LEVEL OF AWARENESS, PERCEPTION AND PRACTICE OF CONVENTIONAL

PREVENTIVE MEASURES FOR COMPUTER VISION SYNDROME AMONG

UNIVERSITY STUDENTS, MASENO, WESTERN KENYA

BY

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……………………………………………

ii
 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.

iii
 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.

iv
 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.

v
 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

vi
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

vii
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

viii
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

ix
 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.

x
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.

xi
 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

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

xiii
 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

xiv
 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
 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.

5
 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.

6
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

11
 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.

12
 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.

13
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
𝑍 2 𝑝𝑞
was calculated as follows: 𝑛 = 𝑑2

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

15
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.

18
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.

21
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.

22
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.

23
 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

24
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
<arms length 26 33.1 15.4 17.4 8
Above eyelevel 25.3 32.6 16.9 17.7 7.6
High brightness 26.8 29.7 16.9 18.8 7.8
Average 26.46 31.58 16.3 18.46 7.24
Awareness of Preventive Measures
Regular
breaks 29.4 35.7 9.6 18.2 7
Below level 28.9 31.8 14.8 18 6.5
Antiglare 28.9 31.5 12.5 18.8 8.3
Contrast 31 29.7 14.6 16.4 8.3
Correct error 31.3 30.5 13.3 16.9 8
Average 29.9 31.8 12.9 14.4 7.6

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%

26
(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

27
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

28
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 31.9 8.3 23.7
>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:

29
 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).

30
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).

31
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.

32
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.

33
 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.

34
 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.

References

35
Agarwal, S., Goel, D., & Sharma, A. (2013). Evaluation of the factors which contribute to the
ocular complaints in computer users. Journal of Clinical and Diagnostic Research, 7(2),
331–335. https://doi.org/10.7860/JCDR/2013/5150.2760
Akinbinu, T. R., & Mashalla, Y. J. (2013). Knowledge of computer vision syndrome among
computer users in the workplace in Abuja, Nigeria. Journal of Physiology and
Pathophysiology, 4(4), 58–63. https://doi.org/10.5897/JPAP.
AOA. (2013). The Effects of Computer Use on Eye Health and Vision. American Optometric
Association, (314), 1–9. Retrieved from
http://www.aoa.org/Documents/optometrists/effects-of-computer-use.pdf
AOA. (2017). Computer Vision Syndrome. Optometry and Vision Science, 20189. Retrieved
from http://www.imedpub.com/articles/ocular-ergonomics-for-the-computer-vision-
syndrome.pdf
Arif, K. M., & Alam, M. J. (2015). Review Article Computer Vision Syndrome, 10(1), 33–35.
Retrieved from https://www.banglajol.info
Arumugam, S., Kumar, K., Subramani, R., & Kumar, S. (2014). Prevalence of Computer Vision
Syndrome among Information Technology Professionals Working in Chennai. World
Journal of Medical Sciences, 11(3), 312–314.
https://doi.org/10.5829/idosi.wjms.2014.11.3.84262
Assefa, N. L., Weldemichael, D., Alemu, H. woretaw, & Anbesse, D. H. (2017). Prevalence and
associated factors of computer vision syndrome among bank workers in Gondar City,
northwest Ethiopia, 2015. Clinical Optometry, Volume 9, 67–76.
https://doi.org/10.2147/OPTO.S126366
Azuhairi bin Ariffin, A. (2015). Knowledge, Attitude and Practice of Computer Vision
Syndrome Among Staffs That Use Video Display Terminal in a Faculty of a Malaysian
Public University. International Journal of Public Health and Clinical Sciences, 2(1),
2289–7577.
Bali, J., Navin, N., & Thakur, B. R. (2017). Computer vision syndrome: a study of the
knowledge, attitudes and practices in Indian ophthalmologists. Indian Journal of
Ophthalmology, 55(4), 289–294.
Bhanderi, D. J., Choudhary, S., & Doshi, V. G. (2008). A community-based study of asthenopia
in computer operators. Indian Journal of Ophthalmology, 56(1), 51–55.
https://doi.org/10.4103/0301-4738.37596
Brosius, F. (2013). Spss 21. Mitb. https://doi.org/10.1007/978-3-540-72978-5_23
Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In HEALTH BEHAVIOR
AND HEALTH EDUCATION Theory, Research, and Practice (pp. 67–96).
https://doi.org/10.1016/S0033-3506(49)81524-1
Chang, P. C., Chou, S. Y., & Shieh, K. K. (2013). Reading performance and visual fatigue when
using electronic paper displays in long-duration reading tasks under various lighting

