Nomophobia and Its Association with Sleep Quality, Communication Skills, and Stress Among Nursing Students: A Cross-sectional Study

Abstract

Background: Nomophobia, the fear of being without mobile phone connectivity, is increasingly prevalent among university students, particularly nursing students who face rigorous academic and clinical demands. Objectives: This study examines the prevalence of nomophobia and its associations with sleep quality, communication skills, and perceived stress in nursing students to inform targeted interventions for their well-being and professional competencies. Methods: A cross-sectional study was conducted from March to May 2025 with 208 undergraduate nursing students from two universities in Kashan, Iran, using stratified sampling. Participants completed validated Persian versions of the Nomophobia Questionnaire (NMP-Q), Pittsburgh Sleep Quality Index (PSQI), Communication Skills Attitude Scale (CSAS), and Stress Index in Nursing Students (SINS). Data were collected via paper-based questionnaires during class and clinical sessions. Descriptive statistics, Pearson correlations, hierarchical regression, and Bayesian regression with a Jeffreys-Zellner-Siow (JZS) prior were used to analyze relationships between nomophobia and study variables, controlling for demographics. The sample size was calculated using G*Power, targeting a minimum of 200 participants for adequate power. Results: The mean NMP-Q score indicated moderate-to-high nomophobia levels. Participants reported poor sleep quality (mean PSQI = 7.91) and elevated stress (mean SINS = 82.38). Nomophobia was positively correlated with poor sleep quality (R = 0.42, P < 0.001) and stress (R = 0.51, P < 0.001), and negatively correlated with positive communication attitudes (R = -0.26, P < 0.001). Hierarchical regression showed that stress (β = 0.39, P < 0.001) and poor sleep quality (β = 0.28, P < 0.001) were the strongest predictors of nomophobia, with positive communication attitudes offering a protective effect (β = -0.16, P = 0.014). Bayesian analysis confirmed these findings (BF10 = 142.6). Daily smartphone use was not significant after controlling for psychosocial variables. The cross-sectional design limits causal inference. Conclusions: Nomophobia is prevalent among nursing students and significantly associated with poor sleep quality and high stress, while positive communication attitudes mitigate its impact. These findings suggest the possibility of interventions targeting stress management, sleep hygiene, and communication skills to reduce nomophobia. Future longitudinal studies should explore causality and evaluate intervention efficacy to support nursing students’ well-being.