Background: Osteoarthritis (OA) stands among the leading causes of chronic disability in older adults, yet awareness regarding its early signs and lifestyle-based management remains insufficient in many low-resource settings. Particularly in rural and semi-urban populations, this knowledge gap contributes to delays in diagnosis and increased functional decline. This study evaluates awareness, misconceptions, and early management practices related to OA among elderly individuals in Kangra district, Himachal Pradesh. Materials and Methods: A community-based descriptive cross-sectional study was conducted from January to March 2025 involving 410 participants aged 60 years and above. A validated questionnaire was used to assess socio-demographic variables, OA-related knowledge, and health behaviors. Scores were categorized as Very Good (≥80%), Good (60–79%), Fair (41–59%), and Poor (<40%). Statistical associations were tested using chi-square analysis. Results: Of the 410 participants, 71.2% demonstrated good to very good knowledge. While 83.6% accurately identified OA as a joint degenerative disorder, only 52.1% recognized exercise as a key non-pharmacological intervention. Beliefs that OA is an inevitable part of aging or only treatable through surgery were noted in a significant fraction. Lower educational attainment and rural residence were strongly associated with limited awareness. Conclusion: The findings emphasize moderate awareness with notable misconceptions, especially concerning early management and non-surgical options. Bridging this gap through targeted geriatric education, accessible physiotherapy programs, and culturally relevant outreach can reduce disability and promote healthy aging. Regular screening and community-led joint care initiatives must be integrated into rural public health programs for long-term impact.
Osteoarthritis (OA), a chronic degenerative condition affecting the articular cartilage and underlying bone, is among the most common causes of disability worldwide. Its symptoms-joint pain, stiffness, reduced mobility-have far-reaching consequences on an individual’s independence, mental health, and social engagement, especially among the elderly [1,2].
India’s aging population makes OA a growing public health concern. Factors such as sedentary lifestyles, obesity, poor dietary habits, and delayed health-seeking behavior amplify the burden. Despite the growing prevalence, community awareness about OA’s risk factors and preventive strategies remains inconsistent, especially in rural or hilly areas like Kangra district in Himachal Pradesh [3,4].
There exists a common perception that OA is a natural, unpreventable consequence of aging. As a result, elderly individuals often delay seeking medical care or rely solely on painkillers without understanding long-term management options. Lifestyle interventions like physiotherapy, joint protection techniques, regular mobility exercises, and weight management are underutilized due to misinformation and limited access to rehabilitation services [5,6].
This study seeks to systematically assess the level of awareness, perceptions, and practices related to osteoarthritis among elderly residents of Kangra. By analyzing the association between socio-demographic factors and OA knowledge, we aim to inform public health strategies that can empower older adults to maintain functional independence through informed choices.
Study Design
A descriptive cross-sectional survey was conducted to evaluate osteoarthritis awareness and early management practices among the elderly population.
Study Setting and Population
The study was carried out in various rural and urban regions of Kangra district, Himachal Pradesh. Participants were aged 60 years or older and living independently in the community.
Study Duration
The study was conducted over a three-month period from January to March 2025.
Sample Size and Sampling
A sample of 410 was calculated using standard methods, assuming a 50% awareness rate, 5% margin of error, and 95% confidence level. Participants were selected through purposive and convenience sampling during door-to-door visits, health camps, and visits to local senior associations.
Inclusion Criteria
Age ≥60 years
Resident of Kangra
Cognitively able to participate and understand the questionnaire
Voluntary consent to participate
Exclusion Criteria
Diagnosed cognitive impairments
Immobility or serious illness
Incomplete responses
Data Collection Tool
A structured, bilingual questionnaire was developed with inputs from orthopedic and public health experts. It included:
Demographic Profile: Age, gender, education, residence, and occupation
OA Knowledge Assessment: 20 multiple-choice questions covering cause, symptoms, myths, treatment options, and prevention
Behavioral Practices: Use of physiotherapy, exercise, diet modifications, screening, and doctor consultations
Scoring and Classification
Each correct answer received one point. Scores were classified as:
Very Good: ≥80%
Good: 60–79%
Fair: 41–59%
Poor: <40%
Statistical Analysis
Data were analyzed using SPSS v26. Descriptive statistics summarized demographic details and knowledge levels. Associations between demographics and knowledge were tested using chi-square, with significance set at p<0.05.
Ethical Considerations
The study was approved by the district health department ethics committee. Written or verbal informed consent was obtained from all participants.
