RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

MR. SACHIN. C.R. NAME OF THE 1ST YEAR M.SC NURSING 1 CANDIDATE AND BGS COLLEGE OF NURSING ADDRESS MYSORE

NAME OF THE BGS COLLEGE OF NURSING 2. INSTITUTION MYSORE

COURSE OF STUDY DEGREE OF MASTER OF NURSING, 3. AND SUBJECT PSYCHIATRIC NURSING.

DATE OF ADMISSION 4. 30/06/2012 TO COURSE

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON 5. TITLE OF THE TOPIC KNOWLEDGE REGARDING SOCIAL NETWORK ADDICTION AMONG ADOLESCENTS STUDYING IN SELECTED PU COLLEGES AT MYSORE 6. BRIEF RESUME OF THE INTENDED WORK:

6.1 INTRODUCTION:

Social Network Sites

Social network sites are web-based services that allow individuals to construct a public or semi-public profile within a bounded system, articulate a list of other users with whom they share a connection, and view and traverse their list of connections and those made by others within the system. The nature and nomenclature of these connections may vary from site to site1.

Social network sites (SNSs) such as MySpace, Facebook, twitter, skype, Cyworld, Bebo have attracted millions of users, many of whom have integrated these sites into their daily practices. As of this writing, there are hundreds of SNSs, with various technological affordances, supporting a wide range of interests and practices. Most sites support the maintenance of pre-existing social networks, but others help strangers connect based on shared interests, political views, or activities.

In terms of social network sites history, the first social networking site (Six Degrees) was launched in 1997, based on the idea that everybody is linked with everybody else via six degrees of separation 2, and initially referred to as the “small world problem”3. In 2004, the most successful current SNS, Facebook, was established as a closed virtual community for Harvard students. The site expanded very quickly and Facebook currently has more than 500 million users, of whom fifty percent log on to it every day. Furthermore, the overall time spent on Facebook increased by 566% from 2007 to 2008 3. This statistic alone indicates the exponential appeal of SNSs and also suggests a reason for a rise in potential SNS addiction. Hypothetically, the appeal of SNSs may be traced back to its reflection of today’s individualist culture. Unlike traditional virtual communities that emerged during the 1990s based on shared interests of their members4, social networking sites are egocentric sites. It is the individual rather than the community that is the focus of attention 1

As of April 2012, Facebook and other social network sites have over 900 million active worldwide users. The statistic shows that number of social network users in India in 2011was 50.76 millions. In 2012, it is estimated that there will be around 76.1 million social network users in India4.

On Web sites like Facebook and MySpace, users can instantly see what their friends online are doing and can keep them updated on their every move. Most users know it's not a substitute for face-to-face communication, but they say it's the next best thing7.

These sites provide an appropriate forum for discussion. It has also not left politics untouched. This is evident from the fact that Hillary Clinton had networking profiles on all popular sites during the period of her campaign. Social network addiction:

Social Networking Addiction has become increasingly debated among experts and social network users. Addiction to the internet has been treated and studied for well over a decade. With the introduction of formats that allow users to interact more often then they may have previously done, such as Twitter, Facebook, Hi5, and Friendster the ability to become addicted or attached to social networking sites has become more plausible. This ability to interact can be quite elevating to moods, and be more easily accelerated into addiction. Any behavior which causes the elevation of a persons mood can cause addiction.

The last decade witnessed an explosion of social networks such as Myspace and Facebook, which added a new social dimension to the web.

While such networks have made people, communities and groups with shared interests stay more “connected,” social network addiction in particular also started being recognized as psychological disorders all over the world. While several 90′s studies focused on Internet addiction, the next decade saw the growth of a new addiction related to all manner of social networking sites, especially the current king of the jungle: Face book.

People who have become disconnected from, or have had a inability to connect too, social activities are more likely to use and abuse the foundations of social networking. Psychiatrists often see social networking addiction as a symptom of other underlying conditions such as loneliness, depression, anxiety, and phobias. The American psychiatry association and other expert organizations agree that there is a possibility, but require more in-depth investigation and research.

Recent studies show that social media is addictive by nature. In fact, according to a 2011 study by online security(webroot), 54% of those who use social media networking sires feel some sort of addiction towards sites like facebook, twitter28.

An American psychologist believes so. In fact, he’s even introduced a new term to describe such an addiction. FAD, or Facebook Addiction Disorder, is a condition that is defined by hours spent on Facebook, so much time in fact that the healthy balance of the individual’s life is affected. It has been said that approximately 350 million people are suffering from the disorder that is detected through a simple set of six-criteria. People who are victims of the condition must have at least 2-3 of the following criteria during a 6-8 month time period5.

6.2 NEED FOR THE STUDY:

Social networks have changed the ways we interact with each other enormously. One thing that has changed dramatically is the concept of meeting people. In addition to this, scholars have hypothesized that young vulnerable people with narcissistic tendencies are particularly prone to engaging with SNSs in an addictive way6 As social networking sites have risen in popularity over the past years, people have been spending an excessive amount of time on the Internet in general and social networking sites in specific. This has led researchers to debate the establishment of Internet addiction as an actual clinical disorder8. Social networking can also affect the extent to which a person feels lonely. In a Newsweek article, Johannah Cornblatt explains “Social- networking sites like Facebook and MySpace may provide people with a false sense of connection that ultimately increases loneliness in people who feel alone.” John T. Cacioppo, a neuroscientist at the University of Chicago, claims that social networking can foster feelings of sensitivity to disconnection, which can lead to loneliness9.

Daily overuse of these social networking sites tends to have a negative effect on the health of all students as it makes them more susceptible to various health problems in the future. This is where peers, teachers and parents need to play a major role by making the students aware of what they are missing out while spending too much time on these sites28.

Recent study carried out at a Czech University analyzed Facebook-related academic procrastination. Though based on a sample too small to draw any general conclusions, one interesting finding of the research was that people tended to be unaware of just how much time they really spent on Facebook, and the effect this might have on their academic performance26.

A new survey study found that most of the teenagers are facing loneliness in their life though most of them have huge followers in social sites. The study revealed that despite of having an average of some 2443 ‘face book’ friends, teenagers are spending so much time on the internet that 60% have little time to go out with friends in life.

A Mexican study found that Facebook addicts (a category defined by reportedly spending over four hours every day on Facebook) had a higher incidence of depression and lower physical and general self-esteem levels than less frequent Facebook users26.

There are many factors that determine the characteristics of Internet and social network addictions in different parts of the world. The nature and scope of these problems are not only affected by technological advancement and the number of computers connected to the Internet per capita and other such quantitative data, but cultural factors are also key in determining the local incidence of these addictions.

Since the average South Korean high school student spends about 23 hours 1.2 million are believed to be at risk for addiction and to require basic counseling. In particular, therapists worry about the increasing number of individuals dropping out from school or work to spend time on computers. As of June 2007, South Korea has trained 1,043 counselors in the treatment of Internet addiction and enlistedover 190 hospitals and treatment centers26. Nevertheless, the DSMV V draft released earlier this year revealed “work group members decided there was insufficient research data” to include Internet addiction in the newly created “behavioral addictions” category26.

It has been over 13 years since pioneer Kimberley S. Young adapted the DSM IV criteria for gambling addictions to define Internet addiction. While her proposed diagnosis criteria have virally spread (to use a familiar term related to social networking) all over the world, it seems that the scientific community is not yet ready to reach a consensus as to what this type of addiction entails26.

The rapid growth of social networks both in reach and in the number of interaction possibilities, poses new problems everyday for the elaboration of solid diagnostic criteria. From academic procrastination to social impairment as far as real physical interactions are concerned, diminished productivity at work and physical problems associated with a sedentary lifestyle; there seem to be enough problems related to Internet and social network addictions to give researchers enough to work on for many years to come.

Social network statistics in India

There were an estimated 61 million unique Internet users in India in June2012. The social network face book site also achieved roughly 51 million unique visitors from the country. With India's online population growing - the figure should cross the 200 million mark by the end of this year, the number of Facebook users should also touch 50 million in a few months and close to 60 to 70 million by the year-end. This will make India's Facebook population an extremely influential force10.

Youth today is addicted to these sites. The fact that they can express their opinion without getting reprimanded or chided for it is enough for them to be dragged to their computers. This has been proved in studies which go on to substantiate that there are people who log in to these sites up to 20 times a day as a result of their obsessive and compulsive behaviour. This addiction is not restricted only to students. Numerous companies have been complaining of addicted workers who spend hours in front of their computers focussing only on the social networking sites14.

This growing addiction has led to dysfunctional lifestyles, with addicts giving up on essentials such as sleep and exercise in order to spend more time on their PCs. & the study regarding social network addiction among adolescents is in extreme need of identifying the real cause & appropriate interventions to be made to resolve such problems.

