The Correlates of Technology-Based Addictive Behaviors and Their Impacts on Wellbeing

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 40838

Special Issue Editors


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Guest Editor
Department of Social Work, University of North Dakota, 225 Centennial Drive, Stop 7135, Grand Forks, ND 58202-7135, USA
Interests: Internet addiction; bullying and cyberbullying; online victimization; family processes; adverse childhood experiences; children’s and adoelscent’s mental health and behavioral problems
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
Interests: patient-reported outcomes; childhood adversity and mental health in children/adolescents; therapeutic effects on people with mental illness; psychometric testing
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

With technological advancement and the development of convenient application functions, modern society is living in a digital era. Although digital technology has been developed to improve human health and life satisfaction, some people are involved in technology-based addictive behaviors, which have negative impacts on their wellbeing. Common types of technology addiction include internet addiction, smartphone addiction, gaming addiction, social media addiction, pornography addiction (online sexual addiction), and online shopping addiction. The American Society of Addiction Medicine has acknowledged that addictions are not limited to drugs and alcohol, but can also be behavioral in nature. In addition to the symptoms of addiction or dependency (e.g., loss of control, tolerance, withdrawal, changes in mood, and continuation of use despite adverse consequences), a technology-based addiction is apparent if and when digital usage interferes with one’s daily life and general wellbeing, and when the individual shows a preoccupation with using their digital medium of choice. It is important to examine how technology-based addictive beahviors influence various aspects of wellbeing (e.g., physical wellbeing, social wellbeing, emotional wellbeing, psychological wellbeing, economic wellbeing, life satisfaction, and engagement in activities and work), and what the risk and protective factors are which can reduce or increase the likelihood of digital addiction, which can and buffer or amplify the negative effects of digital addiction on wellbeing.  

This Special Issue aims to examine and advance understanding surrounding technology-based addictive behaviors and their correlates and impacts on wellbeing through rigorous and empirical research. It is also important to address policy implementation that involves all stakeholders in screening and preventing technology-based addictive behavior; such legislation has the potential to reduce its harm on human wellbeing, capture the broad lessons emerging from global cross-country scholars, inform practices, and enhance capacity for tackling such addictions.

We welcome original research articles and reviews for submission to this Special Issue. We look forward to receiving your contributions. 

Dr. Yi-Ping Hsieh
Dr. Chung-Ying Lin
Guest Editors

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Keywords

  • internet addiction
  • smartphone addiction
  • technology addiction
  • pathological technology use
  • online gaming
  • social media use
  • wellbeing
  • mental health
  • risk and protective factors
  • prevention/intervention

Published Papers (11 papers)

