In the Palm of Your Hand: The Mediating Role of Locus of Control in Selfie Addiction and Nomophobia Among Nursing Students

Abstract

Introduction

In today’s hyperconnected world, nursing students are increasingly vulnerable to behavioral dependencies such as selfie addiction and nomophobia.

Objectives

This study aimed to investigate the mediating role of locus of control in selfie addiction and nomophobia among nursing students.

Methods

A cross-sectional design incorporating a mediation model was conducted. A stratified random sampling technique was used to recruit 379 nursing students. Data were collected using: the Selfie-taking Habits Questionnaire, the Nomophobia Questionnaire (NMP-Q), the Selfie Addiction Scale, and the Locus of Control Short Scale (IE-4).

Results

Among 379 nursing students, the results demonstrated a significant positive correlation between selfie addiction and nomophobia (r = 0.268, p < 0.001), as well as a significant negative correlation between locus of control and both selfie addiction (r = -0.218, p < 0.001) and nomophobia (r = -0.145, p = 0.001). Mediation analysis revealed that locus of control significantly mediated the relationship between selfie addiction and nomophobia (indirect effect = 0.114, p = 0.015), indicating that higher selfie addiction is associated with lower internal locus of control, which in turn increases nomophobia.

Conclusion

Locus of control serves as a significant partial mediator between selfie addiction and nomophobia. These findings underscore the importance of addressing individual psychological traits in interventions to promote healthier digital behavior and reduce mobile-related risky behavior among nursing students. These findings highlight the need to enhance the internal locus of control as a strategy to reduce selfie addiction related to nomophobia, thereby empowering students to manage their digital habits more effectively.

Keywords

behavior addictive cell phone use anxiety locus of control nursing students

Introduction

With the increasing usage of social media and smartphones in recent years, young adults have undergone significant changes in their behavioral and psychological patterns (Sabar et al., 2024). A notable behavioral trend is the growing incidence of selfies, defined as self-portraits taken to celebrate an overabundance of pride in one’s beauty. A selfie is defined by The Oxford English Dictionary as a “photo taken by an individual, usually using a smartphone, and shared on social media platforms.” The term “selfie” was declared the word of the year based on a statistical examination (Sorokowski et al., 2015).

Mental health professionals view selfie-taking as a significant concern. Selfies may begin as a hobby or form of amusement at first, but they may quickly turn into a habit and, in extreme cases, an addiction (Begum, 2019). Nomophobia is another notable behavioral trend that has become a concern in psychological and clinical contexts (Boggero et al., 2022). Nomophobia is an irrational fear of losing one’s mobile device. In the modern era, nomophobia refers to the fear of being without a phone (Copaja-Corzo et al., 2022). When people miss their cell phone, run out of charge, they get really anxious. Nomophobics never put their phones away, never put them to bed, and never even leave them alone for a second. Additionally, nomophobics will have a backup cell phone in case their first one breaks down (Than & Shan, 2021).

Selfie addiction and nomophobia play a role in personality formation and mental health concerns. It significantly diminishes overall enjoyment, impacts self-esteem, and increases feelings of loneliness, particularly among younger individuals. Under the umbrella of mental health, the significance includes worse workplace performance due to dependence on mobile devices, which promotes continuous distractions (Gutiérrez-Puertas et al., 2019). Our relationships and social interactions are changing due to nomophobia and selfie addiction, creating a disturbing gap between people and their real surroundings and reality (Rodríguez-García et al., 2020).

On the other hand, the locus of control, a dynamic element that significantly inspired this inquiry, was first introduced by Julian Rotter in 1966. The idea of locus of control pronounces the tendency of the person to attribute situations that impact them to either external factors, such as the result of uncontrollable elements like fate, good fortune, or influential people, or internal factors that interpret outcomes as the result of their own actions, as their own enduring traits and behaviors (Rotter, 1966).

Nomophobia and selfie addiction have been examined separately; a new study indicates that several psychological characteristics may affect or explain how they are related. The locus of control is one such characteristic. These apprehensions are important for nursing students, as their learning and education require a consistent focus, emotional control, and effective stress management. Given this, locus of control becomes a significant reflection factor warranting further research, as it may affect how vulnerable or protected students are to selfie addiction and nomophobia (Boggero et al., 2022). While previous studies have examined selfie addiction, nomophobia, and locus of control independently, the mediating role of locus of control between selfie addiction and nomophobia has not been formally tested, particularly among nursing students in a Middle Eastern context.