6.3 REVIEW OF LITERTURE:

A cross sectional study was conducted in surat to find out ‘addiction to social networking websites & its effect on life course of college students. Data were collected from 300 various college students age group was 19-24years by using semi structured questionnaire. The study result shows that around half of the students accepted that they utilized 50% of their time on internet for surfing various social networking websites, 54 (18%) students agreed that dating was their main purpose behind using these websites, 168(56%) students agreed to the fact that they would be more comfortable in striking up a conversation with a stranger on orkut, rather than doing it in person to person, this reflects the changing mentalities of the youth where they seem to live more in the virtual world. A striking 110 (37%) respondents agreed to the fact that because of using these social networking websites, their academic studies have suffered, 107(36%) respondents agreed that they watched porn videos from the links available on these websites.93(31%) respondents found that were addicted to social network websites. The study suggested that youths are eroded by the evil in the form of social networking websites11.

A study was conducted in USA to assess the use of social networking and quality of social networking- interactions and depressive symptoms. Data were collected from 600 under-graduates. The result of the study was the use of social network--how frequently people engage in using facebook for example--is not associated with depressive systems, but "the quality of the interactions that people have with other is associated with depression. Study concluded that when people have more negative interactions with people they're interacting with online, they're more likely to have a depressed mood and depressive systems9.

A study was conducted in Family Research Laboratory, University of New Hampshire, Durham, USA to identify the online harassment among youths. The data was collected from 1500 youth Internet users whose age between 10 to 17years by using telephone Survey. The study result showed that were 91% (n = 129) of youth were harassed online, 43% (n = 56) by known peers and 57% (n = 73) by people they met online and did not know in person. Most online harassment incidents did not appear to meet the standard definition of bullying used in school-based research and requiring aggression, repetition, and power imbalance. Only 25% of incidents by known peers and 21% by online-only contacts involved both repeated incidents and either distress to targets or adult intervention12.

A study was conducted in Australia to know young adults' use of SNSs and addictive tendency toward the use of SNSs from their personality characteristics and levels of self-esteem. Data were collected from 201 University students age between 17 to 24 years by NEO Five-Factor Personality Inventory and the Coopersmith Self-Esteem Inventory. The result shown that indicated that extroverted and unconscientious individuals reported higher levels of both SNS use and addictive tendencies. Future research should attempt to identify which other psychosocial characteristics explain young people's level of use and propensity for addictive tendencies for these popular Internet sites19.

A cross-sectional study was conducted to determine the general pattern of internet usage and to identify potential hazards, including; bullying, inappropriate contact, overuse, addiction and invasion of users' privacy among irish teenagers. Data were collected from 474students of three Irish secondary schools age between 11-16 years by using questionnaire. The study result showed that, 306 (72%) reported frequent usage of social network sites, 403 (95%) of whom were Facebook users. 10% males and 12% females experienced bullying online, while 27% reported inappropriate contact from others. Concerning overuse and the risk of addiction, 33% felt they accessed SNSs too often. The study concluding that these patterns among Irish teenagers suggest that SNS usage poses significant dangers, which are going largely unaddressed13.

A correlation study was conducted in USA to examine the association between SNS use and psychological well-being inequalities. Data were collected from U.S adults by survey. The study result showed that SNS use was significantly associated with a 0.80 (p = .00) increment in psychological distress. The study concluded that there is a potential deleterious effect of SNS use on psychological well-being15.

An experimental study was done in Chicago’s Booth School of Business to analyze the addictive properties of social media. Data were collected from 205 people by using telephone survey. A study found that social networking services such as Facebook and Twitter are more difficult to resist than cigarettes or alcohol16

A study was conducted in china to know the social network sites addiction among youths. Data were collected from 335 college students aged 19 to 28 years by using Young’s Internet Addiction Test. The result has shown that 34% were classified as addicted. The study concluded that social activities and relationship building were found to predict SNS addiction17

A correlative study was conducted in china to know the SNS game addiction & self esteem. Data were collected from 342 college students aged 18 to 22 years by using Internet Addiction Test. The findings indicated that there was a positive correlation between loneliness and SNS game addiction. The study concluded that the gratifications “inclusion” (in a social group) and “achievement” (in game), leisure boredom, and male gender

18 significantly predicted SNS game addiction .

.An experimental study was conducted to predict risk for developing social network sites addiction. Data

+ were collected from 233 undergraduate university students (64% females, mean age = 19 -2 by survey method. The result showed that those who identified themselves as SNS users and those who looked for a sense of belongingness on SNSs appeared to be at risk for developing an addiction to SNSs 20.

