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Tuco, Castro-Diaz, Soriano-Moreno, and Benites-Zapata: Prevalence of Nomophobia in University Students: A Systematic Review and Meta-Analysis

Abstract

Objectives

The aim of this study was to assess the prevalence of nomophobia in university students.

Methods

A systematic search was conducted of the following databases: Web of Science/ Core Collection, Scopus, PubMed, Embase, and Ovid/ MEDLINE until March 2021. Cross-sectional studies reporting the prevalence of nomophobia in undergraduate or postgraduate university students that assessed nomophobia with the 20-item Nomophobia Questionnaire (NMP-Q) tool were included. Study selection, data extraction, and risk of bias assessment were performed in duplicate. A meta-analysis of proportions was performed using a random-effects model. Heterogeneity was assessed using sensitivity analysis according to the risk of bias, and subgrouping by country, sex, and major.

Results

We included 28 cross-sectional studies with a total of 11,300 participants from eight countries, of which 23 were included in the meta-analysis. The prevalence of mild nomophobia was 24% (95% confidence interval [CI], 20%–28%; I2 = 95.3%), that of moderate nomophobia was 56% (95% CI, 53%–60%; I2 = 91.2%), and that of severe nomophobia was 17% (95% CI, 15%–20%; I2 = 91.7%). Regarding countries, Indonesia had the highest prevalence of severe nomophobia (71%) and Germany had the lowest (3%). The prevalence was similar according to sex and major.

Conclusions

We found a high prevalence of moderate and severe nomophobia in university students. Interventions are needed to prevent and treat this problem in educational institutions.

I. Introduction

Nomophobia is the fear of not being able to use a mobile phone and/or the services it offers [1]. The prevalence of nomophobia ranges from 6% to 73% among various populations [2]. This prevalence is predicted to increase, becoming a major problem, due to the massive use of smartphones; likewise, the global coronavirus disease 2019 (COVID-19) pandemic has increased the time of use of these devices [3].
This problem occurs more frequently in adolescents and young adults [4], a population that corresponds to university students, who present a high prevalence of severe nomophobia [5]. The major problems of nomophobia in this population are poor academic performance and sleep disturbances [6], because nomophobia can be associated with anxiety, stress, dependence, low self-esteem, social problems, and fear, which is followed by feelings of frustration and obsessive thoughts, among others [7]. In addition, excessive cell phone use is associated with harmful effects on physical health such as repetitive motion injuries, pain in elbows, wrists, back, shoulders and thumb, index and middle fingers, as well as migraines and numbness due to constant mobile phone use [8,9]. Furthermore, a lack of confidence, low self-esteem, and lack of social skills when making social connections cause more dependence on mobile phones [10]. It should also be taken into account that demanding academic and personal lives make the use of these devices indispensable [10,11].
It is important to determine the prevalence of nomophobia, as it is a global problem. Systematic reviews of the prevalence of nomophobia have been carried out; however, they are limited in evaluating general populations, and none used uniform criteria to establish the prevalence of nomophobia [2,5]. Therefore, the aim of the present review was to synthesize previously reported data on the prevalence of nomophobia, as well as to establish its prevalence according to severity in university students.

II. Methods

We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020 [12]. The study protocol was registered on PROSPERO (No. CRD42021230740).

1. Eligibility Criteria

Cross-sectional studies reporting the prevalence of nomophobia in undergraduate or postgraduate university students were included. Studies that assessed nomophobia with the 20-item Nomophobia Questionnaire (NMP-Q) tool developed by Yildirim and Correia [13] were considered. We chose this instrument as an inclusion criterion, since it is the most widely used validated scale [14] and divides nomophobia into absent (20 points), mild (21–60 points), moderate (61–100 points) and severe (101–120 points) [A1]. Studies with fewer than 30 participants, duplicate populations, clinical trials, case-control studies, case reports, editorials, commentaries, clinical practice guidelines, opinions, and reviews were excluded.

