Association between nomophobia, attention, and decision-making among university students: a cross-sectional study

Associação entre nomofobia, atenção e tomada de decisão entre estudantes universitários: um estudo transversal

Abstract

Introduction:  Nomophobia has become a widespread concern in young adults. Excessive reliance on these devices may be associated with reduced attention and concentration, as well as maladaptive decisionmaking under stress. University students are particularly vulnerable due to academic demands and continuous digital engagagement.

Objective:  To investigate the relationship between nomophobia, attention, and decisionmaking styles in university students.

Methods:  One hundred and fifty students aged 20–25 years (62% female, 38% male) participated through convenient sampling. Nomophobia was assessed using the Nomophobia Questionnaire, attention using the Mindful Attention Awareness Scale, and decisionmaking styles using the Melbourne Decision Making Questionnaire. Data were analyzed with Spearman's rank correlation.

Results:  Nomophobia showed a significant positive correlation with maladaptive decisionmaking patterns (ρ = 0.42, p < 0.001), particularly hypervigilance, procrastination, and buckpassing. A strong negative correlation was found between nomophobia and attentional control (ρ = −0.65, p < 0.001).

Conclusion:  Higher levels of nomophobia are associated with lower mindfulness and maladaptive decisionmaking patterns. The findings highlight the need for increased awareness of smartphone use and its association with attention and decisionmaking among university students.

Keywords:
Phobic disorders; Awareness; Quality of life; Questionnaires; Students

Resumo

Introdução:  A nomofobia tornouse uma preocupação generalizada entre jovens adultos. A dependência excessiva desses dispositivos pode estar associada à redução da atenção e da concentração, bem como a processos de tomada de decisão desadaptativos sob estresse. Estudantes universitários são particularmente vulneráveis devido às exigências acadêmicas e ao engajamento digital contínuo.

Objetivo:  Investigar a relação entre nomofobia, atenção e estilos de tomada de decisão em estudantes universitários.

Métodos:  Cento e cinquenta estudantes com idades entre 20 e 25 anos (62% mulheres, 38%homens) participaram por meio de amostragem por conveniência. A nomofobia foi avaliada utilizando o Questionário de Nomofobia, a atenção utilizando a Escala de Atenção Plena e Consciência e os estilos de tomada de decisão utilizando o Questionário de Tomada de Decisão de Melbourne. Os dados foram analisados com a correlação de Spearman.

Resultados:  A nomofobia apresentou uma correlação positiva significativa com padrões de tomada de decisão desadaptativos (ρ = 0,42, p < 0,001), particularmente hipervigilância, procrastinação e transferência de responsabilidades. Uma forte correlação negativa foi encontrada entre nomofobia e controle atencional (ρ = −0,65, p < 0,001).

Conclusão:  Níveis mais elevados de nomofobia estão associados a menor atenção plena e padrões de tomada de decisão desadaptativos. Os resultados destacam a necessidade de maior conscientização sobre o uso de smartphones e sua associação com a atenção e a tomada de decisões entre estudantes universitários.

Palavras-chave:
Transtornos fóbicos; Conscientização; Qualidade; de vida; Questionários; Estudantes

Introduction

Smartphones have evolved into an indispensable aspect of daily life, with their influence particularly pronounced among young populations. In recent years, nomophobia, the fear or anxiety of being without a mobile phone, has garnered attention as a significant behavioural concern among young adults, particularly in academic settings. This issue is especially notable among students enrolled in health professions such as physiotherapy, where high smartphone dependency may interfere with cognitive focus, learning efficiency, and academic discipline.¹

Recent research suggests that while nomophobia shares characteristics with behavioural addictions, it is primarily characterized by anxiety related to disconnection from mobile phones, with individuals often exhibiting compulsive and emotionally driven usage patterns.² This behavioural overlap suggests that nomophobia may not be an isolated phenomenon, but part of a broader spectrum of digital dependence. Among youth, these tendencies can lead to psychosocial challenges such as anxiety, social withdrawal, and poor academic outcomes.³ Such an understanding can inform the development of digital health interventions aimed at promoting healthier smartphone habits and mitigating cognitive disruption among students.

