RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

DISSERTATION

1

NAME OF THE CANDIDATE

AND ADDRESS

MR.AKSHAY SADANSHIV

I YEAR M.SC NURSING

RAJEEV COLLEGE OF NURSING

K.R PURAM, HASSAN - 573201

2 NAME OF THE INSTITUTION RAJEEV COLLEGE OF NURSING

K.R PURAM, HASSAN

3 COURSE OF STUDY AND

SUBJECT

MASTER IN NURSING

-PSYCHIATRIC NURSING

4 DATE OF ADMISSION TO

COURSE

15/07/2013

5 TITLE OF THE STUDYEFFECTIVENESS OF STRUCTURED

INSTRUCTIONAL MODULE REGARDING

KNOWLEDGE ON INTERNET ADDICTION

AMONG GNM STUDENTS IN SELECTED

SCHOOLS OF NURSING, HASSAN’.

5.1 STATEMENT OF THE PROBLEM‘A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED

INSTRUCTIONAL MODULE REGARDING

KNOWLEDGE ON INTERNET ADDICTION

AMONG GNM STUDENTS IN SELECTED

SCHOOLS OF NURSING, HASSAN’.

1

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

As this 21st century has opened new avenues and horizons of progress and development through

advancement in technology, life style, and social relationship.

The Internet is a global network connecting millions of computers. More than 100 countries are

linked into exchanges of data, news and opinions. According to Internet World Stats, as of December 31,

2011 there was an estimated 2,267,233,742 Internet users worldwide. This represents 32.7% of the

world's population.[1]

Though Internet has been established only a few decades ago, the Internet is a system of

enormous technical and social complexity. It comprises a gigantic but almost invisible universe that

includes thousands of networks, millions of computers, and billions of users across the world. [2]

Computer access and use among adolescents and other age brackets have grown exponentially over the

past decade. More than 80% youth, ages 12 to 17, use the Internet, and nearly half log on daily. Although

little research has been conducted on the effects of the Internet on various aspects of human

development, the role of computers and the Internet as a means for socialization, education, information

access, entertainment, shopping, and communication is increasing dramatically. Many adolescents

reportedly prefer being online to other media, including the telephone, TV, and radio. Given that so many

adolescents are spending so much time on the Internet, it is essential to be aware of its impact on

adolescent behavior, well-being, and development. [2]

Easy and continuous access to the Internet provides tremendous opportunities for adolescent

socialization, allowing them to connect with their peers as well as with complete strangers from across

the world. Clearly, the Internet is transforming the social world of adolescents by influencing how they

communicate, establish and maintain relationships, and find social support. Therefore, it is essential to

gain awareness of both the potential benefits and risks of teen Internet use, and provide strategies to

guide safe and positive practice.

As a complex medium of communication, the Internet provides the possibility of small, intimate

social environments geared towards faster or “instant” communication. At the same time, the networks

can be very large offering global access to its users. This global network allows for American teens to

connect with those in Botswana or any “wired” area in the world. This propels the development of youth

leadership, communication, socialization, information, and learning to an international scale. For

example, teens in Accra, Ghana use the Internet as a source of health information in order to gain the

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necessary information on both sexual and general health issues that they would probably not have access

to in their own local environment .

Rainie & Horrigan, (2005) Found that the Internet serves as a powerful resource for information

about socially sensitive topics such as sex and interpersonal relations, it also serves as a community

building tool providing information on civic engagement and political participation. Studies have shown

that through Internet communication, youth are given the opportunity to exercise leadership skills and

become stakeholders in communities that they themselves have created. This encourages autonomy and

identity construction free of norms and expectations. Despite fears of stalkers and inappropriate sites,

parents are beginning to recognize the Internet as a powerful tool for both networking, and academic

enhancement for their children.

Low-income youth who consistently used the Internet exhibited higher grade point averages over

the course of time than less frequent users.