2. Literature Search and Study Selection

A systematic search was conducted in five databases: Web of Science/Core Collection, Scopus, PubMed, Embase and Ovid MEDLINE on March 16, 2021. No language or publication date restrictions were applied. The full search strategy for each database is available in Supplementary Table S1. We also screened the reference list of all included studies for additional eligible studies.
The identified references were exported to the Rayyan program [15] where duplicates were manually removed. Subsequently, two authors (KGT and SDCD) screened articles by titles and abstracts to identify potentially relevant articles for inclusion. Selected studies then underwent full-text screening (KGT and SDCD). These processes were conducted independently, and a third author (DRSM) resolved discrepancies by reaching a consensus for the final decision.

3. Data Extraction

Two authors (KGT and SDCD) independently extracted the following data of interest using a Microsoft Excel sheet: author, year of publication, country, sample size, setting (undergraduate, postgraduate), age, sex, major, cut-off points used in the scale, and the prevalence of nomophobia overall and by severity. A third author (DRSM) resolved any discrepancies.

4. Risk of Bias

Two authors (KGT and SDCD) independently assessed the methodological quality of prevalence studies using the Joanna Briggs Institute Critical Appraisal Tool [16]. A third author (DRSM) resolved discrepancies at this stage. This scale has nine items with possible answers of “yes,” “no,” and “unclear” if the study did not have enough data to reach a conclusion about the item. For the quality score of the study, 1 point was given if it complied with each item, and 0 if it did not comply or did not make the item clear. For the prevalence analysis according to the risk of bias, a total score of 0–3 was considered as indicating low methodological quality, 4–6 moderate quality, and 7–9 high quality.

5. Statistical Analyses

We calculated the pooled prevalence of nomophobia in university students, using a random-effects model, 95% confidence intervals (CIs) using the exact method with the Freeman-Tukey double-arcsine transformation to stabilize variance. Studies using standardized cut-off points for the NMP-Q scale were included in the meta-analysis. To assess heterogeneity and its sources, we used the Cochrane Q statistic and the I2 test, and we performed subgroup analyses according to country, sex, and major. We also performed a sensitivity analysis according to the risk of bias of the studies. We also assessed publication bias with the Egger test, considering p < 0.05 as indicating the presence of publication bias. The analyses were performed with Stata version 16.0 (StataCorp, College Station, TX, USA).

III. Results

1. Search Results

After removing duplicate records, we identified 230 studies through database searching. We reviewed 78 full-text studies and selected 24 after applying the inclusion criteria. We also identified four studies by checking the references of the included articles. We finally included 28 studies in the review (Figure 1). Reasons for the exclusion of the full-text articles reviewed are given in Supplementary Table S2.

2. Studies’ Characteristics

Twenty-eight studies with a total of 11,300 participants were chosen (Table 1, Appendix 1). With respect to countries, 15 studies were conducted in India [A2,A5–A8, A12,A13,A19–A21,A23–A25,A27,A28], six in Turkey [A3, A10,A11,A15,A17,A26], and one each in Oman [A9], the United States [A14], Pakistan [A4], Kuwait [A16], Saudi Arabia [A18], Indonesia [A22], and Germany [A1]. In terms of populations, the majority had a mean age between 19 to 22 years, and 23 included undergraduate university students [A1,A2–A6,A8,A10–A15,A17–A22,A24,A26–A28], one included graduate students [A23], and four were conducted in both populations [A7,A9,A16,A25].
The majority of studies evaluated students majoring in health-related professions (medicine, nursing, physiotherapy, dentistry, and pharmacy, among others) while six studies did not mention the majors evaluated [A4,A5,A9,A16,A25,A26].
Regarding cut-off points, most studies classified nomophobia into four groups (absent 20; mild 21–59; moderate 60–99; severe 100–120), three studies used statistical methods to divide nomophobia into present and absent [A21,A23,A26], one used cut-off points to classify participants into two groups (absent < 59; present 60–100) [A6], and one study did not specify this information [A15].

