITERATURE REVIEW

The Study "Investigation of Nomophobia and smartphone addiction predictor among

adolescent in Turkey: Demographic variables and academic performance " was
conducted by "Hatice Yildiz Durak" in September 2018. The study aimed to
determine the addiction to smartphones amongst 12–18-year age group of secondary
and high school going students and to determine the demographic and academic
variables as well. The population for their research consisted of 612 students who
were studying in higher and secondary schools. Two scales were mainly used for this
study. One was descriptive analysis and the other was hierarchical linear multiple
regression. For data collection personal information forms, and a smartphone
addiction questionnaire were used. The finding of this study is thought to have added
to current literature in terms of theoretical foundation. One of the significant
achievements of this study was the development of a more comprehensive model. The
study showed a Negative relationship between Nomophobia and smartphone use
disorder. This finding showed low academic achievement that may lead to further
problems in adolescents. There is compelling evidence in research that showed
smartphone use disorder and Nomophobia are related to academic achievement
issues(17).

Mohammed Qutishat, Eilean Rathinasamy Lazarus, A Mohamed Razmy, and Samson

Packianathan studied "Nomophobia prevalence, socio-demographic factors, and
relationship with academic performance of University students in Oman" which was
conducted in 2019 and accepted on 28 April 2020. The study aimed to find out the
pervasiveness of Nomophobia and statistical characteristics affecting Nomophobic

xxvii
behaviors and relation between the Nomophobia and educational performance among
the university students of Oman. A descriptive correlation study design was used to
describe the occurrence of Nomophobia in Sultan Qaboos University students. The
sampling method was used to select 735 students based on inclusion criteria. The self-
report instrument was used to find Nomophobia, the Nomophobia Questionnaire
includes a 20 Likert scale rated between 1 to 7. Pearson correlation demographic test
and Descriptive analysis were used to find the relation between Nomophobia and
educational activities. The widespread presence of Nomophobia in the group of
students was 99.33% majority with the average level of Nomophobia. The students
with critical Nomophobia appeared with poor educational performance but it was not
demographically important. This study established the excessive widespread presence
of Nomophobia and poor relation with educational performance(18).

This study " Adaptation of the Nomophobia Questionnaire (NMP-Q) to Spanish " was
conducted by Joaquín González-Cabrera, Ana León-Mejía, Carlota Pérez-Sancho,
Esther Calvete in July 2017 and was accepted in September 2017. This study aimed to
find the fear of being out of mobile phone contact. It was a cross-section study
conducted amongst 306 students with ages ranging from 13 to 19. The Spanish
Version Of the "Mobile Phone Problem Use Scale" and "The Generalized Problematic
Internet Use Scale " were identified. Problematic mobile phone use patterns were
examined. Results showed that the fear of being out of mobile phone contact was
massive. There were scores of 39, 87, and 116 on NMP-Q at risk of problematic
users. The Spanish version of The NMP- Q was a success and it was valid(19).

The Investigation of different dimensions of Nomophobia among medical students "

was conducted by Mohammad Darvishi, Majid Noori, Mohammad Reza Nazer,
Soheil Sheikholeslami, and Ebrahim Karimi from 2016 to 2017. The study aimed to
investigate Nomophobia. It was a cross-sectional study conducted amongst 100
students studying in different majors of medical sciences at Islamic Azad University,
Tehran Branch. The data of the students were recorded on a data sheet and SSPS
statistical software version 21. The results of the study showed that participants with

xxviii
lower mean age felt more discomfort, anger, anxiety, and insecurity due to lack of
access to mobile phones and other related issues compared to This study " Adaptation
of the Nomophobia Questionnaire (NMP-Q) to Spanish " was conducted by Joaquín
González-Cabrera, Ana León-Mejía, Carlota Pérez-Sancho, Esther Calvete in July
2017 and was accepted in September 2017. This study aimed to find the fear of being
out of mobile phone contact. It was a cross-section study conducted amongst 306
students with ages ranging from 13 to 19. The Spanish Version Of the " Mobile Phone
Problem Use Scale" and " The Generalized Problematic Internet Use Scale " were
identified. Problematic mobile phone use patterns were examined. Results showed
that the fear of being out of mobile phone contact was massive. There were scores of
39, 87, and 116 on NMP-Q at risk of problematic users. The Spanish version of the
NMP- Q was a success and it was valid for other people. This indicated that
understanding the pattern of Nomophobia occurrence among cell phone users can
facilitate our path to prevent its harm including discomfort, anger, anxiety, and feeling
of insecurity among users of technology(20).

This study on "Nomophobia-Mobile phone Dependence, among students of a Medical

college in Banglore" was conducted by Pavithra MB, Suwarna Madhukumar, and
Mahadeva Murthy TS in May 2015, accepted in August 2015, and published in
September 2015. The study aimed to evaluate the widespread presence of
Nomophobia and addiction to mobile phones among the students of medical college.
This cross-sectional study was conducted among 200 students in the age group of 17-
27years. In this study, the pre-designed and pre-tested questionnaire was used to
collect the data. Statistical Package of Social Sciences was used to analyze the data.
The study of 200 students consists of 47.5% females and 52.5% males. The study
showed that a greater number of students used up to 300-500 Rupees every month to
recharge their mobiles and 23% of students go through stress and become depressed
when they do not have their mobile phones. Students mentioned several reasons for
using mobile as they bought mobile to remain in contact with their family and friends.
The students also asked how much time they spent on their mobiles daily. The study

xxix
showed that 79 students were Nomophobic and 27% were developing Nomophobia.
The result of this study showed that the addition of mobile phones among students is
increasing and more distant studies are needed to find out intellectual features and
resolve problems related to Nomophobia(1).

The Study "Nomophobia- an insight into psychological aspect in India" was

conducted by Aparna Kan Mani S, Bhavani U, and Maragatha R.S in December 2016
and was accepted in Feb 2017. The study aimed to find the fear of losing a mobile
phone or having no mobile phone affects people. It was a cross-sectional study
conducted among 200 Mbbs Students in Indore and a random sampling technique was
used to find out the prevalence of Nomophobia. Data were collected using a
structured questionnaire. The research indicated that Nomophobia is prevalent in
Indian society. Results showed that the fear of not being able to communicate with
their friends or family was found to be the big factor. This demonstrated the
widespread use of smartphones for a legitimate reason. Furthermore, it showed that
the use of smartphones is for the genuine purpose of communication rather than to
maintain a perceived Virtual World. However, 20% of people agreed that smartphone
use interrupted whatever work they do they are unable to reduce the use of a
smartphone. This indicated that there is a need to monitor dependent behavior now
because it might be too late to realize people are at Mercy of technology and not
otherwise(21).

2.1: Rationale:

1. Because of the growing concern about the negative impacts of excessive

smartphone use during COVID-19 period, it is important to find out the potential
hazards and also how they are affecting people well-being , as well as the implications
of having the device taken away from frequent users.
2. The research on nomophobia is also in its early stages and much is still remained to
be determined.
2.2: Objective:

xxx
The objective of our study was:

1. To find the frequency of Nomophobia among teenagers in different schools in

Sialkot.

2. To find the association of physical well-being with Nomophobia among teenagers.

3. To find the association of mental well-being with Nomophobia among teenagers.

CHAPTER 3-

xxxi
 3. MATERIALS AND METHODS

 Research Design:

The research design was a Cross-Sectional study.

 Study Settings:

Participants were students from different schools and colleges in Sialkot.

 Study Duration:

This survey was conducted from October 2021 to April 2022.

 Sample Size:

The sample size was calculated using Rao soft Sample Size Calculator with a 95%
confidence interval (CI), 5% margin of error, and considering a response rate of 50%;
the minimum number of students required was 380.

 Sampling technique:

Non-probability convenient sampling technique was used.

 Selection criteria:

Inclusion Criteria:
1. Teenagers and undergraduate students of different schools and college of
Sialkot

2. Both gender

3. Age: 13-20

4. Minimum duration of using smartphone devices: 1 h per day

Exclusion Criteria:

1. Older than 20 years

xxxii
 2. Participants with special needs

3. Participants with psychological illness

4. Faculty and admin members

3.1: Data collection procedures:

After obtaining approval from the Institutional Review Board and Ethical Committee
(IRB & EC) of Islam College of Physical Therapy, Sialkot. The group of teenagers
from different schools and colleges including Govt. Secondary School Sialkot, Classic
School System Sialkot, Misali Shaheen Public School and Superior College for girls
Daska Road Pasrur were approached. In this research demographics, Nomophobia
Questionnaire (NMP-Q), Depression Anxiety Stress Scale (DASS-21), International
Physical Activity Questionnaire (IPAQ) were used to collect relevant data. These
questionnaires were distributed among students with informed consent, over one hour
period at selected schools and academic institutions after the end of lectures.

