[version 1; peer review: 2 approved with reservations]
No competing interests were disclosed.
Sedentary nature of desk job workers makes them prone to various diseases, and using display screen equipment increases the risk. This study focused on the intricate associates linked with sedentary behavior, physical activity patterns, and morbidity profiles among display screen equipment users employed at a university in central rural India. Sedentary lifestyles, particularly those prevalent in desk-based occupations, contribute significantly to non-communicable diseases, including hypertension, diabetes, and cardiovascular diseases. Display screen users face additional risks such as vision-related issues, strain on eyesight, and musculoskeletal disorders.
The study aimed to comprehensively understand the morbidity profile and perceptions of physical activity among display screen equipment users.
This shall be a cross-sectional study with a mixed method component conducted at a medical university located in central India from January 24 to June 2024. A sample size of 97 participants was determined based on a previous study, and data collection shall be done utilizing systematic random sampling. Data will be gathered using the International Physical Activity Questionnaire (IPAQ) and Standardized Nordic Scale for musculoskeletal disorders through an online survey.
This study aims to elicit morbidity patterns among Display screen users and their perceptions and practices regarding physical activity. This will also increase awareness regarding physical activity and associated morbidities regarding display screen use.
The World Health Organization (WHO) defines physical activity as any movement initiated by the skeletal muscles that requires energy expenditure. This includes all types of movement, whether during leisure, transportation, or occupational activity. Participation in both moderate- and vigorous-intensity physical activities has been demonstrated to improve overall health.
Healthcare professionals constitute a group facing both physical and mental burdens. The challenges of rotating work shifts, demanding tasks, and family-related responsibilities create difficulties in planning and engaging in physical exercise. Numerous studies emphasize that healthcare professionals not only lack sufficient physical activity but also engage in unhealthy dietary habits and alcohol misuse, placing them at an elevated risk of professional burnout.
Insufficient physical activity is responsible for 6% of global deaths, contrast to a previous study that proposed a higher estimate of 9%.
A sedentary lifestyle is a high-risk factor for the development of non-communicable diseases, such as hypertension, diabetes mellitus, dyslipidemia, stroke, and cardiovascular disease.
Display screen equipment users have an additional risk of screen time, leading to morbidities such as ophthalmic complaints, headache, vertigo, and other vision deformities.
This study assesses the pattern of physical activity level and morbidity profile simultaneously and aims to provide a holistic understanding of the health status of display screen equipment users.
This comprehensive approach allows for the identification of potential associations between sedentary behavior and health conditions among desk job workers, while qualitative inquiry with the study participants will enable a better understanding of their subjective perceptions.
Assessment of Morbidity profile and perceptions regarding Physical Activity among display screen equipment users working in a university located in central rural India.
To study the socio demography profile of display screen equipment users. To determine the Morbidity profile amongst study participants. To study the display screen use duration and association with morbidity amongst study participants. To assess the perceptions in regards to physical activity amongst study participants.
The current study will utilize a cross-sectional design incorporating a mixed-method approach.
The current study will be conducted at a university located in rural central India.
The male and female employees (>18 years) using Display screen equipment.
Study participants working at the university using display screen equipment and were willing to participate in the study.
The study participants not using Display screen equipment shall be excluded from study.
The study will be carried out between January 2024 to June 2024.
Considering the prevalence reported in previous studies to be 0.933.
Alpha (
Estimated proportion (
Estimated error (
Estimated sample size = 97
A systematic random sampling procedure will be used, where a list of all eligible employees will be extracted from the head office, and the sampling fraction will be obtained by dividing the total population by sample size, which will be used as interval(n). The 1st number will be chosen randomly, and then every nth number after the 1st will be included as a study participant. An interview technique using the online tool Kobo Collect (
The study variables that shall be studied are as follows:
Demographic data Job desk workers Display screen users
This study will be using the International Physical Activity Questionnaire (IPAQ)
An in-depth interview guide will be used to conduct qualitative inquiries among randomly selected participants until data saturation is reached. All important information about variables, data sources, and methods is shown in
| Key study parameters | Variables | Data source | Data collection method |
|---|---|---|---|
| Socio-demography profile | Age
|
Job desk workers used display screen equipment working in university central rural area Wardha | Online questionnaire |
| Job desk workers | Sitting
|
Online questionnaire | |
| Type display screen user | Computer
|
Online questionnaire | |
| Time | Working hours
|
Online questionnaire | |
| Morbidity | Neck pain
|
Online questionnaire |
The list of all eligible employees shall be obtained from head office.
The study participants shall be selected using a systematic random sampling method. To ensure that participants fully understood the research goals, the purpose of the study will be explained to them in their local language. Those willing to participate asked to provide written informed consent. Similarly, in-depth interviews with randomly selected study participants will be conducted until the point of data saturation.
There may be some bias include in the study,
Recall bias: Bias arises when the participants inaccurately remember the report information about past exposure and health problems. To minimize recall bias, the standardized well-structured questionnaire is used, and training the interviewer and establishing a rapport with participants can enhance the accuracy of the information provided. Social desirability bias: In qualitative inquiry related to perceptions and practices in regards to physical activity bias may occur as participants tend to give information to be aligned with existing social norms.
The Datta Meghe Institute of Higher Education and Research (DU), Ethical approval (DMIHER (DU)/IEC/2023/36) was granted by the Institutional Ethical Committee on Human Research for this study on dated 20/12/2023. Additionally, written informed consent will be obtained from all the participant before their inclusion in the study. Privacy and confidentially will be maintained throughout the study. Measures will be taken to minimize any potential harm or risks to the participants such as referrals for the medical consultation if needed.
The data will be analysis by the ‘R’ statistical software 4.3.2 version, available at
The qualitative data analysis will be done using Thematic content analysis.
This study shall generate evidence regarding the existing patterns of physical activity and the use of display screens. Morbidity among the study participants, which should also lead to sensitization of study participants and intervention strategies to be planned accordingly.
A cross-sectional descriptive study conducted in Mumbai by Shrivastav et al. India (2011). This study aimed to assess the prevalence of health issues among professionals in the software industry. In total, 178 participants were included in this study. The prevalence of visual is 67%, musculoskeletal is 63%, and stress is 44% are found. This study focused on ocular discomfort, musculoskeletal disorders, and psychosocial problems among computer screen users.
The qualitative study was conducted in a United Kingdom city of a small software engineering company, on “they should stay at their desk until the work is done”: a qualitative study examining perceptions of sedentary behavior in a desk-based occupational setting to explore the desk-based office workers’ perception of factors that influence their behavior. It is essential to consider this discovery when implementing modifications that diminish sedentary behavior in the workplace.
Gurhan Kayhan conducted a survey involving young female desk job workers to investigate the relationship between daily physical activity (PA) level and low back pain (LBP) in young women, to take an appointment for physical examination at the personal nutrition training center in Ankara, Turkey. To explore the correlation between daily physical activity levels and the occurrence of lower back pain. A total of 240 job desk women were included in the study, and the main finding was a U-shaped relationship between physical activity and lower back pain disability score in young women.
Shah and colleagues conducted a cross-sectional descriptive study in Kathmandu Metropolitan City, Nepal. This study aimed to evaluate the occurrence rates of cardiovascular disease, musculoskeletal disorders, and job-related stress among individuals who use visual display screens in office settings. Among the study population, 36.7% experienced work-related stress, which was moderately challenging to manage. Additionally, this research aims to comprehend the awareness and utilization of preventive measures in this population. This study had 95% CI factors associated, and prevalence is (<0.01) was considered statistically significant.
A cross-sectional study was conducted at a tertiary care hospital in New Delhi, India to evaluate work-related neck pain among individuals with desk-based occupations. The study included a total of 441 participants, revealing a higher prevalence of this burden among females than males in the desk job workforce. The primary factor identified was prolonged computer usage of 4-6 hours, which emerged as the most significant predictor for WRNP. Subsequently, work-related aspects, such as screen height and posture, were also found to be associated with WRNP.
A systematic review conducted by Garlich et al. at the Cullen Eye Institute, Baylor College of Medicine, indicated that the connection between screen use and dry eye was particularly noteworthy. This is because patients experiencing dry eye may have a detrimental impact on their quality of life, potentially attributable to ocular pain and visual disturbances arising from tear film instability. The interconnection between dry eye and quality of life was observed in both health- and vision-related aspects. Furthermore, there is a correlation between dry eye and mental health, especially among individuals with an extensive use of digital screens.
Yu et al. conducted a survey on Musculoskeletal problems among visual display unit workers in an international bank in Hong Kong. A self-administered questionnaire was used to gather information pertaining to work that involved the use of a visual display unit. All 121 employees were included in the study, of whom 70 were male and 51 were female age–18-41 years. Musculoskeletal issues, particularly neck, back, shoulder, and wrist pain, were most frequently observed. Employees predominantly experienced 30% of the back pain and neck pain cases.
Kristel Oha et al. conducted a cross-sectional investigation of individual and work-related risk factors for musculoskeletal pain in computer users at two universities in Estonia. This study aimed to assess the prevalence of musculoskeletal pain (MSP) across different body parts in the preceding year and explore its correlation with individual attributes and work-related risk factors. The study included 412 participants. High prevalence rates were observed, with neck pain being the most common at 51%, followed by low back pain at 42%, wrist/hand pain at 35%, and shoulder pain at 30%.
To increase employees’ awareness of the importance of physical activity and strategies to mitigate health challenges associated with prolonged display screen equipment use by desk workers. The insights obtained can help healthcare professionals understand the problem and interventions planned to promote physical activity in display screen users. Recommendations on employee well-being programs that address both physical activity and morbidity identified in this study contribute to a healthier workforce and work environment.
The cross-sectional nature of the study restricts the generalization of the findings to other settings, so the findings could have limited external validity.
This study was approved by the institutional ethics committee. The supervisor created and approved the study’s data collection tool, which will now be evaluated for piloting in the study area.
No data associated with this article.
Repository Name: Figshare
File name: STROBE checklist for “Assessment of morbidity profile and perceptions in regards to physical activity amongst display screen equipment users working in a university located in central rural India: A mixed method study.”, DOI:
Data are available under the terms of the
Overall, this is a good start, and I commend the authors for planning to conduct the study -since there are no results yet. The authors could think about conducting a case-control study, i.e., having cases (any participants who have one or more morbidity) and controls (participants with no morbidity), then comparing their levels of exposure to screen time and level of sedentary behavior. The authors will still get the data they wanted for their cross-sectional study, but the comparison between the cases and controls could improve our understanding further. Of course, this implies changes in sample size calculation and perhaps measures adding questions.
Abstract could be improved. Should the abstract state the aim or objective? There is no information about interviews or focus groups for the qualitative component.
The objective in the abstract -
Introduction section is also too long and can be reduced, then combined with the rationale and aims section. Objectives do not need to be listed unless these sections are required by the journal.
Methods section needs to be clearer and include details. No information is provided on when the surveys will be sent. Will they all be sent at the same time?
The authors should consider excluding people who had morbidity before they started using screens or working, i.e., people with childhood chronic diseases or diseases diagnosed before they adulthood/started working
What was the nth number? Was it every 7 th number, or 8th or 3rd?
Variables need to be better explained, including an indication of the dependent and independent variables with their responses. For example, how was the physical activity measured? What questions were used? If word count is an issue, this can be done in the table.
How is morbidity defined? Is the morbidity profile more of a musculoskeletal profile because based on the table, only musculoskeletal pain is being evaluated by the questionnaire.
The name of the tools, i.e., IPAQ etc., should be included in the table. The middle column ‘data source’ may not be really needed if one comment applies to all. It can be removed and the responses to each variable included.
More information is needed to describe how the qualitative analysis will be done. Who will do it and how? How will participants be recruited for the qualitative component? What types of questions are on the kobo? How many people will be interviewed? If there are concerns over word count, the introduction section can be reduced to accommodate this.
Now it is clear why the paper is in future tense. It appears that this manuscript is a protocol paper…this should be made clear in the title and abstract.
The discussion section should start with a focus on the current manuscript before writing about other studies. It also needs to be revised for better flow.
There are more ‘potential limitations’ besides the cross-sectional nature of the study. The fact that the data is all self-report should be mentioned as there will be under or over estimation. Also, to their statement, cross-sectional nature of their study does not restrict generalization -it prevents us from establishing causation, thus they can only speak of associations. The generalization concerns are because the study is conducted in a sample from rural India, thus the results are not generalizable to other settings or populations, even those from urban India.
Is the study design appropriate for the research question?
Yes
Is the rationale for, and objectives of, the study clearly described?
Partly
Are sufficient details of the methods provided to allow replication by others?
No
Are the datasets clearly presented in a useable and accessible format?
No
Reviewer Expertise:
Epidemiology, Chronic Disease Prevention, Sedentary Behavior, Cancer Disparities
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
The current study proposes to understand the morbidity profile and perceptions of physical activity among display screen equipment users. The authors plan to recruit 97 participants to complete the IPAQ to determine physical activity levels and the Standardized Nordic Scale for Musculoskeletal Disorders to determine musculoskeletal problems. They intend to then run cross-sectional analyses between sedentary time/physical activity and morbidity/pain/eye problems using Chi-squared tests.
This study holds promise; however, it would be necessary for the authors to expand upon their statistics. I think that the authors should also examine the relationship between their variables using Pearson’s correlation.
The authors seem to be using questionnaires that they have created themselves on Kobo to ask questions about sedentary time and morbidity. This is okay, however I would suggest that the authors include these questionnaires in their proposal so that the reviewers can. Vet them.
Please also mention that you will be collecting sociodemographic data, display screen use data, and morbidity data in the methods section of the abstract. The abstract currently makes the reader think that your study will only be looking at the association between physical activity and musculoskeletal disorders.
Please provide a citation for the following sentence “Sedentary behavior is described as activities performed while sitting or reclining, with energy expenditure not exceeding 1.5 times the basal metabolic rate.”
Please also use Pearson’s correlation analyses to examine the relationship between your variables.
This discussion immediately dives into prior studies, and it is initially difficult for the reader to determine whether or not you actually already conducted the study you are proposing herein and are stating the results in the discussion. Please restate the purpose of the study you are currently proposing in the first paragraph of your discussion to alleviate any confusion.
Is the study design appropriate for the research question?
Partly
Is the rationale for, and objectives of, the study clearly described?
Yes
Are sufficient details of the methods provided to allow replication by others?
Partly
Are the datasets clearly presented in a useable and accessible format?
Not applicable
Reviewer Expertise:
Physical activity, human health, exercise, sedentary behaviour, vascular physiology.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.