INTRODUCTION:

The internet has evolved as media channel for personal communication, academic research, information exchange, and entertainment.^[1]India became the world’s second-largest Internet user base by this December, 2015 overtaking the US.

This is among the many interesting findings in the ‘Internet in India 2015’ Report released by the Internet and Mobile Association of India (IAMAI) and IMRB International. According to report, India will have 402 million Internet users by December 2015 and its user base has increased by 49 per cent compared to last year. In October 2015, 317 million Indian users accessed Internet.^[2]The rapid development in technology resulted in paying the cost of internet for educational purposes by many families. In some cases, internet is used to establish quick connections around the world. Many applications in science and technology and attractiveness of the internet usage have led to the emergence of internet addiction in recent years. While the positive aspects are renowned, concerns continue to mount regarding problematic Internet usage behaviors. The Internet has been gaining worldwide popularity in recent years, but a loss of control over Internet use might lead to negative impacts on our daily lives. Problematic computer use is a growing social issue which is being debated worldwide. Internet Addiction Disorder (IAD) ruins lives by causing neurological complications, psychological disturbances, and social problems. The term “internet addiction” was proposed by Dr. Ivan Goldberg in 1995 for pathological compulsive internet use. Griffith considered internet addiction as a subset of behavior addiction and any behavior that meets the 6 “core components” of addiction i.e., salience, mood modification, tolerance, withdrawal, conflict, and relapse. Young linked excessive internet use most closely to pathological gambling, a disorder of impulse control. According to her, various types of internet addiction are cyber-sexual addiction, cyber-relationship addiction; net compulsions, information overload, and computer addiction. Caplan’s findings also indicated that social isolation plays a greater role in behavioral symptoms of pathological internet use than does the presence of psychopathology. Hence, Caplan suggested replacing the term “pathological internet use” with “problematic internet use. ^[3]College life is accompanied by many new stressful challenges, with increased freedom, self-responsibility, disorganized lifestyle, variable schedules, repeated deadlines, dormitory living, and social and academic obligations. During the undergraduate nursing program, the student nurses are likely to experience even “more stress” than their friends and colleagues enrolled in other programs. These students are especially vulnerable to develop dependence on the Internet, more than most other segments of the society. The Internet offers a route of escape from exam stress, all of which make Internet overuse a significant cause of concern for parents and faculty.^[4]It was noticed that students experiencing sleep deprivation try to avoid more difficult tasks. Also, they often are not aware that the difficulties they have academically can be directly related to their poor sleep quality. Nursing students usually have an irregular sleep pattern, characterized by changing start time and end time, which occur later at weekends, compared to weekdays. Moreover, during the week sleep time is shorter in relation to the weekend, because students undergo sleep deprivation during the school day or clinical practice, as in the case of nursing students. Such irregularities may have a negative impact on students' health, and is thus a risk factor.^[5]It is studied that the prevalence of insomnia was highest in Internet addicts, middle in possible addicts, and lowest in non-addicts. With adjustment for duration of Internet use, duration of sleep time, age, gender, smoking, taking painkillers due to headache, insomnia symptoms, witnessed apnea, and nightmares, the odds of excessive daytime sleepiness were 5.2-fold greater in Internet addicts and 1.9-fold greater in possible Internet addicts compared to non-addicts.^[6,7] Despite the increasing prevalence of internet addiction and its link with mental health and insomnia, relatively few studies have examined the nature of internet addictions influence on insomnia and mental health among nursing students^.Hence this study was conducted.

· To find the pattern of internet usage and to estimate the prevalence of internet addiction among nursing students in a premier institute of India.

· To study the quality of sleep among these subjects

· To examine the association between internet addiction and selected socio demo graphic variables.

METHODS:

Study Design:

The present study used a cross sectional design, where the subjects’ were assessed pattern of internet use and the quality of sleep. The objectives were to study the pattern of internet use and to estimate the prevalence of internet addiction, to study the quality of sleep among the subjects and to find the association between internet addiction and selected socio demographic variables.

