Gout is a common and complex form of arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints. The condition results from an accumulation of urate crystals in the joints, which occurs due to high levels of uric acid in the blood. While gout has been well-documented in medical literature, public awareness and understanding of the condition remain limited, particularly in rural and semi-urban areas. This lack of knowledge often leads to delayed diagnosis and inadequate management, contributing to a significant burden of disease and a reduced quality of life for those affected.^1-4

In addition to the physical symptoms, gout also carries a significant socioeconomic burden. The chronic nature of the disease often results in lost workdays, decreased productivity, and increased healthcare costs, particularly when the condition is not managed effectively. Furthermore, misconceptions about gout being solely a disease of affluence or related to dietary indulgence can prevent individuals from seeking timely medical attention. Addressing these misconceptions is vital for improving the overall management of gout and ensuring that those affected receive appropriate care and support.^5-10

Himachal Pradesh, with its unique demographic and geographic characteristics, presents a particular case for studying the awareness and knowledge of gout among its population. District Kangra, being one of the most populous regions in the state, provides a representative sample for understanding the public's perception of gout. Despite the rising incidence of lifestyle-related diseases, including gout, there is a noticeable gap in the public's awareness about the causes, symptoms, prevention, and treatment of this condition.

Understanding the level of awareness and knowledge about gout among the general public is crucial for developing effective public health strategies and educational interventions. This study aims to assess the awareness and knowledge of gout among adults in District Kangra, Himachal Pradesh. By identifying the myths and misconceptions surrounding the condition, this research seeks to contribute to more informed healthcare practices and better disease management at the community level.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Gout among general public of District Kangra, Himachal Pradesh. 

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: District Kangra, Himachal Pradesh

• Study duration- between January 2024 to May 2024

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra Himachal Pradesh for a minimum of 12 months

• Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Gout, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Gout was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structuredknowledge related questions regarding Gout. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Kangra Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The study included 400 participants, with age groups distributed as follows: 31.5% were aged 18-30 years, 23.8% were aged 31-40 years, 21.0% were aged 41-50 years, and 23.8% were above 50 years of age. Gender distribution was nearly equal, with 49.5% males and 50.5% females. Regarding marital status, 38.0% of the participants were single, 58.0% were married, and 4.0% belonged to other categories. In terms of religion, the majority were Hindu (82.3%), followed by Muslim (6.8%), Sikh (7.8%), and others (3.3%). Employment status showed that 48.8% were employed, 27.0% were unemployed, and 24.2% were students. Educational levels varied, with 12.8% having education below high school, 27.0% being high school graduates, 35.5% having completed graduation, and 24.8% having postgraduate or higher education.

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

The participants' knowledge of gout symptoms was assessed, and 78.5% had heard of gout. Regarding specific symptoms, 71.8% knew that gout could cause severe joint pain, 69.8% were aware that it could lead to joint swelling, 66.0% recognized that it could cause redness in the joints, and 64.5% knew it could lead to joint tenderness.

Table 2: Knowledge Regarding Symptoms of Gout (N=400)

When asked about the causes and risk factors associated with gout, 62.0% of the participants knew that high uric acid levels could lead to gout. Awareness about dietary influences was also notable, with 59.8% recognizing that certain foods could increase the risk, and 57.8% being aware of the risks posed by alcohol consumption. Additionally, 56.3% understood the link between obesity and gout, while 53.8% knew that a family history of gout could increase their risk.

Table 3: Knowledge Regarding Causes and Risk Factors of Gout (N=400)

The study also examined participants' knowledge of gout prevention. About 52.0% were aware that dietary changes could help prevent gout, and 50.3% knew that avoiding certain foods could reduce the risk. Furthermore, 48.5% recognized the importance of drinking plenty of fluids, 45.5% understood the role of regular exercise in prevention, and 44.0% were aware that maintaining a healthy weight could help prevent gout.

Table 4: Knowledge Regarding Prevention of Gout (N=400)

Regarding the treatment and management of gout, 46.8% of participants knew that medications could help manage the condition, and 43.8% understood that lifestyle changes could be effective in managing gout. Additionally, 41.3% were aware that managing uric acid levels could control symptoms, 39.5% knew that avoiding trigger foods could help manage the condition, and 36.8% were aware that medical procedures might be necessary for severe cases.

Table 5: Knowledge Regarding Treatment and Management of Gout (N=400)

Participants' overall knowledge about gout was categorized into four groups. A "Very Good" knowledge score (16-20 points) was achieved by 24.5% of the participants, while 29.5% scored in the "Good" category (12-15 points). A "Fair" score (8-11 points) was observed in 27.0% of participants, and 19.0% fell into the "Poor" category with scores below 8 points.

Table 6: Overall, Knowledge Score Categories for Gout (N=400)

This study provides a comprehensive evaluation of the awareness and knowledge regarding gout among the general public in District Kangra, Himachal Pradesh. The findings underscore significant gaps in understanding gout, its causes, symptoms, prevention, and management, despite the growing prevalence of lifestyle-related diseases in the region. These insights are crucial for public health efforts aimed at reducing the burden of gout through better education and early intervention strategies.

The study sample consisted of a well-distributed demographic profile, with nearly equal representation of males (49.5%) and females (50.5%). The participants' age distribution was balanced across various age groups, with a significant proportion falling within the 18-30 age range (31.5%). This demographic distribution is critical as it provides insights into how knowledge and awareness of gout are spread across different age and gender groups. Notably, a majority of the participants 

were married (58.0%), Hindu (82.3%), and employed (48.8%), reflecting the socio-cultural fabric of the region.

