SENTRI: Jurnal Riset Ilmiah

Vol.3, No.5 Mei 2024

ejournal.nusantaraglobal.ac.id/index.php/sentri

SMARTPHONE ADDICTION LEVELS IN SCHOOL-AGE CHILDREN AFTER

THE COVID-19 PANDEMIC IN RURAL AREA

Revita Nur Istiqomah Muslim1, Kurniawan Yudianto2, Umar Sumarna3, Mamat

Lukman3, Hendrawati Hendrawati4, Tuti Pahria5
1
Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
2
Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang,
West Java, Indonesia
3
Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran,
Sumedang, West Java, Indonesia
4
Department of Mental Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang,
West Java, Indonesia
5
Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran,
Sumedang, West Java, Indonesia.
E-mail: [email protected]

Article History: Abstract: The level of dependence of children on smartphones

Received: 05-04-2024 increased during the Covid-19 pandemic to 47.5%. The average
Revised: 21-05-2024 smartphone use time for school-age children is 6.85 hours a day.
Accepted: 03-05-2024 Meanwhile, the ideal screen time for school-age children is no more
than 2 hours/day. Smartphone addiction is a growing problem in
children with adverse physical, psychological, and social health conse-
Keywords: quences. The purpose of the study was to see the levels of smartphone
smartphone addiction; addiction in school-age children after the Covid-19 pandemic in rural
school-age children; area of Indonesia. This study used a cross-sectional descriptive design.
covid-19 The research subjects were school-aged children at "X" Elementary
School (N=114), total sampling. Data collection was carried out
using the Indonesian version of the Smartphone Addiction Scale
(SAS) instrument which is valid and reliable. Data were analyzed
using descriptive statistics. The smartphone addiction levels were
13.2% for low addiction, 77.2% for moderate addiction, and 9.6% for
severe addiction. Item 4 SAS, which contains a statement of feeling
happy when using a smartphone gets the highest score. The positive
anticipation dimension is the most dominant with the highest score.
The level of smartphone addiction after the Covid-19 pandemic
among school-age children in this study was dominated by moderate
smartphone addiction. The role of parents, teachers, health workers,
and the government is an important key to reducing smartphone
addiction incidents in school-age children in the future.
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INTRODUCTION
The Covid-19 pandemic situation has led to digital transformation or digitization
processes in various aspects of human life (Mutiara 2022). Even though at this time the
Covid-19 numbers in the world have dropped, digital lifestyles or online habits during the
Covid-19 pandemic which aim to minimize contact and prevent the transmission of Covid-
19 still survive and even tends to increase because the use of digital technology is
considered more practical and makes human life easier. With digitalization, gadgets and
internet networks have become a necessity for all circles in this modern era. Starting from
young to old age, currently it has been exposed and coexists with gadgets supported by the
internet network.
The rapid development of ICT has the potential to cause an increase in the use of
gadgets in all circles of society, including student groups. The high rate of gadget use
among students in Indonesia is evidenced by the results of Asosiasi Penyelenggara Jasa
Internet Indonesia (APJII) research on the level of internet penetration in students has
increased to 99.26% in 2022 from the previous 71.8% in 2018 (APJII 2019). Smartphones
are one of the most dominant types of gadgets used to access the internet.
In 2022, the gadget market share in the world included smartphones at 60.73%,
desktop PCs at 37%, and tablets at 2.27% (StatCounter 2022). According to the results of
an APJII survey in 2022, most Indonesians (89.03%) use smartphones to access the internet
compared to using computers/laptops (0.73%) (APJI 2022). The reason why more people
choose to use smartphones instead of laptops or computers because smartphones are more
portable, mobile, practical, can access information quickly and spontaneously, as well as
better start-up times compared to desktop PCs and laptops (Bröhl et al. 2018). Smartphones
and various applications in them offer quick access to the internet and social media through
various applications such as Facebook, Twitter, WhatsApp, and Skype (Aljomaa et al.
2016). In addition, smartphones have many entertainment features such as games,
cameras, videos, bluetooth, multi-media, radio, youtube, movies, GPS, and other
applications (Aljomaa et al. 2016).
One of the active users of smartphones among students is the group of school-age
children. School-age children are defined as individuals who are in the age range of 6 to 12
years.(Damayanti, Lutfiya, and Nilamsari 2019) In this age range, individuals are studying
in elementary school. According to APJII research in 2022, in Indonesia, the internet
penetration rate in school-aged children (5-12 years) is 62.43% with 89.03% using
smartphone devices to access the internet (APJI 2022). Smartphone usage rates are
increasing rapidly among school-age children aged 6-10 years (Fischer-Grote,
Kothgassner, and Felnhofer 2019). The average smartphone usage time of school-aged
children in a day is 6.85 hours, an increase of 53.86% from the pre-pandemic period
(Mokhtarinia et al. 2022). On the other hand, the ideal screen-time for school-age children
according to IDAI is no more than 2 hours per day (IDAI 2014).
The main impulse of children using smartphones with the support of the Internet is
to search and get information, communicate, as well as for entertainment (Zaini and
Soenarto 2019). The search for information carried out by children is often motivated by
school assignments, while the use of entertainment applications and social media are
motivated by personal needs (Broto 2014). Parents' and teachers' awareness of the use of
smartphones and the internet as a means of supporting children's teaching and learning
activities is increasingly enabling school-age children to use smartphones more often.
The use of smartphones should have a positive impact on elementary school children
such as facilitating children's needs to establish relationships with others, obtain and share

