The Influence of Smartphone Use and Smartphone Addiction on Sleep Quality among Universiti Kebangsaan Malaysia Students

(1)

Buletin SK 6(2)(2022): 33 – 38 ISSN 2250-1852

http://myjms.mohe.gov.my/index.php/bsk

Copyright © 2022 Faculty of Health Science UKM. All right reserved Artikel Asli/Original Article

The Influence of Smartphone Use and Smartphone Addiction on Sleep Quality among Universiti Kebangsaan Malaysia Students

Pengaruh Penggunaan Telefon Pintar dan Ketagihan Telefon Pintar ke atas Kualiti Tidur dalam Kalangan Pelajar Universiti Kebangsaan Malaysia

SHASVINE VIKNESH SUGUMARAN, NUR NAZIHAH BINTI HAZIZI, FARAH NATASHA BINTI MOHD ARIS, PEI YIN WONG, NUR FADHILAH BINTI FAIZ, SANGEETHA MANIMARAN,

HAMZA MUSHTAQ DAR, ABDUL MUTAAL & CHING SIN SIAU

ABSTRACT

Smartphone addiction has been increasing among university students. Excessive smartphone use may lead to smartphone addiction and may cause sleep disturbance among university students. This cross-sectional study examined the influence of smartphone use and addiction on sleep quality among university students at the National University of Malaysia (UKM). University students (N=142) were recruited through convenience sampling. All participants were asked to complete an online questionnaire consisting of demographic information, Malay Smartphone Addiction Scale-Short Malay Version (SAS-SV Bahasa Malaysia), and Pittsburgh Sleep Questionnaire Index Malay version. The results showed that there was a weak positive correlation between duration of smartphone use, smartphone addiction, and sleep quality. The multiple linear regression analysis showed that higher levels of smartphone addiction (ß=0.307, p<0.001) and longer smartphone use duration (ß=0.194, p=0.024) independently predicted poorer sleep quality. Hence, university students with smartphone addiction should be provided with knowledge and skills to overcome their addiction.

Keywords: Smartphone, smartphone use, smartphone addiction, sleep quality

ABSTRAK

Kadar ketagihan terhadap telefon pintar dalam kalangan pelajar universiti semakin meningkat. Penggunaan telefon pintar yang berlebihan didapati telah membawa kepada ketagihan penggunaan telefon pintar yang mengakibatkan masalah tidur dalam kalangan pelajar universiti. Kajian keratan rentas ini menyelidik pengaruh penggunaan dan ketagihan telefon pintar terhadap kualiti tidur pelajar di Universiti Kebangsaan Malaysia (UKM). Pelajar universiti (N=142) telah direkrut melalui pensampelan mudah. Semua peserta telah diminta untuk melengkapkan borang soal selidik dalam talian yang merangkumi profil demografi, Smartphone Addiction Scale versi pendek Bahasa Malaysia (SAS-SV Bahasa Malaysia) dan Pittsburgh Sleep Questionnaire Index versi Bahasa Malaysia. Hasil kajian menunjukkan terdapat perhubungan positif yang lemah antara tempoh penggunaan telefon pintar, ketagihan telefon pintar dan kualiti tidur. Analisis regresi linear berganda menunjukkan bahawa tahap ketagihan telefon pintar yang lebih tinggi (ß=0.307, p<0.001) dan tempoh penggunaan telefon pintar yang lebih lama (ß=0.194, p=0.024) secara bebas meramalkan kualiti tidur yang lebih buruk. Oleh itu, pelajar universiti yang ketagih terhadap telefon pintar perlu diberikan langkah pencegahan yang sewajarnya.

Kata Kunci: Telefon pintar, penggunaan telefon pintar, ketagihan telefon pintar, kualiti tidur

INTRODUCTION

A smartphone is an essential tool which provides applications for communication, information, education, and entertainment (Khoury et al. 2017).

According to the Department of Statistics Malaysia (2020), the percentage of individuals that use mobile phones increased from 97.9% in 2019 to 98.2% in 2020.

Smartphone addiction is also known as

problematic smartphone use (PSU), or smartphone dependence (Sohn et al. 2021) which is a behavioral addiction that involves human-machine interaction. A meta-analysis showed that Malaysia has one of the highest levels of smartphone addiction among 24 countries (Olson et al. 2022).

Interestingly, two studies found that the prevalence of smartphone addiction did not change before and during the COVID-19 pandemic, even though the duration of smartphone use had increased (Sui et al.

