qualitative research about effects of social media to students

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• Published: 31 October 2023

Social media usage and students’ social anxiety, loneliness and well-being: does digital mindfulness-based intervention effectively work?

BMC Psychology volume  11 , Article number:  362 ( 2023 ) Cite this article

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The increasing integration of digital technologies into daily life has spurred a growing body of research in the field of digital psychology. This research has shed light on the potential benefits and drawbacks of digital technologies for mental health and well-being. However, the intricate relationship between technology and psychology remains largely unexplored.

This study aimed to investigate the impact of mindfulness-based mobile apps on university students' anxiety, loneliness, and well-being. Additionally, it sought to explore participants' perceptions of the addictiveness of these apps.

The research utilized a multi-phase approach, encompassing a correlational research method, a pretest–posttest randomized controlled trial, and a qualitative case study. Participants were segmented into three subsets: correlations ( n  = 300), treatment ( n  = 60), and qualitative ( n  = 20). Data were gathered from various sources, including the social anxiety scale, well-being scale, social media use integration scale, and an interview checklist. Quantitative data was analyzed using Pearson correlation, multiple regression, and t-tests, while qualitative data underwent thematic analysis.

The study uncovered a significant correlation between social media use and the variables under investigation. Moreover, the treatment involving mindfulness-based mobile apps led to a reduction in students' anxiety and an enhancement of their well-being. Notably, participants held various positive perceptions regarding the use of these apps.

Implications

The findings of this research hold both theoretical and practical significance for the field of digital psychology. They provide insight into the potential of mindfulness-based mobile apps to positively impact university students' mental health and well-being. Additionally, the study underscores the need for further exploration of the intricate dynamics between technology and psychology in an increasingly digital world.

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Introduction

The field of digital psychology is undergoing rapid evolution, navigating the intricate intersection of psychology and technology to elucidate the profound impact of digital technologies on human behavior, cognition, and emotions [ 1 , 2 ]. With digital technologies becoming increasingly ingrained in our daily lives, researchers are embarking on a journey to explore the multifaceted implications they bear for mental health and overall well-being. Within the realm of digital psychology, a diverse array of topics has captured the attention of investigators, encompassing the innovative use of technology for psychological interventions like cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) [ 1 , 2 ]. Furthermore, scrutiny has extended to the influence of social media on mental health, unveiling the potential for excessive social media use to contribute to feelings of anxiety and loneliness [ 3 , 4 ].

The exploration of digital psychology has also delved into the impact of video games on cognitive and emotional faculties, with some studies suggesting that specific genres of video games have the potential to enhance attention and problem-solving skills [ 5 , 6 ]. However, concerns surrounding video game addiction and the potential influence of violent video games on aggressive behavior have been the subject of extensive investigation [ 7 , 8 , 9 , 10 ]. The ubiquity of digital technologies in our daily existence has ignited a burgeoning interest in the domain of digital psychology. While research in this domain has yielded valuable insights into the prospective benefits and hazards of digital technologies for mental health and well-being, there remains a vast expanse of knowledge yet to be uncovered regarding the intricate interplay between technology and psychology. Specifically, there is a compelling need for an extensive body of research aimed at comprehending the enduring impacts of digital technologies on cognitive, emotional, and social functionality. Furthermore, it is crucial to decipher how these effects may vary among diverse demographic groups.

One particularly promising avenue of research within digital psychology is the integration of mindfulness-based mobile applications, which has shown considerable potential in alleviating symptoms of anxiety and loneliness. These applications typically offer guided meditation, breathing exercises, and various mindfulness practices that are readily accessible via mobile devices [ 2 ]. Their accessibility and user-friendly nature render them an appealing resource for individuals seeking to enhance their mental well-being without the need for traditional face-to-face therapy [ 3 , 6 ].

In the contemporary landscape of higher education, university students are exposed to the pervasive influence of social media, which has the potential to induce negative psychological consequences such as heightened social anxiety and increased feelings of loneliness. The omnipresence of social media platforms can foster a sense of comparison, social pressure, and disconnection among undergraduate students, amplifying the challenges they already face. Given these circumstances, there is a compelling need to explore interventions that can counteract these adverse impacts, and mindfulness-based interventions emerge as a promising avenue for consideration.

By examining the intersection of these interventions with the digital sphere, this study seeks to illuminate how Digital Mindfulness-based treatments might serve as a potent tool to mitigate the detrimental effects of social media exposure, thereby fostering a healthier psychological landscape among university students [ 11 , 12 , 13 , 14 , 15 ].

Furthermore, many of these applications provide personalized features such as progress tracking and goal setting, which enhance user engagement and motivation [ 9 ]. As the popularity of these applications continues to soar, it becomes imperative to further investigate their effectiveness across various demographic cohorts and contextual settings, as well as to identify the most potent features and interventions for fostering improvements in mental health [ 10 ].

The rationale for this study is firmly grounded in the contemporary higher education landscape, where undergraduate students navigate a myriad of challenges that may impact their mental well-being. With the pervasive integration of digital technologies into students' lives, the investigation of Digital Mindfulness-based interventions becomes not only relevant but crucial. The novelty of this study lies in its exploration of the intricate relationship between social media usage and the well-being of university students, specifically targeting social anxiety and loneliness. Moreover, it introduces an innovative approach by examining the effectiveness of digital mindfulness-based interventions in ameliorating these psychological challenges. By addressing this uncharted territory, the study not only contributes to the growing field of digital psychology but also offers valuable insights into the potential of technology-driven mindfulness interventions as a means to enhance the mental well-being of the digital-native student population. This unique blend of investigating the impact of technology on psychological well-being while simultaneously assessing the effectiveness of digital interventions positions the study at the forefront of contemporary research in the field. Given the potential benefits of digital mindfulness apps in reducing anxiety and loneliness, coupled with the distinct challenges that emerge during the undergraduate phase, this research seeks to provide invaluable insights into the perceptions and experiences of students. By delving into the perceptions of adults regarding these treatments, this study aspires to shed light on the feasibility, effectiveness, and potential limitations of digital mindfulness-based interventions for enhancing the mental health of undergraduate students in the modern digital age. Therefore, this study endeavors to address the following critical questions:

What is the relationship between social media use and symptoms of social anxiety, loneliness, and well-being among university students?

Does the use of a mindfulness-based mobile app intervention result in significant improvements in social anxiety, loneliness, and well-being in college students?

What are university students’ perspectives on the use of technology for mental health support, including the benefits and challenges of using technology for this purpose?

Review of literature

Theoretical background.

The study investigating the effects of mindfulness-based mobile apps on university students' anxiety, loneliness, and well-being in the context of social media usage draws upon a multifaceted theoretical framework. At its core, it is rooted in mindfulness theory, which emphasizes present-moment awareness and non-judgmental acceptance to alleviate stress and anxiety [ 5 , 6 , 7 , 8 ]. To understand the influence of social media on students, social cognitive theory is relevant, as it explores how individuals learn from observing others in their social networks. Additionally, social comparison theory informs the study by shedding light on how students may constantly compare themselves to others on social media, potentially leading to feelings of loneliness and social anxiety [ 11 , 12 , 13 , 14 , 15 ]. The study also taps into addiction and compulsive behavior theories to comprehend the perceived addictiveness of mindfulness-based mobile apps. Technology acceptance models (TAM) help in understanding user acceptance and perceptions of these apps. Moreover, the study aligns with principles of positive psychology by aiming to enhance well-being and reduce anxiety and loneliness, which are central concerns in this field. Finally, media effects theories, like cultivation theory and uses and gratifications theory, inform the exploration of how social media use affects students' mental health and well-being [ 13 ]. This multifaceted theoretical approach provides a comprehensive foundation for unraveling the intricate relationship between technology, psychology, and well-being in the digital age, offering a well-rounded perspective on the research questions at hand [ 12 , 13 ].

Social media and symptoms of mental health

The use of social media has become increasingly prevalent among university students, and with it comes growing concern about its potential impact on mental health and well-being. Specifically, research has focused on the relationship between social media use and symptoms of social anxiety, loneliness, and well-being among university students. The majority of studies focused on the relationship between social media use and symptoms of social anxiety and/or loneliness. These studies generally found that higher levels of social media use were associated with greater symptoms of social anxiety and loneliness among university students [ 11 , 12 , 13 , 14 , 15 , 16 ]. For example, Schønning et al. [ 16 ] found that social media use was positively associated with symptoms of social anxiety among Chinese university students. Similarly, a study by Wang et al. [ 13 ] found that social media use was positively associated with symptoms of loneliness among Chinese university students.

Two studies focused on the relationship between social media use and well-being. One study found that higher levels of social media use were associated with lower levels of well-being among university students [ 17 ] Another study found that social media use had a curvilinear relationship with well-being, such that moderate levels of social media use were associated with higher levels of well-being, while both low and high levels of social media use were associated with lower levels of well-being [ 13 ].