Based on this, studying whether locus of control lessens or exacerbates nomophobia and selfie addiction in nursing students is crucial. This research aimed to investigate locus of control as a mediator in combination with these behaviors. Besides, identifying individuals at risk and developing early interventions to promote healthier technology use. The time has come to address these issues and develop a comprehensive strategy for digital engagement.

Literature Review

Selfies are defined by the American Psychiatric Association (APA) as the act of taking, as a mental condition known as “selfitis.” This condition is characterized by an excessive preoccupation with one’s ego. The APA further describes it as an “obsessive-compulsive enjoyment” of capturing images and posting them on social platforms (Balakrishnan, &Griffiths, 2018). Everyone admits that taking selfies has become an inevitable aspect of daily life. The insatiable desire to take selfies significantly influences radical lifestyle changes (Nagalingam et al., 2019).

Selfies pose risks such as poorer performance in work environments, elevated stress levels, dysfunctional family relationships, and interpersonal disputes. It can also result in several health problems, including cervical spondylitis, tennis elbow, bad posture, frozen shoulder, and lower back pain. From a psychological standpoint, taking too many selfies might lead to negative tendencies, such as selfishness and asocial behavior. Additionally, people may take pictures in dangerous or harmful situations to show off, gain approval, and gain adoration, which could lead to potentially fatal scenarios (Begum, 2019).

Nomophobia is becoming a significant concern in our digital age, a growing concern defined by four key dimensions that highlight its profound implications: (1) the fear of losing contact with people; (2) the worry of becoming disconnected; (3) the necessity of having instant Information accessibility; and (4) The apprehension of relinquishing the convenience and comfort that accompany mobile gadgets. Recognizing these anxieties highlights the profound effects of our modern-day reliance on technology (Ali et al., 2017).

Given how often university students use cellphones, it is not unexpected that they are prone to selfie addiction and nomophobia. Although this issue has only recently emerged, it has spread rapidly and more widely. Nursing university students are increasingly at risk for behavioral issues, including selfie addiction and nomophobia, which raises questions about their academic achievement, mental health, and future professional competency. Common characteristics of both habits include excessive dependence on technology, a desire for external approval, and a propensity to disrupt social connections and focus (Aslani et al., 2025; Boggero et al., 2022).

Personalities with an internal locus of control believe that their efforts and abilities can influence outcomes. As a consequence, they typically achieve their time efficiently, navigate their surroundings well, develop strong social ties, and succeed academically. On the other hand, people with an external locus of control attribute their outcomes to external factors. They hold that fate and luck are among the forces that determine events beyond their control. This viewpoint often leaves people anxious and feeling passive, as they believe they have no control over their situation and may grow more doubtful of their ability to bring about change (Aidooa & Mensah, 2024). Improved mental health, reduced anxiety and depression, enhanced stress management strategies, increased social skills and popularity, and higher self-esteem are associated with an internal locus of control. So, this study examines whether locus of control lessens or exacerbates nomophobia and selfie addiction in nursing students.

Theoretical Framework

The present study proposes a mediated relationship between selfie addiction and nomophobia through locus of control, drawing on Social Cognitive Theory and Locus of Control Theory. According to Bandura’s Social Cognitive Theory, behaviors are shaped through reciprocal interactions among personal factors, environmental influences, and behavioral reinforcement, suggesting that excessive selfie-taking and online self-presentation may foster reliance on external feedback, such as likes and comments, for self-evaluation (Bandura, 1986). This repeated dependence on external validation may gradually shift individuals’ locus of control from internal to external, as described by Rotter’s Locus of Control Theory (Rotter, 1966). Individuals with an external locus of control are more likely to perceive outcomes to external agents rather than personal agency, which can increase psychological reliance on smartphones as essential tools for social connection and emotional regulation. Consequently, the inability to access one’s smartphone may provoke nomophobia. Thus, locus of control is theoretically positioned as a key mediating mechanism explaining how selfie addiction translates into heightened nomophobia symptoms.

Research Questions

1. What are the levels of selfie addiction, nomophobia, and locus of control among nursing students?

2. What is the relationship between selfie addiction, nomophobia, and locus of control among nursing students?

3. Does locus of control mediate the relationship between selfie addiction and nomophobia?

Methods

Research Design and Setting

A descriptive correlational cross-sectional design incorporating a mediation model was employed to explore potential indirect relationships and investigate the locus of control in the relationship between nomophobia and selfie addiction among nursing students. Urban Cairo and rural Zagazig Universities were selected as two of the most prominent public universities, with diverse enrollments and reputable nursing schools. Their inclusion ensures a broader sample of both urban and rural students, allowing for more broadly applicable conclusions about nursing students' locus of control, nomophobia, and selfie addiction. This study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (von Elm et al., 2007).