(2)

34 Bul. Sains Kes.

2022; Yang et al. 2021). Smartphone overuse is known to cause sleep problems and somatic effects such as fatigue, tension, headache and dizziness, and social problems (Nasser et al. 2020). Previous studies also reported that smartphone addiction is associated with sleep disorders, depressive and anxious symptoms and reduction in academic and labour performance (Thomée et al. 2011). A study conducted by Haripriya et al. (2019) showed that extended use of smartphones decreased the quality of sleep, and led to increased symptoms of insomnia in most of the participants. According to an Italian study by Serra et al. (2021) children and adolescents spend more time on smartphones for social support, communication, online education, and entertainment due to the prohibition of socializing physically during the COVID- 19 pandemic. Hence due to the extensive usage, students may develop an addiction to the smartphone, which could lead to poor sleep quality.

This has been supported by Kumar et al. (2019), that smartphone addiction was found to be associated with poor sleep quality among students in the university.

There are numerous studies on smartphone addiction and sleep quality. However, further research is needed to study the relationship of detailed information on the pattern of smartphone use and their demographic data (Luk et al. 2018), relationship between smartphone duration.

Towards the end of 2019, a pandemic situation was caused by the outbreak of the novel coronavirus, COVID-19 worldwide. One significant lifestyle change during the lockdown or Movement Control Order (MCO) is the increased reliance on the internet and smart devices (Saadeh et al 2021).

Therefore, this study aimed to examine the influences of the duration of smartphone use and smartphone addiction on sleep quality among National University of Malaysia (UKM) students.

MATERIALS AND METHODS

RESEARCH DESIGN, PARTICIPANTS AND SAMPLE SIZE CALCULATION

This was a cross-sectional study conducted among National University of Malaysia (UKM) students.

Inclusion criteria in this study were local and international students of the National University of Malaysia (UKM) aged 18 to 45 years old with no vision problems, literate and able to provide informed consent and have an internet network connection. The sample size for this study was estimated using G*Power software version 3.1 with medium effect size f² = 0.15, α err prob = 0.05, power (1-β err prob) = 0.80, and with 10 predictors. Hence, a total sample size of 142 participants (given a 20% dropout rate) were

needed for this study (Faul et al. 2007).

MEASURES

The demographic profile sheet consisted of age, gender, marital status, nationality status, current academic level, and faculty. Duration of smartphone use consisted of a question on hours spent on the smartphone in a 24-hour period, adapted from Lee et al. (2021).

The Malay Smartphone Addiction Scale short version (SAS-SV Malay) was used to examine smartphone addiction was developed by Ching et al. (2020), which consists 19 items. The scoring of SAS-SV Malay was done by adding the scores altogether which yielded a total score. The respondents with a score of ≥36 are considered to have smartphone addiction symptoms (Ching et al.

2020).

The Pittsburgh Sleep Quality Index (PSQI) was developed by Buysse et al. 1989 the PSQI was used to provide a reliable, valid, and standardised measure of sleep quality, and to distinguish between good and poor sleepers among test takers.

The validated Malay PSQI (Farah et al. 2019) consisted of 19 items. Each of the seven components was equally weighted on a scale ranging from 0 to 3. The total score was compiled and those respondents who scored a global score of 5 or higher were considered poor sleepers.

DATA COLLECTION

Data was collected using an online questionnaire place on the Google Form platform. The questionnaire was distributed using convenience sampling through friends and relatives of the researchers, and was posted on social media such as WhatsApp and Facebook. Participation was voluntary, and participants who consented to join the study clicked in a box indicating their informed consent before being directed to the questionnaire.

It took approximately 10 minutes for the participants to answer the questionnaire. This study was carried out in accordance with the principles of the Declaration of Helsinki to ensure ethical research conduct involving human subjects.

DATA ANALYSIS

Data was analysed using three methods which were descriptive statistics, Pearson’s correlation, and multiple linear regression using the IBM Statistical Package for Social Sciences (SPSS version 27.0).

A p-value of less than 0.05 w a s considered statistically significant.

After data cleaning to remove outliers, data normality was tested using skewness and Kurtosis values of <±2.00 and <±7.00 respectively (Kim 2013). Missing data were deleted listwise. Multiple

(3)

linear regression was carried out to determine if the duration of smartphone use and smartphone addiction independently influenced sleep quality after adjusting for demographic variables.

RESULTS

A total of 142 participants completed the questionnaire. After excluding those with missing data, 141 participants were analysed. More than

half (58.2%) of the participants were between 18 and 25 years old, with a large majority being females (92.2%), single (80.1%), and Malaysian citizens (92.2%). Participants reported a mean of 6.53 hours of smartphone use (SD = 3.08), smartphone addiction mean score of 32.88 (SD = 8.97), and mean PSQI score of 7.06 (SD = 3.63). A total of 53.2% of the participants had smartphone addiction symptoms and nearly three-thirds of the participants (73.8%) had poor sleep quality (Table 1).