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Research

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11 pages, 253 KiB  
Article
Understanding Children’s Online Victimization through the Psychosocial Lens: The Roles of Loneliness, Online Social Currency, and Digital Citizenship
by Yi-Ping Hsieh and Bonni Gourneau
Healthcare 2024, 12(1), 97; https://doi.org/10.3390/healthcare12010097 - 31 Dec 2023
Viewed by 986
Abstract
This study employed a risk and resilience framework to investigate the influence of multidimensional factors, considering psychosocial and behavioral aspects, on online victimization among fifth-grade children (ages 10–11). Loneliness, online social currency disturbance, and digital citizenship were examined as predictors of online victimization. [...] Read more.
This study employed a risk and resilience framework to investigate the influence of multidimensional factors, considering psychosocial and behavioral aspects, on online victimization among fifth-grade children (ages 10–11). Loneliness, online social currency disturbance, and digital citizenship were examined as predictors of online victimization. Data were collected from 196 students through a self-reported online survey conducted on electronic devices provided by the schools. The findings indicated that 78.6% of fifth-graders owned a smartphone, 70.9% had a gaming console, and the most common online activities were playing online gaming (73%), talking with friends (62.8%), and seeking entertainment (62.2%). Online victimization was prevalent, with 30.8% of children reporting they had been called bad names, 24.7% receiving rude comments, 15.9% expressing feelings of worry or threat due to online harassment, and 3.1% experiencing cyberbullying lasting for days. Furthermore, the results revealed a negative association between digital citizenship and online victimization, while loneliness and online social currency disturbance were positively associated with online victimization after accounting for children’s gender and time spent online. In conclusion, this study suggests that efforts to prevent and address online victimization should prioritize promoting digital citizenship and increasing awareness of the roles of loneliness and social currency disturbances in online social dynamics. Full article
11 pages, 582 KiB  
Article
Effect of Smartphone Use on Sleep in Undergraduate Medical Students: A Cross-Sectional Study
by Ashish Goel, Arsalan Moinuddin, Rajesh Tiwari, Yashendra Sethi, Mohammed K. Suhail, Aditi Mohan, Nirja Kaka, Parth Sarthi, Ravi Dutt, Sheikh F. Ahmad, Sabry M. Attia, Talha Bin Emran, Hitesh Chopra and Nigel H. Greig
Healthcare 2023, 11(21), 2891; https://doi.org/10.3390/healthcare11212891 - 2 Nov 2023
Cited by 1 | Viewed by 2126
Abstract
Smartphone use, particularly at night, has been shown to provoke various circadian sleep–wake rhythm disorders such as insomnia and excessive daytime tiredness. This relationship has been mainly scrutinized among patient groups with higher rates of smartphone usage, particularly adolescents and children. However, it [...] Read more.
Smartphone use, particularly at night, has been shown to provoke various circadian sleep–wake rhythm disorders such as insomnia and excessive daytime tiredness. This relationship has been mainly scrutinized among patient groups with higher rates of smartphone usage, particularly adolescents and children. However, it remains obscure how smartphone usage impacts sleep parameters in adults, especially undergraduate college students. This study sought to (1) investigate the association between smartphone use (actual screen time) and four sleep parameters: Pittsburgh sleep quality score (PSQI), self-reported screen time, bedtime, and rise time; (2) compare the seven PSQI components between good and poor sleep quality subjects. In total, 264 undergraduate medical students (aged 17 to 25 years) were recruited from the Government Doon Medical College, Dehradun, India. All participants completed a sleep questionnaire, which was electronically shared via a WhatsApp invitation link. Hierarchical and multinomial regression analyses were performed in relation to (1) and (2). The average PSQI score was 5.03 ± 0.86, with approximately one in two respondents (48.3%) having a poor sleep index. Smartphone use significantly predicted respondents’ PSQI score (β = 0.142, p = 0.040, R2 = 0.027), perceived screen time (β = 0.113, p = 0.043, R2 = 343), bedtime (β = 0.106, p = 0.042, R2 = 045), and rise time (β = 0.174, p = 0.015, R2 = 0.028). When comparing poor-quality sleep (PSQI ≥ 5) to good-quality sleep (PSQI < 5), with good-quality sleep as the reference, except sleep efficiency and sleep medications (p > 0.05), five PSQI components declined significantly: subjective sleep quality (β = −0.096, p < 0.001); sleep latency (β = −0.034, p < 0.001); sleep duration (β = −0.038, p < 0.001); sleep disturbances (β = 1.234, p < 0.001); and sleep dysfunction (β = −0.077, p < 0.001). Consequently, public health policymakers should take this evidence into account when developing guidelines around smartphone use—i.e., the when, where, and how much smartphone use—to promote improved sleep behaviour and reduce the rate of sleep–wake rhythm disorders. Full article
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17 pages, 900 KiB  
Article
Prevalence and Determinants of Social Media Addiction among Medical Students in a Selected University in Saudi Arabia: A Cross-Sectional Study
by Mansour A. Alfaya, Naif Saud Abdullah, Najim Z. Alshahrani, Amar Abdullah A. Alqahtani, Mohammed R. Algethami, Abdulelah Saeed Y. Al Qahtani, Mohammed A. Aljunaid and Faisal Turki G. Alharbi
Healthcare 2023, 11(10), 1370; https://doi.org/10.3390/healthcare11101370 - 10 May 2023
Cited by 5 | Viewed by 3501
Abstract
