The Impact of Internet Addiction on Academic Performance Among Medical Students in Bangladesh: A Cross-Sectional Study and the Potential Role of Yoga #

Abstract

Background

Excessive internet use is a growing concern globally, and internet addiction negatively impacts academic performance. Limited research has been conducted on this topic among undergraduate medical students in Bangladesh.

Purpose

This study aimed to determine the prevalence of internet addiction and its impact on academic performance among medical students in Bangladesh, with a focus on the role of yoga in reducing Internet addiction as a proposed intervention.

Methods

A cross-sectional study was conducted among third-year medical students in four colleges in Dhaka, Bangladesh. Simple random sampling techniques were used to select participants, and data were collected using pretested questionnaires and a checklist for office records through face-to-face interviews. SPSS version 25 was used for data processing and analysis.

Results

Out of 312 students, 84% were addicted to the internet, and only 16% were normal. In total, 64.4% had good results in the first professional examination, while 35.6% had poor results. In total, 85.9% had good attendance, while 14.1% had poor attendance. The association between internet addiction level and first professional examination results and class attendance was highly significant.

Conclusion

This study highlights the high prevalence and negative impacts of internet addiction among medical students in Bangladesh. The study suggests that promoting awareness about healthy technology use, establishing a better balance between internet usage and academic study, and encouraging the practice of yoga can help alleviate this problem. Further research and interventions are needed to tackle this emerging public health issue. Encouraging students to use the internet for academic purposes and providing education and resources can help promote healthy technology use. Healthcare professionals should also be aware of the risks and encourage seeking help if needed.

Keywords

Internet addiction academic performance Bangladesh yoga

Introduction

Global internet and smartphone usage surged to around 4.6 billion users by January 2021, with Asia, particularly China, India and Bangladesh, reporting the highest numbers.^{1, 2} This widespread accessibility has heightened concerns about internet addiction disorder, marked by pathological and compulsive internet use, resulting in adverse life consequences.^{3, 4} Such accessibility issues are linked to challenges like poor academic performance, relationship difficulties, and work-related hurdles, with varying global prevalence, for example, 18.3% in the UK and 4.25% in the United States among college students, and 17.3% in Qatar, 0.7% in India, and 17.9% in Taiwan.^{5, 6, 7}

The internet plays a pivotal role in knowledge acquisition and communication, revolutionising research and information accessibility. However, excessive social media use can disrupt academic performance by diverting scholars from their academic responsibilities, leading to reduced performance.^{8, 9} Excessive internet use is also associated with academic challenges and an inability to complete assignments.¹⁰

Excessive internet use can foster addiction and pathological behaviours, particularly among medical students who often use the internet for non-academic purposes, impacting their academic performance.^11–21 Nevertheless, limited research has explored the link between internet addiction and academic performance among undergraduate MBBS medical students in Bangladesh. Studies in Bangladesh have reported mixed findings, suggesting both negative and positive correlations between internet use and student outcomes.^{22, 23, 24} Recognising the global public health concern of internet addiction, it is important to consider potential interventions. Yoga, renowned for its benefits in stress management, mental well-being and overall health, has garnered attention as a complementary approach to address internet addiction among medical students. This study explores the potential of yoga interventions as holistic and well-being-focused strategies to supplement the demands of medical education. Given the demanding nature of medical curricula, undergraduate medical students may be particularly susceptible to internet addiction,²⁵ which can detrimentally affect their future careers and personal lives. Internet addiction has emerged as a significant global public health issue, affecting health, academic pursuits, sleep patterns and family relationships.²⁶

While several studies have explored internet addiction among medical students, varying results can be attributed to differences in study design, assessment methods and specific sub-populations studied worldwide. Therefore, this cross-sectional study aims to ascertain the prevalence of internet addiction and its impact on the academic performance of undergraduate MBBS medical students in Bangladesh. The findings hold the potential to raise awareness about internet addiction prevention, encourage students to adopt precautionary measures and inform targeted interventions by relevant authorities.

Methods

Study Design

A cross-sectional study was conducted over a period of one year, from January 2021 to December 2021, in four medical colleges located in Dhaka, Bangladesh. The study population consisted of third-year medical students enrolled in the selected medical colleges, including Dhaka Medical College (DMC), Medical College for Women and Hospital, Tairunnessa Memorial Medical College and International Medical College. The study places were selected based on convenience. Medical students from each college were selected by simple random sampling techniques.

Data Collection

Data collection was conducted using pretested semi-structured questionnaires (Table 1). These questionnaires were administered through direct face-to-face interviews with respondents after taking informed written consent.