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information, get entertainment, and support the child's education and learning process.
The child's lack of self-control and parental supervision causes the use of smartphones in
children to become excessive and uncontrollable (Smartphone addiction). Smartphone
addiction can result in a variety of problems in the physical, psychological, and social
aspects.
The negative impact of smartphone addiction on physical aspects can cause
headaches, pain in the hands, elbows, neck, and back, sleep disturbances, and refractive
problems. In the psychological aspect, smartphone addiction can cause depression,
neuroticism, Obsessive-Compulsive Disorder (OCD), and have an effect on academic
performance (Amalia and Hamid 2020). Other negative impacts on the psychological
aspects caused by smartphone addiction include excessive expressions of anger when
activities using smartphones are disrupted, being lazy, easily feeling saturated while
studying, withdrawing more often, and easily hating others (Aulia 2019). In the social
aspect, smartphone addiction also causes negative impacts, including the development of
children's social interactions being hampered, children becoming anti-social, and a reduced
sense of empathy for others (Aulia 2019).
The negative impact of smartphone addiction in school-age children is quite
concerning, so it needs attention from many parties, including parents, teachers, health
workers, and the government. From several phenomena that have been stated, knowing
the picture of the level of smartphone addiction after the Covid-19 pandemic in school-age
children is an urgent thing to do, especially for students from schools that have held online
learning before because they have more potential to own and use smartphones. The
purpose of this study is to see an overview of the level of smartphone addiction in school-
age children after the COVID-19 pandemic in rural area of Indonesia. This research is
focused on schools located in rural area to see a picture of the level of smartphone addiction
in school-age children in area where the internet penetration rate is still low.

THEORETICAL BASIS
1. School-Aged Children as Smartphone Users
WHO defines school-age children as individuals in the age range of 7-15 years.
According to Erik H. Erikson, school age children are in the age range of 5-12 years
(Hickson 2022). According to Damayanti et al., school-age children are individuals in the
age range of 6 to 12 years (Damayanti, Lutfiya, and Nilamsari 2019). In this age range,
individuals are studying at elementary school. School-aged children find it easier to absorb
new information and knowledge because their cognitive abilities increasingly develop in
that age range (Damayanti, Lutfiya, and Nilamsari 2019). School-aged children can
already respond to intellectual stimuli or carry out learning tasks that require intellectual
or cognitive abilities such as reading, writing, arithmetic (Basit 2022). In the 6-12 year age
period, children begin to gain basic knowledge/cognitive abilities, are able to interact with
their peers, and begin to be responsible for their own behavior (Rahmawati, Herlina, and
Hasneli N. 2021).
Elementary school students are in the developmental phase of school-aged children,
where children experience rapid growth and cultivation of various aspects of human
experience (Park 2020). During this phase, children develop sociality along with active
interactions with peers in the same age group (Park 2020). They learn a sense of
accomplishment and perseverance by acquiring and utilizing behavioral patterns required
by society (Park 2020). All of these experiences may have a profound impact on the
formation of a positive self-concept and self-esteem (Park 2020). However, excessive