Setting and Sample:

Universal sampling method was adopted where 171 students who were enrolled in B.Sc. (Hons) Nursing course in the selected nursing college in Bhopal participated. Subjects who had significant chronic illness were excluded.

Ethical Considerations:

This study was approved by the Institute Human Ethics Committee (IHEC), All India Institute of Medical Sciences, Bhopal, India. The participants’ confidentiality, and anonymity were assured and they were informed that they could withdraw from the study anytime at their request without any disadvantages.

Measurements:

The subjects’ were given Socio Demographic Sheet, The Young’s Internet Addiction Test and Pittsburgh Sleep Quality Index.

The Young’s Internet Addiction Test:

The Internet Addiction Test developed by Kimberly Young- 1998, a 20-item 5-point Likert scale that measures the severity of self-reported compulsive use of the internet with an alpha coefficient of 0.93. Total internet addiction scores are calculated, with possible scores for the sum of 20 items ranging from 20 to 100. According to Young’s criteria, total IAT scores 20-39 represent average users with complete control of their internet use, scores 40-69 represent over-users with frequent problems caused by their internet use, and scores 70-100 represent internet addicts with significant problems caused by their internet use.^[8]

Pittsburgh Sleep Quality Index (PSQI):

Pittsburgh Sleep Quality Index (PSQI) by Buysse and co-workers (1980) used to measure the quality and patterns of sleep. It differentiates “poor” from “good” sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction over the last month. The client self-rates each of these seven areas of sleep. Scoring of answers is based on a 0 to 3 scale. A global sum of “5” or greater indicates a “poor” sleeper. The PSQI has internal consistency and a reliability coefficient (Cronbach’s alpha) of 0.83 for its seven components.^[9]

Data Collection:

After getting The IHEC approval, the researchers visited the nursing college and explained the study contents and role of the study participants. A total of 171 students were consented and participated.

Data Analysis:

Data were analyzed using SPSS 18 version. Nominal variables were summarized as counts and percentages. Chi square test was used for association between numerical variables. Comparison of internet addicts and non addicts was done by chi square and unpaired t test.

RESULTS AND DISCUSSION:

General Characteristics:

General characteristics of the participants were described in Table 1.

Table 1: Frequency and Percentage Distribution of Subjects Based On Their Personal Profile (n=171)

Sl. No	Sample characteristics		Frequency	Percentage
1	Age	18 Years	32	18.7
		19 Years	53	30.9
		20 Years	52	30.4
		21 years	27	15.8
		22 years	04	2.3
		23 years	03	1.7
2.	Year of study	I Year	59	34.5
		II Year	58	33.9
		III Year	54	31.6
3.	Religion	Hindu	121	70.8
		Christian	35	20.5
		Muslim	6	3.5
		Others	9	5.3
4.	Education	Higher Secondary	169	98.8
4.	Education	Graduation	2	1.2
7.	Residence	Rural	40	23.4
		Urban-town	114	66.7
		Metro	17	9.9

Among 171 B. Sc (N) students 32(18.7%) of them were 18 years, 53(30.9%) of them were 19 years old 52(30.4) of the students were 20 years, 27(15.8%) of them were 21 years old, 4(2.3%) and 3(1.7%) of the students were 22 and 23 years old respectively. With regards to the gender, all the subjects 171(100%) were females. All the subjects 171(100%) stay in hostel. Out of the 171 students 59(33.5%) of them doing I year B.Sc (Hons) Nursing, 58(33.9%) of the students belong to II year B.Sc (Hons) Nursing and 54 (31.6%) of the students are in the III Year of the course.

