Level of Awareness, Perception and Practice of Conventional

LEVEL OF AWARENESS, PERCEPTION AND PRACTICE OF CONVENTIONAL

PREVENTIVE MEASURES FOR COMPUTER VISION SYNDROME AMONG

UNIVERSITY STUDENTS, MASENO, WESTERN KENYA

SHADRACK MUMA

A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF MASTER OF PUBLIC HEALTH (EPIDEMIOLOGY AND POPULATION HEALTH)

SCHOOL OF PUBLIC HEALTH AND COMMUNITY DEVELOPMENT

MASENO UNIVERSITY

NOVEMBER 2019

DECLARATION

1. THE STUDENT I, Shadrack Muma, Registration number MPH/PH/00033/2016, do hereby declare that this thesis is my original work and has not been presented for the award of a degree or diploma in any other university or college.

Signature…… Date…………………………………………

2. THE SUPERVISORS We, the undersigned, confirm that this thesis has been submitted for examination with our approval as university supervisors: Dr. Dickens Omondi Department of Clinical Medicine University of Kabianga

Signature…… Date…………………………………………. Dr. Patrick Onyango School of Biological and Physical Sciences Maseno University Signature…………………………...... Date……………………………………………

ACKNOWLEDGEMENT

First, I thank the almighty God for giving me strength during my study. I sincerely thank my supervisors Dr. Patrick Onyango and Dr. Dickens Omondi of Maseno University and University of Kabianga respectively for their professional guidance and tireless efforts to assist me during the course of my study. My appreciation also goes to Maseno University office of the DVC, PRI for granting me permission to carry out research at Maseno University. I would also like to extend my appreciation to the students who spared their time to respond to the questionnaires. I extend my appreciation to Barrack Okello who has constantly been responsible for a lot of staffs in relation to this work.

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DEDICATION

To my parents, late mother, Mrs. Damaris Opudo who taught me persistence and commitment in education and my dad who taught me the value of discipline and hard work.

ABSTRACT Computer vision syndrome (CVS) is a multi-factorial condition of the eye that results in symptoms of stress and eye discomfort among electronic device users. It causes considerable chronic vision-related morbidity and reduced work productivity. Ninety percent and 75% of computer users globally and in Africa, respectively, suffer from CVS. The risk factors for CVS include prolonged period of electronic device use, glare, refractive error, short viewing distance and inappropriate seating position. It is an insidious chronic condition that has hitherto received little attention, both by health providers as well as computer users. Also, it is likely to be under diagnosed as it mimics other eye conditions. In Kenya, lack of awareness of the disease is a key barrier to early detection, health seeking and practice of preventive measures. The burden of CVS and how much computer users in learning institutions are aware of and perceive CVS remains unknown. The purpose of the proposed study was to investigate the level of awareness, perception on CVS and practice of conventional preventive measures of CVS among students at Maseno University, an institution where information technology is a core component of the curriculum. The specific objectives of the study were to: determine the prevalence of students reporting symptoms of CVS; assess the level of awareness of CVS; determine students’ perception on CVS; and to determine the proportion of students who practices the conventional preventive measures of CVS. A cross-sectional design was used. Simple random sampling procedure was used to select 384 students from a target population of 21,000. Fishers’ formula was used to calculate sample size. The mean age of participants was 19.5 (SD= 0.7466) with 18-24 years as the modal age group (p=0.001). Females comprised 51.3% and males 48.7% of the participants. Participants who had at least 5 symptoms of CVS were 60.4% (n= 232).Awareness level was classified as low in 47.8%; medium level in 38.2% and high level in 13.8% of participants (p=0.001). Based on perception, 39.8% of the participants perceived CVS susceptibility, severity and benefits while 60.2% did not (p=0.001). Only viewing distance (40.0%, p=0.001) and duration of computer use (46.2%, p=0.001) were practiced by participants. These study results show that at least 2 out of 5 students have at least five symptoms of CVS, whereas awareness of the disease and related risks remain low. In conclusion, results of the present study indicate that CVS is present however, it is a less recognized health concern perceived by few and practice of conventional preventive measures is low among university students. Consequently, screening for the disease and awareness campaigns to improve recognition of disease and uptake of interventions is recommended. The study recommends sensitization of students on CVS.

TABLE OF CONTENTS

DECLARATION……………………………………..………………………………….………ii

ACKNOWLEDGEMNT………………………………………………………………………..iii

DEDICATION…………...... iv

ABSTRACT………………………………………………………………………………………v

ACRONYMS ...... Error! Bookmark not defined.

DEFINITION OF TERMS...... x

LIST OF TABLES ...... xii

CHAPTER ONE: INTRODUCTION ...... 1

1.1 Background ...... 1

1.2. Statement of the problem ...... 3

1.3 General Objective ...... 4

1.3.1 Specific Objectives ...... 4

1.4 Research Questions ...... 4

1.5 Significance of the Study………………………………………………...……………………5

CHAPTER TWO: LITERATURE REVIEW…………………………………………………6

2.0 Introduction ...... 6

2.1 Computer Use and Symptoms of CVS ...... 6

2.2 Awareness on CVS……………………………………………………………………………7

2.2.1Computer Vision Syndrome Risk Factors ...... 7

2.2.2 Computer Vision Syndrome Preventive Measures ...... 9

2.3 User Perception on CVS…..…………………………………………………………………10

2.4 Practice on Conventional Preventive Measures of CVS...... 10

2.5 Theoretical Framework ...... 11

2.6 Summary of Knowledge Gaps……………………………………………………………….12

CHAPTER THREE: RESEARCH METHODOLOGY ...... 13

3.0 Introduction ...... 13

3.1 Study Area ...... 13

3.2 Study Design ...... 13

3.3 Study Population ...... 13

3.4 Inclusion Criteria ...... 14

3.5 Exclusion Criteria ...... 14

3.6 Sample Size Determination...... 14

3.7 Sampling Procedure ...... 14

3.8 Research Assistant Recruitment and Training ...... 15

3.9 Data Collection Instrument ...... 15

3.10 Data Collection Procedure………………………………………….………………………16

3.11Pilot Study…………………………………………………………………………………...16

3.12Validity of Data Collection Instrument...... 17

3.13 Reliability of Instrument ...... 17

3.14 Data Analysis ...... 17

3.15 Ethical Considerations ...... 20

3.15.1Informed Consent………………………………………………………………………….20

3.15.2 Anonymity………………………………………………………………………………..20

3.15.3 Confidentiality……………………………………………………………………………20

3.15.4Potential Benefits and Risks………………………………………………………………21

3.15.5 Participation………………………………………………………………………………21

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3.15.6 Reimbursement…………………………………………………………………………...22

3.15.7 Data Protection …………………………………………………………………………...22

CHAPTER FOUR: RESULTS………………………………………………………...………24

4.1 Demographic Characteristics of the Respondents…………………………………………...24

4.2 Prevalence of CVS…………………………………………..………………………………24

4.3 Level of awareness of CVS………………………………………………………………….25 4.4: Perception of CVS……………………………………………………………………..……27

4.5: Practce of Conventional Preventive Measures……...………………………………………28

CHAPTER FIVE: DISCUSSION………………………………………………………..…….30

5.0 Introduction………………………………………………………………………….……….30

5.1Prevalence of CVS………………………………...... 30

5.2 Level of Awareness of Computer Vision Syndrome……………………………..………….30 5.3 Perception of Computer Vision Syndrome……………………………………..……………31

5.4Practice of Conventional Preventive Measures……..………………………………………..32

5.5 Limition of the Study………………………………………………………………………..33

CHAPTER SIX: SUMMARY, CONCLUSION AND RECOMMENDATION……………34

6.0 Introduction………………………………………………………………………………….34

6.1 Summary of the Findings…………………………………………………………………….34

6.2 Conclusions…………………………………………………………………………………..34

6.3 Recommendations…………………………………………………………………...……….35

6.4 Suggestion for Further Research…………………………………………………………...35

REFERENCES………………………………………………………………………………….36

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APPENDICES……………………………………………………………………………..……42

ACRONYMS

AOA American Optometric Association CA Communication Authority of Kenya CVS Computer Vision Syndrome HBM Health Belief Model IT Information Technology MSU Maseno University OSHA Occupational Safety Health Administration TV Television VDT Video Display Terminal

DEFINITION OF TERMS

Awareness: In this study awareness will be defined as having heard of risk factors and preventive measures of CVS.

Artificial tear: It is a substitute for tear applied on the eye to prevent the cornea from being dry as a result of exposure to environmental conditions while focusing on computer screen.

Blinking: It refers to voluntary movement of the eyelids to lubricate the cornea while using computer.

Contrast: It is the balance between the brightness on the computer screen and the surrounding brightness.

Computer vision syndrome: This refers to experiencing any of the symptoms including eye strains, tired eyes, sore eyes, watering eyes , irritation of eyes, dry eyes, blurred vision, slowness of focus change and double vision , while using a computer (Shahid et al., 2017).

Computer: A computer is a general term used to describe all portable electronic devices used for storing, communication and processing data.

Glare: It is a shine with a strong light from computer screen which affects the eye on prolonged exposure.

Levels of awareness: Refers to how much one know about preventive measures and the risk factors of CVS

Near vision: Refers to where close objects appear clearly but far ones appear blurred.

Prevention: This refers to measures applied to reduce symptoms of CVS from manifesting and progressing among computer users.

Presbyopia: An age related condition in which the lens power of the eye cannot change.

Perception: It refers to how much the computer users agree or disagree with the statements on potential impacts of CVS.

Perceived susceptibility: It refers to the extent to which a computer user agrees or disagrees with the risk factors of CVS

Perceived severity: It is used in this study to refer to the extent to which a computer user agree or disagree with the consequences of CVS.

Perceived benefits: It refers to the extent to which a computer user agrees or disagrees with the interventions of CVS.

Risk factors: This refers to aspects of personal behavior while using digital electronic device exposing one to CVS symptoms.