A study was conducted to know the characteristics of people who spent more time in social network sites. Data were collected from 184 Internet users by online survey. The study result highlighted that people who use SNS more in terms of time spent on usage were perceived to be less involved with their real life communities. The study concluded that the nature of the feedback from peers that is received on a person’s SNS profile

21 determines the effects of SNS usage on wellbeing and self-esteem .

A correlation study was conducted to assess the relationships between Facebook usage and academic performance. Data were collected from 219 university students. The study result showed that Facebook users had lower Grade Point Averages and spent less time studying than students who did not use this SNS, 26% of students reporting an impact of their usage on their lives, 74% claimed that it had a negative impact, namely procrastination, distraction, and poor time-management22.

A study was conducted in Columbia University to find that using internet social networking sites like Facebook are more likely to end up addicted to drink and drugs. Data were collected from Teenagers aged between 12 and 17 through online poll & telephone survey. Result shown that those who spent any time on social networks each day were five times as likely to smoke than those who didn't visit them. They were also three times more likely to drink alcohol and had double the chance of smoking cannabis23.

A study was conducted to know use of social- networking sites & subjective well being. Data were collected by providing users with a unique computer-mediated environment where individuals are able to disclose their thoughts, feelings, & experiences within their circle of personal ties. The results have shown the time spent using a SNS in not related to well being, the amount of self- disclosure on SNSs is positively related to subjective well-being24.

A study was conducted to know about the social network sites addiction. Data were collected from 4,000 computer users in the US, UK and Australia by survey. Study found that 46% of the respondents visit their favourite social networking sites several times a day. Interestingly, only 18 percent visit once per day. The 42 percent of those who visit their socials several times a day or constantly are accessing them from mobile devices. The respondents in the age group between18-34 felt like they are addicted to social sites than the older respondents. The study concluded that the security attacks through social networks are becoming more prevalent. According to the firm, cybercriminals continue to target social networks because they can quickly access a large pool of victims25.

A correlation study was conducted to investigate how adolescents solicit and share information related to self-injurious behaviour. Data were collected from more message boards by observational methods. Result showed that More than 400 self-injury message boards were identified and online interactions clearly provide essential social support for, but they may also encourage self-injurious behavior and add potentially lethal behaviors27.

6.4 STATEMENT OF THE PROBLEM:

A Study To Evaluate The Effectiveness Of Structured Teaching Program On Knowledge Regarding Social Network Addiction Among Adolescents studying In Selected PU colleges At Mysore.

6.5OBJECTIVES:

• To assess pre-test level of knowledge on social network addiction among adolescents. • To evaluate the effectiveness of structured teaching program on knowledge regarding social network addiction among adolescents.

• To find the association between pre-test level of knowledge with selected demographical variables among adolescents.

6.6 OPERATIONAL DEFINITIONS:

• Evaluate: In this study, evaluate refers to determining the level of knowledge on social network addiction among adolescents which is measured by structured knowledge questionnaire.

• Effectiveness: in this study, effectiveness refers to the extent to which structured teaching program brings positive changes regarding knowledge on social network addiction and is measured in terms of significant knowledge gain in post test.

• Knowledge: In this study, it refers to the facts, information, description on skills acquired regarding social network addiction.

• Adolescents: In this study, it refers to the students between the age group of 16-19 years who are studying in selected PU colleges.

• Social network addiction: In this study, it refers to compulsive using of social networking sites which interferes with persons activities of daily life.

6.7 CONCEPTUAL FREAME WORK:

In this study, “Health promotion model” will be used.

6.8 HYPOTHESIS:

At 0.05 level of significance,

• H 1: There will be a significant difference between mean pre-test & mean post test knowledge score on social network addiction among adolescents

• H2: There will be a significant association between pre-test knowledge on social network addiction with selected demographic variables among adolescents.

6.9 ASSUMPTIONS:

The study assumes that,

• The adolescents may use social network to build new social relationship.

• The adolescents may have less knowledge regarding the social network addiction. 6.10 DELIMITATIONS:

The study will be limiting to students who are,

• The study will be limiting to adolescents who are,

• Studying in selected PU colleges at Mysore.

• Present at the time of data collection.

7.0 MATERIALS AND METHOD:

7.1 Source of data: Data will be collected from the adolescents who are studying in selected PU colleges at Mysore.

7.1.1 Research design: In this study, pre experimental design (One group pretest-posttest design) will be used.

7.1.2 Research approach: Evaluative approach will be used for the study.

7.1.3 Settings: settings consist of selected PU colleges at Mysore.

7.1.4. Population: population under study consists of adolescents studying in selected PU colleges at Mysore

7.2 MATHODS OF DATA COLLECTION:

7.2.1 Sampling procedure:

 Samples: Samples consists of adolescents who are studying in selected PU colleges at Mysore based on inclusion and exclusion criteria.