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smartphone use can cause many problems for children's healthy growth and development,
including reduced physical activity due to increased sitting time, decreased visual function,
decreased sleep quality, decreased participation in social activities, and increased risk of
depression or anxiety. Additionally, fast and easy access and transfer of information can
be detrimental to children's cognitive development by inducing declines in critical thinking
and concentration (Sohn et al. 2019). Therefore, it is important to provide appropriate
guidance and education to children regarding healthy smartphone usage habits.
2. Smartphone Addiction
2.1. Definition of Smartphone Addiction
Smartphone addiction is a disorder that involves compulsive and excessive use
of mobile devices, usually measured as the number of times users access their devices
and/or the total amount of time they are online during a certain period (Wigmore
2018). Smartphone addiction is defined as a lack of control over using a smartphone
despite adverse effects including financial, psychological and physical, as well as
socially harmful consequences on the user (Mehrnaz et al. 2018). Smartphone
addiction is uncontrolled behavior in using smartphones which can cause problems in
the user's daily life (Antang 2021). Leung (in Simangunsong, 2017) defines smartphone
addiction as a condition where a person is tied to a smartphone, accompanied by a
lack of control in using the smartphone, which has a negative impact on the person.
2.2. Aspects/Dimensions of Smartphone Addiction
There are six aspects of smartphone addiction according to Kurniawan et al.,
(2016), namely:
a. Daily-life disturbance
These disorders include carrying out unplanned activities, having difficulty
concentrating when working or studying, experiencing blurred vision or mild
headaches, experiencing pain in body parts such as the neck, back, elbows and hands,
and experiencing disturbed sleep patterns. Someone who is addicted to a smartphone
may have difficulty concentrating on the activity they are doing because they cannot
forget about their smartphone. Apart from that, smartphone addicts will also spend
more time using their smartphone, which will make them feel pain in their wrists, neck,
back, eyes, head and other body parts due to prolonged use of their smartphone.
b. Positive anticipation
Positive anticipation is described as a feeling of excitement when using a
smartphone, relieving stress by using a smartphone, and a feeling of emptiness when
not using a smartphone. For most smartphone users, a smartphone is not just a
communication tool, a means for playing games, and a personal digital assistant
(PDA), but also a friend in everyday life because it can provide pleasure, relieve fatigue
and anxiety, and make them feel safe.
c. Withdrawal
Withdrawal includes a situation where a smartphone user becomes impatient,
fussy and intolerant without a smartphone, thinks about the smartphone constantly
even when not using it, and becomes very angry or irritated when feeling disturbed
when using the smartphone.
d. Cyberspace-oriented relationship
This dimension includes feelings that one's relationship with other people
obtained via smartphone is closer than the relationship obtained in the real world,
having an excessive sense of loss when one cannot use a smartphone, and checking
one's smartphone continuously or periodically. Smartphone users often think of

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cyberspace as a streamlined real community or society formed by Social Networking

Service (SNS) sites, such as Instagram, TikTok, Facebook, or Twitter.
e. Overuse
Overuse refers to uncontrolled use of a smartphone, a preference for doing your
own searches using a smartphone rather than asking someone else for help, always
having a charging pack handy, and the desire to use the smartphone again after you
have finished using it.
f. Tolerance
Tolerance is defined as a condition where smartphone users always try to
control smartphone use but always fail.

METHODS
Study Design
This study uses a quantitative descriptive research design with a cross-sectional time
approach.
Study Setting
This research was conducted at "X" Elementary School, Sukasari Kaler Village, Ar-
gapura District, Majalengka Regency, West Java Province, Indonesia, in January 2023.
Population and Sample
The population in this study is all Elementary School Students "X" for the 2022/2023
School Year (N = 114).
Sampling in this study used the Total Sampling technique so that the number of
samples was equal to the number of populations (n = 114).
Measurement and data collection
This study used a valid and reliable Indonesian Version of the Smartphone Addiction
Scale (SAS) Instrument developed by Kurniawan et al., (2016) based on the theory of
Kwon et al., (2013) (Kurniawan, Rustika, and Aryani 2016; Kwon et al. 2013).
This instrument is in the form of a self-reporting questionnaire which is composed of
21 statement items from six dimensions of smartphone addiction, namely: daily-life
disturbance, positive anticipation, withdrawal, cyberspace-oriented relationship, overuse,
and tolerance. Measurements on this instrument are carried out using a likert scale. Each
statement item has six answer scales that describe the respondent's conformity with the
respondent's self-centeredness with a scale range of 1-6. On favorable items (an item that
supports smartphone addiction variables), the assessment given is as follows: Absolutely
Inappropriate (AI) = 1; Inappropriate (I) = 2; Slightly Inappropriate (SI) = 3; Slightly
Appropriate (SA) = 4; Appropriate (A) = 5; Absolutely Appropriate (AA) = 6. On
unfavorable items (items that do not support smartphone addiction variables), the
assessment given is as follows: Absolutely Inappropriate (AI) = 6; Inappropriate (I) = 5;
Slightly Inappropriate (SI) = 4; Slightly Appropriate (SA) = 3; Appropriate (A) = 2;
Absolutely Appropriate (AA) = 1. The total score of smartphone addiction is obtained
through the summation of the score of each item with a total score range from 21 (minimal
score) to 126 (maximum score). A higher score indicates a higher level of smartphone
addiction as well.
Each statement item in the Indonesian Version of the Smartphone Addiction Scale
(SAS) Modification Instrument contains one of the six dimensions of smartphone
addiction with the distribution of smartphone addiction dimensions on each item number
as follows:

