Health Informatics Meets eHealth 33

G. Schreier and D. Hayn (Eds.)

© 2018 The authors and IOS Press.
This article is published online with Open Access by IOS Press and distributed under the terms
of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0).
doi:10.3233/978-1-61499-858-7-33

Use of Mobile Apps Among Medical and

Nursing Students in Iran
Abbas SHEIKHTAHERIa,b, Farzaneh KERMANIa,1
a
Health Management and Economics Research Center, Iran University of Medical
Sciences, Tehran, Iran
b
Department of Health Information Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Abstract. Mobile technologies have a positive impact on patient care and cause to
improved decision making, reduced medical errors and improved communication in
care team. The purpose of this study was to investigate the use of mobile
technologies by medical and nursing students and their tendency in future. This
study was conducted among 372 medical and nursing students of Tehran University
of Medical Science. Respectively, 60.8% and 62.4% of medical and nursing students
use smartphone. The most commonly used apps among medical students were
medical dictionary, drug apps, medical calculators and anatomical atlases and
among nursing students were medical dictionary, anatomical atlases and nursing
care guides. Also, the use of decision support systems, remote monitoring, patient
imagery and remote diagnosis, patient records documentation, diagnostic guidelines
and laboratory tests will be increased in the future.

Keywords. Mobile technology, mobile education, medical education, nursing

education

1. Introduction

The use of Smartphone, personal digital assistant (PDA) and other mobile and handheld
devices with immediate access to health information has had a positive impact on patient
care. In addition, these technologies led to improved decision-making process and
reduced medical errors, improved communication between the treatment team and
enhanced telemedicine capabilities. Currently, doctors and nurses are able to store
textbooks and video tutorials, and use sources such as medical calculators [1], diagnostic
guidelines, management and drug references apps [2] on their Smartphone. Additionally,
library and educational apps [3], simulated health care environment [4], laboratory test
and drug interaction guides, nursing care and clinical examination guidelines [5] are also
available features for mobile devices. The use of pharmaceutical and therapeutic
information on Smartphone is effective in providing patient care reports [6], better
communication between providers [7] and increasing information exchange in health
care settings [8]. A study in the USA showed that doctors believed that the use of PDAs
in the field of pharmaceutical and therapeutic information was effective in providing
patient care reports in 91% of cases [6].
In addition to clinical usage, the educational use of this technology is highly
prevalent amongst students. A study in the USA showed that more than 70% of medical
1
Corresponding author, Farzaneh Kermani, PhD candidate in Medical Informatics, Department of Health
Information Management, School of Health Management and Information Sciences, Iran University of Medical
Sciences, Tehran, Iran; Email: [email protected].
34 A. Sheikhtaheri and F. Kermani / Use of Mobile Apps Among Medical and Nursing Students in Iran

students use these devices mostly for electronic reference books, medical databases,
medical calendars, and patients tracking [9]. The study of medical students and junior
doctors in United Kingdom also showed that most of these people have between 1 to 5
medical apps on their phone [1]. Another study showed that 98% of nursing students use
drug guidelines and 83% of them use medical dictionary on these devices [2]. Students
can use apps for predicting, checking for drug interactions and counseling on differential
diagnosis [9] that lead to improved learning, reduced medical errors, increased accuracy
of students at the clinic, and saving training time [10].
Although there are many studies in other countries, there is not much study in Iran
about the use of this technology among medical and nursing students. Given the fact that
these two groups form the next generation of physicians and nurses, one can expect the
use of mobile technology to increase among new-generation students. However, there is
not much information about the use of this type of technology and its type of use among
this group of students in Iran. Therefore, the purpose of this study was to investigate the
use of mobile technologies by medical and nursing students and their tendency in using
these technologies in future.

2. Method

This research was conducted in teaching hospitals of Tehran University of Medical

Sciences in 2016. The research population included medical and nursing students
working in these hospitals. The sample included 400 individuals who were invited to
participate using simple random sampling and Morgan sampling table (200 individuals
from every group). A questionnaire was used to collect data. The questionnaire included
questions about demographic data, the current use and app of mobile technology, and
favorite apps for future use. Validity of the questionnaire was evaluated using the
comments of three faculty members of Health Information Technology and six medical
and nursing students (three individuals from each group) to present their views on the
transparency and necessity of the questions. The revised questionnaire was re-submitted
to the same faculty members, and changes were made based on their comments.
In order to control the reliability, the questionnaire was first provided to 30 students
(15 individuals from each group) and the amount of Kuder Richardson's alpha was
calculated. The test-retest method was also used. The questionnaire was provided to 10
medical and nursing students in two phases in a 10-day interval and the correlation of
the responses was calculated. No significant difference was observed in two phases.
After collecting the questionnaires, the data analysis was performed using SPSS 16 and
descriptive methods (frequency and percentage). Chi-square, Fisher test and t-test were
used for comparing medical and nursing students.