Table 1.

The Semi-structured Study Questionnaire.

Section A: Socio-demographic information of the students
SI	Questions (Code category)
1	How old are you? (Age in complete years)
2	What is your gender? (Male/female)
3	What is your religion? (Islam/Hindu/Buddhist/Christian)
4	What is the name of your country? (Bangladesh/Nepal/Malaysia/India/Others [Specify])
5	What is your marital status? (Married/unmarried/separated/divorce/widow/widower/others [Specify])
6	What is your family type? (Nuclear family/joint family)
7	What is your present residence? (Home/hostel/rented house/relative house)
8	What is your Father’s occupation? (Physician/teacher/service holder/business/farmer/others [Specify])
9	What is your Mother’s occupation? (Physician/teacher/service holder/business/farmer/others [Specify])
10	What is your monthly income in BDT? (Write in Bangladeshi Taka)
Section B: Level of internet addiction by Young’s Internet Addiction Test (IAT)
	Statement (In 5-point rating scale [0–5])
1	Stay online longer than intended
2	Neglect household chores to spend more time online
3	Prefer the excitement of the internet to intimacy with partner
4	Form new relationships with fellow online users
5	Others complain about the amount of time spent online
6	Grades or college work suffer because of the amount of time spent online
7	Check email before something else
8	Academic performance or productivity suffers because of internet
9	Become defensive or secretive when anyone asks regarding online presence
10	Block out disturbing thoughts about life with soothing thoughts of the Internet
11	Find yourself anticipating to go online again
12	Fear that life without internet would be boring, empty and joyless
13	Snap, yell, or act annoyed if someone bothers you while you are online
14	Lose sleep due to late-night logins
15	Feel preoccupied with internet when offline or fantasise about being online
16	Find yourself saying ‘just a few more minutes’ when you are online
17	Try to cut down the amount of time spent online and fail
18	Try to hide how long you have been online
19	Choose to spend more time online over going out with others
20	Feel depressed, moody or nervous when offline
Section C: Variable related to sleep quantity
1	Do you use internet before sleep at night? (Yes/no)
2	How many hours do you sleep at night? (Yes/no)
3	Do you fall asleep soon after getting into bed, within 30 minutes or less? (Yes/no)
4	Do you typically sleep straight through the night, waking up no more than once per night? (Yes/no)
5	Do you fall back asleep within 20 minutes if you do wake up? (Yes/no)
6.	Do you feel rested, restored and energised upon waking up in the morning? (Yes/no)
Section D: Variable related to academic performance
1	Class attendance (%) (Less than 75% = poor; 75 to 85 = good; >85 = very good)
2	First professional result (passed in all subjects [anatomy, physiology, biochemistry] = very good; passed one or two subjects [among three subjects] = good; failed in all subjects [anatomy, physiology, biochemistry] = poor)

Target Population

Inclusion criteria must be the following:

An MBBS medical student, irrespective of gender

Present in the college on the days of data collection

Willing to participate.

Exclusion criteria must be the following:

Absent in the college on the days of data collection

Unwilling to participate.

Sample Size Estimation

The sample size was estimated using the following formula: n = z²pq/d²

where

n = the desired sample size

z = the value for 95% confidence level, usually set at 1.96

p = the proportion of internet addiction among medical students, which was reported to be 30.1% in a previous study (Zhang, 2018)

q = (1 – p) = 0.70

d = absolute precision, set at 5% (0.05)

Using these values, the desired sample size was calculated as n = (1.96)² × 0.301 × 0.70 ÷ (0.05)² = 324

After accounting for a 10% non-response rate, the sample size was set at 356.

Pretesting

Before data collection, a pretesting of the questionnaire was conducted at Shaheed Monsur Ali Medical College. Data were collected from 20 respondents using a semi-structured questionnaire, and academic performance-related data were collected using a checklist. Based on the results of the pretesting, no modifications were necessary and the finalised questionnaire was used for data collection.

Study Procedure

Data were collected with the help of students and administrative staff from the selected medical colleges. Permission to conduct the study was obtained from the medical college authorities with the submission of a request letter from DMC. Data were collected through face-to-face interviews using a pretested semi-structured questionnaire and checklist. Approximately 10–15 minutes were taken to collect data from each student. At the end of each interview, the collected questionnaires were checked for completeness and accuracy.

Data Processing and Analysis

The collected data were checked, cleaned, edited, compiled, coded and categorised according to the study objectives and variables to detect errors and maintain consistency, relevancy and quality control. Data was entered into the computer for analysis, and the corrected data were analysed using Statistical Package for Social Sciences (SPSS) version 25. Quantitative data were summarised by percentage, while qualitative data were summarised by mean and standard deviation.