Social media addiction has become a serious public health concern due to its adverse psychological effects. Therefore, the purpose of this study was to assess the prevalence and determinants of social media addiction among medical students in Saudi Arabia. A cross-sectional study was [...] Read more.
Social media addiction has become a serious public health concern due to its adverse psychological effects. Therefore, the purpose of this study was to assess the prevalence and determinants of social media addiction among medical students in Saudi Arabia. A cross-sectional study was designed. Participants (n = 326) from King Khalid University in Saudi Arabia completed the sociodemographic information, patient health questionnaire-9 scale, and the generalized anxiety disorder-7 tool to measure explanatory variables. The Bergen social media addiction scale (BSMAS) was used to measure social media addiction. A multiple linear regression model was fitted to investigate the predictors of social media addiction. The prevalence of social media addiction among study participants was 55.2% (mean BSMAS score: 16.6). According to the adjusted linear regression, male students had higher social media addiction scores than their female counterparts (β = 4.52, p < 0.001). Students’ academic performance was negatively associated with social media addiction scores. Moreover, students with symptoms of depression (β = 1.85, p = 0.005) or anxiety (β = 2.79, p = 0.003) had a higher BSMAS score compared to their counterparts. Further longitudinal studies are warranted to identify the causal factors of social media addiction, which would assist intervention initiatives by policymakers. Full article
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17 pages, 306 KiB  
Article
Sharenting Syndrome: An Appropriate Use of Social Media?
by Ayten Doğan Keskin, Nazan Kaytez, Mustafa Damar, Fatma Elibol and Neriman Aral
Healthcare 2023, 11(10), 1359; https://doi.org/10.3390/healthcare11101359 - 9 May 2023
Cited by 4 | Viewed by 3851
Abstract
Background: The use of social media is on the rise, and posts about anything can be shared these days, whether it be clothes, jewelry, shoes, books, or food and beverages. Some parents even use their children as objects of sharing, and post about [...] Read more.
Background: The use of social media is on the rise, and posts about anything can be shared these days, whether it be clothes, jewelry, shoes, books, or food and beverages. Some parents even use their children as objects of sharing, and post about their children continuously. Parents who use social media share important moments before and after their children are born on their social network sites accounts. Sharenting refers to the practice of parents, caregivers or relatives sharing information about their children (underage) online, typically on some online platforms. This can include photos, videos, personal stories, and other updates about the child’s life. The study aimed to examine the phenomenon of sharenting syndrome in terms of its potential to cause child abuse and neglect. In addition, the aim of this study is to explore the factors associated with and predicting sharenting syndrome by evaluating it through the lens of child abuse and neglect. Methods: This study was designed with a survey model among quantitative research methods. Data were collected through social network sites with snowball sampling method. The sample consisted of people aged 18 years and over from Turkey (n = 427). Results: A total of 86.9% of the participants stated that sharing children’s photos and videos on social media platforms by parents, relatives and caregivers can be evaluated as child neglect and abuse. The variables of “gender” and “the impact of sharing on children” are factors that are associated with determining whether the sharenting syndrome is classified as abuse or not. Gender is a negative predictor of the classification of sharenting on social media as a type of child abuse and neglect. Conclusions: Since the use of social media by people is increasing, there should be measures to protect children from sharenting syndrome. Full article
11 pages, 263 KiB  
Article
Smartphone Use and Addiction among Pharmacy Students in Northern Thailand: A Cross-Sectional Study
by Dujrudee Chinwong, Pattarapan Sukwuttichai, Natthachai Jaiwong, Chalermpong Saenjum, Nuntaporn Klinjun and Surarong Chinwong
Healthcare 2023, 11(9), 1264; https://doi.org/10.3390/healthcare11091264 - 28 Apr 2023
Cited by 2 | Viewed by 1470
Abstract
In Thailand and worldwide, smartphone addiction among university students is a growing concern. This study aims to investigate behaviors of smartphone use, the prevalence of smartphone addiction, the duration of smartphone use, and their associated factors among pharmacy students at a university in [...] Read more.
In Thailand and worldwide, smartphone addiction among university students is a growing concern. This study aims to investigate behaviors of smartphone use, the prevalence of smartphone addiction, the duration of smartphone use, and their associated factors among pharmacy students at a university in northern Thailand. This cross-sectional study was conducted using an online self-administered questionnaire to collect data from January to February 2021. Smartphone addiction was measured using the Smartphone Addiction Scale: Thai Short Version (SAS-SV-TH). Of 281 students (70% female, average age of 21.1 (2.0), year 1 to 5), 87% used smartphones and tablets. Their average time spent on a smartphone was 7.5 (±3.1) hours daily on weekdays and 8.1 (±3.1) on weekends. The top three reasons for using smartphones were social networking (92.9%), education (90.3%) and entertainment (89.6%). Health-related problems associated with smartphone use were insomnia (51.3%), anxiety (41.3%), headache (38.8%) and stress (38.4%). The prevalence of smartphone addiction was 49% (95% CI: 44–55%); the associated factor comprised time spent on smartphones (>5 h/day). The prevalence of spending more than five hours daily on smartphones was 75% (95% CI: 70–80%) during weekdays and 81% (95% CI: 77–86%) during weekends; associated factors for during weekdays included a monthly smartphone bill of more than 500 THB (adjusted odds ratio: 4.30 (95% CI: 2.00–9.24) and for senior students (adjusted OR: 3.31 (95% CI: 1.77–6.19). The results remained the same for the weekend. In short, the results show that half of the pharmacy students were addicted to their smartphone; time spent on smartphones (>5 h/day) was associated with addiction. Therefore, university students should be encouraged to adopt healthy habits for smartphone use (such as limiting screen time and maintaining good posture while using a smartphone or tablet) and to increase their awareness of health-related problems. Full article
