The millennial generation includes people born between the early 1980s and early 2000s, who are generally proficient in the use of information technology and very familiar with digital devices such as smartphones. Smartphones are now an indispensable part of daily life, as they are used not only for communication, but also for numerous other activities such as information searching, entertainment, and commercial transactions. However, growing concerns have been raised about the adverse effects of smartphone use [1]. Among adult smartphone users in Korea, 18.1% in 2018 and 18.8% in 2019 were reported to be at-risk for overdependence on mobile devices [2]. The highest average daily time spent on smartphones was found among younger millennials in their 20s and 30s, and especially among college students [3].

College students use smartphones to form social relationships, acquire information acquisition, and engage in academic and leisure activities; therefore, in light of the broad applications of smartphones, smartphone overdependence is expected to become more severe among college students [4]. A study among undergraduates showed associations between smartphone overuse and various problems, such as fewer in-person conversations, an increased burden of monthly mobile phone charges, and privacy concerns; additionally, a higher degree of smartphone addiction was found to be associated with a higher level of learning disorders and ADHD [5,6]. In addition, excessive smartphone users have been reported to show decreased interest in activities other than smartphone use and to experience anxiety symptoms and difficulty focusing without the smartphone in hand. Smartphone overuse thus prevents college students from accomplishing their developmental tasks in an appropriate way and may even cause maladjustment in college life [7]. Since college students attain interpersonal closeness through developmental tasks during the undergraduate period, the negative impacts of excessive smartphone use on interpersonal relationships are likely to affect their future quality of life as well [6]. In addition, for nursing students, efficient communication with patients is a core capacity of nursing skills, and smartphone overuse can hinder them from acquiring effective communication skills and interpersonal relationships.

Since smartphones are used to maintain social relationships and communicate with others, an ironic, but frequently-observed phenomenon is that people have trouble paying attention to their companion or conversation partner while using a smartphone. This phenomenon is called “phubbing,” a portmanteau word formed by combining “phone” and “snubbing” that refers to the act of ignoring one’s companion or companions in order to pay attention to one’s smartphone. Phubbing should not be considered a simple problem; instead, it is a novel and dangerous form of technology addiction that affects the psychological and social domains of human beings [8]. Many classes are now conducted fully or partially online due to the spread of COVID-19, and this transition to online classes has given students more opportunities to use smartphones in class instead of focusing on the class. As a result, cases of classroom phubbing (i.e., students’ use of smartphones during lectures) have been frequently reported [9]. According to a previous study, students tend to spend increasingly more time per day on the smartphone since they think that their peers make more use of mobile devices. According that study, 41% of the students surveyed said that they checked their smartphones at least once in class in order to use a social networking site, check messages through WhatsApp (a mobile messaging app similar to KakaoTalk), or surf the internet to search for something unrelated to the contents of the class. In addition, 80% of students using smartphones in class responded that they experienced reduced concentration during classes and failed to understand some course content [10]. These results show the necessity of preventing phubbing through appropriate interventions and education and providing nursing students with guidance on the proper use of smartphones.

Moreover, since phubbing involves smartphone addiction and media multitasking, which are typical characteristics of the digital generation, it is highly likely to hinder the development of the interpersonal skills of undergraduate students. Smartphone addiction is defined as “the state in which the individual exhibits major characteristics of addiction such as tolerance, withdrawal symptoms, and control loss in relation to the use of the smartphone, and consequently experiences daily living disability.” [11] Media multitasking refers to simultaneously performing two or more tasks using one or more forms of media [12]. A media environment where the smartphone penetration rate reaches 95% is considered a structural factor that can increase multitasking, and modern people’s information-seeking, entertainment-seeking, and sensation-seeking traits can be regarded as a psychological contributing factor. The interaction of these two factors is expected to increase media multitasking [13]. To understand the phubbing phenomenon and to establish preventive strategies to reduce phubbing, it is necessary to identify relationships between smartphone addiction, media multitasking, and interpersonal competency and examine their effects on phubbing.

Previous studies on phubbing are largely divided into research on phubbing and jealousy between people of the opposite gender and investigations of factors influencing phubbing [14]. Since research on phubbing is still at an early stage, very few studies have investigated factors affecting phubbing. Previous studies on factors influencing phubbing investigated factors associated with technology addiction [15]. Research has also investigated the personality traits of individuals (boredom, narcissism, and conscientiousness) in association with phubbing [16] and phubbing among parents and caregivers [17].

In situations where the non-face-to-face classes predominantly given to, phubbing of nursing students are likely to increase with Corona pandemic. Phubbing has been regarded as an addiction, and if it continues, it might compromise the quality of patient care. Efforts are needed to investigate and prevent phubbing of nursing student, who have been able to come forward to support our services over this challenging time. In this study, we investigated phubbing, focusing on smartphone addiction and media multitasking in nursing student. In particular, we attempted to determine the levels of smartphone addiction, media multitasking, interpersonal competency, and phubbing among undergraduate students and to identify factors influencing phubbing. The study findings may serve as basic data for reducing phubbing and preventing smart phone addiction in the future research.