A total of 450 questionnaires were distributed among the students of different schools
out of which 400 questionnaires were returned. A total of 380 questionnaires were
filled in completely and considered valid. Concealment and secrecy of the participants
were preserved during the study.

3.2: Method used for data analysis:

Data were analyzed using a statistical package for social science (SPSS) for windows
software, version 25. Statistically significant was set at P=0.05. Consequently, this
study provided the prevalence and association of physical and mental well-being with
Nomophobia. All the variables were defined on the SPSS sheet. The percentage and
frequency tables were also computed through the SPSS. Bar and Pie charts were
developed for the calculated results. Chi-square test was used to find the association
between physical and mental well-being with NMP-Q in teenagers.

3.3: Data collection tools:

1. No Mobile Phone Questionnaire (NMP-Q)

xxxiii
 2. International Physical Activity Questionnaire (IPAQ)

3. Depression Anxiety Stress Scale (DASS-21)

Nomophobia Questionnaire (NMP-Q): Yildirim and Correia (2015) developed the

Nomophobia Scale (NMP-Q), which was modified to Turkish by Yildirim et al.
(2016) and used as the data collection method in the study. There are 20 items on the
scale, each having a 7-point Likert scale. The original scale's dependability coefficient
was discovered to be 95. The reliability coefficient of the scale converted to Turkish
was computed as.92, indicating a good level of reliability. the scale's dependability
(Field, 2005). There are four sub-dimensions to the scale. "Not being able to reach" is
one of them." Losing connectedness" (5 items), "not being able to communicate" (6
items), and "losing information" (4 items) are all on the list. "Sacrificing convenience
(5 items).

International Physical Activity Questionnaire: The development of an international

measure for physical activity commenced in Geneva in 1998 and was followed by
extensive reliability and validity testing was undertaken across 12 countries (14 sites)
during 2000. The final results suggest that these measures have acceptable
measurement properties for use in many settings and in different languages, and are
suitable for national population-based prevalence studies of participation in physical
activity.
Depression, Anxiety and Stress Scale-21: -The depression, anxiety, and stress scale-
21(DASS-21) is a set of three self-reporting scales designed to measure the emotional
states of depression, anxiety, and stress. It was designed by Lovibond and Lovibond
(1995) to assess symptoms of depression, anxiety, and stress among adults. Out of 21
questions, 7 questions are related to stress, 7 questions are about anxiety and the
remaining 7 questions are about Depression

xxxiv
 CHAPTER 4:

4. RESULTS

Table 4.1: Demographics Characteristics of Participants

VARIABLES FREQUENCY PERCENTAGE

Gender Male 108 28.4

Female 272 71.6

Age >15 83 1.8
16-18 236 62.1

19-20 53 13.9

<20 8 2.1
Body mass index underweight 90 23.7

Normal 210 55.3

Overweight 50 13.2

Obese 30 7.9

Duration of using Less than 3h per 192 50.5

smartphone devices day
112 29.5
3-6h per day
More than 6h per 76 20.0
day

xxxv
Gender of participants:

Fig 4.1: The pie chart represents the gender distribution of participants, 71.6% were
females. While 28.42% were males.

xxxvi
Age of participants:

Fig4.2: The simple bar chart shows the age range of participants. The age range 16-18
years made up the majority of the participants.

xxxvii
Body Mass Index (BMI):

Fig 4.3: The pie chart shows that 210 participants had a normal BMI, 90 were
underweighted, 50 were overweight and 30 were obese

Duration of using smart devices daily:

xxxviii
Fig 4.4: The pie chart shows that 50.53% participants used mobile phone less than 3h
per day, 29.47% used mobile phone 3-6h per day and 20% used mobile phone
more than 6h per day

TABLE 4.2: Frequency of Nomophobia

xxxix
 Scoring Frequency Percent

Absent 7 1.8

Mild 36 9.5

Moderate 214 56.3

Severe 123 32.4

Total 380 100.0

Fig 4.5: The simple bar chart shows the frequency of Nomophobia among teenagers,
with 214 (56 %) showing moderate Nomophobia, 123(32%) and 36(9%) with severe
and mild Nomophobia respectively.

