Perception, Smartphone, Mobile applications, Knowledge, Students, e-learning

Currently, the extent of technology is not limited to gadgets, instruments, motors, and techniques but revolves around the human attempt to fulfill their needs and wants using cutting-edge technology. Many gadgets, such as smartphones, are not just inventions triggering a revolution in the communication sector but have integrated many tools and widgets in themselves by gradually obsoleting the use of narrow feature devices [1]. Technology is multifaceted, which fascinates its users to master all of its features but complicates the situation by advancing the existing features quickly. The causal nexus between technology and its users initiates an intense obsession where people believe life is meaningless without technology [2]. Progressive technology directly or indirectly impacts all segments of society, resulting in many modifications [3].

The smartphone is among the fascinating technological inventions attracting people from different socioeconomic strata with diverse demographic attributes [4]. Smartphones contain multiple features aiding users' needs, such as a camera, a global positioning system (GPS), maps, internet accessibility, and a scientific calculator. Despite having valuable features, smartphones also account for specific difficulties. For example, the excessive use of smartphones reduces social interactions and physical activities among users, resulting in multiple physical and mental healthcare problems [5]. The literature suggests that smartphone usage during adulthood is correlated with delayed sleep time, shorter sleep periods, and sleep disorders, which lead to mental issues and initiate symptoms of depression [6]. Unrestricted access to sexual and pornographic content is also causing porn addiction among adults, with increasing psychological health problems [7].

In the meantime, smartphones have become a popular and effective learning tool among students of all disciplines, especially in health science, gradually replacing conventional learning methods with advanced e-learning techniques [8]. The student's use of smartphones encompasses using different applications for academic purposes to access rapidly evolving scientific knowledge such as scholarly articles, industry reports, infographics, visual aids, etc. [9]. Given the importance of the field, healthcare students and professionals need to be informed about new technologies, organizational models, and high-value clinical procedures to attain optimal healthcare outcomes. The advancement of technology has made it possible through smartphones with ancillary benefits of cost-effectiveness, as well as rapid and easy access to a broad spectrum of relevant knowledge. After the emergence of COVID-19 as a global pandemic, smartphones are still more vital owing to their copious use in online learning [10,11].

Pakistan is a densely populated country with many smartphone users. It ranks 11th on the list of emerging economies experiencing an increasing shift in demand for smartphones over a decade. The primary motivation for purchasing smartphones could be the affordability of internet services offered by mobile service providers [12]. Currently, almost every student keeps a smartphone to access online libraries, take notes, and share academic material among themselves [13].

A Pakistani-based study reported that 95.8% of medical students had smartphones, among which 41.46% were using medical applications and 28.08% were aware of medical learning applications [14]. Moreover, nearly three-quarters of the students (71.7%) were not reading e-books and e-materials. Therefore, in conformity with previous findings, it is unclear how smartphones could enhance health science students' knowledge. However, it can be comprehended by exploring the self-reported perception of smartphone users. Therefore, we aim to explore students' perception of smartphones as a new modality to enhance health science knowledge and whether this technology could assist them in accomplishing their educational goals.

2.1. Ethical considerations

The study adhered to international ethical guidelines for research involving human subjects [15] and obtained ethical clearance from the Ethical Review Committee at Rai Medical College, Sargodha, Pakistan (No. RMCS/ERC/11/21).

2.2. Study design

This study was conducted using a descriptive cross-sectional study design.

2.3. Study duration

The research was carried out during the period spanning from January to March 2022.

2.4. Study settings

The present study was conducted in Lahore, Pakistan, at three universities: the University of Punjab, the University of Health Sciences, and the University of Lahore. These universities have a combined enrollment of over 144,520 students across various on-campus degree programs, representing diverse social strata [16,17,18].

2.5. Participant eligibility

We recruited participants from undergraduate health sciences degree programs who had been enrolled for at least one year and owned and regularly used smartphones. Degree programs included physical therapy, human nutrition, dietetics, radiography and imaging technology, and nursing. We excluded students with any disabilities or impairments from the study.

2.6. Sampling method

We used a convenience sampling technique to collect data for this study. This nonprobability sampling method was utilized due to the practical time constraints and resources available. In addition, the participants were recruited based on their availability and willingness to participate in the study.

2.7. Sample size estimation

At a 95% confidence level, the sample size of 203 was calculated by keeping the significance level at 5%, the power of the test at 90% with a test value proportion of 82%, and the anticipated population proportion at 90% by using the WHO calculator (version 2.0.21) [19]. However, the sample size was further increased to 222 to cater to nonresponses, dropouts, and refusals.

