Background: Digital drugs are stimulus sounds that are believed to be capable of modifying brain wave rhythms and manipulating the state of mind. This phenomenon has recently emerged as a danger alert to Arab countries. The present study intended to evaluate the knowledge and attitude of Omani nurses regarding digital drugs.

Method: The study adopted a descriptive correlational design. The total sample was 389 based on defined inclusion criteria. The sample was chosen at convenience. We used a self-report instrument to investigate the extents of the research phenomena, and it consists of demographical data and a digital drug awareness scale.

Result: The mean age of the participants is 32.9 ± 6.11 years. The majority of the participants were male 51.2% (199), married 53.0 % (206), have a Bachelor's degree, 60.2% (234), have 11-20 years of clinical experience, and are working in Emergency units 40.9% (159) as Register Nurse (RN) 70.2% (273). The mean awareness level of nursing participants in this study about the phenomenon of digital drugs has reached 98.01.

Conclusion: The results indicated a moderate level of digital drug awareness; the participants of this study were highly aware of the effect of digital drugs on the body system. They were less mindful of how to utilize this kind of drug, the required tools, software, and environments.

Keywords: Addiction; Digital drugs; I-dosing; Nurses Awareness

New technologies have become integral parts of our lives, spreading widely, and play a key role in social connections, expression, information sharing, entertainment, and others [1]. As an example, smartphones become more than accessories due to their operating system and advanced applications [2]. Entertainment via smartphones is also readily available and transmitted through platforms such as online games, movies, social media, videos, and music [3].

Smartphones have many impacts on our lives, potentially including problematic health issues that may develop as a consequence of overuse and addiction [4]. The result is unhealthy behavior, harmful psychological dependency, anxiety, and possible fear.

Digital drugs abuse, also known as "I-dosing," has recently elicited as a danger alert to Arab countries through different media platforms including smartphones, laptops, iPad, and others [5], it raised significant debates and discussions all over the world, particularly among mental health discipline, due to its impact on the individual psychological well- being and cognitive functions [6,7].

Digital drugs are auditory illusion tones that are thought to be capable of changing brain wave patterns, and altering the state of consciousness, just similar to that effects by taking some certain substances like heroin and cocaine, in the way that the theory of biofeedback is well known in explaining its process of addiction and dependency [8].

The digital drug tones come with different electromagnetic oscillations on two different degrees of frequencies as small as 30 hertz. It is usually heard through the ears with headsets and sometimes associated with visual effects [9,10]. Because these waves are unfamiliar to the brain, they leave the brain in an unstable state in the process of interpreting its nerve signals and puts the user in a state of euphoria (extreme happiness) as in the case of consuming traditional drugs that affect the secretion of neurotransmitters such as dopamine, serotonin, and nor-epinephrine needed for vital body functions like coordination, movement, breathing, happiness, hopefulness, forgetfulness, memory, perception, and balance [9,10].

When the users listen to those beats through headsets, they can notice the minimal difference in frequencies of perceived tone (for example, 1600 hertz on the left ear, and 1560 hertz on the right ear). The brain naturally processes the new rhythmic sounds (40 hertz as the difference between the two ears) as electrical impulses producing the desired effect [11], that is varied effects among individual perception, cognition, and emotional status [12,13].

Digital drugs can mimic the dangerous effects of cocaine, heroin, opium, and others. The side effects of these drugs are harmful, no matter how they are achieved, in substance or sound [14]. Opinions from experts are also varied and divided on how digital drugs may affect the human body, as is the case with traditional drugs. Despite their earlier medical uses in helping patients with depression and anxiety, some digital drugs have serious adverse effects on human health leading to a malfunction of the auditory system, head and back pain, involuntary muscle spasms, hallucinations, and social isolation [7,15].

Digital drugs may become more addictive due to their ability to alter mood properties even without much more evidence to support this claim, especially if the individual is interested in exploring it or is sometimes under the pressure of peers or has poor emotional regulations [16,17]. Perhaps one of the most important reasons for the spread of such modern phenomena in our societies is the significant similarity between advanced techniques of addiction and those previously known, in terms of its physical and psychological impact on the user, and a sense of euphoria, away from social, moral, official and legal rejections associated with the traditional forms.

General speaking, there is a need for increased awareness for the prevention of digital drugs-related in our society [5], in which health team members can strengthen the collaboration among different disciplines such as families, schools, health agencies decision-makers, and others to design and implement of prevention programs especially among adolescents and young adults who become more interested in exploring it as a result of peer pressure, previous e-cigarette exposure, high-perceived drug accessibility, high-attitude to use the synthetic drug, high impulsivity, homework completeness and others [16,18]. Limited research was conducted to address and investigate this impact. The current study addresses the lack of knowledge that exists and will provide us as academic staff with the required expertise beyond this problem. The present study intended to evaluate the awareness of registered nurses regarding digital drugs in Oman.