This table outlines the demographic profile of the elderly participants surveyed in Kangra district, Himachal Pradesh. The age distribution was fairly balanced, with the largest group being between 60–69 years (42.4%), followed by those aged 70–79 years (37.6%), and a smaller proportion (20%) aged 80 years and above. Gender distribution was nearly equal, with 50.2% male and 49.8% female respondents, reflecting a representative sample of the region’s elderly population. Educational attainment showed that a majority had low literacy levels, with 25.6% being illiterate and another 28.8% having only primary education. Just 14.1% had completed college-level education or above. This education profile is crucial in understanding health awareness gaps. Additionally, a significant rural dominance was observed, with 60.7% of the participants residing in rural areas compared to 39.3% in urban settings. This rural predominance, combined with lower educational levels, underscores the necessity for accessible, culturally sensitive health education and outreach strategies tailored for these communities.
This table presents a comprehensive overview of osteoarthritis (OA) knowledge among the elderly respondents, using a set of 18 core questions (out of a 20-question tool), each with four multiple-choice options. The results indicate a general understanding of OA’s clinical aspects, with particularly strong awareness around OA being a joint disease (83.6% correct), its prevalence among the elderly (75.4%), and common symptoms like morning joint stiffness (65.1%). However, misconceptions were evident in several areas. Only 52.1% correctly acknowledged the role of exercise in OA management, and less than half (45.4%) understood that OA is not an inevitable part of aging. The belief that surgery alone cures OA was correctly disputed by just 58.3%, revealing a need for more nuanced education on treatment modalities. Encouragingly, knowledge about the value of physiotherapy (68.5%) and lifestyle changes (64.1%) was moderately strong. However, gaps persisted in recognizing early diagnosis importance (47.3%) and in dismissing myths such as OA being linked to fever or cured by antibiotics. These findings highlight areas for focused intervention, especially in promoting early, non- invasive management and correcting prevalent myths through community-based health literacy campaigns.
Table 1: Socio-Demographic Characteristics of Participants (N = 410)
| Variable | Category | Frequency (n) | Percentage (%) |
| Age Group | 60–69 | 174 | 42.4 |
| 70–79 | 154 | 37.6 | |
| 80+ | 82 | 20.0 | |
| Gender | Male | 206 | 50.2 |
| Female | 204 | 49.8 | |
| Education | Illiterate | 105 | 25.6 |
| Primary | 118 | 28.8 | |
| Secondary | 129 | 31.5 | |
| College and above | 58 | 14.1 | |
| Residence | Urban | 161 | 39.3 |
| Rural | 249 | 60.7 |
No. | Question | Options | Correct Answer | Correct Responses (n) | Percentage (%) |
1 | OA primarily affects? | a) Muscles, b) Joints, c) Skin, d) Bones, | b) Joints | 343 | 83.6 |
2 | Who is at higher risk of OA? | a) Children, b) Teenagers,c) Elderly, d) Middle-aged men | c) Elderly | 309 | 75.4 |
3 | Can exercise help manage OA? | a) Yes, b) No, c) Only in young people. d) Sometimes | a) Yes | 214 | 52.1 |
4 | Is OA curable by surgery alone? | a) True, b) False, c) Only in early stages, d) Depends on age | b) False | 239 | 58.3 |
5 | Is OA inevitable with aging? | a) Yes b) No c) Only in women,d) Only after 80 | b) No | 186 | 45.4 |
6 | Is physiotherapy useful for OA? | a) Yes, b) No, c) Only post-surgery,d) Not sure | a) Yes | 281 | 68.5 |
7 | Early symptom of OA? | a) Swelling, b) Fever, c) Redness,d) Morning joint stiffness | d) Morning joint stiffness | 267 | 65.1 |
8 | Can OA affect hands and fingers? | a) Yes, b) No, c) Only toes, d) Rarely | a) Yes | 274 | 66.8 |
9 | Role of weight in OA? | a) No role,b) Excess weight worsens OA,c) Only important in young people,d) Helps reduce pain, | b) Excess weight worsens OA | 231 | 56.3 |
10 | Best time for diagnosis? | a) After severe pain,b) During surgery,c) Before severe symptoms,d) When immobile | c) Before severe symptoms | 194 | 47.3 |
11 | Which is NOT a symptom of OA? | a) Joint pain, b) Swelling, c) Fever,d) Stiffness | c) Fever | 272 | 66.3 |
12 | OA can be managed with? | a) Only medication,b) Lifestyle changes and therapy,c) Rest alone, d) Antibiotics | b) Lifestyle changes and therapy | 263 | 64.1 |
13 | Common cause of OA? | a) Virus, b) Cartilage degeneration, c) Poor sleep, d) Diet | b) Cartilage degeneration | 289 | 70.5 |
14 | Helpful activity for OA patients? | a) Bed rest, b) Running,c) Walking and light exercise,d) Lifting weights | c) Walking and light exercise | 252 | 61.5 |
