key: cord-1022787-1zafmx2m
authors: Rakhmawati, Windy; Kosasih, Cecep Eli; Widiasih, Restuning; Suryani, Suryani; Arifin, Hidayat
title: Internet Addiction Among Male Adolescents in Indonesia: A Qualitative Study
date: 2021-06-30
journal: Am J Mens Health
DOI: 10.1177/15579883211029459
sha: 443778bf37a7a8301f87751f3b8c4adf4bef9a48
doc_id: 1022787
cord_uid: 1zafmx2m

Internet has become an important part of the daily life of adolescents. Easy access to internet and its social appeal among adolescent males render them at an increased risk of internet addiction and the associated adverse physical and psychosocial effects. We conducted a qualitative study using a phenomenological approach. A purposive sample of nine male adolescents was recruited in West Java, Indonesia. Semistructured interviews were conducted until data saturation was achieved. Data were subjected to thematic analysis. We identified four main themes from the experiences of adolescents with internet addition: reasons for internet addiction, unmet social need without the internet, effects of internet addiction, and self-control over internet usage. Internet addiction among male adolescents is a major public health problem that should be addressed. The findings of this study may be useful for health professionals and families to help male adolescents manage their internet addiction.

Recent years have witnessed a dramatic increase in the use of internet across the world. In particular, internet has become an important part of the daily life of adolescents (Ballarotto et al., 2018) . Globally, Indonesia ranks fourth in terms of the number of internet users (approximately 64.8%). Adolescents account for the highest proportion of internet users in Indonesia (Indonesia, 2018; Stats, 2020) . Studies have documented a growing phenomenon of excessive internet use and internet addiction (IA) among adolescents, including online gaming (Shek & Yu, 2016) . A previous study in Aligarh showed that male adolescents are more liable to IA compared to female adolescents (Arthanari et al., 2017) . A study conducted in China found high prevalence of IA among adolescents, which adversely affected their well-being (decreased selfesteem, life satisfaction, and increased depression; Wang et al., 2013) . IA has been shown to affect physical and psychosocial well-being by inducing mental distress, impairing academic performance, and affecting family relationships (Al-Gamal et al., 2016; Clark et al., 2004; Kusnanto et al., 2020; Tsitsika et al., 2011) Adolescence is a period of development marked by significant biological, cognitive, psychosocial, emotional, and personal relationship changes (National Academies of Sciences, 2019). Male adolescents are strongly attracted to the internet, which is easily accessible and offers unlimited access to information and connection with others worldwide (Kurniasanti et al., 2019) . Adolescence is the stage of development wherein individuals try to express their identity, which can cause emotional crisis as well as trigger interpersonal and social conflict. However, male adolescents tend to distract themselves from negative thoughts by overusing the internet as a coping mechanism (Karacic & Oreskovic, 2017; Rębisz & Sikora, 2018; Santrock, 2011) .

Many parents are unaware of the effects of IA among adolescents (Wu et al., 2016) . Owing to the lack of knowledge, parents may inadvertently promote excessive online activities (such as online gaming) by the children; in addition, lack of parental attention and interaction may also act as aggravating factors in promoting IA (Drayton et al., 2014; Schneider et al., 2017) . Moreover, family conflict also causes adolescents to seek diversion to the internet, which can lead to addiction (Schneider et al., 2017) . However, there is still much that needs to be known and explored about IA among male adolescents. In addition, better characterization of IA among adolescents can help inform interventions aimed at prevention and management of IA and promotion of healthy child development in the internet era.

Given the negative physical and psychosocial effects of IA on male adolescents, exploring the effects of IA and development of strategies to reduce IA is imperative. There is a paucity of studies about IA that focus on behavioral aspects, effect of IA, and self-control among male adolescents. The gap in knowledge about internet use among adolescents and the role of parents needs to be addressed. The aim of this study was to identify the socioemotional phenomena among male adolescents with IA in Indonesia, which can help inform policy-level interventions against IA.

A qualitative study with a phenomenological approach was undertaken between February and October 2020. A phenomenological approach is effective in describing the meaning of the phenomena related to IA among adolescents (Creswell, 2014) . We explored the life experiences from the perspectives of adolescents (Neubauer et al., 2019) .

A purposive sample of nine adolescents with senior high school education level who exhibited IA behavior were enrolled. Participants belonged to several cities in the West Java province of Indonesia. IA test was used by researchers to determine the IA behavior among adolescents (Young Nabuco de Abreu, 2011). The inclusion criteria were male adolescents with IA behaviors. Purposive sampling was carried out by selecting participants who had knowledge and experience of IA in several high schools (Cresswell & Plano Clark, 2011) . The availability and willingness to participate, and the ability to communicate experiences and opinions in an articulate, expressive, and reflective manner are important determinants of purposive sampling (Bernard, 2017) . After identification, the potential participants were contacted and provided information about the study. Verbal and written informed consent was obtained from all participants prior to their enrolment.

All participants underwent individual semistructured interviews, which helped the researchers to systematically focus on the aims of the study and to obtain participants' experiences (Jamshed, 2014) . Using an interview guide, the lead author conducted in-depth interviews, which explored the participants' experiences with IA, effects of IA, and strategies to reduce IA. Data collection and analysis took place concurrently. Data saturation was reached, when no new information was discovered with repeated confirmation, and recurrence of themes and codes during data analysis. These are redundancy signals indicating that data collection may cease (Faulkner & Trotter, 2017; Morse et al., 2002) .

Participants were interviewed by telephone to prevent transmission of COVID-19. Strategies to ensure the success of the telephone interviews included the use of speakerphones and recording of interviews with the permission of participants. The interviewer also provided a private space in order to minimize background noise and distraction. The duration of each telephone interview was limited to 30-40 min to avoid fatigue and inattention. The identity of the participant was also confirmed by the researcher prior to the initiation of the interview (Bolderston, 2012) . The strategy of investigator triangulation was used for data analysis, which refers to the use of several researchers in a study (Noble & Heale, 2019) . Lincoln and Guba's evaluative criteria for qualitative research was applied for establishing the trustworthiness of this study, including credibility, dependability, confirmability, and transferability (Polit & Beck, 2012) .

We use NVIVO version 1.4.1 for Mac to manage and organize the categories. Then, WR transcribed and analyzed the data using thematic analysis. This type of analysis is used to uncover complex meanings and group these into themes. Thematic analysis consists of (1) familiarizing oneself with the collected data by reading through it several times; (2) searching for meanings and themes by exploring their similarities and differences to identify patterns; and (3) organizing themes into a meaningful whole (Sundler et al., 2019) . Peer debriefing was implemented by having all researchers discuss the data during analysis. Subsequently, the analyzed data were returned to the participants to re-check and validate the findings.

Ethical approval for this study was obtained from the Research Ethics Committee of Universitas Padjadjaran (No. 465/UN6.KEP/EC/2020). All participants were provided information about the study, following which written informed consent was obtained using a Google Form. Parental consent was not required because risks were deemed minimal, and the confidentiality of responses was assured. This is consistent with best practices in research (Holder, 2008) . Confidentiality in this study was assured by protecting the identities of participants in the collected data. The names of all participants were coded (e.g., P1 for participant number 1) in all documentation and only the researchers knew about the codes. Nevertheless, participants were encouraged to seek parental or school support prior to participating. Participation in this study was entirely voluntary with no potential for physical or mental harm to the participants.

Demographic data are presented in Table 1 . The age of participants ranged from 15 to 17 years. Most participants accessed the internet via their mobile phones. Participants mainly used the internet for (1) entertainment, such as online gaming, watching Korean dramas, and YouTube, or accessing social media applications such as Instagram, Facebook, Twitter, and TikTok; (2) peer-to-peer messaging through WhatsApp and Line; and (3) seeking information, particularly related to school assignments and activities (using Google) and other purposes including business and online shopping (using Tokopedia). Most participants used internet for more than 8 hr per day.

Four main themes emerged from the data analysis: reasons for IA, unmet social need without the internet, effects of IA, and self-control over internet usage (Table 2) .

All participants reported that their IA had developed over time due to habitual frequent use of internet. We identified distinct external, internal, and COVID-19-related factors that contributed to IA.

External Factors. External factors included the influence of peers (friends) who accessed the internet, which placed pressure on participants to use mobile phone and internet.

Almost all my friends always use a mobile phone; thus, if I do not use it too, I feel awkward, and I do not know what I have to do (P1).

Another external factor was the family environment.