Participants and Sampling

A stratified sampling technique was employed to ensure representation across undergraduate nursing students at Levels 1 to 4 who were accepted to participate in the study. Several factors led to the choice to enroll undergraduate students. First, the academic development of undergraduate students is still in its early stages. Internship students, on the other hand, are typically more focused on clinical duties and might already have coping strategies that lessen or conceal the effects of these actions. Second, university students are a more suitable group for studying the combination of these behaviors because they spend most of their time in academic and social learning settings where peer interactions and mobile phone use are more prevalent. Contrarily, internship students labor in supervised, structured clinical environments where outside influences (such as hospital policies and patient care goals) could skew the relationship between the variables under study. Last but not least, choosing undergraduates guarantees uniformity in age and academic background, enhancing the findings' internal validity and increasing their applicability to the vast majority of nursing students.

The sample size was calculated using Cochran’s formula (Cochran, 1977). for estimating proportions in large populations: $n_{0} = \frac{z^{2} \cdot p (1 - p)}{e^{2}}$

N population size = 9208, p is the estimated proportion in the population = 0.5, and the margin of error = 5%=0.5. The standard normal value, z, has a 95% confidence level of 1.96.

n_{0} = \frac{{(1.96)}^{2} \cdot 0.5 (1 - 0.5)}{{(0.05)}^{2}} = \frac{3.8416 \cdot 0.25}{0.0025} = 384.16

n = \frac{n_{0}}{1 + \frac{n_{0} - 1}{N}} = \frac{384}{1 + \frac{383}{9208}} \approx 369

To compensate for incomplete or invalid responses, a slightly larger sample was targeted. The final analyzed sample consisted of 379 respondents, which exceeds the minimum required sample size and is therefore adequate to maintain statistical precision at a 95% confidence level. The study sample consisted of the following numbers from each level: 215 from Zagazig University out of 5129, and 164 from Cairo University out of 4079 (supplementary).

Inclusion Criteria

Participants were eligible for inclusion if they were undergraduate nursing students enrolled in Levels 1–4 at Cairo and Zagazig University, both genders, and willing to participate voluntarily after providing informed consent. Students were also required to understand and complete the study questionnaire.

Exclusion Criteria

Students were excluded if they were enrolled in the internship year, had a diagnosis of cognitive impairment or psychiatric disorder, or reported experiencing severe acute physical or psychological conditions at the time of data collection that might significantly affect participation or response accuracy.

Study Instruments

The Selfie-Taking Habits Questionnaire, developed by researchers based on an extensive review of the relevant literature, comprises two sections. Firstly, the Personal data section incorporates items about nursing students, such as age, gender, monthly family income, family type, area of residence, and university name. Secondly, Selfie-taking habits: included seven questions, such as how often you take selfies, why you take selfies, and where you take selfies (Begum, 2019; Nagalingam et al., 2019).

A pilot study was conducted on a small subgroup of participants to assess the clarity and relevance of the Selfie-Taking Habits Questionnaire. No modifications to the instrument were required based on pilot feedback, and the same version was used in the main study. The Selfie-Taking Habits Questionnaire demonstrated acceptable internal consistency, with a Cronbach’s alpha of 74 for the total scale, indicating reliable measurement.

Nomophobia Questionnaire (NMP-Q), developed by Yildirim and Correia (2015). It consists of 20 items, which include four dimensions: “not being able to access information” from question 1to question 4, “giving up convenience” from question 5 to question 9, “not being able to communicate” from question 10 to question 15, and “losing connectedness” from question 16 to question 20. All 20 items in NMP-Q are rated using a 7-point Likert scale, with 1 being ‘‘Strongly Disagree’’ and 7 being ‘‘Strongly Agree. The total Nomophobia Questionnaire score ranges from 20 to 140. NMP-Q scores are interpreted as follows: a score of 20 indicates the absence of nomophobia, a score greater than 20 and less than 60 corresponds to a mild level of nomophobia, a score greater than or equal to 60 and less than 100 corresponds to a moderate level of nomophobia, and a score greater than or equal to 100 corresponds to a severe nomophobia. The internal consistency coefficient, Cronbach’s alpha, for all the items in the NMP-Q was .945, and the four dimensions (being unable to communicate, losing connectedness, being unable to access information, and giving up convenience) were as follows.939, .874, .827, and .814, respectively.

