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KNOWLEDGE, ATTITUDE AND PRACTICE OF COMPUTER

VISION SYNDROME AMONG STAFFS THAT USE VIDEO
DISPLAY TERMINAL IN A FACULTY OF A MALAYSIAN
PUBLIC UNIVERSITY
Amirul F.Z.1, Aqilah R.1, Lee M.L.1, Azuhairi A.A.2*, Isa M.M.3
1

Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

Department of Community Health, Faculty of Medicine and Health Sciences, Universiti
Putra Malaysia
3
Department of Surgery (Ophthalmology), Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia
2

*Corresponding author: Dr. Ahmad Azuhairi bin Ariffin, Department of Community Health,
Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, zuhairifin@upm.edu.my

ABSTRACT
Background: Computers are one of the commonest office tools used in Malaysia nowadays.
Computer Vision Syndrome (CVS) is a complex of eye and vision problems related to the
near activities that experienced in relation to or during the use of the computer. The aim of the
study is to determine the knowledge, attitude and practice of Computer Vision Syndrome
among staff that use visual display terminal (VDT) in the Faculty Medicine and Health
Science, University Putra Malaysia.
Methodology: This is a cross-sectional study using self-administered questionnaires
regarding socio-demographic factors, occupational factors and knowledge, attitude and
practices of respondents. Responses were analyzed using IBM SPSS Statistics version 21.0
for Windows.
Results: The response rate was 91.0%. There was a significant association between the
ethnicity, educational level and spectacles or contact lens users with the knowledge on CVS
(P<0.05). There was a significant association between spectacles or contact lens users with
their attitude on CVS (P<0.05). Also, there was a significant association between age,
ethnicity, educational level and spectacles or contact lens users with practice of CVS
(P<0.05). Besides, there was a significant association between job categories with the
knowledge, attitude and practice of CVS (P<0.05).
Conclusions: Knowledge, attitude and practices on preventive measures on CVS were
satisfactory among the staffs that use VDT. There was a knowledge gap about CVS in the
studied population.
Keywords: Computer vision syndrome, video display terminal, knowledge, attitude, practice

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1.0 Introduction
Computers are one of the commonest office tools used in Malaysia nowadays. A video
display terminal (VDT) is also known as computer screen (Reddy et al., 2013).
Computer Vision Syndrome (CVS) is defined as a group of eye and vision-related problems
that result from prolonged computer use (American Optometric Association, 2007). Many
experiences eye discomfort and vision problems when viewing a video display terminal for
extended periods and increases with the amount of video display terminal use. Symptoms
related to computer use are divided into four categories which are asthenopic, ocular surface
related-symptoms, visual and extra-ocular symptoms (Blehm et al., 2005).
Nearly 60 million people suffer from CVS globally and a million new cases occur each year
(Sen et al., 2007). According to Izequardo (2010), the prevalence of CVS worldwide ranges
from 25% to 93%. In Malaysia, a study done by the by National Institute of Occupational
Safety and Health (NIOSH) showed that 61.4% of workers who used computers in their
workplace complained of lower back pain, shoulder and neck pain, while 70.6% of them
complained of eyestrain which are all related to CVS (Loh et al., 2008).
There are several factors that lead to CVS. Visual symptoms increased with the increase in
working hours on the computer (Ye et al., 2007). In studies of Subratty and Korumtolee
(2005), symptoms of CVS were more in spectacle-wearers, compared to non-spectacle users.
Computer users who viewed the computer screen below eye level has a significant reduction
in symptoms of CVS compared with those who viewed the screen at or above the eye level
(p=0.0001) (Reddy et al., 2013). Environmental factor such as poor lighting and imbalance
between light of the computer screen and the surrounding, age, gender, and systemic diseases
will also influence the risk to develop CVS (Rosenfield, 2011).
Prevention is the most important strategy in managing CVS. These include environment
factor modification and proper eye care. Taking a short break between computer usages is
crucial to prevent CVS. Dry eyes which are one of the symptoms of CVS can be easily
relieved by applying lubricating eye drops or artificial tears. It is also important to use proper
corrective glasses to prevent further deteriorating of the ocular symptoms (Loh et al., 2008).