Owing to the lack of intensity of relationship and interaction with the family members, the participants used internet and mobile phone as a means of distraction. In addition, at home, all family members are busy with work and mobile phones. Everybody in my family is busy with their own business. Everybody stays in their own room. We rarely interact with each other. Everybody is busy with their own mobile phone (P1).

Internal Factors. Internal factors included loneliness, boredom, and distraction from problems. One participant expressed that he overused the internet to reduce his feelings of loneliness: Five participants reported that they overused the internet to reduce their feelings of boredom. For instance, one participant spent most of his time in online entertainment avenues.

My parent rarely stays at home, so accessing the internet is good to reduce my boredom. . . I often play games and watch YouTube (P4).

Avoidance of danger from gangs was also reported as a reason for overuse of the internet: I saw terrible fighting between adolescent gangs. It is a terrifying thing if I have friends like them. It is better if I stay at home and have no friends. . . I worry that I will be influenced by the bad things. (P7) COVID-19 Factors. Four participants expressed that their addiction had worsened during the COVID-19 pandemic because of the need to stay at home and quarantine for long time, including for schooling. I often play games online, but I have spent more time during this pandemic (P6).

This theme relates to the behaviors and feelings of adolescents related to IA. This theme consisted of three categories, namely internet behavior, feeling about the internet, and feelings when unable to connect to the internet. Gamers also experienced a feeling of achievement when they won a game. Adolescents feel that winning a game is an achievement because it implies their ability to compete in a challenge and beat the opponents in the game. In addition, by playing games, users can collect points that can be used to upgrade the characters in the game. In addition, online games can also be addictive. One participant reported:

I am addicted to gaming online. I play in teams, and the cohesiveness of the team and the excitement of gaming online make me comfortable. Particularly, when I win the game, it makes me more addicted (P7).

Feelings When Unable to Connect to the Internet. When participants were unable to connect to the internet, they felt that something was incomplete or missing in their life. This was because the participants were already addicted to mobile phones and the internet. Therefore, they felt the need to carry a mobile phone at all times. One participant described this feeling. 

The four main effects of IA were related to daily activities, interpersonal relationships, physical effects, and psychological effects. Psychological Effects. Psychological effects of IA were reported by four participants. These participants reported feelings of emotional lability (easily angered) or insecurity. Some participants felt angry if they felt inconvenienced, did not win an online game, or had a poor internet signal. Another participant felt insecure as a result of social media addiction:

I often access social media. I often see other people who have many advantages and more than me. I feel insecure. Why I am like this? When will I be like them? It is about a physical problem. I always feel inferior and ugly. (P1)

At times, participants would become aware of their excessive internet use, particularly when they experienced its effects on their life or were reprimanded by their parents. Participants resorted to several self-control strategies to reduce their internet habit, including forming relationships with people, engaging in other activities, and controlling their internet usage.

Forming Relationships With Others. Four participants described their attempts to reduce their internet use by increasing their interactions with others. One participant, who engaged in online gaming for long periods through his mobile phone, stated:

I try to go out and play with my friends. If I play with them, I rarely hold my mobile phone (P6).

Engaging in other activities such as playing football, taking care of pets, joining a martial arts class, or helping with household tasks was another strategy used to reduce internet use. One participant who frequently accessed the internet for entertainment attempted to reduce his internet use because of its physical effects.

Sometimes I had sore eyes when using my mobile phone. . . then I stopped it and tried to find other activities to do. . . helping my mother, playing football, or other activities (P8).

Controlling Internet Usage. The final strategy reported by participants was to control their internet use by turning off their mobile data, deleting game applications, managing their time, and putting away their mobile phone. For example, one participant who had been admitted to hospital from overuse of the internet stated: 

In this study, we elicited the reasons for IA, unmet social need without the internet, effects of IA, and strategies to reduce IA adopted by adolescents with IA. However, management of IA among adolescents is a serious concern for parents, society, and health workers.