3. Prevalence of Nomophobia in University Students

A meta-analysis was performed with the 23 studies that presented the prevalence of nomophobia in university students using standardized cut-off points to classify the condition as absent, mild, moderate, and severe [A1,A2–A5,A7–A14,A16–A20,A22,A24,A25,A27,A28]. The overall prevalence was close to 100%. According to severity, the prevalence of mild nomophobia was 24% (95% CI, 20%–28%; I2 = 95.3%), that of moderate nomophobia was 56% (95% CI, 53%–60%; I2 = 91.2%), and that of severe nomophobia was 17% (95% CI, 15%–20%; I2 = 91.7%). High heterogeneity was consistently evident in the meta-analysis (Figures 24).
In addition, the prevalence was assessed according to country, sex and major. Among the nine countries studied, Indonesia had the highest prevalence of severe nomophobia (71%; 95% CI, 55%–84%) and Germany had the lowest prevalence (3%; 95% CI, 1%–8%) [A1,A22]. In relation to major and sex, the prevalence was similar between categories, albeit with high heterogeneity (Table 2).

4. Risk of Bias

Regarding risk of bias, fewer than half of the studies met the items of “appropriate sampling frame,” “appropriate sampling,” “adequate sample size,” and “analysis conducted with sufficient sample coverage.” However, the majority met the items “validated methods for the identification of nomophobia,” “condition measured in a standard and reliable way for all participants,” and “appropriate statistical analysis” (Supplementary Table S3). When performing a sensitivity analysis according to risk of bias, we found that the prevalence rates among low-, moderate-, and high-quality studies were similar.

5. Publication Bias

When the Egger test was performed, no publication bias was evident in the meta-analysis of the prevalence of mild (p = 0.953), moderate (p = 0.359) and severe (p = 0.428) nomophobia.

