The utilization of social networking sites, their perceived benefits and their potential for improving the study habits of nursing students in five countries

In today’s generation, the rapid and ever-changing advances in technology and interconnectivity through networking has dramatically influenced the culture of learning and knowledge acquisition. The abundance of easy and accessible information and the rapid development of social networking sites (SNSs) have proven that the world is small and within reach. The great implication of this interconnectivity is attributable to the change in the learning and sharing environment, which for the most the part is something that classrooms are lacking. Additionally, social media in nursing education have shown great potential for influencing students’ study habits [1]. Online SNSs (e.g., Facebook, Myspace, Flicker, Twitter, and YouTube) have emerged as the fastest means of exchanging personal and professional information among college students [2]. SNS utilization is defined as the utilization of information networks as a form of communication widely used for several purposes. SNSs are used to interact with users and to generate content, and in recent years, they have seen expansion with regard to creating and maintaining relationships between people [3]. The issues related to SNSs are unlimited, but there is growing research on the use of social media as learning tools in higher education [4]. SNSs function like an online community of web users, depending on the website, and many of online SNSs are based on a shared interest. Once accessed, users may begin to socialize. This socialization may include reading the profile pages of other members and possibly even contacting them. The profiles of SNS users vary according to users’ discretion with regard to privacy and their visibility settings [5]. In this age of technological acuity, the world has become too small, and communication has become more efficient than ever. SNSs have played a vital role in forging connections, and Facebook is the most popular SNS in use today. Facebook has become one of the most regularly visited websites among college students, and because of its rise in popularity, the subject of SNSs among students and faculty has been a topic of concern. SNSs are seen as an alternative to social interaction, access to information and face-to-face interaction. SNSs, such as Facebook, seem to provide a ready space where the role conflicts that students and faculty often experience in their relationship with university work, staff, academic conventions, and expectations can be worked out in a backstage area. SNSs, such as Twitter, are utilized as a tool for posting explanations in study groups, for academic advising, and for student education [5]. Many researchers have discussed the broad benefits of SNSs in higher education [6]. Nursing students have identified three proposed reasons for the use of social media to learn through social networking and to socialize with other students, thus establishing professional social networking [7]. First, SNSs also allow communication with students through instant messages. Second, they enable rapid responses to questions asked by students, and they facilitate virtual discussions that make students part of a community. Third, SNSs also allow active, interactive and reflective learning [8]. A study on the use of Facebook for online discussions among distance learners showed that there was more frequent interaction via Facebook compared to the use of a forum, which indicates that Facebook has the potential to be used in online academic discussions [9]. The use of Twitter allowed connections between students, access to external resources, improved learning, and support to access videos, providing opportunities for reflection, flexibility, collaboration, and feedback [10]. The use of a social networking tool called Ning verifies the feasibility and effectiveness of integrating interprofessional education, which most students showed interest in learning more about, and optimizing patient care [11]. The use of social networking platforms is a less expensive way to provide interpersonal education, and it creates the possibility of implementing interprofessional education on a large scale and in the long term [11]. A study identified that most students agree that the use of SNSs, such as Ning, contributed to adding knowledge and increasing their understanding of content [12]. A study considering the potential implications of SNS for nursing education revealed the benefits of SNSs in allowing students to communicate and interact with a wider audience and beyond the classroom [13]. One example is the creation of a research group called the mentor and researcher group (MARG), which creates mentors who use Facebook as a communication platform to promote events and serve as a network to discuss issues and concerns among nursing students [14]. Students realize that Facebook groups can be an innovative method of studying. Facebook has also been described as being useful in promoting learning among peers and teachers [15]. SNSs are widely used among college students and are beneficial to them because they have the ability to gather students from all over the world to mingle in one virtual world [16]. This also means that campuses can now begin to blend the subject areas of classes as well as different campuses. A similar study agreed that students spend, on average, 1–2 h a day on SNSs for educational purposes [17]. In this respect, a study on social networks and learning stated that students listed learning as a top priority when utilizing SNSs [18]. In contrast, other studies say that Facebook leads to lower grades [17]. Students have reported concerns that include time management issues, lack of information and communication technology (ICT) skills and limited technical infrastructure in some higher education institutions [6]. The use of social media has greatly shown an unlimited influence on a student’s general lifestyle. This research was empirically designed to identify the degree of SNS utilization by nursing students, the perceived benefits of SNSs and their potential for improving the study habits of students. This study also seeks to determine the relationship between the utilization of SNSs, their perceived benefits, and their potential for improving the study habits of nursing students in five countries. That is, this study was conducted in five countries: Israel, Iraq, Oman, the Philippines and Turkey. Geographically and demographically, Israel, Iran, Oman and Turkey are homogenous in terms of their settings and cultural background. On the other hand, although it is also part of Asia, the Philippines is more geographically and demographically different in many ways. According to the Internet World Statistics in 2019, the Philippines, Iran and Turkey were among the top 20 counties in the world with regard to the number of Internet users; on the other hand, in Israel and Oman, 3.8 and 2.2% of the population, respectively, are Internet users [19]. There is a scarcity of research that specifically addresses nursing education and the use of SNSs. Therefore, this study generally aims to shed light on the potential of SNSs for improving the study habits of nursing students in these five countries.