3. Results

A total of 372 students (194 medical students, 178 nursing students) participated in this
study. Female subjects accounted for the majority of the participants (51.9%) and most
of students (83.3%) were under 30 years of age. The average hospital work experience
of medical and nursing students was 42.5 ± 4.2 and 30.5 ± 2.9 months, respectively. The
most used technologies among medical and nursing students were Smartphone (60.8%
vs. 62.4%, respectively). Medical and nursing students had 41.4 ± 21.02 and 29.6 ± 21.59
 A. Sheikhtaheri and F. Kermani / Use of Mobile Apps Among Medical and Nursing Students in Iran 35

months’ experience in using mobile technology (p<0.001). Medical and nursing students
had had used these technologies in clinical and educational tasks for 28.9 ± 17.2 and 18.7
± 15.4 months, respectively (p<0.001) and only 6.5% of medical students and 18.9% of
nursing students stated that they rarely use or do not use the mobile technology in clinical
and educational tasks.
Most students used this technology more than once or twice a day. The smartphone
was the most favorite device for future use among medical and nursing students with
62.4% and 59.7%, compared to other technologies like tablets. Also, 88.2% and 91.8%
of medical and nursing students, respectively, were willing to use the mobile technology
in the future.
The current use of most apps was less than 40% in both groups (Tables 1 and 2).
There was no significant difference between the two groups in terms of using most of
these apps. The medical students used apps such as medical dictionary, drug apps,
medical calculators, medical video tutorials, decision support and access to databases
more than nurses (P<0.05). Nurses used nursing care guides more than medical students
(P<0.05).
Considering the willingness of students to use these apps in the future, both groups
showed willingness rate of less than 40%. In addition, there was no significant difference
between the two groups in terms of using most of these apps in the future, but nursing
students would be more in need of medical dictionary, nursing care guides, anatomical
atlases, educational management apps than medical students (Tables 1 and 2, sorted
alphabetically).
According to Tables 1 and 2, there will be an increase in demand for most of these
apps in the future, with the highest increase for apps used in decision support (31.7% for
medical students and 18.2% for nursing students), monitoring and remote care (26.8%
for medical students and 20% for nursing students), patient imagery and remote
diagnosis (23.7% in medical students and 12.9% in nursing students), patient record

Table1. Comparison of usage rates of apps (current and future) among medical students (N=186)
Current Tendency for Change
use future use rate
n (%) n(%) %
Anatomical atlases 81(43.5) 56(30.1) -13.4↓
Calendar (visit schedule) 19(10.2) 41(22) +11.8↑
Clinical guidelines 39(21) 55(29.6) +8.6↑
Decision support systems 4(2.2) 63(33.9) +31.7↑
Diagnostic guide & laboratory tests 29(15.6) 59(31.7) +16.1↑
Drug apps (doses & drug interactions) 112(60.2) 72(38.7) -21.5↓
Educational management apps 14(7.5) 20(10.8) +3.3↑
Electronic reference books 60(32.3) 48(25.8) -6.5↓
Identification Program (student card, library) 6(3.2) 10(5.4) +2.2↑
Library apps (access to digital library, book depository) 10(5.4) 27(14.5) +9.1↑
Medical calculators 85(45.7) 45(42.2) -3.5↓
Medical database (Medline) 61(32.8) 58(31.2) -1.6↓
Medical dictionary1 132(71) 78(41.9) -29.1↓
Medical encyclopedia2 43(23.1) 56(30.1) +7↑
Medical news track 49(26.3) 49(26.3) 0
Medical video tutorials 50(26.9) 51(27.4) +0.5↑
Nursing care guidelines 14(7.5) 23(12.4) +4.9↑
patient imagery and remote diagnosis 11(5.9) 55(29.6) +23.7↑
Patient records documentation 9(4.8) 39(21) +16.2↑
Physical examinations apps 18(9.7) 47(25.3) +15.6↑
Remote monitoring & patient care 20(10.8) 70(37.6) +26.8↑
1
Medical dictionary: a lexicon for words used in medicine
2
Medical encyclopedia: a comprehensive written compendium that holds information about diseases, medical conditions, tests, symptoms, injuries,
and surgeries.
36 A. Sheikhtaheri and F. Kermani / Use of Mobile Apps Among Medical and Nursing Students in Iran

Table2. Comparison of usage rates of apps (current and future) among nursing students (N=170)
Current use Tendency for Change
n(%) future use n(%) rate %
Anatomical atlases 61(35.9) 75(44.1) +8.2↑
Calendar (visit schedule) 17(10) 37(21.8) +11.8↑
Clinical guidelines 31(18.2) 57(33.5) +15.3↑
Decision support systems 12(7.1) 43(25.3) +18.2↑
Diagnostic guide & laboratory tests 37(21.8) 65(38.2) +16.4↑
Drug apps (doses & drug interactions) 82(48.2) 57(33.5) -14.7↓
Educational management apps 19(11.2) 40(23.5) +12.3↑
Electronic reference books 41(24.1) 44(25.9) +1.8↑
Identification Program (student card, library) 12(7.1) 28(16.5) +9.4↑
Library apps (access to digital library, book depository) 14(8.2) 36(21.2) +13↑
Medical calculators 22(12.9) 35(20.6) +7.7↑
Medical database (Medline) 20(11.8) 48(28.2) +16.4↑
Medical dictionary 89(52.4) 95(55.9) +3.5↑
Medical encyclopedia 37(21.8) 58(34.1) +12.6↑
Medical news track 35(20.6) 58(34.1) +13.5↑
Medical video tutorials 30(17.6) 51(30) +12.4↑
Nursing care guidelines 44(25.9) 82(48.2) +22.3↑
patient imagery and remote diagnosis 11(9.5) 38(22.4) +12.9↑
Patient records documentation 13(7.6) 41(24.1) +16.5↑
Physical examinations apps 22(12.9) 46(27.1) +14.2↑
Remote monitoring & patient care 15(8.8) 49(28.8) +20↑

documentation and access to the records (16.2% among medical students and 16.5%
among nursing students), diagnostic guidelines and laboratory tests (16.1% for medical
students and 16.4% for nursing students). In comparison, the rates of students' use of
some apps, such as medical dictionary (29.1% among medical students), medical
calculators (3.5% among medical students) and anatomical atlas (13.4% among medical
students) will be decreased. Figure 1 shows the current and future use of apps among all
students.

4. Discussion

Newzoo's 2017 Global Mobile Market Report shows the top 50 countries in terms of
smartphone users in 2017. According to this report, Iran is among the top 50 countries
by 30 million smartphone users. China, India and United States respectively have the
highest rates (717.31, 300.12, 226.29 million smartphone users). [11] Smartphones are
also the most common technology used by students. According to a review study, about
60% -70% of students and physicians used PDA in educational and clinical tasks [9],
which is consistent with the results of this study. A study in the USA showed that 96%
of nursing students used mobile technology in clinical tasks [2]. In the UK, 78.3% and
39.9% of medical students used smartphones for educational and clinical purposes,
respectively [1]. According to these studies, the use of mobile technology, especially the
smartphone, is increasing among medical and nursing students, which is consistent with
the results of the present study. Most medical and nursing students used this technology
several times a day for clinical and educational use, indicating that the daily use of mobile
technology is relatively high. In the United Kingdom, 47% of medical students used their
device at home or at point of care at least once a week [12]. In Sweden, this rate was 1
to 5 times a day for nursing students and up to 10 times a day [13]. These studies show
a high rate of daily use of mobile technologies among students, which is roughly
consistent with our results.
 A. Sheikhtaheri and F. Kermani / Use of Mobile Apps Among Medical and Nursing Students in Iran 37

Figure 1. Comparison of usage rates of apps (current and future) among medical and nursing students

The results showed that the most commonly apps used by medical students included
medical dictionary, drug apps, medical calculators and anatomy atlases. In this regard,
according to a review study, the most commonly apps used by students included drug
information apps, medication references, medical calculators and information
management [9]. A study in the UK has reported that the major use of apps among
medical students is related to drug handbook and medical books [12]. These results are
roughly similar to our results. The apps widely used by nursing students included medical
dictionary, drug apps, anatomy atlas and nursing care guides. A study in the USA showed
that the most desired apps by nursing students include clinical guidelines and dictionary
[2]. A review study also showed that most nursing students used these apps to receive
reference information [14], which is almost consistent with our results.
Future apps needed by medical students will include medical calculators, medical
dictionary, drug apps and remote monitoring and patient care. Nursing students will also
need medical dictionary, nursing care guides, anatomy atlases, diagnoses and laboratory
test guidelines. In Germany, medical students need some apps to search for diagnostic,
therapeutic and predictive information, access to patient records, interaction and social
communication, organization of medical education, remote patient monitoring and
online reporting [15]. As for nursing students, other apps like access to patient
information, tests and reference values of tests, knowledge resources such as reference
books, information about diseases, preparation for patient examination, medical
calculators and the possibility of taking notes from journals were reported [16].
According to these results, current and future needs of Iranian students are similar to
those of other developed countries. However, these requirements are also subject to the
conditions of that country, the relevant educational programs and the special educational
needs of the students of each country.
According to the current study, demand for most of these mobile apps will increase
in the future. The highest increase is related to remote monitoring and patient care remote
diagnosis, patient records documentation, diagnostic guidelines and laboratory tests.
38 A. Sheikhtaheri and F. Kermani / Use of Mobile Apps Among Medical and Nursing Students in Iran