DEPRESSION:

TABLE 4.3: Frequency of Depression

xl
 Scoring Frequency Percent
Normal 85 22.4
Mild 38 10.0
Moderate 115 30.3
Severe 75 19.7
extremely severe 67 17.6
Total 380 100.0

Fig 4.6: The simple bar chart shows that 115 had moderate depression, 85 were
classified as normal, 75 and 67 had severe and extremely severe depression
respectively.

ANXIETY:

TABLE 4.4: Frequency of Anxiety

xli
 Grading Frequency Percent
Normal 46 12.1
Mild 21 5.5
Moderate 78 20.5
Severe 74 19.5
Extremely severe 161 42.4

Total 380 100.0

Fig 4.7: The simple bar chart shows that 42% population had extremely severe
anxiety. 12 % were classified as normal, 20.5 % and 19.5% had moderate and severe
anxiety respectively.

STRESS:

TABLE 4.5: Frequency of Stress

xlii
 Scoring Frequency Percent

Normal 133 35.0

Mild 64 16.8

Moderate 100 26.3

Severe 58 15.3

Extremely severe 25 6.6

Total 380 100.0

Fig4.8: The simple bar chart shows that 35% of participants were classified as normal,

26% had moderate stress and 16.8 % had mild stress.

TABLE 4.6: Level of Activity in participants

xliii
 activity Frequency Percent

130 34.2
vigorous activity

89 23.4
moderate activity

161 42.4
low activity

380 100.0
Total

Fig 4.9: The simple bar chart shows the activity level of the participants. Out of total,
42% were fall under low activity, 34% showed vigorous activity and 23% showed
moderate activity. `

ASSOCIATIONS:

xliv
Table 4.7: Association of physical activity with Nomophobia

IPAQ
vigorous moderate
activity activity low activity Total
n(%) n(%) n(%) n(%) P-value
Absent 1 (.3) 2(.5) 4(1.1) 7(1.8)
Mild 12 (3.2) 12(3.2) 12(3.2) 36(9.5)
NMPQ
Moderate 81(21.3) 47(12.4) 86(22.6) 214(56.3) .366
Severe 36(9.5) 28(7.4) 59(15.5) 123(32.4)
Total
130(34.2) 89(23.4) 161(42.4) 380(100)
n(%)

The table 4.8 shows that 22.6% of participants have moderate nomophobia with low
activity level, as p value is more than 0.05, there was no significant association
between nomophobia and physical activity level of participants.

Table 4.8: Association of NMPQ with Gender of participants

xlv
 Gender of participant
Male Female Total p-value
n (%) n (%) n (%)
Absent 3(.8%) 4(1.1%) 7(1.8%)
Mild 16(4.2%) 20(5.3%) 36(9.5%)
Moderate .009
NMPQ 47(12.4%) 167(43.9%) 214(56.3%)

Severe
42(11.1%) 81(21.3%) 123(32.4%)

Total
n (%) 108(28.4%) 272(71.6%) 380(100%)

xlvi
Fig 4.10 shows that 43.9% of the female were affected with moderate nomophobia as
p value> 0.05 there was no significant association between nomophobia and gender of
the participants

xlvii
Table 4.19: Association between Nomophobia and Age of the

Participants

Age of participants p-
Total
NMPQ value
>15 16-18 19-20 <20 n(%)
Absent
2(.5) 4(1.1) 1(.3) 0(.0) 7(1.8)

Mild
14(3.7) 16(4.2) 5(1.3) 1(.3) 36(9.5)

Moderate .255
47(12.4) 137(36.1) 25(6.6) 5(1.3) 214(56.35)

Severe
20(5.3) 79(20.8) 22(5.8) 2(.5) 123(32.4)

Total
n(%) 83(21.8) 236(62.1) 53(13.9) 8(2.15) 380(100.0)

xlviii
The fig 4.11 shows that majority of age group 16-18 years have the moderate
nomophobia as p value is more than 0.005 there was insignificant association between
nomophobia and age of the participant.

