In the digital era, screen-based lifestyles have become an integral aspect of daily functioning—particularly among youth. From academic activities and professional commitments to social interaction and entertainment, prolonged engagement with digital devices such as smartphones, laptops, and tablets has significantly reshaped behavioral and occupational patterns. While this digital immersion has amplified convenience and connectivity, it has also introduced a spectrum of physical health risks, most notably Repetitive Stress Injuries (RSIs) and poor digital ergonomics—both of which are increasingly prevalent among adolescents and young adults.^1-4

Repetitive Stress Injuries, including carpal tunnel syndrome, “texting thumb,” and digital eye strain, arise from continuous and improper use of devices without adequate rest or ergonomic posture. Poor screen habits—such as slouching, prolonged sitting, incorrect hand positioning, and excessive scrolling—contribute to musculoskeletal strain, visual discomfort, fatigue, and diminished concentration. The 20–30 age group, in particular, is experiencing a surge in complaints of neck stiffness, backache, and hand numbness, which were once considered symptoms of aging or labor-intensive occupations. The rise in “digital overuse syndromes” calls for urgent attention to ergonomics, especially among students and early-career professionals who may be unaware of long-term consequences.^5-7

Despite the growing body of global research linking improper digital practices to RSIs, awareness of ergonomic principles remains limited in developing regions like Himachal Pradesh, where terrain, infrastructure, and education access vary significantly. The hilly geography and climatic conditions of the region may further amplify the sedentary tendencies of its youth, particularly during winter months. Additionally, a lack of inclusion of digital health literacy and ergonomic training in school or college curricula compounds the problem, leading to widespread misconceptions—such as viewing discomfort as “normal” or inevitable, or relying solely on painkillers or massage therapy for relief.^7-9

Himachal Pradesh also presents a unique context where rural-urban disparities, socioeconomic status, and educational exposure may significantly influence both ergonomic behavior and access to preventive knowledge. Youth in urban centers may have relatively better access to ergonomic equipment or physiotherapy, while their rural counterparts often resort to home remedies or remain undiagnosed. Moreover, the increasing use of smartphones and laptops during online learning periods—especially post-pandemic—has escalated digital screen exposure among adolescents and young adults across both geographies.

Understanding the awareness, knowledge, and beliefs about digital ergonomics and repetitive strain prevention is critical in guiding interventions. Despite the high digital penetration, there is a notable research gap on ergonomic health education in Indian youth, particularly within smaller or underserved states. Systematic evaluation of these knowledge gaps is essential not only to inform public health planning but also to integrate ergonomic literacy into academic, vocational, and wellness programs.

This study, therefore, aims to assess digital ergonomic awareness and identify misconceptions related to repetitive stress injuries among youth aged 15–30 years in Himachal Pradesh. By analyzing the knowledge patterns in relation to socio-demographic factors such as age, gender, education, occupation, and rural–urban residence, this research seeks to generate evidence for targeted health education, early preventive strategies, and curricular integration of ergonomic practices. The findings can guide policymakers, educators, and healthcare providers to address this silent, yet growing musculoskeletal burden among India’s digitally native generation.

Study Design and Setting

This study was designed as a descriptive, cross-sectional survey to evaluate the level of awareness, misconceptions, and knowledge gaps regarding digital ergonomics and repetitive stress injuries (RSIs) among the youth population of Himachal Pradesh, India. Due to the geographical diversity of the state and the digital fluency of the target population, data were collected through a Google Form-based online questionnaire, allowing for cost-effective, wide-area coverage, and contactless participation, especially useful in remote or hilly areas.

Study Duration

The data collection was conducted over a two-month period from April to May 2025, ensuring representation across different academic schedules, examination periods, and digital activity patterns among the youth. This time window was also intended to capture seasonal differences in device usage habits, particularly during summer breaks when screen time often increases.

Target Population and Sampling

The target population included digitally active individuals aged 15 to 30 years residing in Himachal Pradesh. A non-probability, convenience sampling technique was employed, primarily due to the online nature of data collection and the youth-centric focus. The Google Form survey link was disseminated via multiple online platforms including WhatsApp, Instagram, Facebook, Telegram, and institutional mailing lists of schools and colleges. Peer-to-peer sharing and involvement of digital literacy volunteers further helped in outreach across both urban and rural districts.