18 pages, 1718 KiB  
Article
The Psychometric Properties of the DASS-21 and Its Association with Problematic Internet Use among Chinese College Freshmen
by Cui-Hong Cao, Chang-Yan Dang, Xia Zheng, Wang-Guang Chen, I-Hua Chen and Jeffrey H. Gamble
Healthcare 2023, 11(5), 700; https://doi.org/10.3390/healthcare11050700 - 27 Feb 2023
Cited by 7 | Viewed by 2614
Abstract
During transitional periods, college freshmen may experience mental health issues. The Depression, Anxiety, and Stress Scale—21-item version (DASS-21) is commonly used for mental health assessment in China. However, evidence is lacking regarding its applicability with freshmen as a demographic. Debates also exist regarding [...] Read more.
During transitional periods, college freshmen may experience mental health issues. The Depression, Anxiety, and Stress Scale—21-item version (DASS-21) is commonly used for mental health assessment in China. However, evidence is lacking regarding its applicability with freshmen as a demographic. Debates also exist regarding its factor structure. This study aimed to evaluate the DASS-21′s psychometric properties with Chinese college freshmen and investigate its association with three kinds of problematic Internet use. A convenience sampling method was used to recruit two samples of freshmen—one of 364 (female 248; mean age 18.17 years) and the other of 956 (female 499; mean age 18.38 years) participants. McDonald’s ω and confirmatory factor analysis were conducted to evaluate both the scale’s internal reliability and construct validity. The results indicated acceptable reliability, with a one-factor structure inferior to a three-factor structure in terms of model fit. Furthermore, it was demonstrated that problematic Internet use was significantly and positively associated with depression, anxiety, and stress among Chinese college freshmen. Based on the prerequisite of measurement equivalence across two samples, the study also found that freshmen’s problematic Internet use and psychological distress were likely to be affected by the strict measures put in place during the COVID-19 pandemic. Full article
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15 pages, 732 KiB  
Article
The Mediating Role of Selfitis in the Associations between Self-Esteem, Problematic Social Media Use, Problematic Smartphone Use, Body-Self Appearance, and Psychological Distress among Young Ghanaian Adults
by Derek Oppong, Emma Sethina Adjaottor, Frimpong-Manso Addo, Worlali Nyaledzigbor, Amma Serwaa Ofori-Amanfo, Hsin-Pao Chen and Daniel Kwasi Ahorsu
Healthcare 2022, 10(12), 2500; https://doi.org/10.3390/healthcare10122500 - 10 Dec 2022
Viewed by 2336
Abstract
Selfie-related activities have become pervasive to the point that they may affect the mental health of people who engage in them. To ascertain this mechanism, this study examined the mediating role of selfitis in the associations between self-esteem, problematic social media use, problematic [...] Read more.
Selfie-related activities have become pervasive to the point that they may affect the mental health of people who engage in them. To ascertain this mechanism, this study examined the mediating role of selfitis in the associations between self-esteem, problematic social media use, problematic smartphone use, body-self appearance, and psychological distress among young Ghanaian adults. A total of 651 participants completed a questionnaire with measures on self-esteem, body-self appearance, problematic social media use, problematic smartphone use, depression, anxiety, stress, coping skills, and selfitis. There were direct associations between all the variables except between self-esteem and selfitis. In addition, selfitis mediated the associations between problematic social media use, problematic smartphone use, body-self appearance, and psychological distress except between self-esteem and psychological distress. These findings suggest that selfitis can serve as a pathway by which people who overly engage in problematic social media use, problematic smartphone use, and have poor body-self appearance may experience psychological distress. Hence, there is a need for health communicators, school authorities, and opinion leaders to educate young adults on the consequences of the problematic use of technology, especially for selfitis behaviour. Future studies can examine the factors that predict selfitis behaviour among adults. Full article
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10 pages, 641 KiB  
Article
The Mediating Roles of Anxiety, Depression, Sleepiness, Insomnia, and Sleep Quality in the Association between Problematic Social Media Use and Quality of Life among Patients with Cancer
by Vida Imani, Daniel Kwasi Ahorsu, Nasrin Taghizadeh, Zahra Parsapour, Babak Nejati, Hsin-Pao Chen and Amir H. Pakpour
Healthcare 2022, 10(9), 1745; https://doi.org/10.3390/healthcare10091745 - 11 Sep 2022
Cited by 6 | Viewed by 2637
Abstract
The present study examined the mediating role of anxiety, depression, sleepiness, insomnia, and sleep quality in the association between problematic social media use and quality of life (QoL) among patients with cancer. This cross-sectional survey study recruited 288 patients with cancer to respond [...] Read more.
