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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 181-188

Knowledge, attitude, and challenges in digital learning using smartphones among dental students of South India: a cross-sectional survey


1 Oral Cancer Screening Vertical, Indian Cancer Society, Mumbai, Maharashtra, India
2 Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India
3 Department of Dentistry, Shri Sathya Sai Medical College & Research Institute, Ammapettai, Nellikuppam Post, Tamil Nadu, India
4 Department of Conservative Dentistry & Endodontics, Sathyabama University Dental College & Hospital, Chennai, Tamil Nadu, India
5 Department of Oral and Maxillofacial Pathology, College of Dental Sciences, Davangere, Karnataka, India
6 Department of Prosthodontics, Crown & Bridge, Adhiparasakthi Dental College & Hospital, Melmaruvathur, Tamil Nadu, India

Date of Submission21-Aug-2020
Date of Decision19-Jan-2021
Date of Acceptance20-Feb-2021
Date of Web Publication17-Apr-2021

Correspondence Address:
Dr. Krishnasamy Nitya
Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College & Hospital, Melmaruvathur 603319, Tamil Nadu.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_285_20

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  Abstract 

Aim: Smartphones are a class of mobile phones with multipurpose facilities. They are being used for entertainment, shopping, and even educational purposes. Therefore, a study was planned to assess the knowledge, attitude, and challenges toward smartphone usage for digital learning among the dental students of South India. Materials and Methods: An observational cross-sectional web-based survey was conducted by using a structured, validated, 21-item questionnaire among dental students (final-year students, interns, and postgraduates) from seven random dental colleges in and around Chennai. The data about demographic status, the extent of smartphone utilization for knowledge, students’ attitudes toward smartphone usage, and barriers in digital learning were collected. Chi-square test was applied. Results: In the present survey, 701 students have responded, predominantly females (80%). All participants owned a smartphone, and 62% of them had surfing time as more than 4 h. Nearly 94% had used smartphones for social network surfing. Almost 99% participants viewed instructional videos and read scientific articles using their smartphone. The most common site accessed for knowledge seeking was Google Scholar (39%), followed by Wikipedia (34%) and PubMed (20%). Forty-five percent of postgraduates felt that smartphones enabled them to study independently. Small screen (56%) of smartphones and less knowledge about the available resources (42%) were the major reported barriers for digital learning through the smartphone. Conclusion: Dental students used their smartphones for educational purpose and showed a favorable attitude toward their use in dentistry. Smaller screens, nonavailability of wireless access, and less awareness about the reliability of available resources were reported as barriers.

Keywords: Attitude, Barriers, Dental Students, Digital Learning, Knowledge, Smartphones


How to cite this article:
Bhuvaneshwari G, Nitya K, Karthikeyan M, Purushotham M, Vikram SA, Kirubakaran AK. Knowledge, attitude, and challenges in digital learning using smartphones among dental students of South India: a cross-sectional survey. J Int Oral Health 2021;13:181-8

How to cite this URL:
Bhuvaneshwari G, Nitya K, Karthikeyan M, Purushotham M, Vikram SA, Kirubakaran AK. Knowledge, attitude, and challenges in digital learning using smartphones among dental students of South India: a cross-sectional survey. J Int Oral Health [serial online] 2021 [cited 2021 Jun 17];13:181-8. Available from: https://www.jioh.org/text.asp?2021/13/2/181/313844


  Introduction Top


Smartphones are a class of mobile phones with multipurpose mobile computing devices. They have broader software, internet, multimedia facilities, etc. The smartphones became popular in the early 2010s with faster wireless communication. And this has fostered the growth of smartphones worldwide by using a touch screen to allow the users to interact with them.[1] According to the Telecom Regulatory Authority of India (TRAI), the country’s overall number of mobile phone users had risen to 1,16 billion in 2019 (TRAI April 2019).[2] Various advantages of smartphones include instant communication, web surfing, camera, entertainment, education, and privacy.[2]

“Can a mobile phone be an educational tool?” Yes, nowadays, educational methods are adapting to the changing social environment. Digital learning is replacing the traditional educational methods more and more each day. They are varying from simply using tablets instead of paper to using elaborate software programs and equipment as opposed to a simple pen. Digital assignments are also making students more interested in learning, expanding their horizon and also sharpening their critical thinking skills. Thus, the penetration of digital learning is evolving fast. But also, this digital learning can lead to social isolation and sometimes lack of communication skills.[3],[4],[5] According to a Student Online Behaviour Report by Hindustan Times (HT) Digital and Indian Market Research Bureau (IMRB), 93% of students in India access the internet every day, and 73% of students use their mobile phone to access the internet.[6] The increased usage of mobile phones and tabs made the students get the information readily in an efficient manner. The internet has become a popular medium for delivering teaching material through smartphones.[7] Depending on the year of study, the smartphones, laptops, and tabs have become the choice and mode of learning. Smartphones also play a significant role in the health-care field, such as in medicine and dentistry.