Table 2: Frequency and percentage distribution of subjects based on their family profile (n=171)

Sl. No	Sample characteristics		Frequency	Percentage
1	Type of family	Nuclear	136	79.5
1	Type of family	Non Nuclear	35	20.5
2.	Father’s education	Illiterate	4	2.3
		Secondary	32	18.7
		Higher Secondary	45	26.3
		Graduate	61	35.7
		Post-graduate	27	15.8
3.	Mother’s education	Illiterate	9	5.3
		Secondary	52	30.4
		Higher Secondary	53	31.0
		Graduate	39	22.8
		Post-graduate	17	9.9
4.	Father’s occupation	Unskilled worker	22	12.9
		Semi-skilled worker	91	53.2
		Skilled worker	35	20.5
		Professional worker	9	5.3
5.	Mother’s occupation	House wife	131	76.6
		Semi-skilled worker	10	5.8
		Skilled worker	19	11.1
		Professional worker	2	1.2

Table 2. provides the information regarding subjects’ family type, parents’ education, occupation, family income and chronic illnesses in the family. The result of the present study was consistent with T. Jain et al. who noted that the students were of 17-26 yrs of age with mean age of 19.29 years.^[10]

The Pattern of Internet Usage and the Prevalence of Internet Addiction.

A considerable number of researches on internet usage pattern and addiction among college students can be found in other countries. However, Indian studies remain limited and particularly among nursing students. Descriptive statistics were used to find the respondents internet usage pattern which includes purpose of using internet, location of internet access, device used for access, money spent, frequency and duration. It is found that most of the subjects159 (93%) use internet for social networking.

Figure 1: Distribution of Subject Based on Purpose of Internet Use

Around 154(90%) students using internet for education and 144(84%) of them access internet for the entertainment purpose. On the contrary out of 171 students only 3(1.8%) of them using internet for business purpose. (Fig.1). Similar results were also found in Goel^[3], Teong KV^[11]study among students. The findings are not unexpected as the present generation of students are known to be constantly checking their email messages, face booking and engaging in online games. In addition computer classes are included in their school curriculum. Thus exposing this generation formally to the internet at a young age. Mobile phones became an indispensable gadget of student’s life. It has been observed in this study that mobile phone was the main source for accessing internet for almost all of the students (99.4%). It was reported that owning a mobile phone is one of the main reasons for problematic internet use. These results mimic the findings the study conducted in Nepal, Saudi and Egypt. This resemblance dictates that the source of access to internet is similar globally among students.^[12]

Around 167(96.5%) students using internet for while they are in college and 156(91.2 %) of them access internet at their living place. only 4(2.3%) of them using cybercafé for their internet access. Around 167(96.5%) students using internet for while they are in college and 156(91.2 %) of them access internet at their living place. Only 4(2.3%) of them using cybercafé for their internet access. (Figure 2.)

Figure 2 : Distribution of Subject Based on Access of Internet Use

Figure 3: Distribution of Subjects Based on the Money Spent on Internet

Most of the subjects 91(53.2 %) access internet during night time. Around 61(35.7%) students using internet at evening while 15(8.8 %) and 4(3.3%) of the students use internet during afternoon and morning hours respectively (Figure 3.) This finding was consistent with Goel et al study where most of the addicts used the internet mostly in the evening and nights as compared to other users who used it in the mornings and afternoons as well. ^[3] Duration of internet use has a close relationship with internet addiction, the longer the duration, the more risk is to be addicted^[13]. In this study, most of the subjects 82(48%) spent on internet between 1 to 3 hours a day, 62(33.3%) of the students spent less than an hour per day. Around 26(15.2%) of the subjects reported that they spare between 3 to 6 hours of time in a day for internet. Only one student (0.6%) mentioned that spending more than 6 hours per day for internet use. (Fig.4). This is parallel to Teong KV study conducted among students in Malaysian public universities.^[11]

Prevalence of Internet addiction among the Subjects:

It has been observed that university students are among the high risk groups for internet addiction because they use internet for both educational and entertainment. In addition access to Wi-Fi in the campus and absence of parental control are the factors could be reason for overuse of internet.