 Sampling technique: Purposive sampling.

7.2.2 Sample size: 60

7.2.3 Inclusion criteria: Students, who are,

 Age between 16 to 19 years.

 Both males & females

 Studying in English and Kannada medium

7.2.4 Exclusion criteria: Students, who are,

 Not willing to participate in the study

 Not present during the time of data collection. 7.2.5 Instrument used: The tool was organised into two sections.

 Section -I: Socio demographic variables.

 Section -II: Structured knowledge questionnaire regarding social network addiction

7.2.6 Methods of collection of data: Data will be collected from the adolescents by direct administration of structured knowledge questionnaire on social network addiction.

7.2.7 Plan for data analysis: In this study, descriptive and inferential statistical test will be used.

• Demographic data will be analyzed using number, frequency and percentage.

• Effectiveness of STP will be measured by using paired‘t’ test, mean & standard deviation.

• Association between the knowledge scores of adolescents and selected demographic variables will be analyzed by using chi-square test. .

7.3 Does the study require any investigations or interventions to other humans or animals? If so please describe briefly?

Yes. Interventions will be in the form of structured teaching programme provided to improve the knowledge regarding social network addiction among adolescence in selected PU colleges at Mysore.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes REFERENCE:

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2. Milgram S. The small world problem. Psychol Today. 1967; 2:60–67.

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Available from;http://theviewspaper.net/the-newest-addiction-of-the-youth-social-networking-sites/

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16. Kontos EZ, Emmons KM, Puleo E, Viswanath K Communication inequalities and public health implications of adult social networking site use in the United States.J Health Commun. 2010;15 Suppl 3:216-35.

Available from:http://www.ncbi.nlm.nih.gov/pubmed/21154095

17. Wan C. MS Thesis. Chinese University of Hong Kong; Hong Kong, China: 2009. Gratifications & loneliness as predictors of campus-SNS websites addiction & usage pattern among Chinese college students. 98. Young K. Internet addiction: The emergence of a new clinical disorder. CyberPsychol Behav. 1996;3:237–244.

18. Zhou SX. MS Thesis. Chinese University of Hong Kong; Hong Kong, China: 2010. Gratifications, loneliness, leisure boredom and self-esteem as predictors of SNS-game addiction and usage pattern among Chinese college students.

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23. Chris MurphySocial networking teenagers 'more likely to become addicted to drink and drugs', 26 August 2011. A vailable from: http://www.dailymail.co.uk/sciencetech/article-2029957/Social-networking-teenagers-likely-addicted- drink-drugs.html 24. Lee G, Lee J, Kwon S.Use of social-networking sites and subjective well-being: a study in South Korea. 2011 Mar;14(3). Available from: http://www.ncbi.nlm.nih.gov/pubmed/20649450 [PubMed ] 25. Technology54 pct computer users addicted to social networking sites , August 17, 2011. Available from: http://news.oneindia.in/2011/08/17/tech-54-percent-computer-users-addicted-to-social-sites.html 26. Veronica Pamoukaghlian Social Network Addiction – A Scientific No Man’s Land? Veronica, MA January 7, 2011. Available from: http://brainblogger.com/2011/01/07/social-network-addiction-a-scientific-no-mans-land/ 27. Whitlock JL, Powers JL, Eckenrode J.The virtual cutting edge: the internet and adolescent self-injury. 2006 May;42(3):407-17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16756433

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29. Steve Armstrong, Negative Effects of Social Networking Sites for Students Social Media. October, 2012. Available from: http://www.business2community.com/social-media/negative-effects-of-social- networking-sites-for-students-0311887 9 Signature of the candidate

10 Remarks of the guide

11 Name and designation (in block letters)

11.1 Guide Mr. BALACHANDAR.S ASST PROFESSOR & HOD DEPT OF PSYCHIATRIC NURSING BGS COLLEGE OF NURSING MYSORE

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

12 12.1 Head of the department Mr. BALACHANDAR.S ASST PROFESSOR & HOD DEPT OF PSYCHIATRIC NURSING BGS COLLEGE OF NURSING MYSORE

12.2 Signature

13 13.1 Remarks of the Chairman and Principal:

13.2 Signature: