Internet addiction and associated factors among undergraduate students of Jimma University; Jimma, South West Ethiopia, institutional based cross-sectional study

The research was carried out at Jimma University in Southwest Ethiopia. Jimma town is located 351 km southwest of Addis Ababa, Ethiopia’s capital city. Jimma University is one of Ethiopia’s public higher education institutions, with four campuses: Jimma Institute of Technology (JIT Campus), College of Agriculture and Veterinary Medicine (CAVM Campus), College of Business and Economics (BECO Campus), and the main campus. The main campus was the study area, which included one institute and five colleges. These are institute of health science, college of natural and computational science, college of social science and humanity, college of business and economics, college of educational and behavioral science, and college of law and governance. During the study period, the main campus had a total of 5011 regular undergraduate students. The study was carried out between August 1 and August 30, 2021.

An institutional-based cross-sectional study design was used.

All regular undergraduate students at Jimma University’s main campus.

Regular undergraduate students in randomly selected departments at Jimma University’s main campus during the study period.

Students who were severely ill were excluded from the study.

The minimum sample size for this study was determined using a single population proportion formula with assumptions of a 95% confidence level of 1.96, a margin of error of d = 5%, and a proportion of internet addiction (p = 0.352) [14]. The maximum sample size calculated for this study was 772 after incorporating a design effect of 2 and a 10% nonresponse rate. A multistage cluster sampling technique was used to recruit study participants, first among the colleges (college of natural and computational science, college of social science and humanities, college of business and economics, college of educational and behavioral science, college of law and governance, and one institute (institute of health). All colleges and the institute found in Jimma University’s main campus were involved. In the second stage, 13 departments (4 from the institute of health, 3 from the college of natural and computational science, 3 from the college of social science and humanities, 1 from the college of business and economics, 1 from the college of educational and behavioral science, and 1 from the college of law and governance) were selected proportionally using the lottery method. Then the students were selected proportionally from each selected department and year of study using the simple random sampling lottery method by taking a list of undergraduate students from each department. Finally, the selected students filled out the questionnaire.

The Youngs internet addiction test (YIAT) was used for the collection of data regarding the components of internet addiction. With an overall alpha coefficient of 0.79, this scale has been widely used for screening and measuring the level of internet addiction among Nigerian university students [15]. Internal consistency was high in the current study (Cronbach’s 0.885). Each YIAT item is evaluated on a scale of “rarely” to “always.“ It consists of 20 questions answered on a five-point Likert scale, ranging from “Does Not Apply” to “Always.“ For “Does Not Apply,“ “Occasionally,“ “Frequently,“ “Often,“ and “Always,“ the items were scored 0, 1, 2, 3, 4, and 5, respectively. Subjects would be classified as normal (0–30), mild (3–49), moderate (50–79), or severe (80–100) internet addicts based on their scores [16]. Since there is no gold standard for differentiating between IA and non-IA, we considered those with mild, moderate, or severe Internet addiction to have Internet addiction. The existing literature fairly supports this classification of internet addiction [8, 17].

Depression was assessed by the patient health questionnaire (PHQ-9). The PHQ-9 questionnaire has been validated among Ethiopian patients with specificity and sensitivity of 67% and 86%, respectively, with a cut-off point of 10 or greater, and is used to screen for depression [18].

A self-reported version of the Liebowitz social anxiety scale was used to assess social anxiety (LSAS). It is a scale that evaluates fear or anxiety as well as social avoidance [19]. It includes 11 items about social interaction and 13 items about public performance. Study participants were given 24 statements explaining various social situations (for example, “meeting strangers”) and asked to rate their level of fear on a 4-point scale ranging from 0 (none) to 3 (severe), as well as their level of avoidance in the previous week, ranging from 0 (never avoided this activity) to 3 (always avoided this activity) (usually avoided this activity).

Based on scoring subjects classified as having a moderate social phobia score of 50–65, a marked social phobia score of 65–80, a severe social phobia score of 80–95, and a very severe social phobia score of more than 95, a total score was calculated by adding up all of the fear and avoidance ratings [20]. Oslo 3-item social support scale was used to assess social support [21].

The questionnaires used to assess socio-demographic and economic features, academic data, time-related elements, and the purposes of internet use were adopted from various works in previous literature.

Substance use was assessed by a modified version of the Alcohol, Smoking, and Substance Involvement Screening Tool (ASSIST). A worldwide group of substance abuse researchers developed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) for the World Health Organization (WHO) to detect psychoactive substance use and related problems in primary care patients [22].

Has no internet addiction: 0–30, and has internet addiction: a score of 31–100 [8, 17].

Furthermore, according to YIAT, a score of 0–30 is normal internet use. A score of 31–49 is mild internet addiction. A score of 50–79 is moderate internet addiction. A score of 80–100 is severe internet addiction [16].

PHQ-9: 0–9 has no depression. 10–27 has depression [23]. The OSS-3 scores: a score of 3–8 = poor support 9–11 = moderate support 12–14 = strong support [24].

According to the LSAS, a score of 50–65 is moderate social phobia. A score of 65–80 is marked by social phobia. A score of 80–95 is severe social phobia. A score greater than 95 is a very severe social phobia [20].

Academic performance: The JU grade reporting scale was used depending on students’ reports. Students last semester CGPA was taken to categorize students as follows: great distinction > 3.75 distinction 3.25–3.75, and promoted to 2.00–3.24.

Lifetime substance use students who had ever used substances in their lives Current substance use students who used substances in the past three months [22].

University students: students who are attending their education at Jimma University in the 2021 academic year.

Satisfaction with major study: perceived satisfaction with major study by students as poor, moderate, or good.

Four B.Sc. degree holders in psychiatry nursing collected the data and were supervised by two supervisors with M.Sc. degrees in integrated clinical and community mental health. In addition, data collectors and supervisors received intensive one-day training. The information was gathered through a self-administered technique using a well-structured and organized questionnaire.

To keep the data collection tool consistent, the questionnaire was written in English and translated into local languages (Afan Oromo and Amharic) by language experts. To weigh the acceptability and applicability of the procedures and tools, a pretest was administered to 5% of the total study participants, who were chosen at random from the College of Agriculture and Veterinary Medicine (JUCAVM) one week before data collection. After the pretest, grammatical errors, spelling errors, and ambiguous terms were corrected. Cronbach’s alpha was also determined for the current study. Data collectors were strictly supervised by supervisors throughout the data gathering process to guarantee the uniformity and completeness of the questionnaire. The collected data was reviewed and checked for missing data, completeness, and consistency before data entry by the principal investigators.

The data was coded and entered into the computer using Epi Data version 4.6 after being examined for accuracy and consistency, and then it was exported to the Statistical Package for Social Science (SPSS) version 25 for analysis. Simple descriptive statistics were employed for the study of the data that was collected. The association between each independent variable and the outcome variable was examined using bivariate analysis. In order to determine how each independent variable affected the outcome variables, only variables with a p-value of less than 0.25 in bivariate analysis were included in the multivariate logistic regression model. A p-value of less than 0.05 was finally deemed statistically significant, and the strength of the association was determined using an adjusted odds ratio with a 95.0% confidence interval (CI). The model’s goodness of fit was evaluated using the Hosmer-Leeshawn statistic and the omnibus test. In order to determine the correlation between independent variables, the multicollinearity test was also performed using the VIF, the standard error (SE), and the tolerance test.

After receiving ethical approval from Jimma University’s Institutional Review Board (IRB), the study was carried out. The participants were informed that the information would be used solely for research purposes and that their names would not be disclosed. The information was kept private and anonymous. Participants’ written consent was obtained after being informed of the study’s goal. For the purpose of assisting students with issues linked to Internet addiction, substance abuse, depression, and social anxiety, the principal investigator’s contact information and name were included on the questionnaire. Additionally, the upkeep of confidentiality and anonymity was guaranteed. During the data collection period, appropriate COVID-19 prevention methods were taken into account to protect data, collectors, and participants.