Online communication may encourage more truthful exchanges: many people report a greater

willingness to share thoughts and feelings online than they would in person. This freedom from social

pressures may help adolescents build more confidence in real social situations and can elicit a sense of

connection to others, an important aspect in adolescent social development. On the other hand, this lack

of “on the ground” interactions may pose risks for teens, especially those who are socially anxious. [2]

Risk Factors of Teens Internet Use

Although the Internet has consistent positive impacts on modern society, it has also caused

various societal concerns about privacy, security, pornography, Internet crime, and virtual community. Its

easy accessibility poses greater risks and dangers for youth as compared to other forms of media.

According to the National Altitudinal Poll, the number one media concern for parents has shifted from

television to the Internet: 85% of parents reported that among all forms of media, the Internet posed the

greatest risk to their children (Common Sense Media, 2006). Parental concerns are valid, especially

considering that teens are essentially free to view and post whatever they choose and communicate with

whomever they want. Hand in hand with this, the Internet has become a highly effective and profitable

means of distributing sexually explicit material, as well as a sophisticated channel for compulsive sexual

behavior, sex trafficking, and sex crimes.

According to a survey performed by the London School of Economics (2002), 90% of children

between ages 8 and 16 have viewed pornography on the Internet. In most cases, the sex sites were

accessed unintentionally when child, often in the process of doing homework, used an innocuous word to

search for information or pictures. Such free access and exposure to this information by adolescents who

have not yet developed a full maturity could pose negative impacts on adolescent development and could

potentially manifest in their social interactions with peers, their sexual activity, and their emotional

development. [2] In addition, free and sometimes anonymous communication through chat rooms, blogs, 3

and IM pose risks to teens. Recent studies have shown that adolescents form virtual communities to

support unhealthy behavior including self-injury and eating disorders. [2]

Analysis of chat conversations suggests that chat participants often resort to the age/sex/location

chat code to share identity information. A nationwide poll showed that half of teens ages 13-18 often

communicate through the Internet with someone they have not met in person; one-third have talked about

potentially meeting someone face-to-face whom they have only met through the Internet (Polly Klaas

Foundation, 2006). [2]

6.1. NEED FOR STUDY

Internet Addict is a person who spends most of his time not living his own life but rather living

the life set out for him by the websites over the internet. Websites like Facebook, Orkut, Twitter,

MySpace, YouTube…. the list is just endless. The time that a person can spend in doing his job or

studying is rather wasted on internet doing nothing. So the productivity of our work is decreasing day by

day just because people want to spend more time writing on their Facebook walls, watching videos,

reading blogs than living their own real life. This problem is rapidly increasing but can it be solved.

More than 750 million active users.People spend over 700 billion minutes per month on

Facebook. There are over 900 million objects that people interact with (pages, groups, events and

community pages). More than 30 billion pieces of content (web links, news stories, blog posts, notes,

photo albums, etc.) shared each month. Every month, more than 250 million people engage with

Facebook on external website .There are more than 250 million active users currently accessing

Facebook through their mobile devices.

More than 13 million hours of video were uploaded during 2010 and 48 hours of video are

uploaded every minute, resulting in nearly 8 years of content uploaded every day. Nearly 17 million

people have connected their YouTube account to at least one social service (Facebook, Twitter, Orkut,

Buzz, etc.). 150 years of YouTube video are watched every day on Facebook and every minute more

than 500 tweets contain YouTube links, 100 million people take a social action on YouTube (likes,

shares, comments, etc.) every week.[3]

The Word Internet Addiction says It All. Internet Addict is a person who spends most of his time

not living his own life but rather living the life set out for him by the websites over the internet. Websites

like Facebook, Orkut, Twitter, MySpace, YouTube…. the list is just endless. The time that a person can

spend in doing his job or studying is rather wasted on internet doing nothing. So the productivity of our

work is decreasing day by day just because people want to spend more time writing on their Facebook

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walls, watching videos, reading blogs than living their own real life. This problem is rapidly increasing

but can it be solved.

