Knowledge, Attitude, and Practices (KAP) Of Carpal Tunnel Syndrome (CTS) Among Office Workers in UiTM: A Study Protocol

Knowledge, Attitude, and Practices (KAP) of Carpal Tunnel Syndrome (CTS) Among Office Workers in UiTM: A Study Protocol

Hasyimah Razali¹, Shamsinar Ibrahim¹*, Hanani Hussin¹, Tofan Agung Eka Prasetya², Ratih Damayanti²

^¹Management Department, Faculty of Business and Management, Universiti Teknologi MARA (UiTM), Kedah Campus, Malaysia

²Management Department, Faculty of Vocational, Universitas Airlangga (UNAIR), Surabaya, Indonesia

DOI: https://dx.doi.org/10.47772/IJRISS.2025.909000282

Received: 07 September 2025; Accepted: 14 September 2025; Published: 08 October 2025

ABSTRACT

Carpal Tunnel Syndrome (CTS) is one of the most prevalent work-related musculoskeletal disorders, particularly among office workers who are exposed to prolonged computer use, repetitive hand movements, and non-neutral wrist postures. Despite its growing burden, there is limited evidence on the knowledge, attitudes, and practices (KAP) of office workers regarding CTS, especially within academic institutions. This study aims to evaluate the current level of knowledge, attitudes, and practices (KAP) toward CTS among office workers at Universiti Teknologi MARA (UiTM) and to identify the key sociodemographic and medical history factors that influence these indicators. A cross-sectional design will be employed, using a structured questionnaire adapted from validated KAP frameworks and guided by the Health Belief Model (HBM). The study population will consist of UiTM office workers selected through proportion sampling to ensure representation across 35 campuses. Data will be analyzed using descriptive statistics, chi-square tests, and regression models to explore associations between sociodemographic variables, medical history, and KAP outcomes. Preliminary findings suggest that while most office workers demonstrate moderate knowledge of CTS risk factors, there remain significant gaps in preventive practices such as regular breaks, ergonomic adjustments, and early medical consultations. The integration of the KAP model with HBM highlights how awareness and perception of susceptibility influence positive behavioral change. This study has important theoretical and practical implications, particularly in guiding workplace health promotion programs, ergonomic interventions, and awareness campaigns tailored to reduce CTS risk. Ultimately, it contributes to strengthening occupational health strategies within higher education institutions.

Keywords: Carpal Tunnel Syndrome (CTS), Knowledge, Attitudes, and Practices (KAP), Office Workers, Occupational Health, Ergonomics

INTRODUCTION

Carpal tunnel syndrome (CTS) is one of the most prevalent work-related musculoskeletal disorders (WMSDs) affecting office workers worldwide. Symptoms of pain, numbness, and tingling around the wrist due to compression of the median nerve have been increasingly reported among populations performing work with repetitive hand and wrist movements [4], [7]. Office workers, particularly those in higher education institutions, are vulnerable due to prolonged computer use, limited breaks, and suboptimal workstation ergonomics [10]. The burden of CTS not only impairs individual health and work performance but also contributes to increased organizational costs through absenteeism, reduced productivity, and medical care [6].

The existing literature indicates that the prevalence of CTS among office workers varies widely, ranging from 9.6% to as high as 74.1% depending on work environment and population characteristics [4], [7]. Several studies have identified risk factors such as age, body mass index (BMI), smoking, and occupational exposure to repetitive hand tasks [6], [2]. Although these risks have been identified, there is evidence that this knowledge does not translate into preventive practices among workers as they lack support from their organizations and are not free from work pressures to sit and type for long periods of time, thus making it important to investigate not only knowledge, but also attitudes and actual practices in order to understand the determinants of CTS prevention [12], [23].

The problem is pertinent in the context of Universiti Teknologi MARA (UiTM) as office staff spend their working hours sitting sedentary and engaging in computer activities, thereby increasing their risk of developing CTS. Despite the existence of studies on the prevalence of CTS and interventions applied in ergonomics in healthcare and industrial settings, there are few studies conducted in academic institutions in Malaysia. In addition, although the risk factors of CTS have been identified, the gap between knowledge and preventive practices such as exercise protocols, making ergonomic changes, and following healthy work routines remains [8]. Therefore, the gap needs to be addressed using a framework that links knowledge, attitudes and practices (KAP) to reduction in CTS risk.

This protocol study therefore, aims to develop a conceptual framework based on the knowledge, attitudes and practices (KAP) model to investigate how knowledge of CTS affects preventive attitudes and leads to the translation into safe work practices among office workers in UiTM. The study aims to assess the extent of knowledge about CTS risk factors, attitudes toward preventive measures, and the implementation of ergonomic practices, while also identifying barriers to effective practice. By employing a mediation framework (Knowledge → Attitude → Practice), the study will advance understanding of behavioral pathways in CTS prevention and provide evidence-based insights for workplace interventions.

The significance of this study lies in its potential to inform institutional policies, occupational health strategies, and ergonomic interventions that reduce the burden of CTS among office staff. The findings will be valuable for designing training programs, fostering positive attitudes toward prevention, and encouraging sustainable workplace practices. Theoretically, the study adopts the KAP model as its guiding framework, acknowledging that knowledge influences attitudes, which in turn shape practices. The remainder of this paper is structured as follows. The next sections review the literature and develop the KAP-HBM conceptual framework, followed by the study methodology, anticipated outcomes, implications for occupational health in academic environments, and concluding remarks.

LITERATURE REVIEW

Office-based CTS research shows substantial variability in reported prevalence but consistent links between work exposures and CTS symptoms. Large cross-sectional studies of office populations report clinically confirmed CTS prevalence around 9.6%, with self-reported wrist/hand symptom rates considerably higher (e.g., 22% for wrist symptoms), and other samples report even higher self-reported symptom burdens depending on the instrument used. Prolonged computer use, working without breaks, high repetition, and non-neutral wrist postures are repeatedly associated with increased odds of wrist or hand symptoms and CTS. These associations are further influenced by individual sociodemographic factors such as age, gender, race, marital status, work experience and duration of using computers or laptops. These occupational and personal risk patterns remain robust across epidemiologic designs and settings, and are summarized in large cohort syntheses that identify high Strain Index, high force, and high repetition as consistent predictors of work-related CTS.

Studies that have investigated knowledge, attitudes and practices (KAP) and interventions show an important behavior gap: knowledge of risk factors of CTS or office ergonomics principles does not lead to sustained preventive action. Web-based knowledge, attitudes and practices (KAP) interventions and office ergonomics training have shown potential in improving individual office workplace adjustments and behavior change. However, implementation and organizational uptake have been variable, and response or retention rates vary in real-world applications. Furthermore, exercise-based preventive protocols in symptomatic office workers have shown improvements in forearm and grip strength as well as functional status. However, the impact on pain is inconclusive, which suggests the complex nature of symptom perception and the need for multi-component prevention (ergonomic + behavioral + organizational). Surveillance data also indicate that employer primary-prevention practices, such as changing equipment and workstations, as well as enforced breaks, are infrequently undertaken in many workplaces. This highlights organizational barriers to translating KAP into practice.

Despite this evidence base, gaps remain that directly motivate the present UiTM protocol: (1) most large-scale CTS KAP or prevalence studies have been conducted in hospital, corporate, or industrial cohorts rather than university administrative or office populations in Malaysia, (2) few studies explicitly model how sociodemographic factors (age, sex, education), occupational factors (hours, device use), and medical history (BMI, prior CTS, comorbidities)  shape the K → A → P pathway, and (3) organizational or contextual moderators, such as workload pressure and employer ergonomics climate are seldom integrated into KAP mediation frameworks. To address these gaps, the proposed study will (a) evaluate current levels of CTS knowledge, attitudes and practices among UiTM office workers and (b) test a conceptual mediation model linking sociodemographic and medical history variables → knowledge → attitudes → preventive practices, with organizational climate and exposure measures as potential moderators. The model builds on established occupational risk factors and evidence from KAP interventions. It is designed to inform targeted, multi-level prevention strategies appropriate for a university office setting.

• Sociodemographic Factors

Sociodemographic characteristics such as age, sex, education level, and body mass index (BMI) are important determinants of CTS among office workers. Evidence suggests that older age and female sex are consistently associated with higher CTS prevalence due to hormonal, anatomical, and occupational exposure differences [4], [6]. Higher BMI has also been identified as a significant risk factor, as obese individuals are more likely to develop median nerve compression due to increased soft tissue pressure [7]. Moreover, high workload and working hours contribute to the cumulative hand and wrist load, and the lack of ergonomics education or training may reduce the level of awareness to prevent CTS [14]. These sociodemographic factors influence the need for university office workers, such as UiTM workers who usually sit for long periods of time and use computers in their work, to adapt office ergonomics intervention programs for the prevention and management of CTS.

• Medical History

Medical history and comorbidities play a crucial role in shaping susceptibility to CTS among office employees. Studies report that individuals with prior musculoskeletal injuries, diabetes mellitus, thyroid disorders, or a previous diagnosis of CTS are at significantly greater risk of recurrence or symptom aggravation [13], [26]. Smoking has also been linked to impaired microcirculation in the wrist and delayed nerve healing, further elevating CTS risk [6]. In addition, cumulative occupational exposures such as repetitive hand motions, force exertion, and sustained non-neutral wrist postures interact with pre-existing medical vulnerabilities to worsen symptom severity [25]. For UiTM office staff, understanding medical history is therefore essential in designing screening and secondary prevention programs that identify high-risk workers and implement early interventions.

• Knowledge, Attitude, and Practices (KAP)

Research on KAP highlights a gap between awareness of CTS and the actual adoption of preventive measures in office settings. Workers generally acknowledge that repetitive tasks and poor ergonomics contribute to CTS, yet preventive practices such as micro-breaks, stretching, and ergonomic adjustments are inconsistently applied due to workload pressures or lack of institutional support [12], [23]. Intervention studies show that structured exercise protocols can improve muscle strength and function in symptomatic office workers, although pain reduction is not always significant [8]. Workplace-based ergonomic interventions, including workstation redesign and improved work rhythms, also demonstrate effectiveness in reducing musculoskeletal strain [24]. However, despite available evidence, implementation in university office environments remains limited. At UiTM, evaluating the KAP of office staff regarding CTS is therefore essential for identifying knowledge gaps, shaping positive attitudes toward prevention, and promoting sustainable ergonomic practices that reduce the burden of CTS.

• Theoretical Framework Development

A theoretical framework for this study is derived mainly from the Knowledge, Attitude, and Practice (KAP) model. The model has been widely applied in occupational health research to understand how awareness and perceptions influence behavior [9]. The framework assumes that knowledge about CTS, its risk factors, symptoms and methods to prevent its occurrence serves as the basis for developing health attitudes among workers. Thereafter, the attitudes influence practices through adopting ergonomic strategies, performing preventive exercises and seeking early medical care. By incorporating sociodemographic variables as influencing factors (e.g., age, gender, BMI) and medical history (e.g., previous musculoskeletal issues, comorbidities) the present theoretical framework takes on a multidimensional perspective that places KAP within the context of the work realities of office workers in UiTM.

In applying the KAP model to the present study, the study defines knowledge as the level of understanding about CTS risk factors and ergonomics; attitude as perceptions and beliefs about susceptibility and perceived severity; and practice as actual preventive and coping practices. This definition of the three components of the KAP model is consistent with the Health Belief Model (HBM), which proposes that individuals’ readiness to act is influenced by attributes of perceived susceptibility, perceived severity, perceived benefits, and perceived barriers [16]. The theoretical framework proposed in this study integrates these attributes by hypothesizing that increased knowledge will positively affect attitudes and, in turn, lead to protective practices such as taking micro-breaks, adjusting workstations and performing exercises. Literature supports this mediational pathway, where ergonomic knowledge improves attitudes toward prevention and translates into healthier workplace practices [12], [8].

The theoretical framework has important practical implications for intervention strategies. By providing a structured pathway for designing intervention strategies tailored for the office workers in UiTM, the model allows practitioners to focus on where gaps exist, whether in knowledge, attitude, or practice. This, in turn, informs targeted intervention strategies such as ergonomic training, organisational policy changes and health promotion campaigns that are culturally acceptable to the target group. Furthermore, the application of sociodemographic and medical history factors as influencing KAP and the integration of these variables into the KAP-HBM framework provides an important lens for examining differential vulnerability among subgroups of workers. Ultimately, this theoretical model not only guides empirical investigation but also supports the translation of findings into preventive occupational health strategies, reinforcing its value for both research and practice in managing CTS among university office employees.

Fig. 1 KAP-HBM Framework for Carpal Tunnel Syndrome (CTS) Prevention.

Fig. 1 illustrates the KAP-HBM Framework for CTS Prevention among office workers. The framework combines the KAP model with HBM to explain how influencing factors such as sociodemographic characteristics and medical history shape workers’ knowledge of CTS risk factors. This knowledge subsequently informs their attitudes, including perceptions and beliefs about susceptibility and severity, and ultimately guides their protective practices such as ergonomic adjustments, preventive exercises, and early treatment-seeking. The concentric circles highlight the interdependent relationship between knowledge, attitudes, and practices, emphasizing that improved understanding and positive attitudes can enhance preventive behaviors, while also demonstrating that these behaviors are rooted in broader contextual influences. This framework provides the theoretical foundation for analyzing preventive behaviors and developing interventions for CTS prevention among office workers at UiTM.

METHODOLOGY

• Research Design

This study employed a cross-sectional survey design and adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. The Institutional Research Ethics Committee (REC) of Universiti Teknologi MARA (UiTM) reviewed and approved the study protocol, procedures, participant information sheet, and consent statement. The Ethics approval code is (REC/03/2025 [ST/MR/39]).  It is important to note that the STROBE guidelines are not intended for conducting a study but rather to enhance the transparency and quality of published reports, covering all sections from the title and abstract to the methods, results, and discussion.

• Population and Sampling

The target population comprised both academic and non-academic staff from UiTM. For the purpose of this study, office workers were defined as both academic and non-academic staff of UiTM whose job scope involves the routine use of a computer or laptop to perform work-related tasks. Office work was operationally defined as any task or duty requiring the use of a computer or laptop as a primary tool for accomplishing daily responsibilities.  Participants were recruited from 35 UiTM campuses across Malaysia. Eligibility was determined based on the following inclusion criteria:

(a) permanent academic or non-academic staff;

(b) staff who use a laptop or desktop computer with a keyboard on a daily basis to perform work-related tasks;

(c) staff aged 18 years and above; and

(d) staff who demonstrated understanding of the study objectives and provided informed consent.

Exclusion criteria included:

(a) staff who were on study leave at the time of data collection; and

(b) staff who declined to participate in the study.

Given the large number of employees at UiTM, a proportionate sampling approach will be adopted to determine the appropriate sample size. As this was a cross-sectional study, the prevalence-based sample size calculation method proposed by Repilda et al. was applied [15]. The calculation will be performed using the Raosoft Sample Size Calculator (http://www.raosoft.com/samplesize.html) to minimize potential human error associated with manual computation.

The total population of academic and non-academic staff across UiTM was 19,304. Using Raosoft, with a 95% confidence level, a 5% margin of error, and a 50% response distribution, the minimum required sample size was estimated at 642 participants. To account for possible non-response, an additional 20% was added, resulting in an adjusted target of 770 participants. This adjustment was deemed necessary, as data collection was conducted through digital surveys distributed via personal staff email, which may influence response rates.

In order to ensure adequate representativeness across all study sites, a 10% proportional allocation of the total sample size will be distributed to each participating campus.

Fig. 2 Thirty-five UiTM Campuses of Malaysia

• Research Instruments

The questionnaire was adapted from the KAP study on CTS by Farpour et al.  [3]. It was designed to collect comprehensive information across five components: (i) sociodemographic characteristics, (ii) medical history, (iii) knowledge about CTS, (iv) attitudes toward CTS, and (v) practices related to CTS.

To assess KAP, respondents were provided with multiple-choice questions. Each correct response was awarded one point, while incorrect responses received zero points. Knowledge and practice scores were derived from 12 measurement items, with possible scores ranging from 0 to 12. A score of ≤ 3 was classified as low, ≥ 8 as high, and 4-7 as average. Attitude scores ranged from 0 to 15, with ≤ 4 categorized as low, ≥ 10 as high, and 5-9 as average. Table 1 presents an overview of the parameters and measurement domains used in the KAP assessment of CTS.

Table 1.   Overview of the topic/parameter and research measures applied in the KAP score towards CTS

Objective 1: To assess the level of knowledge towards CTS among office workers in UiTM; Objective 2: To assess the level of attitude towards CTS among office workers in UiTM; Objective 3: To assess the level of practices towards CTS among office workers in UiTM; Objective 4: To determine the factors influencing KAP towards CTS among office workers in UiTM.

^bN/A: Not applicable.

• Data Collection and Handling

The questionnaire was developed in Google Forms and made available in both Malay and English. A professional translator conducted back translation, which was then reviewed and verified by subject-matter experts. Data collection will be initiated by disseminating the survey link via the official UiTM email system, as well as through WhatsApp and Telegram channels. The data collection phase is planned to span approximately three months, beginning with the initial distribution of the survey. To improve response rates, biweekly email reminders will be sent throughout the data collection period, encouraging staff members to complete the survey. These reminders will continue until the end of the three-month period. The Google Forms will be configured to allow only one submission per Gmail account, thereby preventing duplicate entries and ensuring that each participant provides a single, valid response.

• Data Analysis

The collected data will be analyzed using IBM SPSS Statistics version 28. The Kolmogorov-Smirnov test will be used to assess the normality of all variables. A significance level of p < 0.05 will be applied for this study. Descriptive statistics, including frequencies and percentages, will be used to summarize the data. The dependent variables are the knowledge, attitudes, and practices related to CTS. Response scores will be categorized into three levels: low, average, and high.

To compare KAP scores across different sociodemographic groups and medical history, either parametric or non-parametric tests will be applied, depending on the data distribution obtained from the survey.   Extended inferential analysis, such as Pearson’s correlation test, will be used to assess the relationship between sociodemographic and medical history variables with KAP scores. Correlation values of < 0.30 will be considered weak, 0.30-0.50 moderate, and > 0.50 strong, with statistical significance determined at an alpha level of 0.05 [18].

RESULTS AND DISCUSSION

At the time of writing, data collection is still ongoing and has not yet been completed. The subsequent phases, including data preparation and statistical analyses, are scheduled to commence in May 2025 and will proceed according to the planned timeline.

This study will provide insights into the levels of KAP related to CTS among office workers in universities. Furthermore, the collected and analyzed data will describe the factors influencing these levels. This paper also recognizes existing gaps in knowledge, attitudes, and practices concerning CTS among office workers at UiTM. A conceptual review of the available literature indicates that most office employees are poorly informed about CTS and effective prevention strategies. Although awareness of CTS exists, it is often superficial and lacks depth [11]. For instance, a systematic review highlighted that most workers were unaware of preventive measures that could help reduce the risk of developing CTS [19]. This lack of knowledge may contribute to inadequate preventive behaviors, such as failing to adjust workstations or neglecting to take necessary breaks during prolonged computer use. A study conducted at UiTM also emphasized the importance of implementing educational initiatives to enhance staff knowledge and perceptions regarding CTS [1]. These knowledge gaps indicate that organizations must develop targeted training to equip employees with the necessary information to minimize their risk exposure.

In addition to knowledge deficits, workplace practices and attitudes play a critical role in shaping preventive behaviors related to CTS. Negative or self-limiting attitudes, such as misconceptions that discomfort is normal and does not warrant changes, may delay clinical consultation and hinder early preventive action [15]. Conversely, positive attitudes toward ergonomics and workplace health foster proactive behavior. For example, research has shown that when management prioritizes safety, encourages open discussions on occupational health risks, and promotes satisfaction in the workplace, employees are more likely to adopt preventive practices [17]. Hence, understanding employees’ attitudes toward CTS at UiTM is crucial for determining their influence on knowledge levels and preventive practices.

The application of adequate knowledge and the cultivation of positive attitudes are essential for effective CTS prevention among office workers. Recommended strategies include ergonomic adjustments in the workplace, regular rest breaks to relieve muscle strain, and specific exercises to strengthen the wrist and hand muscles. However, despite the availability of guidelines and recommended practices, evidence suggests that many employees do not adhere consistently to these preventive measures [11]. This highlights the need for continuous organizational engagement to ensure compliance with best practices.

Accordingly, this study also aims to identify the challenges associated with current practices at UiTM and propose strategies to enhance prevention efforts. Determining the current state of knowledge, attitudes, and practices regarding CTS among office workers at UiTM will serve as a foundation for planning effective awareness programs, student engagement initiatives, and ergonomically informed preventive strategies. By addressing the identified gaps, this research seeks to contribute to the development of targeted educational interventions and workplace solutions that promote healthier behaviors, minimize health risks, and improve productivity. Ultimately, increasing CTS knowledge and fostering positive attitudes will enable office workers to adopt beneficial changes in workplace habits while avoiding behaviors detrimental to their health and performance.

CONCLUSION

In conclusion, this study highlights the importance of understanding the knowledge, attitudes, and practices related CTS among office workers, with sociodemographic and medical history factors identified as key influences on awareness and preventive behaviors. The integration of the KAP model with HBM provides a strong theoretical foundation for examining how knowledge shapes perceptions and attitudes, which in turn influence protective practices. Practically, the findings underscore the need for workplace health promotion initiatives, ergonomic interventions, and targeted awareness programs to reduce the risk of CTS. However, the study is limited by its cross-sectional design, reliance on self-reported data, and focus on a single institutional setting, which may limit generalizability. Future research should consider longitudinal studies, objective clinical assessments, and broader populations across different organizational contexts to better capture the dynamic interplay between risk factors, behavioral change, and preventive practices for CTS.

ACKNOWLEDGMENT

The authors would like to express their sincere gratitude to Universiti Teknologi MARA (UiTM) Kedah Campus for the continuous support and to the anonymous reviewers for their valuable feedback, which greatly enhanced the clarity and quality of this article. The authors also gratefully acknowledge the financial support provided through the Matching Grant awarded in 2025- REC/03/2025 (ST/MR/39), which made this research possible.

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