The researcher is keen to obtain approval for conducting the study from the College of Nursing's Research Ethics Committee at Sultan Qaboos University. The researcher used a descriptive correlational study design to achieve the research objectives among Omani nurses. The researcher used the power analysis (Confidence Level 95%, Margin of Error 5%, and Population Proportion 50%) to identify a total sample of 350 nurses; the sample consists of nurses who are willing to participate in this study and exclude, non- Omani nurses, other medical health team workers as well as nursing students.

After obtaining the college research committee approval (Ref. No. CON/NF/2020/02), the researcher prepared and presented the survey through the application of Google form and then distributed it through social media platforms via a link. To avoid bias resulting from the inclusion of none Omani nurses, we allowed all nurses to participate and excluded them in the data cleaning and verification phase.

The sample was chosen at convenience; which means that those who participated first and completed the questionnaire were accepted in the study, and as soon as the participants' numbers exceeded the requested sample identified by power analysis, the link for participation has been closed, and the data were ready for its clearance. The researcher approached the participants with written, informed consent. The nature, intent, methodology, and potential benefits of the study were clarified, ensuring that their participation in the survey was entirely voluntary and anonymous. The participants then provided an in-depth- self-report questionnaire determining their demographical background, career history, and digital drug awareness. The researcher distributed the survey in two months between May and July 2020, and it took approximately 10-15 min to be filled. All data were treated with confidentiality, and no access to the data was allowed except for the researcher.

Study Instruments

The researcher used a self-report instrument as a tool measurement to investigate the extent of the research phenomena. It consists of two sections: (1) demographical data and (2) digital drug awareness scale.

Digital drug Awareness Scale

The digital drug awareness scale was developed by [19]; the scale consists of 35 items that are rated on a 5-point Likert scale ranging from 1 ("extremely agree") to 5 ("extremely disagree"). An example item is "I heard about the phenomenon of digital drugs." The Digital drug awareness scale demonstrated good internal consistency (Cronbach’s α = 0.89) with higher scores indicating increased levels of awareness.

We used SPSS Statistics (IBM Corp. Released in 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.) For statistical analysis, a p-value of 0.050 was considered significant. Data were described using mean and percentage; Analysis of variance was performed to determine the significant statistical differences between the variables.

Four hundred two participants returned the questionnaire. The researcher attempted to do data cleaning for all missing information, un-completed survey, delayed submission, incorrect, and not-eligible participation. Exclude other medical health team workers as well as nursing students. After data cleaning, the investigators arrived at 389 samples, the age of the respondents ranged from 23 to 47 years. The mean age is 32.9 ± 6.11 years. The majority of the participants are male 51.2% (199), married 53.0 % (206), have Bachelor degree 60.2% (234), have 11-20 years of clinical experience, are working in Emergency units 40.9% (159) as RN 70.2 (273) [Table 1].

Table 1: Participants' demographics.

The awareness of study participants is divided into three categories, are the high level of awareness, the medium level of awareness, and the level of low awareness, where this criterion was adopted according to the formula that the category length of the level of knowledge = (highest grade - lowest grade) divided by three. Thus the level of awareness was split into three levels: Low level from 1 to 2.33, medium level from 2.34 to 3.66, and high level from 3.67 to 5 [Table 2].

The tool's reliability was assessed on our sample and showed a high Cronbach's α value (0.948). A composite score of each tool was calculated by summarizing the nurses’ responses to the questionnaire; The mean awareness level of nursing participants in this study about the phenomenon of digital drugs has reached 98.01, ranging between 54 and 145, where the item " I know about some sites that provide digital drug doses" came with lowest average (2.11) and the item "I am interested in following scientific and medical information via the Internet" went with the highest average level 3.98. The analysis of the study participants' responses indicated that the majority of them are moderately known or hear about the phenomenon of digital drugs by different means; the participants, for example, responded moderately to the items "I heard about the phenomenon of the digital drug," "I know what a digital drug is and what it is" and "I conducted searches to verify the phenomenon."

The participants also indicated a low to moderate level of awareness regarding the way of utilizing this kind of drugs, the required tools, software, and environments; the participants, for example, responded moderately to the items "I Know what tools to listen while taking a dose" and "I know about the volume of sound density the ear can hold" and low to the items "I know about the time limits required for a dose-effect to occur" and "I know the types of software for providing digital doses." However, the participants of this study indicated a high level of awareness regarding the effect of digital drugs on the body system as they respond to the items "I know about the effect of EAR waves on EEG," "I understand that listening to the dose aloud may cause hearing loss, "and" I think digital addiction is causing sustainable physical and mental harm".

Table 2: Participants responses to the digital drug awareness scale.

One-way ANOVA and independent t-test were conducted to compare the mean of the dependent variables digital drug awareness with the independent demographical variables of age, gender, marital status, and level of education. Overall, the findings of this study showed that nurse's digital drug awareness is significantly correlated with gender (P= 0.000) and level of education (P= 0.005) [Table 3].

Table 3: The awareness of digital drugs based on the participants' demographics; * Significant at p<0.05.

Regarding the nurses' employment history, the result of this study indicated a significant correlation between the nurses' awareness of digital drugs, the year of experience (P=0.000), and the working department (P=0.000) [Table 4].

Table 4: The awareness of digital drugs based on the participants' employment history; * Significant at p<0.05.

There have been few studies, particularly among nursing disciplines, regarding the problematic use of digital drugs, especially in Arab countries. Although the percentage of awareness among intellectuals in some previous studies exceeded 50% slightly [20], the few types of research released on digital drugs have indicated that Arab culture, in general, is not conscious of this form of addiction. This research represents a tentative step towards understanding this phenomenon among nurses in Oman. Our analysis finds that the mean digital drug awareness among Omani nurses is 98.01. These scores indicate a moderate level of digital drug awareness. This is incongruent with another previous study that showed that the healthcare worker (70%) is not aware of these terms and their impact on human health [5]. This may be because these concepts are currently new among the Omani society where legal restrictions are applied when exploring such things in media platforms and the internet [21]. One more explanation might be due to the lack of knowledge, information, guidance available about the phenomenon of digital drugs and their risks since it is a relatively recent topic and has not been adequately addressed in the studies, analysis, and educational programs directed at young people in general and nursing students on their academic seats in specific [22]. One study stated that the participants preferred that the topic of digital drugs should not be discussed or explained openly [23], this may be due to the purpose of keeping these issues more away from teenagers and college students who are in the front line of using the smartphone and its application continuously [24], where they concern an excessive amount of time for learning and entertainment purposes [25]. The result is that it can impact psychological aspects, interpersonal relationships, physical problems, and [7], leading to more addictive patterns [26].

Besides, the results postulated that the participants of this study indicated a high level of awareness regarding the effect of digital drugs on the body system, which is also not supported by other studies [5]. This may not necessarily influential factor for high awareness and protective measures. In this regard, the core of the discussion goes beyond the cognitive outcomes and addresses the issue of access to information and the power it has to mediate behavioral change [27].

The authors of this study found a significant difference in the awareness of digital drugs among the participant gender (P=0.000); males are more aware of the term for digital medicines than females. The mean scores are 100.54 and 90.47, respectively, supported by other studies [7]. Indeed, it can be inferred that both genders use smartphones applications in different ways to socialize with their families and friends through social media platforms; females tend to emphasize social and emotional bonding with their family, whereas, males are more inclined to expand their connection even oversea, getting more experiences, discovering more things, engaging in more entertainment, and social connections leading them for addiction [28,29].

In this study, it was found that the awareness of digital drugs among Omani nurses is significantly varied among the participants Level of education (P=0.005), Years of experience (P=0.000), and working department (P=0.000); nurses who completed their post-graduate studies (mean=123.08), have more than ten years experiences in the field (mean=112.95) and are working in the emergency department (mean=109.84) are more aware of digital drugs than other this claim is supported by the previous kind of works [7], as some investigations have shown that the percentage of young Arabs who are aware of the extent of this type of addiction is not sufficiently high [20]. The threats to the well-being of individuals and populations reached 31 percent [20]. This may be due to the reason that the awareness of such current issues does not depend on what is related to following up on what is published in various electronic, digital, audio, visual, and print media, as well as official and non-official satellite media channels, but it depends on many other factors such as peer experiences, previous case exposure, self-personal development and other [30].

This study reveals several other limitations; first, the participants' self-reported questionnaires have the inherent limitation of accurate responses. Second, data collection was from without concerning the non-Omani nurses who are working in Oman side by side with the Omani nurses and have a significant role in the health care system, culture, and health awareness which could restrict our generalization; therefore, more potential studies would involve more ex-pat nurses from different Omani governorates.

In Oman, the number of regular mobile users and the amount of time spent on social media are increasing day by day and worldwide. The present study intended to evaluate the awareness of registered nurses regarding digital drugs in Oman. The mean awareness level of nursing participants in this study about the phenomenon of digital drugs has reached 98.01, indicating a moderate level of awareness, the participants of this study were highly aware of the effect of digital drugs on the body system they respond to the survey items. However, they showed finite awareness regarding utilizing this kind of drug, the required tools, software, and environments. because this topic in the Arab countries is particularly new, where few types of research have been conducted compared to other countries where these behaviors become to be as normal among with the absence of authority at the official level to prevent or prohibit such practices. More studies are required to investigate this phenomenon and to discuss it properly through the media, schools, and health care colleges' curricula.

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Corresponding author: Mohammad Qutishat, Lecturer, Community and Mental Health Department, College of Nursing, Sultan Qaboos University (SQU), Oman.

Copyright: © 2022 All copyrights are reserved by Mohammad Qutishat, published by Coalesce Research Group. This work is licensed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.