Material and Method: A cross-sectional study was carried out between May and June 2022. The sociodemographic information form and Nomop-hobia Scale (NMP-Q) were used to collect data in the study. SPSS 22.0 software was used for statistical analysis. Mann Whitney U, Kruskall Wallis test, and Spearman correlation analysis were performed.

Results: Of 293 medical secretaries, 59.0% (n =173) of the participants were female, with a mean age of 36.5±6.9. According to NMP-Q, 0.6% of the participants were healthy, 32.8% mild, 48.5% moderate, and 18.1% severe nomophobia. The NMP-Q scores were significantly higher among partici-pants who are single, use social media, and use mobile phones at work (p <0.05). A positive and significant correlation was found between daily mobile phone use and NMP-Q scores (p <0.01).

Conclusion: The study revealed that most participants experienced varying degrees of nomophobia. The presence of individuals experiencing no-mophobia among healthcare professionals and the lack of awareness that this is a problem pose a great risk. It is recommended to address this issue by conducting in-house training programs within the hospital.

Nomophobia, the fear experienced when a mobile device cannot be accessed or communicated, is the new phobia of the modern age¹. The term nomophobia was first used in a study conducted in England in 2008 ³. People with nomophobia are afraid, unhappy, stressed, and anxious when they are away from their phones, out of battery, or out of range^3-5. Nomop-hobic people usually suffer from physical problems such as headaches, eye problems, radiation exposure, numbness in fingers, and musculoskeletal pain^5,6. The excessive use of mobile phones can lead to withdrawal from the social environment, depression, loneliness, low self-esteem, negative communication with the environment, and sometimes even suicide attempts^7,8. This disorder has become so common that 86% of participants had mild or moderate nomophobia while 13.2% had severe nomophobia, leaving only 0.8% of participants labeled as not having this disorder in a large-scale study with 2838 participants⁹. Similarly, in Turkey, 8.5% of the youth had severe, 71.5% moderate, and 20.0% mild nomophobia¹⁰.

The problem of nomophobia is also apparent to health professionals, as health professionals were found to have moderate nomophobia¹¹. One type of health professional, medical secretaries, is responsible for filing and archiving patient correspondences, as well as the reports of physicians and administrators working in health institutions. Compared to other health professio-nals, medical secretaries spend more time in front of computers and the internet¹². As nomophobia can cause people to neglect their work, a high level of no-mophobia in medical secretaries can lead to many problems, including forgetting patient data, making careless mistakes, sacrificing professional patient dia-logue, and causing quality degradation. Such problems can endanger patients’ health, as it may cause neglect of patients for reasons¹³.

Although there are studies evaluating nomophobia in health professionals in the literature^5,13, no study has evaluated nomophobia in medical secretaries. The fact that this study was conducted with a sample of medical secretaries in the health sector is valuable in revealing how common nomophobia is in this line of work, as high percentages of nomophobia can lead to severe consequences. This study aimed to determine the prevalence of nomophobia and influencing factors in medical secretaries who are health professionals.

Ethical Approval
Ethical permission (15.04.2022-7985) was given from the Firat University Non-Interventional Research Eth-ics Committee, and official permission from the hospi-tal was obtained before the research. Each participants gave their written informed consent to participate in the study, and the study was carried out in accordance with the principles of the Declaration of Helsinki.

Data Collection
The questionnaire form consisted of two sections: soci-odemographic characteristics and Nomophobia Scale (NMP-Q). Independent variables in this study; socio-demographic characteristics were characteristics related to occupation and mobile phone use. The dependent variable of the study was the NMP-Q scores of the individuals.

Sociodemographic Data Form
The questionnaire consisted of 33 questions, and the names of the participants were not included in the questionnaire. There were 21 questions on socio-demographic characteristics such as gender, age, mari-tal status, level of education, smoking and alcohol consumption. There were 6 questions on occupational characteristics such as type of work, years worked and work unit. There were 6 questions about the reason for using mobile phones and social media applications. The average time for completion of the questionnaire was 20 minutes per participant.

Nomophobia Scale (NMP-Q)
The nomophobia scale developed by Yıldırım and Correira (1) was adapted into Turkish by Yıldırım et al¹⁴. The scale is in 7-point Likert type and consists of 20 questions. The questions were divided into four subdimensions: Giving up Convenience (N-GC), Losing Connectedness (N-LC), Not Being Able to Access Information (N-NBI), Not Being Able to Communicate (N-NBC). The sum of these four sub-dimensions sco-res gives the NMP-Q score. This score can be interpre-ted as follows: =20 scores no-nomophobia, 21≤scores<60 mild nomophobia, 60≤ scores <100 moderate nomophobia, 100≤ scores ≤140 severe no-mophobia.

Data Analysis
All the analyses were carried out by the IBM Statistical Package for the Social Sciences (SPSS) 22.0. The data was not normal according to the Kolmogrov-Smirnov test; therefore, non-parametric tests were used (Mann Whitney U, Kruskall Wallis test, Bonferroni test, Spe-arman correlation, Binary logistic regression). The thresold for statistical significance was taken as p <0.05.

Click Here to Zoom

Table 1: Distribution of medical secretaries according to descriptive statistics.

When the mobile phone usage characteristics of medi-cal secretaries were examined, it was found that 97.3% of them had a mobile phone, and 64.5% used their mobile phones during working hours. The average use of mobile phones by the participants in a day were 3.5±2.2 hours. More than one tenth of the participants (13.3%) thought they were mobile phone addicts, and 54.6% thought they were partially mobile phone addicts. The most used social media applications were Instagram, YouTube, and Facebook, respectively. The distribution of medical secretaries according to their mobile phone usage characteristics is given in table 2.

Click Here to Zoom

Table 2: Distribution of medical secretaries by mobile phone usage characteristics.

Nomophobia scale scores of the medical secretaries were as follows: NMP-Q 72.9±26.4, N-NBI 14.3±6.3, N-GC 18.3±2.6, N-NBC 25.5±10.0, and N-LC was 14.7±8.7. According to NMP-Q, 32.8% of the partici-pants had mild nomophobia, 48.5% moderate nomop-hobia, and 18.1% severe nomophobia, while only 0.6% of them were labelled as normal. A statistically significant difference was found between NMP-Q scores and marital status, chronic illness, family type, and mobile phone use while at work (p <0.05). The NMP-Q scores were higher for the participants who were single, did not have a chronic disease, thought that they were addicted to a mobile phone, the participants who used mobile phones during work (p <0.05). NMP-Q scores did not change according to gender, age, smokingalcohol use, educational status, regular eating habits (p >0.05, Table 3).

Click Here to Zoom

Table 3: Distribution of participants' NMP-Q scores according to sociodemographic variables.

The distribution of participants' NMP-Q scores accor-ding to various variables is given in table 4.

Click Here to Zoom

Table 4: Distribution of participants' NMP-Q scores according to various variables.

Participants who were using social media, used mobile phones at work, and used mobile phones immediately upon waking up in the morning had significantly hig-her NMP-Q scores (p <0.05).

A positive, significant correlation was found between the daily use of mobile phones and the NMP-Q scores (p <0.01, Table 5).

Click Here to Zoom

Table 5: Correlation of medical secretaries' NMP-Q scores with various variables.

No correlation was found between age, height, weight, BMI, years of work in the profession, and NMP-Q scores (p >0.05).

Binary logistic regression analysis of various characteristics with nomophobia as the outcome variable is shown in table 6. It was found that using a smartphone during working hours could increase the risk of no-mophobia by 0.4 times (p <0.05, Table 6).

Click Here to Zoom

Table 6: Binary logistic regression analysis of characteristics with nomophobia* as the outcome variable.

In our study, the mean score of the NMP-Q of the par-ticipants was found to be 72.9±26.4. Similar to our findings, it was found to be 77.6±25.7 in Demirel et al.^17, 72.7±28.8 in Al et al.^11, 60.0±15.0 in Bulbuloglu et al. (18), 50.3±29.0 in Lupo et al.⁸. The difference in the sample and the places where the studies were conducted may affect the nomophobia scores.

N-NBC was the highest of the NMP-Q subdimension scores. Studies conducted on nurses, university students, and young people also parallel to our study.^16-19. However, in another study conducted with nurses, the mean score of N-GC was high⁵. This finding may be because health professionals are a professional group that uses communication at a high level.

Female participants had high nomophobia scores, but it was not significant. In the literature, besides the studies in which the scores of women were found to be significantly higher^5,17, some studies found no relations-hip between gender and nomophobia^11,20,21. Indepth studies are needed in this regard.

In this study, NMP-Q scores decreased as the age of the participants increased, but it was not statistically significant. There were studies in the literature that found a negative correlation between age and NMP-Q scores^5,11,15,18. Yildiz et al. found that individu-als in the Z generation had higher nomophobia scores than those in the X and Y generations²². On the other hand, there were also studies reporting that the age of individuals did not make a significant difference in their nomophobia scores^14,17. These results were consistent with our study. This may be because young people are more familiar with technologies and use social networks more²³.

Single participants in this study had significantly hig-her scores. In Demirel¹⁷ et al.'s study, singles' scores were high but not significant. In the study of Uguz⁵ et al., there was no relationship between marital status and nomophobia. The fact that single participants have more free time and fewer domestic responsibilities may cause them to spend more time with their mobile phones.

Nomophobia scores were not changed according to the education level of the participants. The literature was also parallel to our study^5,17. This is because the sample group is from the same profession.

The nomophobia scores of the participants who used mobile phones during the task were significantly hig-her. The study of Bulbuloglu¹⁸ et al. was similar to our study. In a study conducted with Italian nurses, it was shown that the use of personal digital technologies in the workplace negatively affects work performance and may cause errors during clinical applications⁸. In the literature, it has been stated that nomophobia causes distraction^24,25.

The NMP-Q scores of the participants who thought they were addicted to mobile phones were found to be significantly higher. The literature was also similar to our study⁵. This shows that medical secretaries are aware of their dependence on their mobile phones.

The NMP-Q scores of the participants who used mobile phones when they woke up in the morning were significantly higher. The literature was also consistent with our study^1,5,17. Spending time on a mobile phone right after waking up can be considered a risky behavior regarding nomophobia. The fact that indivi-duals want to check their mobile phones so often can be interpreted as giving importance to the notifications they may receive.

A positive, significant correlation was found between the daily use of mobile phones and the NMP-Q scores. In the literature, NMP-Q scores increase significantly as the daily mobile phone usage time increases^{5,11,13,17,18,21}.

The scope of the research is limited to medical secreta-ries, so it cannot be generalized to all health professio-nals in a university hospital. Due to the cross-sectional design of the study, it may not be possible to establish definite cause-and-effect findings. However, the findings of this study are important as they reveal the nomophobia status of health professionals in Turkey.

Individuals with severe nomophobia can be directed to addiction treatment. The presence of individuals expe-riencing nomophobia among healthcare professionals and the lack of awareness that this is a problem pose a great risk. In light of these results, it is essential to increase awareness and education about the optimal use of these devices. Large-scale studies are needed on this subject.

Acknowledgments
The authors thank all the medical secretaries who parti-cipated in this study.

Conflict of Interests
The authors declare that there are no conflicts of inte-rest.

Financial Disclosure
The authors declared that this study received no finan-cial support.

Availability of data and materials
Data will be shared with individuals upon request.

1) Yildirim C, Correia AP. Exploring the dimensions of nomophobia: Development and validation of a self-reported questionnaire. Comp Human Behav 2015; 49: 130-7.

2) Social WA. “Digital 2023 global overview report”. http://wearesocial.com/uk/blog/2023/01/digital-2023/ 17.08.2023.

3) SecurEnvoy. “Industry news”. http://www.securenvoy.com/en-gb/blog/66-population-suffer-nomophobia-fear-being-without-their-phone/ 17.08.2023.

4) Dixit S, Shukla H, Bhagwat A et al. A study to evaluate mobile phone dependence among students of a medical college and associated hospital of central India. Indian J Community Med 2010; 35: 339-41.

5) Uguz G, Eskin Bacaksiz F. Relationships between personality traits and nomophobia: Research on nurses working in public hospitals. Perspect Psyc-hiatr Care 2021; 58: 673-81.

6) Argumosa-Villar L, Boada-Grau J, Vigil-Colet A. Exploratory investigation of theoretical predictors of nomophobia using the mobile phone involve-ment questionnaire (MPIQ). J Adolesc 2017; 56: 127-35.

7) Bhattacharya S, Bashar MA, Srivastava A et al. Nomophobia: No mobile phone phobia. J Family Med Prim Care 2019; 8: 1297-1300.

8) Lupo R, Zacchino S, Caldararo C et al. The use of electronical de vices and relative levels of nomop-hobia within a group of Italian nurses: An observa-tional study. Epidemiol, Biostat Public Health 2020; 17: e13272‐13271-13210.

9) Kaviani F, Robards B, Young KL et al. Nomopho-bia: Is the fear of being without a smartphone as-sociated with problematic use? Int J Environ Res Public Health 2020; 17: 6024.

10) Gurbuz IB, Ozkan G. What is your level of no-mophobia? An investigation of prevalence and le-vel of nomophobia among young people in Tur-key. Community Ment Health J 2020; 56: 814-22.

11) Al AF, Baspinar MM, Basat O. The relationship of job satisfaction with nomophobia and social media addiction in healthcare professionals: A cross-sectional study. Bagcilar Med Bull 2022; 7: 311-8.

12) Ozata M, Yorulmaz M. A research on working conditions of medical secretaries and stress factors. Kirsehir Ahi Evran University J Health Sci 2020; 1: 41-52.

13) Marletta G, Trani S, Rotolo G et al. Nomophobia in healthcare: An observational study between nur-ses and students. Acta Biomed 2021; 92: e2021031.

14) Yildirim C, Sumuer E, Adnan M et al. A growing fear: Prevalence of nomophobia among Turkish college students. Information Development 2015; 32: 1322-31.

15) Hosgor H, Coskun F, Caliskan F et al. Relations-hip between nomophobia, fear of missing out, and perceived work overload in nurses in Turkey. Perspect Psychiatr Care 2021; 57: 1026-33.

16) Gurol A, Ejder Apay S, Ozdemir S et al. A compa-rison of nomophobia and social anxiety levels of universıty students. AUHSJ 2020; 4: 701-5.

17) Demirel B, Sarikoc G. The relationship between nomophobia and social well-being in nurses: A descriptive study. Turkiye Klinikleri J Nursing Sci 2022; 14: 1205-20.

18) Bulbuloglu S, Ozdemir A, Kapikiran G et al. The effect of nomophobic behavior of nurses working at surgical clinics on time management and psyc-hological well-being. J Substan Use 2020; 25: 318-23.

19) Aparna Kanmani S, Bhavani U, Maragatham S. Nomophobia-an insight into its psychological as-pects in India. Internat J Indian Psychol 2017; 2: 87.

20) Gursel C. Symptoms associated with mobile phone usage among Turkish university students. Internat J Innovat Res Educat 2018; 5: 41-50.

21) Copaja-Corzo C, Aragón-Ayala CJ, Taype-Rondan A et al. Nomophobia and its associated factors in Peruvian medical students. Int J Environ Res Pub-lic Health 2022; 19: 5006.

22) Yildiz A. Comparison of nomophobical properties of x, y and z‐consumers: An application on the Adiyaman province. Adiyaman Univ J Social Sci 2019; 12: 695-726.

23) Joshi SV, Stubbe D, Li ST et al. The use of tech-nology by youth: Implications for psychiatric edu-cators. Acad Psychiatry 2019; 43: 101-9.

24) Abeele M, Antheunis M, Schouten A. The effect of mobile messaging during a conversation on impression formation and interaction quality. Computers in Human Behavior 2016; 62: 562-9.

25) Lee S, Kim M, McDonough I et al. The effects of cell phone use and emotion-regulation style on col-lege students' learning. Applied Cognitive Psycho-logy 2017; 31: 360-6.