SENIOR HIGH SCHOOL

INFORMED CONSENT FORM

To the prospective research subject. Read this consent form carefully and ask as many
questions as you like before you decide whether you want to participate in this study or not. You
are also free to ask questions any time before, during, or after your participation in this research.

RESEARCH INFORMATION:

Research Title:
PREVALENCE OF SELF-REPORTED COMPUTER VISION SYNDROME
(CVS) AMONG FIRST AND SECOND-YEAR NURSING STUDENTS OF THE
UNIVERSITY OF SAN AGUSTIN DURING BLENDED LEARNING

Investigators: Strand & Section: STEM 12-K

Nava, Richdile John G.
Department: Senior High School
Arancillo, Jose Gabriel S.
Pontillas, Steven Ken E.
Degoma, Hanz Gabriel T.
Alovera, Klarina R.
Tabaosares, Aizelle Rhayne P.
Danieles, Patricia Lavigne G.
Tolentino, Alessandra Nicole G.

1. PURPOSE OF THE STUDY

You are being asked to participate in a research study that aims to assess the
prevalence of Computer Vision Syndrome (CVS) among the first and second-year
nursing students of the University of San Agustin, during the Blended learning of the
Second semester of A.Y 2022-2023. Subsequently, the study aims to determine the
prevalence of Computer Vision Syndrome (CVS) when taken as a whole and when
grouped according to sex, device used for learning, and the average number of hours for
online learning purposes. The results of this study will serve as a basis and proof of the
researchers for the implementation of future interventions and recommendations when it
comes blended learning and/or prolonged digital device usage notably in the College of
Nursing Nutrition and Dietetics (CNND) department. Specifically, this paper aims to
answer the following specific research questions:

1. What is the profile of the respondents?

2. What is the Computer Vision Syndrome (CVS) score among First and Second-
year nursing students at the University of San Agustin when taken as a whole
and when grouped according to sex, device used for learning, and average
number of hours for online learning purposes?
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3. Is there a significant difference in the Computer Vision Syndrome (CVS) score
among First and Second-year nursing students at the University of San Agustin
when taken as a whole and when grouped according to sex, device used for
learning, and average number of hours for online learning purposes?
2. PROCEDURES
You will be asked to answer a survey questionnaire in the sheet provided by the
researchers.
Specifically, you will be requested to do the following:
• Read and sign the informed consent form.
• Answer the first part a) socio-demographic profile b) method of learning.
• Answer the second part, the questionnaire proper which is the adopted CVS
questionnaire.

3. POSSIBLE RISKS OR DISCOMFORT

No known or possible risks can pose danger to you in any form, as this research only
involves a survey. However, may consume a portion of your time.

4. POSSIBLE BENEFITS
• Students and Teachers. The result of this study would help them to have awareness
of the eye disorders experienced during blended learning and may drive them to look
for mitigating steps. Also, these may encourage improvements in the teaching system
and/or the practices of students and teachers when utilizing digital screens for
learning, this benefits the students and teachers as this will lead the teaching-and-
learning situation better, and more suitable and comfortable for students and teachers
in terms of their eye health while maintaining academic excellence and active learning.
• Academe. This study will enlighten the school administration about the prevalence of
CVS caused by prolonged usage of electronics on the students' eye health brought
about by online learning. This may help in persuading the school to improve its
teaching system or have an implementation of the intervention for CVS and make this
school a much better institution for learning.
• Parents. The parents can be informed of the effects brought by online education to the
eye health. They can also think of ways to mitigate its negative effects and do some
ways to better improve their child’s eye health amidst online learning
• Health Practitioners. The result of this study could be a good reference that will help
health practitioners in their job and help them to develop and improve preventive
measures and regulations to be done in regard to eye health for the betterment of
health and wellness of the students.
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• Future Researchers. This study can be used as a basis if they decided to have the
same research topic. The results of this study will help provide new direction for further
studies that can be explored related to this topic.

5. FINANCIAL CONSIDERATIONS
No additional cost, on your part, is required for your involvement in this study.

6. CONFIDENTIALITY
Your identity in this study will be treated with utmost confidentiality. The results of the study
or any other related data may be published for scientific purposes. To maintain your
anonymous identity, your name will not be mentioned as well as any other identifiable
information to you.
However, any records or data obtained because of your participation in this study, may be
inspected by the sponsor or by the persons conducting this study. It is provided that such
inspectors are legally obligated to protect any identifiable information from public
disclosure, except where disclosure is otherwise required by law or a court of competent
jurisdiction. The records that we will acquire from you will be kept private to the extent that
the law allows.

7. TERMINATION OR RESEARCH STUDY

Any further questions you have about this study will be answered by the investigators. It
is all within your right to choose whether to or not participate in this study. There will be no
penalty if you choose not to participate. Any significant new discoveries discovered during
the conduct of this research that may correlate to or influence your determination to keep
participating will be shared with you. If you decide to discontinue your participation in the
study, no amount shall be given or charged to you.
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8. AVAILABLE SOURCES OF INFORMATION

Any further questions you have about this study will be answered by the researchers:

Name: RICHDILE JOHN NAVA Name: AIZELLE RHAYNE TABAOSARES

Email: rnava@usa.edu.ph Email: artabaosares@usa.edu.ph

Name: STEVEN KEN PONTILLAS Name: HANZ GABRIEL DEGOMA

Email: spontillas@usa.edu.ph Email: hgdegoma@usa.edu.ph

Name: ALESSANDRA NICOLE TOLENTINO Name: JOSE GABRIEL ARANCILLO

Email: atolentino@usa.edu.ph Email: jarancillo@usa.edu.ph

Name: PATRICIA DANIELES Name: KLARINA ALOVERA

Email: pdanieles@usa.edu.ph Email: kalovera@usa.edu.ph

9. AUTHORIZATION
I have read and understood this consent form. I voluntarily choose to participate, but I
understand that my consent does not take away any legal rights in the case of negligence or
other legal fault of anyone who is involved in this study. I further understand that nothing in
this consent form is intended to replace any applicable laws. I willingly agree to the terms and
conditions mentioned above and will answer the survey with honesty.

Participant’s signature__________________________ Date_____________

Do you meet the following qualification?

[ ] A first-year or second-year nursing student of the University of
San Agustin of A.Y 2022-2023
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RESEARCH QUESTIONNAIRE

I. First Part

a) Socio-demographic profile
Name (optional): __________________________________________________
Sex: [ ] Male [ ] Female
Year Level: [ ] First-Year [ ] Second-Year

b) Method of learning
Device used for online learning purposes (check all that apply):
[ ] Mobile Phone [ ] Laptop/ Computer
[ ] Tablet/iPad [ ] Others

Average hours spent for online learning purposes per day:

[ ] below 3 hours [ ] 6-8 hours [ ] 12-14 hours
[ ] 3-5 hours [ ] 9-11 hours [ ] more than 14 hours

II. Second Part

COMPUTER VISION SYNDROME QUESTIONNAIRE (CVS-Q)

Indicate whether you experience any of the following symptoms during the time you use digital

devices for study purposes. Mark each symptom with a /:

a) First the frequency, that is how often the symptoms occur considering that:

NEVER =The symptom does not occur at all

OCCASIONALLY = sporadic episodes or once a week

OFTEN OR ALWAYS = 2 or 3 times a week or almost everyday

b) Second, the intensity of the symptom:

Remember: if you indicated NEVER for frequency, you should not mark anything for intensity
 SENIOR HIGH SCHOOL

a. Frequency b. Intensity

NEVER OCCASIONALLY OFTEN MODERATE INTENSE

OR
ALWAYS
1.Burning
2.Itching
3.Feeling of a
foreign body
4.Tearing
5.Excessive
Blinking
6.Eye Redness
7.Eye Pain
8.Heavy Eyelids
9.Dryness
10.Blurred Vision
11.Double Vision
12. Difficulty
Focusing for near
vision
13. Increased
Sensitivity to Light
14. Colored Halos
around objects
15.Feeling that sight
is worsening
16. Headache