While digital interaction offers shortterm comfort, overdependence on mobile devices may paradoxically undermine real-life social engagement and reduce social capital.⁴ Some researchers have discussed its similarity to anxiety-related conditions; however, it is not formally classified in current diagnostic systems.⁵ In academic environments, especially in demanding programs like medicine and allied health, nomophobia is both prevalent and underdiagnosed, often slipping through the cracks of institutional mental health services. This underscores the urgency of exploring how nomophobia may interfere with fundamental cognitive functions such as attention regulation and decision-making patterns among university students.⁶

Emerging neuroscientific research shows that nomophobia-related anxiety significantly has been associated with variations in decision-making processes. These impairments are linked to heightened emotional reactivity and reduced cognitive control, particularly in high-stress or uncertain situations.⁷ On a broader scale, a systematic review confirms the widespread prevalence of nomophobia, affecting diverse populations irrespective of culture or geography.⁸ This global consistency suggests that smartphone dependence is becoming a normalized behaviour with cognitive consequences. Furthermore, while nomophobia shares characteristics with social phobia, it reflects a distinct form of virtual dependence, rooted in the psychological need to remain digitally connected.⁹

Altogether, this body of evidence underlines the importance of examining nomophobia not only as a behavioural trend but as a cognitive risk factor, one that may be associated with changes in essential executive functions like attention regulation and decision-making among university students.

Previous findings have shown that nomophobia can intensify the symptoms of panicrelated conditions, especially in individuals with agoraphobia or heightened emotional sensitivity.¹⁰ Rather than serving as a tool for managing anxiety, excessive mobile phone use may reinforce maladaptive patterns, further entrenching dependency and emotional dysregulation.¹¹

From a psychometric perspective, the Nomophobia Questionnaire (NMP-Q) has proven to be a reliable and valid tool for quantifying the psychological components of smartphone addiction.¹² High nomophobia scores are linked to anxietyrelated behavioural patterns, placing this condition within the broader framework of compulsive and addictive behaviours. Additionally, recent studies highlight a strong association between nomophobia and the fear of missing out, particularly among university students, where digital disconnection is associated with increased stress and attentional difficulties.¹³ These findings suggest that nomophobia not only disrupts emotional well-being but may also compromise executive cognitive functions, making it a critical issue to investigate in academic environments.

Recent work has advocated for the classification of nomophobia within the spectrum of smartphone addiction disorders, particularly due to its compulsive behavioural traits and anxiety-driven symptoms among youth.¹⁴ These patterns are increasingly relevant not only in academic settings but also in professional environments, such as healthcare, where nomophobic behaviours have been shown to impair critical decision-making and elevate stress among clinical staff. The development of the NMPQ, by Yildirim,¹⁵ further solidified the construct's multidi-mensional framework, providing a reliable tool to assess its impact across communication, information-seeking, and emotional regulation domains.

Therefore, the aim of this study was to examine the association between nomophobia, attention, and decision-making among university students. It was hypothe-sized that higher levels of nomophobia would be significantly associated with lower mindfulness and variations in decision-making styles.

Methods

A convenience sampling method was employed to recruit 150 participants from Saveetha Institute of Medical and Technical Sciences.

Participants were recruited through online surveys and university participant pools and chosen according to inclusion and exclusion criteria. The inclusion criteria were: students aged 20 to 25 years enrolled in undergraduate and postgraduate program at a university; frequent use of smartphones for social, academic, and private purposes; and willingness to provide informed consent. Frequent smartphone use was defined as usage exceeding three hours per day.

Exclusion criteria included: clinically diagnosed cognitive impairments (e.g., dementia, attentiondeficit/hyperactivity disorder) that may interfere with attention or decision-making; previously diagnosed neurological disorders that substantially impair cognitive function; a history of substance abuse affecting cognitive clarity; restricted access to or infrequent use of smartphones; failure to complete the cognitive assessments and questionnaires.

Before the study procedure began, the informed consent form was received from all participants, and they received a thorough explanation of the study's methodology. The Institutional Scientific Review Board of Saveetha Institute of Medical and Technical Sciences provided ethical approval (027/10/2025/ISRB/PGSR/SC PT). Data collection was conducted using a structured Google Form that included the NMP-Q, Mindful Attention Awareness Scale (MAAS), and Melbourne Decision-Making Questionnaire (MDMQ). Responses were securely stored in Google Sheets, Excel, and Statistical Package for the Social Sciences (SPSS) for subsequent analysis. Anonymity and confidentiality were ensured by excluding personally identifiable information, and all participants confirmed their understanding of the study procedures and their rights prior to participation. A formal sample size calculation was not performed due to feasibility constraints; however, the sample size was considered adequate to detect moderate associations.

