Perceptions and Targeted Behavioral Change Interventions for Social Networking Site Addiction in School-going Adolescents of Karachi: A Concurrent Embedded Mixed-methods Case Study
Perceptions and Targeted Behavioral Change Interventions for Social Networking Site Addiction in School-going Adolescents of Karachi: A Concurrent Embedded Mixed-methods Case Study
Addiction to Social Networking Sites (SNS) is considered a major public health problem and is well recognized around the world with serious social and health-related implications. There have been numerous studies that have been undertaken to examine the prevalence and severity of SNS addiction in Pakistani undergraduates. However, there are limited studies that have been done on the school-going adolescent population, especially in Pakistan. More importantly, there have been no interventions done to improve the minimization of the level of SNS addiction in this vulnerable cohort. This study will evaluate the effect of implementing targeted interventions for reducing the burden of SNS addiction so that in the future, evidence-based decisions may be taken and changes are incorporated in school curriculums.
Objective The specific objectives of this study are to estimate the prevalence of SNS addiction and to explore the perceptions of school-going adolescents regarding SNS addiction in metropolitan Karachi, Pakistan. It will further aim to introduce well-designed, online, tailored behavioral change interventions amongst students found with a high burden for significantly decreasing the prevalence of SNS addiction and for assessing their readiness to change.
Methodology This will be a mixed-methods concurrent embedded interventional study. The study will be conducted in selected private schools of Karachi in all its seven Districts. Prevalence will be assessed online by sharing an internationally validated tool with the students after getting students and their parent's consent. Concurrently, focus group discussions will be conducted in school premises with selected students from grades VI-XI. Once prevalence is ascertained, interventions will be designed to reduce levels of SNS addiction. Students will be randomly assigned to control and intervention groups and will be shown carefully designed interventions in the form of videos targeting specific domains of addiction. The effects of these interventions and readiness to change will be assessed after a period of three months.
Addiction to Social Networking Sites (SNS) has emerged as a growing public health concern globally, with documented associations with psychological distress, academic decline, sleep disturbances, and impaired social functioning. While several studies in Pakistan have examined the prevalence and severity of SNS addiction among university students, there is a significant research gap concerning school-going adolescents-a population particularly vulnerable due to early and widespread digital exposure. Notably, no behavioral intervention studies have been conducted in Pakistan targeting the reduction of SNS addiction among adolescents. Addressing this gap is critical for informing preventive strategies and school-based digital wellness programs.
This study aims to assess the burden of SNS addiction among adolescents enrolled in private schools in Karachi and to evaluate the effectiveness of structured, online, behavioral change interventions tailored specifically for this age group. By generating actionable evidence, the study seeks to support future policy recommendations and integration of digital well-being content into school curricula.
Objectives
The primary objectives of this study are:
To estimate the prevalence and severity of Social Networking Site addiction among school-going adolescents in Karachi using an internationally validated assessment tool.
To explore perceptions, attitudes, and contextual factors influencing SNS overuse through focus group discussions with adolescents.
To implement and evaluate targeted behavioral change interventions, tailored to students identified with high levels of SNS addiction.
To assess readiness to change and the effect of the intervention on reducing SNS addiction scores over a three-month period.
Study Design
This research will employ a mixed-methods, concurrent embedded, quasi-experimental interventional design. Quantitative and qualitative components will be conducted simultaneously, with the quantitative arm functioning as the primary driver of the study and qualitative insights embedded to contextualize findings.
Study Setting
The study will be conducted in selected private schools across all seven districts of Karachi, Pakistan. Schools will be approached through administrative approval, and written consent/assent will be obtained from both parents and students as per ethical guidelines.
Study Procedures
Baseline Assessment
An online, self-administered survey will be distributed to students (Grades VI-XI).
The survey will include:
Bergen Social Media Addiction Scale (BSMAS) & Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), that are both internationally validated tools will be employed. Demographic information and patterns of SNS use will also be assessed.
Students identified with moderate to high SNS addiction scores will qualify for the intervention phase.
Qualitative Component
Focus Group Discussions (FGDs) will be conducted with selected students to explore:
Perceptions about social media use
Motivations and triggers for excessive use
Barriers to reducing screen time
Suggestions for acceptable intervention formats
FGDs will be conducted on school premises by trained facilitators.
Intervention Phase
Eligible students will be assigned to Intervention or Control groups based on school logistics and administrative feasibility (non-random assignment).
The intervention group will receive online, pre-recorded, culturally tailored behavioral change videos addressing:
Digital hygiene and time management
Emotional regulation
Sleep hygiene
Healthy alternative activities
Risks of excessive social media use
The control group will continue usual routines and will be offered the intervention later.
4. Follow-up and Outcome Assessment
After three months, both groups will complete the BSMAS & SOCRATES again.
Primary Outcome: Change in SNS addiction scores from baseline to three months.
Secondary Outcomes:
Self-reported changes in screen time
Improvement in readiness to change (using adapted readiness-to-change scales)
Sample Size
A sample size of approximately 260 students (130 per group) is planned, accounting for anticipated attrition.
Significance of the Study
This will be the first interventional study in Pakistan evaluating structured behavioral strategies to reduce SNS addiction among adolescents. The results will provide critical evidence to support:
Integration of digital wellness modules into school curricula
Development of adolescent-centered mental health promotion strategies
Early preventive interventions for problematic technology use
By adopting a mixed-methods approach, the study will not only quantify addiction levels but also explore contextual influences, making the findings more relevant for policy, program design, and future research.
Inclusion Criteria:
Exclusion Criteria: