INTRODUCTION:

With over 500 million Internet users, India ranks second globally and has the youngest population. The majority of young people's internet time is spent on educational, pornographic, gambling, video games, excessive chat, cyberbullying, and criminal activities., etc.¹The global issue of Internet addiction (IA) has been acknowledged. It seems necessary to educate people aboutthe harmful effects of irresponsible internet use and the risk it has been posing to our health^2,3.

According to estimates, the prevalence of digital eye strain (DES), also known as computer vision syndrome, maybe 50% or more among computer users^.4. Computer users frequently complain of musculoskeletal issues and pain in their upper extremities and neck-shoulder region⁵. Internet overuse leads to sedentary lifestyles and a deterioration in physical fitness. A correlation has also been found between the level of stress and IA⁶.

Internet addiction affects sleep patterns and brain changes, which eventually lead to depression. Long periods of time spent online at night make it difficult to sleep and might lead to irregular sleeping patterns⁷. Research demonstrated that using the internet too much might make it harder to spend time with friends and family, which shrinks social networks and increases loneliness and stress levels^8,9.

There is a lack of data on the interventional studies related to internet addiction and associated health hazards among students, which requires urgent attention to increase awareness about the negative consequences of irrational internet use on physical and mental health. The educational intervention would help them develop healthy practices and prevent the health hazards of internet addiction. Therefore, the objective of the study was to evaluate the effectiveness of educational intervention inpreventing health problems due to internet addiction in terms of knowledge and practice and to find out the association of post-test knowledge and practice scores with selected demographic variables. (Gender, Academicyear, Education of father, Education of mother)

MATERIALS AND METHODS:

Quantitative Experimental research with a one-grouppre-test, and post-test design was conducted at PGDAV College, New Delhi. The sample of 54 college students were taken up after surveying to assess the prevalence of internet addiction (a self-reported tool by Dr.K.Young) among 288 college students and those identified having moderate to severe addiction were recruited for the study using total enumeration sampling. Data was collected from 17^th December 2019 to 10^th January 2020.

Three-part questionnaires were used to gather the data a) socio-demographic Profile; b) structured knowledge questionnaires; c) Expressed practice checklist. The researcher developed A structured knowledge questionnaire comprising 30 multiple-choice questions covering areas like eye problems, musculoskeletal problems, Obesity, Sleep problems, Depression, and Anxiety due to internet addiction. Each correct response was awarded a score of 1 and the wrong answer was given a score of 0. The maximum score was 30. The scores ranging from 0-10 were classified as poor knowledge, 11-20 as fair knowledge, and 21-30 as good knowledge.

The expressed practice checklist is a tool developed by the researcher and consisted of 20 questions covering the preventive practices for health problems such as eye strain, muscle strain, insomnia, depression, and anxiety due to excessive internet use measured on 3 3-pointLikert scale. The most appropriate responsescored 2 and the least scored 0. The scores range from 0-10 depicting poor knowledge, 11-20 as fair knowledge,21-30 as good knowledge, and 31-40 as excellent knowledge. The content validity of the tool is measured by submitting it to 8 experts from the field of psychiatry and clinical Psychology, ophthalmology, physical Medicine, and Nursing Education, for their expert opinion. Necessary modifications were incorporated. Using the Kuder-Richardson formula (KR 20), the reliability of the structured knowledge questionnaire was determined to be 0.87, while the reliability of the expressed practice checklist was determined to be 0.7.

An educational intervention on the prevention of health problems due to internet addiction was developed based onthe literature review on the prevalence and healthproblems associated with internet addiction, consultation with experts, and the researcher's personal experience. It comprised of Power Point presentation, an Information booklet, Flashcards, and a Demonstration of exercises to prevent eye strain and muscle strain of the upper extremities. The content outlines the Introduction to internet addiction and its signs and symptoms, health problems due to internet addiction with the signs and symptoms, causes, prevention, and treatment covering eye strain, repetitive strain injury, carpal tunnel syndrome, insomnia, obesity, depression, and anxiety. The tool`s content validity was established.

Ethical permission was obtained from the concerned authority of PGDAV College, New Delhi. Informed consent was taken from the participants and given full autonomy for study withdrawal at any time. The anonymity and confidentiality of the participants were maintained throughout the study.

RESULT:

Table 1: Frequency percentage of socio-demographicsof studentsn=54

Demographics Characteristics

Frequency

Percentage

Age (in years)

16-20

21-24

94.4

5.6

Gender

Male

Female

42.71

57.29

Academic year

1^st

2^nd

3^rd

59.3

29.6

11.1

Type of family

Joint

Nuclear

42.6

57.4

Place of residing

Home

Hostel

90.7

9.3

Educational status of the father

Illiterate

primary

Elementary

Secondary

Senior Secondary

Graduate and above

3.7

14.8

13.0

9.2

46.3

Educational status of the mother

Illiterate

primary

Elementary

Secondary

Senior Secondary

Graduate and above

14.8

9.3

16.6

13.0

9.3

Table 1 provides an overview of the students' demographic characteristics. The majority of students, accounting for 94.4%, fell within the age group of 16-20 years. In terms of gender distribution, 57.29% were female, while 42.71% were male. Additionally, a significant portion, constituting 59.3%, were in their 1st year of college. Regarding family structure, the majority of students (59.72%) belonged to nuclear families, and an overwhelming majority (90.7%) were residing at home. Notably, the education status of both fathers and mothersof most students was graduate and above.

The data in table 2 shows that the mean gain in knowledge (6.79) was found to be statistically significant (t=18.39, df =53) at a 0.05 level of significance. This indicates that the educational intervention was effective in enhancing the knowledge of college students.

Data intable 3 depicted that the meanpost-test practice scores (26.04) were higher than the mean pre-test scoresand the mean gain in practice scores (6.21) was found to be statistically significant (t=14.76, df=53) at a 0.05 level of significance. This indicates that the educational intervention was effective in increasing the practice scores of college students.

Table 4 depicts that the academic year (p=0.002), education of the father (p=0.04), and education of the mother (p=0.004) of the students were found to be statistically significant. However, gender (p=0.36) was not found to be statistically significant.

Table 2: Mean knowledge scoreof the students

Scores	Mean	n	Mean difference	Standard deviation	Standard error of the mean difference	t value
Pre-test	12.67	54	6.79	2.71	0.37	18.39*
Post-test	19.46	54	6.79	2.71	0.37	18.39*

t-testd(f)=53 * = significant at ≤ 0.05

Table 3: Mean practice scores of the students

scores	Mean	n	Mean difference	Standard deviation	Standard error of the mean difference	t value
Pre-test	19.83	54	6.21	3.11	0.42	14.76
Post-test	26.04	54	6.21	3.11	0.42	14.76

t-test d(f)=53 * = significant at ≤ 0.05

Table 4: Association of post-test knowledge score and selected variablesn=54

	Selected variables						Total	Chi-square
Post-test Knowledge scores Fair Good Total	Gender						29 25 54	ꭓ2=1.22 d(f)=1 p=0.36
	Male			Female
	14 9 23			15 16 31
Fair Good Total	Academic Year						30 24 54	ꭓ2=11.3 d(f)=2 P=0.002^*
	1^st year			2^nd		3^rd year
	24			5		1
	8			11		5
	32			16		6
Fair Good Total	Education of father						30 24 54	ꭓ2=10.39 d(f)=5 P=0.04^*
	illiterate	primary	Elementary	Secondary	Senior Secondary	Graduate and above
	7	0	5	4	4	10
	0	2	3	3	1	15
	7	2	8	7	5	25
Fair Good Total	Education of mother						30 24 54	ꭓ2=17.55 d(f)=5 P=0.004
	illiterate	Primary	Elementary	Secondary	Senior Secondary	Graduate and above
	7	4	7	5	3	4
	1	1	2	2	2	16
	8	5	9	7	5	20

# Yates correction applied * significant at (p< 0.05)

Table 5: Association of post-test expressed practice score and selected variables n=54

	Selected variables						Total	Chi-square
Post-test practice scores Fair Good Excellent Total	Gender						1 49 4 54	ꭓ2=1.59 d(f)=2 P=0.47
	Male			Female
	1			0
	20			29
	2			2
	23			31
Fair Good Excellent Total	Academic Year						1 49 4 54	ꭓ2=4.28 d(f)=4 P=0.45
	1^st year		2^nd year		3^rd year
	0		1		0
	30		13		6
	2		2		0
	32		16		6
Fair Good Excellent Total	Education of father						1 49 4 54	ꭓ2=12.2 d(f)=10 P=0.28
	illiterate	Primary	Elementary	Secondary	Senior Secondary	Graduate and above
	0	0	1	0	0	0
	7	2	7	5	5	23
	0	0	0	2	0	2
	7	2	8	7	5	25
Fair Good Excellent Total	Education of mother						1 49 4 54	ꭓ2=15.5 d(f)=10 P=0.11
	illiterate	Primary	Elementary	Secondary	Senior Secondary	Graduate and above
	0	1	0	0	0	0
	8	4	7	7	4	19
	0	0	2	0	1	1
	8	5	9	7	5	20

# Yates correction applied * significant at (p< 0.05)

DISCUSSION:

Thecurrent studywas to determine the effectiveness of educational intervention in the prevention of health problems due to internet addiction.