Selfie Addiction Scale, formulated and validated by Arumugam and Nagalingam (2015). The Selfie Addiction Scale is a comprehensive tool for identifying addictive patterns and also factors related to Selfie addiction. It was evaluated using a simplified version of the 10-item questionnaire, based on a 5-point Likert scale (Strongly Agree: 5, Agree: 4, Neutral: 3, Disagree: 2, Strongly Disagree: 1). The summed score of these 10 questions embodies the attitude towards Selfie or the condition caused by Selfie addiction. The Score ranges from 10 to 50 points. Scores between:<20-normal, 21-30-mild addiction, 31-40-moderate addiction, and 41-50-severe addiction. The scale was developed as a content-validated psychometric tool, with all items meeting acceptable content validity standards. The overall content validity index for the scale was 0.94, indicating strong relevance and supporting the scale’s validity (Arumugam et al., 2018).

Locus of Control Short Scale–4 (IE-4). The Locus of Control Short Scale–4 (IE-4) measures two dimensions of the personality trait, internal and external locus of control (Kovaleva, 2012). IE-4 was initially developed and validated in German and subsequently translated into English, with two items for measuring internal locus of control and two for measuring external locus of control. The four items are answered using a 5-point rating scale, ranging from “does not apply at all” (1) to “applies completely” (5). For each subscale, the unweighted mean score of the respective two items is computed to obtain subscale scores for internal and external locus of control. The reliability estimates for IE-4 are .71 for internal locus of control and .64 for external locus of control (Nießen et al., 2022).

Validation of Study Tools

Content Validity

Content validity was assessed by a panel of five academic experts from the Faculty of Nursing at Cairo University [Nursing under code (ID/ZU.Nur.REC#208)], and their feedback was incorporated to refine the study instruments (The Selfie-Taking Habits Questionnaire). A pilot study was subsequently conducted with 10% of the total sample (n = 44 nursing students) to evaluate item clarity and estimate the time required to complete the items. Participants involved in the pilot study were excluded from the final data analysis.

Construct Validity

Construct validity of (The Selfie-Taking Habits Questionnaire) was assessed through confirmatory factor analysis (CFA) using AMOS version 28 (SPSS). Model adequacy was determined using widely accepted fit indices, including a chi-square to degrees of freedom ratio (χ²/df) < 5, goodness-of-fit index (GFI), incremental fit index (IFI), and comparative fit index (CFI) values exceeding 0.90, and a root mean square error of approximation (RMSEA) below 0.08, following established recommendations (West et al., 2023).

The confirmatory factor analysis results indicated that the Selfie-Taking Habits Questionnaire demonstrated an acceptable model fit, with indices meeting recommended thresholds (χ²/df = 4.85, GFI = 0.902, IFI = 0.912, CFI = 0.942, RMSEA = 0.068).

The findings support the construct validity of the developed instrument used in the present study.

Ethics Approval and Consent to Participate

The study was conducted in accordance with the ethical guidelines of the Declaration of Helsinki. The Research Ethics Committee obtained primary approval. Participation in the study was voluntary and obtained through participants’ informed consent, as evidenced by their submission of the completed study tools. The ethical considerations include explaining the purpose and nature of the study to ensure that the information remains confidential and is not accessible to others. The study posed no risk to the participants.

Data were collected via an online survey formed with Google Forms. Nursing students from the first to the fourth year were sent the survey link through the WhatsApp groups created for each academic level. The researcher first distributed the link to students at a particular academic level using a sequential distribution technique. The form was then closed for that group after the number of responses needed to meet the level’s calculated sample size was reached. Then the link was sent to the next academic level, and the procedure was repeated until each group had the desired number of members. This method controlled the number of replies to match the predefined sample size. Following a thorough description of the study’s purpose, students who consented to participate completed the study form. They were informed that their answers would be kept confidential and that they could withdraw at any time without facing any repercussions. All instruments were administered in their original English versions. Although participants were Arabic speakers, they were university students whose entire academic curriculum was conducted in English, making translation or back-translation unnecessary. A pilot study was conducted on a small subgroup of participants to assess the clarity, relevance, and timing of the Selfie-Taking Habits Questionnaire. No modifications to the instrument were required based on pilot feedback, and the same version was used in the main study. The survey was systematically dispersed among all academic levels during its two-month accessibility period, which ran from early December 2024 to the end of January 2025. Participants completed the questionnaires in an average of 15 to 30 minutes.

Statistical Analysis

The statistical analysis of the data was performed using IBM SPSS software version 20.0 (Armonk, NY: IBM Corp, released 2011). Categorical data were summarized as numbers and percentages. For continuous data, normality was assessed using the Kolmogorov-Smirnov test. Quantitative data were described using range (minimum and maximum), mean. The Chi-square test is used for categorical variables, the Monte Carlo correction for chi-square when more than 20% of the cells have expected count less than 5, the Spearman coefficient to correlate between two abnormally distributed quantitative variables, the Kruskal-Wallis test, for abnormally distributed quantitative variables.