The study recruited 1200 participants, based on which a post hoc sample using proportion analysis yielded 1137 students who were taken as the actual sample for this study. The profile distribution of nursing students grouped by country showed that the students from Israel were mostly 26–28 years old, female and first-year students. The nursing students from Iraq were mostly 20–22 years old, female and second-year students. In Oman, most of the nursing students were also 20–22 years old and female, and they were not classified as being first- to fifth-year students. They were irregular students who could be placed in between year levels depending on their nursing major courses, and they could be clustered in a specific year. In the Philippines and Turkey, most of the students were 20–22 years old, female and third-year students. Overall, the majority of the students were 20–22 years old, female and third-year students (Table 3).

The percentage distribution of the extent to which SNSs were utilized as a means of communication for educational purposes among nursing students in the five countries showed that the majority of nursing students slightly utilized SNSs in terms of their accessibility (61.3%) and moderately utilized them in terms of usability (60.2%). The distribution also showed that most of them moderately utilized SNSs in terms of their efficiency (45.2%) and reliability (46.8%) (Table 4). Figures 1, 2, 3 and 4 show the extent of SNS utilization among nursing students grouped according to age, gender, the year level and country. The results also revealed that nursing students had varied responses in terms of their perception of the extent to which SNSs were utilized as a means of communication. At least 2.1% and at most 6.2% of nursing students did not utilize SNSs, and 27.8 to 61.3% of nursing students slightly utilized SNSs. It was also observed that more than one-fourth (30.6%) to 60.2% of the students moderately utilized SNSs. At most 16.8% of students perceived SNSs as being highly utilized. Moreover, on average, nursing students slightly utilized SNSs in terms of accessibility (2.34) and moderately utilized them in terms of usability (2.81), efficiency (2.74) and reliability (2.66). Similarly, nursing students slightly utilized SNSs in terms of accessibility. Regarding the extent of accessibility, the results indicated that nursing students sometimes used an Internet café (2.33), their campus (1.94), malls (2.42), restaurants (2.12), game consoles (2.23), an iPad (1.76) or USB broadband (2.20). They often accessed SNSs in their own houses (2.88) and via mobile phones (2.52) and portable laptops (3.01). In terms of usability, nursing students moderately utilized SNSs. This result means that they often utilized SNSs to receive updates on school activities (3.10), to gain more knowledge about their current lessons (2.97), to share their thoughts and opinions about discussions (2.79) and to carry out advanced studies (2.74). Sometimes, they utilized SNSs for communication purposes related to their studies (2.40). In terms of reliability, the results revealed that they often relied on SNSs to familiarize themselves with their future lessons (2.71), to receive updates on school activities (2.69), to improve their knowledge and skills (2.79), to participate in group research (2.72) and to carry out assignments and projects (2.75). This result means that they moderately utilized SNSs. In terms of efficiency, nursing students often enhanced their abilities to provide nursing care through SNSs (2.82). They often considered that the sources obtained from SNSs were accurate (2.71) and that they learned proper techniques related to nursing skills by using SNSs (2.56) (Table 5). Nursing students were also recognized by their clinical instructors because of the expertise obtained from SNSs (2.39). This result meant that they moderately utilized SNSs.