Statistical Methods

We utilised a combination of descriptive statistics to summarise the characteristics of our study population, including mean values and standard deviations (mean ± SD) to present the central tendency and variability of our data. We also applied the chi-square test to examine associations between categorical variables and determined statistical significance at the P < .01 level.

Privacy and Informed Consent

It was ensured that the rights and welfare of the participants were protected. The aim and objective of the study, along with its procedure and benefits, were explained to the students in easily understandable local language and informed written consent was obtained. Each student was interviewed separately and the privacy and confidentiality of the respondents were maintained strictly. Any queries regarding questions and answers were clarified to the respondents as per their demands and desires. The respondents were informed about their full freedom to participate or refuse to participate in the study.

Results

Socio-demographic Characteristics of Respondents

The study used a semi-structured questionnaire to collect data on internet addiction, while academic data were collected using a checklist. A total of 312 students participated in the study.

Table 2 summarises the socio-demographic characteristics of the participants. The majority of the respondents were between 20 and 22 years old (95.5%), and the mean age was 21.05 ± 0.83 years. Most of the respondents were Muslim (83%), Bangladeshi (90.1%) and unmarried (94.2%). In terms of family structure, 78.0% of the respondents were living in a nuclear family, and the majority of the respondents (77.2%) were living in a hostel. In terms of monthly income, the majority of the respondents had a monthly income between BDT 20,000 and 40,000 (50.0%).

Table 2.

The Socio-demographic Characteristics of the Participants.

Characteristics	Number (%)
Age
20–22 years	298 (95.5%)
23–25 years	14 (4.5%)
Mean age (±SD)	21.05 ± 0.83
Gender
Male	159 (51%)
Female	153 (49%)
Religion
Muslim	261 (83%)
Hindu	51 (17%)
Nationality
Bangladeshi	281 (90.1%)
Nepali	20 (6.4%)
Indian	11 (3.5%)
Marital status
Unmarried	294 (94.20%)
Married	18 (5.80%)
Family type
Nuclear	244 (78.0%)
Joint	68 (22.0%)
Monthly income
BDT 20,000–40,000 (USD $200–$400)	156 (50.0%)
BDT 40,001–60,000 (USD $400–$600)	137 (43.9%)
Above BDT 60,000 (USD >$600)	19 (6.1%)
Mean monthly income (±SD)	BDT 44,416.67 ± 12,886.57
Residential status
Living in hostel	241 (77.2%)
Living with family	47 (15.1%)
Living in a rented house	24 (7.7%)

Occupation of the Respondents’ Parents

Table 3 shows the occupation of the respondents’ fathers, with service holder being the most common occupation (34.3%), followed by businessman (26.9%) and teacher (24.4%). The occupation of the respondents’ mothers is also shown in Table 3 with housewife being the most common occupation (68.6%), followed by teacher (17.0%) and physician (6.1%).

Table 3.

Showing the Occupation of the Respondents’ Parents.

Occupation	Number (%)
Father
Service holder	107 (34.3%)
Businessman	84 (26.9%)
Teacher	76 (24.4%)
Physician	27 (8.7%)
Farmer	13 (4.2%)
Lawyer	5 (1.6%)
Mother
Housewife	214 (68.6%)
Teacher	53 (17.0%)
Physician	19 (6.1%)
Service holder	19 (6.1%)
Nurse	5 (1.6%)

Internet Addiction Status, Academic Performance and Class Attendance

Table 4 shows that 84% of the students were addicted to the internet, with only 16% being normal. Among the addicted students, 36.9%, 35.6% and 11.5% had mild, moderate and severe addiction, respectively. In terms of academic performance, 64.4% of the respondents had good results in the first professional examination, while 35.6% had poor results. In terms of class attendance, 85.9% of the respondents had good attendance, while 14.1% had poor attendance.

Table 4.

Internet Addiction, Academic Performance and Class Attendance of Participants.

