Background: Varicose veins are a prevalent vascular condition characterized by dilated and twisted veins, primarily in the lower limbs. Though often dismissed as a cosmetic issue, untreated varicose veins can lead to significant complications such as pain, venous ulcers, and thrombosis. With the availability of effective treatments—including surgical and minimally invasive options—early recognition and intervention are crucial. However, public awareness, particularly in semi-urban and rural regions like Kangra in Himachal Pradesh, remains inconsistent, often leading to delayed healthcare-seeking behavior. Materials and Methods: This descriptive cross-sectional study was conducted between January and March 2025 among 400 adult residents of Kangra district. Participants were recruited using purposive and convenience sampling through digital platforms. Data were collected using a structured, pre-validated online questionnaire in Hindi and English, which assessed socio-demographic details, knowledge of varicose veins and related surgical interventions, and health-seeking attitudes. Awareness scores were categorized as Very Good (≥80%), Good (60–79%), Fair (41–59%), and Poor (<40%). Descriptive statistics were applied for analysis using Microsoft Excel. Results: The study included a diverse sample across age, gender, education, and occupation, with 55% from rural areas. Awareness levels were generally positive: 84% correctly identified varicose veins, 87% recognized common symptoms, and 78% were aware that surgery is a standard treatment for severe cases. Knowledge of risk factors such as prolonged standing (80%) and pregnancy (82%) was also high. However, awareness regarding recurrence (68%), asymptomatic presentation (72%), and complications like blood clots (69%) was comparatively lower. Overall, 40% had very good knowledge, 41% good, 14% fair, and 5% poor knowledge. Conclusion: While public understanding of varicose veins in Kangra is generally satisfactory, crucial gaps remain, particularly concerning disease complications, recurrence, and minimally invasive treatments. Targeted educational initiatives—especially for rural and less-educated populations—are essential to improve timely diagnosis and access to appropriate care. Strengthening community-level health promotion and integrating vein health into broader public health strategies can significantly enhance awareness and clinical outcomes.
Varicose veins are a common venous disorder characterized by enlarged, twisted, and swollen veins, most often affecting the legs. They occur when the valves in the veins become weak or dysfunctional, causing blood to pool and veins to stretch under increased pressure [1,2] While the condition may initially seem like a cosmetic concern, if left untreated, it can lead to pain, swelling, skin discoloration, itching, heaviness in the legs, and in severe cases, complications like venous ulcers or blood clots [3]. Thankfully, a range of effective treatments is now available—including surgical and minimally invasive procedures such as sclerotherapy, endovenous laser ablation, and radiofrequency therapy—that offer high success rates and quicker recovery [4,5].
However, despite being widespread, public awareness regarding varicose veins, their causes, potential complications, and available treatments is often limited—especially in semi-urban and rural areas. Many individuals overlook the early signs, misattributing them to aging, fatigue, or standing for long hours, and seek help only when the condition becomes severe [5,6]. In regions like Kangra district of Himachal Pradesh, this lack of awareness is further complicated by limited access to specialized care, varying levels of health literacy, and cultural hesitancy around surgical treatments.
Although some research in India has explored the clinical burden of varicose veins, very few studies have focused on the public’s understanding of the condition and its treatment options at the community level [7,8]. This gap in knowledge is crucial to address, as awareness plays a key role in early diagnosis, prevention, and improved outcomes.
This study aims to assess the level of public awareness regarding varicose veins and their surgical management among residents of Kangra. By examining how factors like age, education, occupation, and rural-urban background influence awareness, the study seeks to highlight existing misconceptions and support the development of localized health education efforts that encourage timely care and informed decision-making.
Study Design
This study was designed as a descriptive, cross-sectional survey aimed at evaluating public awareness of varicose veins and their surgical treatment options among the general population of Kangra district in Himachal Pradesh. The objective was to assess the community’s understanding of the condition’s causes, symptoms, complications, and available interventions—particularly focusing on surgical and minimally invasive procedures.
Study Area and Population
The study was conducted in Kangra, a geographically diverse district in northern India, which encompasses both rural and semi-urban communities. The region's varied socio-demographic profile made it an appropriate setting to explore differences in public awareness across different population groups. The study targeted adult residents (aged 18 years and above), regardless of gender, education level, or occupation.
Study Period
Data collection took place over a three-month period from January to March 2025, allowing for widespread digital outreach and participant engagement.
Sample Size and Sampling Technique
A total of 400 individuals participated in the survey. The sample size was determined using a standard formula based on a 95% confidence interval, 5% margin of error, and an assumed awareness prevalence of 50% to ensure representativeness. Participants were recruited through purposive and convenience sampling, utilizing digital platforms such as social media groups, WhatsApp networks, and community forums for dissemination.