This study aimed to examine the current status of phubbing among nursing students, to explore the relationships between smartphone addiction, media multitasking motivation, and interpersonal competency, and to identify factors affecting phubbing in order to provide basic data for the prevention of phubbing. Interpersonal competency, media multitasking motivation, smartphone addiction, and interpersonal relationships were found to be major factors explaining phubbing among nursing students.

The average time that participants spent per day on the smartphone was 6.44 hours, which is higher than the average of 4.9 hours spent daily on mobile devices in Korean adults [24]. It is also higher than the values of 2.5 hours among general undergraduate students [25] and 2.24 hours among nursing students [26] reported in previous studies. The average score for smartphone addiction was 35.66±9.25 points out of 60 points, corresponding to the normal user group. This result is similar to the average of 36.99 points among nursing students obtained using the same instrument by Im and Noh [27], and it is also similar to the score of 35.5 points reported by Kim [28]. The high-risk user group and the potential-risk user group comprised 24.9% and 12.2% of participants, respectively, which indicates that more than a third of nursing students experience daily living disability or addiction symptoms such as withdrawal symptoms and tolerance in relation to smartphone use. Thus, some caution is needed regarding the use of smartphones among nursing students.

The average score for media multitasking motivation was 71.51 points out of 100, which indicates a moderate level, although it is difficult to make comparisons with other studies because of the lack of prior research using the same instrument. The average score for interpersonal competency was 112.41 points out of 188, which is a relatively high level. Providing emotional support was the subdomain with the highest average score, followed by conflict management, initiating relationships, asserting displeasure with another’s behavior, and self-disclosure in descending order. In this study, the average score for interpersonal competency was 3.63 points, which is higher than the score of 3.34 points out of 5 that Cho [29] obtained using the same instrument among nursing students. The average score for phubbing was 2.59 points out of 5, which represents a moderate level of phubbing; however, this score is markedly higher than that of 2.53 points measured on a 10-point scale among undergraduates [30] using the instrument developed by Karadağ et al. [31]. Altogether, a considerable level of phubbing was found among nursing students.

In this study, regression analysis showed that interpersonal competency had the strongest impact on phubbing among nursing students, and a lower level of interpersonal competency was associated with a higher level of phubbing. Several empirical studies have demonstrated that interpersonal competency is closely linked to mental health. In particular, it has been reported that poor interpersonal relationships lead to anxiety, which reduces interpersonal competency, thereby increasing the likelihood of experiencing loneliness [32]. These findings imply that anxiety, loneliness, and stress have a negative impact on interpersonal relationships and thereby increase phubbing [15,33]. It has also been reported that phubbing is highly likely to cause more severe conflicts and jealousy of one’s companion or companions [34]. Phubbing weakens or undermines empathic interest, closeness, and interpersonal trust [35], and leads to a vicious cycle—as the length of time spent phubbing another person increases, empathy between the two people decreases, and the relationship quality deteriorates [36]. Since phubbing occurs frequently among nursing students, educators in nursing are required to develop and implement active interventional measures to help nursing students avoid phubbing and improve their interpersonal relationships by increasing their empathic ability and communication skills.

The second strongest predictor of phubbing was media multitasking motivation. The results of the present study are corroborated by a previous study reporting that the behavior of checking smartphone notifications in the presence of a companion or companions is a representative type of media multitasking motivation, and that media multitasking motivation induces phubbing [37]. A common example of media multitasking is students’ habitual and automatic use of smartphones in classrooms, which has been reported to lead to distractions, decreased attention, and phubbing [38]. Since media multitasking allows individuals to easily connect with others and engage in social exchanges, it has the advantage of facilitating the formation and maintenance of social relationships [39], and it is helpful for enhancing learning in the e-learning era and for using and providing healthcare services [36]. However, several studies pointed out negative effects of media multitasking. In particular, media multitasking has been reported to hinder the processing of transmitted information, thereby decreasing the effects of media by reducing attention to messages and diminishing comprehension and recall [40] and hindering job performance [41]. Even though media multitasking is a common pattern of media consumption, since it acts as a predictor of phubbing, strategies for preventing media multitasking are required.

Smartphone addiction was found to be the third predictor of phubbing. In previous studies, smartphone addiction, SMS addiction, internet addiction, and game addiction were all shown to be predictors of phubbing [33,36]. Especially, the overuse of Instagram on smartphones was found to cause a higher level of phubbing [42]. Boredom, loneliness, and the so-called “fear of missing out” (FOMO) syndrome have been found to be associated with phubbing. The FOMO syndrome and a lack of self-control predict both smartphone addiction and the level of phubbing [33,36]. These findings suggest that management of smartphone addiction of students is vitally important to prevent phubbing. If individuals excessively use social networks and specific games, they should change their habitual smartphone usage patterns and try to improve their self-control. Furthermore, college students should receive nuanced education on smartphone use, rather than simply advising against or restricting their phubbing, so that they can develop their self-regulatory capacity to appropriately control the use of mobile devices and reduce phubbing.

