Structural equation model of gratitude, two-way social support, and smartphone addiction among nursing students

Gratitude and social support are considered important intervention factors within the framework of positive psychology. However, their roles in influencing smartphone addiction among nursing students remain insufficiently understood. From a positive psychology perspective, this study aims to further elucidate the underlying mechanisms through which gratitude and two-way social support influence smartphone addiction.

A stratified sampling method was employed to conduct an online survey among 1,200 undergraduate nursing students from four medical universities in western China. Data were collected using a demographic questionnaire, the Mobile Phone Addiction Index, the Gratitude Questionnaire, and the Two-way Social Support Scale. Structural equation modeling (SEM) was performed using AMOS 28.0, and the bias-corrected percentile Bootstrap method was applied to examine mediating effects.

Gratitude, two-way social support, receiving social support, and giving social support were all negatively correlated with smartphone addiction. SEM results indicated that two-way social support, receiving social support, and giving social support each independently mediated the relationship between gratitude and smartphone addiction. Further analysis of the sequential mediation effects revealed that the pathway from receiving social support to giving social support was significant, whereas the reverse pathway (giving → receiving) was not.

Moreover, when both dimensions were simultaneously included in the model, giving social support remained a significant independent mediator, whereas receiving social support did not show a significant independent mediating effect. Gratitude not only directly predicts smartphone addiction but also indirectly influences it through the mediating role of two-way social support. In the sequential mediation process, both the order and the relative strength of receiving and giving social support should be taken into account.

These findings suggest that nursing educators should pay close attention to the directional dynamics and relative contributions of social support when developing interventions targeting smartphone addiction among nursing students. These authors equally contributed to this work as first authorship: JianLuo and Chunfan Xue. The Fifth People’s Hospital of Sichuan Province, Chengdu, 610031, China Jian Luo, Chunfan Xue, Fangyan Gong, Mingjing Zhong & Junhong Li The Third People’s Hospital of Xindu District, Chengdu, 610500, China Chengdu University of Chinese Medicine, Chengdu, 611137, China North Sichuan Medical College, Nanchong, 637000, China The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China Chengdu Medical College, Chengdu, 610500, China Correspondence to Mingjing Zhong, Zheng Yang or Junhong Li.

The authors declare no competing interests. This study was approved by the Ethics Committee of Chengdu Medical College (Approval No. 2023No.64). Prior to data collection, an informed consent statement was provided to all participants through the online questionnaire platform.