Nowadays, dental education has become a demanding form of professional education that requires students to acquire a diverse collection of skills and theoretical knowledge within the given span of education. There are differences in the dental education system among different countries worldwide. Dental education in India can be improvised to meet the global standard by comparing it with curriculum and teaching modalities in the developed countries, wherein the usage of the latest technologies has been employed for teaching and learning purposes.[3]

Smartphones have been used in educational activities to access the syllabus, acquire information, know students’ performance, and also share information between teachers and students. So, it is apparent that smartphones can have a significant contribution to modern health-care education. Thus, they provide an eye to teaching and learning.[8],[9] But only a few studies on how dental students perceive their smartphones as an educational tool in India are available in the literature.[4],[5],[10]

This study was conducted to know the knowledge, attitude, and challenges in digital learning by using smartphones among the dental students of South India. Research questions were: To what extent do the dental students (final-year undergraduate students, interns, and postgraduates) use their smartphones for accessing scientific information and what are the barriers to using smartphones to access information related to dentistry?


  Materials and Methods Top


Setting and design

The present study was an observational cross-sectional web-based questionnaire survey. The Checklist for Reporting Results of Internet E-Surveys[11] (CHERRIES) was followed wherever applicable for the present survey. Ethical approval was obtained from the Institutional Review Board. A convenience sample of undergraduates (final year, interns) and postgraduate students, who volunteered to participate in the study from seven randomly selected dental colleges in and around Chennai, Tamilnadu, were invited to participate in the survey.

Instruments

The research questionnaire was designed based on the available references from previous studies.[4],[5],[12],[13] A structured questionnaire containing 21 questions was prepared, which consisted of five sections, which included the collection of information about demographic status, smartphone utilization rate, the extent of its use for knowledge purpose, students’ attitude toward smartphone use, and barriers for its usage in digital learning. Questions were open–closed ended, Yes/no questions, multiple choice, and contingency type. The responses for attitude questions were recorded on a three-point Likert scale, that is, strongly agree, neutral, and strongly disagree.

The questionnaire was framed with the help of google forms. A link of the survey was created and sent to selected dental institution groups via email and WhatsApp. The questionnaire was in the form of a booklet with multiple sections, consisting of participant information form, online consent, survey questionnaire, and a thank you note. An open-ended question was provided at the end to view the participants’ suggestions regarding the survey. Google form was prepared with a restriction, to allow only one response per person. Participant information form included details of the primary investigators and purpose of the study. Participation for the survey was completely voluntary. The information of responses was connected to a spreadsheet to record the answers automatically.

Validṭation of the questionnaire

The questionnaire was tested for its content validity by three experts (Public Health Dentist, Oral and Maxillofacial pathologist, and an Oral and Maxillofacial surgeon). The questionnaire was assessed for relevance, simplicity, clarity, and ambiguity. Content validity index (CVI) score for the total scale was computed. A satisfactory level of agreement was found (CVI = 0.8) among the panelists. As all the components had a CVI score more than 0.75, it was found to be valid.[14] The internal consistency of the questionnaire was assessed by Cronbach’s α (alpha) test. The value calculated was 0.82, which reflected a high level of correlation.[15]

Statistical analysis

The period for the data collection was one month (May 2020). The data obtained were compiled and subjected to statistical analysis by using SPSS software version 20. Descriptive statistics were generated in terms of frequencies or percentages. Chi-Square test was used to assess the effect of dental students’ year (final-year undergraduates, interns, and postgraduates) on their knowledge, attitude, and barriers related to digital learning through smartphones. The significant level was fixed at P < 0.05.


  Results Top


Demographics

In the present survey (701/1096), students responded with a response rate of 64%, and the majority were predominantly female (80%). The mean age was 22.47, with nearly 42% being final-year undergraduates, 38% interns, and 20% postgraduate students who participated in the survey [Table 1].
Table 1: Distribution of study sample based on demographic details

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Smartphone utilization

All the participants reported owning a smartphone. The majority used android as the operating system, 591 (84%). There was a significant association with respect to the operating system among the participants (P < 0.05). Nearly 433 (62%) had surfing time as more than 4 h. The majority 658 (94%) had used smartphones for social network surfing such as WhatsApp, Facebook, email, and Twitter [Table 2]. There was a significant association with respect to the purpose of smartphone usage for social network surfing among the study participants (P < 0.001).
Table 2: Distribution of study sample based on smartphone utilization

Click here to view


Usage for knowledge purpose

Almost 692 (99%) participants had used their smartphone to view instructional videos and read scientific articles, and 671 (96%) felt it helped to improve their knowledge and skills. The most common site accessed for knowledge seeking by final-year undergraduates was Google Scholar 133(45%), followed by PubMed 50(36%) among postgraduates. Interns majorly preferred Google Scholar, 95 (35%) and Wikipedia, 88 (34%) for scientific knowledge purposes. The association between dental students’ study year and sites surfed for scientific knowledge purpose was highly significant (P < 0.001). Nearly 80 (58%) postgraduates were aware of dental apps used for training or teaching purposes. There was a significant association between participants’ study year and awareness about dental apps. Around 424 (60%) participants did not have any apps on their smartphone, and the association was significant; 33 (48%) postgraduates used smartphones for seminar or journal presentation. There was a significant association between the proportion of participants’ dental apps usage and study year (P < 0.05). About 507 (72%) participants preferred usage of smartphones than using the library, because of its faster use; 330 (65%) of them felt that information available was satisfactory and reliable [Table 3].
Table 3: Distribution of study sample based on mobile phone usage for knowledge purpose

Click here to view


Attitude toward mobile phone usage

About 56% postgraduates strongly agreed that smartphones improved their access to courses and learning materials. Nearly 76% of interns had a neutral opinion that mobile tools are beneficial. More than 40% of participants felt that smartphones distract them. The majority of final-year undergraduates (48%) felt that smartphones enabled them to study independently. Nearly 53% of postgraduates and final-year undergraduates had a neutral view related to the usage of smartphones by university and staff. The association between the participants’ attitude toward smartphone usage for digital learning was nonsignificant (P > 0.05) [Graph 1].
Graph 1: Distribution of study sample based on attitude toward mobile phone usage

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Barriers to access

Nearly 399 (57%) and 392 (56%) participants had reported nonavailability of wireless access in hospital/ hostel and small screen of smartphones as major barriers, respectively. Majorly, 553 (79%) had used smartphones for accessing literature than library due to lack of time. About 295 (42%) of our participants were not aware of the available resources. There was a significant association between participants’ year of study and the awareness about the available resources (P < 0.001) [Table 4].
Table 4: Distribution of study sample based on barriers to access by user group

Click here to view



  Discussion Top


Technology has become a fundamental aspect of our lives, and we cannot neglect its contribution to the welfare of human beings. Among these, smartphone development has made humans aim for a more luxurious life. Smartphones are characterized by several features, including ease of use, speed, internet connection, and download capacities.[13],[16] The present generation students find the teaching method to be monotonous, and they prefer more interactive learning using information technology such as the internet and teaching software, which enables easier visualization and knowledge transfer. Hence, our study focused on the attitude and knowledge of dental students toward mobile learning. The results showed that all dental students in this study owned a smartphone with an internet package and majorly used them for social networking and learning purposes. They had a favorable attitude toward e-learning through smartphones and reported smaller screens, nonavailability of wireless access, and less awareness about the reliability of available resources as barriers.