TABLE 1 The demographic characteristic of participants (N = 142) Characteristic Frequency (n) Percentage (%) Age

18-25 26-50

82 59

58.2 41.8 Gender

Male Female

11 130

7.8 92.2 Marital status

Single Married

113 28

80.1 19.9 Nationality

Non-Malaysian Malaysian

11 130

7.8 92.2 Academic level

Postgraduate Undergraduate

66 75

46.8 53.2

A positive weak correlation was observed between duration of smartphone use and smartphone addiction r (139) = 0.366, p <

0.001; duration of smartphone use and sleep quality r (139) = 0.264, p = 0.002; and smartphone addiction and sleep quality r (139) = 0.364, p <

0.001. This means higher smartphone addiction is correlated with longer smart phone use duration and worse sleep quality. Longer smart phone use duration was also correlated with worse sleep quality.

The findings to determine whether the duration of smartphone use and smartphone addiction were independently associated with sleep quality after

adjusting for demographic variables are presented in Table 2. Data analyzed using multiple linear regression. From this analysis, smartphone addiction (ß = 0.307, p < 0.001) has the highest beta value, followed by age (ß = 0.272, p = 0.022, p <

0.05) and duration of smartphone use (ß = 0.194, p

= 0.024), showing they were significantly associated with sleep quality. The results suggest that smartphone addiction has the strongest association with sleep quality. In addition, the Mahalanobis distance did not exceed the critical χ² for df = 8 (at = 0.001) of 26.13 for any case data file and that there were no multivariate outliers from this data (Table 2).

TABLE 2 Factors associated with sleep quality

Variables B S. E. 95%CI for B β p-value R²

Lower Upper

Model 1.735 1.910 -2.043 5.512 0.365 0.227

Duration of smartphone

use 0.229 0.101 0.030 0.429 0.194 0.024

(4)

Smartphone addiction 0.124 0.034 0.057 0.191 0.307 <0.001 Age

18 to 24 years old*

> 25 years old 1.997 0.859 0.297 3.697 0.272 0.022

Gender Male*

Female 0.252 1.047 -1.818 2.323 0.019 0.810

Faculty

Faculty of Health Sciences*

Non-Faculty of Health Sciences

0.122 0.723 -1.307 1.552 0.016 0.866

Nationality Non-Malaysia*

Malaysian -1.238 1.153 -3.519 1.042 -0.092 0.285

Marital Status Single*

Married -1.183 0.885 -2.935 0.568 -0.131 0.184

Academic Level Post-graduate*

Undergraduate -0.065 0.745 -1.538 1.408 -0.009 0.931

DISCUSSION

This study aimed to determine the duration of smartphone use, and the proportion of Universiti Kebangsaan Malaysia students who had smartphone addiction symptoms and poor sleep.

The mean daily use of smartphones was 6.53 hours.

This finding was comparable with a study conducted among Korean university students at 6.52 hours (Winskel et al. 2019). The proportion of individuals with smartphone addiction symptoms in this study (53.2%) was slightly higher than another study by Ithnain et al. (2018) at 47.7%. The SAS- SV mean score of 32.88 was higher than the average found in a meta-analysis of 24 countries (Olson et al. 2022). The proportion and score may be higher as during the COVID-19 pandemic, dependence on smartphone may have increased (Caponnetto et al. 2021). Poor sleep affected more than three-thirds of students in this university. In another study, the lockdown during the COVID-19 pandemic was associated with changes in sleep patterns (Ravi et al. 2020), and this may have affected the university students of this study as well..

From this study, the duration of smartphone use has a positive association with sleep quality.

Smartphone usage affected smartphone addiction (Gokcearslan et al. 2016). The use of smartphones for four to six hours or longer causes statistically significantly higher addiction points compared to lower daily use times (Bavli et al. 2018). Greater duration of smartphone use was also associated

with poorer sleep quality. A study from Grimaldi et al. (2020), reported that those who are more likely to use smartphones have a poor quality of sleep (PSQI index >5). In addition, Huang et al. (2020) suggested that poor sleep quality was specifically associated with more than five hours of daily smartphone use among Chinese college students.

According to Ravi and Ngam (2020), sleeping problems may arise due to the radiation from the light emission from the smartphone. Finally, a study suggested that smartphone electromagnetic pollution may be associated with sleep loss among Thai high school students (Chongchitpaisan et al.

2020).