Regarding the question of what SNS nursing students found to be the most helpful, slightly more than one-fourth of nursing students considered Facebook (25.3%), WhatsApp (26%), and Google (25.8%) to be the most helpful social media networks. The results also showed that some students considered Instagram, Snapchat, e-learning, YouTube, Twitter, and others to be the most helpful. Three of the students (0.3%) claimed that they used no social media networks (Table 6). In terms of usability, reliability, accessibility, and efficiency, the results showed that nursing students perceived SNSs as slightly beneficial in terms of accessibility (2.34). They also revealed that SNSs were moderately beneficial in terms of usability, reliability, and efficiency.

With regard to study habits, nursing students often have different study habits in terms of their time management, study focus, and personal perceptions of learning, as well as receiving good grades and carrying out assignments, in addition to the importance of earning exceptional grades. In terms of time management, students allotted enough time (2.85) for studying (2.74), scheduled a fixed time (2.94), and set the best time so that they could study (2.84), reviewing either every day (2.71) or every week (2.51). They also often considered how to focus entirely on studies (2.87) or how to become interested in their studies (2.93), for example, by seeking a quiet place (3.12) or, sometimes, by studying with music or while watching TV (2.41). Moreover, they often considered studying even without exams (2.70) or completing difficult assignments (2.70). They normally enjoyed learning (2.81), and they were always confident that they could receive good grades (3.10). They also frequently attached importance to earning exceptional grades (3), and they ensured that they knew which homework assignments to carry out (3.10) (Table 7). The results of the extent of SNS utilization in terms of accessibility, usability, and reliability suggested that the younger the age group of the nursing students, the lower their extent of utilization, except for the 23–25 age group. However, the results of the extent of SNS utilization in terms of efficiency contradicted this possible correlation; it suggested that the younger the age of the students was, the lower the extent of SNS utilization in this area, except for the 23–25 age group. The results further showed that there was a significant difference in the extent of SNS utilization in terms of usability (χ2(4) = 16.038, p = 0.003) and efficiency (χ2(4) = 12.360, p = 0.015). There was also a significant result in terms of reliability (χ2(4) = 11.012, p = 0.026). However, pairwise comparison disconfirmed the result of a significant difference. The extent of SNS utilization in all areas was consistently higher in female nursing students, except for accessibility. This suggested a possible relationship where female students tended to have a higher extent of SNS utilization but not in terms of accessibility. The Mann-Whitney U test was performed, revealing that there was a significant difference in the extent of SNS utilization only in terms of accessibility. This result indicated that the extent of nursing students’ SNS utilization in terms of accessibility was significantly higher in male students than in female students. Since the results indicated a non-significant p-value (p > 0.05), this also meant that the extent of nursing students’ SNS utilization in terms of usability (p = 0.134), reliability (p = 0.264) and efficiency (p = 0.586) was the same regardless of gender. Regarding accessibility, fifth-year nursing students had the highest SNS utilization in terms of accessibility (Mn rank = 538.86), reliability (Mn rank = 603.22), and efficiency (Mn rank = 631.38). Fourth-year nursing students consistently had the lowest extent of SNS utilization in terms of usability (Mn rank = 471.68), reliability (Mn rank = 448.22), and efficiency (Mn rank = 419.48) but not accessibility (Mn rank = 486.23). It was also observed that there was a fluctuating pattern as the students’ year level increased, which was consistent with the results presented.

From the initial extent of SNS utilization of first-year nursing students, the extent of SNS utilization of second-year students was lower compared to that of first-year students. The extent of SNS utilization was higher in third-year students than in fourth-year students. Additionally, the extent of SNS utilization among fourth-year students was lower than that among fifth-year students. Inferential testing was performed through the Kruskal-Wallis test. The results of the test revealed that there were significant differences in the extent of SNS utilization in terms of accessibility when grouped by the year level (χ2(4) = 19.897, p = 0.001), reliability (χ2(4) = 21.345, p < 0.01), and efficiency (χ2(4) = 33.682, p < 0.01). However, no significant difference in the extent of SNS utilization in terms of usability was found (χ2(4) = 1.187, p = 0.880). A significant difference was found between the extent of utilization and the perceived benefits of SNSs in terms of accessibility (χ2(4) = 126.981, p < 0.01), usability (χ2(4) = 40.096, p < 0.01), reliability (χ2(4) = 51.915, p < 0.01), and efficiency (χ2(4) = 147.964, p < 0.01) (Table 8). It was observed that Oman and the Philippines had the highest mean ranks among all five countries, except for SNS utilization in terms of usability (where Israel obtained the highest mean rank). This result indicated that nursing students in Oman had the highest SNS utilization in terms of accessibility and reliability. The Philippines had the highest SNS utilization in terms of reliability but with a slight difference compared with Oman. Moreover, Turkey obtained the lowest mean rank in all areas, except in terms of accessibility. This result indicated that Turkey had the lowest SNS utilization in terms of usability, reliability, and efficiency. The extent of SNS utilization by nursing students was the highest in terms of usability (2.81), followed by reliability (2.74), efficiency (2.65) and accessibility (2.34) (Table 9).