2.8. Study instrument development

We utilized a modified version of Delone and Mclean's information systems (IS) success model, as proposed by Seddon and Kiew [20], as the basis for our study instrument. To develop the questionnaire, we extensively reviewed the relevant literature [19] and formulated a set of questions covering five IS success constructs. The initial questionnaire was subjected to expert validation. University educationists provided feedback on the tool's various sections regarding simplicity, importance, and relevance. Additionally, the questionnaire was pretested on a sample of five students to evaluate its presentation, ease of comprehension, and acceptability. Based on the pretest results, we made necessary modifications to the questionnaire prior to its final use.

2.9. Study Measures

The instrument used in this study consisted of four sections: sociodemographics, students' status regarding smartphone usage, general information regarding smartphone usage, and student perception regarding smartphones as a new modality. The last section was further divided into five subsections that collected information regarding the system quality, information quality, system importance, usefulness, and satisfaction.

Responses were measured using two Likert scales ranging from 'never' to 'always' and strongly disagree' to 'strongly agree,' with scores ranging from 1 to 5.

2.10. Informed consent and questionnaire distribution

Prior to participating in the study, students were provided with information about the purpose of the study and its voluntary nature. Written informed consent was obtained from each participant before the data collection team distributed the questionnaire.

2.11. Data analysis

Data analysis was performed using both Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) and Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA). The internal consistency and reliability of the five IS success constructs, comprising 27 items, were assessed using Cronbach's alpha coefficient. The commonly accepted criterion of 0.70 or higher was used to determine good internal consistency. Descriptive statistics, such as frequencies, percentages, means, and standard deviations (SDs), were used to describe the participants' demographic characteristics. Additionally, the study variables' weighted mean and standard deviation were computed and interpreted using the weighted averages for a 5-point Likert scale guide adapted from a previously conducted study [21].

The Cronbach's alpha value was 0.832, indicating high correlation and reliability among the items measuring each construct. This suggests that the constructs were accurately and consistently measured, and the items can be considered reliable indicators of the underlying constructs.

Table 2 shows that the participation rate of females (70.27%) was higher than that of males (29.73%). The majority of students studied under the local education system, namely, matriculation (88.29%) and higher secondary level (91%). In contrast, a smaller proportion of students followed the Cambridge study system: O levels (11.71%) and A levels (9.01%). Notably, the average usage of smartphones among students varied significantly, ranging from less than an hour to over six hours. Furthermore, students' average monthly household income was PKR 65,216.22 ± 34,807.53.

Table 3 indicates that students use smartphones for a range of purposes. Among the study respondents, accessing learning content (4.58 ± 4.05), text messaging services (4.48 ± 3.95), and internet-based text messaging services (4.36 ± 3.83) were the most commonly used functions. The table also reveals that the study participants viewed smartphones as essential for educational purposes (4.26 ± 3.72), such as understanding and revising concepts delivered through lectures (4.26 ± 3.73). However, students reported using smartphones less frequently to access online libraries (3.27 ± 2.27).

Table 4 shows that all components indicating smartphones as a new modality to enhance health sciences knowledge, including system quality, information quality, system importance, usefulness, and satisfaction, influenced the students' perception.

Our study findings have highlighted the significant role of smartphones in the daily lives of health sciences students. The results demonstrated that students use smartphones for a variety of purposes, including accessing learning content, text messaging services, and internet-based messaging services. Interestingly, the average daily smartphone usage among students varied widely, ranging from less than an hour to more than six hours. Our study also revealed that the majority of students had completed their secondary and high secondary education under the local education system, specifically matriculation and higher secondary level, while a smaller proportion of students had followed the Cambridge study system, i.e., O and A levels. Moreover, our study showed that students perceived smartphones as a new modality to enhance their knowledge in health sciences, as evidenced by their positive perception of system quality, information quality, system importance, usefulness, and satisfaction. These findings suggest that smartphones have become an integral part of the educational experience for health sciences students, and their use should be encouraged for educational purposes.

