الفهرس 
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Abstract
All facets of life are greatly impacted by technology on a global scale, which may be attributed to the advancement of computer and information technology. The internet is one of the most used technologies. While the internet offers a wealth of information, amusement, commerce, brand promotion, education, and other benefits, it may also have unfavorable effects such as internet addiction disorder, which is characterized by an uncontrollable want for engaging in one or more online activities.
Internet addiction Problem(IAP) is proved to cause bad effects on individual physical and mental health and all quality of life(QOL) domains which include physical, psychological, social and economic, environmental and academic domains . IAP may affect individual physically as it may cause many physical discomforts such as: musculoskeletal disorder, vision problems, backaches and neck aches, weight disturbance, headaches, sleep disturbances, and it affects level of activity and exercise. Psychological effects asit may cause depression, anxiety, stress, impaired self-esteem, loneliness and affects quality of sleep. Social effects as it decreases the time spent on social activities and with family, friends and relatives causing social isolation, also it decreases the available leisure time and activities. In turn these negative consequences affect students’ satisfaction of their affordable environmental services and academic life through affecting study time, sleep quality, absentism rate, physical functioning, self-esteem, attention span, concentration, cognition, performance and achievement levels, productivity and satisfaction with academic services.
Likewise, research has demonstrated that active internet use reduces attention span, with studies indicating a reduction from 12 to 5 minutes. According to other research, a heavy reliance on technology is changing people’s capacity for thought, their level of engagement and memory, their attention span. The majority of psychologists and educators believe that a person’s capacity for sustained attention and focus is essential to achieving their objectives and has a significant impact on the process of learning.Shorter attention spans can lead to a number of detrimental outcomes, such as subpar work or school performance, missing important facts or information, and trouble communicating in relationships.
Usually internet addiction disorder is highly prevalent among adolescents, so it affects greatly students. Nursing students are the future of health care sector and community health improvement. Improving their quality of life and attention span is a necessity to improve their learning and competence which will be reflected on the health care system. While internet addiction disorder greatly affect QOL and attention span it was necessary to seek solutions to such disorder
Management of internet addiction disorder is a vital method to improve QOL and it can be non-psychological, psychological or alternative solutions. Non -psychological means; the use of pharmacological therapy. While psychological means; the use of dialectical behavioral therapy, family therapy, art therapy, equine therapy, support groups, individual and group therapy, and cognitive behavioral therapy. Some possible alternative treatment include; exercise, leaving smart phone at home, take breaks, control content software and health education activities using effective educational models and theories such as (health belief model).
Aim of the study:
Explore the effect of utilizing health belief educational model on nursing students’ internet addiction, attention span levels and quality of life.
Materials and method:
Research Design:
This study was conducted usinga quasi-experimental research design.
Setting:
This study was carried out at the Faculty of Nursing, Damanhour University, which has nine scientific departments namely; Medical Surgical Nursing, Critical Care and Emergency Nursing, Pediatric Nursing, Obstetric Nursing, Nursing Education, Nursing Administration, Gerontological Nursing, Psychiatric and Mental Health Nursing and Community Health Nursing. The study was conducted at Medical Surgical Nursing Department.
Subjects:
All nursing students who enrolled in the first academic year at the Faculty of Nursing, Damanhour University,during the second term of the academic year 2022-2023 were surveyed for internet addiction level. Then according to the results of the survey, a random sample of 144 out of 227 students who have moderate and high levels of internet addictionwere recruited to participate in the study.The sample size was selected using simple randomization technique (random number table) and the students were assigned randomly and equally into study and control groups(72 students in each group).
group A (study group): received educational intervention based on health belief model
group B (control group): didn’t receive any intervention
Tools of the study:-
Three tools were used for data collection:
Tool I: Internet Addiction test (IAT):
It was used to identify probable cases of internet addiction. It is used to measure addictive use of internet. The test consisted of 20 items on 5-point likert scale and scored from 1 to 5 ranging from Rarely (1) to Always (5).
Tool II: Attention span assessment levels questionnaire:
To assess attention span level, it consisted of 20 items on 5-point likert scale ranging from rarely (1) to always (5).
Tool III: Student Quality of Life Assessment Questionnaire (SQLAQ)
It was used to assess quality of life level. It consisted of 5 categories about quality of life included 51 items as follows: quality of life in physical and life style domain (10 items), psychological and emotional domain (10 items), social and economic domain (11 items), environmental domain (5 items), academic domain (15 items).It was a 5- point- likert scale ranging from rarely(1) to always (5).