Sample Size Determination

The final sample comprised 400 respondents, determined using Cochran’s formula for estimating proportions in cross-sectional studies at a 95% confidence level, 5% margin of error, and assuming a 50% prevalence of adequate awareness. This sample size allowed for subgroup analyses across age groups, education levels, and place of residence.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Youth aged 15–30 years currently residing in Himachal Pradesh.
• Individuals using digital devices (mobile/laptop/tablet) for a minimum of 2 hours per day.
• Respondents fluent in English or Hindi, with the ability to independently complete the form.
• Participants who provided informed digital consent before beginning the survey.

Exclusion Criteria:

• Healthcare professionals (physiotherapists, occupational therapists, ergonomists) to minimize bias.
• Incomplete, duplicate, or technically invalid responses (filtered through Google Form settings).
• Participants with pre-diagnosed musculoskeletal disorders unrelated to digital overuse, such as congenital or traumatic injuries.

Survey Tool and Validation

A structured, bilingual questionnaire (available in English and Hindi) was designed based on international digital ergonomics guidelines (e.g., OSHA, Mayo Clinic) and previously published RSI awareness studies. The questionnaire was validated by a panel of experts including physiotherapists, digital ergonomics specialists, and public health researchers. A pilot test was conducted among 25 participants to assess clarity, language, duration, and digital responsiveness. Minor linguistic and technical adjustments were made based on feedback before deploying the final version.

Questionnaire Structure

The survey consisted of four key sections:

1. Socio-Demographic Details:
   Age, gender, education level, occupation, and place of residence (urban/rural).
2. Knowledge and Awareness Assessment:
   20 multiple-choice questions covering:
   • Optimal posture and device positioning.
   • Symptoms and risks of repetitive stress injuries.
   • Preventive strategies (e.g., 20-20-20 rule, breaks, hand exercises).
   • Ergonomic tools and screen-time behavior.
   • Misconceptions (e.g., safety of using laptops in bed, headphone usage effects).
3. Knowledge Scoring System:
   • Each correct answer was awarded one point.
   • Cumulative scores (out of 20) were categorized as:
     • Very Good (17–20)
     • Good (13–16)
     • Fair (9–12)
     • Poor (0–8).

Ethical Considerations

This study was conducted in compliance with the Declaration of Helsinki. The survey included an informed consent section at the beginning, clarifying the voluntary, anonymous, and non-commercial nature of participation. No personal identifiers were collected, ensuring confidentiality and data protection throughout the study process.

Data Management and Statistical Analysis

All responses were automatically recorded and securely stored within the encrypted Google Workspace environment. After cleaning for duplicates and incomplete entries, the dataset was exported to Microsoft Excel and analyzed using IBM SPSS Statistics 25.

• Descriptive statistics (frequencies, percentages) were used to summarize demographic variables and knowledge levels.
• Chi-square tests were employed to evaluate associations between knowledge scores and demographic variables (age, gender, education, occupation, residence).
• A p-value < 0.05 was considered statistically significant in all inferential analyses.

The study comprised 400 participants aged between 15 and 30 years, reflecting a balanced demographic cross-section of Himachal Pradesh's youth. The majority of respondents (36.0%) belonged to the 19–22 age group, followed by 29.0% in the 23–26 range, 20.5% aged 15–18, and 14.5% in the 27–30 age bracket. Gender distribution was nearly equal, with females accounting for 50.5% and males for 49.5% of the sample, ensuring gender parity in responses. In terms of educational background, nearly half (46.0%) were pursuing undergraduate degrees, while 30.0% had postgraduate qualifications and 24.0% were enrolled in secondary education. The occupational distribution revealed a youth-dominated cohort, with 68.0% identifying as students, followed by 14.0% as interns or trainees, 13.5% in private jobs, and 4.5% in other professions. Geographically, 53.5% of respondents were from urban areas, whereas 46.5% hailed from rural settings—ensuring balanced representation across Himachal Pradesh's diverse terrain and lifestyle contexts.