2.0 Materials and Methods

The study location was a faculty in a Malaysian public university. The study population
chosen was all staffs that use video display terminal. A cross-sectional study design was
utilized to get the required information from 24th Jun to 3rd July 2014.
The data was collected by using validated, pre-tested and self-administered questionnaire. The
questionnaire was designed in both English and Malay languages. There were four sections in
the questionnaires. Section A was about the socio-demographic factors and occupational
factors. Section B contained questions on knowledge of respondents on CVS. Section C was
one the attitude of respondents on CVS such as sitting posture, distance of eyes to the
computer screen and viewing angle. Section D was questions on the preventive measure of
CVS. Likert scale was used measure attitude and practice.
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The sample size calculated with two-sample formula was 172. After considering 10% of the
dropout rate, the final sample size was estimated at 189. The inclusion criteria was all staffs
that use video display terminal the faculty whether they were permanent, contract or
temporary who were present during the data collection period. During data collection period,
questionnaires were distributed to the study units who fulfilled the inclusion criteria of the
sampling population. Staffs who were absent at the time of questionnaire distribution or
refuse to participate in the study were excluded. Pretested questionnaire was used in this
study. It was given to the respondents and recollected after 15 minutes. Consent from the
respondents were also obtained prior to distribution of the questionnaire. They had been
assured that all data and information provided will be kept confidential and meant for the
research purpose only.
The dependent variables were level of knowledge, attitude and practice on computer vision
syndrome. Independent variables were socio-demographic factors and occupational factors.
Data was analysed using Predictive Analytic Software Version 21.0 (Social Package for
Social Science Version 21.0). In order to determine the association between variables, ChiSquare test was used. A p-value of less to 0.05 was used for level of significance.

3.0Results
3.1 Response rates
A total number of 172 data was collected based and the response rate was 91.0% (n=172).
3.2 Socio-demographic factors
Female constituted 112 (65.1%) of the respondents while male were 60 (34.9%). The majority
of respondents were between 30 to 39 years old with percentages of 39.5% (68). Age ranged
from 25 to 62 years old. Majority of the respondents were Malays, which constituted 152
(88.4%), followed by Chinese 10 (5.8%), Indians 9 (5.2%) and others 1 (0.6%). In terms of
education, majority of the respondents (26.2%) attained up to the master level. There were
109 (63.4%) respondents who used correction spectacle, lenses or both.
3.3 Occupational factors
Administrative staffs were in majority of respondents in this study with 65.1% (112) and only
34.9% (60) were academician. Most of the respondents had 7 years of working experiences
with computer and median was 7 years. The staffs whom uses video display terminal mainly
made up by those who had 7 years of working experiences or less, which was 91 (52.9%)
while staffs that had more than 7 years of working experiences was 81 (47.1%). The median
for daily usage duration of computer was 8 hours. Majority of the respondents worked with
computer for 8 hours daily.
3.4 Knowledge, attitude and practice
Table 1 showed knowledge, attitude and practice on CVS. With median score (m=5.0) as a
cut-off point, 88 (51.2%) of the respondents had good level of knowledge on CVS while 84
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(48.8%) respondents had poor knowledge. With median score (m=28.0) as a cut-off point, 90
(52.3%) of the respondents had good level of attitude on CVS while 82(47.7%) respondents
had poor attitude. With median score (m=5.0) as a cut-off point, 108 (80.2%) of the
respondents had good level of practice while 64 (19.8%) respondents had poor practice.
Table 1: Knowledge, Attitude and Practice on Computer Vision Syndrome (CVS) (N=172)
Percentage
Median
Variable
Frequency
Mode Maximum Minimum
(%)
(IQR)
Knowledge Score:
5.0 (2.8)
5.0
7.0
1.0
Good
88
51.2
Poor
84
48.8
Attitude Score:
28.0 (5.8)
28.0
40.0
17.0
Good
90
52.3
Poor
82
47.7
Practice Score:
5.0 (3.0)
4.0
11.0
0
Good
108
80.2
Poor
64
19.8

3.5 Association between socio-demographic and knowledge, attitude and practice on CVS
3.5.1 Association between socio-demographic and occupational factors and knowledge on
CVS
Based on Table 2, P-value for ethnicity, educational level and spectacles or contact lens users
are smaller than 0.05. They are statistically significant. Hence, there were association between
these variables with knowledge of CVS. P-value for job category was smaller than 0.05. Null
hypothesis was rejected. Hence, there was an association between job categories with the
knowledge of CVS.
Table 2: Association between Socio-demographic and
on CVS (N=172)
Knowledge
Variables
Good n (%) Poor n (%)
Age
20-29
14 (45.2)
17 (54.8)
30-39
39 (57.4)
29 (42.6)
40-49
50 (51.7)
28 (48.3)
50
5 933.3)
10 (66.7
Gender
Male
33 (55.0)
27 (45.0)
Female
55 (49.1)
57 (50.9)
Ethnicity
Malay
73 (48.0)
79 (52.0)
No-Malay
15 (75.0)
5 (25.0)
Educational level
PMR/SPM
8 (26.7)
22 (73.3)
STPM/Diploma
15 (37.5)
25 (62.5)
Bachelor
23 (56.1)
18 (43.9)

Occupational Factors and Knowledge

x2

df

P-value

3.882

0.442

0.543

0.461

5.147

0.023*

21.250

<0.001*

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Master
28 (62.2)
PhD
14 (87.5)
Spectacles/Lens Users
Yes
64 (58.7)
No
24 (38.1)
Job Category
Administrative
46 (41.1)
Academic
42 (70.0)
Working Experiences
(Years):
7
51 (56.0)
>7
37 (45.7)
* Significant P-value<0.05

17 (37.8)
2 (12.5)
6.794

0.009*

13.085

<0.001*

1.843

0.175

45 (41.3)
39 (61.9)
66 (58.9)
18 (30.0)

40 (44.0)
44 (54.3)

3.5.2 Association between socio-demographic and occupational factors and attitude on

CVS
Based on Table 3, P-value for spectacles or contact lens users is 0.011, which is smaller than
0.05. Hence, there were association between this variable with attitude of CVS. P-value for
job category was 0.041. The P-value is smaller than 0.05. We will reject the null hypothesis.
Hence, there was an association between job categories with the attitude of CVS.
Table 3: Association between Socio-demographic and
CVS (N=172)
Attitude
Variables
Good n (%) Poor n (%)
Age
20-29
22(71.0)
9(29.0)
30-39
34(50.0)
34(51.7)
40-49
28(48.3)
30(57.1)
50
6(40.0)
9(60.0)
Gender
Male
34(56.7)
26(43.3)
Female
56(50.0)
56(50.0)
Ethnicity
Malay
81(53.3)
71(46.7)
No-Malay
9(45.0)
11(55.0)
Educational level
PMR/SPM
19(63.3)
11(36.7)
STPM/Diploma
25(62.5)
14(37.5)
Bachelor
20(48.8)
21(51.2)
Master
20(44.4)
25(55.6)
PhD
6(37.5)
10(62.5)
Spectacles/Lens Users
Yes
49(45.0)
60(55.0)
No
41(65.1)
22(34.9)
Job Category
Administrative
65(58.0)
47(42.0)
Academic
25(41.7)
35(58.3)

Occupational Factors and Attitude on

x2

df

P-value

6.448

0.168

0.696

0.404

0.487

0.485

5.854

0.210

6.482

0.011*

4.197

0.041*

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Working Experiences
(Years):
7
50(54.9)
>7
40(49.4)
* Significant P-value<0.05

0.532

0.466

41(45.1)
41(50.6)

Based on Table 4, P-value for age, ethnicity, educational level and spectacles or contact lens
users were smaller than 0.05. Hence, there were association between these variables with
practice on prevention of CVS. P-value for job category was smaller than 0.05. Hence, there
was association between job categories with the practice of CVS.
3.5.3 Association between socio-demographic and occupational factors and practice on
CVS
Table 4: Association between Socio-demographic and
CVS (N=172)
Practice
Variables
Good n (%) Poor n (%)
Age
20-29
8(25.8)
23(74.3)
30-39
51(75.0)
17(25.0)
40-49
42(72.4)
16(27.6)
50
7(46.7)
8(53.3)
Gender
Male
40(66.7)
20(33.3)
Female
68(60.7)
44(39.3)
Ethnicity
Malay
89(58.6)
63(41.4)
No-Malay
19(98.0)
1(5.0)
Educational level
PMR/SPM
14(46.7)
16(53.3)
STPM/Diploma
20(50.0)
20(50.0)
Bachelor
23(56.1)
18(43.9)
Master
35(77.8)
10(22.2)
PhD
16(100)
0(0)
Spectacles/Lens Users
Yes
83(76.1)
26(23.9)
No
25(39.7)
38(60.3)
Job Category
Administrative
57(50.9)
55(49.1)
Academic
51(85.0)
9(15.0)
Working Experiences
(Years):
7
56(61.5)
35(38.5)
>7
52(64.2)
29(35.8)
* Significant P-value<0.05

Occupational Factors and Practice on

x2

df

P-value

27.760

<0.001*

0.592

0.441

10.049

0.002*

20.733

<0.001*

22.721

<0.001*

19.453

<0.001*

0.130

0.719

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4.0 Discussions
In this study, majority of the study population were female, Malay, age group 30 to 39 years
old, Master level of education and wear spectacles, contact lens or both. The result showed
that female respondents were the majority in this study, counting 112 respondents (65.1%).
This is consistent with a study by Zairina and Suhaila (2011), which found that female
respondents were more than male respondents. Thus, it concludes most computer based work
were dominated by females.
For age distribution, it was found that most of the respondents in this study are in the range of
30 to 39 years old (39.5%). Whilst for the ethnicity factor, Malays (88.4%) were the majority
of respondents in our study. This was concordant with the study by Lee et al. (2012) that
stated that Malays had account for most of the respondents (93.2%). This is due to the Malays
is the major ethnic population in this multi-racial country.
In this study, it was found that out of 172 respondents, 88 (51.2%) of them were categorized
into group of having good knowledge level on CVS while 84 (48.8%) of them were in the
poor knowledge group. It could be seen that the good knowledge group was slightly higher
than poor knowledge group. In a study done by Akinbinu and Mashalla (2012), there was
only 27% of respondents had good knowledge of CVS suggesting a serious knowledge gap
exists about CVS in the studied population and possibly in the general population. In the
study, the term awareness was used to mean having heard of CVS. Among the respondents,
there was a large portion (43.0%) who were not aware about the condition of CVS and 32.0%
of them did not know about CVS. Only small portions (25.0%) of the respondents were aware
of CVS, compared to a study by Bali et al. (2007) that claimed that all the respondents were
aware of CVS. The possible reason is the respondents in the study were ophthalmologists that
had more knowledge in the aspect. One of the reasons is CVS is that, there are not many
educational programs to effectively educate computer users about how to protect their eyes,
despite the fact that the American Optometric Association (1995) conducted a public
awareness campaign in1995. Public and professional attention is primarily drawn to the wellknown musculoskeletal disorders associated with computer use like Carpal Tunnel Syndrome
rather than to a condition characterized primarily by visual problems (Yan et al., 2008).
For the attitude towards CVS, both good and poor attitude categories showed almost the same
percentage of respondents which is 52.3% (90) and 47.7% (82) respectively. However, with
regards to the practices on prevention of CVS, more than half of the respondents, 80.2% had
good practice while 19.8% of the respondents had poor practice. It could be seen that the good
practices group was almost twice in proportion than that of the poor practice. In contrast, a
study done by Stella et al. (2007) in University of Benin reported that there were only 32.0%
of the respondents who practiced their knowledge on preventive measures for CVS. The
possible reason is the generations today could explicit input of knowledge easier and more
accessible with various sources such as mass media, magazines, internet networks and so on
compared with the past. They will apply the knowledge they get into their daily lives.
Besides, most of the generations nowadays are more easily influenced by peer pressures or
people around them.
There was a significant association between the ethnicity, educational level and spectacles or
contact lens users with the knowledge on CVS (P<0.05). With regards to ethnicity, a study
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done by Lee et al. (2012) in Universiti Putra Malaysia showed that the level of knowledge on
CVS among Malays was higher (61.6%) compared with other ethnicity (2.7%). Nevertheless,
Malays that have poor knowledge on CVS was higher (31.5%) compared with other ethnicity
(4.1%). This may be due to the larger proportion of Malay staffs in the faculty studied.
For educational level, a study by Bali et al. (2012) showed that all ophthalmologist who were
master and PhD level were aware of CVS. There was another study by Zairina and Suhaila
(2011) showed that 68.1% of the respondents that had secondary level of education had good
knowledge level. This was consistent with our study that stated that there was a significant
association between the educational level and the knowledge on CVS. The possible reason is
that respondents that had higher education level would have prioritised the knowledge on
CVS.
Respondents that wore spectacles, contact lens or both, had good knowledge level were 64
(37.2%). Nevertheless, spectacles and contact lens users that had poor knowledge on CVS
also had higher percentage 26.2% (45) compared with those that did not wear which is 22.7%
(39). Compared with study by Akinbinu and Mashalla (2012), there was only 1% of the
respondents that had good level of knowledge on CVS. A study by Subratty and Korumtolee
(2005), CVS were more in spectacle-wearers as compared to non-spectacle users.
In this study, it was found that there were no significant association between age, gender,
ethnicity and educational level with the attitude of CVS. However, there was a significant
association between spectacles or contact lens users with the attitude towards CVS (P<0.05).
Respondents in our study that wore spectacles, contact lens or both had good attitude level,
constituted of 49 (28.5%). Nevertheless, spectacles and contact lens users that had poor
knowledge on CVS also had higher percentage 34.9% (60) attitudes towards CVS as
compared with those that did not wear which is 12.8% (22). In this study, there were
associations between age, ethnicity, educational level and spectacles or contact lens users with
practice on prevention of CVS. For age distribution, our finding was supported by studies
from Akinbinu and Mashalla (2012) which revealed that there was a significant association
between age group and practices on CVS.
For educational level, our study showed that there was a significant association between
educational level and practices on CVS. A study by Bali et.al. (2012), they revealed that those
ophthalmologists had poor level of practices. The doctors believed that the symptoms
occurred after one to 10 hours of exposure to computers (mean=3.59; SD=1.66 hours).
According to them almost four hours of continuous work on a computer was safe
(mean=226.08 min; SD=116.174 min). It was not consistent with our study. The possible
reason is that those respondents with higher level of education will have more concern about
their health compared with respondents with lower level of education.
Respondents in our study that wore spectacles, contact lens or both had good practice level,
constituted of 83 (76.1%). Compared to a study by Reddy et al. (2013), those wearing
corrective lens either contact lens or spectacles (N = 176) showed a higher risk to develop
headache (OR = 1.8, 95% CI = 1.2-2.6, P < 0.01) and blurred vision (OR = 2.1, 95% CI = 1.43.4, P<0.001). It was statistically significant. This can indicated that corrective lens users had
poor level of practice. The possible reason that shows differences in our study is that there are
a larger proportion of staffs that wore spectacles, contact lens or both in faculty studied.
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There was a significant association between job categories with knowledge, attitude and
practice of CVS (P<0.05). Our study showed that administrative staffs had poor level of
knowledge and practice as compared to academic staffs. In contrast to a cross-sectional study
by Zairina and Suhaila (2011) which found that knowledge level of CVS was pronounced
amongst administrative staff since majority of the staffs were working with computers.
Another study done among National Institute for Medical Research (NIMR) administrative
staff which shows that 87.3% of the respondents have acknowledged computer as essential
appliance in their daily lives and CVS was among the health problems they experienced (Yan
et al., 2008). All of the above may indicated that administrative staffs had poor level of
practice on preventive measures on CVS.

5.0 Conclusion and recommendation

Knowledge, attitude and practices on preventive measures on CVS are quite satisfactory
among the staffs that use VDT. From this study, Chi-Square tests showed that there was a
significant association between the ethnicity, educational level and spectacles or contact lens
users with the knowledge on CVS. There was a significant association between spectacles or
contact lens users with their attitude on CVS. A significant association was also found
between age, ethnicity, educational level and spectacles or contact lens users with practice on
prevention of CVS.
With regards to occupational factors, it was found that that there was a significant association
between job categories with knowledge, attitude and practice of CVS. Nevertheless, there was
no significant association between working experiences and knowledge, attitude and practice
on CVS.
Future studies are recommended to use a larger sample size from different populations to
provide higher statistical reliability. Information and training programmes regarding
preventive measures on CVS are relevant to all VDT users in order to increase their
knowledge, attitude and practices on CVS, hence, the incidence of CVS can be reduced. The
information obtained from this study will act as a guide to the training institutions and health
educators for developing and revising training curricula that will enhance the knowledge and
level of awareness of CVS among computer users.

Acknowledgement
We would like to thank the Ethical Committee for Research involving Human Subjects of the
public university and the Dean of the faculty for their permission to do this study. We fully
acknowledge all people who participated and supported to complete this study.

Declaration
Authors declare that there is no conflict of interest regarding publication of this article.

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Authors contribution
The 1st, 2nd and 3rd author carried out the research, analysed the data and prepared draft of
manuscript while the 4th and 5th author supervised the research and data analysis. The 4th
author edited final manuscript.

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