Every 10 seconds there is a cyber crime committed somewhere in the world. As India is the 3 rd

largest internet using country, with most the colleges and institution providing facilities of Wifi, internet

browsing and pathological use of internet by adolescents. Hence researcher felt it is very important to

conduct research on internet addiction among Indian adolescents.

6.2. REVIEW OF LITERATURE“The philosophies of one age have become the absurdities of the next and foolishness of yesterday

has become the wisdom of tomorrow”.

-Anonymous.

The review of literature is organized under the following headings:

1. Review of literature related to internet addiction

2. Review of literature related to effectiveness of Structured Instructional Module

1. Review of literature related to internet addiction

A functional magnetic resonance imaging study was conducted in Department of Psychology,

Zhejiang Normal University and found that 'Internet addiction disorder' (IAD) is rapidly becoming a

prevalent mental health concern in many countries around the world. The neurobiological underpinnings

of internet addiction should be studied to unravel the potential heterogeneity in the disorder. The study

examines the neural correlates of response inhibition in males with and without IAD using an event-

related functional magnetic resonance imaging (fMRI) Stroop task. The IAD group demonstrated

significantly greater 'Stroop effect'-related activity in the anterior and posterior cingulate cortices

compared with their healthy peers. These results may suggest diminished efficiency of response-

inhibition processes in the IAD group relative to healthy controls .[4]

A symptomatic study was conducted by Müller KW which suggested that internet addiction is a

relevant factor among minors in psychiatric institutions. Those with comorbid internet addiction show

distinct patterns of psychopathology and may require disorder-specific treatment.[5]

Economist Professor Kimberley Scharf, from the Centre for Competitive Advantage in the Global

Economy (CAGE) at the University of Warwick, claims that when people have more friends on a social

site like Facebook, the less likely we are to share information about charitable causes, a phenomenon

called 'free riding'. She added that social interactions are not always good for giving, as people may share

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information about worthy causes or good providers, but if there are too many people sharing information,

the messages could get lost in the 'noise' of the crowd.[6]

According to Times of India report which was based on the survey the usage patterns of over 61

million netizens above 15 years of age, accessing the internet from home or office. It did not take into

account cybercafes, mobile phones or PDAs. Social networking continues to dominate the attention of

Indians online, taking up one out of every four minutes of the time spent on the internet. The report found

that Google Sites ranked as the top destination in June 2012 reaching nearly 95% of the online Indian

population, while among local web properties led the pack, reaching 33.7% of India's netizens.[7]

A study conducted by School of Management and Medical Informatics, Isfahan University of

Medical Sciences, Isfahan, Iran on Impact of addiction to internet on a number of psychiatric symptoms

in students of Isfahan universities suggested that psychiatrists and psychologists involved in the field of

mental health need to be well informed about mental problems due to internet addiction, such as anxiety,

depression, aggression, and job and educational dissatisfaction.[8]

Case control study was conducted by Medical Faculty Mannheim, Heidelberg University,

Mannheim, Germany on The Role of the CHRNA4 Gene in Internet Addiction studies from Asia

provided first evidence for a molecular genetic link between serotonergic and dopaminergic

neurotransmission and Internet addiction. The report offers data on a new candidate gene in the

investigation of Internet addiction-the gene coding for the nicotinic acetylcholine receptor subunit alpha

4 (CHRNA4).[9]

A systematic review was by National Centre for Suicide Research and Prevention of Mental Ill-

Health (NASP) at Karolinska Institutet, Stockholm, Sweden, which suggested Pathological Internet use

(PIU) has been conceptualized as an impulse-control disorder that shares characteristics with behavioral

addiction. Depression and symptoms of ADHD appeared to have the most significant and consistent

correlation with PIU. Associations were reported to be higher among males in all age groups. Limitations

included heterogeneity in the definition and diagnosis of PIU.[10]

The study conducted by Department of Psychological Counseling and Guidance, Faculty of

Education, Sakarya University , Sakarya, Turkey on the relationships between internet addiction,

subjective vitality, and subjective happiness found that subjective vitality and subjective happiness were

negatively predicted by Internet addiction. On the other hand, subjective happiness was positively

predicted by subjective vitality. In addition, subjective vitality mediated the relationship between Internet

addiction and subjective happiness.[11]

6

According to the Institute for Research on Children, Youth and Family, Faculty of Social Studies,

Masaryk University, Brno, The Czech Republic which conducted study on Associations between online

friendship and Internet addiction among adolescents and emerging adults found that The study revealed

that effects between Internet addiction and approaches to friendship may be reciprocal: Being oriented

toward having more online friends, preferring online communication, and spending more time online

were related to increased risk of Internet addiction; on the other hand, there is an alternative causal

explanation that Internet addiction and preference for online communication conditions young people's

tendency to seek friendship from people met online.[12]

The study conducted by Department of Sociology & Addiction Research Group, Stockholm

University, on Extensive internet involvement found that Most Swedes (85%) do use the Internet to some

degree. The prevalence of excessive use parallels other similar countries. Respondents in our study spend

(mean value) 9.8 hours per week online at home, only 5 percent spend more than 30 hours per week.

There are both positive and negative social effects at hand. Many respondents have more social contacts

due to the use of Internet, but there is a decline in face-to-face contacts. About 40% of the respondents

indicate some experience of at least one problem related to Internet use, but only 1.8% marked the

presence of all problems addressed. Most significant predictors for problem indicators, except for age,

relate to "time" and time consuming activities such as gaming, other activities online or computer skills.[13]

The study conducted by Department of the Navy, Pensacola, Florida, USA on Relationship

between Facebook use and problematic Internet use among college students suggested that the

popularity of Facebook and other online social-networking sites has led to research on the potential risks

of use, including Internet addiction. Previous studies have reported that between 8 percent and 50 percent

of college students report problems consistent with Internet addiction. The current study assessed a range

of variables related to Facebook use, and sought to determine how the use of Facebook relates to

problematic Internet use. Undergraduate participants (N=281, 72 percent women) completed a battery of

self-report measures, including the Internet Addiction Test, via an online interface. The results of the

current study suggest that a sizable minority of students experience problems related to Internet use and

that the use of Facebook may contribute to the severity of symptoms associated with Internet addiction.[14]

The study conducted to investigate the psychiatric symptoms of adolescents with and without Internet

use. A total of 2,080 students (1,105 male, 975 female) were recruited for the study. This administered

the Symptom Checklist-90-Revision and Questions Related to Internet Use. Students in 10th through

12th grades were recruited from 14 senior high schools in Sivas, Turkey. Data were analyzed after

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excluding the participants who provided incomplete data. It was found that Internet use in adolescents

was associated with more severe psychiatric symptoms. Attention should be devoted to adolescents with

Internet use for the design of preventive strategies. [15]

Review of literature related to treatment and Education programme on internet addiction

Study was conducted by Department of Family Medicine, Medical University of South Carolina

College of Medicine, Charleston, USA on The effectiveness of the structured  instructional module found

that the mean scores of students in group structured instructional module higher than those of students

in group of lecture. These results suggest that the SIM is an effective patient-based standardized

instructional program that enhances the instruction of clinical skills to students. [16]

Study conducted on treatment of internet addiction by Cognitive behavior therapy.Researchers

have suggested using cognitive behavioral therapy (CBT) as the treatment of choice for Internet

addiction, and addiction recovery in general has utilized CBT as part of treatment planning. To

investigate the efficacy of using CBT with Internet addicts, this study investigated 114 clients who

suffered from Internet addiction and received CBT at the Center for Online Addiction. This study

employed a survey research design, and outcome variables such as client motivation, online time

management, improved social relationships, improved sexual functioning, engagement in offline

activities, and ability to abstain from problematic applications[17]

The study was conducted to determine effects of an empowerment education program (EEP) on

internet games addiction, empowerment, and stress in middle school students. The EEP used in this study

was based on the Freire's Empowerment Education Model. The results shown that "the experimental

group would have higher empowerment scores than the control group."The experimental group would

have lower internet games addiction scores than the control group,the experimental group would have

lower stress scores than the control group. [18]

A study conducted on Internet addiction and the role of counseling and education for the

prevention of internet addiction.The study was aimed to measure the degree of Internet addiction among

a group of medical students. Amongst the study population (n=130, age 19-23 years), 40% had mild

addiction. Moderate and severe addiction was found in 41.53% and 3.07% of the participants

respectively. The study revealed that 24% often and 19.2% always found themselves using Internet

longer than they had planned or thought. Results reflected that a significant number of participants

suffered from mild to moderate addiction. The role of counseling and education should be emphasized

for prevention of Internet addiction. [19]

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6.3. STATEMENT OF THE PROBLEM“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED INSTRUCTIONAL

MODULE REGARDING KNOWLEDGE ON INTERNET ADDICTION IN SELECTED GNM

STUDENTS OF HASSAN.”

6.4. OBJECTIVES

To assess the effectiveness of structured instructional module regarding internet addiction on

knowledge about internet addiction in selected GNM students.

To find association between selected demographic variables and knowledge score of internet

addiction among GNM students at selected schools of nursing, Hassan.

6.5 HYPOTHESIS

H0: There is no significant difference in knowledge score before and after administering

Structured Instructional Module regarding Internet Addiction.

H1: There is significant increase in knowledge score after administering Structured Instructional

Module regarding Internet Addiction.

6.6 ASSUMPTION

1. Structured instructional model may have affect on knowledge of student regarding internet

addiction.

2. Adolescents may have some knowledge regarding internet addiction.

6.6OPERATIONAL DEFINITIONS

1. Addiction: The fact of condition being addicted to a particular substance or activity. [20]

In this study, person is addicted to internet.

2. Effectiveness: The degree to which something is successful in producing a desired result. [21] In this

study, degree to which structured instructional module is successful in improving the knowledge of

adolescents about internet addiction.

9

3. Structured Instructional Module :A instructional unit that includes one or more learning objectives,

appropriate learning materials and methods. In this study it includes knowledge about internet addiction.

4. Knowledge:Facts, information, and skills acquired through experience or education; the theoretical or

practical understanding of a subject.

Facts information, definition, causes, risk factors, physical factors, diagnosis, effects and elf help tips

regarding internet addiction.

5. Internet: Global computer network providing variety of information and communication facilities,

consisting of inter connected network using standardizes communication protocols.[22]

In this study, a network of information and communication facilities comprising social networking sites

and entertainment site that causes psychological, social or physical problem for the user.

6. Internet addiction

Excessive, non-essential use of internet that causes psychological, social or physical problem for the user.[23]

In this study excessive, non-essential use of internet comprising social networking sites and

entertainment sites that causes psychological, social or physical problem for the user

7. MATERIALS AND METHODS OF STUDY :

7.1 SOURCE OF DATA :Data will be collected from GNM students of Hassan college of nursing, Karnataka

7. 2 METHOD OF COLLECTION OF DATA

7.2.1 RESEARCH APPROACH

Evaluative research approach.

7.2.2RESEARCH DESIGN

One group pretest posttest design.

7.2.3 SAMPLE:

Population for the study will be the students of GNM, Hassan

7.2.4 SAMPLE SIZE:

In this study, the sample consisted of 60 students who fulfill the criteria laid down for the selection of the

sample. [25]

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7.2.5 SAMPLING TECHNIQUE

Probability multistage cluster sampling will be used.

7.2.6 SELECTION OF TOOL

A tool is an instrument used for the collection of data.

Development of the Tool

The investigator developed the tool after updating theoretical knowledge by reviewing relevant

literature on temporary contraceptive methods.