In addition, nursing students’ socio-demographic data and pattern of internet use assessment sheet attached and included:
Part(1) socio-demographic data such as student’s name, age, gender, previous grades, family income and residence
Part (2) pattern of internet use such as average hours of internet use, minutes of internet use in every time, the main cause of using internet, number of friends on internet, preferred device and feeling when deprived of or stopping from internet.
The study was conducted through four phases as follow:
Phase I: Assessment phase:
The researcher explained the aim of the study and its pathway to all study participants and took their approval to participate in the study, this phase was conducted through two steps:
Survey step; includedsurveying of all nursing students who were enrolled in the first academic year during the second semester (2022-2023) through;
Assessing internet addiction level using tool I (IAT), it was conducted through asking the students to fill an electronic form through Microsoft team
Then according to the results of the survey, a random sample of nursing students who had moderate or severe level of internet addictionwere recruited to participate in the study. Then, the students assigned randomly into two equal groups( study and control group).
Pretest step; Initial assessment were done for both groups (study and control group) before application of educational intervention to collect baseline data using tool (II) to assess nursing student’s attention span level and tool (III) to assess quality of life.
Phase 2: Planning phase:
Researcher prepared the content, teaching methods and media during this phase: the educational sessions and its schedules designed by the researcher, in term of; objectives, content, teaching strategies, timing, place, media and evaluation (time, place, tools).
Phase 3: Implementation phase:
The educational intervention based on health belief model was implemented for the study group in 5 sessions, each session lasted about 60 -90 minutes.
The study group only received the relevant content, power-point for each session. These educational sessions implemented over one month, one/week. It was conducted at the end of the day after nursing students finishing clinical hours (face to face) in clinical labs (70%) or online through Microsoft team (30%).
The control group didn’t receive any intervention.
Phase 4: Evaluation phase:
All students (study and control group) were evaluated two times after finishing the educational intervention by two months( at the second week of June) and by three months( at the second week of July 2023) after completion of sessions using tool I, II, III to assess the effectiveness of applying educational intervention based on health belief model.
Comparisons between the control and study groups were carried out using appropriate statistical analysis in order to evaluate the effectiveness of the program.
The main results of this study were:
It was found that more than three quarters 77.8% of the study group compared to two thirds 63.9% of the control group aged between 19 years old .
There was an equal distribution of above two thirds of both groups (66.7, 65.3%) respectively were males .
Regarding residence more than half of the study and control groups (55.6, 52.8 %) respectively were rural residents.
Concerning family income near half of both groups (48.6, 44.4 %) respectively were between 3000-5000.
Regarding previous grades both groups mean scores were (79.7±3.3, 80.1±4.1) respectively.
There were no statistically significant difference between both groups regarding personal and academic data, p= 0.196, 0.654, 0.860, 0. 162, 0.598, 0.554 respectively
Regarding average hours of internet use, it was found that mean scores of both groups before the intervention were (9.5±5.3, 9.6±3.0) respectively which decreased to 6.1±2.8 post1 (after intervention by two months), 6.6±2.4 post2(after intervention by three months) respectively after the intervention in favor of study group. Also, there were statistically significant difference between both groups after intervention p= 0.002 post1,0.004 post2.
In the same line concerning minutes of internet use per time mean score for both groups were 82.1±95.0, 84.0±85.8 respectively which decreased for study group after the intervention to 44.8±29.9 post1, 48.0±30.4post2
Regarding internet addiction level , there were statistically significant difference in favor of the study group at p<0.001. There was no statistically significant difference for control group before and after intervention where p=0.092. Finally, there were statistically significant difference in favor of study and control group after intervention p<0.001.
Regarding attention span, there were statistically significant difference in favor of the study group that p <0.001, with no statistically significant difference for control group p= 0.499. Finally, there were statistically significant difference between study and control group after intervention p<0.001
Regarding quality of life, there were statistically significant difference in favor of the study group before and after intervention where p<0.001, there were no significant difference regarding control group before and after intervention that p=0.181. There were statistically significant difference between study and control groups after intervention p<0.001
It was found that there were statistically significant negative correlation between internet addiction and attention span(p<0.001* , =0.001*, r =-0.812*,-0.729, -0.601* , -0.371* ), there were statistically significant negative correlation between internet addiction and quality of life(p<0.001*,=0.041*, r =-0.905*, -0.472* , -0.551*, -0.241*), while there were statistically significant positive correlation between quality of life and attention span(p<0.001*, r =0.702*, 0.484*, 0.443*)
Conclusion:
Health belief educational intervention was found to be effective in decreasing internet addiction, improving attention span and quality of life among study group compared to control group( there were statistically significant negative correlation between internet addiction, attention span and quality of life).
Recommendations
Replication of the current study on large study sample, other settings to ensure that results can be generalized.