The findings of this literature review suggest that social media use may be associated with greater symptoms of social anxiety and loneliness among university students. However, the relationship between social media use and well-being is less clear, with some studies suggesting a negative relationship and others suggesting a curvilinear relationship. Several additional studies have also examined this relationship. For example, a study by Kose and Dogan [ 18 ] found that social media use was negatively associated with psychological well-being among Turkish university students. Another study by Błachnio, et al., [ 19 ] found that Facebook addiction was negatively associated with self-esteem and life satisfaction among Polish university students. Similarly, Chen et al. [ 20 ] conducted a systematic review of 23 studies examining the relationship between social media use and mental health outcomes among college students. The authors concluded that social media use was generally associated with negative mental health outcomes, including loneliness, anxiety, and stress. However, they noted that the strength of this relationship varied across studies and suggested that more research was needed to better understand the mechanisms underlying this relationship. In another study, Seabrook et al. [ 21 ] conducted a systematic review of 20 studies examining the relationship between social networking sites and loneliness and anxiety. They found that social networking sites were associated with both loneliness and anxiety, but that the strength of this relationship varied across studies and depended on factors such as frequency and intensity of social networking site use and individual differences in vulnerability to mental health problems. Similarly, Tandoc Jr. et al. [ 14 ] conducted a study examining the relationship between Facebook use, envy, and depression among college students in the United States. They found that Facebook use was positively associated with envy, which in turn was positively associated with depression. They suggested that envy may be a mechanism underlying the relationship between social media use and negative mental health outcomes.

Mindfulness-based apps effect mental health

Mindfulness-based mobile apps are becoming increasingly popular as a tool for promoting mental health and wellbeing. These apps include a variety of different mindfulness-based practices, such as guided meditations, breathing exercises, and other techniques aimed at reducing stress and anxiety. While there is growing evidence that mindfulness-based interventions can be effective in promoting mental health, less is known about the effectiveness of these interventions when delivered via mobile apps. This literature review aims to synthesize the existing research on mindfulness-based mobile apps and mental health outcomes.

The majority of studies focused on the effectiveness of mindfulness-based mobile apps in reducing symptoms of anxiety and depression. These studies generally found that mindfulness-based mobile apps were effective in reducing symptoms of anxiety and depression in a variety of populations, including college students, adults, and individuals with chronic medical conditions [ 2 , 10 , 22 , 23 , 24 ]. For example, a study by Strauss et al. [ 23 ] found that a mindfulness-based mobile app was effective in reducing stress and improving coping skills in a sample of healthcare workers. Similarly, a study by Lomas et al. [ 24 ] found that a mindfulness-based mobile app was effective in reducing stress and improving resilience in a sample of university students. In addition to examining the effectiveness of mindfulness-based mobile apps, several studies explored the factors that influence user engagement and adherence to these interventions. For example, a study by Valinskas et al. [ 25 ] that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142–11.93) and 2.644 (95% CI 1.024–7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. Another study by Linardon, et al. [ 22 ] found that interventions that were more interactive and personalized were more effective in promoting user engagement and adherence.

Some studies also explored the effectiveness of mindfulness-based mobile apps in addressing other mental health conditions beyond anxiety and depression. For example, a study by Wahbeh et al. [ 10 ] found that a mindfulness-based mobile app intervention was effective in reducing symptoms of posttraumatic stress disorder (PTSD) in a sample of veterans. Similarly, a study by Biegel et al. [ 26 ] found that a mindfulness-based mobile app intervention was effective in reducing symptoms of ADHD in a sample of adolescents.

The use of technology for mental health support

The utilization of technology for the provision of mental health support has gained increasing prominence within the context of university students, prompting a burgeoning interest in comprehending their encounters and viewpoints. Related inquiries have been undertaken in diverse geographical regions, including the United States, Canada, Australia, and the United Kingdom. Predominantly, these investigations have centered on the advantages and obstacles inherent in employing technology for mental health support. Generally, these inquiries have ascertained that technology is perceived as a convenient and readily accessible modality for accessing mental health support services among university students [ 27 , 28 , 29 , 30 ]. For instance, Birnbaum et al. [ 27 ] conducted a study revealing that college students in the United States exhibited a willingness to engage with mental health applications to manage their stress and anxiety. Nevertheless, certain studies have also discerned impediments associated with the adoption of technology for mental health support, encompassing apprehensions regarding privacy and confidentiality [ 27 , 28 , 29 , 30 ], concerns about the quality and dependability of information [ 29 ], and challenges related to navigating and effectively utilizing mental health applications [ 30 ].

Additionally, two investigations have focused their attention on delineating the determinants influencing the utilization of technology for mental health support among university students. These studies have identified an array of factors exerting an influence over students' engagement with technology for mental health support, encompassing individual attributes (e.g., mental health literacy, technological attitudes) [ 31 ], societal influences (e.g., stigma, peer support) [ 31 ], and environmental considerations (e.g., technology availability, access to mental health services). The cumulative insights garnered from this comprehensive literature review underscore the potential of technology as a convenient and accessible avenue for accessing mental health support among university students. However, it is essential to acknowledge that complexities and multifaceted dynamics underlie the factors influencing its utilization, and an array of challenges remain associated with its application in this context.

Likewise, a study conducted by Kern et al. [ 32 ] documented that 23.8% of users reported experiencing a positive impact on their mental health through the use of mental health applications. Notably, individuals who had received mental health services within the past 12 months exhibited a significantly higher propensity to embrace mental health apps in comparison to those who had not accessed such services. The allure of convenience, immediate availability, and confidentiality emerged as prevalent factors driving interest in Mental Health Apps (MHAs).

Furthermore, a study conducted by Free et al. [ 33 ] unveiled the unsurprising proliferation of numerous mobile applications designed to aid in the diagnosis, monitoring, and management of health conditions, albeit with varying levels of efficacy. Similarly, research by Brindal et al. [ 34 ] found that participants who had intermittent access to a smartphone app over a 4-week trial period demonstrated notable enhancements in indicators of emotional well-being. This broader observation suggests that uncomplicated and easily accessible solutions can yield substantial improvements in overall well-being. In addition, a study by Karyotaki et al. [ 35 ] reported the effectiveness of web-based interventions in mitigating the symptoms of depression and anxiety among college students.

Methodology

This was a multi-phase research design. In the first phase, a correlational research method was used for exploring the correlation among the research variables. In the second phase, we used a pretest–posttest randomized controlled trial to assess the effectiveness of a mindfulness-based mobile app intervention on symptoms of anxiety, loneliness, and well-being. Moreover, in the third phase, a qualitative research method was used for exploring the participants’ perceptions of mindfulness-based intervention.

Participants

Participants for this study were selected from graduate students at Zhoukou Vocational and Technical College in China. Three separate groups were recruited for the study. The first group consisted of 300 participants who were recruited for a correlational study related to question 1. The eligibility criteria for this group were as follows: participants must be graduate students at Fudan University and willing to participate in the study. The sample size was determined based on power analysis and the expected effect size. The second group consisted of 100 participants who were recruited for question 2. The eligibility criteria for this group were the same as for the first group. Participants were randomly assigned to either an intervention group or a control group. The third group consisted of 20 participants who were recruited for question 3. The eligibility criteria for this group were the same as for the first two groups. Participants were selected using purposive sampling based on their responses to the questionnaire in question 2. All participants provided informed consent prior to participating in the study. The study was approved by the Institutional Review Board at Zhoukou Vocational and Technical College. Participants were assured of confidentiality and the right to withdraw from the study at any time without penalty.

The following instruments were used to collect data for this study:

Social Anxiety Scale for Adolescents (SAS-A)

It is a 22-item self-report questionnaire that measures social anxiety in adolescents [ 36 ]. SAS-A assesses various aspects of social anxiety, including fear of negative evaluation, social avoidance and distress, and physiological symptoms such as sweating and blushing. Each item is measured on a 5-point Likert scale, ranging from 1 (not at all) to 5 (extremely). The total score on the SAS-A ranges from 22 to 110, with higher scores indicating higher levels of social anxiety.

Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

It is a 14-item self-report questionnaire that measures mental well-being in adults and adolescents [ 37 ]. The items on the WEMWBS assess various aspects of mental well-being, including optimism, positive relationships, and a sense of purpose. Participants rate each item on a 5-point Likert scale, ranging from 1 (none of the time) to 5 (all of the time). The total score on the WEMWBS ranges from 14 to 70, with higher scores indicating higher levels of mental well-being. The fourth instrument was social.

Social Media Use Integration Scale (SMUIS)

The SMUIS is a 10-item self-report questionnaire that assesses the frequency, duration and emotional connection to social media use [ 38 ]. The SMUIS includes questions related to the frequency and duration of social media use, as well as questions related to the emotional connection to social media use, such as "How often do you feel happy when using social media?" and "How often do you feel anxious when you are not able to use social media?" Participants are asked to rate each item on a 5-point Likert scale, ranging from 1 (never) to 5 (always). The reliability of the instruments was estimated using Cronbach’s alpha. Results revealed that the obtained Cronbach’s alpha for the instrument was above, 0.78 indicating that all used instruments enjoyed an acceptable level of reliability.

Interview checklist

The interview checklist consisted of 8 open-ended questions followed by the interviewer’s prompts. The questions elicited the interviewees’ perceptions of the benefits and challenges of using mobile apps for improving mental health and well-being and reducing social anxiety symptoms and loneliness (See Additional file 1 ). The interview checklist was approved by 4 colleagues and there was a high agreement among the panel of experts regarding the relevance of the interview questions.

Mindfulness-based mobile apps

Mindfulness-based mobile apps are mobile applications designed to help individuals develop mindfulness skills and reduce symptoms of stress, anxiety, and depression. These apps typically include guided mindfulness exercises, educational resources, and other features to help individuals practice mindfulness on a regular basis. The specific features of mindfulness-based mobile apps may vary but typically include guided meditations, breathing exercises, and other mindfulness practices. Some apps may also include educational resources, such as articles or videos that provide information about mindfulness and its benefits. Many apps also include features for tracking progress, setting goals, and sharing progress with others. In this study, the participants who participated in the treatment phase were asked to download popular mindfulness-based mobile apps including Headspace, Calm, and Insight Timer. These apps are available for download on mobile devices and offer a range of mindfulness exercises and resources for users to explore.