The investigator’s own experience, theoretical knowledge and guidance from the expert along

with the review of literature helped in developing the tool necessary for the study.

The following tool was developed for the study

- Self instructional module on temporary contraceptive methods.

Description of the Tool

Questionnaire: A semi structure questionnaire was prepared to determine the knowledge of adolescents

regarding internet addiction.

“A questionnaire is a totally structured instrument, the subjects are asked to respond to the

questions in sequential order, and they are given the same set of option for other response”.

The questionnaire consisted of all closed ended questions as they are easier to administer and

analyze. They can also be completed in a given amount of time.

Section I: Deals with the demographic data of adolescents.

Section II: Multiple choice question regarding internet addiction.

Scoring

A score of ‘1’ was given for each correct answer and the score of ‘0’ was given for every wrong

answer. The total score was 20. No negative scoring was done.

Technique

The technique used was self-reporting.

7.2.7 CRITERIA FOR SAMPLE SELECTION

The researcher identified all the samples, who met the inclusion criteria. The criteria are set for the

selections of the samples were done as follows:

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INCLUSION CRITERIA

i. Students who are willing to participate in study.

ii. Students who are present at the time of data collection.

EXCLUSION CRITERIA

i. Students who are not willing to participate in study.

ii. Students who are available during study.

7.2.8 DELIMITATION OF THE STUDY

The study is limited to adolescent’s students.

The study is limited to Hassan city.

The study is limited to students who are ready to participate.

7.2.9 SIGNIFICANCE OF THE STUDY

The study helps to assess various dimensions of knowledge of adolescents regarding internet

addiction, cyber crime, pathological gambling and excessive use of social networking sites, social

isolation and problem faced by adolescents regarding internet addiction.

7.2.10. CONCEPTUAL FRAMEWORK

The conceptual framework of the present study is based on General Systems Theory. It mentions

input, process, output and feedback. This theory was first introduced by Ludwig Von Bertalanffy in

1968.

7.2.11. SETTING OF STUDY

Study will be conducted in selected GNM schools of nursing, Hassan.

7.2.12. PILOT STUDY

“A pilot study is a miniature of the main study”.

The pilot study is planned with 10% of the sample which will be conducted in selected GNM

schools of nursing, Hassan and that will be excluded in the main study.

7.2.13. VARIABLES OF STUDY

Variables are qualities, properties or characteristics of person, things or situations that change or vary.

Independent Variable: In this study, the independent variable is structured instruction model on internet

addiction.12

Dependent Variable:It is response behavior or outcome that the researcher wants to predict or explain

changes in the dependent variable which are presumed to be caused by the dependent variable.

In this study, the dependent variable is knowledge of adolescents regarding interne addiction.

7.2.14 PLAN FOR DATA ANALYSIS

“Analysis is the systematic organization and synthesis of research data and the testing of research

hypothesis using those data.”

7.2.15 DEVELOPMENT OF SELF INSTRUCTIONAL MODULE

The self instructional module on Internet addiction was developed for adolescents. Self instructional

module covered the following aspects of internet addiction.

1. Section I : Socio demographic variables.

2. Section II : Questionnaire related to addiction.

3. Section II : Question related to causes, signs and symptoms of internet

Addiction.

4. Section III : Question related to Management of internet addiction.

7.2.16 VALIDITY

“Validity refers to degree of which an instrument measures what it is supposed to be measuring”.

In order to obtain content validity, the tool was given to a total 13 experts, experts from

Psychiatric Nursing Department, experts form Department of Psychiatry, experts from department of IT

and Media Developers, and bio-statistician. After receiving the opinion from the experts some

modifications were done in framing of the items and same were incorporated into the tool. Some of the

questions were deleted.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CONDUCTED ON

PATIENTS OR OTHER HUMANS?

YES, the structured teaching programme will be administered on teachers regarding identification of

Internate addiction among students.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

Yes, permission obtained from the research committee of Rajeev college of nursing. Informed consent

will be obtained from the subjects who are selected for the subjects.

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