IV. Discussion

In the present study, we found that the overall prevalence of nomophobia in university students was approximately 100%. According to the severity of nomophobia, we found that one in four participants had mild nomophobia, more than half had moderate nomophobia, and approximately one in five participants had severe nomophobia. In addition, we evaluated the prevalence according to country, sex, and major; however, we found no differences between them.
Nomophobia is the fear of not having access to a mobile device or feeling disconnected [14]. We found two systematic reviews that assessed the prevalence of nomophobia. The first aimed to report on the prevalence of nomophobia and differences between sex and age; however, it did not perform a meta-analysis [2]. The second of these studies meta-analyzed the prevalence of nomophobia by population type, instrument, and severity [5]; however, the diagnostic criteria and severity classification used were not uniform. Therefore, we focused on evaluating the prevalence of nomophobia in university students, including studies that assess nomophobia with the NMP-Q scale. Furthermore, in the meta-analysis, we only included studies using standardized cut-off points for defining nomophobia as absent (20), mild (21–59), moderate (60–99), and severe (100–120). Regarding prevalence, the aforementioned systematic review found that the prevalence of severe nomophobia in university students was 25.5% (95% CI, 18.5%–34.0%; I2 = 97.0%) [5]. This overall prevalence is slightly higher than that found in the present study; however, the confidence intervals overlap. However, that study could not be compared regarding the other grades (mild and moderate) since it did not present the corresponding results.
When analyzing the prevalence rates according to major and sex, we found that they were similar. This last finding differs from the previous literature, where it was described that women were more likely to have nomophobia [2]. However, when evaluating prevalence rates by country, we found that most studies were from India, and the study that presented the highest prevalence of severe nomophobia was from Indonesia [A22].
In addition to the characteristics assessed, the prevalence of nomophobia and its severity can vary due to various factors.
The results of the research carried out highlight a high prevalence of moderate and severe nomophobia. The importance of nomophobia lies in the fact that it is associated with mental health problems, such as increased stress, anxiety, irritability, insomnia and depression, and can cause personality disorders and problems of self-esteem, loneliness or social isolation, and unhappiness [17]. It can also cause cognitive and motor impulsivity, whereby a person cannot concentrate on activities or performs them without thinking [6]. This can especially affect university students, in whom it has previously been reported that levels of nomophobia have a positive relationship with anxiety, stress and depression, and also interfere with their interpersonal relationships and academic performance, since a higher level of nomophobia was associated with worse academic performance [18]. It has even been proposed to include this phobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM) fifth edition, due to its growing importance [19]. To address this problem, online educational interventions with interactive interfaces have been shown to decrease nomophobia; however, studies evaluating other types of interventions to address this problem are still lacking [2,19].
The included studies had limitations. We found high heterogeneity despite uniformity in the NMP-Q cut-off points used to classify nomophobia severity. Because five studies did not use standardized cut-off points to define nomophobia, they were excluded from the quantitative synthesis. This heterogeneity could be explained by differences in the sampling frame between the included studies. Only three articles conducted research at more than one university and in at least two majors. Furthermore, only six studies used random sampling or surveyed the entire population and only nine reported the sample calculation. Similarly, the diversity of majors and countries included in the meta-analysis would contribute to the high heterogeneity. Other factors that could explain the heterogeneity are the daily hours of phone use, social skills, and the year of study; however, these data are underreported in studies. Furthermore, worldwide, we found 26 studies from the Middle East and Asia that met the inclusion criteria, and only two studies in Europe and America.
It is recommended that future prevalence studies use random sampling, report the sample calculation, and detail the setting, specifying the major, year of study, age and sex of the participants. In addition, it is recommended that studies use the cut-off points of the NMP-Q scale to define nomophobia as absent, mild, moderate, and severe and that they present prevalence rates according to characteristics such as sex, major, and year of study. Finally, more studies are needed in other European and American countries.
Our study also has certain strengths. We conducted a comprehensive search of multiple databases and reviewed the references of included studies to capture more studies. In addition, we only included studies that used the NMP-Q scale to standardize and find studies with comparable prevalence rates. We also performed subgroup analyses to assess the heterogeneity found.
The prevalence of nomophobia in university students was very high. According to severity, the prevalence of mild, moderate, and severe nomophobia was 24%, 56%, and 17%, respectively. Regarding countries, Indonesia had the highest prevalence of severe nomophobia (71%) and Germany had the lowest (3%). The prevalence was similar according to sex and major. We recommend that further studies be conducted in more countries using the NMP-Q scale to make them comparable. We also suggest educational programs on the appropriate use of technology in university students.

Acknowledgments

Special thanks to Moises Huarhua, Universidad Peruana Unión, who provided language help of this article. Funding for open access charge: Universidad Peruana Union (UPeU).