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Table 1. Distribution of Smartphone Addiction Dimensions on Each SAS Item Number

No. Dimension Item Total

Favorable Unfavorable
1. Daily-life disturbance 1, 2, 3 3
2. Positive anticipation 4, 6, 7, 8 5 5
3. Withdrawal 9, 10, 11 12 4
4. Cyberspace-oriented 13, 14 15, 16 4
relationship
5. Overuse 17, 18, 19 3
6. Tolerance 20, 21 2
Total 17 4 21

This study used a paper-based questionnaire consisting of several fill-in sheets with
the following data collection procedures: 1) Distributing a research questionnaire that
already contains a questionnaire introduction sheet, research information, informed
consent sheet, respondent identity sheet, and an Indonesian version of the Smartphone
Addiction Scale (SAS) sheet to potential respondents; 2) Respondents respond to fill-in,
questions, or statements that are on the research questionnaire. The answers from the
Smartphone Addiction Scale (SAS) questionnaire used a likert scale with six answer
choices; 3) After the questionnaire is filled in completely, the researcher collects the
questionnaire from the re-spondents and performs data processing.
Data Analysis
This research explores four things, namely: demographic characteristics of the study
subject, levels of smartphone addiction, analysis of SAS items, and analysis of SAS
dimensions. Data processing and analysis are carried out with the help of Microsoft Excel
software version 2212 and IBM SPSS Statistics version 26.
The levels of smartphone addiction in this study was expressed in 3 categories,
namely: 1) Low addiction: X < Mean – SD; 2) Moderate addiction: Mean – SD ≤ X ≤
Mean + SD; 3) Severe addiction: X > Mean + SD. This categorization uses the basis of
hypothetical categorization, namely by comparing the total scores obtained by the study
subjects with the standard cut scores obtained from the scale. Hypothetical norms are based
on the scale of measuring instruments. The category points are arranged based on the
hypothetical mean value and the hypothetical standard deviation obtained from the
instrument. In this study, the instrument used was the Modified Smartphone Addiction
Scale (SAS) version Indonesian which had 21 statement items with a six-scale likert scale
that had a score range of 1-6. Based on the information, it can be known that Xmaks =
126; Xmin = 21; Hy-pothetical Mean 73.5; Hypothetical Standard Deviation: 17.5. Thus,
the level of Smartphone Addiction can be obtained by comparing the value of X with the
following cut scores: 1) Low addiction: X < 56; 2) Moderate addiction: 56 ≤ X ≤ 91; 3)
Severe addiction: X > 91; where X is the total score obtained by the study subjects from
the Indonesian version of the Smartphone Addiction Scale (SAS) instrument. After the
data were categorized, the researcher presented a table of the frequency distribution of the
levels of the smartphone of the study subject.
Smartphone Addiction Scale (SAS) item analysis was carried out by ranking the
cumulative value of the study subjects on 21 SAS items from the highest to the lowest
scores with the help of the microsoft excel rank function.

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Smartphone Addiction Scale (SAS) dimension analysis was carried out by ranking
the average cumulative value of the study subjects on 6 SAS dimensions from the highest
to the lowest scores with the help of the Microsoft Excel rank function.
Research Ethics
This research has received ethical approval from the Research Ethics Committee of
Padjadjaran University with Number: 84/UN6.KEP/EC/2023.

