25 JANUARY – JUNE 2023, VOL,5. NO.1 J Aziz Fatm. Med Den College Original Research Prevalence and Purpose of Medical App Usage in Pakistan: A Cross-Sectional Study Ibtehaj Munir, Farhat Ijaz, Kanza Waqar, Iman Hussain, Rana Khurram Aftab, Asim Zia ABSTRACT Objective: To determine the prevalence and purpose of medical app usage in Pakistan. Methodology: A cross-sectional study was conducted using a pretested form, distributed via Google Forms. Convenience sampling was used to select a sample of 357 MBBS, BDS, Allied Health, and Nursing students of CMH Lahore Medical College. Data was analyzed using “SPSS version 23.0”. Descriptive statistics were calculated as frequencies. A “p-value” of less than 0.05 was deemed statistically significant Results: Out of all the participants (357), 40.3% were males, and 59.7% were females, with an average age of 20.89 ± 1.61. 95.5% of the participants used intelligent devices, and 86.6% were aware of the medical apps available for use on mobiles. A majority (64.1%) of the students had various medical apps installed on their phones. Almost half of these students (45.1%) were advised by medical educators to use different medical apps for their studies. Most of the students made use of medical apps to search for medical information (49.7%), followed by exam preparations (37.6%), Revision (34.6%), and preparation of presentations (26.4.%). The use of general clinical textbooks and clinical skills guide apps were 22.2% and 23.9%, respectively. 20.5% of the participants did not use Medical Apps for any purpose. A Likert scale showed that students think that Medical Apps are easy to obtain, and many of them frequently use them too. They believe that these apps save time during clinical practice. Medscape was the most common app being used (29.3%), followed by Gray’s Anatomy (25%) and Pharmapedia (23.9%). Conclusion: The common usage of medical apps was recurrent amongst medical students. KEYWORDS: Medical Apps, Medical Students, Smartphones INTRODUCTION Conventionally the primary medium for obtaining education for students was textbooks1; however, with passing the time and advancements in technology, there has been an increase in the tools available to acquire information with mobile Ibtehaj Munir, MBBS House Officer CMH Lahore Medical College & Institute of Dentistry, LHR, Pakistan Farhat Ijaz, MBBS, Mphil Associate professor CMH Lahore Medical College & Institute of Dentistry, LHR, Pakistan Kanza Waqar, MBBS House Officer CMH Lahore Medical College & Institute of Dentistry, LHR, Pakistan Iman Hussain, MBBS CMH Lahore Medical College & Institute of Dentistry, LHR, Pakistan Rana Khurram Aftab, MBBS Additional medical superintendent Services hospital LHR, Pakistan Asim Zia, MBBS, Msc Assistant professor Continental Medical College, Lahore Correspondence Dr. Farhat Ijaz Email: farhatkhurrumrana@cmhlahore.edu.pk phones and applications (apps) replacing the traditional settings of acquiring knowledge.2The world's earliest smartphone was launched in 1994, and the portion of individuals using smartphones have been steadily increasing since then.3 Hence, innovative mobile technology has penetrated deeply into society in a relatively short period, attracting a range of subscribers ranging from school going children to senior citizens.4 Smartphone applications and the internet have introduced a recent wave of approachability and flexibility within academic processes.5 A similar trend can be seen in Medical education, as it was shown that smartphones are a valuable educational aid for medical students4. Greater than 13,000 mobile applications associating to health under the headings of "medical" and "healthcare and fitness" are available on different App stores.4 Medical students are using smartphone applications for many purposes, including guidelines for clinical setup, medical calculators, drug reference tools and other decision-support aids, textbooks, and literature search portals.6,7,8 Numerous apps cater to 26 Ibtihaj Munir at el JANUARY – JUNE 2023, VOL,5. NO.1 J Aziz Fatm. Med Den College multiple subfields of medicine, while others are used for mere ease and convenience and to decrease the paper load. For example, some apps can simulate surgical procedures and operations. In contrast, others can be used to assess various sensory functions of the body, such as hearing and visual tests, and other apps are used as an alternative to constantly buying and carrying a load of new edition textbooks as medical applications by way of technology are constantly being updated with apt information.9,10 These apps can further help healthcare workers to remember their appointments, provide reference ranges for multiple systems of the body, count calories and count the Body Mass Index without applying much manual labor.11 Various research on the use of mobile phones and applications in supporting medical students has been undertaken worldwide, and as data suggests, intelligent devices were deemed beneficial to 84% of medical students in the United Kingdom. 