The study reveals that while a substantial portion of the participants (78.5%) had heard of gout, detailed knowledge about the symptoms was relatively lower. For instance, while 71.8% knew that gout could cause severe joint pain, only 64.5% were aware that it could lead to joint tenderness. This indicates a superficial understanding of the disease, where participants recognize gout as a painful condition but may not fully comprehend the range of symptoms that characterize it. This lack of detailed knowledge can lead to delayed diagnosis and inadequate symptom management, further exacerbating the disease's impact on quality of life.^3,4

The findings regarding the causes and risk factors of gout highlight significant misconceptions and knowledge gaps among the participants. While 62.0% were aware that high uric acid levels could lead to gout, fewer participants recognized the role of dietary factors (59.8%) and alcohol consumption (57.8%) in increasing the risk. Moreover, only 56.3% linked obesity with gout, and an even lower percentage (53.8%) were aware of the hereditary risk factors. These findings suggest that public health messages regarding the modifiable risk factors for gout, such as diet, alcohol consumption, and weight management, need to be more effectively communicated.^5,7

The study also reveals that knowledge about the prevention of gout is limited. Only 52.0% of participants were aware that dietary changes could help prevent gout, and even fewer (44.0%) recognized the importance of maintaining a healthy weight. This highlights a critical area for intervention, as lifestyle modifications are a key component in preventing gout. Public health initiatives should focus on educating the population about the importance of healthy dietary habits, regular exercise, and weight management in preventing the onset of gout.^6,8,9

The participants' knowledge regarding the treatment and management of gout was also found to be lacking. Less than half (46.8%) knew that medications could help manage gout, and only 43.8% were aware of the effectiveness of lifestyle changes in managing the condition. Furthermore, knowledge about the importance of managing uric acid levels (41.3%) and avoiding trigger foods (39.5%) was even lower. These findings suggest that even among those who may be aware of gout, there is limited understanding of how to manage and treat the condition effectively. This could result in suboptimal treatment outcomes and an increased risk of complications.^8,10

The overall knowledge scores further reinforce the need for enhanced public education on gout. While 24.5% of participants demonstrated very good knowledge, a significant proportion fell into the good (29.5%) and fair (27.0%) categories, with 19.0% showing poor knowledge. This distribution indicates that while some individuals possess a good understanding of gout, a substantial number lack adequate knowledge. This variability in knowledge underscores the need for targeted educational interventions that address the specific gaps in awareness and understanding.^7,8

Implications For Public Health

The findings of this study have important implications for public health efforts in District Kangra and similar settings. First, there is a clear need for public health campaigns to address the myths and misconceptions surrounding gout, particularly the idea that it is solely a disease of affluence or related only to dietary indulgence. Second, educational initiatives should emphasize the modifiable risk factors for gout, such as diet, alcohol consumption, and weight management, as well as the importance of early diagnosis and treatment.

Healthcare providers in the region should also be trained to recognize the signs and symptoms of gout early and to educate their patients about the disease's management and prevention. Community-based interventions, including workshops, seminars, and health camps, could be effective in raising awareness and improving knowledge about gout among the general population.

Furthermore, the use of digital platforms, as demonstrated in this study, can be a powerful tool in reaching a broader audience. The successful use of online modes such as email and social media to collect data suggests that similar platforms can be leveraged for educational campaigns to disseminate information about gout and its management.

This study sheds light on the significant knowledge gaps regarding gout among the public in District Kangra, Himachal Pradesh. While there is a general awareness of the condition, detailed knowledge about its symptoms, causes, prevention, and management is lacking. Addressing these gaps through targeted educational interventions and public health initiatives is essential to improve the management of gout and reduce its burden on individuals and the healthcare system. By breaking the myths and misconceptions surrounding gout, healthcare providers and public health practitioners can ensure that individuals receive timely and appropriate care, ultimately improving health outcomes for those affected by this condition.

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7. Thakur, P., and Lyngdoh, C. A. "Knowledge and Attitude Towards Gout and Its Management: A Cross-Sectional Study." International Journal of Scientific Research (IJSR), vol. 10, no. 8, 2021, pp. 1184-1186. doi:10.36106/ijsr/3299895.

8. Tiwaskar, M., and Sholapuri, D. "An Assessment of Knowledge, Attitude, and Practices of Physicians in the Management of Hyperuricemia in India: A Questionnaire-Based Study." Journal of the Association of Physicians of India, vol. 69, no. 4, Apr. 2021, pp. 11-12. doi:10.47726/japi/2021/69/4/11.

9. Liu, M., Gao, Z., Zhang, X., Yuan, X., Lu, Y., and Meng, J. "General Practitioners’ Knowledge of Gout and Its Management: A Case Study in Beijing." Primary Health Care Research & Development, vol. 22, 19 Oct. 2021, e54. doi:10.1017/S1463423621000267.

10. Alshammari, I. M., and Mujtaba, M. A. "Public Knowledge and Awareness About Gout: A Cross-Sectional Study in Qatar." Journal of Pharmaceutical Research International, vol. 17, no. 4, 2017, pp. 1-11. doi:10.9734/jpri/2017/35763.