xlix
Table 4.10: Association between Nomophobia and Duration of using

smart phone daily

l
 Duration of using smart devices daily

less than 3h per more than 6h

NMPQ day 3-6h per day per day Total
n(%) n(%) n(%) n(%) p-value
Absent
2(.5) 2(.5) 3(.8) 7(1.8)

Mild
23(6.1) 12(3.2) 1(.3) 36(9.5)

moderate
123(32.4) 53(13.9) 38(10.0) 214(56.3) .001

Severe
44(11.6) 45(11.8) 34(8.9) 123(32.4)

Total
n(%) 192(50.5) 112(29.5) 76(20.0) 380(100.0)

li
The fig 4.12 shows that 32.4% of the participants using devices less than 3h per day
have the moderate nomophobia as p value is less than 0.05 there was a significant
association between nomophobia and duration of using smart devices.

Table 4.11 Association between Nomophobia and Depression

Depression

extremel
NMPQ p-value
Normal Mild Moderate Severe y severe Total
n(%) n(%) n(%) n(%) n(%) n(%)
Absent
2(.5) 0(.0) 4(1.1) 1(.3) 0(.0) 7(1.8)

Mild
11(2.9) 5(1.3) 12(3.2) 8(2.1) 0(.0) 36(9.5)

Moderate .075
46(12.1) 19(5.0) 55(14.5) 46(12.1) 48(12.6) 214(56.3)

Severe
26(6.8) 14(3.7) 44(11.6) 20(5.5) 19(5.0) 123(32.4)

Total
n(%) 85(22.4) 38(10.0) 115(30.3) 75(19.7) 67(17.6) 380(100.0)

lii
The fig 4.13 shows that 12.6% of the participants have the extremely severe
depression with moderate nomophobia, as results were non-significant because p
value is more than 0.05

Table 4.12 Association between Nomophobia and Anxiety

liii
 Anxiety

p-
NMPQ extremely value
Normal Mild Moderate Severe severe Total
n(%) n(%) n(%) n(%) n(%) n(%)
Absent
2(.5) 1(.3) 2(.5) 1(.3) 1(.3) 7(1.8)

Mild
5(1.3) 4(1.1) 10(2.6) 7(1.8) 10(2.6) 36(9.5)

Moderate .196
21(5.5) 10(2.6) 44(11.6) 49(12.9) 90(23.7) 214(56.3)

Severe
18(4.7) 6(1.6) 22(5.8) 17(4.5) 60(15.8) 123(32.4)

Total
n(%) 46(12.1) 21(5.5) 78(20.5) 74(19.5) 161(42.4) 380(100)

liv
The fig 4.14 shows that 23.7% of the participants have the extremely severe anxiety
with moderate nomophobia as p value is more than 0.05 results were non-significant.

Table 4.13 Association between Nomophobia and Stress

lv
 Stress

extremely
NMPQ Normal Mild Moderate Severe severe Total p-
n(%) n(%) n(%) n(%) n(%) n(%) value
Absent
4(1.1) 1(.3) 1(.3) 1(.3) 0(.0) 7(1.8)

Mild
19(5.0) 7(1.8) 6(1.6) 3(.8) 1(.3) 36(9.5)
.190
moderate
65(17.1) 35(9.2) 56(14.7) 41(10.8) 17(4.5) 214(56.3)

Severe
46(12.1) 21(5.5) 37(9.7) 12(3.2) 7(1.8) 123(32.4)

Total
n(%) 134(35.5) 64(16.8) 100(26.3) 57(15.0) 25(6.6) 380(100)

lvi
The fig 4.15 shows that 17.1% of the participants were normal with moderate
nomophobia as results were non-significant, p value is more than 0.05.

lvii
 CHAPTER 5:

5.DISCUSSION

In our study the objectives of our study were to find the frequency of Nomophobia
among teenagers as well as the physical and mental wellbeing of Nomophobia among
teenagers. The mobile phone has been dubbed as one of the biggest non-drug
addictions of the 21st century. As observed use of cell phone is increasing and
unjustified use may result in problems. Prevention is better than cure, most of the
subject using mobile phone belong to younger age group(22).
In our study the total prevalence of Nomophobia was 98% out of which 56% have
moderate nomophobia, 32% and 9% showed mild and severe Nomophobia.:
In Müge ADNAN, Deniz Mertkan GEZGİN, study aims at investigating the
prevalence of nomophobia among 433 Turkish college students enrolled in a state
university in the 2014-2015 academic year through survey method it was found that
Nomophobia prevalence was more in college students which was parallel to our study
as our prevalence in teenagers was 98%. This number is higher than previous
estimates. Only 2% of the participants did not have Nomophobia.(23)
Our aim in doing this thesis was to find whether Nomophobia in teenagers is an
expected result of the rapid increase in mobile phone use in our daily life. According
to our findings, out of 377, females (272) are more Nomophobic than males (108).
Similar to our study Tugba Didem Kuscua et al,found in their study that females are
significantly more Nomophobic than male, and this is compatible with most of the
studies (SecurEnvoy 2012; Gezgin and C¸akır 2016; Yildirim et al. 2016),because
girls have social anxiety because they hesitate to speak in front of a large group of
people or they dont feel comfortable in expressing themselves, especially addressing
to strangers. (Deursen et al. 2015). For this reason ,girls tend to spend their leisure
time mostly on mobile phone, hence are more Nomophobic than males(12).

lviii
The study was conducted in Indonesia by Ayu Selvi Mansyur at which the frequency
of the largest subject was at the level of moderate Nomophobia who were male and
the percentage was 67.2% and 61.2% women were nomophobic(24). whereas the
finding in our research give contaray results about the gender prevalence in our study
Out of 380 participants the 167 (43.9%) females have moderate Nomophobia as
compare to 47(12.4%) males.
In our study, 12.6% of the participants have the extremely severe depression with
moderate Nomophobia in teenagers, as results were non-significant because p value is
more than 0.05. In contrast to another study, Nomophobia is positively correlated with
depression and anxiety as their results were significant because their p value was less
than 0.005. Self-defeating beliefs, low self-esteem, youth, impulsivity, a sense of
urgency, and sensation seeking may all be linked to excessive usage of mobile
phones. (25).
Katherine et al. (2008) evaluated in 2163 participants in England. The results of their
study showed that 52% of users experienced anxiety and stress in case of losing their
mobile phones, dying battery charge, or being short on credit, so lacking access to
their mobile phones. Also, their results showed that 58% of males and 48% of females
had nomophobia. On the contrary, our study showed that out of 377 participants
showed that 161(42.4%) have extremely severe anxiety. Furthermore, in our study
79% participants were female while 215 were males.
Esha Bichu and Neeraj Kumar conducted study on Association of level of physical
activity in physiotherapy undergraduates with Nomophobia showed that there is
negative correlation between nomophobia and level of physical activity in young
adults. The scores of nomophobia questionnaires NMP-Q and international physical
activity questionnaire IPAQ showed relevant association. They concluded that if the
score of NMPQ is increased, there is decreased in the score of IPAQ. Furthermore,
the conclusion of their study was that students with increase in smartphone time had
high risk of decrease in physical fitness level. Whereas in our study there is non-
significant relationship between nomophobia and IPAQ level as the p value is more
than 0.005. In our study 86 participants have moderate nomophobia with low activity
level, as p value is more than 0.05, there was no significant association between
nomophobia and physical activity level of participants.

lix
Deniz Mertkan Gezgin conducted study on “The Relationship between levels of
nomophobia prevalence and internet addiction among high school students” in which
929 high school students were chosen at random from Turkish high school students in
various socioeconomic sectors in the province of Afyon, Ankara, Mardin. A
demographic questionnaire as well as the NMP-Q scale and internet addiction scale
were used in the data collection procedure according to the finding high school pupils
have level of nomophobia are slightly above normal, in terms of gender difference
female students are more likely than male students to engage in nomophobic
behavior. When looking at the duration of the smartphone ownership it was
discovered that the longer the duration of smartphones ownership, the higher the
chance of developing nomophobia. Similarly in our study female participants are
more nomophobic than males. Moreover, in our study it is found that those teenagers
who use smart devices less than 3h per day exhibit moderate nomophobia.
Finally technological advancements and extensive use has resulted in the emergence
of new diseases and dependencies. Addressing this problem can reveal some crucial
but hazy parts of technical difficulties. We may deduce from the finding of this study
that nomophobia is more relevant among persons of lower ages, those who use short
duration mobile phones. Although the study data are not significant for any of the
statistics, employing the statistical descriptions would allow us to plan and conduct
future investigations as well as identify a more influential target community. As a
result, further research is needed to explore, investigate, and highlight which factors
influence this contemporary pathology the most. Evidence has indicated that
Nomophobia is directly related with individual mental health, physical health, and
behaviour change.