There will a reduction in the use of some apps, such as the medical dictionary, medical
calculators and anatomy atlas. In this regard, there is no report in other studies. In short,
the use of mobile technology in both groups is beneficial for educational and clinical
tasks, and students tend to use different types of apps on their mobile technologies, and
there is increased tendency with regard to some apps. Therefore, university officials and
app developers should consider developing new apps with multiple features to meet the
growing needs. The results of this research can be used for developing appropriate
mobile applications that are more interesting for students. In fact, app developers,
especially those who are working in the education field may use these results to develop
in-demand apps for future medical and nursing students. Some limitations should be
considered. Although, the sample size is high, this study was conducted in one university.
This university is the biggest medical university in the country with students from the
whole country, however, we could not generalize the results to the whole country.

Acknowledgment

This study is a part of a research financially supported by Tehran University of Medical

Sciences (Code 94-01-76-28289)

5. References

[1] K.F.B. Payne, H. Wharrad, K. Watts, Smartphone and medical related app use among medical students
and junior doctors in the United Kingdom (UK): A regional survey, BMC Med Inform Decis Mak 12(1)
(2012), 1-11.
[2] L.E. George, L.J. Davidson, C.P. Serapiglia, S. Barla, A Thotakura, Technology in nursing education:
A study of PDA use by students, J Prof Nurs 26(6) (2010), 371-376.
[3] D.H. Shin, Y.J. Shin, H. Choo, K. Beom, Smartphones as smart pedagogical tools: Implications for
smartphones as u-learning devices, Comput Human Behav 27(6) (2011), 2207-2214.
[4] C.P. Hawkes, B.H Walsh, C.A. Ryan, E.M. Dempsey, Smartphone technology enhances newborn
intubation knowledge and performance amongst paediatric trainees, Resuscitation 84(2) (2013), 223-
226.
[5] O.I. Franko. Smartphone apps for orthopaedic surgeons, Clin Orthop Relat Res 469(7) (2011), 2042-
2048.
[6] C.R. Dee, M. Teolis, A.D. Todd, Physicians' use of the personal digital assistant (PDA) in clinical
decision making, J Med Libr Assoc 93(4) (2005), 480-486.
[7] E. Ozdalga, A. Ozdalga, N. Ahuja, The smartphone in medicine: A review of current and potential use
among physicians and students, J Med Internet Res 14(5) (2012), 1-19.
[8] G.J. Putzer, Y. Park, The effects of innovation factors on smartphone adoption among nurses in
community hospitals, Perspect Health Inf Manag 7 (2010), 1-18.
[9] A. Kho, L.E. Henderson, D.D. Dressler, S. Kripalani, Use of handheld computers in medical education,
J Gen Intern Medi 21(5) (2006), 531-537.
[10] A. Jotkowitz, J. Oh, C. Tu, D. Elkin, L.A. Pollack, H. Kerpen, The use of personal digital assistants
among medical residents, Med Teach 28(4) (2006), 382-384.
[11] Newzoo, Top 50 Countries by Smartphone Users and Penetration, available from:
https://newzoo.com/insights/rankings/top-50-countries-by-smartphone-penetration-and-users/.
[12] B.S. Davies, J. Rafique, T.R. Vincent, J. Fairclough, M.H. Packer, R. Vincent, I. Haq, Mobile Medical
Education (MoMEd)-how mobile information resources contribute to learning for undergraduate clinical
students-a mixed methods study, BMC Med Educ 12(1) (2012) 1-11.
[13] P.E. Johansson, G.I. Petersson, G.C. Nilsson, Nursing students' experience of using a personal digital
assistant (PDA) in clinical practice—an intervention study, Nurse Educ Today 33(10) (2013), 1246-
1251.
 A. Sheikhtaheri and F. Kermani / Use of Mobile Apps Among Medical and Nursing Students in Iran 39

[14] C. Strandell-Laine, M. Stolt, H. Leino-Kilpi, M. Saarikoski, Use of mobile devices in nursing student–
nurse teacher cooperation during the clinical practicum: An integrative review, Nurse Educ Today 35(3)
(2015), 493-499.
[15] M. Sandholzer, T. Deutsch, T. Frese. A. Winter, Medical students’ attitudes and wishes towards
extending an educational general practice app to be suitable for practice: A cross-sectional survey from
Leipzig, Germany, Eur J Gen Pract 22(2) (2016), 141-146.
[16] M. Berglund, C. Nilsson, P. Révay, G. Petersson, G. Nilsson, Nurses’ and nurse students’ demands of
functions and usability in a PDA, Int J Med Inform 76(7) (2007), 530-537.