Results

Table 1 presents the personal data of the nursing students who participated in the study. The findings indicate that 48.9% of students are aged 21-22 years, with a mean age of 19.89 ± 1.82 years. Additionally, 59.4% are female, and 40.6% are male. Furthermore, 56.2% of students come from rural areas, 74.5% live with their families, and 25.5% live away from their families. Among the nursing students, 55.9% are enrolled at Zagazig University, with 29.3% in their first academic year and 21% in their second year. Regarding income, 64.2% reported having enough income, while 35.8% described their income as just sufficient. Additionally, 36.3% of the nursing students live in nuclear families, and 28.8% live in joint families (Table 1).

Table 1.

Personal Data of Studied Nursing Students (n=379)

Personal data	No.	%
Age (years)
17 – 18	109	29.3
19 – 20	81	21.8
21 – 22	182	48.9
Mean ± SD.	19.89 ± 1.82
Gender
Male	151	40.6
Female	221	59.4
Monthly family income
Enough	239	64.2
Not Enough	133	35.8
Faculty name
Cairo University	164	44.1
Zagazig University	208	55.9
Academic year
First	109	29.3
Second	78	21.0
Third	99	26.6
Fourth	86	23.1
Type of Family
Nuclear	135	36.3
Extended	130	34.9
Joint	107	28.8
Area of Residence
Rural	209	56.2
Urban	163	43.8
Residence
With family	277	74.5
External/university housing	95	25.5

Table 2 shows that 69.4% of nursing students enjoy taking selfies; 53.8% take selfies occasionally, while 18.3% take them daily. Additionally, 43.8% of these students reported taking selfies to pass the time, and 10.2% do so to share them with friends. Interestingly, 58.3% of students said they do not get annoyed when interrupted while taking selfies, whereas 41.7% do. In terms of locations, 46.5% of nursing students take selfies in public, while 21.8% take them on college campuses. The majority, 85.5%, take fewer than 10 selfies per day, while only 4.3% take more than 20 selfies daily. When asked for their opinions, 79.8% of the students believe that taking selfies is a good practice.

Table 2.

Distribution of the Studied Nurses According to Selfie-Taking Habits (n = 372)

Personal data	No.	%
Do you like taking selfies?
No	114	30.6
Yes	258	69.4
How often do you take selfies?
Daily	68	18.3
Weekly	104	28.0
Occasionally	200	53.8
Reason for taking selfies?
Just for time pass	163	43.8
To admire my self	104	28.0
To post on social media	67	18.0
To send my friends	38	10.2
Do you get annoyed when interrupted while taking selfies?
Yes	155	41.7
No	217	58.3
Which place of taking selfies?
Public	173	46.5
Home	118	31.7
College	81	21.8
No. of selfies taken/day
Less than 10	318	85.5
11 – 20	38	10.2
More than 20	16	4.3
Do you think taking selfies is good?
Yes	297	79.8
No	75	20.2

Table 3 assumed that students had a higher total score for Internal Locus of Control (Mean = 7.12 ± 2.20, 63.94%) than for External Locus of Control (Mean = 5.35 ± 2.09, 41.94%). The overall mean score for Locus of Control was 12.47 ± 3.33. The total score for selfie addiction among students was low (Mean = 24.79 ± 8.83, Percent = 36.98%). The average rating on a 5-point scale was 2.48, below the midpoint. Contrarywise, nomophobia was found to be moderately high (Mean = 85.59 ± 21.58, Percent = 54.66%). The most significant concern was the inability to communicate (Mean = 27.31 ± 7.88, 59.18%), highlighting a substantial anxiety about losing phone access. Other significant concerns included difficulties in accessing information (57.75%) and feelings of disconnection (50.53%).

Table 3.