The present study findings were consistent with the past study by Kumar et al. (2019) where smartphone addiction was found to be significantly associated with poor sleep quality. It also reported that smartphone addiction has a deleterious impact on sleep where 68.7% had poor sleep quality compared to 57.1% of those not exhibiting smartphone addiction (Sohn et al., 2021).

Smartphone addiction could change the sleep pattern of a person where they may tend to prefer engaging with the smartphone rather than go to sleep (Dhamija et al., 2021), contributing to bedtime procrastination, longer sleep latency, shorter sleep duration, and lower sleep quality (Zhang et al. 2020).

This study has a few limitations. First of all, it is a cross-sectional study, which does not allow for the inference of cause-and-effect. Secondly, we had used convenience sampling, and as a result did not

(5)

control for bias. Finally, we did not measure other potentially confounding factors that could increase the symptoms of smartphone addiction, such as measuring the direct effect of COVID-19 and personality factors. Future studies should consider addressing these concerns.

CONCLUSIONS

In conclusion, the study also showed that the duration of smartphone use and smartphone addiction were independently associated with sleep quality after adjusting for demographic variables.

The findings emphasise the urgency for future researchers to design interventions on preventive measures and awareness of smartphone addiction among university students leading to poor sleep quality.

ACKNOWLEDGEMENT

We would like to thank all the students who participated in this study.

REFERENCES

Bavli, Ö., Katra, H. & Günar, B. B. 2018.

Investigation of smartphone addiction levels among university students. Uluslar. Kültür.

Sos. Araşt. Derg. 4(1): 326-333.

Buysse, D. J., Reynolds Iii, C. F., Monk, T. H., Berman, S. R. & Kupfer, D. J. 1989. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 28(2): 193-213.

Caponnetto, P., Inguscio, L., Valeri, S., Maglia, M., Polosa, R., Lai C. & Mazzoni, G. 2021.

Smartphone addiction across the lifetime during Italian lockdown for COVID-19. J.

Addict. Dis. 39(4): 441-449.

Chongchitpaisan, W., Wiwatanadate, P., Narkpongphun, A., Tanprawate, S. & Siripon, N. 2020. Sleep loss among Thai high school student’s smartphone users affected by smartphone electromagnetic pollution: Time series study. J. Health Res. 34(4): 317-327.

Dhamija, S., Shailaja, B., Chaudhari, B., Chaudhury, S. & Saldanha, D. 2021.

Prevalence of smartphone addiction and its relation with sleep disturbance and low self- esteem among medical college students. Ind.

Psychiatry J. 30(3): 189-194.

Farah, N. M., Saw, Y. T. & Mohd Rasdi, H. F.

2019. Self-reported sleep quality using the Malay version of the Pittsburgh sleep quality index (PSQI-M) in Malaysian adults. Int. J.

Environ. Res. Public Health 16(23): 4750.

Faul, F., Erdfelder, E., Lang, A.-G. & Buchner, A.

2007. G*Power 3: A flexible statistical power analysis for the social, behavioural, and biomedical sciences. Behav. Res. Methods 39:

175-191.

Grimaldi-Puyana, M., Fernández-Batanero, J. M., Fennell, C. & Sañudo, B. 2020. Associations of objectively assessed smartphone use with physical activity, sedentary behavior, mood, and sleep quality in young adults: A cross- sectional study. Int. J. Environ. Res. Public Health 17(10): 3499.

Haripriya, S., Samuel, S. E. & Megha, M. 2019.

Correlation between smartphone addiction, sleep quality and physical activity among young adults. J. Clin. Diagnostic Res. 13(10):

YC05-YC09.

Huang, Q., Li, Y., Huang, S., Qi, J., Shao, T., Chen, X., Liao, Z., Lin, S., Zhang, X., Cai, Y.

& Chen, H. 2020. Smartphone use and sleep quality in Chinese college students: A preliminary study. Front. Psychiatry 11:

Article 352.

Khoury, J. M., De Freitas, A. A. C., Roque, M. A.

V., Albuquerque, M. R., Das Neves, M. D. C.

L. & Garcia, F. D. 2017. Assessment of the accuracy of a new tool for the ccreening of smartphone addiction. PloS one 12(5):

e0176924.

Kumar, V. A., Chandrasekaran, V. &

Brahadeeswari, H. 2019. Prevalence of smartphone addiction and its effects on sleep quality: A cross-sectional study among medical students. Ind. Psychiatry J. 28(1): 82- 85.

Lee, S. P., Zamimi, H. A., Elias, S. M. S., Atan, A.

& Makhdzir, N. 2021. Smartphone use and addiction among secondary school students in Kuantan, Malaysia. Int. J. Care Scholars 4(1):

36-41.