Notes

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figure 1
Flow diagram summarizing the process of the literature search and selection.
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Figure 2
Prevalence of mild nomophobia in university students. ES: effect size, CI: confidence interval.
hir-2023-29-1-40f2.jpg
Figure 3
Prevalence of moderate nomophobia in university students. ES: effect size, CI: confidence interval.
hir-2023-29-1-40f3.jpg
Figure 4
Prevalence of severe nomophobia in university students. ES: effect size, CI: confidence interval.
hir-2023-29-1-40f4.jpg
Table 1
Characteristics of the included studies assessing the prevalence of nomophobia in university students (n = 28)
Study Year Country Sample size Setting Age (yr) Male sex (%) Career Cut-off point Nomophobia prevalence Quality score (Max. 9)
Bartwal and Nath [A2] 2020 India 451 Undergraduate 20.7 ± 1.7 37.9 Medicine Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 15.5%
Moderate: 67.2%
Severe: 17.3%
5
Celik Ince [A3] 2021 Turkey 607 Undergraduate 20.5 ± 1.8 24.5 Nursing Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 99.7%
Mild: 26%
Moderate: 58%
Severe: 15.7%
4
Schwaiger and Tahir [A4] 2020 Pakistan 138 Undergraduate 20.4 ± 1.9 30.4 NR Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 97.1%
Mild: 11.6%
Moderate: 59.4%
Severe: 26.1%
5
Guin et al. [A5] 2020 India 200 Undergraduate NR NR NR Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 21.5%
Moderate: 57%
Severe: 21.5%
3
Marthandappa et al. [A6] 2020 India 419 Undergraduate NR 56.6 Medicine Absent: < 59
Present: 60–100
General: 62.8% 4
Ismail et al. [A7] 2020 India 100 Undergraduate/postgraduate NR 29.0 Nursing Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 18%
Moderate: 68%
Severe: 14%
3
Chethana et al. [A8] 2020 India 228 Undergraduate 21.0 ± 3.0 36.8 Medicine Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 35.1%
Moderate: 53.5%
Severe: 11.4%
7
Qutishat et al. [A9] 2020 Oman 740 Undergraduate/postgraduate NR 34.5 Nursing, science, economics Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 99.3%
Mild: 15.1%
Moderate: 64.2%
Severe: 20%
4
Torpil et al. [A10] 2021 Turkey 181 Undergraduate NR 15.5 NR Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 30.9%
Moderate: 52.5%
Severe: 16.6%
4
Iscan et al. [A11] 2021 Turkey 641 Undergraduate 20.6 ± 2.0 26.8 Medicine, dental, nursing, physiotherapy Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 99.7%
Mild: 25.1%
Moderate: 58.7%
Severe: 15.9%
4
Ahmed et al. [A12] 2021 India 113 Undergraduate 21.2 ± 2.2 28.3 Medical science, allied health science, business, engineering, arts, nursing Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 13.3%
Moderate: 67.3%
Severe: 19.5%
6
Jilisha et al. [A13] 2019 India 774 Undergraduate NR 41.2 Arts, Science Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 98.8%
Mild: 20.8%
Moderate: 54.5%
Severe: 23.5%
8
Cain and Malcom [A14] 2019 EEUU 192 Undergraduate NR 35.4 Pharmacy, health science Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 99.5%
Mild: 24.5%
Moderate: 56.8%
Severe: 18.2%
5
Apak and Yaman [A15] 2019 Turkey 307 Undergraduate NR 41.0 Social work Cluster analysis of K-means General: 76.9%
Mild: 35.8%
Moderate: 25.7%
Severe: 15.3%
5
Veerapu et al. [A28] 2019 India 364 Undergraduate 20.6 ± 1.0 37.4 Medicine Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 17%
Moderate: 64.3%
Severe: 18.7%
5
Farooqui et al. [A27] 2018 India 145 Undergraduate 19.0 ± 0.7 45.5 Medicine Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 17.9%
Moderate: 60%
Severe: 22.1%
5
Al-Balhan et al. [A16] 2018 Kuwait 512 Undergraduate/postgraduate 21.6 ± 4.3 51.8 NR Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 18%
Moderate: 56.3%
Severe: 25.8%
5
Ayar et al. [A17] 2018 Turkey 755 Undergraduate 21.4 ± 1.3 20.1 Nursing Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 99.7%
Mild: 34.2%
Moderate: 51.9%
Severe: 13.6%
4
Alahmari et al. [A18] 2018 Saudi Arabia 622 Undergraduate 21.8 ± 2.0 48.1 Medicine, dentistry, pharmacy, applied medical sciences Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 85.5%
Mild: 14.5%
Moderate: 63.3%
Severe: 22.2%
7
Sethia et al. [A19] 2018 India 473 Undergraduate NR 48.4 Medicine Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 99.8%
Mild: 32.1%
Moderate: 61.5%
Severe: 6.1%
8
Harish and Bharath [A20] 2018 India 405 Undergraduate 20.1 ± 1.3 49.4 Medicine Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 99%
Mild: 35.8%
Moderate: 49.9%
Severe: 13.3%
6
Dasgupta et al. [A21] 2017 India 608 Undergraduate 20.4 ± 2.0 73.5 Medicine, engineering Using log-likelihood distance measure, a two-cluster solution was retained General: 43.6% 6
Akun and Andreani [A22] 2017 Indonesia 42 Undergraduate NR 35.7 Humanities Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 9.5%
Moderate: 19%
Severe: 71.4%
1
Davie and Hilber [A1] 2017 Germany 104 Undergraduate NR 51.0 Business, engineering Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 100%
Mild: 57.7%
Moderate: 39.4%
Severe: 2.9%
3
Chandak and Dagdiay [A23] 2019 India 100 Postgraduate NR 51.0 Medicine Not specified General: 38% 5
Madhusudan et al. [A24] 2017 India 429 Undergraduate NR 28.4 Medicine Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 97%
Mild: 33.3%
Moderate: 56.2%
Severe: 7.5%
4
Kanmani et al. [A25] 2017 India 1166 Undergraduate/postgraduate NR NR NR Absence: 20
Mild: 21–59
Moderate: 60–99
Severe: 100–140
General: 98.6%
Mild: 41.1%
Moderate: 40.7%
Severe: 16.9%
7
Yildirim et al. [A26] 2016 Turkey 484 Undergraduate 20.0 ± 1.7 NR NR Using log-likelihood distance measure, a two-cluster solution was retained General: 42.6% 3