RESULTS AND DISCUSSION

1. Demographic Characteristics of the Research Subject

Table 2. Demographic Characteristics of the Research Subject

Characteristic Frequency Percentage (%)
Gender
Male 67 58,8%
Female 47 41,2%
Total 114 100%
Class
1 18 15,8%
2 23 20,2%
3 16 14,0%
4 13 11,4%
5 20 17,5%
6 24 21,1%
Total 114 100%
Age (Years)
7 22 19,3%
8 22 19,3%
9 13 11,4%
10 14 12,3%
11 17 14,9%
12 21 18,4%
13 5 4,4%
Total 114 100%
Smartphone Users
User 114 100%
Not User 0 0%
Total 114 100%
Smartphone Ownership
Personal 101 88,6%
Parents 12 10,5%
Sib 1 0,9%
Total 114 100%
Main Purposes of Using
Smartphone
Play Games 56 49,1%
Learning 12 10,5%
Opening Tiktok 24 21,1%
Opening Youtube 6 5,3%

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Characteristic Frequency Percentage (%)

Opening WhatsApp 12 10,5%
Opening Instagram 4 3,5%
Total 114 100%

Based on the information in Table 2, it can be seen that the research subjects in this
study were 114 elementary school students "X" (100%), consisting of 67 (58.8%) male
students and 47 (41.2 %) female students. The study subjects consisted of 18 (15.8%) class
1 students, 23 (20.2%) class 2 students, 16 (14.0%) class 3 students, 13 (11.4%) class 4
students, 20 (17.5%) class 5 students, and 24 (21.1%) class 6 students who were in the age
range of 7-13 years. As many as 114 (100%) "X" elementary school students are
smartphone users. In everyday life, as many as 101 (88.6%) people use personal
smartphones, 12 (10.5%) people use smartphones owned by their parents, and 1 (0.9%)
people use smartphones owned by relatives. The majority of students, 56 people (49.1%)
use smartphones for the main purpose of playing games.
2. Smartphone Addiction Levels

Table 3. Smartphone Addiction Levels Frequency Distribution

Category Score Frequency Percentage
Low Addiction X < 56 15 13,2%
Moderate Addiction 56 ≤ X ≤ 91 88 77,2%
Severe Addiction X > 91 11 9,6%
Total 114 100,0%

Based on Table 3, it can be seen that as many as 15 students (13.2%) had low-level
smartphone addiction, as many as 88 students (77.2%) had moderate-level smartphone
addiction, and as many as 11 students (9.6%) had severe smartphone addiction. The most
dominant level of smartphone addiction in school-age children in elementary school "X"
is moderate-level smartphone addiction as the first rank (77.2%), followed by low-level
smartphone addiction as the second rank (13.2%), and severe level of smartphone
addiction as the third rank (9.6%).
3. Item Analysis of Smartphone Addiction Scale (SAS)

Table 4. Smartphone Addiction Scale (SAS) Item Ranking

Ranking Item Statement Score
1 4 (PA) I feel happy when I use my smartphone 489
2 6 (PA) Using a smartphone is the most fun thing 476
for me to do
3 7 (PA) I feel very free when using a smartphone 454
4 13 (COR) I can get to know more people through the 448
use of smartphones
5 3 (DLD) My concentration in doing tasks is often 398
interrupted due to the use of smartphones
6 21 (T) I have tried many times to shorten my 391
smartphone usage time but always failed
7 20 (T) People around me told me that I had been 385
using my smartphone for too long

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Ranking Item Statement Score

8 18 (O) I'm using my smartphone longer than I 384
planned
9 11 (W) I always think of my smartphone even 380
though it's not using it
10 17 (O) I prepare a backup battery or power bank 380
so that smartphone use is not interrupted
11 14 (COR) I feel that relationships with friends on 373
smartphones are more intimate than
friends in real life
12 9 (W) I can't resist not having a smartphone 368
13 8 (PA) My life feels empty without a smartphone 363
14 19 (O) Every time I finish using the smartphone, I 363
will be encouraged to reuse it
15 15 (COR) I feel like my real-life friend understands 361
me better than my friend on a smartphone
16 5 (PA) I remain confident even if I don't use a 354
smartphone
17 10 (W) I get annoyed when disturbed while using 339
a smartphone
18 2 (DLD) I experience dizziness or blurred vision due 333
to excessive smartphone use
19 1 (DLD) I often miss activities /activities that I have 325
planned due to the use of smartphones
20 12 (W) I was able to stay patient even if I didn't 315
bring a smartphone
21 16 (COR) I'd rather go for a walk with a friend in real 309
life than talk to my friend on a smartphone