Internet Addiction and Academic Performance	Number (%)
Internet addiction status
Addicted	262 (84%)
Normal	50 (16%)
Degree of addiction (among addicted students)
Mild	115 (36.9%)
Moderate	111 (35.6%)
Severe	36 (11.5%)
Academic performance (first professional examination)
Good (passed in all subjects)	201 (64.4%)
Poor results (failed in ≥1 subjects)	111 (35.6%)
Class attendance (community and forensic medicine)
Good attendance (>75%)	268 (85.9%)
Poor attendance (<75%)	44 (14.1%)

Association Between Internet Addiction Level and Academic Performance

Table 5 shows that among the students who had poor results in the first professional examination, 21.6%, 39.6% and 34.3% were severely, moderately and mildly addicted to the internet, respectively. Only 4.5% of these students were normal. Among the students who had good results in the first professional examination, 6.0%, 33.3% and 38.3% were severely, moderately and mildly addicted to the internet, respectively. About 22.4% of these students were normal. The association between the internet addiction level and first professional examination results was highly significant (P < .01).

Table 5.

Association Between Internet Addiction Level and Academic Performance and Class Attendance Among Students with Good and Poor Attendance.

	Academic Performance		Class Attendance
Internet Addiction Level	Good (Number [%])	Poor (Number [%])	Good (Number [%])	Poor (Number [%])
Normal	45 (22.4%)	5 (4.5%)	48 (17.9%)	5 (4.5%)
Mild	77 (38.3%)	36 (32.4%)	103 (38.4%)	12 (27.3%)
Moderate	67 (33.3%)	44 (39.6%)	98 (36.6%)	13 (29.5%)
Severe	12 (6.0%)	24 (21.6%)	19 (7.1%)	17 (38.6%)
P value	P < .01^*

Association Between Internet Addiction Level and Class Attendance

Table 5 shows that among the students with poor class attendance, 38.6%, 29.5% and 27.3% were severely, moderately and mildly addicted to the internet, respectively. Only 4.5% of these students were normal. Among the students with good class attendance, 7.1%, 36.6% and 38.4% were severely, moderately and mildly addicted to the internet, respectively. About 17.9% of these students were normal. The association between the internet addiction level and class attendance was highly significant (P < .01).

Discussion

The present study determined the prevalence of internet addiction and its relationship with academic performance among third-year MBBS medical students in Bangladesh. The majority of the participants had a mean age of 21 years, which was higher than in Nepal.²⁷ The sex distribution of the participants showed that males (51%) were slightly more represented than females (49%), which differed from a study in India where females (71.9%) were more represented.²⁸ The difference may be attributed to the availability of the male students during data collection. The majority of the participants were Muslim (83.0%). The majority of the participants were unmarried (94.2%), which is in line with a study in Nepal (90.7%),²⁷ but higher than in a Malaysian study (81.9%).²⁹ This may be due to the fact that medical students in Bangladesh usually do not get married during their academic life.

In the current study, most of the participants belonged to a nuclear family (78%), which may indicate the rapid changing of family patterns in Bangladesh due to the expansion of education and employment opportunities, as well as westernisation and modernisation. The majority of the participants were living in a hostel (77.2%), which was higher than a study in India (65.96%).³⁰ The prevalence of internet addiction among the study participants was 84.0%, which was in line with Pakistan (85%)³¹ and Malaysia (81%),²⁹ but lower than in Egypt (87%)³² and Nepal (92.8%),²⁷ and two studies in India (76.84% and 58.07%).^{30, 33} The prevalence of internet addiction among the study participants was 36.9% mild, 35.6% moderate and 11.5% severe, while only 16% of students were not addicted to the internet. These findings differed from a study in Bangladesh³⁴ that reported 76.9% of the respondents had internet addiction, with 62.6% moderate, 13.1% mild and 14.3% severe addiction. In an Indian study, the prevalence of internet addiction was 52.63% mild, 24.21% moderate, while 23.16% of students reported normal internet usage, and severe internet addiction was not reported among the participants.³⁵ The higher prevalence of internet addiction among the participants in this study may be due to increasing advances in technology and cheaper internet costs, as well as the COVID-19 pandemic leading to longer online periods and restricted outdoor activities.

Furthermore, the current study revealed a significant negative association between internet addiction and academic performance. This finding is consistent with the other study conducted among medical students.³⁶ The negative association between internet addiction and academic performance could be attributed to several reasons. For instance, internet addiction may lead to time wastage, procrastination, distraction and reduced attention span, which can adversely affect academic performance. Excessive internet addiction can significantly hinder academic performance through several key mechanisms. It often leads to time mismanagement, diverting valuable study hours towards online activities. Moreover, late-night internet use disrupts sleep patterns, which are crucial for cognitive functioning and academic success.^{36, 36, 37, 38} The constant distractions that come with internet addiction can decrease focus during academic tasks, reducing productivity. Additionally, the psychological consequences, including heightened stress and anxiety, create a detrimental cycle where academic stress and internet addiction feed into each other. These interrelated mechanisms illuminate how internet addiction can undermine academic performance.