In the present study, there was a significant gain in knowledge in all the areas like internet addiction, eye problems, musculoskeletal problems, obesity, sleep, and psychological problems after the educational intervention which is congruent with the study by Chander in which knowledge scores in mental health and physical health areas were increased after structured teaching program¹⁰.

The majority of the students were in the poor category on knowledge scores in theprevention of eye problems due to internet addiction which is in line with a narrative review to assess knowledge of DES (digital eye syndrome) to address the negative effect of gaming disorder and internet addiction on vision, reported the subjects experiencing eye strain¹¹. The low knowledge scores in the musculoskeletal problems category of the study suggested poor knowledge of body mechanic practices while using the Internet by college students and the findings are in alignment with a review conducted by Heydari Abdolahi F reported only 5% or fewer of the students were aware of the concepts of functioning ergonomically while using e-devices, and they are in danger of acquiring musculoskeletal problems^12.

The present study reported poor knowledge of sleep problems due to internet addiction and preventive practices for insomnia among students which aligns with the findings of the study by Awasthi reported that internet addiction is related to poor sleep quality in college students¹³. Students also had poor knowledge about the psychological problems that may occur due to internet addiction and preventive practices to manage those problems which is consistent with the study by Kumar found depression, anxiety, and interpersonal sensitivity to be correlated with Internet addiction¹⁴.

The current study revealed that there was no association of gender with the knowledge scores. However, the findings are inconsistent with a study conducted by Chander in which a significant association of gender was noted with knowledge scores. The possible reason for the contradiction with the findings of the study is that the subjects in the study were students of nursing colleges¹⁰. In the current study, a significant association of knowledge scores with the education of the father and mother was found which is consistent with the findings of a study by Nepal¹⁴.

Thecurrent study revealed that educational intervention was effective in augmenting the knowledge and practice of college students. These findings concurred with the study conducted by Chander in which there was a significant improvement in the knowledge scoresnoted¹⁰. The findings are also in line with a similar study conducted by Nepal where there was a mean gain in knowledge scores of 36.4% after the structured teaching Programme on Facebook addiction¹⁴. Collectively, these congruent findings underscore the potency of educational interventions in enhancing awareness and knowledge regarding the adverse effects of internet addiction among students, thereby emphasizing the importance of such programs in mitigating this growing concern.

Thestudy findings are consistent with the study conducted by Gholamian where the knowledge scores wereincreasedafter being exposed to the educational intervention based on the BASNEF model (Beliefs, Attitudes, Subjective Norms, and Enabling Factors)¹⁵. However, the study, exclusively examined high school girls aged 16 to 17 years, while our study encompassed college students of both genders. Interestingly, in both studies, there were positive outcomes in terms of knowledge scores across diverse gender groups.

In this paper, the effectiveness of educational intervention inthe prevention of health problems due to internet addiction in terms of knowledge and practice was evident. The study delved into the students' awareness of health issues, specifically pertaining to the eyes, musculoskeletal system, sleep patterns, obesity, and psychological well-being, all of which could be affected by irresponsible internet use. Importantly, the educational intervention not only explored these health concerns but also imparted preventive practices to empower students in safeguarding their well-being in the digital age.

The study also has limitations due tothe small sample size and convenience sampling technique used, which restricts the generalizability of the study's findings. Additionally, the post–test was conducted on the 8th day of the pre-test which called for pre-test sensitization bias.

CONCLUSION:

The educational intervention was implemented successfully and was found effective in increasing knowledge and practiceon the prevention of health problems due to internet addiction among college students. Implementation of preventive strategies for inculcating safe and healthy internet usage among students is needed and educational intervention is proven to be instrumental as one of the strategies to combat the ill effects on health due to internet addiction. In future works, it is suggested to investigate the impact of the educational intervention by an extensive selection of colleges and compare the knowledge and practice of students belonging to metropolitan cities and rural areas.

CONFLICT OF INTEREST:

No conflict of interest.

ACKNOWLEDGEMENTS:

The PGDAV College (Morning Shift) Principal, Mr. Mukesh Aggarwal, and Mr. Surender Kumar, Burser, have given the authors permission to perform the research study, for which the authors would like to express their sincere gratitude.

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Received on 19.08.2023 Modified on 22.09.2023

Int. J. Nur. Edu. and Research. 2023; 11(4):309-314.

DOI: 10.52711/2454-2660.2023.00070