In table 4, we can find out the score ranking of 21 SAS items. This score is obtained
by adding up the scores of 114 respondents in each item. Researchers then sort the scores
from largest to smallest scores and sort the equal-valued scores by item number. The item
with the largest score (489) is item number 4 of the positive anticipation dimension which
contains the statement, "I feel happy when using a smartphone". The item with the smallest
score (309) is item number 16 of the cyberspace-oriented relationship dimension that
contains the statement "I would rather go for a walk with a friend in real life than talk to
my friend on a smartphone". A larger item score indicates a higher population smartphone
addiction rate on the item. The larger the item score, the greater the match between the
population with the statement on the favorable item or with the negation of the statement
(~P) on the unfavorable item.
4. Dimension Analysis of Smartphone Addiction Scale (SAS)

Table 5. Smartphone Addiction Scale (SAS) Dimension Ranking

Ranking Dimensions Item Score
1 Positive anticipation 4, 5, 6, 7, 8 427,2
2 Tolerance 20, 21 388
3 Overuse 17, 18, 19 375,7
4 Cyberspace-oriented relationship 13, 14, 15, 16 372,8

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Ranking Dimensions Item Score

5 Daily-life disturbance 1, 2, 3 352
6 Withdrawal 9, 10, 11 350

In table 5, we can find out the score ranking from the 6 dimensions of SAS. This
score is obtained by average the score of items on each dimension. The researchers then
sorted the dimension scores from largest to smallest. The SAS dimension ranking and their
scores are as follows: 1) Positive anticipation (427.2); 2) Tolerance (388); 3) Overuse
(375.7); 4) Cyberspace-oriented relationships (372.8); 5) Daily-life disturbance (352); 6)
Withdrawal (350). A larger dimension score indicates the smartphone addiction behavior
of the population that is more dominant in that dimension.
Based on the results of the analysis of respondents' characteristics, 114 (100%) of "X"
elementary school students were smartphone users with 101 (88.6%) students using
personal smartphones. This suggests that the majority of school-age children aged 7-13
years in primary school "X" already have a personal smartphone device. These findings
are in line with the results of a ChildWise survey of 2,167 children aged 5-16 years which
revealed that the majority of children (53%) already had a personal smartphone by the age
of seven (ChildWise 2020). The covid-19 pandemic situation in the past can be an
antecedent of the high level of smartphone ownership in school-age children today. Seeing
the percentage of smartphone users reach 100% in elementary school students "X"
indicates that smartphones have now become a fundamental part of the lives of school-age
children. Smartphones have now become a necessity for everyone including groups of
children, as they can help them to connect with each other as well as keep them busy by
browsing websites, playing games, listening to music, and watching movies (Lava 2018).
Today's technological advances have not only penetrated into adult lives, but have also
touched the lives of children.
In this study, it was found that the majority of children, 88 out of 114 children
(77.2%), in elementary school "X" had a moderate level of smartphone addiction.
Moderate smartphone addiction can be interpreted as a condition in which a person feels
heavy-hearted when parting with a smartphone, even though no pathological signs have
appeared yet (Sumiyarini and Yuliyani 2022). The results of this study are not in line with
the research of Vyas (2021) on subjects of schoolchildren aged 8-12 years in Nadiad City,
India, which stated that out of 100 children, the majority of children as many as 49 people
(49%) had a severe level of smartphone addiction (Vyas 2021). The results of this study are
also not in line with the research of Mokhtarinia et al (2022) on school-age children in the
capital of Teheran Iran, which stated that the majority of children as many as 312 out of
585 children (53.3%) had a high level of smartphone addiction (Mokhtarinia et al. 2022).
The discrepancy in the results of this study can be caused by differences in internet
infrastructure in urban and rural areas, where in urban areas the digital infrastructure is
more built than in rural areas.
"X" elementary school is a school located in a rural area of Argapura District,
Majalengka Regency, Indonesia. When the researcher took data to the study site, the
researcher found a blank spot area or area that did not receive a signal from the
telecommunication tower (Base Transceiver Station). The cell phone signal available at the
research site is only for the largest provider in Indonesia with a signal strength that is not
too large. At the study site, there is no signal available for the provider that the researcher
uses (the 4th largest provider in Indonesia), so the researcher does not have access to the
internet while there. From these circumstances, researchers assessed that access to the