Furthermore, the results of repeated-measures ANOVA revealed that there was a significant difference among the domains of SNS utilization. Hence, in an additional test performed using Bonferroni’s post hoc test, accessibility was significantly lower than usability, reliability or efficiency. However, usability was significantly higher than reliability and efficiency, and reliability was significantly higher than efficiency (Table 10). Pearson’s r revealed a significant positive correlation between the extent of a possible improvement in study habits and the extent of SNS utilization in terms of the four domains, namely, accessibility (r = 0.246), usability (r = 0.377), reliability (r = 0.287) and efficiency (r = 0.387). This result meant that there was a direct relationship between the two variables and further meant that the more the nursing students studied, the higher the extent of their SNS utilization in terms of accessibility, usability, reliability, and efficiency (Table 11).

The findings of this study identified SNSs and the relationship between their utilization, their perceived benefits and their potential for improving the study habits of nursing students in five different countries. Based on the analysis of the findings of this study, most student respondents were 20–22 years old, female, and in their third year. Our findings are similar to those of a study conducted in Pakistan, where the majority of the nursing respondents were female and within the 21–25 age group [22]. A relevant finding explained how social media are an important aspect of today’s adolescents, offering efficiency if properly utilized [23]. A similar study on social networking identified that SNS addiction was higher in male than in female students [24].

This study revealed that the majority of the nursing students across the five countries were more engaged in websites and SNSs, such as Facebook, WhatsApp and Google. A study conducted in 2009 in Brazil and Singapore showed the wide utilization of Facebook on a regular basis [25]. These findings were also obtained in earlier studies where Myspace and Facebook were among the most popular sites among students, even though they were not created for educational purposes [26]. In the results of this study, it was also evident that the use of SNSs was important for establishing communication for educational purposes, and 61.3% of the respondents utilized SNSs for the purpose of relaying information relevant to their studies.

A study has suggested that SNSs are platforms that can be used to improve educational impacts by adapting modifications in the instructional curricula of medical schools [2]. The aspect of accessibility is an important factor in today’s generation of Internet-savvy students, and the study findings suggest the great importance of accessibility. It was found that students were able to gain access to their social networking profiles through Internet cafés, malls, restaurants and their campus. A study mentioned that access to information was just a click away and that the accessibility of the information on the Internet and SNSs was widely used, which was inherently identified as the main reason why most students were no longer visiting libraries [27]. Most students prefer SNSs because of their quick and easy access and, in particular, for the purpose of education and learning.

The usability of SNSs in terms of educational purposes is a topic that needs contextualization, as the study findings showed that nursing students in the five countries use SNSs for educational gains by taking advantage of the Internet to acquire knowledge on current lessons, by receiving updates on ongoing school activities, and by carrying out advanced studies. Many educational institutions are still dependent on a traditional learning system, which does not use the full capacity of SNSs as a tool for teaching and learning [28]. The results of this study contradict those of a study conducted in Oman, where the findings showed that SNSs were mainly used for entertainment purposes and were less used for educational purposes [29]. SNSs can present various media, such as photos, videos, interactive interfaces and games, which make them highly engaging among students. Moreover, nursing students engage in more interactive skill-based learning sessions. In terms of reliability, nursing students from the five participating countries identified that SNSs were moderately utilized for the purpose of keeping track of school activities and improving knowledge and skills. Regarding efficiency, students scored high in providing correct data and information, enhanced their abilities to provide nursing care, and learned how to perform proper techniques relevant to their nursing skills. It was also noted that some clinical instructors recognized the expertise of students drawn from SNSs, which was supported by a study intervention using SNSs that taught nursing students about ethical and moral behaviours through humanized mannequins in social networks, such as Facebook [30].