The study was conducted in multiple steps. Initially, a sample of 300 graduate students from Fudan University was selected to participate in the research. These participants were asked to complete the Social Media Use Integration Scale (SMUIS) and the Depression Anxiety Stress Scales (DASS-21) to evaluate their social media use and mental health status. Next, a sample of 60 students from the same university was selected for the intervention study. These participants were randomly assigned to either an intervention group or a control group. The intervention group was given access to a mindfulness-based mobile app for eight weeks, while the control group received no intervention. Both groups completed the SMUIS and the DASS-21 at baseline, post-intervention, and three-month follow-up to evaluate the effectiveness of the intervention. Lastly, a qualitative study was conducted to gather in-depth information about the participants' experience with the mindfulness-based mobile app intervention. A purposive sample of 20 participants from the intervention group was selected for this study. They underwent semi-structured interviews to provide qualitative data about their perceptions and opinions regarding the intervention.

Data analysis

For the quantitative data, the statistical software was employed. Firstly, descriptive statistics were calculated to determine the mean, and standard deviation of the Social Media Use Integration Scale (SMUIS) and Depression Anxiety Stress Scales (DASS-21) scores, as well as the mean, and standard deviation of the SMUIS and DASS-21 scores at baseline, post-intervention, and three-month follow-up for both the intervention and control groups. Secondly, bivariate correlations were conducted to examine the relationship between social media use and symptoms of anxiety and depression. Thirdly, multiple regression analysis was performed to determine the unique contribution of social media use to symptoms of anxiety and depression while controlling for other relevant variables. Fourthly, repeated measures ANOVA was conducted to examine changes in SMUIS and DASS-21 scores over time and to determine if there were differences between the intervention and control groups. Finally, post hoc tests were conducted to examine differences between groups at each time point. Effect sizes were calculated to determine the magnitude of the intervention's effects. However, for the qualitative data, the qualitative analysis software was employed. Firstly, the transcripts of the semi-structured interviews were analyzed using thematic analysis to identify themes and subthemes related to participants' experiences with the mindfulness-based mobile app intervention. Secondly, quotes were selected to support and illustrate the identified themes and subthemes. Lastly, the themes and subthemes were interpreted and discussed to provide insight into participants' perceptions and opinions regarding the intervention.

Research question1

Pearson correlations between the variables were estimated and results are presented in Table 1 .

This table shows that social media use is negatively correlated with well-being ( r  = -0.21, p  < 0.01) and positively correlated with symptoms of social anxiety ( r  = -0.35, p  < 0.01) and loneliness ( r  = 0.24, p  < 0.01). Additionally, symptoms of social anxiety are positively correlated with loneliness ( r  = 0.47, p  < 0.01) and negatively correlated with well-being ( r  = -0.61, p  < 0.01), while loneliness is negatively correlated with well-being ( r  = -0.50, p  < 0.01). These results suggest that social media use is associated with poorer mental health outcomes, including higher levels of social anxiety and loneliness and lower levels of well-being, among university students.

Table 2 shows the results of a multiple regression analysis that examined the relationship between social media use, social anxiety, and loneliness as predictor variables and well-being as the outcome variable. The regression equation is:

The results indicate that all three predictor variables significantly contributed to the prediction of well-being, with social media use (β = -0.29, p  = 0.001), social anxiety (β = 0.31, p  = 0.001), and loneliness (β = 0.28, p  = 0.001) each having a significant unique effect on well-being, after controlling for the other variables. The constant term (B = 3.10, p  = 0.001) represents the predicted well-being score when all predictor variables are held at zero.

Research question 2

The second research aimed at investigating the effects of the intervention on the students’ social anxiety, loneliness, and well-being. Results are presented in Table 3 .

This table presents the results of a pretest–posttest randomized control-experimental research design investigating the effects of a mindfulness-based mobile app intervention on social anxiety, loneliness, and well-being in college students. The results indicate that the intervention group showed a significant improvement in social anxiety (F (1, 98) = 17.23, p  < 0.001, partial eta squared = 0.15), loneliness (F (1, 98) = 13.70, p  < 0.001, partial eta squared = 0.12), and well-being (F(1, 98) = 21.41, p  < 0.001, partial eta squared = 0.18) from pretest to posttest. The control group did not show significant changes in any of the measures. The effect sizes (partial eta squared) ranged from moderate to large, indicating that the intervention had a meaningful impact. These findings suggest that the use of a mindfulness-based mobile app intervention can be an effective approach for improving mental health outcomes in college students.

Research question 3

The third research question explored the students’ perceptions of the effects of mindfulness-based mobile apps on the students’ social anxiety, loneliness, and well-being. The detailed analysis of the interviews revealed 6 benefits and 4 challenges of using technology for mental health support. The first extracted benefit as mentioned by 10 students was thematically coded "Convenience and Accessibility". Participants reported that technology-based mental health support services are convenient and accessible, allowing them to access support anytime and anywhere. The following quotations exemplify the theme:

"I like using mental health apps because I can access them whenever I need to. I don't have to wait for an appointment or anything like that." (Student 3). Another student stated, "Online support groups are great because I can connect with people who have similar experiences no matter where I am."(student 11).

The second extracted benefit was thematically coded "Anonymity and Privacy". Participants appreciated the ability to access mental health support services online while maintaining anonymity and privacy. For instance, student 5 stated, "I like that I can access support without having to go to an office or talk to someone face-to-face. It feels less intimidating." This finding was also confirmed by student 6, who stated, "I feel more comfortable talking about my mental health online because I know that no one else needs to know about it."

The third extracted benefit was thematically coded "Customizable and Tailored Support". Participants appreciated the range of options available for mental health support online, including customizable and tailored support that they could access at their own pace. For instance, student 11 stated, "I like that I can choose the type of support that works for me. Some days I just need to read something and other days I need to talk to someone”. Similarly, student 6 stated, "The mental health app I use sends me reminders to check in with myself and practice self-care. It's nice to have that kind of tailored support."

The fourth extracted benefit was thematically coded as "Cost-effective". Participants reported that technology-based mental health support services are often more affordable than traditional face-to-face therapy, making them a more accessible option for those with limited financial resources. This finding was supported by student 17 who stated, "I can't afford traditional therapy, so using mental health apps is a great option for me since it's usually free or very affordable." Similarly, one of the students stated, “Online therapy is much cheaper than traditional therapy, so it's more accessible for people who can't afford to pay a lot."

The fifth extracted benefit was thematically coded as "Increased Awareness and Education". Participants reported that technology-based mental health support services helped them to become more aware of their mental health and provided education about mental health issues and coping strategies. For example, student 12 stated, "The mental health app I use has taught me a lot about mindfulness and how to manage my anxiety." Student 14 also stated, "I learned a lot about depression and how to cope with it from an online support group I joined."

The sixth extracted benefit was thematically coded as "Reduced Stigma". Participants reported that accessing mental health support services online helped to reduce the stigma associated with seeking mental health The following quotations exemplify the theme of support. For instance, one of the students stated, “I used to feel ashamed about seeking mental health support, but using mental health apps has helped me realize that it's okay to take care of my mental health." (Student 9). Similarly, another student argued, “Online support groups have helped me realize that I'm not alone in my struggles with mental health. It's nice to know there are others out there who understand."

Despite the above-mentioned benefits, the participants mentioned some challenges. The first extracted challenge was thematically coded "Quality and Accuracy of Information". Participants expressed concerns about the quality and accuracy of mental health information available online, and the potential for misinformation to be spread. For instance, student 11 stated, "There's so much information online, it's hard to know what's trustworthy and what's not." Another student stated, "I worry that some of the mental health information I see online is not based on evidence and could actually be harmful."(student 6).

The second extracted challenge was thematically coded as "Lack of Human Connection". Participants reported missing the human connection they would get from traditional face-to-face therapy and felt that technology-based mental health support services lacked the same level of personal connection. The following quotations from student 12 exemplify the theme:

"Sometimes I just need someone to talk to face-to-face. It's not the same as talking to a computer screen…. I miss the empathetic listening I would get from a therapist in person. It's hard to replicate that online."

The third extracted challenge was thematically coded as "Technical Difficulties". Participants reported experiencing technical difficulties with technology-based mental health support services, which could be frustrating and hinder their ability to access support. For instance, student 8 stated, “Sometimes the mental health app I use glitches or crashes, which can be really frustrating when I'm trying to use it for support…. I don't have the best internet connection, so sometimes it's hard to access online support groups."

The fourth extracted challenge was thematically coded "Privacy and Security Concerns". Participants expressed concerns about the privacy and security of their personal information when using technology-based mental health support services, and whether their information was being shared without their consent. As an example, student 13 stated, "I worry that my personal information could be shared without my consent, which would be a huge breach of trust." Student 9 also stated, “It's hard to know if my information is really secure when I'm using online mental health support services."

The study investigating the effects of mindfulness-based mobile apps on university students' anxiety, loneliness, and well-being in the context of social media usage is anchored in a multifaceted theoretical framework. At its core, the research draws upon mindfulness theory, a foundational framework emphasizing present-moment awareness and non-judgmental acceptance to alleviate stress and anxiety [ 5 , 6 , 7 , 8 ]. This theory forms the bedrock of the study's understanding, as mindfulness-based mobile apps are designed to foster these very principles, encouraging users to engage with the present, accept their experiences without judgment, and, in doing so, mitigate stress and anxiety.