15 | Joint commonly affected by OA? | a) Elbow, b) Knee, c) Ankle,d) Wrist | b) Knee | 298 | 72.7 |
16 | Which does NOT increase OA risk? | a) Obesity, b) Aging,c) Family history, d) Vaccination | d) Vaccination | 319 | 77.8 |
17 | Suitable initial OA treatment? | a) Surgery,b) Exercise and physiotherapy,c) Joint replacement,d) Cortisone injection | b) Exercise and physiotherapy | 237 | 57.8 |
18 | Aim of OA treatment? | a) Cure completely,b) Manage symptoms and improve function,c) Avoid all movement,d) Prevent infection | b) Manage symptoms and improve function | 282 | 68.8 |
19 | Common myth about OA? | a) Only elderly get OA,b) OA cannot be prevented,c) OA causes joint pain,d) OA is lifelong | b) OA cannot be prevented | 205 | 50.0 |
20 | Can lifestyle changes delay OA? | a) No, b) Only with medicine,c) Depends on age d) Yes | d) Yes | 248 |
Knowledge Level | Score Range | Frequency (n) | Percentage (%) |
Very Good | ≥80% | 118 | 28.8 |
Good | 60–79% | 175 | 42.4 |
Fair | 41–59% | 80 | 19.5 |
Poor | <40% | 37 | 9.0 |
The extended version of the OA knowledge assessment tool consolidates insights from all 20 questions used in the study. It reveals a complex pattern of awareness and misunderstanding among elderly individuals. While a large proportion correctly identified OA as related to cartilage degeneration (70.5%) and commonly affecting the knees (72.7%), fewer respondents were aware of the preventive potential of lifestyle changes, with only 60.5% acknowledging that such changes could delay OA progression. Misconceptions were evident in overestimating the inevitability of OA in aging and undervaluing early diagnosis and exercise as key preventive strategies. The ability to differentiate true symptoms (e.g., stiffness) from unrelated ones (e.g., fever) was reasonably strong (66.3%), suggesting that symptom-related awareness was more developed than treatment understanding. The least understood aspects were the curability of OA through surgery alone and the importance of proactive screening before symptom severity escalates. This expanded tool not only provides a more complete picture of community knowledge but also serves as a valuable template for future educational interventions aimed at improving early diagnosis, functional independence, and quality of life among aging populations.
This study provides valuable insights into osteoarthritis awareness among Kangra's elderly. While general knowledge about the disease was relatively high, significant misconceptions and practical knowledge gaps persist-particularly regarding prevention and non-pharmacological management.
The finding that less than half of respondents viewed OA as preventable reflects a widespread belief that joint deterioration is an unavoidable aspect of aging. This misconception delays care-seeking and reduces motivation for early lifestyle changes. Notably, knowledge about the role of weight management and exercise was weak, despite clear evidence linking both to improved outcomes in OA patients.
Further, many participants incorrectly believed surgery to be the only definitive treatment. Such beliefs not only delay more conservative interventions but may also increase anxiety and reduce treatment adherence among the elderly. Education about the benefits of physiotherapy, walking aids, and home-based mobility programs must be a priority [6,7].
Socio-demographic factors played a substantial role in knowledge levels. Illiterate and rural participants scored significantly lower, suggesting a clear digital and educational divide. Addressing this requires low-literacy materials, regional language campaigns, and involvement of ASHA workers, panchayat leaders, and family caregivers in outreach efforts [8,9].
Integrating osteoarthritis screening and education into primary care visits for seniors, particularly during routine health checkups, could promote early intervention. Encouraging intergenerational support-such as children accompanying parents to clinics-may also enhance understanding and support better adherence to care.
The study reveals a reasonably good level of awareness about osteoarthritis among the elderly in Kangra, but it also identifies clear areas of concern. Misbeliefs about OA being untreatable or a normal part of aging, and a lack of understanding about non-surgical interventions like physiotherapy and exercise, persist among a significant portion of the population. Targeted, community-led health education-especially for rural and less-educated groups-is essential. Additionally, integrating OA care into routine geriatric outreach, along with promoting active aging and early intervention, can significantly improve the quality of life and mobility outcomes for the elderly in Himalayan settings.
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