Figure 4: Distribution of Subjects Based on the time Spent on Internet

The present study revealed that majority i.e. 140(81.9%) of the subjects reported to have average use of internet; while, 30(17.5%) of them have occasional or frequent problem. Only one subject (0.6%) reported to have significant internet addiction (Fig.5). This prevalence rate seems to be in par with what has been studied in the literature among students.^{[1], [3], [14-16]}

Figure 5 : Distribution of Subject Prevalence of Internet Addition

Level of Sleep Quality among the Subjects:

Several studies have reported that internet addiction has negative impact on the metal health of the students. As sleep in one of the essential indicator for mental health this study intended to find the level of sleep among the nursing students. Sleep is essential for our physical, intellectual and emotional health. It was found that sleep has the largest effect on semester grades compared to the other health related variables. If a person reduces the amount of sleep by only one hour in a night, it still has a significant impact on next day functioning.^[17]

Table 3: Distribution of Subjects Based on their level of Sleep Quality (n=171)

Sl. No	Level of sleep quality	n	Percentage
1	Poor sleep quality	88	51.5
2	Good sleep quality	83	48.5

Indeed this study showed 88(51.5%) of the students reported to have poor sleep quality whereas 83(48.5%) of them have mentioned good sleep quality. (Table 3).These findings were consistent with Hsu et al study^[18] conducted among nursing students where more than half of participants (53%) had poor sleep quality. However, Entsarkamel M et al reported highest numbers of nursing students had poor sleep. ^[19]

Association between Patterns of internet use and Internet Addiction Disorder:

The association between study subjects’ patterns of internet use with internet addiction disorder was done. There was significant association was found between subjects’ internet addiction and students used internet for the purpose of education with the p value of 0.009. (Table 4). However there were no other socio demographic variables had shown significant impact. To mention, a study by Lam et. al reported that students who were very dissatisfied with their family were nearly 2.5 times more likely than those who were satisfied with their family, to be addicted to the Internet. ^[20]

Table 4: Association between Patterns of internet use and Internet Addiction Disorder

Sl. No	Variable		Internet Addiction Disorder			p value
			Average	Occasional problem	Significant problem
			No (%)
1.	Purpose Of Internet- Education	No	14(82.4%)	2(11.8%)	1(5.9%)	0.009 (S)
		Yes	126(81.8%)	28(18.2%)	0
2.	Purpose Of Internet- Entertainment	No	25(92.6%)	2(7.4%)	0	0.284 (NS)
		Yes	115(79.9%)	28(19.4%)	1(0.7%)
3.	Purpose Of Internet- Business	No	137(81.5%)	30(17.9%)	1(0.6%)	0.713(NS)
		Yes	3(100%)	0	0
4.	Purpose Of Internet- Social Net Working	No	12(100%)	0	0	0.24(NS)
		Yes	128(80.5%)	30(18.9%)	1(0.6%)
5.	Access Of Internet-Home	No	15(100%)	0	0	0.16(NS)
		Yes	125(80.1%)	30(19.2%)	1(0.6%)
6.	Access Of Internet-Cybercafé	No	136(81.4%)	30(18%)	1(0.6%)	0.63(NS)
		Yes	4(100%)	0	0
7.	Access Of Internet-Workplace	No	6(100%)	0	0	0.50(NS)
		Yes	134(81.2%)	30(18.2%)	1(0.6%)
8.	Access Of Internet-Mobile	No	1(100%)	0	0	0.89 (NS)
		Yes	139(81.8%)	30(17.6%)	1(0.6%)

S- Significant; NS-Not Significant

CONCLUSION:

Proper sleep length and quality are essential for physical and mental health and poor sleep quality has been found to be associated with poor academic achievement and health. Internet addiction disorder has proven to have significant effect on sleep quality. College students are recognized as one of the most sleep-deprived groups especially nursing students as they need to deal with patient care delivery. Careful evaluation of the exposure of students to internet and their sleep habits and daytime functioning will help to identify the nursing students who are under the risk of internet addiction and sleep problems. It is therefore recommended that secondary preventive measures like ‘monitoring nursing students respect to their internet use and early counseling, services be provided to promote sleep hygiene and to deal with stress is the need of the hour.

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Received on 29.11.2016 Modified on 24.12.2016

Int. J. Nur. Edu. and Research. 2017; 5(2): 154-159.

DOI: 10.5958/2454-2660.2017.00032.1