Refractive error: When one cannot see far or near objects.

Self-efficacy: It refers to belief of a computer user to likely uptake on interventions.

Video display terminal: It refers to the screen of computer.

LIST OF TABLES

Table 3.1 Variables of the Study………………………………………………………….…....23

Table 4.1 Demographic Characteristic of the Respondents (n=384)……………………….…..24 Table 4.2: Prevalence of CVS………………………………………………………….…….…25

Table 4.2.1: Self Report of Symptoms of CVS…………………………………………….….25

Table 4.3: Students’ Awareness of CVS…………………………………………………..…26

Table 4.4: Students Perceptions of CVS by Individual Susceptibility, Symptom Severity and Benefit of Preventive Measures (n=384)……………………………………………..…………27

Table 4.5: Practice of Conventional Preventive measures of CVS…………………………29

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LIST OF FIGURES Figure 4.1 Composite Awareness Score ...... 18 Figure 4.2 Summative Perception Score ...... 19

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LIST OF APPENDIXES

Appendix 1: Map of Maseno University ………………………………………………………..42

Appendix 2: Study Approval by Maseno University………………………………….…………43

Appendix 3: Recruitment Letter for Participants………………………………………………...44

Appendix 4: Study Questionnaires………………………………………………………………45

Appendix 5: Prevalence Assessment Tool……………………………………………………….53

Appendix 6: Maseno University Ethical Approval………………………………………………55

Appendix 7: Nacosti Permit……………………………………………………………………...56

Appendix 8: Informed Consent Form……………………………………………………………57

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CHAPTER ONE: INTRODUCTION 1.1 Background

According to WHO (2013), worldwide, 285 million people are suffering due to visual impairment. Eighty percent related to visual are due to refractive error and can be preventable (Hashemi, Fotouhi, Yekta, Pakzad, & Ostadimoghaddam, 2018). Use of computers has increased drastically over the last decades in all parts of the world which may promote public health in regard to provision of information and facilitation of social activities (Disord, Firouzeh, & Tabatabaee, 2018). However, the increase is associated with documented cases of a vision problem called computer vision syndrome (CVS) that warrants consideration. Computer vision syndrome is an epidemic which is widely spread but largely unknown among computer users (Yan, Hu, Chen, & Lu, 2008). Globally, 90% of computer users suffer from CVS, while in Africa, 75% of computer users suffers from CVS (Mathew & Menon, 2016; Mowatt et al., 2018; Shrivastava & Bobhate, 2012). Computer vision syndrome, synonymous with digital eye strain is a multi-factorial condition of the eye that result in symptoms of stress and eye discomfort among computer users (AOA, 2013; Randolph, 2017a). Computer vision syndrome largely exists as temporary condition characterized by symptoms that subside after computer work. However, some individuals may experience chronic decline in visual abilities even after stopping computer use and the symptoms will continue to recur and perhaps worsen with future computer use (Rosenfield et al., 2012).

WHO guidelines, recommend that infants less than 1 year are not recommended to view a computer screen, the ones aged 1-2 years, no screen time for 1 year old and no more than an hour for 2 year old with less time preferred while those aged 3-4 years no more than an hour is recommended (WHO, 2014). Computer vision syndrome can be chronic, and individuals who uses computer for a prolonged period of time or in environments with poor lightning or when the computer has glare, bright screen, refractive errors or when the workstation setup is improper are highly susceptible to CVS (Assefa et al., 2017; Gupta et al., 2016; Han et al., 2013). Due to the increasing demand and efficiency in carrying daily activities using computers, some computer users may extensively use the devices without understanding the associated risks (Zainuddin & Isa, 2014). Prevention and control of CVS symptoms is dependent on individual behavior like good seating position, taking regular breaks, wearing computer glasses, reducing the number of

1 hours spent on a computer and using artificial tears (Arif & Alam, 2015;Gupta et al., 2016). Even though the preventive measures and risk factors of CVS have been determined, how much the computer users’ are aware about them remains unknown.

Computer vision syndrome prevalence of 55.46%-Nigeria, 67.2%-Pakistan and 51.56%-India has been reported among medical students, engineering students and dental students respectively (Mathew & Menon, 2016; Noreen et al., 2016; Singh et al., 2016). As CVS is a multi-factorial condition (Reddy et al., 2013), the strength of epidemiological reports on the subjects depend on the population being studied and how the disease is defined and perceived. Programs vary in different institutions and the depth of computer use varies depending on the institution core interest in information technology. Nevertheless, the prevalence of students using computers whose programs are entirely integrated with IT and report symptoms of CVS has not been determined thus the burden of this condition in this population remains unknown.

Just like awareness, perception of CVS susceptibility, severity and benefits vary across professionals and across the general population. In USA for instance, the American Optometric Association (AOA), conducted a public awareness campaign on CVS to sensitize the public (Rosenfield, 2011). The AOA reports that individuals in tertiary institutions are at greater risk of developing CVS as compared to their counterparts in lower levels since in tertiary the individuals have the freedom to use the devices (AOA, 2017). Since personal computer is becoming one of the commonest tools used extensively by many people, for users to practice on appropriate mitigation strategies, they need to perceive CVS susceptibility, severity, benefits and barriers (Julius et al., 2014). In developing countries such as Kenya, no study has been conducted to investigate computer user’s perception of CVS susceptibility, severity, benefits and barriers. Hence the perception of CVS across student’s population remains unknown in developing countries.

Being that CVS is a multi-factorial condition arising from multiple risk factors; practicing the conventional preventive measures available on the OSHA webpage provide users with necessary information needed to develop a free risk work station for computers (Mussa, 2016). Computer vision syndrome not only results in multiple symptoms but it also results in reduced job accuracy and productivity by up to 40% and in Africa, it is reported that CVS has reduced productivity by 4% to 19% indicating the need to explore whether student’s practices the

2 conventional preventive measures (Arif & Alam, 2015; Charpe & Kaushik, 2009; Shantakumari et al., 2014).Computer vision syndrome is at risk of becoming a major public health issue hence, there is a call for behavioral programs to help computer users address this visual epidemic (Priyanga Ranasinghe et al., 2011). However, there are guidelines available and provided to the public by OSHA addressing the conventional preventive measures CVS a condition due to improper computer use (Mussa, 2016). However, practice of the conventional preventive measures in the population remains unknown. The level at which Information and Communication Technologies (ICT) is embraced in Kenya has progressed and institutions like Maseno University have embraced information technology to an extent of integrating all its programs with information technology (Maseno University, 2013) hence exposing students to CVS. Therefore, the scientific reason for conducting the study at Maseno University is because the population constitutes individuals born in the era when computers were available and easily accessible. Due to this the cumulative period of exposure is longer as compared to the intense groups using computers. However very little if any, has been done to investigate the level of CVS awareness and perception among students. Hence this study was designed to fill this gap by assessing the level of CVS awareness and perception among students at Maseno University.

1.2. Statement of the problem

Use of computers has increased drastically over the last decades in all parts of the world which may promote public health in regard to provision of information and facilitation of social activities (Hashemi et al., 2018). However, the increase is associated with documented cases of vision problem called computer vision syndrome (CVS) that warrants consideration. According to NCIT, (2016), the vision of Information and Communication Technologies (ICT) sector is to convert Kenya into a truly knowledge and information economy by enabling access to quality, affordable and reliable ICT services. According to NCIT, (2016), the vision of Information and Communication Technologies (ICT) sector is to convert Kenya into a truly knowledge and information economy by enabling access to quality, affordable and reliable ICT services. Computer vision syndrome is a public health problem which impacts negatively on vision necessitating the need for mitigation at an individual level. However mitigation of CVS requires the public to be fully aware and perceive CVS as a problem of public health concern. The government of Kenya has introduced a digital learning project among primary school pupils a

3 clear implication that exposure to digital electronic devices begins very early hence exposure to CVS. The population under study constitutes individuals who have been exposed to computers since a tender age, and as a result they are at risk of CVS. Yet, the vast majority of students is unaware of CVS, but with current advancement of technology in the country, there calls a need to assess how the students’ know about CVS and how they perceive CVS impacts so as to necessitate interventions. Majority of students in Kenya have limited understanding of CVS hence the students are overly exposed to higher CVS risk but symptoms also go unreported. Therefore, this study was intended to assess the level of CVS awareness among students at Maseno University, with a bid to highlight burden and recommend mitigation strategies.

1.3General Objective

To investigate Maseno University students’ level of awareness, perception and practice of conventional preventive measures for computer vision syndrome.

1.3.1 Specific Objectives

1. To determine the prevalence of students at Maseno University with computer vision syndrome. 2. To assess the level of awareness of computer vision syndrome among students at Maseno University. 3. To determine Maseno University students’ perception on computer vision syndrome. 4. To determine the proportion of students who practices the conventional preventive measures for computer vision syndrome at Maseno University.

1.4 Research Questions

1. What is the prevalence of computer vision syndrome among students at Maseno University? 2. What is the awareness level of computer vision syndrome among students at Maseno University? 3. What is the perception of computer vision syndrome among students at Maseno University?

4. What proportion of students at Maseno University practicing the conventional preventive measures for computer vision syndrome?

1.5 Significance of the Study

The current study supplements the existing literature by adding information on the level of awareness and perception which are key determinants on the burden of CVS and its prevalence. The study also informs the students that even though computers make their work easier, inappropriate use of the devices results to a vision related problems which create discomfort and stress. Therefore, the students get to know about the risk factors, preventive measures and uptake on the conventional interventions. The study also ascertains that a lot needs to be undertaken by institutions such as Maseno University to come up with policies and education strategies to enlighten students on CVS.

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter is a review of literature on the proportion of students using computers who report symptoms of CVS, level of awareness of CVS, perception of CVS and proportion of students who regularly use the recommended preventive measures.