8. Another study conducted at Monash University, Melbourne, Australia, stated that 76% of students using smartphones used medical applications. Similar results were obtained at a Canadian university where 65% of students utilized a medical application to access clinical texts and pharmacological references.12 However, a discrepancy was seen in Pakistan, where one study suggested the frequency of usage of these smartphone apps was 71%, 2while another stated it was 41.46%, so there was a difficulty in understanding the prevalence observed in this region.13 There has been very little research focused on this topic in Pakistan to reflect upon the benefit of medical phone applications amongst medical students despite smartphones' fair use and popularity in the medical setup. So the current study was designed to explore the knowledge and perception regarding medical apps among participants, and to determine the prevalence of medical app usage in Pakistan, and the purpose for which they are used. METHODOLOGY A cross-sectional analysis was conducted on "CMH Lahore Medical College" students from January to July 2021 after taking informed consent. Students of all years from MBBS, BDS, nursing, and allied health sciences were part of the study. A convenience sampling method was used. A sample size of 306 was calculated using the WHO equation: “n = z2 x p x (1 - p) / e2” Where: z = 1.96 for a confidence level (α) of 95% p = proportion (expressed as a decimal), e = margin of error. We got 357 responses just to be on the safer side. The data were collected utilizing a pretested, self- designed questionnaire. The questionnaire was comprised of three main parts. The first portion of the questionnaire asked questions on demographic data like age, gender, Year, the field of study, whether or not to use a mobile device, having medical apps installed on the smart device, and the intent of installing the applications. The second portion was focused on the students' perceptions of medical apps on smartphones. The third portion aimed to see the importance of medical applications in clinical practice. The fourth portion asked about the students' use of various medical applications and aimed to identify the prevalent applications among them. Five options were given to the students in the second part of the questionnaire, from which they could select only one from the following: strongly agree, agree, neutral, disagree, or strongly disagree. Statistical analysis The information collected was analyzed using “SPSS version 23.0”. Descriptive statistics were calculated as frequencies. A “P- value” of less than 0.05 was deemed statistically significant. The "Ethical Review Committee of CMH Lahore Medical College" provided ethical approval. RESULTS Out of all the participants (357), 40.3% were males, and 59.7% were females, with a combined mean age of 20.89 ± 1.61. 95.5% of the participants used intelligent devices, and 86.6% were aware of the medical apps available for use on mobiles. A majority (64.1%) of the students had various medical apps installed on their phones. Almost half of these students (45.1%) were advised by their medical educators to use different medical apps for their studies. (Table `1) Most of the students used medical apps for Looking up Medical Information (49.7%), followed by Exam Preparations (37.6%), Revision (34.6%), and Preparation of Presentation 27 Prevelance purpose of medical app usage JANUARY – JUNE 2023, VOL,5. NO.1 J Aziz Fatm. Med Den College (26.4.%). The use of General Clinical Textbooks and Clinical Skills Guide apps were 22.2% and 23.9%, respectively. 20.5% of the participants did not use apps for any purpose. (Table 2) All of the items in Tables 3 and 4 were scored on a Likert scale, and the average and standard deviations for each response were determined. 1 stood for Strongly Agree, whereas five stood for Strongly Disagree. Table 5 represents the apps used by the students. Medscape was the most common (29.3%), followed by Gray's Anatomy (25%) and Pharmapedia (23.9%). Table 6 shows the apps most frequently used in each medical year. Table 1: Demographic data and characteristics of participants Parameters Frequency Percentage Total Participants 357 100 Gender Male 144 40.3 Female 213 59.7 Using Smart Devices Yes 341 95.5 No 16 4.5 Awareness about the availability of Medical Apps on Smart Devices Yes 309 86.6 No 48 13.4 Have Medical Apps installed on your smart devices Yes 229 64.1 No 128 35.9 Have your medical educators ever recommended that you obtain a specific medical app for your mobile? Yes 161 45.1 No 196 54.9 Table 2: Purpose of use of Medical Apps Parameters Frequency Percentage Revision 123 34.6 Preparation of Presentations 94 26.4 Lookup Medical Information 177 49.7 Medical Journals 50 14 During Ward Rounds 43 12.1 Medical News 53 14.9 Medications/Drug Guide 64 18 Exam Preparations 134 37.6 General Clinical Textbook 79 22.2 Clinical Skills Guide 85 23.9 I do not have medical apps 73 20.5 Other Purpose 2 0.6 Total 977 100 Table 3: Students' Perceptions about Medical Apps on Smart Phones Parameters Mean (total score 5) St. Deviation Medical Apps are easy to obtain 2.25 1.10 I am looking to obtain more apps in future 2.37 1.08 I would recommend the use of apps to my fellow medical students 2.27 1.06 I do most of my medical learning using medical apps 3.38 1.24 Medical apps are essential tools for undergrad students 2.62 1.02 Medical apps are superior to medical books 3.61 1.13 Medical Apps are as good as medical books 3.31 1.07 Medical Apps are inferior to medical books 