36
 conditions. Displays, 34(3), 208–214. https://doi.org/10.1016/j.displa.2013.06.001
Charpe, N. A., & Kaushik, V. (2009). Computer Vision Syndrome (CVS): Recognition and
Control in Software Professionals. Journal of Human Ecology, 28(1), 67–69.
Chendilnathan, C., Ramalingam, P., Raja, A., Janti, S., & Matheen, A. (2015). Cross-sectional
questionnaire study of ocular effects among IT professionals who use computers.
International Journal of Medicine and Public Health, 5(1), 63.
https://doi.org/10.4103/2230-8598.151264
Chiemeke, S. C., Akhahowa, A. E., & Ajayi, O. B. (2007). Evaluation of vision-related problems
amongst computer users: A case study of University of Benin, Nigeria. World Congress on
Engineering 2007, Vols 1 and 2, I, 217–221.
Conrady, C. D., Joos, Z. P., & Patel, B. C. K. (2016). Review : The Lacrimal Gland and Its Role
in Dry Eye, 2016.
Disord, J. E. D., Firouzeh, F., & Tabatabaee, S. (2018). Can Low Vision Aids Improve the
Quality of Life of Low Vision Patients ?, 3(1), 3–6.
Divjak, M., & Bischof, H. (2009). Eye Blink Based Fatigue Detection for Prevention of
Computer Vision Syndrome. Mva, 350–353. Retrieved from http://www.mva-
org.jp/Proceedings/2009CD/papers/10-04.pdf
George, D., & Mallery, P., George, D., & Mallery, P. (2003). SPSS for Windows step by step: A
simple guide and reference. 11.0 update (4th ed.). Boston: Allyn & Bacon. British Journal
of Haematology (Vol. 11.0 updat).
Gowrisankaran, S., & Sheedy, J. E. (2015). Computer vision syndrome: A review. Work.
https://doi.org/10.3233/WOR-152162
Gupta, N., Moudgil, T., & Sharma, B. (2016). Computer Vision Syndrome: Prevalence And
Predictors Among College Staff And Students. Journal of Dental and Medical Sciences,
15(9), 28–31. https://doi.org/10.9790/0853-1509022831
Gupta, R., Gour, D., & Meena, M. (2014). Interventional Cohort Study for evaluation of
Computer Vision Syndrome among Computer Workers, 2(1), 40–44.
Han, C. C., Liu, R., Liu, R. R., Zhu, Z. H., Yu, R. B., & Ma, L. (2013). Prevalence of asthenopia
and its risk factors in Chinese college students. International Journal of Ophthalmology,
6(5), 718–722. https://doi.org/10.3980/j.issn.2222-3959.2013.05.31
Hashemi, H., Fotouhi, A., Yekta, A., Pakzad, R., & Ostadimoghaddam, H. (2018). ScienceDirect
Global and regional estimates of prevalence of refractive errors : Systematic review and
meta-analysis. Journal of Current Ophthalmology, 30(1), 3–22.
https://doi.org/10.1016/j.joco.2017.08.009
Jawahar, C. V., & Shan, S. (2014). Computer vision - ACCV 2014 workshops: Singapore,
Singapore, november 1-2, 2014 revised selected papers, Part III. In Lecture Notes in
Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture

37
 Notes in Bioinformatics) (Vol. 9010). https://doi.org/10.1007/978-3-319-16634-6
Julius, N., Computer, K., & Syndrome, V. (2014). Take-A-Break Notification. 2014
International Conference on Information Technology and Multimedia (ICIMU), 390–395.
Khalaj, M., Ebrahimi, M., Shojai, P., Bagherzadeh, R., Sadeghi, T., & Ghalenoei, M. (2015).
Computer Vision Syndrome in Eleven to Eighteen-Year-Old Students in Qazvin.
Biotechnology Health Sciences, 2(3). https://doi.org/10.17795/bhs-28234
Khan, R., Surti, A., Rehman, R., & Ali, U. (2012). Knowledge and practices of ergonomics in
computer users. Journal of the Pakistan Medical Association, 62(3), 213–217.
Ko, P., Mohapatra, A., Bailey, I. L., Sheedy, J., & Rempel, D. M. (2014). Effect of font size and
glare on computer tasks in young and older adults. Optometry and Vision Science, 91(6),
682–689. https://doi.org/10.1097/OPX.0000000000000274
Logaraj, M., Madhupriya, V., & Hegde, S. (2014). Computer vision syndrome and associated
factors among medical and engineering students in Chennai. Annals of Medical and Health
Sciences Research, 4(2), 179. https://doi.org/10.4103/2141-9248.129028
Logaraj, M., Priya, V. M., Seetharaman, N., & Hedge, S. K. (2013). Practice of Ergonomic
Principles and Computer Vision Syndrome (CVS) among Undergraduates Students in
Chennai. National Journal of Medical Research, 3(2), 111–116. Retrieved from
http://sjournals.net/ojs/index.php/NJMR/article/view/18
Loh, K. Y., & Reddy, S. C. (2008). Understanding and preventing computer vision syndrome.
Malaysian Family Physician.
Mallik, D., Gahlot, A., Maini, A., & Garg, S. (2017). Prevalence of dry eye amongst computer
workers in Kanpur. International Journal of Community Medicine and Public Health, 4(7),
2308–2311.
Manjusha, V., Devakumar, V. S., & Babu, B. K. (2013). Computer Vision Syndrome.
International Journal of Innovative Research and Development, 2(5).
Martinez-de Dios, J. R., Arrue, B. C., Ollero, A., Merino, L., & Gómez-Rodríguez, F. (2008).
Computer vision techniques for forest fire perception. Image and Vision Computing, 26(4),
550–562. https://doi.org/10.1016/j.imavis.2007.07.002
Martínez-Mesa, J., González-Chica, D. A., Bastos, J. L., Bonamigo, R. R., & Duquia, R. P.
(2014). Sample size: How many participants do i need in my research? Anais Brasileiros de
Dermatologia, 89(4), 609–615. https://doi.org/10.1590/abd1806-4841.20143705
Maseno University. (2013). Varsity News, 1(1), 1–8. Retrieved from http://maseno.ac.ke
Maseno University. (2017). Maseno University in brief. Retrieved from
http://maseno.ac.ke/index/index.php?option=com_content&view=article&id=147&Itemid=
174
Mathew, A., & Menon, L. (2016). the Prevalence of Computer Vision Syndrome Among

38
 Information Technology Students. International Journal of Current Research, 8(11), 2–5.
Mekuriaw Alemayehu, Ansha Nega, Eniyew Tegegne, Y. M. (2014). Prevalence of Self
Reported Computer Vision Syndrome and Associated Factors among Secretaries and Data
Processors Who are Working in University of Gondar, Ethiopia. Journal of Biology, 4(15),
33–37.
Mowatt, L., Gordon, C., Santosh, A. B. R., & Jones, T. (2018). Computer vision syndrome and
ergonomic practices among undergraduate university students. International Journal of
Clinical Practice, 72(1). https://doi.org/10.1111/ijcp.13035
Mugenda, O. M., & Mugenda, A. G. (2008). Research methods : quantitative and qualitative
approaches, 256.
Mussa, A. (2016). Computer Vision Syndrome, 4(3), 4–7.
https://doi.org/10.15406/aovs.2016.04.00110
NCIT. (2016). National ICT Survey 2015, (June).
Noreen, K., Batool, Z., Fatima, T., & Zamir, T. (2016). Prevalence of Computer Vision
Syndrome and Its Associated Risk Factors among Under Graduate Medical Students.
Pakistan Journal of Ophthalmology, 140(3). Retrieved from http://www.pjo.com.pk/32/3/3.
OA-Khola Noreen.pdf
Nursyifa, G., Teesa, P., Santoso, R., & Musa, I. R. (1016). Computer Vision Syndrome among
Call Center Employees at Telecommunication Company in Bandung. Althea Medical
Journal, 3(2), 181–185.
Oruonye, E. D. (2015). An assessment of the level of awareness of the effects of climate change
among students of tertiary institutions in Jalingo Metropolis , Taraba State Nigeria, (January
2011).
OSHA. (2007). The occupational safety and health act, 2007 arrangement of sections part i ―
preliminary. Kenya Health Policy 2014-2030, 2(1), 1–128. Retrieved from
http://www.health.go.ke/wp-content/uploads/2015/09/OSH Act 2007.pdf
OSHA. (2018). OSHA Safety and Health Program Management Guidelines. Journal of Current
Ophthalmology, 2(1), 12. Retrieved from
https://www.osha.gov/shpmguidelines/SHPM_guidelines.pdf
Plackal, J., Ismail, G., & Mohanraj, K. (2018). Perception of Refractive Error among
Adolescents - A Pilot Study, 6(2), 1–9. https://doi.org/10.21522/TIJPH.2013.06.02.Art013
Ranasinghe, P., Perera, Y. S., Lamabadusuriya, D. A., Kulatunga, S., Jayawardana, N.,
Rajapakse, S., & Katulanda, P. (2011). Work related complaints of neck, shoulder and arm
among computer office workers: a cross-sectional evaluation of prevalence and risk factors
in a developing country. Environmental Health, 10(1), 70. https://doi.org/10.1186/1476-
069X-10-70
Ranasinghe, P., Wathurapatha, W. S., Perera, Y. S., Lamabadusuriya, D. A., Kulatunga, S.,

39
 Jayawardana, N., & Katulanda, P. (2016). Computer vision syndrome among computer
office workers in a developing country: An evaluation of prevalence and risk factors. BMC
Research Notes, 9(1). https://doi.org/10.1186/s13104-016-1962-1
Randolph, S. A. (2017a). Computer Vision Syndrome. Workplace Health and Safety.
https://doi.org/10.1177/2165079917712727
Randolph, S. A. (2017b). Computer Vision Syndrome. Workplace Health and Safety, 65(7), 328.
https://doi.org/10.1177/2165079917712727
Reddy, S., Low, C., Lim, Y., Low, L., Mardina, F., & Nursaleha, M. (2013). Computer vision
syndrome : a study of knowledge and practices in university students. Nepal Journal of
Ophthalmology, 5(10), 161–168. https://doi.org/10.3126/nepjoph.v5i2.8707
Rosenfield, M. (2011). Computer vision syndrome: A review of ocular causes and potential
treatments. Ophthalmic and Physiological Optics. https://doi.org/10.1111/j.1475-
1313.2011.00834.x
Rosenfield, M. (2016). Computer vision syndrome (a.k.a. digital eye strain). Optometry in
Practice, 17(2), 1–10. Retrieved from
https://www.researchgate.net/profile/Mark_Rosenfield/publication/295902618_Computer_v
ision_syndrome_aka_digital_eye_strain/links/56cf685008ae4d8d649fc316.pdf
Rosenfield, M., Bababekova, Y., & Portello, J. K. (2012). Prevalence Of Computer Vision
Syndrome (CVS) And Dry Eye In Office Workers. Investigative Ophthalmology & Visual
Science, 53(14), 5459. Retrieved from http://dx.doi.org/
Rosenstock, I. M. (1974). Historical Origins of the Health Belief Model. Health Education
Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403
Sa, E. C., Ferreira Junior, M., & Rocha, L. E. (2012). Risk factors for computer visual syndrome
(CVS) among operators of two call centers in São Paulo, Brazil. In Work (Vol. 41, pp.
3568–3574). https://doi.org/10.3233/WOR-2012-0636-3568
Schaumberg, D. A., Dana, R., Buring, J. E., & Sullivan, D. A. (2009). Prevalence of dry eye
disease among US men: Estimates from the physicians’ health studies. Archives of
Ophthalmology, 127(6), 763–768. https://doi.org/10.1001/archophthalmol.2009.103
Sen, a, & Richardson, S. (2007). A study of computer-related upper limb discomfort and
computer vision syndrome. Journal of Human Ergology, 36(2), 45–50.
https://doi.org/10.11183/JHE1972.36.2_45
Shahid, E., Burhany, T., Siddique, W. A., Fasih, U., & Shaikh, A. (2017). Frequency of
Computer Vision Syndrome in Computer Users. Pakistan Journal of Ophthalmology, 33(2),
108–112.
Shantakumari, N., Eldeeb, R., Sreedharan, J., & Gopal, K. (2014). Computer use and vision-
related problems among university students in Ajman, United Arab Emirate. Annals of
Medical and Health Sciences Research, 4(2), 258. https://doi.org/10.4103/2141-
9248.129058

40
Shapiro, L., & Stockman, G. (2001). Computer Vision. October, 2004(October), 608.
https://doi.org/10.1525/jer.2008.3.1.toc
Sheetal. (2011). The Perceptions Regarding Refractive Errors and Their Psychosocial Impact on
Youth in Dakshina Kannada, 5(4), 746–748.
Shrivastava, S., & Bobhate, P. (2012). Computer related health problems among software
professionals in Mumbai: A cross-sectional study. International Journal of Health & Allied
Sciences, 1(2), 74. https://doi.org/10.4103/2278-344X.101684
Singh, H., Tigga, M. J., Laad, S., & Khan, N. (2016). Prevention of Ocular Morbidity Among
Medical Students By Prevalence Assessment of Asthenopia and Its Risk Factors. Journal of
Evidence Based Medicine. Healthc, 3(15), 532–536.
https://doi.org/10.18410/jebmh/2016/122
Torrey, J. (2003). Understanding Computer Vision Syndrome. Employment Relations Today,
30(1), 45–51. https://doi.org/10.1002/ert.10073
Uchino, M., Schaumberg, D. A., Dogru, M., Uchino, Y., Fukagawa, K., Shimmura, S., …
Tsubota, K. (2008). Prevalence of Dry Eye Disease among Japanese Visual Display
Terminal Users. Ophthalmology, 115(11), 1982–1988.
https://doi.org/10.1016/j.ophtha.2008.06.022
Uchino, M., Schaumberg, D., Dogru, M., Uchino, Y., Fukagawa, K., Shimmura, S., … Tsubota,
K. (2008). Prevalence of dry eye disease among Japanese visual display terminal users.
Ophthalmol, 115(11), 1982–1988. https://doi.org/10.1016/j.ophtha.2008.06.022
Vagias, W. M. (2006). Likert-type Scale Response Anchors. Clemson International Institute for
Tourism. & Research Development, Department of Parks, Recreation and Tourism
Management, Clemson University. https://doi.org/10.1007/s10459-010-9222-y
WHO. (2014). Public Health Implications of Excessive Use of the Internet , Computers ,
Smartphones and Similar Electronic Devices Meeting report, (August).
Xu, L., You, Q. S., Wang, Y. X., & Jonas, J. B. (2011). Associations between gender, ocular
parameters and diseases: The Beijing Eye Study. Ophthalmic Research, 45(4), 197–203.
https://doi.org/10.1159/000321522
Yan, Z., Hu, L., Chen, H., & Lu, F. (2008). Computer Vision Syndrome: A widely spreading but
largely unknown epidemic among computer users. Computers in Human Behavior, 24(5),
2026–2042. https://doi.org/10.1016/j.chb.2007.09.004
Zainuddin, H., & Isa, M. M. (2014). Effect of Human and Technology Interaction: Computer
Vision Syndrome among Administrative Staff in a Public University. International Journal
of Business, Humanities and Technology, 4(3), 39–44.
Zucker, S. (2013). Computer Vision and Human Perception. Journal of Chemical Information
and Modeling, 53(9), 1689–1699. https://doi.org/10.1017/CBO9781107415324.004
APPENDIX 1: MASENO UNIVERSITY MAP

41
APPENDIX 2: LETTER TO CONDUCT A STUDY AT MASENO UNIVERSITY

42
APPENDIX 3: RECRUITMENT LETTER

43
 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:mumashadrack275@gmail.com 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

44
 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.

45
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.

46
 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

47
 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)

48
 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

49
 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?

50
 


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

51
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

52
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)

53
APPENDIX 6: MASENO UNIVERSITY ETHICS REVIEW COMMITTEE APPROVAL

54
APPENDIX 7: NACOSTI PERMIT

55
56
 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

57
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.

58
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

59
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-
secretariate@maseno.ac.ke; muerc-secretariate@gmail.com.
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.

60