2.1 Computer Use and Symptoms of CVS

Clinically, any person using computer and experiences one or more of the following symptoms: eye strains, tired eyes, sore eyes, watering eyes , irritation of eyes, dry eyes, blurred vision, slowness of focus change and double vision is suspected of having computer vision syndrome (Shahid et al., 2017). Globally 90% of computer users suffer from CVS, while in Africa 75% computer users suffers from CVS with a variation in the magnitude of the symptoms associated to CVS (Mathew & Menon, 2016; Mowatt et al., 2018). This suggests that although Africa has embraced technology, it has paid little attention to ill health associated with exposure to computers.

The magnitude of CVS symptoms varies depending on age and gender. A cross-sectional study conducted in Nigeria among computer users above 40 years reported prevalence of watery eye to be 10.8% while a prevalence 83% was reported among computer users in Benin below 40 (Chiemeke et al., 2007). The studies contradict each other and this can be linked to anatomy and physiology of the eye in relation to age. A cross-sectional study assessing dry eye prevalence among computer users in India and Nepal reported 66.9% and 79% respectively (Divjak & Bischof, 2009; Reddy et al., 2013). Watery eye and dry eye are closely linked to age, therefore as one age; the lacrimal gland functionality may become impaired hence frequently secreting tears (Conrady, Joos, & Patel, 2016). At early age, the gland maybe considered to have normal functionality. The magnitude of dry eye has been determined among the elderly while little is known of its burden among computer users below 40 years. Therefore a prevalence of dry eye among a population where students are using computers for different functions needs to be determined.

The magnitude of symptoms of CVS varies between female and male computer users. For example, a longitudinal study reported dry eye prevalence of 52.5% and 10.1% among male and female respectively in Japan (Uchino et al., 2008); other longitudinal study have reported prevalence of 60% and 18.6% in male and female users respectively in Chennai (Logaraj, Madhupriya, & Hegde, 2014). A possible explanation for the differential burden of CVS between the males and females is that most males spend a lot of time using their computers making them more vulnerable to dry eye unlike the female partners who may spend less hours starring at computer screen. Another cross-sectional study contradicts this aspect and reports a dry eye prevalence of 52% and 10.5% among female and male in China respectively (Xu, You, Wang, & Jonas, 2011) suggesting a role of contextual factors. A cross sectional study among Information Technology professionals who used computers reported headache and eye strain prevalence of 78% and 72% in Nepal and China respectively (Reddy et al., 2013; Chendilnathan et al., 2015). The importance of determining prevalence of CVS symptom assisted in identifying the gender which was more vulnerable to CVS.

In addition to dry eyes, a burning sensation is a common symptom of CVS experienced by most computer users. For example, in a cross sectional study, a burning sensation prevalence of 32.3% and 52.7% have been reported among medical students and engineering students in Chennai respectively (M Logaraj et al., 2014), while a relatively higher prevalence of 73% has been reported among bank workers in Ethiopia (Assefa et al., 2017) and 73.9% among university employees in Brazil (Sa et al., 2009). Most of the studies on the burden of burning sensation have been directed towards professionals who require computer to carry their duties. However, it can be argued that differential exposure can explain the variability in symptom severity.

2.2Awareness of Computer Vision Syndrome 2.2.1Computer Vision Syndrome Risk Factors Given that access to computers has increased, there is a potential that computer users will be exposed to the risk factors for CVS. Computer vision syndrome is linked to various risk factors such as dimly illuminated surrounding, glare and reflection on the computer display, inappropriate viewing distance from the screen, bad posture, under corrected or over corrected refractive error and various combinations of these factors (Chang et al., 2013; Gowrisankaran & Sheedy, 2015; Khalaj et al., 2015). Awareness and understanding of these risk factors for CVS is

7 crucial for users to make informed health seeking or prevention decisions. Hence there is need to clarify awareness among students using computers and how this affects their health promoting responses. The AOA conducted a public awareness campaign to sensitize computer users about CVS where over 60% of the population was reached (Noreen et al., 2016). Information on CVS risk factors may be obtained from different sources like from eye specialists, the internet, media, and through education.

Behavioral aspects that enhance exposure to CVS are diverse. First, the risk for CVS consistently increases with the duration of continuous staring at a computer screen (Mallik, Gahlot, Maini, & Garg, 2017; Singh et al., 2016). A cross-sectional study among computer office workers in Chennai who worked for more than 10 hours 78.3% developed CVS (Ranasinghe et al., 2016). Additionally, conditions of high illumination and user sensitivity to glare are associated with prolonged computer use and a cross-sectional study in USA among office workers reported that 45.2% had CVS (Schaumberg et al., 2009). In addition, individuals’ awareness and perception may play an important role in mitigating exposure to risk for CVS. For instance, it was reported in a cross-sectional study among call centres in Bandung that 67% with poor knowledge did not take necessary precautions and developed CVS (Nursyifa et al., 2016). In the context of learning institutions, there is need to determine the level of awareness on the risk factors of CVS among a group of individuals whose programs are integrated with IT.

At the individual level, there is variability in user habits. For example, computer users view the screen at different distances depending on how one perceives distance as a risk factor to CVS. A cross-sectional study conducted among computer users in Nigeria showed that the distance of the Video Display Terminal (VDT) from the eye is a risk factor to CVS since the closer the VDT to the eyes the more difficult the eyes have to work to accommodate it, and concentration on VDT tends to reduce the rate of blinking exposing the eye to free air and 87.3% had CVS (Bhanderi et al., 2008). The risk of developing CVS increases as the viewing distance from the screen decreases and a cross-sectional study among undergraduate students in Chennai reported a prevalence of 64.2% for users who viewed the screen at a distance less than arm length (Logaraj et al., 2013). Fourth, the size of the text being observed particularly on hand held devices affects accommodation of the eye. Attempting to read texts of a size at or close to the threshold of resolution of the eye for an extended interval may produce significant discomfort for instance in

8 a cross-sectional study among older adults in China, 83% had CVS as a result of trying to read texts at a close distance (Ko et al., 2014). This is further augmented by improper viewing angle where adults in Malaysia viewed screen at an improper angle and 65.9% developed CVS (Loh & Reddy, 2008).Understanding user habits and behavioral aspects is important in determining intervention points in the workplace and among computer users such as students. Therefore this study assessed student’s level of awareness on risk factors of CVS.

2.2.2 Awareness on Preventive Measures

Computer vision syndrome is as a multi-factorial condition which results from multiple risk factors. Combining the preventive measures at the same time may adequately reduce the symptoms of CVS unlike applying a single preventive measure, since CVS is as a result of multiple risk factors (Agarwal, Goel, & Sharma, 2013) For instance, a cross-sectional study among office workers in Japan, reported that 23% of workers who used more than one preventive measure developed CVS while 89.3% who used only one preventive measure developed CVS (Miki Uchino et al., 2008). Most preventive measures of CVS are both device specific and behavioral in nature hence user awareness of preventative measures may enhance reduction in CVS symptoms. To effectively curb CVS it is recommended that an individual takes frequent breaks while using computers as it increases the efficiency since the breaks tends to relax eye accommodative system thus decreasing eye fatigue and headache (Agarwal et al., 2013). For example, a cross sectional study conducted in Nigeria among male students in a college showed that 78.3% of the students who did not take break developed CVS and only 2% developed CVS and took break (Martínez-Mesa, González-Chica, Bastos, Bonamigo, & Duquia, 2014). However, Ranasinghe et al. (2016)showed that 20.4% of the computer users who took breaks did not relieve symptoms associated with CVS.

Preventive measures may have a potential impact on the prevalence to be reported among computer users. The use of anti-glare cover over the screen and use of flat screen so as to increase the reading time and decreases attention to the task since the computer user might not observe other preventive measures (Schaumberg et al., 2009). However, this is still a problem in developing countries such as Kenya in which there are no existing guidelines on electronic devices use by OSHA(OSHA, 2007). Viewing distance of arm’s length as a measure to reduce visual symptoms and this can be equated to arms length (Bhanderi et al., 2008); use of screen

9 filters (Shantakumari et al., 2014); obtaining regular professional eye care checkup and getting prescriptions of special lens design, powers and tints which may help maximize visual abilities and comfort. Awareness of preventive measures is thus an important first step in any interventions for CVS. However, the level of aware among at-risk populations such as university students in developing countries such as Kenya is poorly understood.

2.3 User Perception of Computer Vision Syndrome

Just like awareness, perception of CVS risks and interventions varies across professionals and across the globe. Studies show that people in developed countries are more likely to perceive CVS susceptibility, severity and benefits of preventive measures (Julius et al., 2014; Manjusha et al., 2013; Martinez-de Dios et al., 2008; Torrey, 2003; Zucker, 2013). Other eye conditions like refractive errors are also poorly perceived for instance, 87% of the students in Dakasha did not perceive the aspects of refractive error (Plackal, Ismail, & Mohanraj, 2018). A cross sectional study among university students in India through purposive sampling reported that 75% poorly perceived myopia (Sheetal, 2011). Hence, there is need to determine how much computer users perceive issues associated with CVS. In developing countries such as Kenya, empirical evidence on the perception of computer users towards CVS is not available.

2.4 Practice of Conventional Preventive Measures of CVS

Knowledge of risk factors and preventive measures for CVS is an important aspect in reducing the health burden of CVS. In developing countries, the use of technology is being encouraged and has been embraced by many people (Randolph, 2017). However, the practice of preventive measures has been minimally stressed (Rosenfield et al., 2012). In developed countries such as the USA, progress has been made in the last few years towards establishing regulations to guide manufacturers on the type of digital electronic devices to manufacture with specific designs such as antiglare VDT (OSHA, 2018). In America the practice of CVS preventive measures has improved, for example, in 2013, 10 million company workers scheduled eye exams due to computer related problems (Khalaj et al., 2015; Rosenfield, 2016). In developing countries, the practice of preventative measures is comparatively low. In Pakistan, for example, the practice of the preventive measures has been estimated at 2% (Khan et al., 2012). Even though in developing countries like Kenya, the government encourages the use of technology and has made

10 a step by introducing a digital learning program among class one pupils, however the practice on the conventional preventive measures for CVS has not been assessed so as to identify issues relevant to developing health promotion strategies to educate the populations.

2.5 Theoretical Framework

This study aimed at assessing University student’s level of awareness on CVS, perception of CVS, proportion of students who practice the conventional preventive measures of CVS and prevalence of students at Maseno University with CVS. The study was guided by the health belief model, first developed in 1950s by psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services (Rosenstock, 1974). The study did not adopt a conceptual framework because it was inquiring about specific variables and no relationship was sought, hence a theoretical framework was deemed fit for the study. The study was guided by the health belief model because it justifies that human behaviors is determined by the belief or perception towards a condition, its risk factors and how to manage the condition. For this case CVS which arises from continuous inappropriate computer use and all that surrounds CVS is behavioral and the prevention is also behavioral. It posits that six constructs predict health behavior (Champion & Skinner, 2008).

a. Perceived susceptibility- Computer users are likely to believe that exposure to risk factors such as inappropriate seating position, prolonged computer use, viewing distance less than arm’s length, refractive errors, level of computer screen and poor contrast expose them to possibility of acquiring CVS. The likelihood that computer users will engage in precautionary behaviors to prevent CVS depends on how much they believe that they are at risk of CVS. b. Perceived severity- Computer users are likely to believe that experiencing blurred vision, eye strain, eye fatigue, headache, irritation, redness, dry eye, double vision and burning sensation are due to CVS. This can result in increased error rate, economic burden increase and reduced job satisfaction. The negative impacts arising from computer use are likely to motivate the users to act so as to avoid the negative impacts. c. Perceived benefits- Computer users believe that the recommended actions such as maintaining a proper contrast, level of computer screen below the eye level, the refractive errors to be corrected, use computer eye glasses, maintain viewing distance of not less

than arm’s length, apply artificial tears, massage the eye and finally apply the rule 20/20/20 that is after 20 minutes of computer use look at an object 20 meters away and return to computer use after 20 minutes will effectively prevent them from acquiring CVS. Computer users must perceive that the target behaviour will provide strong positive benefits and adopting these health behaviors may likely eliminate the symptoms and reduce the burden from computer use. d. Perceived barriers- Computer users may experience inconvenience such as reducing the number of hours spent viewing a computer and unpleasant activities such as wearing spectacles which generally reduces CVS. Maintaining computer screen at arm’s length maybe perceived by some users as a barrier since they cannot see clearly at arm’s length. To adopt the healthy behaviors the computer users, have to believe that the benefit outweighs the consequences. Additional ways to eliminate these barriers such as educating electronic device users to put computer glasses with anti-glare. e. Self efficacy: For computer users to adopt appropriate interventions there is a likelihood that they must think about the interventions and decide that they have the potential to put them into practice. To enhance high self-efficacy, computer users must highly perceive the benefits of interventions.

2.6 Summary of Knowledge Gaps

From the literature reviewed in this chapter, there exists a universal consensus across the world that CVS is a public health concern. Despite this concern, little attention has been accorded the condition in developing countries. The level of CVS awareness is not known in developing countries despite the fact that governments and institutions embrace computer technology making the public more vulnerable to CVS. The perception dimensions that shape practice of preventive measure behavior remain unclear. In Kenya, for instance, hardly any studies have been carried out on CVS among computer users. This study attempted to fill these gaps by undertaking a cross-sectional study to assess the level of awareness, perception and practice of conventional preventive measures of CVS and prevalence of CVS among students at Maseno University, Kenya.

CHAPTER THREE: RESEARCH METHODOLOGY

3.0 Introduction

This chapter outlines the methods and procedures that were used to collect data for this study. The data collected was used to determine the prevalence of CVS among students at Maseno University; assess the level of awareness of CVS; determined perception of students on CVS susceptibility, severity and benefits and finally determined the proportion of students at Maseno University who practices the conventional preventive measures of CVS.

3.1 Study Area

The study was carried at Maseno University. Maseno University is based at Maseno town along Kisumu-Busia road, 25 km from Kisumu City and 400 km west of Nairobi. Currently the university has a total student enrolment of 21,000 (Maseno University Statistics, 2017). It is one of the public Universities in Kenya, located along the equator. Maseno University is located at a latitude of 0° 0' 24.1" (0.0067°) south, a longitude of 34° 35' 49.3" (34.597°) east and an elevation of 1,531 meters (5,023 feet). It has three campuses: The Main Campus, Kisumu Campus and e-Campus. The present study was conducted at the Main Campus because this is where a large pool of academic programmes is domiciled. The map showing Maseno University (Appendix 1)

3.2 Study Design

A cross-sectional research design was used in this study. A descriptive research design provides accurate account of the characteristics of a particular individual, event or group in real-life situations for the purpose of discovering new meaning, describing what exists, determining the frequency with which something occurs and categorizing information.

3.3 Study Population

The population of Maseno University undergraduate and post-graduate students was approximately 21,000. A sample of 384 male and female students aged 18-39 years were included to participate in the study since they constituted upcoming professionals who are still under training.

3.4 Inclusion Criteria

1. Undergraduate and graduate students aged 18-39 years. This age bracket is included since there is an age related condition called presbyopia which sets above 39 years and presents with symptoms like those of CVS hence eliminating false outcome. 2. Students who consented to participate in the study.

3.5 Exclusion Criteria

Students wearing low vision devices such as magnifiers were excluded from the study. Low vision makes an individual not to see clearly hence aspects like straining, which is a symptom similar to that of CVS is already established.

3.6 Sample Size Determination

The sample size was determined using Fisher formula (Conrady et al., 2016). The sample size

푍2푝푞 was calculated as follows: 푛 = 푑2 Where, n = the desired sample size (for population size >10,000); z = the standard normal deviate required at a confidence level of 1.96; p = the proportion in the target population estimated to have the characteristic being measured. Where p is not known, a value of 0.5 is used. For purposes of this study the characteristic being measured was CVS prevalence. This was not known at Maseno University; therefore p was pegged at (0.5); d= the level of statistical significance (0.05), Therefore, n= (1.96)2(0.5) (0.5)

(0.05)2 n= 384

3.7 Sampling Procedure

After obtaining authorization from DVC Planning, Research and Innovation Maseno University to conduct the study (Appendix 2), the authorization letter was presented at the office of Director of Students who acknowledged the permission to proceed with the study. A visit at the registry office Maseno University followed where list of students was obtained. A simple random sampling procedure was carried. From a sampling frame of N=21,000 students in which a sample size of 384 students was required. The researcher listed the population and assigned consecutive

14 numbers from 1 to N=21000. An online random number calculator was used to generate random numbers. The researcher selected 384 random numbers from the sampling frame which later constituted the sample size. Recruitment letters were sent to the prospective participants informing them about the study (Appendix 3). The participants were informed that computer means a combination of all portable electronic devices they use on daily basis and they were only to report symptom they experience when using the devices only.

3.8 Research Assistant Recruitment and Training

The researcher identified and trained 7 research assistants who were Bachelor of Optometry holders on the purpose of the study, questionnaires administration and research ethics. The researcher opted for seven research assistants they had background in optometry and they had understanding of the concept and once in their lifetime they had collected data for completion of their programs hence had some understanding. The entry point involved submission of approval letter from DVC, PRI to the Director of students. The Director of students was sensitized about the study so as to get the support before the study begins. Before the study begun, research assistants were trained for 5 days on the study protocol. The training involved elaborating for them the objectives of the study, the importance of the investigation and application to real life, complete review of the questionnaire, how to interview participant, review of the consent form, training on bio-ethics in biomedical research, regulation of research participants and maintaining of confidentiality.

3.9 Data Collection Instrument

Self-administered questionnaire was developed for this study where the respondents were able to choose more than one answer depending on the instructions (Appendix 4). The tool was adapted from previous study (Akinbinu & Mashalla, 2013) with all questions translated in English. The tool was used for the following reasons: a) it had potential in reaching out to large number of respondents within a short time, b) it was able to give the respondents adequate time to respond to the items, c) it offered a sense of anonymity to the respondents and, d) it was an objective method hence no bias resulting from the personal characteristics. Since CVS is a condition associated with multiple symptoms which can only be reported subjectively by an individual, an already designed tool for assessing the prevalence of computer users who report symptoms of

CVS (Appendix 5) was used (Shahid et al., 2017). According to the tool, computer users who report five or more symptoms are considered positive for CVS while those who report less than five symptoms are considered negative for CVS.

Questionnaires consisted of 4 sections labeled A-D to assess practice of the conventional interventions. Section A consisted of questions on socio-demographic details; section B consisted of awareness questions to establish respondents basic knowledge of CVS; the items were scored as 1=not at all aware, 2=slightly aware, 3=somewhat aware, 4=moderately aware, 5=extremely aware; section C consisted of statements on a Likert’s scale to further assess respondents perception of CVS susceptibility, severity and benefits. Finally section D consisted of questions on regular practice of conventional preventive measures of CVS.

The variables in the questionnaires were scored on a scale of 1-5. That is, strongly agree-5, agree-4, don’t know-3, disagree-2 and strongly disagree-1 (Vagias, 2006). Being that the respondents were literate, the instrument was developed as self-administered questionnaires.

3.10 Data Collection Procedure

The seven research assistants, who were properly trained, administered the informed written consent to the respondents and later administered the questionnaire. A clear explanation about the study, its goal procedures and benefit were given to study participants. The completed questionnaires were checked at the end of each day for omissions, incomplete answers and unclear statements. Data was collected for a period of 3 days being that the participants were given the questionnaires to go with and return immediately after completion.

3.11 Pilot Study

The research instrument was pretested among 38 students from Maseno University. According to Mugenda & Mugenda, (2003), a pilot study with a sample of a tenth of the total sample is appropriate for a pilot study. Therefore, a tenth of the total sample was 38. The researcher used the data to assess reliability and validity of the instrument. The reliability of items in the Likert’s scale as measures of the level of awareness on CVS and perception were tested using Cronbach’s alpha which yielded a reliability of 0.974 and 0.936 respectively. According to George, (2003) a Cronbach’s alpha of ≤ 0.5 is unacceptable, ≥ 0.7 is adequate, ≥ 0.8 is good, and ≥ 0.9 is

16 excellent. To test validity, a Pearson correlation coefficient was used where a sig. (2 tailed) of 0.000<0.05, N=38 was obtained. This ascertained that the instrument was valid.

3.12 Validity of Data Collection Instrument

According to Mugenda & Mugenda (2008), validity is the accuracy of a tool used for data collection. It is the degree to which results obtained from analysis of the data actually represent the variables of the study. To test validity, a Pearson correlation coefficient was used where a sig. (2 tailed) of 0.000<0.05, N=38 was obtained hence the instrument was valid. The researcher looked into the content and face validity of the research instrument. Content validity shows whether the questions and statements fully represent every element of the research questions and objectives of the study. To further ensure face validity, the researcher shared the details and structure of the research instruments with public health experts for analysis, for the public health and clinical experts to cross-check and affirms that indeed the research instruments captured the full concept of the study and for technical input on clinical issues. Thereafter, the researcher made the necessary changes needed.

3.13 Reliability of Instrument

Reliability is defined as the measure of the degree to which a research instrument yields consistent results on data in another given similar situation. Reliability assessment of instrument was performed to ensure that there was consistency across all given variables (Mugenda and Mugenda, 1999). The questionnaires were given to 38 randomly selected students from school of computing and informatics. Internal consistency reliability was used to measure the instruments reliability. An alpha of ≥0.7 was considered adequate. Level of awareness and perception yielded a reliability of 0.974 and 0.936, respectively.

3.14 Data Analysis

A mark sheet was used to assess the responses and to obtain scores of each respondent. All the completed questionnaires were first examined for completeness and consistency. Data was coded and then entered into a SPSS (version 17) (Brosius, 2013). Detailed documentation of raw and final data including variable names, response format and frequencies were prepared to allow for

17 easy access of data for analysis and review. Descriptive statistics of frequency, percentages and chi square were used to organize, describe and summarize data.

Frequency counts was carried out to estimate the prevalence of students using computers who report symptoms of CVS and the scores were presented in a frequency table and also in percentages.

Students’ awareness level on CVS was assessed through a series of statements on the five point Likert scale in which 1=not at all aware, 2=slightly aware, 3=somewhat aware, 4=moderately aware and 5=extremely aware. Scores of 1 and 2 were regarded as negative while scores of 4 and 5 were considered positive. Respondents who scored 5 in all the 10 items had a composite awareness score of 100 while those who scored 1 in all the 10 items had a composite awareness scale of 20. Hence a composite awareness scale ranging from 20 to 100 was designed in which case any respondent whose score fell below the middle score (60) was treated as being negative while those who fell above the middle score were treated as positive. The information on awareness was presented through percentages. This was analyzed through frequency counts depending on the category as either low, medium or high level of awareness as shown below.

Figure 4.1 Composite Awareness Score (Source, Oruonye,(2015)

Low level of awareness: Respondents in this category remained negative (i.e. either not at all aware or slightly aware) hence only scored between 20 to 40 point in the composite awareness scale. Respondents who fell in the category were considered unaware of CVS.

Medium level of awareness: Respondents in this category had mixed response in either direction of the statements hence their score in the composite awareness scale ranged from 41 to 79 points. Respondents who fell in this category were considered aware of CVS but with a gap in their knowledge.

High level of awareness: Respondents remained positive (moderately aware or extremely aware) hence they had a score of 80 to 100 in the composite awareness scale. Respondents who fell in this category were considered highly aware of CVS.

Respondent’s perception on CVS was assessed using a series of statements in a 5 point Likert scale. Participants were asked to indicate whether they strongly agreed, agreed, neutral, disagreed, or strongly disagree with each statement. The responses were weighted on a five point scale in which case 1=strongly disagree, 2=disagree, 3=don’t know, 4=agree and 5=strongly. Out of the total 19 items, perceived susceptibility had 5 items, perceived severity had 9 items and perceived benefits had 5 items. The data was analyzed as individual items using frequency count and computation of percentages. A summative perception score was adopted (Zainuddin & Isa, 2014) where students who scored 19 to 57 were rated in a group of individuals who do not perceive CVS susceptibility, severity, benefits and an issue of public health concern. The other group who scored 58 to 95 as per the summative perception score constituted individuals who perceive CVS susceptibility, severity, benefits and an issue of public health concern. The items were expressed in percentages.

Figure 4.2: Summative Perception Score (Source Oruonye,(2015)

Based on proportion of students who practice the conventional preventive measures of CVS, the data collected indicating how an individual uses a preventive measure were analyzed as individual item and as a group of items through frequency counts and later expressed in percentages. The proportion of students who experienced symptoms of CVS was graded as low,

19 medium or high. A low score was less than 50%, a moderate score was 50-75% while a high score was above 75% (Arumugam et al., 2014).

The analysis of the study was conducted through descriptive statistics analysis methods in the sense that it provided accurate account of the characteristics of the respondents. The descriptive analysis entailed counts and percentages as the output. A chi-square test was also conducted to determine cases of statistically significant different based on proportions, age and gender.

3.15 Ethical Considerations

The study obtained ethical clearance from Maseno University Ethics and Review Committee (Appendix 6) and NACOSTI (Appendix 7). Since the research involved human beings, it could have been linked to stressful and unpleasant experiences which might have affected the participants. To deal with this potential problem, the researcher explained to the participants about the research and that the study was for academic purposes only.

3.15.1Informed Consent

The participants were given informed consent so as to make a decision whether to participate in the study or not. Each participant had the right to decline or discontinues participating in the research at any time and at will.

3.15.2 Anonymity

Participants had the right to conceal information about them that they might have felt sensitive and private. Names were not used to safeguard the privacy of the participants but only relevant demographic information as well as random code numbers were used. A unique code number was assigned to participants to ensure confidentiality.

3.15.3 Confidentiality

The participants were guaranteed that there was protection of information given and the data collected was treated with total confidentiality. No information that reveals identity of any participant was released or published without participant consent. To ensure this, the researcher listed the data using number codes rather than names. A separate document that links the study

20 code to subjects identifying information was locked in a separate location accessible only by the researcher.

3.15.4 Potential Benefits and Risks

The participants did not benefit directly by participating in this study. However, the information obtained was to be used by the university to improve the general level of awareness on CVS among students. The information obtained was deemed useful to the participants after implementation by the university since the university may include CVS as an introductory course hence creating awareness. The study did not have any physical risk since the participants were required to respond to only questions they feel they are comfortable with.

After data collection the researcher involved the participants to enhance dissemination on relevant measures to undertake while using computers. The investigator emailed the respondents some power point slides on CVS. The power points contained diagrams showing how a computer user should sit while using the computer, the recommended viewing distance, the appropriate level for viewing computer screen and the appropriate brightness of a computer screen. The power points also contained simple notes pertaining to computer use so that the participants could go through them for the concept. The researcher asked the participants to seek clarity in areas they do not understand. The investigator engaged the students to share the slides with the representatives for their respective classes so that the representatives may share the slides with all the students in their classes. This was done to ensure that students who may have not heard of CVS may get the concept and the ones who may have heard of it may get the deep aspect specifically on preventive measures. This ensured that a greater percentage of the students get the concept of CVS and the impacts of computer use on vision.

3.15.5 Participation

Participation in this study was voluntary. No individual was forced to participate in this study. Participants were given a copy of signed and dated consent form to keep.

3.15.6 Reimbursement

The participants who finished the questionnaires and returned to the investigator were awarded a small token of a bottle of soda as an appreciation for loss of their time while responding to the questions.

3.15.7 Data Protection

The researcher explained and assured the participants that the information given in the study was used for academic purposes only. The participant’s data was not exposed to any subject in the study or shared with other respondents. Each participant’s information was handled with care and privacy depending on the participant’s preference. The variables in the present study are summarized in Table 3.1.

Table 3.1 Variables of the Study

Objectives Variables Measurement Method of data scale analysis To determine the Eye irritation Nominal Frequency tables, prevalence CVS among Eye strain means, median and of students. Headache percentages Watering eye Red eye Dry eye To assess students’ level Level of awareness on Ordinal Frequency tables, of awareness on CVS. risk factors. means, median and Level of awareness on percentages preventive measures of CVS. To determine students’ Susceptibility Ordinal Frequency tables, perception on CVS. Severity means, median and Self efficacy percentages Benefits To determine the Reducing the duration of Nominal Frequency tables, proportion of students computer use. means, median and who practice the Wearing computer eye percentages conventional preventive glasses. measures of CVS. Correcting the inability to see near or far.

CHAPTER 4: RESULTS

4.1 Demographic Characteristics of the Respondents

There were more female participants 51.3% (n=197) compared to males 48.7% (n=187) with a female to male ratio of 1.1:1 (p<0.001). Postgraduate participants were 4.7 % (n=18) with 95.3% (n=366) being undergraduate. The overall mean age was 19.5years (SD=0.7466) with a modal age group being 18-24 years. Of all study participants 59.9% (n=230) were aged between 18-24 years, 20.9% (n=80) were aged between 25-29 years, 14.1% (n=54) were aged between 30-34 years and 5.2% (n=20) were aged between 35-39 years (p<0.001). Based on gender the observed proportion of the respondents constituting male and female was different from the proportion expected (p=0.000) similar to age group. Table 4.1 Table 4.1 Demographic Characteristic of the Respondents (n=384) Variable and Variable Characteristics Count Proportion p-value Gender Male 187 48.7 <0.001 Female 197 51.3 Age 18-24 230 50.9 25-29 80 20.9 30-34 54 14.1 <0.001 35-39 20 5.2

4.2 Prevalence of CVS

Out of the 384 participants, 60.4% (n=232) had CVS. Of these, 64.0% (n=126) of females and 56.7% (n=106) of males had CVS. Of those with CVS, 58.6% (n=136) were aged between 18-24 years; 21.6% (n=50) aged between 25-29 years; 15.5% (n=36) aged between 30-34 years and finally 4.3% (n=10) aged between 35-39 years. However, these differences were statistically significant (p<0.001). 6.9% (n=16) of the graduates had CVS compared to 93.1% (n=216) of undergraduates who had CVS. The absence or presence of CVS was not statistically significant based on gender therefore what was observed and what was expected was not different (p=0.088). Table 4

Table 4.2: Prevalence of CVS

Variables CVS absent CVS present p-value Count % Count % Age 18 -24 30 13.0 136 59.1 25-29 94 61.8 50 21.6 <0.001 30-34 18 11.8 36 15.5 35-39 10 21.6 10 4.3 Gender Male 81 43.4 106 56.6 0.088 Female 71 36.0 126 64.0

Table legend: the table above shows participant absence or presence of CVS based on gender and age group.

In this study the most frequent ocular complaint reported was eye irritation, being 62.2% (n=239). The least symptom experienced was eye strain 45.3% (n=174). However, the participants with CVS had more than one symptom. Table 4.2.1

Table 4.2.1: Self Report of Symptoms of CVS

Symptoms Count % Eye irritation 239 62.2 Blurred vision 226 58.8 Double vision 223 58.0 Tired eyes 214 55.7 Dry eye 207 53.9 Watering eye 200 52.0 Slow focus 186 48.4 Eye strain 174 45.3 Table legend: the table above shows frequency of symptoms experienced by the participants. 4.3 Level of awareness of CVS Assessment of the participants awareness of CVS risks and preventive measure showed that 30.5% (n=117) were ‘slightly aware’ that the period of computer use is a risk factor of CVS. Similarly on preventive measures, a third of the participants 35.7% (n=137) were slightly aware that taking regular breaks is a preventive measure for CVS. Most students had not heard of the

25 term CVS, only 24% (n=92) had heard with 76% (n=292) had never heard of CVS. For dissemination of information on CVS the students preferred the medium as follows; eye care provider 21.9% (n=84), public library 20.3% (n=78), internet 19.5% (n=75), radio 15.5% (N=60), newspaper 11.5% (n=44) and finally TV 11.2% (n=43). (Table 4.3)

Table 4.3: Students’ Awareness of CVS (n=384)

Statements Frequency Count NA SA SWA MA EA % % % % % Awareness of Risk Factors Period of use 28.4 30.5 16.4 18.5 6.3 Seating posture 25.8 32 15.9 19.9 6.5

Table legend: the table above shows participant responses when asked about being aware of 5 risk factors for CVS and 5 personal preventive measures based on a five level Likert scale: NA- Not at all aware, SA-Slightly aware, SWA-Somewhat aware, MA-Moderately aware, EA- Extremely aware.

Using a modified 3 category composite awareness scale ranging from 20 to 100 (Figure 4.1) participants classified as having low level of awareness (either not at all aware or slightly aware with scores between 20 to 40 points) were 47.8% (n=184); medium level of awareness (considered aware of CVS with scores between 41 to 79 points) were 38.2% (n=147) and 13.8%

(n=53) had a high level of awareness(moderately or extremely aware with scores between 80 to 100).

4.4: Perception of CVS

Perception was assessed on a 5 point Likert scale. Assessment of participants perception on risk factors, preventive measures and complications of CVS showed that only 22.1% (n=85) of the respondents agreed that viewing computer screen at a distance less than arm length is a risk factor of CVS. Similarly, only 36.2% (n=139) agreed that eye strain is a consequence of CVS. Regarding preventive measures of CVS, almost half of the respondents 36.5% (n=140) did not know that maintaining a proper contrast is a mechanism of reducing the symptoms of CVS. The results are shown in (Table 4.4).

Table 4.4: Students Perceptions of CVS by Individual Susceptibility, Symptom Severity and Benefit of Preventive Measures (n=384)

Variables Frequency Count SD D DK A SA % % % % % Perceived Susceptibility < than arm’s length 11.2 40.6 23.2 22.1 2.9 Prolonged viewing 8.3 29.4 30.2 28.1 3.9 Seating position 10.4 21.4 35.2 28.1 4.9 Above eye level 9.6 24.5 38 21.9 6 Poor light contrast 9.6 20.8 38 26.3 5.2 Perceived Severity Headache 16.8 22.9 33.6 31 5.7 Eye strain 5.2 20.6 29.7 36.2 8.3 Irritation 8.9 15.6 37.2 33.1 4.3 Eye fatigue 14.6 26 27.9 25.8 5.7 Redness 7.6 23.4 38.3 24.2 4.9 Dry eye 8.9 24 38.8 15.9 4.2 Productivity 17.7 26.3 41.1 14.3 0.5 Error rate 19.5 26.6 37.2 14.6 2.1 Health expenditure 21.1 23.4 38 15.9 1.6 Perceived Benefits of Preventive Measures Proper contrast 9.9 29.9 36.5 20.3 3.4 Below eye level 8.1 26.6 38.3 24 3.1 Computer glass 7.3 20.1 43.8 25.8 3.1

Arm length 7.6 21.1 48.2 19.5 3.6 Artificial tear 8.6 21.9 45.8 20.1 3.6

Table legend: the table above shows frequencies of participant responses per individual item under each perception variable and the p value for each and every item: perceived susceptibility (5 items); perceived severity (9 items) and perceived preventive benefits (5 items): SD- Strongly agree, D-Disagree, DK-Don’t know, A-Agree, SA-Strongly agree

Using a modified two category summative perception score, about 39.8% (n=153) of respondents fell in a category of 58 to 95 where students here were considered to perceive CVS risk factors, preventive measures, benefits of preventive measures and an issue of public health concern. Most students, 60.2% (n=231), fell in the category of 19 to 57 a category where students were considered not to perceive CVS risk factors, preventive measures, benefits of preventive measures and not an issue of public health concern.

4.5: Practice of Conventional Preventive Measures of CVS Students were more likely to keep arms-length 40.0% (p<0.001). The p value shows that there was a difference on the proportion of the respondents who had CVS and those who did not have CVS based on arm length and what was observed and what was expected were significantly different. Likewise, 46.2% and 25.7% of the students continuously spent <3 hours and 3 – 6 hours respectively viewing the computer screens compared to 28.1% who spent >6 computer viewing hours (p<0.001). There was a statistically significant difference across all items. Absence or presence of CVS was reported among the students and respondents who did not practice the conventional preventive measures developed CVS. For instance, 54.3% who practiced inappropriate seating position 45.1% developed CVS and this was across all items except viewing distance and duration of computer use. Across all the items in relation to CVS absence or absence, what was observed was significantly different from what was observed. Table 4.5

Table 4.5: Practice of Conventional Interventions for CVS (n=384)

Preventive Frequency Measures Count CVS p-value Absent Present % % % Seating position Appropriate 45.7 30.5 15.4 <0.001 Inappropriate 54.3 9.1 45.1 Viewing distance Arm length 40. 1 27.9 12.2 <0.001 arm length 27.9 3.4 24.5 Duration of use <3hours 46.2 3.0 16.1 3-6 hours 25.7 6.3 19.3 <0.001 >6 hours 28.1 3.1 25.0 Taking breaks >20 minutes 57.3 1.2 45.6 <0.001 <20 minutes 42.7 2.8 14.8 Using eye glasses Yes 41.9 3.4 7.8 <0.001 No 58.1 5.5 52.6 Use of glasses Computer use 41.9 2.1 1.8 Vision 58.1 1.4 7.3 <0.001 N/A 40.0 3.9 56.3 Contrast Yes 49.5 3.1 18.8 <0.001 No 50.5 8.9 41.7 Antiglare lenses Yes 39.3 3.3 6.5 0.013 No 60.7 6.8 53.9

Table legend: the table above shows frequencies of participant responses per individual item under each preventive measure variable and the p value:

CHAPTER 5: DISCUSSION

5.0 Introduction

This chapter discusses the findings of the research, implication of the study findings, and other study findings by other researchers.

5.1 Prevalence of CVS

Computer vision syndrome (CVS) is a multi-factorial condition of the eye that results in symptoms of stress and eye discomfort among computer users (Shrivastava & Bobhate, 2012). This study reported CVS prevalence of 60.4%among university students with the modal group being age 18 – 24 years, showing they constitute the majority of university population. This is comparable to prevalence of 62.6% as reported among university students in Nepal (Reddy et al., 2013). On the contrary, a relatively higher prevalence of 73% was reported among bank workers in Ethiopia (Assefa et al., 2017), a population who are considered exposed to computer use for longer hours than the average population. This indicates there might be subtle variations in prevalence across contexts, given differential exposures. Whereas, majority of the respondents who were from graduate school had a high prevalence of CVS as compared to their counterparts doing undergraduate, the differential exposure across faculties, given some might be more intensely exposed, was not explored in this study. Prevalence of CVS was only slightly higher among female respondents as compared to their male counterparts. The reason for this difference was not investigated in the study, but may indicate either variations arising from sampling error or true differential exposure. Previous studies (Uchino et al., 2008; Logaraj, Madhupriya, & Hegde, 2014; Xu, You, Wang, & Jonas, 2011)show real differences in gender vulnerabilities exist, but there is no consensus on the reasons for the variations. Possible explanations provided include gendered computer use behaviors and contextual factors. Participants, who had CVS, also reported multiple symptoms, of which eye irritation, an early occurring symptom, was the commonest. Often, these symptoms are subtle and occur simultaneously and more likely to be ignored or confused for other eye conditions thus presenting diverse challenges in diagnosis (Assefa et al., 2017).

5.2 Level of Awareness of Computer Vision Syndrome A slight majority of the students had low to medium level of awareness of CVS, CVS risk factors and preventive measures, based on a composite awareness scale ranging from 20 to 100. For instance, being aware that prolonged period of computer use is a risk factor of CVS, 30.5% were slightly aware with only 6.3% being extremely aware. However, the current study did not differentiate between computer use during class work versus outside the class hours. In a study among university students in India, 45.3% were aware that prolonged period of computer use is a risk factor of CVS (Arif & Alam, 2015).Whereas CVS is an emerging chronic health condition, information available in literature show that the level of awareness on risk factors and preventive measures vary widely across population groups.

High level of awareness, understanding of risk factors as well as preventive measures for CVS is crucial to enable users to make informed health seeking or prevention decisions since this condition and its risk factors are amenable to primary preventions. The current study among university students reported a low level awareness with only a few having high level of awareness. This is possible because CVS is a subtle and insidious condition, and as yet is still a low priority condition among computer users and healthcare providers.

Computer vision syndrome awareness has important implications specifically for occupational or workplace health promotion and indicates the need to focus health education activities on enhancing aspects of awareness of occupational risk factors related to use of computers and the corresponding behavioral preventive measures (including seating position; duration of viewing; distance from the computer screen and angle of viewing).

5.3 Perception of Computer Vision Syndrome

About 60.2% of the student’s surveyed did not perceive themselves susceptible to the risk factors for CVS presented to them (prolonged viewing period; poor seating position; above eye level and; poorly adjusted light contrast). This might be expected, as the participants largely being unaware of CVS and related risk factors may not relate to them. A study among health workers in Nepal reported that 67.3% had a belief that viewing the screen at a distance less than arm length is a risk factor (Azuhairi bin Ariffin, 2015).

Most students did not know about the constructs of CVS such as its risk factors, severity of disease symptoms and prevention measures, but were more likely to perceive the severity of symptoms as important. For both perceived severity and benefits of preventive measures, majority did not agree with most elements, for example 33.6% did not agree that headache is a consequence from computer use with only 5.7% to agree. Concerning the prevention of CVS, the recommended ergonomics may not often favor individuals’ accustomed behaviors, thus making it hard to adopt them. This is possible because most students have not heard of CVS and therefore it is hard to agree with what you don’t know. Nevertheless, CVS epidemiology is still an issue which requires great attention to provide evidence for its occurrence and rationale for intervention measures.

5.4 Practice of Conventional Preventive Measures

Most preventive measures of CVS are both device specific and behavioral in nature (Bali et al., 2017). Often, user awareness of respective preventive measures may enhance actual use to mitigate CVS symptoms. The study revealed that only few students practiced appropriately certain interventions. Of these practices, only the recommended arm’s-length screen viewing distance and shorter duration of computer use were the most observed computer-use behaviors. In contrast a study among computer users in Nigeria reported that only 45.3% and 34.8% practiced viewing distance and duration of computer use respectively (Chiemeke et al., 2007). Shorter durations of computer use observed among these students is plausible because often student engage in multiple activities which do not necessarily pin them down on computer screens. Also, keeping at an arm’s length and viewing screen at a distance is consistent with the early physiological eye warning responses, such as head-ache, eye strain and, irritation due to low or high screen light intensities. In a similar study conducted among students in a university in Malaysia,40.2% viewed screen at an arm’s length (Uchino et al., 2008) compared to 40.0% found in the current study. The current study reported a relatively higher proportion of 46.2% as compared to a study among students in Chennai where only 13.7% used their computers for the recommended period of time (Alemayehu et al., 2014). This is possible because the information applied by the students is from their potential efforts like visiting an eye clinic to see an eye care provider or reading from the internet.

This study reported a relatively lower proportion of 45.7% of students practicing appropriate seating position while using computers as compared to a study in Pakistan where 2% of the students practiced appropriate seating position (Khan et al., 2012). The proportion of students who took break was lower than those who did not. This could be due to the fact that students may be willing to complete their task as fast as possible, so as to get time to engage in other activities. A study conducted in USA by American Optometric Association among students in a dental college reported a high proportion of student’s 84.2% who took recommended break time (Jawahar & Shan, 2014). However, there were fewer students using eye glasses. The belief that spectacles destroy the eyes may have influence on the student’s perception hence making them not use the anti-glare. Break time was a low in its practice because the students have high chances of accumulating task which they end up rushing to complete at the last time making it hard for them to have a break during the computer work 5.5 Limitations of the Study

The study involved use of self-report data where students could over report the symptoms of CVS in order to make the situation seen worse. This could be possible as the students may wish to make the situation seen worse with a mindset to accrue certain benefits. In relation to the self report data, the students may remember or may not remember the symptoms they experienced at some point in the past while using computer. Some students may only recall symptoms that occurred at one time as if they occurred at another point, thus self report data have issues with validity. Therefore the researcher did a counter biasing to make the topic less sensitive to counter over reporting and ensured anonymity of the participants was maintained. The findings of this study may only be generalizable to similar populations of students but may not apply to all university students in Kenya.

CHAPTER SIX: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

6.0 Introduction

In this chapter, the research findings are summarized, conclusions and recommendations to the study are drawn, and research gaps are identified for future studies, as this study was aimed at determining the level of awareness and perception on CVS among students at Maseno University.

6.1 Summary of the findings

The study findings showed the modal age-group as 18-24 years with females being dominant. First, CVS prevalence of 60.4% was reported. The most common symptom experienced by the students, in descending order were: eye irritation, blurred vision, double vision, tired eyes, dry eye, watering eye, slow focus change and finally eye strain which was the least.

Second, with regards to student awareness of CVS, almost half of the respondents had never heard of CVS with only a few who knew more about CVS. However, a relatively high proportion of the students had a low level of awareness with a few having high level of awareness. Student’s level of awareness on risk factors and preventive measures was generally low.

Third, most of the students did not perceive their susceptibility to risk factors for CVS, their severity but perceived that viewing computer screen at a distance less than arm length during computer use increased their risk of exposure. Students perception on susceptibility, benefits and severity still remains a challenge.

Finally few students indicated that they practice the conventional preventive measures. Of all the interventions presented, only viewing distance 40.0% (n=154) and duration of computer use 46.2% (n=178) was being practiced by relatively high proportion of the students.

6.2 Conclusions

I. The burden of CVS prevalence remains high among the population. This could be due to the low level of awareness and low practice of conventional interventions among the students.

II. Students have lack of awareness that CVS is as a result of prolonged period of computer use, inappropriate seating position, uncorrected refractive error, glare, poor contrast and inappropriate viewing distance. The students at the same time are not aware that viewing computer at arm’s length and reducing the duration of computer use reduces chances of acquiring CVS. III. Perception regarding risk factors, preventive measures and consequences of CVS is still insufficient and majorities do not perceive them. IV. Practice of conventional interventions such as appropriate seating position, taking breaks during computer use, using antiglare glasses and balancing the contrast besides viewing distance and duration of computer use is still insufficient.

6.3 Recommendations

Based on the findings and conclusions made above, the following recommendations were made:

I. Intensive interventions to reduce progression of CVS II. Optimal plan of education with more awareness campaign to increase the knowledge among students III. There is a high need for health education requirements when it comes to perception of CVS among students at all level of education in Kenya. IV. Dissemination of information pertaining to conventional preventive measures needs to be undertaken to assist computer users know that there is a solution to the problems they experience during computer use so as to motivate them use the measurers. 6.4 Suggestion for Further Research

The study focused on investigating the level of awareness and perception on CVS among students at Maseno University, Kisumu County. Further studies are recommended to:

1. Investigate the association between user perception and uptake of interventions. 2. Prospective study to assess CVS throughout life. 3. Investigate the association between user level of awareness and uptake of interventions.

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APPENDIX 2: LETTER TO CONDUCT A STUDY AT MASENO UNIVERSITY

APPENDIX 3: RECRUITMENT LETTER

12/4/2019

TO WHOM IT MAY CONCERN

RE: INVITATION TO PARTICIPATE IN A STUDY

Having identified you and your contact details through the university registry as a potential participant, I hereby inform you that you are invited to take part in the upcoming study entitled

LEVEL OF AWARENESS, PERCEPTION AND PRACTICE OF CONVENTIONAL

INTERVENTIONS FOR COMPUTER VISION SYNDROME AMONG UNIVERSITY

STUDENTS, MASENO KENYA. This study is intended to assess your level of awareness, perception and practice of conventional preventive measures of computer vision syndrome.

There is no risk associated with participation in this study and it is purely for academic purposes.

The study is being conducted by Shadrack Muma, Master of Public Health, Maseno University.

You are free to ask for additional information through email:[email protected] and phone-0700237580. You will be given consent before participation. I will make a call to confirm your participation status. Thanks

Yours Faithfully

Shadrack Muma

APPENDIX 4: STUDENTS QUESTIONNAIRES

MASENO UNIVERSITY

SCHOOL OF PUBLIC HEALTH AND COMMUNITY DEVELOPMENT

MASTERS OF PUBLIC HEALTH

LEVEL OF AWARENESS, PERCEPTION AND PRACTICE OF CONVENTIONAL INTERVENTIONS FORCOMPUTER VISION SYNDROME AMONG UNIVERSITY STUDENTS, MASENO, WESTERN KENYA

Questionnaire code

Participant code

Date of interview

School

Name of interviewer

Name of field study supervisor

Instructions

This survey is about a condition which results from certain unhealthy behaviors while using computer. The survey has been developed so that you can tell us how much you know about computer vision syndrome. The survey will also require that you report the symptoms you have experienced while using computer. The information you give will be used to improve health education for people who uses computers for different purposes.

Do not write your name on this questionnaire. The answers you give will be kept private. No one will know what you write. Answer the questions based on what you really know.

Completing the questionnaire is voluntary. If you are not comfortable answering a question, just leave it blank.

The questions that ask about your background will be used only to describe the characteristics of students completing this survey. The information will not be used for other purposes other than the study related aims. No personal details and participant names will ever be reported.

Make sure you read every question.

Part A. Socio-Demographic Details

This section requires that you respond to your personal details like gender and age.

1. Gender

 Male

 Female 2. Age

 18-24 years

 25-29 years

 30-34 years

 35-39 years

Part B. Awareness of computer vision syndrome

Question 3 to 12 consists of statement on causes and possible interventions of a condition called computer vision syndrome (CVS). Rate them on a scale of 1-5 expressing how much you are aware with each statement. Where 1=not at all aware, 2=slightly aware, 3=somewhat aware, 4=moderately aware, 5=extremely aware. (Tick only the one that applies)

Statements Not Slightly Somewhat Moderately Extremely at all aware aware aware aware aware 3. Computer vision syndrome is caused by prolonged period of computer use. 4. Computer vision syndrome is caused by poor seating position during computer use. 5. Computer vision syndrome is caused by viewing computer screen at distance less than arm’s length. 6. Computer vision syndrome is

caused by viewing computer screen below the eye level. 7. Computer vision syndrome is caused by a situation when the screen brightness is higher than that at the room. 8. Computer user can reduce CVS by taking regular breaks during computer use 9. Computer user can reduce CVS by viewing computer screen below the eye level. 10. Computer user can reduce CVS by using computer eye glasses with antiglare. 11. Computer user can reduce CVS by maintaining a balanced contrast between computer screen and the room illumination. 12. Computer user can reduce CVS by correcting shortsightedness or long sightedness.

Part C. Perception of CVS

Question 13 to 31 consists of statement on perception of a condition called computer vision syndrome (CVS). The sections have been divided into three aspects of perception that is perceived susceptibility (risk factors), perceived severity (consequences of CVS) and perceived benefits (preventive measures). Rate them on a scale of 1-5 expressing how much you agree with each statement. Where SD=strong disagree, D=disagree, DK=don’t know, A=agree, SA=strongly agree (Tick inside the appropriate one)

1. Perceived susceptibility (Risk factors)

Statement SD D DK A SA

13. Viewing computer screen at a distance less than arm’s length is a risk factor of CVS. 14. Prolonged duration of computer use is a risk factor of CVS. 15. Inappropriate seating position is a risk factor of CVS. 16. Keeping computer screen above the eye level is a risk factor of CVS. 17. Poor contrast of computer screen and the surrounding brightness is a risk factor of CVS.

2. Perceived severity (consequences of CVS) 18. Headache is a consequence of CVS arising from computer use. 19. Eye strain is a consequence of CVS due to computer use. 20. Irritation of the eye is a consequence of CVS. 21. Eye fatigue is a consequence of CVS. 22. Redness of the eye is a consequence of CVS. 23. Dry eye is a consequence of CVS. 24. Reduced job productivity is a consequence of CVS due to computer use. 25. Increased error rate is a consequence of CVS. 26. Increased health expenditure is a consequence of CVS.

3. Perceived benefits (preventive measures of CVS). 27. Maintaining a proper contrast while using computers reduces the symptoms of CVS. 28. Keeping computer screen below eye level is a way of reducing the symptoms of CVS 29. Using computer eye glasses is a way of reducing the symptoms of

CVS. 30. Viewing computer screen at a distance less than arm’s length is a way of reducing the symptoms of CVS. 31. Applying artificial tears while using computers is one of the ways of reducing the symptoms of CVS.

32 Have you heard of the term computer vision syndrome?

 Yes  No 33. Only tick one medium which is most reliable and appropriate for dissemination of information on CVS. Please do not mark more than one.

 Radio

 Internet

 Television

 Eye care provider

 Newspaper and magazine

 Public library

Part D: Practice of Conventional Preventive Measurers

This section is about the practice on the uptake of interventions of computer vision syndrome. The section requires that you respond to what you exactly do.

34. Which seating position do you practice below?



35. At what distance do you view your computer screen?

 Arm length

 Less than arm length

 More than arm length

36. How long do you use computer per day?

 <3 hours

 3–6 hours

 >6 hours

37. After how many minutes of electronic device use do you take a break?

 >20 minutes

 <20 minutes

38. Do you use eye glass?

 Yes

 No

39. If the answer for question no.38 is yes, what is the purpose of the glass?

 For computer use

 For vision

 Not applicable

40. Do you adjust the contrast of your computer with the surrounding brightness?

 Yes

 No

41. Do you use antiglare for your computer screen?

 Yes

 No

APPENDIX 5

SELF ASSESSMENT TOOL FOR DIAGNOSIS OF COMPUTER VISION SYNDROME

LEVEL OF AWARENESS, PERCEPTION AND PRACTICE OF CONVENTIONAL PREVENTIVE MEASURES OF COMPUTER VISION SYNDROME AMONG UNIVERSITY STUDENTS, MASENO, WESTERN KENYA

Tick the symptoms you frequently experience in your eyes while using computers.

1. Do you often experience the following symptoms while using computer? (Tick the symptoms you experience). a. Symptoms associated with headache while using electronic devices (Asthenopic symptoms).

 Eye strain (a feeling of discomfort in the eye muscles)

 Tired eyes (a symptom which makes one not to feel like opening the eye due to discomfort) b. Ocular surface related (symptoms experienced in the eye which are due to environmental exposure while using electronic devices).

 Watering eye (eyes removing water every time you are using electronic device)

 Irritation (eyes becomes itchy and feeling of foreign body in the eye)

 Dry eye (experiencing pain in opening and closing the eye due to tear insufficiency) c. Visual symptoms (symptoms which affects the clarity of the eye while viewing objects)

 Blurred vision (being unable to see objects clearly while using electronic devices and after)

 Double vision (seeing more than one object while using electronic devices and after)

 Slowness of focus change (being unable to see a near object and a distant object at the same time)

APPENDIX 6: MASENO UNIVERSITY ETHICS REVIEW COMMITTEE APPROVAL

APPENDIX 7: NACOSTI PERMIT

APPENDIX 8: INFORMED CONSENT FORM

LEVEL OF AWARENESS, PERCEPTION AND PRACTICE OF CONVENTIONAL INTERVENTIONS FORCOMPUTER VISION SYNDROME AMONG UNIVERSITY STUDENTS, MASENO, WESTERN KENYA

NAME OF INVESTIGATOR INSTITUTION ROLE

SHADRACK MUMA MASENO PRINCIPAL UNIVERSITY INVESTIGATOR(CANDIDATE)

DR DICKENS OMONDI UNIVERSITY OF SUPERVISOR KABIANGA

DR PATRICK ONYANGO MASENO SUPERVISOR UNIVERSITY

Interviewer:

I am Shadrack Muma, a student pursuing a degree in Master of Public Health at Maseno University.

Introduction to the study

I am conducting a research among students of Maseno University to find out more about an illness known as computer vision syndrome. The research findings will be useful in planning ways to prevent unwanted effects arising from use of computers. Self administered questionnaires will be used, and the questionnaire will contain closed ended question where you will respond to your best based on your understanding and rating.

You are being asked to take part in an interview to find out how widespread the disease is among university students. The purpose of this study is to learn about what students’ know about the disease, what they do that may promote or prevent the disease from occurring and how they are coping with the challenges and whether they uptake the preventive measures. The interview will last about 45 minutes and the duration of the entire study will be one week. You will be asked about what you know about the disease, how you perceive the disease and what you do that may lead to or prevent the condition. About 384 male and female individuals from this university will participate in this study. You will be informed of any changes made to the study or should additional relevant information become available.

Procedures

You will be asked to fill in or respond to the questions in the questionnaire form given to you. The questionnaire consists of 45 questions which will take about 45 minutes to complete. You are requested to respond to each question to the best of your knowledge.

What are the risks or discomforts of participating in the study?

The study will not involve any physical harm. But you may decline to respond to any question, if you feel they are personal or if talking about them makes you uncomfortable.

What are the benefits of being in the study?

There will be no direct benefit to you. You will help health care workers and the institution in general to become aware of your health protection needs and concerns. You will have a chance to talk about your opinion and concerns about computer vision syndrome.

Will my information be kept private?

We will not put your name in our report. We will not link your name to your response in any way. All information will be kept under lock and key, to be available only to investigators.

Is there a cost to take part? Will there be payment?

There is no cost to you to take part; neither will there be any reimbursements.

What are the other options to being in the study?

You can choose not to be in the study. You can also choose not to answer any questions that may make you feel uneasy. You can withdraw from the study at any stage.

Is it voluntary to take part in the focus group?

It is your own choice to take part in the interview. Choosing not to take part will involve no penalty or loss to you.

Any other question

We invite you to ask questions. If you think of new questions at later time or have some other concerns, study related injury please call the investigator at the phone number and address below.

NB-a computer is a term used to describe all the portable electronic devices used on a daily basis for storing, communicating and processing data

Researcher: Shadrack Muma (MPH student)

Maseno University department of Public Health and Community Development

Mobile number: 0700237580

Address: 811-40100 Kisumu

Principal investigator: ______;______at [______].

For any questions pertaining to rights as a research participant, contact person is: The Secretary, Maseno University Ethics Review Committee, Private Bag, Maseno; Telephone numbers: 057-51622, 0722203411, 0721543976, 0733230878; Email address: muerc- [email protected]; [email protected]. Signing below shows I have had a chance to read the information provided. Further it confirms that I will be able to ask questions relating to the discussion group participation and sufficient answers will be provided to me. I consent voluntarily to participate in the study, and understand that I can withdraw from the study at any time.

PLEASE SIGN HEREBELOW AND DATE:

NAME: ______. SIGNATURE______. DATE:______.

WITNESSED BY:

NAME______. DESIGNATION/ROLE ______.

SIGNATURE______. DATE______

You will be given a copy of this form to keep for your records.