Distribution of the Studied Nursing Students in Terms of Their Scores on Locus of Control, Selfie-Addiction and Nomophobia (n = 372)

	Score Range	Total Score		Average Score (1 – 5)	Percent Score	Rank
	Score Range	Min. – Max.	Mean ± SD	Mean ± SD	Mean ± SD	Rank
Locus of Control
Internal of Control	(2 – 10)	2.0 – 10.0	7.12 ± 2.20	3.56 ± 1.10	63.94 ±27.53	1
External of Control	(2 – 10)	2.0 – 10.0	5.35 ± 2.09	2.68 ± 1.04	41.94 ±26.10	2
Overall	(4 – 20)	4.0 – 20.0	12.47 ± 3.33	3.12 ± 0.83	52.94 ±20.79
Selfie-Addiction	(10 – 50)	10.0 – 50.0	24.79 ± 8.83	2.48 ± 0.88	36.98 ±22.06
Nomophobia
Not Able communicate	(6 – 42)	6.0 – 42.0	27.31 ± 7.88	4.55 ± 1.31	59.18 ±21.90	1
losing connectedness	(5 – 35)	5.0 – 35.0	20.16 ± 6.88	4.03 ± 1.38	50.53 ±22.93	4
Not being accessible	(4 – 28)	4.0 – 28.0	17.86 ± 5.28	4.47 ± 1.32	57.75 ±22.01	2
Giving up convenience	(5 – 35)	5.0 – 35.0	20.27 ± 6.76	4.05 ± 1.35	50.89 ±22.53	3
Overall	(20 – 140)	20.0 – 140.0	85.59 ±21.58	4.28 ± 1.08	54.66 ±17.99

Table 4 indicates the indirect effect was significant (β = 0.114, 95% CI: 0.030–0.214), indicating partial mediation. Self-addiction significantly predicted lower locus of control (β = –0.107, p < 0.001), which in turn predicted higher nomophobia (β = –1.568, p < 0.001). The direct effect of self-addiction on nomophobia remained significant (β = 0.667, 95% CI: 0.423–0.911), confirming partial rather than full mediation. Approximately 14.6% of the total effect was mediated by the mediator. Model fit indices from AMOS showed excellent fit (CFI = IFI = TLI = 1.000; SRMR = 0.000).

Table 4.

Mediation Analysis Using Hayes’ PROCESS Macro (Model 4) With Bias-Corrected Bootstrap0020Confidence Intervals Based on 5,000 Resamples

	Dependent variables	Independent variables	β	95% CI (LL – UL)	Beta	R²	SE	T	p
Model path	Locus	Addiction	-0.107	-0.144 – -0.071	-0.285	0.081	0.019	5.720^*	<0.001^*
	Nomophobia	Locus	-1.568	-2.212 – -0.924	-0.242	0.058	0.327	4.790^*	<0.001^*
	Nomophobia	Addiction	0.782	0.545 – 1.018	0.320	–	0.120	6.487^*	<0.001^*
Type of effect	Direct Effect (c′)		0.667	0.423 – 0.911	0.273	–	0.124	5.376^*	<0.001^*
	Indirect Effect (ab)		0.114	0.030 – 0.214	0.047	–	0.047	2.426^*	<0.001^*
	Total Effect (c′ + (ab))		0.782	0.545 – 1.018	0.320	0.102	0.120	6.487^*	<0.001^*

Self-Addiction: Independent variable.

Locus of Control: Mediator.

Nomophobia: Dependent Variable. Statistical significance at p < .05

Mediation Analysis Results

Figure 1 illustrates that the Path coefficient is -0.107. Moreover, the path coefficient of -1.063 indicates a strong negative relationship. Finally, the path coefficient: 0.667 clearly demonstrates that increased selfie addiction directly drives higher levels of nomophobia. The mediation analysis demonstrated a statistically significant indirect effect of the independent variable on the dependent variable through the mediator. The proportion of the mediated effect was 14.58%, indicating that the mediator accounted for a modest portion of the total effect.

Figure 1.

Relationships between Selfie-Addiction, Locus of Control, and Nomophobia among nursing students using a path analysis model (n = 372)

The mediation model was specified as a just-identified (saturated) model, resulting in zero degrees of freedom. Consequently, model fit indices such as the comparative fit index (CFI = 1.000), incremental fit index (IFI = 1.000), Tucker–Lewis index (TLI = 1.000), and standardized root mean square residual (SRMR = 0.000) indicated perfect fit by definition rather than model superiority. The chi-square could not be meaningfully computed because the model lacked degrees of freedom. Additionally, the root mean square error of approximation (RMSEA = 0.266) is not considered interpretable in just-identified models.

Discussion

An individual’s vulnerability to nomophobia and selfie addiction, two issues that are becoming more prevalent in our digital age, is greatly influenced by their locus of control. There is a higher likelihood that these behaviors are obsessive among those with an external locus of control regarding smartphone use and online self-presentation, because they tend to look to others for approval and acceptance. This need for outside approval can cause them to take more selfies in an attempt to gain approval and attention on social media, and being unable to leave their phones can further increase their anxiety levels. Conversely, students with a strong internal locus of control exhibit greater self-efficacy and improved emotional regulation, which enables them to avoid dependence on mobile devices. Thus, methods for developing a more robust internal locus of control may be crucial for lowering psychological reliance on electronic gadgets (Durak, 2018). Therefore, the purpose of our research is to investigate the mediating role of locus of control in the relationship between nursing students' nomophobia and selfie addiction.

The findings indicated that selfie addiction had a low mean score in relation to the first research question, suggesting that while nursing students take selfies, their usage usually does not escalate to harmful levels. The present finding suggests and confirms the complexity of the nursing students' experiences. Although they frequently engage in taking selfies and think that taking selfies is good, they don’t appear to have sufficient time for leisure activities, nor have they reached a level of addictive use despite being considered a high-risk population.

Balakrishnan and Griffiths (2018) found that moderate selfie behavior can be normative without necessarily reflecting disorder, which is consistent with these results. Additionally, an Egyptian study, which shares cultural similarities with our context, by Mohamed and Abdel, 2019, reported that only a small percentage of students engaged in borderline selfie behavior. In contrast, three-quarters of them suffered from severe selfie addiction. This might be because the selfie does not hurt the study sample. On the same line, Shajan et al. (2023) discovered that 68% had acute selfitis, 3% had borderline selfitis, and 29% had chronic selfitis.

El-slamoni et al. (2021) found that Egyptian nursing students took significantly more selfies per day than their Saudi counterparts (higher “usually” use: 58.7% vs. 32.0%), while Saudis showed a stronger preference for Instagram posting (82.0% vs. 60.0%). These differences highlight cultural influences: Egyptian females exhibited greater selfie-taking than Saudi females, whereas Saudi males took more selfies, likely reflecting traditional Saudi norms restricting female self-presentation. Additionally, Saudis reported higher selfie motives linked to depression/sadness (14.7% vs. 2.7%), indicating distinct emotional drivers across the two cultures. This confirms that nursing students persist at a borderline position between challenging use and safe use, with their coping strategies helping as the determining factor.

On the other hand, nomophobia was found to be moderately high. These results may be explained by the fact that although nursing students reported occasionally using their phones for selfies, most reported wanting to take selfies to pass the time. This shows that they cannot live without their phones and that they have a phobia or anxiety related to being cut off from them. Additionally, the existing results extend this understanding by highlighting potential implications for nursing education. This result aligns with the findings of Çolak and Önder (2020), who reported a mean score of 54.4 ± 15.18 on the nomophobia scale for their participants. Additionally, Tavolacci et al. (2015) stated that one-third of university students have nomophobia. A survey by Güner and Demir (2022) revealed that participants experienced moderate-to-severe nomophobia. Another study by Gezgin and Çakır (2016) found that students' nomophobia levels were slightly higher than average.

The results of this study indicate a higher mean internal locus of control score. This may suggest that the participating nursing students have confidence in their own abilities. They attribute their behaviors and typically believe they have personal control over them. These skills reflect the foundation traits of nursing students, who are the future of the healthcare workforce. These findings are consistent with those of Wahyeni and Gailea (2022) and Alkhazaleh and Alomery (2023), who report that nursing students have a high degree of internal locus of control, making them feel they are in charge of their own lives.

Answering the second research question, this study identified significant patterns, including a notable negative correlation between locus of control and selfie addiction and a substantial positive correlation between selfie addiction and nomophobia. Based on the obtained results, it can be inferred that locus of control is crucial in understanding different forms of addiction, as people with an external locus often feel that their lives are guided by external influences, which increases their susceptibility to addictive behaviors. Besides, the notable relationship recommends that digital dependency may act as both a coping mechanism and a maladaptive behavior, warranting critical consideration within nursing curricula. Incorporating training on self-regulation, psychological resilience, and digital professionalism can assist moderate these risks.

Conversely, individuals with an internal locus are typically more resilient and skilled at managing their impulses, reducing the likelihood of problematic digital phone use. In the same line, study result by Muraina and Popoola (2022) showed a significant relationship between locus of control and internet addiction (r=0.12; p<0.05), additionally a study conducted by Boggero et al., (2022) showed that a statistically borderline correlation between external locus of control and selfie (r = -. 12) and a significant correlation was found between the score of the selfie and nomophobia (r = .40) confirmed subjects with severe nomophobia reported the highest scores in the selfie addiction scale.

This study revealed significant trends regarding the third research question, indicating that locus of control plays a mediating role in the relationship between selfie addiction and nomophobia among nursing students. This finding suggests that nursing students who believe they have control over outcomes (internal locus of control) are less susceptible to the fear of being without their phones, even if they engage in frequent selfie-taking behavior. In contrast, those with an external locus of control may rely more heavily on phones for reinforcing nomophobia.