Instruments

The NMP-Q consists of 20 items across four domains, rated on a 7-point Likert scale (1 = strongly disagree; 7 = strongly agree), with total scores ranging from 20 to 140. Higher scores indicate greater severity of nomophobia. The scale has shown high internal consistency (Cronbach's α = 0.945). The adapted and validated English version used in this study demonstrated a Cronbach's α of 0.927 in nursing student samples.

The MDMQ assesses decision-making through 22 items across four dimensions: vigilance (6 items; max = 12), hypervigilance (5 items; max = 10), buckpassing (6 items; max = 12), and procrastination (5 items; max = 10). Items are scored on a 3-point Likerttype scale (0 = never; 2 = always). The scale has adequate internal consistency (Cronbach's α = 0.87).¹⁶

MAAS contains 15 items scored on a 6-point Likert scale (1 = almost always; 6 = almost never). Higher scores indicate greater attentional awareness and mindfulness. It measures lapses in attention, automaticity, and absentmindedness, with demonstrated reliability (Cronbach's α = 0.87).¹⁷

Statistical analysis

Data analysis was performed using SPSS version 25. Categorical data were summarized as frequencies and percentages, while continuous data were expressed as means and standard deviations. Spearman's correlation test was used to examine relationships among nomophobia, attention, and decision-making styles. A 95% confidence interval was used, and statistical significance was set at p < 0.05. The chisquare test was used to assess associations between attention (MAAS) and decision-making (MDMQ)

The strength of Spearman's rank correlation coefficient (ρ) was interpreted as follows: 0.00 – 0.19 (very weak), 0.20 – 0.39 (weak), 0.40 – 0.59 (moderate), 0.60–0.79 (strong), and 0.80 – 1.00 (very strong). For descriptive interpretation, prevalence based on frequency distribution was categorized as: <25% (low prevalence), 25–50% (moderate prevalence), and >50% (high prevalence).

Results

Spearman's rank-order correlation analysis revealed a significant negative correlation between nomophobia and mindful attention awareness (MAAS) (ρ = −0.652, p < 0.001), indicating a large (strong) negative effect size, suggesting that students with higher nomophobia scores tend to have lower levels of attention and presentmoment awareness (Table 1). Additionally, a significant positive correlation was found between nomophobia and maladaptive decision-making (MDMQ) (ρ = 0.420, p < 0.001), indicating a moderate effect size, suggesting that higher nomophobia is associated with ineffective decision-making behaviours such as procrastination, hypervigilance, and buck-passing (Table 1). The severity analysis showed that moderate nomophobia was the most prevalent (46.7%), followed by severe (23.3%) and low (30%) among the students (Table 2). The association between attention and decision-making is presented in Figure 1, Tables 3 and 4.

Table 1
Correlation between nomophobia and Mind-ful Attention Awareness Scale (MAAS) and Melbourne Decision-Making Questionnaire (MDMQ)

Variable	Spearman's r	p-value
MAAS vs nomophobia	-0.652	<0.001
MDMQ vs nomophobia	0.420	<0.001

Table 2
Severity distribution of nomophobia, Mindful Attention Awareness Scale (MAAS) and Melbourne De-cision-Making Questionnaire (MDMQ) (n = 150)

Severity level	Nomophobia	MAAS	MDMQ
Low	45 (30.0)	40 (26.7)	50 (33.3)
Moderate	70 (46.7)	80 (53.3)	70 (46.7)
Severe	35 (23.3)	30 (20.0)	30 (20.0)

• Note: Data presented as n (%). For nomophobia, categories represent low, moderate, and severe levels; for MAAS, low, moderate, and high; and for MDMQ, poor, moderate, and good.

Figure 1
Association between attention (Mindful Attention Awareness Scale) and decision-making (Melbourne Decision-Making Questionnaire).

Table 3
Association between attention (Mindful Attention Awareness Scale) and decision-making (Melbourne Decision-Making Questionnaire)

Attention	Decision-making
	Poor	Moderate	Good	Total
Low	30	25	10	65
Moderate	15	35	10	60
High	5	10	10	25

Table 4
Chi-square test between attention (Mindful Attention Awareness Scale) and decision-making (Mel-bourne Decision-Making Questionnaire)

Test	χ² value	DF	p-value
MAAS vs MDMQ	12.35	4	0.015

• Note: DF = degrees of freedom.