In parallel, to fathom the intricate influence of social media on university students, the study leverages social cognitive theory, a framework highly pertinent for analyzing how individuals acquire and adapt behaviors, attitudes, and emotional responses through observation and modeling within their social networks [ 11 , 12 , 13 , 14 , 15 ]. Given the pervasive role of social media, this theory is essential for comprehending how the behaviors, emotions, and attitudes of students may be shaped by the content and interactions they encounter in the digital realm.

Moreover, the research takes into consideration social comparison theory, which underscores how social media users frequently engage in relentless self-comparisons with others, potentially fostering feelings of loneliness and social anxiety [ 11 , 12 , 13 , 14 , 15 ]. This theory is critical for acknowledging the "highlight reel" effect, wherein users predominantly share their positive experiences and achievements, inadvertently prompting social comparison and potentially engendering negative emotional responses.

In the exploration of the perceived addictiveness of mindfulness-based mobile apps, the study employs addiction and compulsive behavior theories. These theories unearth the underlying factors contributing to the allure and habit-forming nature of certain digital interventions, thereby offering valuable insights into the psychology of user engagement and potential addiction [ 12 , 13 ]. When assessing user acceptance and perceptions of mindfulness-based mobile apps, the study draws from technology acceptance models (TAM). TAM provides a valuable framework for unraveling the intricacies of user adoption and attitudes toward technology-based interventions, elucidating critical factors like perceived usefulness and ease of use, which shed light on participants' acceptance of these apps [ 12 , 13 ].

Furthermore, the research aligns with the principles of positive psychology, a framework that centers on the enhancement of human well-being and strengths. The study's focus on bolstering well-being and mitigating anxiety and loneliness aligns closely with the core tenets of positive psychology, making it a pertinent theoretical perspective [ 12 , 13 ].

Lastly, media effects theories, such as cultivation theory and uses and gratifications theory, play a pivotal role in offering insights into how social media usage affects students' mental health and well-being [ 13 ]. Cultivation theory underscores the potential long-term impact of repeated exposure to media content, while uses and gratifications theory delves into how individuals actively use and engage with media to fulfill specific needs and gratifications.

By encompassing this multifaceted theoretical approach, the study constructs a comprehensive foundation for unraveling the intricate relationship between technology, psychology, and well-being in the digital age. This holistic perspective serves as a valuable compass in navigating the complexities of the research questions at hand, offering a deeper understanding of how these factors interconnect and influence one another [ 12 , 13 ]. Additionally, the study incorporates media effects theories to further enrich its theoretical foundation. Cultivation theory, as one of the key media effects theories, underlines the potential long-term consequences of repeated exposure to media content. Given the omnipresence of social media in the lives of university students, understanding how continuous media exposure might shape their perceptions and attitudes is crucial [ 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Moreover, uses and gratifications theory plays a pivotal role by exploring how individuals actively engage with media to fulfill specific needs and gratifications. In the context of the study, this theory sheds light on why students turn to social media, whether it's for social interaction, information seeking, or entertainment, and how these purposes might be linked to their mental well-being [ 13 ].

To round out the comprehensive theoretical framework, the study interweaves elements of positive psychology. This perspective emphasizes the enhancement of human well-being, positive emotions, and strengths. By striving to boost well-being and alleviate symptoms of anxiety and loneliness, the study directly aligns with the core principles of positive psychology. Positive psychology focuses on fostering qualities like resilience, optimism, and emotional intelligence, which are highly relevant to the study's objectives [ 46 , 47 , 48 , 49 , 50 ]. Thus, this framework adds a positive, growth-oriented dimension to the study's theoretical foundation, underscoring the importance of not only addressing negative mental health outcomes but also promoting positive psychological well-being [ 12 , 13 ].

In summary, the multifaceted theoretical framework encompassing mindfulness theory, social cognitive theory, social comparison theory, addiction and compulsive behavior theories, technology acceptance models (TAM), positive psychology, and media effects theories creates a robust and comprehensive foundation for unraveling the intricate relationship between technology, psychology, and well-being in the digital age. This holistic perspective enables the study to navigate the complexities of its research questions, offering a deeper understanding of how these factors interconnect and influence one another, and providing valuable insights into the impact of technology-driven interventions on the mental well-being of university students.

Conclusions

It can be concluded that the current findings add to the growing body of literature suggesting that social media use is linked to negative mental health outcomes. However, it is important to note that the causal direction of these relationships remains unclear. Although social media use may contribute to negative mental health outcomes, it is also possible that individuals who are already experiencing symptoms of anxiety and loneliness may use social media as a coping mechanism or to seek social support. Therefore, more research is needed to understand the complex relationship between social media use and mental health outcomes. It can also be concluded that the use of technology-based interventions can provide increased accessibility and convenience, anonymity and privacy, customizable and tailored support, cost-effectiveness, increased awareness and education, and reduced stigma. These findings demonstrate the potential of technology to offer effective and accessible mental health support for individuals in need.

The implications of investigating the relationship between social media usage and students' social anxiety, loneliness, and well-being within the context of digital mindfulness-based intervention are multifaceted. Firstly, as social media becomes increasingly integrated into students' lives, the study underscores the significance of understanding its potential repercussions on mental health. The findings can offer valuable insights to educational institutions, mental health professionals, and policymakers, prompting them to recognize the importance of promoting responsible social media usage among students. Secondly, the study's exploration of the effectiveness of digital mindfulness-based interventions in alleviating social anxiety, loneliness, and enhancing well-being holds significant implications for mental health intervention strategies. If proven efficacious, these interventions could serve as a practical and accessible means of addressing the psychological challenges posed by social media usage. This could potentially guide the development of tailored programs aimed at improving students' mental health and emotional resilience in the digital age. Furthermore, the study's focus on digital mindfulness-based interventions acknowledges the evolving nature of psychological interventions in the digital era. The implications of successful intervention highlight the potential of technology-assisted approaches to bridge the gap between traditional therapeutic methods and the modern digital landscape. This insight could inspire further innovation in mental health care, encouraging the integration of technology to reach wider audiences and promote positive mental well-being [ 51 ].

The current study also provides evidence that the intervention was effective in improving mental health outcomes over time. However, the study design does not allow us to determine the specific mechanisms by which the intervention was effective. Therefore, more research is needed to better understand how interventions can be optimized to improve mental health outcomes. Finally, while technology-based interventions can provide benefits such as convenience and accessibility, concerns about the quality and accuracy of mental health information available online, the lack of personal connection compared to traditional face-to-face therapy, and technical difficulties with accessing support have been reported by participants in this study.

Availability of data and materials

The data will be made available upon request from the author ( email: [email protected]).

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Exploring the Impact of Social Media on Anxiety Among University Students in the United Kingdom: Qualitative Study

1 Faculty of Medicine, Imperial College London, London, United Kingdom

Rafey Omar Asif

Arunima basu, dylan kanapathipillai, haadi salam.

2 Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom

Rania Selim

Jahed zaman, andreas benedikt eisingerich.

3 Imperial College Business School, Imperial College London, London, United Kingdom

Associated Data

Systematic literature review.

Thematic analysis.

The data sets, including the second-order themes, subthemes, and first-order codes generated during or analyzed during this study, are available from the corresponding author upon request.

The rapid surge in social media platforms has significant implications for users’ mental health, particularly anxiety. In the case of social media, the impact on mental well-being has been highlighted by multiple stakeholders as a cause for concern. However, there has been limited research into how the association between social media and anxiety arises, specifically among university students—the generation that has seen the introduction and evolution of social media, and currently lives through the medium. Extant systematic literature reviews within this area of research have not yet focused on university students or anxiety, rather predominantly investigating adolescents or generalized mental health symptoms and disorders. Furthermore, there is little to no qualitative data exploring the association between social media and anxiety among university students.

The purpose of this study is to conduct a systematic literature review of the existing literature and a qualitative study that aims to develop foundational knowledge around the association of social media and anxiety among university students and enhance extant knowledge and theory.

A total of 29 semistructured interviews were conducted, comprising 19 male students (65.5%) and 10 female students (34.5%) with a mean age of 21.5 years. All students were undergraduates from 6 universities across the United Kingdom, with most students studying in London (89.7%). Participants were enrolled through a homogenous purposive sampling technique via social media channels, word of mouth, and university faculties. Recruitment was suspended at the point of data saturation. Participants were eligible for the study if they were university students in the United Kingdom and users of social media.

Thematic analysis resulted in 8 second-order themes: 3 mediating factors that decrease anxiety levels and 5 factors that increase anxiety levels. Social media decreased anxiety through positive experiences, social connectivity, and escapism. Social media increased anxiety through stress, comparison, fear of missing out, negative experiences, and procrastination.

Conclusions

This qualitative study sheds critical light on how university students perceive how social media affects their anxiety levels. Students revealed that social media did impact their anxiety levels and considered it an important factor in their mental health. Thus, it is essential to educate stakeholders, including students, university counselors, and health care professionals, about the potential impact of social media on students’ anxiety levels. Since anxiety is a multifactorial condition, pinpointing the main stressors in a person’s life, such as social media use, may help manage these patients more effectively. The current research highlights that there are also many benefits to social media, and uncovering these may help in producing more holistic management plans for anxiety, reflective of the students’ social media usage.

Introduction

The rapid surge in social media platforms and users has substantial implications for mental health, particularly anxiety. In the case of social media, the impact on mental well-being has been highlighted by multiple stakeholders as a cause for concern, even being spotlighted by the government of the United Kingdom in the latest Mental Health and Well-being Discussion Paper [ 1 ]. However, there has been a lack of research into how the association between social media and anxiety arises, specifically among university students, a cohort that has witnessed the inception and progression of social media and predominantly engages with it.

Social media refers to a group of internet-based applications that build on the foundations of Web 2.0, allowing the creation and exchange of user-generated content [ 2 ]. There are currently 4.2 billion active social media users worldwide [ 3 ]. Global social media usage is projected to rise by 16.7% over the next 5 years, indicating it is here to stay [ 3 ]. Extant work notes social media’s critical role in people’s lives, including people becoming attached to their favorite social media app and experiencing separation distress when not able to use it [ 4 - 7 ]. Social media has also been highlighted as a potential force for good, for example, through the use of gamification, enhancing people’s happiness, and helping people quit smoking [ 8 - 13 ]. Important questions, however, remain regarding the impact of social media on university students. Consequently, its implications, both positive and negative, ought to be investigated, especially with regard to university students, of whom 76% have an account on some form of social media platform [ 14 ].

Behaviors stemming from social media use, including impaired sleep and sedentary practices, have been suggested as possible mechanisms for the rise of anxiety and symptoms of other mental health disorders [ 15 ]. University students, in particular, may fall victim to such behaviors, with it being found that up to 60% of all college students experience poor sleep quality [ 16 ]. Anxiety, defined by the National Health Service (NHS) [ 17 ] as a feeling of unease, such as worry or fear, is commonplace in adults in the 21st century, with anxiety disorders being the most prevalent form of mental illness [ 18 ]. Anxiety disorders in particular refer to general anxiety disorder, panic disorder with or without agoraphobia, social anxiety disorder, specific phobias, and separation anxiety disorder [ 19 ]. The importance of understanding the impact of social media on anxiety in university students is a priority now more than ever due to the increasing prevalence of both social media use and anxiety [ 3 ]. Studies within child and adolescent populations have demonstrated a significant association between social media use and anxiety [ 15 , 20 ]. However, this association is complicated by the various pathways outlined in much of the adolescent literature. One study described how different metrics of social media activity, including the user’s number of social media accounts and frequency of social media checking, were significantly correlated with higher levels of anxiety [ 21 ]. Another study demonstrated the implication of sleep within this relationship: increased nighttime-specific social media use resulted in later bedtimes and poor sleep, which ultimately led to increased anxiety [ 20 ]. Other phenomena have also been implicated within this relationship, including time spent, addiction, and emotional investment [ 15 , 22 ].

While this relationship has been well researched within child and adolescent populations, there has been limited focus on other groups, such as university students. Adolescents are at a unique stage of development and vulnerable to environmental insults such as social media use due to increased central nervous system plasticity, biological changes, and the shaping of psychological mechanisms [ 23 ]. Yet, university students are the population most susceptible to mental health disorders, with anxiety prevalence higher than the general population average at 11.2% [ 24 - 27 ]. Researchers often consider university students as a distinct population, also with their own unique set of risk factors that have been proposed as contributing toward the anxiety reported. These include strenuous academic demands, challenges of leaving home, distance from support networks, and a harmful predisposition to substance abuse, all specific to this cohort [ 28 , 29 ]. These significant differences in environmental context may affect the interactions these groups have with social media and the resultant impact on anxiety, thus limiting the generalizability of existing adolescent population findings within university student cohorts. Therefore, to build on the limited literature focused on the university student population, a systematic literature review (SLR) on the impact of social media on anxiety was conducted.

Systematic Literature Review

The protocol for the systematic review was registered with the International Prospective Register of Systematic Reviews (Prospero; CRD42022304959) and conducted in accordance with guidelines from the PRISMA (Preferred Reporting of Items for Systematic Reviews and Meta-Analyses) statement [ 30 ]. A systematic search of the literature was conducted in 3 electronic databases: OVID, MEDLINE, Embase, and PsychINFO, from the inception of the databases up to December 13, 2021, as shown in Figure 1 . Search terms were identified prior to the search to generate the search strategy ( Multimedia Appendix 1 [ 31 - 53 ]). A total of 23 studies ( Multimedia Appendix 1 ) were included for analysis within this review from the 1110 available papers following abstract and full-text screenings according to the inclusion and exclusion criteria by 3 independent researchers ( Multimedia Appendix 1 ). For each included study, researchers extracted the author names, country of origin, study design, sample cohort, sample demographic data, relevant exposure measures, relevant outcome measures, and main findings ( Multimedia Appendix 1 ). Owing to the diverse characteristics of the selected studies (ie, study designs, intervention types, or outcomes), a narrative synthesis approach was adopted for a more transparent presentation of findings.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Principal Findings

This systematic review explored the current literature on the association between social media use and anxiety among university students, and it was evident that the association is multifaceted. The included studies were generally of fair to good quality, thus suggesting reasonable validity in our findings.

This review identified that the most commonly investigated factor impacting levels of anxiety was the frequency of social media use, with contrasting associations across the studies [ 31 - 35 ]. Only 1 paper demonstrated a significantly positive association, with increased Facebook use leading to higher anxiety levels [ 31 ]. The remaining studies, however, highlighted significant relationships across other components of social media use beyond the frequency of use.

The nature of social media activity that university students engaged in was a more significant component in evoking anxiety. It was found that the viewing of certain image types induced higher levels of anxiety. Specifically, anxiety levels were immediately higher following the exposure of students to thin-ideal images, with anxiety-reducing as time elapsed [ 36 ]. Another study shared similar findings, with anxiety increasing following activity involving exposure to appearance-focused Instagram accounts [ 37 ]. This may be explained by social comparison theory, whereby comparison of one’s body to others may threaten one’s self-evaluation leading to feelings of anxiety [ 54 ]. Interestingly, while this behavior is more commonly observed in adolescents, our findings suggest that this phenomenon is present in university students as well [ 55 , 56 ]. This is further supported by another study identifying envy as a potential mediator between the relationship between social media and anxiety [ 38 ].

Mediators are indirect pathways through which social media use impacts anxiety levels. Further to envy, another key mediator identified as stress, with social media use increasing stress levels and, consequently, anxiety levels. The positive association between stress and anxiety levels has previously been highlighted in prior literature [ 56 , 57 ], with potential biochemical changes in the body providing an explanation for this association. The role of social media in exacerbating stress has also been previously identified within adolescents [ 58 ] through feeling overwhelmed as well as through indirect ways such as impacting sleep [ 59 ]. Psychological capital was another mediator identified, referring to a combination of positive psychological constructs including hope, resilience, optimism, and self-efficacy [ 60 ]. Social media use had a significant negative effect on psychological capital, while psychological capital decreased anxiety levels. This finding may be particularly useful in attempting to moderate anxiety levels in this population.

Additionally, a few experimental studies showed how social media abstinence can be beneficial in reducing anxiety levels, which is an important consideration in identifying techniques to aid those that experience increased anxiety levels as a result of social media use [ 39 , 40 ].

Conclusion and Design of the Primary Study

The SLR demonstrated that various elements and characteristics of social media can impact anxiety beyond the frequency of use. The SLR further identified a significant lack of qualitative studies within this field of research, highlighting the inadequate depth of exploration on the subject. Further studies are needed to address the underlying pathways and mechanisms through which social media impacts anxiety levels within this population. Additionally, there was a distinct lack of studies that investigated this association in the United Kingdom.

Aims and Objectives

We conducted a qualitative study to examine the impact of social media on university student’s anxiety levels through qualitative research.

Primary data collection was carried out through a mono-method qualitative study approach, in line with an interpretive and inductive approach to underpin and reinforce existing theory and carefully navigate the complex and subjective nature of the interactions between social media and anxiety perceptions [ 61 ]. This study was conducted as per ethical approval by the Imperial College Research Ethics Committee, following assessment by the Research Governance and Integrity Team and Head of Department on February 8, 2022 (ICREC reference number: 21IC7395).

Setting and Sample

A total of 29 semistructured interviews were conducted, comprising 19 male students (65.5%) and 10 female students (34.5%) with a mean age of 21.5 years. All students were undergraduates from 6 universities across the United Kingdom, with most students studying in London (89.7%). Participants were also asked to self-report their ethnicity using the UK Office for National Statistics ethnicity categories. Participants were enrolled through a homogenous purposive sampling technique via social media channels, word of mouth, and across different university faculties in different regions of the United Kingdom. Recruitment was suspended at the point of data saturation. Participants were eligible for the study if they were university students in the United Kingdom and users of social media.

Data Collection

An exploratory pilot interview was conducted prior to data collection, allowing for analysis regarding length, style of question, and interviewer mannerisms to ensure consistency amongst interviewers [ 62 - 64 ].

The semistructured interview guide ( Textbox 1 ) was informed by the aims and objectives of the project, the systematic review findings, and the pilot interview learnings. The interview guide focused on eliciting views and feelings involving (1) the participants’ current social media use, (2) the participants’ general opinions on social media, and (3) the participants’ perceptions of the impact of social media on their feelings of anxiety.

Semistructured interview guide for face-to-face individual interviews.