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internet at the study site was not so adequate when compared to urban and suburban areas.
When internet access is poor, access to application features on smartphones will also be
limited, making a person's attachment to a smartphone not too strong because the utility
obtained from a smartphone is not optimal. This can lead to the level of smartphone
addiction at the study site not being as severe as in urban areas as in the studies of
Vyas(2021) and Mokhtarinia et al (2022).
Although the results showed that severe smartphone addiction in school-age children
in primary school "X" was third (9.6%), this situation should still get intervention as early
as possible so as not to cause more serious smartphone addiction with worse consequences.
To solve this problem, researchers suggest that parents as the closest people to the child: 1)
provide supervision, restrictions, and strict schedules for children in smartphone use; 2)
Activate the parental controls feature on the child's smartphone to set the child's screen-
time restrictions so that the child does not constantly use the smartphone for a long time;
3) encourage children to increase non-screen-time activities such as exercising, reading
books, painting, cooking, cleaning the house, etc.; 4) invite children to chat and interact
while at home so that children do not feel lonely and look for busyness through
smartphones.
Based on the analysis of SAS items, the findings of the item with the largest score
were 4-dimensional positive anticipation items that contained the statement "I feel happy
when using a smartphone". This shows smartphone addiction behavior in school-aged
children in primary school "X" which is the most dominant indicator of feeling happy when
using a smartphone. Feelings of pleasure when using smartphones can be associated with
increased dopamine levels in the brain (Farhud, Malmir, and Khanahmadi 2014). Positive
social stimuli obtained when using a smartphone, such as seeing happy expressions, getting
positive recognition from others through comments or likes, as well as getting calls or
messages from loved ones can activate the dopaminergic reward pathway so as to make a
person feel happy (Krach et al. 2010; Haynes 2018). To feel the sensation of pleasure again
a person will be more intense to access a smartphone. This is what causes a person to
experience addiction and feel heavy to part with a smartphone (Sumiyarini and Yuliyani
2022).
Based on the analysis of SAS dimensions, the dimension findings with the largest
score (427.2) were obtained, namely the positive anticipation dimension which includes
items 4, 5, 6, 7, 8. This shows that smartphone addiction behavior in school-age children
in elementary school "X" is dominated by a positive anticipation dimension. Positive
anticipation includes the feeling of relaxation, calm, excitement, and confidence that a
person feels when using a smartphone (Sumiyarini and Yuliyani 2022). Positive
anticipation is described as a way of reducing stress by using a smartphone and feeling
empty when there is no smartphone (Mohamed and Mostafa 2020). The embodiment of
smartphone addiction behavior the positive anticipation dimensions experienced by the
study subjects includes: feeling happy when using a smartphone, lack of confidence when
not using a smartphone, feeling that using a smartphone is the most fun thing to do, feeling
very free when using a smartphone, and feeling that life feels empty without a smartphone.
Smartphones have helped many people around the world in various ways, such as
connecting people globally and providing easy access to different types of information.
However, excessive smartphone use or smartphone addiction can be detrimental to the
physical, mental, and social health of individuals especially school-age children in this
context. Individuals who experience smartphone addiction are more prone to physical
problems such as feeling tired quickly, headaches, pain in the joints, and visual impairment

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 Istiqomah Muslim et al

(Fathya, Sari, and Mawarpury 2020); it is easier to experience mental problems such as
poor sleep disorders, insomnia symptoms, low self-esteem, stress, anxiety, and
depression(Bhattacharyya 2021; Lemola et al. 2015; Chłoń-Domińczak, Sienkiewicz, and
Trawińska-Konador 2014); and it is easier to experience social problems such as
withdrawing, favoring interaction through social media as opposed to in-person
interaction, and lowering children's social engagement (Jennifer 2018; Bian and Leung
2015). Therefore, there is a need for increased awareness to address this contemporary
problem by maximizing positive utility and minimizing the negative impact of smartphone
use.
Some ways that can be done to prevent smartphone addiction in children include:
monitoring the daily time of smartphone use on the screen-time dashboard in the digital
wellbeing & parental controls smartphone feature; following IDAI's recommendations on
screen-time limits for school-aged children to a maximum of 2 hours per day; providing
children's strict supervision, restrictions, and schedules in smartphone use; activating the
parental controls feature on children's smartphones to set children's screen-time restrictions
so that children do not continue to use the smartphone for a long time; invite children to
increase non-screen-time activities; encourage children to perform the 20-20-20 technique
when using a smartphone to maintain eye health. The 20-20-20 technique means resting
for 20 seconds, every 20 minutes, by looking at objects 20 feet (6 meters) away.
This study provides an overview of the level of smartphone addiction after the
COVID-19 pandemic in school-age children in elementary school "X". The results of this
study are not a diagnosis, but only as an early detection to assess the severity of a child's
addiction to smartphones. Ching et al (2015) proposed criteria A, B, and C as criteria for
the diagnosis of future smartphone addiction (Ching et al. 2015). Although the population
is still dominated by moderate addiction, this should be a warning to all parties, including
school-age children, parents, teachers, and health workers, especially nursing, to equally
prevent more serious incidents of smartphone addiction in children in the future.
The implications of the results of this study for nursing can be a trigger for promotion
and prevention efforts of smartphone addiction in school-age children, one of which is
through education on healthy smartphone use and early detection of smartphone
addiction. With these efforts, health problems caused by smartphone addiction, such as
visual impairment, musculoskeletal disorders, sleep disorders, headaches, stress, anxiety,
and depression in children can also be prevented. This can improve the degree of health of
children who are an aggregate of the community so that the goals of health development
that are part of national development can also be achieved. Healthy children will be the
seeds of superior human resources for a nation. In preparing the next generation of a
superior nation, the health of children should be a priority. The role of parents, teachers,
health workers, and the government is an important key to making this happen.
This study has several limitations, including: 1) It has not been able to statistically
prove the difference in the level of smartphone addiction in rural and urban areas, so the
researcher suggested to the next researcher to conduct a comparative study to see these
differences; 2) Researchers do not present old data on smartphone usage which should be
a predictive factor of smartphone addiction because the data collected is in the form of self-
report of children's estimates, it is feared that there are more biases and are not
representative. The researcher suggested to the next researcher to look at the length of
smartphone use in children not based on self-report of the child's estimated results, but self-
report the results of looking at the screen-time dashboard on the child's smartphone to find
out how long the smartphone use time is in one day accurately.

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 Istiqomah Muslim et al

CONCLUSION
A total of 114 (100%) "X" elementary school students are smartphone users with
101 (88.6%) people owning a personal smartphone. The level of smartphone addiction in
school-age children in elementary school "X" is 15 students (13.2%) had low-level
smartphone addiction, 88 students (77.2%) had moderate smartphone addiction, and 11
students (9.6%) had severe smartphone addiction. In this study, moderate-level
smartphone addiction became the most dominant (77.2%) in contrast to the results of the
research of Vyas (2021) and Mokhtarinia et al (2022), where the most dominant was severe-
level addiction. The difference in the characteristics of internet infrastructure in urban and
rural areas can be the cause of this. Based on the analysis of SAS items, the item with the
highest score (489) is item number 4 of the positive anticipation dimension which contains
the statement "I feel happy when using a smartphone". The feeling of pleasure when using
a smartphone can be associated with an increase in dopamine levels in the brain. Based on
the SAS dimension analysis, the dimension findings with the largest score (427.2) were
obtained, namely the positive anticipation dimension, which includes items 4, 5, 6, 7, and
8. Positive anticipation includes the feeling of relaxation, calm, vibrancy, and confidence
that a person feels when using a smartphone.
The implication of the results of this research for nursing is that it can be a trigger
for promotive and preventive efforts for smartphone addiction in school-aged children, one
of which is through education on healthy smartphone use. By carrying out these efforts,
health problems resulting from smartphone addiction such as vision problems,
musculoskeletal disorders, sleep disorders, headaches, stress, anxiety and depression in
children can be prevented. This can improve the health status of children who are the
aggregate of society, so that the goals of health development which is part of national
development can be achieved. Healthy children will become superior human resources for
a nation. In preparing the nation's superior next generation, children's health should be a
priority. The role of parents, teachers, health workers and the government is an important
key to making this happen.

ACKNOWLEDGEMENTS
The authors thanked the Faculty of Nursing Universitas Padjadjaran, Sumedang,
West Java, Indonesia, for facilitating the databases to articles searching for this study.

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