CONCLUSION

It is concluded that Nomophobia affects most commonly the 16–18-year age group of
teenagers. Moderate Nomophobia affected more females than males. Those using cell

lx
phones less than three hours per day and those had severe depression were more prone
to have moderate Nomophobia. Those teenagers who had a high level of
Nomophobia, exhibit low physical activity or IPAQ score.

LIMITATIONS

1. The study was area bound i.e., only limited to Sialkot city.
2. In this study, time duration was limited.
3. The accuracy of the results may have been harmed because some participants
overestimated or underestimated their responses to the NMP-Q, DASS-21 and
IPAQ. This could be mitigated in future research by comparing results to
similar studies to identify any lopsided findings, or by conducting longitudinal
studies to gain a richer understanding of problematic use among people with
high Nomophobia over time. Any revisions should also address the anomalies in
some of the questions. For example, simply asking about phone use while
driving ignores the types of phone use that may or may not be dangerous, such
as using the phone to change music legally while driving or, in the case of
prohibited use, using a phone with permission in a cinema or library.
4. Another limitation lay in the imbalance of age distribution among respondents
that were surveyed since the participants in our study were teenager students.

RECOMMENDATIONS

1. Based on the results found in this work, it is necessary to address the issue of
dependence on smartphones and the consequences that the distraction they
create can have a bad impact on student studies and on their mental growth.
Health education strategies should be targeted for youth to prevent harmful
effect of this great invention.

lxi
 2. In our study the participants were teenagers. Age limits for participants should
be increased for future research and thesis.
3. Therefore, a greater volume of research is needed to explore, investigate and
note which are the most determining variables that influence this
contemporary pathology, evidence has shown that Nomophobia is closely
associated with individual mental health physical health and behavior
modification.
4. Educational seminars and parents’ teacher meeting should be held in schools
and colleges for the awareness, to combat with the rising prevalence of
nomophobia and to prevent the hazards of health of teenagers.so, it will yield
better use of mobile applications in an educational context in future.

FUNDING: This research received no external funding.

CONFLCIT OF INTEREST: There is no conflict of interest.

ETHICAL CONSIDERATION: This research procedure carried out with honesty

and truthfulness. The consent form got from each person who was included in our
sample there was clear non probability convenient sampling without any biasness, and
all personal information was completely confidential.

CHAPTER 6

8. REFRENCES

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 CHAPTER 7

Annexure

RESEARCH REPORT CONTRIBUTION FORM

Name Roll Concept Literature Data Statistical Drafting

no. & Search collection Analysis
Design

Please fill the above form according to the following criteria

No contribution = ×, Minimal contribution= √, Moderate contribution= √√,

Significant contribution = √√√

Supervisor Name

Institute/College name

Sign

Date

lxv
APPENDIX

Consent Form

Please give your consent to participate in the

study by answering the following questions.
Have you been informed about this study? Yes No
Have you been able to ask questions about this study? Yes No
Have you received answers to all your questions? Yes No
Have you received enough information about this Yes No
study?
Are you involved in any other studies? Yes No
If you are, how many?
Do you understand that you are free to withdraw Yes No
from this study at any time?
Without giving a reason for withdrawing? Yes No
Do you agree to take part in this study? Yes No

Your signature will certify that you have had

an adequate opportunity to discuss the study
with the investigator and have voluntarily
decided to take part in this study. Please keep
your copy of this form and the information
sheet together.

Signature of Participant:
…………,……………………

Date: …………………
Name (block letters):
…………………………………

Signature of investigator……………………………

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10.2: IRB & EC Letter

10.3: Data collection permission letter

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10.4: Data collection tools Questionnaires

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