Twenty-eight studies listed in the table refer to Appendix 1.

NR: not reported.

Table 2
Prevalence of nomophobia in university students and subgroup analysis
Mild nomophobia Moderate nomophobia Severe nomophobia



n Prevalence (95% CI) I2 n Prevalence (95% CI) I2 n Prevalence (95% CI) I2
Overall 23 24 (20–28) 95.3 23 56 (53–60) 91.3 23 17 (15–20) 91.7

Country
 Turkey 4 29 (24–34) 85.6 4 56 (52–59) 65.4 4 15 (14–17) 0.0
 India 12 25 (19–31) 95.3 12 58 (52–64) 93.4 12 15 (12–19) 91.2
 Indonesia 1 10 (3–23) NE 1 19 (9–34) NE 1 71 (52–84) NE
 Germany 1 58 (48–67) NE 1 39 (30–49) NE 1 3 (1–8) NE
 Kuwait 1 18 (15–22) NE 1 56 (52–61) NE 1 26 (22–30) NE
 USA 1 24 (19–31) NE 1 57 (49–64) NE 1 18 (13–24) NE
 Pakistan 1 12 (7–18) NE 1 59 (51–68) NE 1 26 (19–34) NE
 Oman 1 15 (13–18) NE 1 64 (61–68) NE 1 20 (17–23) NE
 Saudi Arabia 1 14 (12–17) NE 1 63 (59–67) NE 1 22 (19–26) NE

Sex
 Male 9 30 (21–40) 91.2 9 56 (49–62) 75.2 9 13 (9–18) 75.9
 Female 9 24 (18–32) 91.2 9 55 (48–63) 89.6 9 16 (11–20) 83.5

Major
 Health-related professions 13 25 (21–30) 93.3 13 59 (56–62) 80.1 13 15 (12–18) 88.3
 Mixed or other professions 5 18 (12–25) 85.9 5 60 (55–65) 66.2 5 20 (18–23) 11.9

Risk of bias
 Low quality 4 25 (9–46) 94.8 4 46 (29–64) 92.4 4 23 (6–48) 96.4
 Moderate quality 14 22 (18–27) 93.3 14 59 (56–62) 79.6 14 17 (15–20) 85.3
 High quality 5 28 (18–40) 97.9 5 55 (45–64) 96.5 5 15 (10–22) 95.7

CI: confidence interval, NE: not evaluated.

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Appendices

Appendix 1

List of studies included in a systematic review

A1. Davie N, Hilber T. Nomophobia: is smartphone addiction a genuine risk for mobile learning? Proceedings of the 13th International Conference Mobile Learning; 2017 Apr 10-12; Budapest, Hungary.
A2. Bartwal J, Nath B. Evaluation of nomophobia among medical students using smartphone in north India. Med J Armed Forces India 2020;76(4):451-5. https://doi.org/10.1016/j.mjafi.2019.03.001
A3. Celik Ince S. Relationship between nomophobia of nursing students and their obesity and self-esteem. Perspect Psychiatr Care 2021;57(2):753-60. https://doi.org/10.1111/ppc.12610
A4. Schwaiger E, Tahir R. Nomophobia and its predictors in undergraduate students of Lahore, Pakistan. Heliyon 2020;6(9):e04837. https://doi.org/10.1016/j.heliyon.2020.e04837
A5. Guin NB, Sharma S, Yadav S, Patel D, Khatoon S. Prevalence of nomophobia and effectiveness of planned teaching program on prevention and management of nomophobia among undergraduate students. Indian J Public Health Res Dev 2020;11(9):64-9. https://doi.org/10.37506/ijphrd.v11i9.10987
A6. Marthandappa SC, Sajjan SV, Raghavendra B. A study of prevalence and determinants of nomophobia (no mobile phobia) among medical students of Ballari: a southern district of India. Indian J Public Health Res Dev 2020;11(5):575-80. https://doi.org/10.37506/ijphrd.v11i5.9390
A7. Ismail PA, Patel D, Patel H, Patel F, Patel D. A study to assess the level of nomophobia among students at Sumandeep Nursing College, Vadodara with a view to develop an information booklet. Indian J Public Health Res Dev 2020;11(3):121-4. https://doi.org/10.37506/ijphrd.v11i3.707
A8. Chethana K, Nelliyanil M, Anil M. Prevalence of nomophobia and its association with loneliness, self happiness and self esteem among undergraduate medical students of a medical college in coastal Karnataka. Indian J Public Health Res Dev 2020;11(3):523-9. https://doi.org/10.37506/ijphrd.v11i3.1215
A9. Qutishat M, Lazarus ER, Razmy AM, Packianathan S. University students’ nomophobia prevalence, sociodemographic factors and relationship with academic performance at a University in Oman. Int J Afr Nurs Sci 2020;13:100206. https://doi.org/10.1016/j.ijans.2020.100206
A10. Torpil B, Unsal E, Yildiz E, Pekcetin S. Relationship between nomophobia and occupational performance among university students. Br J Occup Ther 2021;84(7):441-5. https://doi.org/10.1177/03080226209509
A11. Iscan G, Yildirim Bas F, Ozcan Y, Ozdoganci C. Relationship between “nomophobia” and material addiction “cigarette” and factors affecting them. Int J Clin Pract 2021;75(4):e13816. https://doi.org/10.1111/ijcp.13816
A12. Ahmed S, Akter R, Pokhrel N, Samuel AJ. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health 2021;29(2):411-6. https://doi.org/10.1007/s10389-019-01139-4
A13. Jilisha G, Venkatachalam J, Menon V, Olickal JJ. Nomophobia: a mixed-methods study on prevalence, associated factors, and perception among college students in Puducherry, India. Indian J Psychol Med 2019;41(6):541-8. https://doi.org/10.4103/IJPSYM.IJPSYM_130_19
A14. Cain J, Malcom DR. An assessment of pharmacy students’ psychological attachment to smartphones at two colleges of pharmacy. Am J Pharm Educ 2019;83(7):7136. https://doi.org/10.5688/ajpe7136
A15. Apak E, Yaman OM. The prevalence of nomophobia among university students and nomophobia's relationship with social phobia: the case of Bingol University. Addicta: The Turkish Journal on Addictions 2019;6(3):609-29. https://doi.org/10.15805/addicta.2019.6.3.0078
A16. Al-Balhan EM, Khabbache H, Watfa A, Re TS, Zerbetto R, Bragazzi NL. Psychometric evaluation of the Arabic version of the nomophobia questionnaire: confirmatory and exploratory factor analysis: implications from a pilot study in Kuwait among university students. Psychol Res Behav Manag 2018;11:471-82. https://doi.org/10.2147/PRBM.S169918
A17. Ayar D, Ozalp Gerceker G, Ozdemir EZ, Bektas M. The effect of problematic internet use, social appearance anxiety, and social media use on nursing students’ nomophobia levels. Comput Inform Nurs 2018;36(12):589-95. https://doi.org/10.1097/CIN.0000000000000458
A18. Alahmari MS, Alfaifi AA, Alyami AH, Alshehri SM, Alqahtani MS, Alkhashrami SS, et al. Prevalence and risk factors of nomophobia among undergraduate students of Health Sciences Colleges at King Khalid University, Abha, Saudi Arabia. Int J Med Res Prof 2018;4(1);429-32. https://doi.org/10.21276/ijmrp.2018.4.1.088
A19. Sethia S, Melwani V, Melwani S, Priya A, Gupta M, Khan A. A study to assess the degree of nomophobia among the undergraduate students of a medical college in Bhopal. Int J Community Med Public Health 2018;5(6):2442-5. https://doi.org/10.18203/2394-6040.ijcmph20182174
A20. Harish BR, Bharath J. Prevalence of nomophobia among the undergraduate medical students of Mandya Institute of Medical Sciences, Mandya. Int J Community Med Public Health 2018;5(12):5455-9. https://doi.org/10.18203/2394-6040.ijcmph20184833
A21. Dasgupta P, Bhattacherjee S, Dasgupta S, Roy JK, Mukherjee A, Biswas R. Nomophobic behaviors among smartphone using medical and engineering students in two colleges of West Bengal. Indian J Public Health 2017;61(3):199-204. https://doi.org/10.4103/ijph.IJPH_81_16
A22. Akun A, Andreani W. Powerfully tecnologized, powerlessly connected: the psychosemiotics of nomophobia. Proceedings of 2017 10th International Conference on Human System Interactions (HSI); 2017 Jul 17–19; Ulsan, South Korea. p. 306-10. https://doi.org/10.1109/HSI.2017.8005051
A23. Chandak P, Dagdiay M. An exploratory study of nomophobia in post-graduate residents of a teaching hospital in Central India. Presented at the 19th WPA World Congress of Psychiatry; 2019 Aug 21–24; Lisbon, Portugal. https://doi.org/10.26226/morressier.5d1a036c57558b317a13fd71
A24. Madhusudan M, Sudarshan BP, Sanjay TV, Gopi A, Fernandes SD. Nomophobia and determinants among the students of a medical college in Kerala. Int J Med Sci Public Health 2017;6(6):1046-9. https://doi.org/10.5455/ijmsph.2017.0203115022017
A25. Kanmani A, Bhavani U, Maragatham RS. Nomophobia: an insight into its psychological aspects in India. Int J Indian Psychol 2017;4(2):5-15. https://doi.org/10.25215/0402.041
A26. Yildirim C, Sumuer E, Adnan M, Yildirim S. A growing fear: prevalence of nomophobia among Turkish college students. Inf Dev 2016;32(5):1322-31. https://doi.org/10.1177/0266666915599025
A27. Farooqui IA, Pore P, Gothankar J. Nomophobia: an emerging issue in medical institutions? J Ment Health 2018;27(5):438-41. https://doi.org/10.1080/09638237.2017.1417564
A28. Veerapu N, Philip RK, Vasireddy H, Gurrala S, Kanna ST. A study on nomophobia and its correlation with sleeping difficulty and anxiety among medical students in a medical college, Telangana. Int J Community Med Public Health 2019;6(5):2074-6. https://doi.org/10.18203/2394-6040.ijcmph20191821


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