Significant differences were found in the level of phubbing by age, class standing, interpersonal relationships, and the time spent per day on the smartphone. The level of phubbing was higher in respondents under the age of 23, freshmen, respondents with poor interpersonal relationships, and those spending more than 10 hours per day on the smartphone. Sophomores showed the highest level of smartphone addiction. A higher level of smartphone addiction was also associated with a low level of major satisfaction and poor interpersonal relationships. The level of media multitasking motivation was higher in sophomores than in freshmen, and respondents with good interpersonal relationships showed a higher level of media multitasking motivation than those with poor interpersonal relationships. Males showed a higher level of interpersonal competency than females. Students with lower class standings showed a lower level of interpersonal competency, and seniors showed the highest level of interpersonal competency. Based on these results, educational programs to prevent phubbing should target students earlier in college (i.e., freshman and sophomores), and a preliminary survey of interpersonal relationships and daily smartphone usage time may help to establish phubbing prevention strategies.

Phubbing was negatively correlated with interpersonal competency, while it was positively correlated with smartphone addiction and media multitasking motivation. The observed relationship between phubbing and interpersonal competency is consistent with the findings of Al‐Saggaf and O’Donnell [43]. Even having a smartphone at hand has been reported to reduce interpersonal closeness, connectedness, and trust [44].

A higher level of smartphone addiction and a higher level of media multitasking were also associated with a greater degree of phubbing. Concentration on the smartphone during a conversation prevents individuals from paying attention to the conversation with their companion or companions, which may lead to phubbing. In a previous study, smartphone addiction was found to have a positive correlation with phubbing [31], and based on this finding, it can be inferred that smartphone overuse causes a state of indifference to others and the loss of empathy, which naturally leads to phubbing. Smartphone addiction has been reported to deteriorate the quality of interactions between two people and consequently damage face-to-face interactions [44]. Internet gaming disorder is classified as a type of addiction and attention is paid to its treatment. In contrast, smartphone addiction is not officially diagnosed as a medical condition, so it may not be recognized as a serious problem [11]. However, given concerns about the negative consequences of smartphone addiction, including phubbing, more attention should be paid to smartphone addiction among college students.

A significant correction was found between media multitasking motivation and phubbing, which is consistent with the results of Ames [39]. According to Ames [39], media multitasking is caused by constant connection with others and competition for the level of connectedness, and multitasking acts as a cause of phubbing. Judd [45] claimed that greater use of SNS is related to increased media multitasking, which hinders face-to-face interactions. Therefore, further research on individual characteristics and personality traits of college students is required to reduce phubbing and media multitasking.

The negative correlation between smartphone addiction and interpersonal relationships is consistent with the previous finding that a higher level of smartphone addiction was associated with a lower level of interpersonal relationship and lower conversation intimacy [46]. Although smartphones are an efficient communication channel, excessive smartphone use may lead to missing or losing opportunities for other social relationships and in-person interactions, which may result in social isolation [47] and difficulties in adjustment. Therefore, smartphone users need to be wary of overdependence and be attentive to the proper use of smartphones.

The results of this study provide grounds for the implementation of interventions and educational programs to increase interpersonal competency and decrease media multitasking motivation and smartphone addiction as a strategy to reduce phubbing among nursing students. Individual and psychological factors also play an important role in the occurrence of phubbing, and the significance of these factors warrants further consideration. Although the present study of phubbing focused on variables related to digital media and interpersonal relationships, further research should consider other individual factors such as depression, anxiety, apprehension, and FOMO syndrome.

This study has several limitations. First, since data collection was conducted using a self-report questionnaire, the results may have been affected by social desirability bias and defense mechanisms. Therefore, qualitative research or observational research should be conducted to observe active and passive phubbing behaviors. Second, since smartphone addiction behaviors and digital multitasking are linked to phubbing, more comprehensive research should consider additional psychological factors. Third, this study did not investigate perceptions of phubbers and phubbees or the impact of phubbing on family members, which are promising topics for future studies.

This study revealed that phubbing behaviors are widely prevalent in nursing students. The key message from our study were that nursing students need regular monitoring and appropriate control of their smartphone usage, and interpersonal competency is the core capacity to reduce their phubbing. This study helps to understand causes of phubbing, that may help nursing educators to explore treatment modalities and design interventions to reduce phubbing behavior.

In conclusion, this study examined the level of phubbing among nursing students and investigated the relationships among phubbing, smartphone addiction, media multitasking motivation, and interpersonal competency to identify factors affecting phubbing. To reduce phubbing, it is important to reduce smartphone addiction and media multitasking and improve interpersonal competency through education on the proper use of smartphones, programs to prevent smartphone addiction, and programs to improve interpersonal relationships. Since phubbing occurs frequently among nursing students, educators in nursing are required to develop and implement active interventional measures to help nursing students avoid phubbing and improve their interpersonal relationships by increasing their empathic ability and communication skills.