The present study examined the mediating role of anxiety, depression, sleepiness, insomnia, and sleep quality in the association between problematic social media use and quality of life (QoL) among patients with cancer. This cross-sectional survey study recruited 288 patients with cancer to respond to measures on anxiety, depression, sleepiness, insomnia, sleep quality, problematic social media use, and QoL. Structural Equation Modeling was used for the mediation analysis. There were significant relationships between all of the variables used in the study. It was revealed that problematic social media use did not directly influence the QoL of patients with cancer except via anxiety, depression, sleepiness, and insomnia. Sleep quality did not mediate the association between problematic social media use and QoL. Healthcare workers managing cancer should pay attention to the mental health needs of their patients even as they treat their cancer so as to improve their quality of life. Future studies may examine other variables that affect the QoL of patients with cancer as well as other mediating and moderating variables. Full article
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14 pages, 304 KiB  
Article
Internet-Related Instruments (Bergen Social Media Addiction Scale, Smartphone Application-Based Addiction Scale, Internet Gaming Disorder Scale-Short Form, and Nomophobia Questionnaire) and Their Associations with Distress among Malaysian University Students
by Serene En Hui Tung, Wan Ying Gan, Jung-Sheng Chen, Kamolthip Ruckwongpatr, Iqbal Pramukti, Siti R. Nadhiroh, Yen-Ling Chang, Chien-Chin Lin, Amir H. Pakpour, Chung-Ying Lin and Mark D. Griffiths
Healthcare 2022, 10(8), 1448; https://doi.org/10.3390/healthcare10081448 - 2 Aug 2022
Cited by 33 | Viewed by 6663
Abstract
The present study evaluated the psychometric properties of four instruments related to internet use, namely the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), (nine-item) Internet Gaming Disorder Scale Short Form (IGDS9-SF), and Nomophobia Questionnaire (NMPQ) as well as their [...] Read more.
The present study evaluated the psychometric properties of four instruments related to internet use, namely the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), (nine-item) Internet Gaming Disorder Scale Short Form (IGDS9-SF), and Nomophobia Questionnaire (NMPQ) as well as their associations with psychological distress among Malaysian university students. A total of 380 Malaysian university students (71.6% females, mean age 24.0 years) were recruited through convenience sampling and completed an online survey including questions concerning socio-demographic background, social media addiction, smartphone addiction, internet gaming disorder, and nomophobia. Confirmatory factor analysis and Rasch analysis were applied to evaluate the psychometric properties of the instruments and Cronbach’s alpha value and McDonald’s omega value were used to confirm the internal consistency reliability of the instruments. The unidimensional structure was confirmed for the BSMAS, SABAS, and IGDS9-SF while the four-factor structure was confirmed for NMPQ. All instruments showed good internal consistency reliability. Promising validity and reliability were confirmed for BSMAS, SABAS, IGDS9-SF, and NMPQ. Therefore, they are useful to assess different types of problematic internet use among university students in Malaysia. Furthermore, a significant association was observed between internet use and psychological distress. The present study is the first to investigate the validity and reliability of BSMAS, SABAS, IGDS9-SF, and NMPQ among Malaysian university students using rigorous psychometric testing methods (i.e., Rasch analysis). Full article
14 pages, 288 KiB  
Article
Does Smartphone Addiction, Social Media Addiction, and/or Internet Game Addiction Affect Adolescents’ Interpersonal Interactions?
by Shang-Yu Yang, Yu-Chi Wang, Ya-Chen Lee, Ying-Lien Lin, Pei-Lun Hsieh and Pin-Hsuan Lin
Healthcare 2022, 10(5), 963; https://doi.org/10.3390/healthcare10050963 - 23 May 2022
Cited by 16 | Viewed by 10974
Abstract
The purpose of this study is to investigate the correlations that levels of addiction to smartphones, social media, and online games have with levels of real-life and online interpersonal interactions among adolescents. In this cross-sectional study of adolescents in a college in Taiwan, [...] Read more.
The purpose of this study is to investigate the correlations that levels of addiction to smartphones, social media, and online games have with levels of real-life and online interpersonal interactions among adolescents. In this cross-sectional study of adolescents in a college in Taiwan, structured questionnaire surveys were used to collect information. The questionnaire included the following: demographic background, Real Interpersonal Interaction Scale (RIIS), Internet Interpersonal Interaction Scale (IIIS), Smartphone Application-Based Addiction Scale (SABAS), Bergen Social Media Addiction Scale (BSMAS), and Internet Gaming Disorder Scale—Short Form (IGDS9-SF). Multiple regression analyses were carried out to investigate the correlations between SABAS, BSMAS, IGDS9-SF, and RIIS/IIIS. We recruited 998 students (413 boys). The average age was 17.18 ± 1.46. The study results show that adolescents with higher levels of addiction to smartphones and social media may have greater interpersonal interaction with friends in real life, but adolescents with high levels of addiction to online games may have less interpersonal interactions with friends in real life. Adolescents with high levels of addiction to smartphones, social media, and online games may have greater interpersonal interactions with friends online. Full article