Similarly, Widiyanto et al. (2022) demonstrate that locus of control mediates the relationship between financial literacy and peer group consumption behavior. Additionally, Yı lmaz and Y ı ld ı z, 2023 also found that locus of control acts as a partial mediator between digital addiction levels of pre-service teachers and their attitudes toward reading. Furthermore, Gunlu and Bas (2022) found that self-control mediates the relationship between psychological needs and nomophobia.

Overall, the results point to the locus of control acting as a mediator element between two dangerous phone-related behaviors. Nonetheless, the observed levels of these behaviors among nursing students still indicate a significant danger. To change such behaviors and lessen their detrimental effects, future intervention research is suggested to focus on improving the internal locus of control and coping abilities.

Strengths and Limitations

The study was limited to nursing students from two public universities, which may have limited its generalizability to other populations or educational disciplines. Additionally, the use of self-reported instruments distributed via WhatsApp may have introduced self-selection and volunteer bias, as well as social desirability and recall inaccuracies. Data collection was conducted online, possibly excluding participants without internet access or technological familiarity. Furthermore, the cross-sectional design limits the ability to infer causal relationships among the study variables, and the mediation analysis is interpreted as exploratory rather than causal. Another limitation concerns the locus of control tool, which uses a brief self-report scale. Although the instrument is widely used, its general nature and limited number of items may not fully capture the multidimensional construct of locus of control, particularly within the context of digital behavioral addictions.

Implications for Practice

These results highlight the significance of strengthening the locus of control as a strategy to mitigate nomophobia associated with selfie addiction. From a nursing perspective, incorporating seminars or modules into nursing curricula can equip nursing students with the knowledge and competencies needed to recognize and manage digital addiction and its psychological effects in both clinical and community settings. Additionally, healthcare and educational Institutions should develop and implement initiatives in digital wellness guidelines programs to promote responsible smartphone use and reduce digital reliance in educational contexts. Experimental and longitudinal research is encouraged to investigate the causal relationships and long-term effects of digital dependency on academic and psychological outcomes and to examine temporal ordering and potential causal pathways among these variables.

Conclusion

According to the study’s findings, nursing students' internal locus of control scores were higher overall than their external locus of control scores. Students' overall score for selfie addiction was low. Conversely, nomophobia was found to be moderately high. The results suggest a partially complementary mediation, indicating that self-Addiction affects nomophobia both directly and indirectly via the mediating role of Locus of Control. This underscores the critical function of locus of control as a mediator in this relationship, while also confirming the direct influence of self-Addiction on nomophobia.

Supplemental Material

Supplemental Material - In the Palm of Your Hand: The Mediating Role of Locus of Control in Selfie Addiction and Nomophobia Among Nursing Students

Supplemental Material for In the Palm of Your Hand: The Mediating Role of Locus of Control in Selfie Addiction and Nomophobia Among Nursing Students by Lamiaa Abd El Hakeem Ali Ahmed, Maha Ibrahim El Bayoumy Ali, Abdulqadir J. Nashwan, Soheir Mohammed Ahmed Ali, Basma Abd El Majid Adly in Sage Open Nursing

Supplemental Material

Supplemental Material - In the Palm of Your Hand: The Mediating Role of Locus of Control in Selfie Addiction and Nomophobia Among Nursing Students

Footnotes

Acknowledgement

The researchers would like to extend their thanks to all the students who participated in this study.

ORCID iDs

Lamiaa Abd El Hakeem Ali Ahmed

Abdulqadir J. Nashwan

Ethical considerations

The study was conducted in accordance with the Declaration of Helsinki ethical guidelines. Primary approval was obtained by the Research Ethics Committee at Zagazig University’s Faculty of Nursing under code (ID/ZU.Nur.REC#209).

Consent to Participate

Participation in the study was voluntary and based on obtaining participants’ informed consent through their submission of the completed study tools. The ethical considerations include explaining the purpose and nature of the study to ensure that the information remains confidential and is not accessible to others. The study posed no risk to the participants.

Authors’ Contributions

L.A.A.: conception of the work, edited and drafted the paper, conceived and designed the study. B.A.A.: conception of the work, edited and drafted the paper; and M.I.E.: Performed the statistical analyses, Methodology, and Formal analysis; S.M.A., Funding Acquisition, Visualization. A.J.N.: critical review and final editing. All authors provided input regarding the manuscript and approved the final version. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.*

Supplemental Material

Supplemental material for this article is available online.

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