Utilization of E-Devices and Internet among Medical Students in a private medical college in central Kerala, India

Introduction: This study was conducted to find the nature, impact, whether beneficial or adverse, the e-Devices are having on student’s academics, physical and mental health and, is making their life convenient or harming them. Material and Methods: Cross-sectional study was conducted in a private medical college in central Kerala and proportions, test of significance like Chi square, t test was used. Objectives: To find the prevalence and pattern of utilization of electronic devices; to evaluate the pattern, purpose of internet usage and factors influencing it; and to assess the need for incorporating computer education in medical curriculum. Results: 350 students participated in the research; 90(25.7%) of students don’t spend money to get access to internet; 255(79.45%) spend 2 hours or less on the internet; 296(84.6%) of students use internet for academic purposes; 152(43.4%) felt that e-Devices made their academic performance better while 40(11.4%) of the students felt it to be worse. 88(25.1%) prefer reading e books over conventional textbooks. 213(60.9%) do not have any problem while using internet but 96(27.4%) students had problems of eye strain while using internet. Conclusions: Most students seem to be able to balance the e-Device used and use it for academic purpose and making their lives efficient. But few got their academic performance worse, and some are suffering from eye strain, so efficient management of time on e-devices and internet without hindering their academic performance is needed.


Introduction
The use of computer and information technology is on an escalation.The internet, one of the key developments in this field, provides instant access to latest medical information [1].Computer assisted management of medical information has also increased.The evolving nature of medical knowledge and technology requires that medical practitioners develop computer skills to enhance the quality of patient care and for ongoing education and research [2].There was an urgent need to do this study on medical students.Medical students are spending increasing amount of their time on electronic devices like laptops, smart phones, tablets, Personal Computers, etc.So this study was done to examine this issue in detail to see how this time can be channelized to meet their education goals, to improve their efficiency, productivity and also to make sure it does not hamper their education, moral, psychological, physical health and safety.We did not include the issue of e-waste in this study as in our opinion very little e-waste is being generated by medical colleges and hospitals in India.
Objectives of the study are to gather data from the students of a medical college to-

After taking permission from Institutional Ethics
Committee & Research Committee a cross-sectional study was conducted in November 2015 in a Private medical college in Central Kerala, India.All medical students were included in the study.Consent was obtained from the students by disclosing that the data collected is for research purpose, that the pretested questionnaire is anonymous and their participation in the study is voluntary.
For convenience, in our study following criteria was given and defined for family income, i.e. >Rs 6 lakhs /year as Upper Income and < or equal to Rs 6 lakhs/year income as Lower Income Family, as we did not want to make multiple small groups based on per capita income or above and below poverty line.
The collected data was tabulated and analyzed using MS Excel and SPSS and for significance by various tests of significance like χ2 and t-test.Religion had no significant difference in the use of mobile phone, smart phone, laptop, and tablet computer.Table 9 shows the utilization of e-devices by urban and rural students.The urban students who have ever used and owned mobile phones were proportionately less than rural students.But the prevalence of utilization and ownership of smart phones and laptops are higher among urban students.Urban students use smart phone daily more than rural students while it is vice versa for mobile phones.

Demography
In table 10, it can be seen that female students are following male students, many times closely, in online behavior; but the girls are much wiser than boys in not giving personal information to the strangers online, and more girls do not go online regularly without any work.
There was no significant difference religion wise in physical discomfort, place of access of Internet, hours of internet use per day, money spend for internet, giving personal information over the internet, using internet for social networking, using internet for academic purposes, using internet for news and gossips.

Discussion
Prevalence and Pattern of Utilization of Electronic Devices-the advancement in modern technology and over all development the role of E-devices in medical education has also increased.Our studies shows that 68.6% own mobile phones, 46.6% own smart phones, 50.9% own lap tops and 63.7%, 44.3% and 25.4% regularly use mobile phones, smart phones and laptops, respectively.But the computer use is fairly higher in other studies, as in study done by Lal et al (81.6%),Inamdar et al (84.5%).[2,4] This is because of increased application, mainly of internet, in mobile phones, smart phones and tablets (Tablet Computers) in the present modern times.
Table 3 clearly shows that even though the students from richer family background, in our study from families with income more than 6 lakhs per year, do not spend too much money more than those students who come from lower income families but they do spend valuable time from daily study time, of 1.274 hours and 1.178 hours of time more per day on e-devices and internet use as compared to students from lower income group families.This type of daily waste of time adds up and may reflects on academic performance.Further studies need to be done that correlate or cross tabulate the academic performance with daily time spent on edevice and internet, to find out if the students from higher income families are throwing little money and lot of time from their academic time.Students from higher income families need to understand that just because you are from a higher income family background does not mean that you should throw away your time on wasteful activities of addiction of new technology, so as to loose daily study time.A student has to attend classes for eight hours and needs good sleep of eight hours, taking another two hours for lunch, dinner, breakfast and bath etc. a total of 18 hours are busy hours.This leaves only five to six hours in a 24 hour day to study.For our calculation we are taking the daily study time to be six hours.Table 11 clearly shows the 256(73.35%)students who did regular social networking spent on an average 1.4 hours (23.3% of study time) more per day on e-devices.The 257(73.43%)students who did social networking, spent on an average 1.13 hours (18.83% of study time) more per day on internet.Those who did social networking regularly as compared to those who did not, the time spent, which comes from study time (almost 42.12% of their average study time daily) is a lot.

Pattern, Purpose of Internet Usage and Factors Influencing
Average time spent for internet usage by the students in our study is 1.81 hours per day whereas from other studies done by Maroof et al and Unnikrishnan et al, it was found to be less than three (3) hours per week.[6,7] From their study about 34.5% students prefer textbooks than internet whereas 25.1% of students in our study prefer e-books.According to our study students (66.6%) preferred internet as it provides latest information and this was high when compared to the above study which gave a result of 58.1%.
Based on the study done by Kochhar et al students had problems in using internet due to lack of time (51.43%),lack of interest (5.71%), cost of accessing (20%), and privacy (<50%) while ours were 11.4%, 8.9%, 8.3%, 0.6%, respectively.[8] The data obtained indicates that majority of the medical students participated in the study embrace and use internet for entertainment.
While looking at the figures from table 4, in the context of medical students we have to take in account that medical students are supposed to study a lot and understand a lot of different complex subjects and ideas during their medical education.This regular medical study, the primary purpose of coming to medical college, also requires work that is a strain on the eyes and can give headache, complain that was found in 27.1% and 19.4% of students.T-test clearly showed (Table 5) that hours spent on e-devices was significantly associated with complain of eye strain.Medical students need to make a choice of more mature behavior with e-device use and those who have eye strain, need to reduce the number of hours they spend on e-devices per day, this is likely to benefit them and reduce their complain of eye strain.
Students need to be more careful about their privacy and security and should not give their real information to strangers online.
Table 8 shows that a gender difference seen as males chasing more latest and new technology.In our study only Forty five (12.9%) would like to have some computer and internet classes and 3(0.9%) said that they have inadequate computer education.This is probably due to the fact that we So, especially for entertainment (movies and music) and e-book download, students need to have their own internet connection.Once downloaded students share these files quite freely in the college.Some students are spending a lot of time on the internet and e-devices and some of those are suffering from eye strain.They need, as a mature and grown up adult, to make a choice to reduce the time they are spending on e-devices to come back to positive health.
The internet was used regularly by the medical students in social networking (73.4%), entertainment (56.9%), and academic purpose (62.6%).Entertainment and social networking is important for morale and happiness, and e-devices are useful.But 11.4% of the students felt that the academic performance became worse with e Device usage.Hence proper planning and utilization of edevices are needed.Some students are giving their personal information to strangers online, this has to be avoided for the reasons of privacy and security.Compared to ten (10) It-Use of the internet is a part of college student's daily routine.It has been integrated into their daily communication habits and become a technology as ordinary as telephone or television.When compared to the study done by Unnikrishnan et al 69.5% undergraduates used internet for entertainment whereas in our study it was 56.9% and a difference of 20% was found in use for academic purposes [7].Public Health Review -International Journal of Public Health Research 2016;3(5) are a new generation of students who have been working on computers and e-devices since lower kindergarten class.Undergraduate students need to use the internet for preparing for seminars and projects.Besides that they do other e-device and internet activity mainly for entertainment and social networking.& Recommendations E-devices have penetrated the student population of this college their and usage is universal.one student did not own a mobile phone.Students are now migrating from wired internet to wireless devices that provide internet, like mobile and smart phones, wireless Netsetter, etc. and are not dependent on partially blocked free internet being provided by the college.Library internet cannot be used to access entertainment, downloading, or other adult sites.Public Health Review -International Journal of Public Health Research 2016;3(5) years ago, the use of edevices has become epidemic, and all colleges need to put a control on it by educating against overuse of e-devices.Acknowledgement The author acknowledges the encouragement provided by Principal Dr. (Commodore) MJ John and Head the Department of Community Medicine Professor (Dr.) Raju Antony for this study; we also acknowledge the help given by House Surgeons Dr. Christy G. Kulathinal, Dr. Darshana D. Sadasivan, Dr. Devi Balasubramaniyam, Dr. Devi Prasannakumar, and Dr. Divya Thankachan.

Table - 7: Pattern & Purpose of Internet Use Purpose of Access Ever Used Regularly Use
Singh RK. et al: Utilization of E-Devices and Internet among Public Health Review -International Journal of Public Health Research 2016;3(5)

Table - 11: Cross-tabulation -Resource utilization and Regular Social Networking
Public Health Review -International Journal of Public Health Research 2016;3(5) Thirty five (10%) students did not spend any time on e-devices in a day.Eighty four (24%) did not spend any time on internet in a day.Ninety (25.7%) do not spend any money to get access to the internet.Two hundred and fifty five (79.complain of eye strain (t=.969,P=.333).We further looked into the second highest complain of headache reported by 68(19.4%)students.We found that those complaining of headache were spending an average of 1.158 and 0.520 hours more on e-devices and internet per day, Respectively; but this was not significantly associated with daily use of e-devices (t=1.945,P=0.053)and daily use of internet (t=1.292,P=0.197).Other complains of pain in the neck, back and hands were reported by less than 10% of students and were not significantly associated with number of hours of daily use of e-devices and daily use of internet, as per this study.Two hundred and fourteen (61.1%) preferred internet because it saved time, 233(66.6%)because it gave latest information, 138(39.4%)felt it was more useful, 84(24%) because it was less expensive and 92(26.3%)felt it was a more preferred medium.

Table - 13: Cross-tabulation -Resource utilization and Regular Use for Academics
Public Health Review -International Journal of Public Health Research 2016;3(5)

Table 10
shows that female students in this college are more conservative in their online behavior.

Need for Incorporating Computer Education in Medical Curriculum-
In our study the number of students willing to undergo training is 12.9%.This when compared to study by Inamdar et al in the year 2004 is quite low which gave result that 82.8 % students were willing to undergo training [4].