Review

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22 pages, 597 KiB  
Review
Reliability Generalization Meta-Analysis of Internet Gaming Disorder Scale
by Júlia Gisbert-Pérez, Manuel Martí-Vilar, César Merino-Soto and Miguel Vallejos-Flores
Healthcare 2022, 10(10), 1992; https://doi.org/10.3390/healthcare10101992 - 11 Oct 2022
Viewed by 2166
Abstract
The objective of this study was to carry out a reliability generalization meta-analysis of the Internet Gaming Disorder Scale (IGDS) to find out if it presents adequate values that justify its application in its four versions: original and abbreviated with dichotomous or ordinal [...] Read more.
The objective of this study was to carry out a reliability generalization meta-analysis of the Internet Gaming Disorder Scale (IGDS) to find out if it presents adequate values that justify its application in its four versions: original and abbreviated with dichotomous or ordinal response. A systematic review including 26 studies that apply this instrument from 2015 to June 2022 was conducted. For each version, a reliability generalization meta-analysis was performed with the random coefficients (RC) and varying coefficients (VC) model. Results showed reliability levels > 0.80 in the ordinal versions (IGDS9P and IGDS27P) and in the dichotomous 27-item version (IGDS27D), while the dichotomous 9-item version (IGDS9D) produced levels > 0.70. High heterogeneity was found in all versions (I2 > 95%; Rb > 90%). Cronbach’s α means with both models (RC-VC) did not differ significantly except for the IGDS9D version. It is concluded that, considering the dependence of the results on sample size, abbreviated versions do not guarantee that reliability remains acceptable, and dichotomous versions may provide limited but acceptable reliability. Finally, IGDS27P version is recommended in contexts where high precision is required. Full article
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