Most of our participants opted for 3G/4G network connection in their smartphones, which is higher than previous surveys.[4],[5] Consistent trends were also observed in other reported surveys in Australia and Turkey.[12],[17] This shows increased adoption of smartphone and internet usage by dental students. The operating system of smartphone usage was significantly different among our participants, with the most common being android. Android phones are user-friendly and also less expensive than Apple, which needs to be updated frequently, probably justifying usage preference. Similar results were reported in recent surveys.[4],[5]

A social network, such as Facebook, is a powerful virtual community with endless possibilities.[18] Sweet et al.[19] stated that Facebook was used by dental students to engage each other for Objective Structured Clinical Examinations (OSCEs). Also, it forms an informal site for advertisement, networking, forums, courses, or study groups nowadays.[19] A significant proportion of our participants reported spending more time surfing social networks, such as WhatsApp, Facebook, emails, and music. The study’s findings were similar to those of Bikumulla et al.[5] and also Suner et al.[12] in which dental students utilized smartphones for personal use followed by educational purposes. In the study by Rung et al, a significant number of students who accessed social media with their smartphones found it valuable for learning.[17] In a previous study by Saxena et al.,[4] nearly 80% of dental students found social media helpful in their professional course studies. George et al.[20] also revealed that incorporating social media tools into traditional educational environments increases student learning and collaboration. The majority of students in our study preferred to take pictures of their work. Students in a study conducted by Rung et al.[17] preferred smartphones for content creation and clicking pictures of their work to record and share their progress with peers and instructors.

The majority of the participants (99%) used their smartphones for reading scientific articles, viewing instructional videos and lectures, and felt they help in improving knowledge. Nearly 70% undergraduates in a study by Bikumulla et al.,[5] 55.4% of Australian dental students,[17] and 50.8% dental students in Central India[4] reported usage of smartphones for knowledge purposes. In our study, the higher reporting of smartphone usage could be due to the lockdown effect in the present COVID-19 pandemic situation where the education system is entirely dependent on online teaching and learning. Another qualitative research revealed that learning from videos was more cognitively engaging and enabled mental preparation of clinical skills before patient care.[21]

A significant proportion of our participants surfed Google Scholar (39%) and Wikipedia (34%). A study in Central India by Saxena et al.[4] showed that 72% of participants had reported Google Scholar as a major surfing site, and only 5.6% used Wikipedia. The possible reason could be less awareness about the available resources, which was also reported as one of the barriers for digital learning by our study participants. Similar to this result, the study by Khatoon et al.[22] indicated that dental students faced difficulty in searching, evaluating, and synthesizing evidence-based information, especially now with instant information available on the web, and recommended the universities to focus on improving information literacy among students.

Nearly one half of undergraduates were not aware of mobile apps in dentistry and did not have any apps on their smartphones. A significantly higher number of postgraduates were aware of the mobile phone apps used for training or teaching purposes and had dental apps on their smartphones. Similar results were reported in a study by Saxena et al., with postgraduates being significant dental app users.[4] The current study participants had used apps majorly for viewing illustrations, journal presentations, poster making, etc. As apps were very convenient to use, they were able to pass on the information among their peers and faculties. Gilavand et al.[8] described the effectiveness of designed mobile software for learning among dentistry students. They suggested the use of technology to design suitable educational activities or materials in smartphones to provide various learning methods for students.[8] The current study participants preferred smartphones for learning than library because of their faster use and availability of instant information; however, in a study by Bikumulla,[5] students reported use of smartphones over library due to convenience purposes.

Postgraduates in the current study majorly agreed that mobile tools are beneficial in dentistry, because they enabled them to learn independently and access scientific resources easily. The reasons were easy accessibility, repeatable action, and the ability to study at any place and at any time. This is possible nowadays, probably due to the improved speed of the network and the upgraded operating systems. Similarly, dental students in Central India showed a keen interest in the inclusion of digital technology in the dental curriculum.[4] In the study by Suner et al.,[12] a significantly higher proportion of dental students reported mobile devices in dentistry courses to be useful. Also, the study described that students had positive attitudes toward m-learning because of the use of multimedia materials such as videos and animations. They concluded that designing learning materials and applications for mobile devices may increase students’ performances.[12] Undergraduate dental students in a study by Bikumulla et al.,[5] agreed that smartphone usage for educational purposes should be encouraged by the university and staff. However, our participants had a neutral opinion about the same and the association was nonsignificant.