Advanced teaching strategies and the availability of updated and timely learning materials can be advantageous as learning platforms for nursing students. Overall, the nursing students in all five countries were aligned in that they moderately utilized SNSs. In terms of benefits, the students from the five countries said that SNSs were highly beneficial. According to a study, 54.92% of dental students at a university in India suggested that the usage of SNSs was beneficial for their studies and learning needs [31]. This result is supported by an online survey on social networking as a learning tool that found that the majority of students perceived SNSs as an innovative method of study support that guided learning and enhanced efficacy [17]. However, the results of this study contradict study results on the effects of online social networking on student performance that suggest that the time that medical students spend on SNSs could negatively influence their academic achievement [32]. The negative and positive aspects of SNS utilization are a contentious issue that has yet to be resolved because SNSs can be addictive and their improper usage may lead to less positive outcomes. Studying is a skill, and developing study habits is vital for the academic performance of students [33]. Some studies strongly advocate the use of SNSs as a means of becoming academically successful. For example, one study mentioned that Facebook and SNSs were considered the greatest distractions among college students, subsequently affecting their study habits and grades [34]. Based on the perspectives of nursing students with regard to their study habits, the study participants from the five countries unanimously identified time management as essential, and a fixed schedule was important when utilizing social networking platforms. This was evidently described by the results of a study showing that SNSs could enhance performance in a simple task environment but made no difference in a complex performance environment [35]. SNS utilization was also found to be consistently high among female nursing students. It is a known fact that nursing is female dominated [36]; there are confirmed gender differences that exist with regard to the technologies adopted, and they occur between genders from the age of 16 to 35 [37]. These findings are firmly contradicted by a study conducted in China showing that Chinese females were clearly less engaged with technology than Chinese males [38]. On the other hand, women who were found to have higher introversion and extraversion traits turn to the Internet for social services, such as online chats and discussion groups [39].

In a geographical and cultural context, it can be seen that in countries such as Iran, Israel, Oman and Turkey, the female gender is given less opportunity for public exposure, which results in a higher use of SNSs, which are viewed as a viable medium to socialize and be engaged with others instead of being physically present. A study observed that cultural considerations influenced the interaction platform of choice and the use of SNSs [40]. Oman and the Philippines were identified as having the highest SNS utilization. In a study of health science students conducted by Sultan Qaboos University, the findings showed that YouTube, Facebook, and Twitter were the most commonly used social media platforms. The findings generally suggest that usage and addiction are similar worldwide [41]. On the other hand, in the Philippines, the US-based Pew Research Center said that 88% of Filipinos felt that increasing Internet usage was good for education, given that the Philippines is often dubbed the “social media capital” of the world [42]. In contrast, with regard to SNS utilization, Turkey ranks lowest according to the findings of Kirschner and Karpinski in Turkey, whose study among undergraduate students revealed that students who reported academic problems were more likely to use the Internet for social networking (e.g., Facebook) purposes [43]. The results of the hypothesis testing yielded a positive relationship between study habits and the extent of SNS utilization among nursing students in the five participating countries. The levels of nursing students’ engagement in SNS utilization can be most beneficial and relevant when they uses SNS for purposes of studying. SNSs are deemed necessary in this generation of learners, wherein a significant amount of information is within grasp and readily available. The utilization of SNSs for educational purposes has both positive and negative implications [44, 45].

The paucity of research and policies related to the integration of SNSs as a learning tool requires attention from both researchers and policymakers. The nursing students from the five participating countries were female dominated, and the extent of SNS utilization was higher among females. This study also identified that the nursing students moderately perceived the utilization and benefits of SNSs, taking into account accessibility, usability, efficiency and reliability. The most commonly utilized social media platforms in Israel, Iraq, Oman, the Philippines, and Turkey were WhatsApp and Facebook. Regarding the correlations with utilization, perceived benefits and study habits showed a positive relationship among the three factors. Similarly, the significant positive correlation between the study habits of students and the extent of SNS utilization means that the more students devote themselves to their study habits, the higher the level of SNS utilization.