Table 1: Socio-Demographic Characteristics of Participants (n = 400)

The knowledge assessment revealed that participants demonstrated a moderate-to-high level of awareness regarding digital ergonomics and repetitive stress injuries (RSIs). A majority (73.3%) understood the importance of taking breaks during prolonged digital use, and 72.3% recognized the association between poor posture and back/neck pain. Additionally, 69.5% correctly identified upright posture with back support as ideal for screen use, and 70.8% were aware of the benefits of blue light filters in reducing eye strain. Awareness of RSI-related symptoms and behaviors was also evident: 68.3% acknowledged that excessive mobile use could cause “texting thumb,” and 67.8% identified hands and wrists as common RSI-affected areas. However, some areas showed lower awareness; for example, only 60.5% correctly identified 30–45 minutes as the ideal screen duration before a break, and just 59.5% were aware that headphone use could affect posture. Despite these variations, the overwhelming majority (74.0%) agreed that digital ergonomics should be incorporated into educational curricula—indicating openness to structured intervention. Overall, the results highlight good baseline knowledge with room for improvement in specific areas such as posture-related practices, screen duration management, and RSI symptom recognition.

Table 2: Awareness and Misconception Questions on Digital Ergonomics and Repetitive Stress Injuries (n = 400)

Participants’ cumulative scores on the 20-question assessment were classified into four knowledge categories to gauge overall awareness. Approximately one-third (32.0%) achieved a "Very Good" score, correctly answering between 17–20 questions, while 35.3% fell under the "Good" category (13–16 correct answers). A total of 21.8% of participants demonstrated a "Fair" level of knowledge (9–12 correct answers), and 11.0% scored in the "Poor" category, answering 8 or fewer questions correctly. These results suggest that more than two-thirds of the youth population in the study possessed a reasonably strong understanding of digital ergonomics and RSI prevention. However, the existence of a sizable minority with fair to poor scores underscores the necessity for targeted awareness programs—particularly among subgroups that may lack access to ergonomic education or suffer from digital fatigue without recognizing its long-term impact.

Table 3: Knowledge Score Classification Among Participants (n = 400)

Statistical analysis using the Chi-square test revealed significant associations between knowledge levels and several socio-demographic factors. Age was significantly associated with awareness (p = 0.018), with participants aged 19–22 and 23–26 years achieving the highest “Very Good” and “Good” scores. Conversely, those aged 27–30 had the highest percentage in the “Poor” category, suggesting an age-related decline in ergonomic vigilance. Education level showed the strongest correlation (p < 0.001); respondents with postgraduate and undergraduate qualifications were more likely to score in the “Very Good” category, while those in secondary school education clustered more in the “Fair” and “Poor” bands. Occupation was also significantly associated (p = 0.021), with students demonstrating higher knowledge scores than employed respondents, perhaps reflecting greater academic exposure to digital wellness concepts. Residence emerged as a noteworthy factor (p = 0.034); urban participants were more likely to achieve higher scores compared to their rural counterparts, indicating disparities in digital literacy or ergonomic resource access. Interestingly, gender did not show a significant association (p = 0.276), suggesting relatively equal awareness levels between male and female participants. These findings emphasize the importance of education, age, and location in shaping ergonomic knowledge and suggest key demographic groups for targeted intervention strategies.

Table 4: Association Between Knowledge Score and Socio-Demographic Variables (n = 400)

This study explored the level of awareness, knowledge, and misconceptions surrounding digital ergonomics and repetitive stress injuries (RSIs) among youth in Himachal Pradesh—a region witnessing rapid digital adoption amidst unique geographical and infrastructural constraints. The findings reveal a nuanced understanding among participants: while a significant proportion of youth demonstrated good to very good awareness levels, notable gaps in ergonomic behavior and knowledge persist, particularly across certain socio-demographic strata.

The high overall awareness (67.3% scoring "Good" or "Very Good") indicates that digital natives in this region are increasingly conscious of the health risks associated with poor device use habits. This is a promising observation in light of India’s digital boom, especially post-pandemic, where virtual education and remote work became mainstream. The widespread understanding of basic ergonomic principles—such as the importance of taking regular breaks (73.3%), recognizing the role of poor posture in back and neck pain (72.3%), and awareness of the “20-20-20 rule” (66.0%)—reflects growing digital health literacy. This could partly be attributed to increased exposure to online wellness content, peer discussions, and digital well-being features now embedded in many smartphones and applications.

However, the persistence of several misconceptions—such as underestimating the ergonomic risks of using laptops in bed (37.7% incorrect), lack of clarity around headphone-related posture issues (40.5% incorrect), and limited understanding of optimal screen duration (only 60.5% correct)—indicates that awareness remains superficial in many areas. These findings are consistent with international literature suggesting that while digital device users may acknowledge discomfort, they often lack the knowledge to implement effective behavioral changes or preventive strategies. For instance, studies in urban India and Southeast Asia have reported similar patterns where basic ergonomic awareness does not always translate to practical application or sustainable behavior change.

Notably, the study found statistically significant associations between knowledge levels and demographic variables such as age, education, occupation, and residence. Youth in the 19–26 age group outperformed those in both younger (15–18) and older (27–30) brackets. This age-related variation may stem from the fact that mid-college students and early-career individuals are at a life stage where digital exposure is high and health consciousness begins to develop. Conversely, older participants may be more engaged in jobs with limited ergonomic training, or may have normalized discomfort as part of digital work life, leading to complacency.

Education level emerged as the most significant determinant of ergonomic knowledge (p < 0.001), with postgraduate and undergraduate participants showing markedly higher awareness than those at the secondary school level. This trend underscores the urgent need to integrate digital health and ergonomic modules into high school curricula, especially as younger students increasingly rely on screens for education. The discrepancy also reflects the uneven distribution of health information access—students in higher education often have better internet literacy and exposure to formal ergonomic guidelines.

Occupation-wise, students demonstrated better awareness compared to working individuals, especially those in private jobs or internships. This may appear counterintuitive, as workplace training is presumed to include ergonomic instruction. However, the reality in many Indian private-sector environments—particularly start-ups and small offices—is a lack of formal ergonomic policy implementation, combined with high workloads and minimal break culture. This reinforces the idea that self-driven or academic learning currently plays a more vital role in shaping ergonomic behavior than professional environments.

A particularly insightful finding was the rural-urban divide. Urban participants significantly outperformed rural counterparts (p = 0.034), likely reflecting disparities in access to ergonomic resources such as adjustable chairs, external keyboards, or awareness campaigns. In rural Himachal Pradesh, digital device use is rising, but often without accompanying ergonomic education. Young people in these areas are more likely to study or work using mobile phones or basic seating arrangements, increasing the risk of posture-related issues and undiagnosed RSIs.

Interestingly, gender was not a significant predictor of knowledge (p = 0.276), indicating a balanced distribution of awareness across male and female youth. This is an encouraging sign, as gender parity in health knowledge is often difficult to achieve in resource-limited settings. It suggests that digital health literacy campaigns—often delivered through smartphones or social media—are reaching both genders equally.

Taken together, these findings emphasize the urgent need for structured ergonomic education targeting youth in both academic and workplace settings. Policy interventions could include: (1) incorporating digital ergonomics into school and college syllabi; (2) launching region-specific awareness campaigns through local influencers or educational institutions; and (3) encouraging government and private employers to provide ergonomic training and equipment, especially for early-career professionals.^7-9

Moreover, healthcare systems in hilly regions like Himachal Pradesh must prepare to address the growing burden of digital overuse syndromes. This includes sensitizing primary care providers to screen for early symptoms of RSIs, investing in community-based physiotherapy and counseling services, and developing mobile-friendly educational tools tailored for rural youth.

Finally, the study’s strength lies in its regionally focused, youth-centric design and validated, bilingual questionnaire, which allowed for comprehensive insights across geographic and educational subgroups. However, certain limitations must be acknowledged. The online, convenience sampling method may have excluded non-tech-savvy youth or those without regular internet access—potentially underestimating the knowledge gap. Self-reported responses are also subject to social desirability bias. Future research could include longitudinal designs, clinical symptom correlation, or intervention-based evaluations to further strengthen causal understanding and guide preventive care.

This study underscores a critical and growing public health concern—digital ergonomics and repetitive stress injuries (RSIs)—among the digitally immersed youth of Himachal Pradesh. While a substantial proportion of participants demonstrated good baseline knowledge of ergonomic principles and screen-related risks, the presence of significant misconceptions and demographic disparities highlights the urgent need for structured, accessible ergonomic education. Key determinants such as age, educational attainment, occupation, and rural–urban residence played a notable role in shaping awareness levels, pointing toward specific subgroups that require targeted intervention. The findings call for a multi-tiered response encompassing curriculum integration, workplace policy reform, and region-sensitive health promotion strategies to cultivate sustainable digital habits among adolescents and young adults. In an era where screen exposure is inevitable, building ergonomic literacy must be prioritized not only to prevent long-term musculoskeletal complications but also to enhance productivity, focus, and overall well-being in India’s digital generation.

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