The ubiquitous nature of smartphones is an advantage, but it could also be a disruption.[17] Dental undergraduates in a study by Suner et al. reported problems associated with the charging, distractibility, and internet connectivity as negative aspects of smartphones. They opined that m-learning might be insufficient where topics are incomprehensible, or further details are required.[12] In a study by Deshpande et al.,[10] faculty members and dental students had positive perceptions regarding the use of mobile apps for learning. However, faculty members in their study believed that the use of mobile apps for learning could also reduce the importance of traditional techniques and, therefore, suggested the use of blended learning techniques.[10] Less than half of our participants reported that smartphones distracted them while studying, as in a study by Saxena et al. where 89% of undergraduates and postgraduates were distracted.[4]

The availability of wireless access in the hostel or clinic was reported as the main barrier to using mobile devices for information seeking. Consistently, in a study among medical students, residents, and faculty members in Canadian medical universities, wireless access was broadly recognized as a problem, particularly among clinical undergraduate students and residents.[13] A small screen was considered as a major barrier by more than half of our participants, but there was no significant association. Maniar[23] studied the effect of screen size on video-based m-learning; it was reported that regardless of the screen size of a mobile device, students tended to have a positive overall opinion of m-learning. Two underlying reasons why screen size is a problem are human visual perception and attention.[24] Human visual perception limits the level of small details that can be seen, which also affects their attention span. To overcome this problem, the user can zoom in to make the content bigger.[23] Other technical challenges for mobile learning include cconnectivity, battery life, number of file/asset formats supported by a specific device, and multiple operating systems.[25]

The strengths of our survey include the Google form questionnaire setting to avoid duplicate responses. The questionnaire was made attractive in the form of a booklet and was divided into five sections with limited questions to avoid fatigue and to improve the response rate. No information related to college details or login credentials was recorded, thereby avoiding social desirability bias. The study had a 64% response rate. In web surveys, there is no printing or mailing of the questionnaires; data already come in an electronic format and allow 24-hr-a-day data collection.[26] The current study used a valid, reliable, and self-modified structured questionnaire adapted from previous literature.[4],[5],[12],[13]

The limitations of the study were: As the study design was a cross-sectional survey, perceptions and perspectives were assessed at a single point of time. The study included the undergraduate and postgraduate students from a few dental colleges within a district. Hence, the results can be generalized to the study population only. The majority of participants opted for a neutral response in attitude questions, leading to some amount of central tendency in answering, but the neutral option was provided to avoid forced answering, which may not reflect their true feelings.


  Conclusion Top


Internet becomes a credible source for researching education-related information as well. Mobile learning or smartphone learning in education has now become an unavoidable alternative during this pandemic. The use of smartphone learning allows learning anytime, anyplace, anywhere. Many countries have closed educational institutions to reduce the spread of this pandemic. Thus, the educational institutions are now strengthening the practice of innovative teaching techniques. Hence, this quick transition to smartphone learning and e-learning has now become successful and is gaining experience that can be used in the future. It also allows the teachers to personalize instructions and enable students to self-regulate learning. In dental schools, the students also have a positive attitude toward the smartphone usage for educational purposes, and it also varies among the students at different years of study.

The present study may contribute toward exploring the field of e-learning in dentistry based on students’ perspectives. From the results of our study, we can conclude that mobile phones can help in the mode of learning and gaining scientific knowledge and dental students have a favorable attitude toward its usage. Small screen of smartphones and less awareness about the available resources were the reported barriers. Thus, it is essential to impart the knowledge of valid and reliable resources to dental students so as to acquire the best available evidence. Future studies are required to explore the perceptions of smartphone usage for learning purposes among teaching faculties and students through different study designs such as a qualitative study.

Acknowledgment

The authors duly acknowledge the principals of the dental colleges for allowing them to conduct the web survey. They extend their gratitude toward the professors who helped to forward the questionnaire link to their students and the participants for their valuable responses and time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Author contributions

BG: Concept, design, definition of intellectual content, literature search, clinical search and experimental study, data acquisition, data analysis, statistics, article preparation, editing, and review. NK: Concept, design, definition of intellectual content, literature search, clinical search and experimental study, data acquisition, article preparation, editing, and review. KM: Definition of intellectual content, data acquisition, and article review. PM: Data acquisition, article review. VSA: Article review. KA: Data acquisition, article review. Finally, all authors had approved the article for publication.

Ethical policy and institutional review board statement

Ethical clearance information – 2020/IRB-12/SBDCH.

Patient declaration of consent: (If In vivo Study / Case reports)

Informed consent was obtained for participation in the study and publication of the data for research and educational purposes through questionnaire.

Data availability statement

Available on request from ([email protected])

 
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