Yoga may benefit medical students in Bangladesh by reducing internet addiction and improving academic performance.^{37, 38, 39, 40, 41} Yoga combines physical postures, breathing techniques and meditation to enhance mental and physical health.^{37, 38, 39} Studies have shown that yoga reduces stress, anxiety and depression, which are common risk factors for internet addiction.^{37, 38} Furthermore, yoga enhances self-control and self-regulation, decreasing the likelihood of internet addiction.³⁸ Practicing yoga also promotes mindfulness and attention, leading to improved focus on academic work.^{37, 38, 39, 40, 41} Additionally, yoga increases cognitive function and memory retention by improving blood flow and oxygenation to the brain.^{37, 38, 39, 40, 41} Including yoga in prevention and intervention programs can be cost-effective and accessible, benefiting medical students. Medical educators and policymakers should consider incorporating yoga into the medical curriculum to promote its benefits.

The study’s findings have significant implications for medical education and practice in Bangladesh, highlighting the need for effective prevention and intervention programs. This includes awareness campaigns through workshops, seminars and media dissemination to educate students about the risks and symptoms of internet addiction. Furthermore, promoting responsible technology use among medical students is crucial, which can be achieved by establishing guidelines and best practices. Offering counselling and psychological support within educational institutions is essential to address internet addiction and associated mental health challenges. Encouraging physical activities, socialisation and extracurricular engagement can serve as alternatives to excessive screen time, contributing to overall student well-being. Recognising the impact of internet addiction on academic performance, integrating relevant topics into the medical curriculum is recommended. These topics should cover the effects of technology on health, strategies for managing internet addiction, and the development of critical thinking and digital literacy skills.

The study’s limitations have implications for its validity and generalisability. The cross-sectional design prevents from establishing causal relationships between internet addiction and academic performance, highlighting the need for future longitudinal studies. While our study provides a snapshot of the prevailing conditions among medical students in Bangladesh, it cannot definitively confirm whether internet addiction directly influences academic performance or if other variables are at play. To address this limitation, future research should consider longitudinal designs that track changes in internet addiction and academic performance over time, allowing for a more comprehensive understanding of the causal pathways at play. Additionally, the use of convenience sampling may introduce selection bias, potentially limiting the generalisability of our findings to all medical students in Bangladesh. Variations in demographic characteristics, internet usage patterns and academic performance may exist in different subsets of the population, potentially limiting the generalisability of our findings to the entire medical student community. To enhance the study’s generalisability and external validity, future investigations should aim to employ more diverse and representative samples, ideally employing random or stratified sampling techniques. To improve the study’s validity and generalisability, future research should consider more diverse and representative samples and employ robust sampling methods. To enhance the study’s generalisability and external validity, future investigations should aim to employ more diverse and representative samples, ideally employing random or stratified sampling techniques.

Conclusion

This study highlights the significant prevalence of internet addiction among medical students in Bangladesh, with associated negative impacts on academic performance and attendance. To address this concern, raising awareness and promoting healthier internet usage is recommended. The integration of yoga interventions shows promise. Encouraging academic internet use and fostering a balanced approach between online activities and academic study is essential. Further research and interventions are needed to combat this public health issue. Thus, incorporating yoga practices into the curriculum and interventions for internet addiction among medical students, supported by healthcare professionals, can enhance students’ well-being and academic success. Additionally, healthcare professionals should be aware of the potential benefits of yoga and encourage patients to incorporate it into their daily routine.

Footnotes

Authors’ Contribution

Conceptualisation: SA, NSR, TTT; data curation: SA, NSR, TTT, FA; formal analysis: SA; investigation: SA, NSR, TTT; Methodology: SA, NSR, TTT, FA; project administration: SA, NSR, TTT, FA, MIR; Software: SA, NSR; supervision: SA, NSR; validation: SA; roles/writing—original draft: SA, NSR, TTT, FA, MIR, VP; writing—review and editing: SA, NSR, TTT, FA, MIR, VP, SHS, LK, KN, FV.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

ICMJE Statement

This article complies with the International Committee of Medical Journal Editors’ uniform requirements for the manuscript.

Informed Consent

Informed consent was taken.

Statement of Ethics

Prior to the commencement of this study, ethical approval was obtained from the Institutional Review Board (IRB) of Dhaka Medical College (DMC). This approval ensured that the study was conducted in an ethical manner, in accordance with relevant guidelines and regulations.

ORCID iDs

Nur-A-Safrina Rahman

Tahsin Tasneem Tabassum

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