The results of our study are consistent with another study conducted at the Medical University of India, which examined the effect of mobile phone use on students' learning [22]. According to this study, medical students primarily use smartphones to access educational resources such as video lectures, medical websites, and applications. They also use their phones to take notes during lectures and assessments after watching the lectures. Other Saudi study results align with our study results that assessed practices of smartphone usage among undergraduate nursing students and revealed that 94.8% of students carry smartphones at all times [23]. In addition, students reported smartphone usage for documenting class information (77.8%), accessing information from websites during group studies (93.3%), using communication applications for group studies (89.6%), and using social media platforms for academic purposes (85.2%). Our study results are consistent with another study in the United Kingdom (UK) that recruited clinical and medical students to determine smartphone usage and its acceptability as a modality to enhance knowledge. The study revealed that 59% of students owned a smartphone; 37% used it to support their learning. Furthermore, the students had a positive attitude toward the concept of smartphones as future academic aids, and 84% believed smartphones are helpful in academics [24].

The use of smartphones among students, specifically for educational purposes, has dramatically increased during the COVID-19 pandemic due to lockdown restrictions. For example, a Jordanian study assessed smartphone addiction among university students during the COVID-19 lockdown period by recruiting 6,157 students [25]. The majority of the students (85%) reported that their smartphone usage greatly increased, and 27.6% reported increased smartphone usage during the lockdown. In addition, 42% of participants reported smartphone use for more than six hours a day. Another study compared electronic gadget usage during the COVID-19 pandemic among higher education students in Italy, Spain, and Ecuador and highlighted that along with smartphones, laptops were among the most widely used devices for educational and information purposes [26].

The study's results are not supported by a Malaysian study that determined smartphone usage among university students and indicated that most students somewhat agreed that they used smartphones without any compelling reasons every hour and that it induced emotional stability [27]. The findings implied that the students were somewhat addicted to smartphones but did not use them for academic purposes [27]. Similarly, a Brazilian study revealed that most students were addicted to smartphones but explicitly used them to access social media platforms, including Instagram, Facebook, and Snapchat [28].

Increased smartphone use among multidisciplinary students, especially in the health sciences discipline, can be attributed to the ease of carrying a phone, taking lecture notes, gathering relevant information, and accessing the internet, which helps them in their studies [29]. Furthermore, students use smartphones due to different discipline-based applications, which aids them in academics and improves their learning concepts [30]. All common uses of smartphones, such as recording lectures, storing files, and retrieving information whenever needed, have made them a novel modality in healthcare education [31]. Additionally, smartphone usage is widespread for communication and socialization as a cheaper, more reliable, and instant source of communication [32]. Finally, in addition to using smartphones for academic purposes, the popularity of this modality can be attributed to various determinants, including entertainment reasons, listening to music, watching videos and movies, and socializing through different social network applications [33].

Our study has shed light on the importance of smartphones in the lives of health sciences students and their positive perceptions of smartphones as a new modality to enhance their knowledge. To the best of our knowledge, this study is among the few that have explored this topic in local settings, making a significant contribution to the literature. Nonetheless, our study has some limitations that should be acknowledged. First, we did not investigate the potential negative effects of smartphone usage on students' academic performance. Additionally, we did not explore the correlation between smartphone usage and academic performance. Future studies could address these gaps in the literature. Second, we used descriptive statistics to analyze the data but did not employ inferential statistics. Therefore, the findings of the study should be interpreted with caution. Despite these limitations, our study provides important insights into students' perceptions of using smartphones for educational purposes in the field of health sciences.

In conclusion, our study highlights the significant role of smartphones in the daily lives of health sciences students and their positive attitudes toward using them as a tool for enhancing their knowledge. Students use smartphones to access learning content and other online resources, and our findings suggest that educators should incorporate them into the educational curriculum. Notably, our study found that students' average daily smartphone usage varied widely. These findings have significant implications for the educational system, as smartphones have become an essential part of the educational experience for health sciences students. However, future studies could investigate the potential negative effects of smartphone usage on academic performance and explore the correlation between smartphone usage and academic outcomes to better understand the impact of smartphones on education.

Conceptualization, SSF, and AA; methodology, SSF, and AA; software, SSF, and AA; validation, SSF, and AA; formal analysis, SSF, and AA; investigation, SSF; resources, SSF; data curation, SSF, and AA; writing—original draft preparation, SSF; writing—review and editing, AA; visualization, SSF, and AA; supervision, AA; project administration, SSF. All authors have read and agreed to the published version of the manuscript.

This research received no specific grant from the public, commercial, or not-for-profit funding agencies.

This study obtained ethical clearance from the Ethical Review Committee at Rai Medical College, Sargodha, Pakistan (No. RMCS/ERC/11/21).

Prior to questionnaire distribution, written informed consent was obtained from all participants.

All data are presented in this study.

We wish to thank all the staff and administrators at the University of Punjab, the University of Health Sciences, and the University of Lahore.

The authors declare no conflicts of interest.

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