In this study, we found that several factors related to the COVID-19 pandemic aggravated IA among adolescents. The internal factors (loneliness, boredom, and avoidance of danger from gangs) and external factors (friends and family environment) contributed to excessive internet use and addiction among male adolescents. Participants were typically first introduced to the internet by their peers. This finding is similar with that of a study conducted in the United States in which peer attachment had an influence on internet use among adolescents (Reiner et al., 2017) . On the other hand, poor relationships with friends or family, leading to feelings of loneliness and boredom were reported as a trigger for excessive internet usage. Participants used the internet excessively as a coping mechanism for loneliness and boredom. Previous studies have found a significant relationship of IA with loneliness (Cheung et al., 2018; Yayan et al., 2019) or boredom (Tenzin et al., 2019) . Poor family relationships may also lead to reduced parental control over adolescent internet use (Cacioppo et al., 2019) . The IA is worsened during the COVID-19 pandemic because of school closures and the need to stay at home. This situation is similar to that reported in China, where addictive internet use among children and adolescents increased during the COVID-19 pandemic (Dong et al., 2020; Duan et al., 2020) . Moreover, this information may underlie the occurrence of IA behavior among adolescents in Indonesia.

As an effect of IA, adolescents experience an unmet social need in the absence of internet. This is certainly a worrisome connotation of IA, wherein the internet affects the condition and social needs of adolescents. Participants in our study spent a lot of time on the internet, more than 8 hours per day. They mostly accessed the internet using their mobile phones, which made it an inseparable part of their daily life. Keeping the mobile phones turned on possibly made it easier for them to access the internet anytime and from anywhere (AlBarashdi et al., 2016; Tenzin et al., 2019) .

This study revealed a new model wherein the IA provided a sense of social connection through social media or online games. This finding aligns with that of a previous study, which found that social media use and online gaming were predictors of social connectedness, defined as the feeling of being a significant part of one's social and emotional relationships (Savci & Aysan, 2017) . Engaging in social media through checking, posting, and interacting can lead to addiction (AlBarashdi et al., 2016) . Participants played online games in teams and developed connections with friends in many places (Lee & Kim, 2017; Young Nabuco de Abreu, 2011) . Peer groups and friendships are an important aspect of adolescent life (Savci & Aysan, 2017) . However, this cannot be justified in its entirety, since IA can have negative effects in the future (Cash et al., 2012) . Social connections can be established via other means without developing IA.

The effect of IA expressed by adolescents included physical and psychological health problems and the adverse effect on interpersonal relationships and daily activities. This finding is consistent with those of studies conducted in Malaysia and Bhutan, which have reported the adverse effects of IA on the psychological health of younger generations (Shah Alam et al., 2014; Tenzin et al., 2019) . Adolescents with severe IA must immediately seek treatment to prevent mental health problems, which can adversely affect their development and growth.

However, adolescents were aware of the need to exercise self-control for mitigating IA. The participants attempted to control their internet use, even though they were not consistent in their efforts. Self-control can induce behavioral change among adolescents, which is important to reduce IA if consistently applied (Akın et al., 2015) . A previous study identified several strategies used to reduce IA, including controlling the time spent online, increasing the frequency of interpersonal interactions, increasing involvement in other activities, being aware of the effects of IA, and using the internet to solve realworld problems (Rębisz & Sikora, 2018) .

Insights gained from this study can help assist health professionals and families in understanding the experiences of IA among male adolescents. Our findings can help inform interventions to manage, prevent, and reduce IA among male adolescents. Educational and psychosocial counseling are required to increase awareness about the effects of IA. In addition, introvert adolescents were found to be at a greater risk of IA. Thus, promotion of physical activity, group activities, and interaction between parents and adolescents can help prevent IA.

Some limitations of this study should be acknowledged. This study adopted a phenomenological approach using a small sample of Indonesian adolescents. Therefore, the findings may not be entirely applicable to other sociocultural contexts and countries. Participants may have chosen to avoid discussing topics such as pornography, which may have resulted in missing data. Nonetheless, this study enriches the contemporary knowledge about IA among male adolescents, which may be transferable to populations with a similar culture. Further research in other populations is recommended.

Internet use has benefits as well as negative effects when excessive. This study explored the experiences of IA among male adolescents, who described having an unmet social need without the internet, the reasons for their IA, the effects of IA, and their self-control over internet usage. These findings may assist health professionals and families to support male adolescents in managing and reducing their internet use.

Thanks to Universitas Padjadjaran for supporting this study and to participants for joining in this study.

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

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grant number 1427/UN6.3.1/ LT/2020 from Universitas Padjadjaran.

Windy Rakhmawati https://orcid.org/0000-0001-7173-4886

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