1 Introduction

The rapid proliferation of smartphones has fundamentally transformed communication and access to information globally. The easy accessibility of the internet via smartphones has significantly influenced the daily lives of young people and adolescents, particularly in urban settings. As of 2021, statistics reveal that one in three young adults residing in urban areas are smartphone users. This trend is no less prevalent in Pakistan, where the digital landscape is rapidly evolving [1].

Smartphones are no longer limited to basic functions such as calling and texting. They have become multifunctional devices used for a wide array of activities, including gaming, streaming movies, and engaging in social networking through various applications. However, the surge in smartphone usage has also led to a range of negative consequences, particularly among young users. A recent investigation indicated that smartphone addiction is a significant issue among Pakistani teenagers, affecting approximately 60% of this population [2].

The implications of excessive smartphone usage are multifaceted and concerning [3]. Research by Lebni et al. has linked overuse of smartphones to several mental health issues, including depression and anxiety, as well as poor academic performance [4]. The dependence on smartphones for various activities can lead to a lack of awareness regarding their negative impacts and foster an overreliance on these devices. This, in turn, can result in diminished academic achievements.

Moreover, the extensive use of smartphones is associated with various physical and behavioral problems. The constant engagement with screens can lead to physical issues such as eye strain, poor posture, and sleep disturbances [5]. Behaviorally, it can contribute to social isolation, decreased physical activity, and increased exposure to cyberbullying and inappropriate content.

Given these concerns, it is crucial to understand the patterns and implications of smartphone usage among specific populations, such as undergraduate medical students in Pakistan. These students represent a critical segment of the youth who are not only at a formative stage of their professional education but are also likely to be heavy users of digital technology. Understanding their smartphone usage and associated behaviors is essential for developing interventions that can mitigate the negative effects while promoting healthy and balanced use of technology.

This study aims to explore the patterns of smartphone usage among undergraduate medical students in Pakistan, examining both the beneficial and detrimental effects of this widespread phenomenon. By analyzing the behaviors associated with smartphone use, this research seeks to provide insights into how these devices impact the academic, physical, and mental well-being of future healthcare professionals.

2 Literature review

Research has indicated that most mobile phone users fall into the age bracket of 21 to 30 years old and are heavily impacted and swayed by this technology. A staggering 77% of smartphone users are included in this demographic addiction [2]. Moreover, the allure of smartphones among adolescents is so strong that certain teenagers seldom switch off their mobile devices, even during nighttime.

This excessive use of mobile phones has been reported as having the highest correlation with addiction [6]. Smartphone addiction is a phenomenon that pertains to the uncontrollability of smartphone use [7]. The Centers for Disease Control (CDC) have reported an association between mobile addiction and associated disruptive behaviours with an increase in both rates from 2010 to 2015. This includes an increase in severe depression among mobile users by 58% and a suicide rate of 65% over 5 years. The CDC also reported females to be at risk particularly pointing towards differences in gender towards psychological effects of excessive smartphone usage [6]. Hence, investigating these disruptive behaviours can enhance our comprehension of the mechanism driving mobile phone addiction development.

Much work hasi been done regarding the identification of these disruptive behaviours leading to smartphone addiction. The Smartphone Addiction Scale (SAS) is a widely used self-report questionnaire designed to assess the severity of smartphone addiction among individuals with good reliability and validity [8]. Developed by Dr Seunghee Lee-Kwon and his colleagues in 2013, the SAS consists of 33 items that measure various aspects of smartphone addiction, including daily life disturbances, overuse, withdrawal, cyber-oriented interactions, and tolerance while using smartphones.

It has been demonstrated that many medical students experience much stress and burnout during their schooling [9]. This puts them at risk of using smartphones as a medium of distraction from the routine, which can then lead to their risk of developing smartphone addiction [10]. Hence it becomes crucial to understand how these students use mobile phones and the behaviours they manifest which can point towards smartphone addiction.

The following questions guided this study:

  1. 1.

    What is the trend of smartphone usage among undergraduate medical students of ABWA Medical College, Pakistan?

  2. 2.

    What are the disruptive behaviours associated with smartphone usage?

3 Material and methods

This study utilised a cross-sectional survey method and was conducted in ABWA Medical College, one of the private medical colleges of Pakistan. After obtaining approval by the Institutional Ethical Board via letter no. ABWA/MC/DME/855–2023.The study was completed in 6 months.

3.1 Study participants

The sample size of the present study was 270 undergraduate medical students from all 5 MBBS years of ABWA Medical College. The participants were selected via a non-purposive sampling method. Participant selection was based on having current status as an undergraduate medical student at ABWA Medical College and using a smartphone on daily basis. The selection was done without any preference for gender, age, MBBS class or type of smartphone usage.

3.2 Data collection and analysis

Before the survey link distribution, the participants were briefed about the study objectives, potential risks and benefits of participation in the study. An informed consent was taken from each participant. An electronic survey questionnaire was shared with the participants for data collection via google forms (https://forms.gle/MuUEDw2gtxa6kuyJ8). The study proforma consisted of demographic data section and a section based on validated Smartphone Addiction survey (SAS). The identities of all participants were kept anonymous and all data were kept confidential.

Data were exported from an Excel sheet obtained from the above online questionnaire and imported to SPSS version 25.0 for further analysis. The numerical data were represented with means and standard deviation whereas categorical data were represented in form of frequency and percentage. ANOVA test was applied to check the difference in ratings obtained within the six themes mentioned in the SAS questionnaire. The level of significance is 5%.

3.3 Hypothesis

H0 = There was no difference in ratings provided by medical students of different MBBS classes between different behaviours as mentioned in the SAS questionnaire.

H1 = There was a difference in ratings provided by medical students of different MBBS classes between different behaviours as mentioned in the SAS questionnaire.

4 Results

4.1 Demographic profile of study participants

Out of 270 invited medical students, 264 returned the form, making a turnover rate of 97%.

Table 1 shows the demographic profile of the study participants. The participants from all years of the MBBS program, with 31.06% (n = 82) in their first year, 15.15% (n = 40) in their second year, 18.18% (n = 48) in their third year, 15.91% (n = 42) in their fourth year, and 19.70% (n = 52) in their final year.In terms of gender, 68.18% (n = 180) of the participants were female, while 31.82% (n = 84) were male.

Table 1 Demographic profile of the participants in the study (n = 264)
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4.2 Patterns of smartphone usage

The table below shows patterns of smartphone usage among study participants. The most common use of smartphones was seen as information storage with frequency usage of 17.42% (n = 46) followed by 14.4% using smartphones for communication only (n = 38). Only 1.5% of students used smartphones for entertainment only (n = 4).

As seen from Table 2, there is no statistical difference between the trend of use of smartphones among males and females.

Table 2 Gender-based comparison of uses of smartphones (n = 264)
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4.3 Identified behaviours associated with smartphone usage

Table 3 below shows the participants’ rating of the identified behaviours associated with smartphone usage among undergraduate medical students, as assessed by the Smartphone Addiction Scale (SAS), “Cyberspace Oriented relations” exhibited the highest mean score of 3.34 (SD:0.53) followed by “Daily Life Disturbance” (Mean = 3.28, SD = 1.53) and “Tolerance” (Mean = 3.18, SD 0.57). Withdrawal behaviours were slightly lower with a mean score of 3.20 (SD = 0.56). Finally, Overuse exhibited the lowest mean score of 3.07 (SD = 0.59).

Table 3 Participants rating for identified behaviours associated with smartphone usage
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The Table 4 below provides the results of the ANOVA test conducted to analyze smartphone-related behaviors among participants.

Table 4 Smartphone related behaviour responses interpretation
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Among the identified behaviors, “Cyberspace Oriented Relations” showed a statistically significant difference (F = 4.27, p = 0.026), indicating variations in participants’ responses related to this behavior. However, other behavior categories, including “Daily-Life Disturbance”, “Overuse”, “Withdrawal”, and “Tolerance”, did not show statistically significant differences among the groups, as indicated by their respective p-values (> 0.05).

5 Discussion

This study examined the trends of smartphone usage and its associated behaviours among undergraduate medical students in Pakistan. The findings offer significant insights into how these students utilize smartphones and the behaviours that emerge from their usage patterns, highlighting the multifaceted nature of smartphone dependency.

5.1 Patterns of smartphone usage

The Venn Diagram in Fig. 1 below illustrates the frequency overlapping uses of smartphones among the students in the current study.

Fig. 1
figure 1

Venn Diagram of frequency of smartphone usage pattern among medical students

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While smartphones were initially introduced for communication purposes, 25% of our study population use them for multiple functions including communication, information storage, education and entertainment apart from other uses like online shopping. This extensive overlap suggests a balanced use of smartphones across multiple domains. The high number indicates that students use smartphones as an all-in-one device, which could be due to the convenience of having various functionalities in a single gadget. These findings align with global trends where smartphones have become ubiquitous tools in the daily lives of young adults [7]. Similar studies have shown that the pervasive use of smartphones is not confined to a single function but spans multiple activities, including accessing educational resources, social networking, and entertainment [11, 12].

The convergence of these functions into a single device explains the high dependency observed among students which makes them more susceptible to developing smartphone addiction along with physical and psychological issues. Comparatively, research by Kwon et al. from Korea has linked extensive smartphone use to various health problems, including sleep disturbances, stress, and depression [1, 2]. The study by Alhazmi et al. from Saudi Arabia further supports these findings, indicating that excessive internet usage, including smartphones, is significantly associated with depression, anxiety, and poor mental [3, 5]. The similarities in these findings emphasize the broader implications of excessive smartphone usage, transcending geographical and cultural boundaries.

5.2 Behavioural patterns in smartphone usage

The study also identified several disruptive behaviours associated with excessive smartphone use. Daily life disturbance, overuse, withdrawal symptoms, cyberspace-oriented relationships, and tolerance were significant issues among the respondents. Although the student ratings showed no statistical differences across the MBBS year for the four domains of SAS i.e. daily life disturbance, overuse, withdrawal, and tolerance (p > 0/05), the mean higher rating point towards moderate daily life disturbance, and experiencing overuse and withdrawal symptoms, as well decreasing tolerance for smartphone restrictions. This was in congruence with a previous study conducted by Eide et al. who demonstrated increasing withdrawal symptoms and decreasing tolerance for mobile usage restriction [13]. Previous studies have indicated the excessive use of smartphones to be linked with psychological syndromes like Fear Of missing out(FOMO) as well as high procrastination leading to disturbance in daily life activities [14, 15].

The category of cyberspace-oriented relations reveals a profound shift in interpersonal dynamics, with students placing significant emotional value on their online interactions. Equating the inability to use a smartphone with the emotional loss of a friend demonstrates the depth of attachment to digital social networks [16]. The preference for virtual interactions over real-life contact indicates a transformation in social preferences, where some students find greater comfort or validation in online communities. The need for constant connectivity, driven by a fear of missing out, underscores an anxiety-driven compulsion to remain continually online [17].

Tolerance to smartphone usage is evident in how students interact with their devices over time. A fully charged battery does not last a day, which reflects not just intensive use but also desensitization, where increased usage is required to achieve the same level of satisfaction or functionality. When students’ smartphone use is stopped, it shows how interactions on digital devices have become more important than quick real-world or social group situations [18].

The behavioural patterns identified through the study reflect a multifaceted relationship between students and their smartphones. While these devices serve as vital tools for information access, communication, education, and entertainment, the downside is a range of behaviours suggesting overreliance and potential addiction [18]. These behaviours have significant implications, including integration into almost every aspect of lifestyle, risk of addiction, shifts in social interaction preferences, as well as various negative physical and psychological effects [19, 20].

This study had several limitations. First, longitudinal associations between the duration of smartphone usage and behavioural and other risk factors cannot be determined due to the cross-sectional design of the Survey. Second, we did not collect detailed information on the pattern of smartphone use among the users, which would have helped interpret the complex relationship between the duration of smartphone usage and other factors. Since this was a single institutional survey, more studies are warranted from other medical schools to get a broader idea about smartphone usage among medical students in Pakistan.

5.3 Implications and recommendations

The insights from this study contribute to a growing body of knowledge necessary for informed decision-making and behavioural change in the digital age. Understanding these behavioural patterns is crucial for developing targeted interventions and policies to promote healthier relationships with technology. This might include educational programs on digital literacy, incorporating breaks and mindful use into daily routines, and supporting students who show signs of problematic use [21]. As smartphones continue to evolve and integrate more deeply into academic and personal lives, balancing their benefits with the potential for addiction and negative impacts will be an ongoing challenge.

6 Conclusion

In conclusion, this study underscores the pervasive nature of smartphone usage among undergraduate medical students in Pakistan and highlights the associated behaviors and psychological impacts. The similarities with global trends in smartphone addiction emphasize the need for comprehensive strategies to address this growing issue. The results can serve as a foundation for developing targeted interventions to promote healthy smartphone habits and enhance the educational experiences of medical students in the digital age.