2.81 1.03 Medical Apps can replace medical books 3.66 1.17 Medical Apps can supplement medical books 2.59 1.17 Medical Apps provide helpful medical information at the point of care 2.45 0.95 Free Medical Apps are inferior in quality compared to paid apps 2.52 1.01 No dangers in using medical apps for patient care 2.91 0.94 Table 4: Students' Perceptions of the impact of Medical Apps on Clinical Practice Parameters Mean (total score 5) St. Deviation Improve clinical decision making 2.58 0.19 Save time 2.12 0.88 Allows faster access to national clinical practice guidelines 2.26 0.93 Allows faster access to common laboratory reference values 2.24 0.93 Helps in making differential diagnosis 2.41 0.96 Perform useful medical-related calculations 2.39 0.94 Allows faster access to reliable sources of medical knowledge 2.35 0.99 Allows faster access to reliable sources of clinical skills 2.44 0.95 Allows accurate medicine dosage calculations 2.61 0.94 Allows more straightforward medicine dosage calculations 2.48 0.93 Allows faster access to evidence- based medical practice 2.54 0.92 28 Ibtihaj Munir et al JANUARY – JUNE 2023, VOL,5. NO.1 J Aziz Fatm. Med Den College DISCUSSION The recent advancements in technology have completely shifted the way we view the world today. Smartphones have played a significant role in that. The medical field has also seen change due to the new technology available now. Smart devices have become a significant part of our lives, as can be seen from the findings of our research, which show that about 95.5% of participants own a smart device. These results are similar to another study conducted in Pakistan, which showed that around 95.8% of participants own a smart device 15, and another study conducted at “King Abdulaziz University,” Jeddah which had a result of 99%.16. In recent years, medical applications have increased in popularity among medical students; however, the results show a varying level of interest among students worldwide. In our study, around 86.6% of participants were knowledgeable about medical apps on their phones, and around 64.1% had various medical apps installed on their phones. This result is less than the results obtained from other studies conducted at King Abdulaziz University, Jeddah 16, and Monash University17, where around 76% and 89.1% of participants had one or more medical apps installed on their phones. 45.1% of these pupils had put applications on their phones on the recommendation of their medical educator. This is greater than the result seen in a study conducted at Monash University, which resulted in 32%.17 In our current study, the primary use of medical applications was for looking up medical information (49.7%), followed by exam preparation (37.6%) and Revision (34.6%). The results were similar to those gathered in other studies, with looking up medical information and Revision being the most common use.16,18 20.5% of students were not using any kind of medical applications, and these results were comparable to another study conducted in Pakistan in 2019, which had a percentage of 28% .19 Students who were using medical applications agreed that medical apps were easy to access, and they demonstrated a desire to achieve medical apps in the future; however, most students did not agree that medical applications can take the role of medical textbooks (Table 3). In clinical practice, students believe that using apps saves time and allows in clinical settings, quicker availability of healthcare information (Table 4). CONCLUSION In our study, around majority of participants were knowledgeable about medical apps on their phones, and half of participants had various medical apps installed on their phones. Despite the increased level of interest and the shift of the students towards eLearning, Grant support and financial disclosure: None Conflict of interest: None REFERENCES 1. Tez M, Yildiz B. How reliable are medical textbooks?. J. Grad. Med. 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Usage and types of mobile medical applications amongst medical students of Pakistan and its association with their academic performance. Pak. J. Med. Sci. 2019; 35(2):432- 436. doi: 10.12669/pjms.35.2.672. Author’s Contribution Ibtehaj Munir Study design, data collection, data analysis and interpretation revise and approve the article Farhat Ijaz Study design, data collection, Data analysis and interpretation, revise all intellectual contents and approve the article Kanza waqar Study design, data collection, manuscript writing, revised and approve the article Iman Hussain Study design, data collection revise and approve the article Rana Khurram Aftab Study design, manuscript writing revise and approve the manuscript Asim Zia Study design, data collection revise and approve the article All authors are equally accountable for accuracy, integrity of all aspects of the research work. Date of Submission: 20-07-2022 Revised: 12-03-2023 Accepted: 13-03-2023 https://doi.org/10.1186/1475-925x-10-24 https://doi.org/10.1111/medu.13131 https://doi.org/10.1016/j.jtumed.2016.07.004 https://doi.org/10.1186/1472-6947-12-67 https://doi.org/10.1186/1472-6947-12-121 https://doi.org/10.1186/1472-6947-12-121 https://doi.org/10.1097/01367895-201324030-00008 https://doi.org/10.1097/01367895-201324030-00008