• Describe how you use social media at the moment. (Clarify using probing questions below if necessary)
• Which social media platform do you use? 
• How much of each social media platform do you use each day? 
• When do you use social media the most?
• What level of activity do you have on social media (passive or active)? For example, passive would be you just scrolling through, and active would be where you are interacting with posts such as messaging, sharing, posting, commenting, and so on.
• What does your use of social media consist of?
• What type of content do you view using social media?
• What are your motivations for using social media?
• What are your views on social media?
• Has social media usage impacted your well-being? If so, how?
• Has social media usage impacted your mental health? If so, how?
• Has social media ever explicitly benefited you? If so, how?
• Has social media use explicitly upset you? If so, how?
• Has social media impacted your anxiety on a day-to-day basis? If so, how?
• Has social media ever impacted your anxiety symptoms? If so, how?
• Which social media platforms have the biggest impact on your anxiety? Are there any reasons for this?
• What type of content or media has the biggest impact on your anxiety?

Web-based interviews were conducted via Microsoft Teams and Zoom between March and April 2022. Interviews consisted of 2 interviewers: 1 principal interviewer and 1 scribe. Interviews lasted approximately 30-60 minutes and were transcribed.

Data Analysis

Thematic analysis of the semistructured interviews was conducted using Braun and Clarke’s 6 steps to provide a rich yet complex analysis of the data in a flexible and robust manner [ 61 , 65 ]. Gioia et al’s [ 66 ] approach was used to construct the data structure to ensure a rigorous inductive research approach. A concurrent and recursive analytical approach was used, in which researchers analyzed data during collection and coding to refine codes and search for themes. To achieve consensual validation of any discrepancies, 3 researchers carried out a thematic analysis.

Phase 1: Data Familiarization

Each investigator read all the transcripts independently, generating concepts, and capturing ideas that explain the phenomena of interest.

Phase 2: Generation of First-Order Codes

First-order codes were generated independently by each investigator to link data referring to the same specific meanings [ 61 ]. Researchers then discussed the first-order codes identified and combined similar ideas under a single code, conscientiously adhering to participants’ terms.

Phase 3: Generation of Second-Order Themes and Subthemes

Investigators sought out similarities and differences among the first-order codes, categorizing these into subthemes and then into second-order themes. To produce a vibrant inductive model, researchers acknowledged the interrelationships among emergent themes. This formed the data structure, which visually demonstrates the process by which raw data transforms into second-order themes.

Phases 4 and 5: Defining, Naming, and Review of Themes

Themes and their encompassing components were reviewed, refined, and reorganized in a 2-level process by the 3 researchers. First-order codes were reviewed to test for coherence and relevance in their overarching subtheme. The subthemes and second-order themes were then refined to ensure relevance to research aims and an accurate representation of the data. The entire data set was revisited, and additional data were recoded that may have been missed in earlier phases. The names of the themes were crafted to be clear and instructive.

Phase 6: Producing a Report

Findings were presented through an analytic narrative approach that included explanations for each theme accompanied by examples from participants to demonstrate the merit and validity of the analysis [ 65 , 66 ].

Research Trustworthiness

The 4 criteria by which Guba [ 67 ] establishes trustworthiness are credibility, transferability, dependability, and confirmability [ 68 ]. Credibility was ensured through member checking of transcriptions, whereby participants were provided with their interview transcripts to guarantee accuracy [ 61 ]. To establish transferability, demographic characteristics have been provided for all participants [ 61 , 68 ]. Dependability was achieved through auditing the methodology, as demonstrated by the pilot interview [ 69 ]. To ensure confirmability, this study’s methodology and rationale served as a rudimentary audit trail, and stages such as thematic analysis were conducted independently by multiple researchers.

Ethics Approval

Ethical approval was given by the Imperial College Research Ethics Committee (ICREC reference number: 21IC7395). This study followed the principles of the Helsinki Declaration and the Danish Code for Research Integrity. Informed consent was obtained verbally and in writing from all participants, and they had the right to withdraw from the study at any given point. The interviews conducted were private, and the study data was kept anonymous, including from other members of the research team. Additionally, participants did not receive any compensation for their participation.

A total of 29 student interviews were conducted; Table 1 represents a summary of the demographics of the participants interviewed.

Demographics of interview participants (N=29).

Student participants’ experiences and perceptions of social media use and its effect on anxiety were analyzed. The analysis resulted in 8 second-order themes: 3 factors that decrease anxiety levels and 6 factors that increase anxiety levels ( Textboxes 2 and 3 ). Factors perceived to be decreasing student anxiety levels were social connections, positive experiences, and escapism (themes 1 to 3, respectively). Factors that were perceived to increase student anxiety levels were comparison, fear of missing out (FOMO), procrastination, stress, and negative experience (themes 4 to 8, respectively), summarized.

Second-order themes and subthemes of factors decreasing student anxiety.

Social connections

• Connect with friends and family
• Communities
• Distraction

Positive experiences

• Positive validation
• Positive content

Second-order themes and subthemes of factors increasing student anxiety.

• Comparison of life
• Comparison of body type
• Fear of missing out
• Procrastination
• Feeling overwhelmed
• Overthinking interactions
• Disturbing and harmful content
• Cyberbullying
• Judgment by others

These second-order themes are further organized into subthemes, which are elaborated on in detail, providing quotes from participants for further harmonization and understanding. First-order concepts and selected quotes illustrate these themes (see Multimedia Appendix 2 ). We have replaced participant names with participant numbers (eg, Student 1).

Theme 1: Social Connections

Subtheme 1.1: connection with friends and family.

A majority of participants (n=19) spoke of the benefits of social media as a tool to create and maintain social connections. When students were worried about long-distance relationships, social media platforms allowed them to maintain these relationships, thus overcoming geographical barriers.

I’m a very social person so I like that side of social media. It helps me stay connected with people all around the world, even my cousins who live abroad Student 22

Social media provided students with a unique opportunity to grow their social circles by building and even reestablishing friendships:

I’ve met like some of my closest most dear friends through it Student 7

I lost contact with him for 10 plus years. We found each other through Instagram. So, we started messaging again. Student 12

Importantly, social media prevented student loneliness and social isolation during difficult times during their transition into university or during the COVID-19 pandemic when students were quarantined:

In terms of my mental well-being, it can help me stop loneliness and keep in touch with friends and family especially when I’m at university. Student 27

So even though you’re at home, by yourself, or with just your family, you’re actually like, connected with the world out there. Student 6

Subtheme 1.2: Web-Based Communities and Support

The establishment of connections through social media has offered opportunities for students to surround themselves with supportive web-based communities of like-minded people. These have formed sources of support and praise:

I’m fortunate enough to belong in one where everyone seeks to uplift one another, with the work you are producing being praised and promoted. Student 21

In lockdown, where a lot of people were then doing like the virtual calls and virtual iftars and virtual like, talks and things and it created such a nice community. Student 6

Theme 2: Positive Experiences Associated With Social Media Usage

Positive experiences are described as social media interactions that induce happiness and inspiration in students, especially when they are in a low mood. This encompassed viewing and interacting with positive content and receiving positive validation.

Subtheme 2.1: Positive Content

There were plentiful types of positive media consumed by students (n=10) on social media, including spiritual, creative, informational, and activist content. This motivated students to adopt healthier lifestyles and inspired creativity.

I can follow someone that has a healthy living account for example I find that seeing posts like that would encourage me to be better or to go out and go for a run or pick something healthy to do. Student 15

So in terms of creativity, it makes me happy seeing other people’s work and then using that to inspire myself. Student 17

Students revealed that social media enables greater visibility and support for social issues and activism. Through awareness and education on global movements through social media, students bonded with others and expressed solidarity.

I’ve learned a lot from people through social media, just different people’s mindsets and different people’s viewpoints. I think specially with certain campaigns, such as BLM [Black Lives Matter] for example, that really showed the power of people when they come together. Student 6

Another benefit mentioned by some students (n=3) was access to religious content, which induced a sense of hope and motivation.

Social media has benefited me a great deal in terms of coming closer to my own faith. I follow a lot of religious accounts on social media and they tend to show positive, bitesize clips that really provides me with hope and motivation to continue being strong in your faith. Student 27

Subtheme 2.2: Positive Validation

Some students mentioned that social media was a channel to receive positive validation and compliments (n=5). Students revealed that they were positively impacted by web-based exchanges with peers:

The endorphins that come with posting or the number of likes does have a positive impact on me Student 22

It’s nice getting positive feedback from people on stuff that you posted and it’s nice receiving compliments, but also complementing other people on stuff they’ve posted. Student 15

Theme 3: Escapism

Social media was described as providing students with an escape from mental health issues or any other stressors that may be plaguing their thoughts, thereby providing them with a sense of calm and relief.

Subtheme 3.1: Distraction

To mentally cope with and divert feelings of anxiety, students discussed using social media as an instrument to distract from or avoid their problems.

If there is anything in the real world that affects my anxiety, funnily social media can act as a way of helping me cope with it. It puts my mind in another place; a place where I don’t have to think too much Student 22

Pull me out of my like, state of like despair, into anything that’s stimulating. That’s why I was like, watching things that were just like, utter trash, like it made no sense. But like, it was something to just distract me. And that’s what I needed at that time. Student 4

Subtheme 3.2: Relief

Social media is commonly used for leisure and mindless entertainment to relax and reduce anxiety levels.

It’s also a nice break in the day so if you had a busy day at work you can just have a quick scroll through. Student 16

Sometimes if you’re just feeling a bit you know, as you put like, a bit anxious or maybe overwhelmed. Just doing something pretty mundane, can sort of help. Student 20

Theme 4: Comparison

A major contributor to anxiety in students (n=22) was described as the comparisons that they would draw between their own lives and the lives of others seen on social media, be that people that they know personally or other personalities such as influencers or celebrities.

Subtheme 4.1: Comparison of Life

Students specifically discussed the comparison of factors that were external to their own physical being. A common thread of comparison was that of the participants’ social lives, for example, seeing how many friends others had or the enjoyment that their counterparts attained from social gatherings. Seeing such content from peers would drive students to be anxious.

When people post a lot of content about their lives whilst you’re just at home, not doing anything special, you feel anxious in that you should really be doing something. Or that I am not doing enough Student 21

Students mentioned that they also compared their academic performances and other life achievements to others, saying that they felt anxious about not performing to the same standard:

...just looking at the success of others and comparing it to my lack of success really heightened my anxiety and pushed me down further. Student 27

One student mentioned the comparison of wealth and social status as a reason for anxiety:

So you can actually see who is financially more well off or of a higher social economic class and then you’re kind of comparing yourself to these people who have more money than you Student 10

Subtheme 4.2: Comparison of Body Types

Students felt that image-based social media platforms contributed to anxiety as they led them to compare their appearance to the perceived ideals that they saw on platforms.

I had like an issue with body image. It wasn’t a big thing, but it played on the back of my mind. And with social media like Instagram, where a big part of it is posting photos of yourself, I could definitely see why it would be a negative Student 11

I think it comes down to influencers – like they have good body types and things that can make you quite insecure. Student 25

Theme 5: FOMO

The concept of FOMO was cited by students as another noteworthy outcome of social media use that contributed to anxiety. FOMO consists of the feeling that by being away from social media, one could eventually feel anxious about missing out on messages.

I would not use my phone for even just 2 hours and I would feel like I was missing out on something. This would drive me crazy and add so much unnecessary stress Student 24

Additionally, in some cases (n=2), FOMO was mentioned to be occurring because of comparison to what other people posted on social media:

You see so many different stories of people doing different things. Sometimes you get that fear of missing out. Student 11

People around me were always on their phones using these apps, so naturally, I would do the same. If I wasn’t on it, it would bring the fear that I felt like I was missing out Student 24

Theme 6: Procrastination

Students (n=13) discussed how the nature of social media is such that they would constantly return to it and hence consume a lot of time. This impulsive use caused them to use social media, thereby procrastinating and causing anxiety from the feeling that they could have been more productive with their time.

if I have a deadline or things to do, like exam preparation, I am not one to just focus on that. I tend to procrastinate an unhealthy amount. Social media takes time away from me completing my uni work, doing my chores or doing things to better myself and, in turn, this increases my anxiety levels. Student 22

Theme 7: Stress

Students also mentioned (n=8) how social media was a large cause of stress through various mechanisms, which in turn caused them to be more anxious.

Subtheme 7.1: Feeling Overwhelmed

Excessive connectivity to others through social media would lead to students feeling overwhelmed by an unmanageable number of notifications. The perceived obligation to respond rapidly was what drove students to feel anxious.

With WhatsApp, there’s kind of a chronic stress and background, especially when you have like later messages and stuff coming through and you can kind of feel obliged to kind of just continually be online and be active Student 5

Subtheme 7.2: Overthinking Interactions

Constant contact with people through direct messages or posts on social media led to students overanalyzing the web-based interactions that they had. Students were self-conscious in their social media interactions, which made them anxious about how their peers might respond.

There is so much overthinking with it; thinking that maybe this person didn’t like me. Or perhaps you message someone, and you see that they are online, but they do not message you. Again, sometimes I look at this and think “Ok, does this person not have enough time for me?” Student 27

Theme 8: Negative Experiences

A common theme that arose from the interviews (n=18) was negative experiences on social media, which were described as those that cause displeasure and unhappiness in students. These negative experiences encompass the consumption of disturbing and harmful content, perceived judgment from others, and being a victim of cyberbullying.

Subtheme 8.1: Disturbing and Harmful Content

A striking factor that induced anxiety, as mentioned by students, was the consumption of distressing content. This was mentioned in multiple contexts; for example, viewing distressing media on the internet was said to cause negative emotional states, possibly even exacerbating symptoms in those already experiencing mental health disorders.

An example of such distressing content is the web-based promotion and glamorization of self-harm–related media.

I think it is scary to think that people can follow pages and accounts that may encourage them to self-harm or to commit suicide or to restrict eating or things like this Student 15

Subtheme 8.2: Judgment by Others

Social media encouraged student behaviors such that they would be anxious about being judged by peers they were connected with. This potential judgment led to students feeling anxious about potential disapproval by others.

I think it mostly lies in the fear of not knowing how it will be perceived by others. I don’t think it’s an innate thing. I think it’s not knowing how other people will react to it Student 18

Posting was an intensely anxious endeavor where students were concerned about the number of likes obtained, even considering removing a post if it did not perform well.

I think twice about keeping pictures up that didn’t receive as many likes as other posts of mine…it is embarrassing if you do not hit a certain number. It makes you feel less valued and less appreciated. Student 27

Subtheme 8.3: Cyberbullying

A considerable negative experience that students had on social media was receiving web-based abuse and negative comments or remarks from others, otherwise known as cyberbullying. This phenomenon had a long-lasting negative impact on students’ anxiety due to the intensely personal nature of the comments:

There were a few people who used to DM (direct message) me. They would talk about my appearance, the way I look and because I am quite self-conscious about that, they would use it to target me and harass me. Student 23

To the best of the authors’ knowledge, this study is one of the first qualitative studies exploring the perceptions of university students on the impact of social media on their anxiety. The results from the SLR suggest that social media use was associated with greater anxiety levels among university students and identified mediating pathways through which this association may occur: stress, envy, psychological capital, and a negative emotional state. Our first qualitative analysis added to the literature by identifying other pathways. These pathways were categorized into those that decrease or increase anxiety levels.

Principal Results

Theme 1: social connectivity.

The primary study identified that social connectivity plays a role in decreasing anxiety levels among university students. This route is consistent with the pathway of positive relationships proposed by [ 70 ] and in prior literature [ 71 ]. According to the 4 drives theory [ 72 ], humans have an intrinsic need to seek and develop mutual social commitments. Thus, our findings suggest that social media creates an alternative route through which students can connect and establish meaningful bonds with friends and family, satisfying such a need. Additionally, the relevance of social connectivity to decreased anxiety levels has been well established [ 73 , 74 ]. Contrary to such findings, Rae and Lonborg [ 41 ] found that those seeking new connections beyond friends and family experienced greater anxiety with increased social media use.

Our qualitative research revealed that students relied on social media for social connectivity during the COVID-19 pandemic. Dos Santos et al [ 75 ] highlighted the potential association between social isolation during the COVID-19 pandemic and symptoms of anxiety. Focusing on the unique circumstances of the university student cohort, who tend to be detached from their family and friends, the importance of social connectivity on anxiety may be greater, especially for international students [ 76 ]. Web-based community and support were another way through which students noted that social media reduced their anxiety. Humans display a need to belong, with prior literature highlighting that an increased sense of belonging (or subjective group identification) was associated with decreased anxiety [ 77 ].

Theme 2: Positive Experience

Positive content, such as spiritual, creative, informational, and activist content, was noted by students to reduce anxiety levels. For instance, activist content mentioned included campaigns such as the “Black Lives Matter” movement. This pathway could potentially be explained by the cohesion and sense of solidarity that activism provides, building a sense of unity and reducing anxiety levels [ 78 ]. Furthermore, engaging with spiritual content can lead to decreased anxiety levels, with individuals mentioning that some spiritual content was both grounding and hope-inducing, as supported by the literature [ 79 ].

Validation was highlighted as another positive experience that students had on social media. Assuming a student’s basic needs are secure, social media has the potential to fulfill self-esteem needs, encompassing the desire for reputation or prestige [ 80 ]. Student participants corroborated this positive effect of external validation through social media by noting the positive effect that it had on their present dispositions. This pathway for the alleviation of anxiety is explained by the fact that users have been found to receive endless joy so long as they receive positive validation in the form of likes and responsive comments [ 81 ]. Thus, when it comes to social media use, positive outcomes for students are inextricably linked to the positive responses that they receive [ 82 ].

Escapism has been defined as individuals choosing to get away from the reality that they live in due to unsatisfying life circumstances [ 83 ]. Students mentioned that sometimes social media provided them with an avenue to avoid negative emotional states such as anxiety by preoccupying themselves with distractions on social media. While escapism has generally been regarded in the literature as a negative and dysfunctional phenomenon [ 84 ], functional escapism has been found to be an effective coping mechanism to produce favorable well-being outcomes [ 85 ]. The description of social media use as a coping mechanism by students to alleviate anxiety follows the concept of self-suppression, as outlined by Stenseng et al [ 85 ]. While, in the short term, this provides students with a reprieve from their anxiety, it is only momentary and simply a tactic to minimize ill-being rather than one to maximize well-being [ 85 ]. That said, from our qualitative analyses, it was apparent that students viewed this as a virtue of social media, giving them an avenue to relax and find some relief in times when they may feel overly anxious.

The findings of this study support social comparison theory [ 37 ], which is the idea that one’s personal worth is established by self-evaluations determined by comparison to others. It was evident that students compared themselves to others on social media in 2 main ways: comparison of life and comparison of body types. Students described numerous occasions of upward comparison through social media. This is the act of comparing oneself to others perceived as superior in certain domains, such as social life, academia, wealth, and social status. Social comparison is well established as a pathway that increases the risk of anxiety [ 86 ]. Certain social media platforms, such as Instagram and Facebook, which are heavily image-based, have been identified as the most triggering comparisons [ 86 ]. Prior research has suggested that reduced self-esteem is another intermediate outcome resulting from social comparison, which in turn leads to greater anxiety [ 87 ]. This suggests that the relationship between social comparison and anxiety is complex and could involve other pathways.

Academic comparison on social media was found to be particularly prevalent within the university student cohort, which then led to anxiety. Competition is one possible explanation for this, as is fear of judgment by others on the internet [ 88 , 89 ]. Charlesworth [ 90 ] distinguishes 2 types of competition: integrative and aggressive. Students in this study displayed a mix of both, expressing happiness for their peers while also feeling hostile competitiveness owing to their own lack of achievement. Research has shown that anxiety can be triggered when one feels as if they are losing or failing [ 91 ]. Competition is not a driver for social media usage [ 92 ]; however, it can be hypothesized that individuals who are more competitive may be more prone to experiencing anxiety due to academic comparison on social media.

Comparison of one’s own body type to others seen on social media was especially common on image-based social media such as Instagram. This is corroborated by research that has revealed photo-based activity on social media to be linked to body image dissatisfaction. Kohler et al [ 37 ] found that beauty and fitness content marginally increased anxiety among university students. Our qualitative research demonstrated that while some students compared their bodies to images posted by their peers, others openly compared their bodies to influencers. Comparing one’s body to that of others briefly threatens one’s self-evaluation, causing feelings of anxiety [ 36 ].

FOMO, or the “fear of missing out,” was also identified as a pathway through which social media increased levels of anxiety symptoms. FOMO tends to arise through the perception of missing out, followed by actions to maintain these social connections [ 93 ]. Students mentioned that on social media platforms, individuals tend to share positive aspects of their lives, including group gatherings or partaking in various activities. Thus, propagating the feeling that their peers are engaging in more rewarding experiences. Drawing on the 4 drives theory [ 71 ], humans have a drive to acquire, thus fueling their need to match the actions and experiences of their peers. Our qualitative findings also identified that comparison drove the feeling of FOMO. This finding highlights the potential sequential nature of the mediating pathways, indicating that these pathways may not be linear in nature.

Procrastination was identified as another mediator, with increased social media use resulting in increased procrastination of tasks such as academic work or other daily activities, which in turn contributed to increased anxiety levels, corresponding with existing literature [ 94 ]. Additionally, qualitative findings outlined that procrastination on social media prevents students from completing other tasks such as exercise, a protective factor against anxiety [ 95 ].

Interestingly, the SLR exhibited mixed results for time spent on social media is associated with anxiety [ 30 , 31 ]. However, this may be due to students’ perceptions of their social media use; those who deem their time spent on social media as “waste” or procrastination may experience greater anxiety symptoms.

Consistent with prior literature [ 42 ], stress acted as a mediating pathway through which social media use drove anxiety levels among student participants. Our qualitative study highlights that this occurs as social media use provokes the overthinking of interactions, leaving students overwhelmed. This could be induced through excessive messages, explained by the theory of reciprocity, which results in individuals feeling obligated to reply to those who have taken the time to message them, otherwise resulting in reciprocity anxiety [ 96 ]. One of the key reasons mentioned that encouraged social media use was connectivity; however, it may be possible that a fine line exists between social media being beneficial for connections and acting as a stressor. Prior literature has identified that social media can drive stress levels, potentially through other mechanisms such as misinformation [ 97 ]. Thus, increased stress levels can drive anxiety, as explained by the increase in adverse psychological reactions caused by stress [ 98 , 99 ]. Students also highlighted that social media led them to overthink interactions, increasing their anxiety levels. However, overthinking interactions (or rumination) is a possible symptom of anxiety, and so overthinking interactions could be seen as an indication of heightened anxiety symptoms rather than a mediating pathway.

Our primary study defined negative experiences as encountering hostile web-based interactions in the form of cyberbullying, exposure to distressing and disturbing content, and the fear of judgment from others. Research suggests that cyberbullying and cybervictimization are prevalent in the student population [ 100 ], with students who are victims of cyberbullying being predicted to harbor higher levels of anxiety and even suicidal thoughts [ 100 - 102 ]. Conversely, some research has shown that anxiety predicts greater cyberbullying victimization among students, drawing a potential reverse pathway [ 103 ]. In our study, students described the fear of being judged by peers through social media. Many students spoke of the anxiety induced by posting content about themselves and the performance of that content. A qualitative study in the United Kingdom of people aged 8-20 years mirrored these concerns [ 104 ], acknowledging that the possible scrutiny from others prompted anxiety. This observation may be explained by the concept of self-presentation, defined by Leary [ 105 ] as “the process by which people convey to others that they are a certain kind of person.” Web-based self-presentation was shown to have a significant relationship with judgment anxiety [ 106 , 107 ]. However, among college students, strategic self-presentation is reported to be associated with increased well-being; thus, the link between self-presentation and anxiety still needs to be explored in depth [ 107 ].

Limitations and Future Research

This study has several limitations, which offer avenues for future research. First, this study relied on SSI for data collection; therefore, findings may be affected by mono-method bias [ 108 ]. The use of other quantitative and alternative qualitative methods may have resulted in a more rigorous analysis. Second, pilot interviews were conducted to test the effectiveness of our questions. All subsequent interviews were carried out by 2 groups of researchers, which helped create consistency in communication styles between interviews. However, this may result in interviewer bias; therefore, training and discussion throughout the interview process were used to minimize this effect. Third, despite reaching theoretical saturation and disseminating our recruitment material to different universities across the United Kingdom, our student sample mainly consisted of students from British Asian ethnic backgrounds (n=19) and those studying in London (n=26). Additionally, the majority of the participants were male (n=19). While the data was collected from a pool that was not directly reflective of the university population in terms of ethnicity proportions, gender ratio, and geographical location, the responses reached theoretical saturation, so further consequential interviews no longer added any new findings. However, we acknowledge that for future research within this domain, greater efforts will need to be made to ensure that participants adequately reflect the greater population. Due to the sensitivity of the subject of the interviews, both groups of participants were provided with a comprehensive informational sheet containing the details of the research. Thus, participants may be subjected to anchoring and availability bias during interviews. To mitigate this, participants were asked neutral, open questions, followed by specific questions on how social media benefits them. An effort was made to ensure that the positive impacts of social media on anxiety were explored in as much depth as the negative impacts.

To enhance confidence in the generalizability of the current findings, we encourage future research to widen the study sample to include participants from a greater number of universities across the United Kingdom, including a wider demographic that is more representative of the population of the United Kingdom. Furthermore, throughout our interviews with students, it was identified that certain social media platforms have a greater effect on SMIA. Participants mentioned that platforms, like Instagram, impacted them more than others, thus emphasizing the need for future research and drawing comparisons and granularity with respect to individual platforms. Moreover, anxiety was chosen due to its prevalence among university students. Nevertheless, other mental health symptoms, such as depressive symptoms, are also prevalent within populations and richly deserving of future study [ 109 ]. Hence, we encourage additional research that focuses on these other mental health symptoms that are also deserving of in-depth research.

This study sheds light on how university students perceive how social media affects their anxiety levels. The findings of this study can be used by many parties, including university counselors, students, and health care professionals, to create materials that will better prepare students to deal with anxious feelings that may arise from using social media.

Acknowledgments

The authors of this study would like to sincerely thank everyone who took part in the study for their time and valuable insights.

Abbreviations

Multimedia Appendix 1

Multimedia appendix 2, data availability.

Authors' Contributions: All 8 authors are joint first authors and have contributed equally to this study. ABE supervised this study. All authors approve of the final manuscript submitted.

Conflicts of Interest: None declared.

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Effect of social media on academic engagement and performance: Perspective of graduate students

• Published: 10 December 2019
• Volume 25 , pages 2427–2446, ( 2020 )

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• Rouhollah Mahdiuon   ORCID: orcid.org/0000-0003-0402-4192 1 ,
• Ghasem Salimi   ORCID: orcid.org/0000-0002-7180-3455 2 &
• Laleh Raeisy   ORCID: orcid.org/0000-0002-5796-6135 2  

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In the past two decades, researchers and educators have always tried to explore the effects of social media on academic engagement and performance in higher education settings. The present study examines the effect of the adoption of Telegram on academic engagement and performance of graduate students in two Iranian universities. The structural equation model was used to examine the hypothesis. The sample consisted of 409 respondents who were students at universities in southern and northwestern Iran. The results showed that the adoption of Telegram among students is a positive and significant predictor of its educational use. There was a positive and significant relationship between educational use of Telegram and student engagement. Educational use of Telegram affected academic performance in a mediating role of student engagement. Student engagement in the process of education and learning has been significantly related to their academic performance. Implications of the study and the findings were also discussed.

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Mahdiuon, R., Salimi, G. & Raeisy, L. Effect of social media on academic engagement and performance: Perspective of graduate students. Educ Inf Technol 25 , 2427–2446 (2020). https://doi.org/10.1007/s10639-019-10032-2

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Received : 31 May 2019

Accepted : 09 October 2019

Published : 10 December 2019

Issue Date : July 2020

DOI : https://doi.org/10.1007/s10639-019-10032-2

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