Luk, T. T., Wang, M. P., Shen, C., Wan, A., Chau, P. H., Oliffe, J., Viswanath, K., Chan, S.

S.-C. & Lam, T. H. 2018. Short version of the smartphone addiction scale in Chinese adults:

Psychometric properties, sociodemographic, and health behavioral correlates. J. Behav.

Addict. 7(4): 1157-1165.

Nasser, N. S., Loh, J. L., Rashid, A. A., Sharifat, H., Ahmad, U., Ibrahim, B., Mustafa, S., Hoo, F. K., Ching, S. M. & Suppiah, S. 2020. A cross-sectional survey on smartphone usage pattern, the level of mobile phone dependence and psychosocial effects among undergraduate students in a Malaysian university. Med. J.

Malays. 75(4): 356-362.

Ng, S.F., Hassan, N. S. I. C., Nor, N. H. M. &

Malek, N. A. A. 2017. The relationship between smartphone use and academic performance: A case of students in a Malaysian tertiary institution. Malays. Online

(6)

J. Educ. Technol. 5(4): 58-70.

Nowreen, N. & Ahad, F. 2018. Effect of smartphone usage on quality of sleep in medical students. Natl. J. Physiol. Pharm.

Pharmacol. 8(9): 1366-1370.

Olson J.A., Sandra D.A., Colucci É.S., Al Bikaii A., Chmoulevitch D., Nahas J., Raz A., Veissière S.P. 2022. Smartphone addiction is increasing across the world: A meta-analysis of 24 countries. Comp. Hum. Behav. 129:

107138.

Osailan, A. 2021. The relationship between smartphone usage duration (using smartphone’s ability to monitor screen time) with hand-grip and pinch-grip strength among young people: An observational study. BMC Musculoskelet. Disord. 22(1): 1-8.

Saadeh, H., Al Fayez, R. Q., Al Refaei, A., Shewaikani, N., Khawaldah, H., Abu- Shanab, S. & Al-Hussaini, M. 2021. Smartphone use among university students during Covid-19 quarantine: An ethical trigger. Front. Public Health 9: Article 600134.

Serra, G., Lo Scalzo, L., Giuffrè, M., Ferrara, P. &

Corsello, G. 2021. Smartphone use and addiction during the coronavirus disease 2019 (COVID-19) pandemic: cohort study on 184 Italian children and adolescents. Ital. J.

Pediatr. 47(1): 1-10.

Sohn, S. Y., Krasnoff, L., Rees, P., Kalk, N.J. &

Carter, B. 2021. The association between smartphone addiction and sleep: A UK cross- sectional study of young adults. Front.

Psychiatry 12: 629407.

Sui, W., Sui, A., Munn, J. & Irwin, J. D. 2022.

Comparing the prevalence of nomophobia and smartphone addiction among university students pre-COVID-19 and during COVID- 19. J. Am. Coll. Health June 21: 1-4.

Thomée, S., Härenstam, A. & Hagberg, M. 2011.

Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults - A prospective cohort study. BMC Public Health 11(1): 1-11.

Wang, P. -Y., Chen, K. -L., Yang, S. -Y. & Lin, P. -

H. 2019. Relationship of sleep quality, smartphone dependence, and health-related behaviours in female junior college students.

PloS One 14(4): e0214769.

Winskel, H., Kim, T. -H., Kardash, L. & Belic, I.

2019. Smartphone use and study behaviour: a korean and australian comparison. Heliyon 5(7): e02158.

Yang, X., Hu, H., Zhao, C., Xu, H., Tu, X. &

Zhang, G. 2021. A longitudinal study of changes in smart phone addiction and depressive symptoms and potential risk factors among Chinese college students. BMC Psychiatry 21(1): 1-9.

Zhang, M. X. & Wu, A. M. 2020. Effects of smartphone addiction on sleep quality among Chinese university students: The mediating role of self-regulation and bedtime procrastination. Addict. Behav. 111: 106552.

Shasvine Viknesh Sugumaran Nur Nazihah Binti Hazizi Farah Natasha Binti Mohd Aris Pei Yin Wong

Nur Fadhilah Binti Faiz Sangeetha Manimaran Hamza Mushtaq Dar Abdul Mutaal Ching Sin Siau

Center for Community Health Faculty of Health Science Universiti Kebangsaan Malaysia 50300 Jalan Raja Muda Abdul Aziz Wilayah Persekutuan Kuala Lumpur Malaysia

Corresponding author: Ching Sin Siau E-mail: [email protected] Tel: 03-9289 8093

Fax: 03-2691 8719 Received: 30 June 2022 Revised: 15 September 2022

Accepted for publication: 20 October 2022