Discussion

The current study investigated the relationship between nomophobia, decision-making styles, and mindfulness among university students. Our results demonstrated a significant prevalence of moderate (46.7%) and severe (23.3%) nomophobia among students, indicating that a large proportion of this population is highly dependent on smartphones. These findings are consistent with previous research, such as the study conducted in Telangana,¹⁸ that reported a high rate of moderate to severe nomophobia, associating it with anxiety and other negative mental health outcomes. However, due to the crosssectional design of the study, causal relationships cannot be established, and the findings should be interpreted as associations rather than effects.

MAAS showed a significant negative correlation with nomophobia (ρ = −0.65, p < 0.001). This finding implies that increased smartphone dependency is associated with diminished attentional control and presentmoment awareness. Such a relationship has been documented in prior studies, emphasizing the detrimental impact of nomophobia on mindfulness and overall psychological well-being. These findings support previous research showing that smartphone overuse contributes to attentional difficulties and reduced mindfulness, as constant preoccupation with mobile devices diverts focus away from important academic and daily tasks.¹⁹,²⁰

Our findings revealed a significant positive correlation between nomophobia and maladaptive decision-making strategies, as measured by MDMQ (ρ = 0.42, p < 0.001). In the present study, 33.3% of participants exhibited poor decision-making, 46.7% had moderate decision-making difficulties, and 20% demonstrated good decision-making abilities (Table 2). This suggests that students with higher levels of nomophobia are more prone to decision-making styles characterized by hypervigilance, buck-passing, and procrastination. These results align with previous research²¹ indicating that excessive smartphone use can impair cognitive functions essential for effective decision-making. Previous research supports this finding, showing that anxiety and depression mediate the relationship between nomophobia and reduced academic performance, further highlighting the cognitive-behavioural impacts of smartphone addiction.

Furthermore, the chisquare analysis [χ²(4) = 12.35, p = 0.015] demonstrated a significant association between the severity of attentional deficits and decision-making difficulties. Students with lower mindfulness awareness were more prone to make poor decisions, supporting the idea that diminished attention not only impairs task focus but also hinders the ability to make effective choices. These results are consistent with cognitive-behavioural models that suggest attention control is a key component of executive functioning and decision-making abilities.²²,²³ Recent evidence suggests that excessive engagement with digital platforms, including gaming, contributes to a growing burden of behavioural addictions among adolescents and young adults, of-ten accompanied by adverse psychological outcomes.²⁴ Furthermore, increasing academic stress and ineffective coping mechanisms among college students have been linked to poor mental health outcomes, which may further exacerbate maladaptive smartphone use and nomophobic behaviours.²⁵

The implications of these findings are particularly pertinent in the context of university education, where decision-making and attentional control are critical competencies. The association between high nomophobia levels and maladaptive decision-making styles raises concerns about the potential impact on clinical judgments and patient care. Furthermore, the link between nomophobia and reduced mindfulness underscores the need for interventions aimed at promoting healthy smartphone use and enhancing cognitive functions among college students. Approaches such as digital detox programs or mindfulnessbased cognitive therapy could be effective in reducing the negative impacts of nomophobia on cognitive performance and behaviour. These findings highlight a concerning trend in which a large proportion of university students experience moderate to severe nomophobia, which is strongly linked to impaired attention and poor decision-making skills, potentially impacting their academic performance and overall mental wellbeing.

This study has several limitations. First, all variables were assessed using self-reported measures, which may introduce response bias and common method bias. Second, attention and decision-making were not evaluated using objective cognitive assessments, limiting the ability to reflect actual cognitive performance. Third, the use of convenience sampling from a single institution limits the generalizability of the findings. Fourth, potential confounding variables were not statistically controlled, which may influence the observed associations. Finally, a formal sample size calculation was not performed, and therefore the statistical power to detect small effects may be limited.

Conclusion

The present study demonstrates a significant association between nomophobia, mindfulness, and decision-making styles among university students. Higher levels of nomophobia were associated with lower mindfulness and a greater tendency toward maladaptive decision-making patterns. Future research employing longitudinal and experimental designs is recommended to further explore these associations and to better understand the underlying mechanisms.

Data availability statement

The data that support the findings of this study are available upon reasonable request.

Acknowledgments

We deeply appreciate the guidance of our mentors and the contributions of our research team, the participants and their families for their cooperation, and the Saveetha College of Physiotherapy for their support in conducting this research.

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Edited by

• Associate editor:
  Emmanuel Souza da Rocha

Publication Dates

• Publication in this collection
  17 Aug 2026
• Date of issue
  2026

History

• Received
  26 Sept 2025
• Reviewed
  22 Apr 2026
• Accepted
  19 June 2026