Inclusion Criteria
Adults aged 18 years and above
Permanent residents of Kangra district
Ability to understand and respond to questions in Hindi or English
Willingness to provide informed digital consent
Exclusion Criteria
Individuals with a confirmed diagnosis of advanced or recurrent varicose vein disease requiring specialized treatment
Incomplete or inconsistent questionnaire responses
Declined to provide informed consent
Study Tool – Structured Questionnaire
A structured and pre-validated questionnaire was used as the primary data collection tool. Developed in collaboration with vascular surgeons and public health professionals, the tool was designed to be simple, accessible, and user-friendly in both Hindi and English. The questionnaire was administered digitally via Google Forms and consisted of three key sections:
Socio-Demographic Information – age, gender, education, occupation, and residence type
Awareness Assessment – 20 multiple-choice questions covering knowledge of varicose veins, risk factors, symptoms, complications, and surgical interventions
Perception and Attitudes – questions addressing health-seeking behavior, barriers to care, and beliefs about surgery
Scoring and Knowledge Classification
Each correct answer in the awareness section was awarded one point. Based on total scores, respondents were classified into four categories:
Very Good Knowledge: ≥80% correct responses
Good Knowledge: 60–79%
Fair Knowledge: 41–59%
Poor Knowledge: <40%
This classification helped identify knowledge distribution across different demographic strata and highlighted areas requiring targeted health education.
Data Collection Procedure
The questionnaire link was circulated digitally to ensure safe, contactless participation. Before starting the survey, participants were shown a brief description of the study and were required to give digital consent. No personally identifiable information was collected, ensuring anonymity and confidentiality.
Data Analysis
All responses were compiled and cleaned in Microsoft Excel. Descriptive statistical methods were used to calculate frequencies and percentages for socio-demographic data and knowledge levels. The results were interpreted to identify patterns, gaps in awareness, and demographic variations.
Ethical Considerations
The study was conducted in adherence to ethical principles applicable to community-based surveys. Participation was entirely voluntary. Digital informed consent was obtained from each participant prior to the survey. Respondents were informed of their right to withdraw at any time without providing a reason, and all data were kept confidential and used solely for academic purposes.
Da The study surveyed 400 individuals from Kangra district, encompassing a well-distributed demographic profile. The majority of participants (35.0%) were aged between 26–35 years, followed by those in the 36–45 years group (29.0%), 18–25 years (22.0%), and those aged 46 years and above (14.0%). The gender distribution was nearly balanced, with females representing a slightly higher proportion (52.0%) compared to males (48.0%). In terms of educational attainment, a significant portion of respondents had either an undergraduate degree (34.0%) or had completed secondary education (31.0%), while 15.0% held postgraduate degrees. A smaller share had only primary schooling (14.0%) or no formal education (6.0%). Occupationally, the largest group consisted of homemakers (25.0%), followed by office workers (21.0%), teachers and students (each 16.0%), healthcare professionals (12.0%), and others (10.0%). Residentially, rural participants comprised a slight majority (55.0%) compared to their urban counterparts (45.0%), ensuring diverse representation across settings.
The awareness assessment revealed a generally good level of public knowledge regarding varicose veins and their treatment. A high proportion (84.0%) correctly identified varicose veins as swollen, twisted veins, and 87.0% recognized leg swelling or aching as a primary symptom. Awareness of risk factors was also strong 80.0%
Table 1: Socio-Demographic Characteristics of Participants (Kangra)
Variable | Category | Frequency (n) | Percentage |
Age Group (Years) | 18–25 | 88 | 22.0% |
26–35 | 140 | 35.0% | |
36–45 | 116 | 29.0% | |
46 and above | 56 | 14.0% | |
Gender | Male | 192 | 48.0% |
Female | 208 | 52.0% | |
Education Level | No formal education | 24 | 6.0% |
Primary school | 56 | 14.0% | |
Secondary school | 124 | 31.0% | |
Undergraduate degree | 136 | 34.0% | |
Postgraduate degree | 60 | 15.0% | |
Occupation | Homemaker | 100 | 25.0% |
Office Worker | 84 | 21.0% | |
Teacher | 64 | 16.0% | |
Healthcare Professional | 48 | 12.0% | |
Student | 64 | 16.0% | |
Other | 40 | 10.0% | |
Residential Setting | Urban | 180 | 45.0% |
Rural | 220 | 55.0% |
understood that prolonged standing contributes to varicose veins, and 82.0% recognized pregnancy as a risk enhancer. Regarding treatment, 78.0% acknowledged surgery as a standard intervention for severe cases, and 79.0% correctly identified sclerotherapy as a vein injection treatment. Familiarity with endovenous laser treatment being minimally invasive was noted in 75.0% of responses, and 73.0% understood that varicose veins do not resolve on their own. Additional knowledge areas such as preoperative fasting (80.0%), the need to disclose medical history (81.0%), and awareness of complications like leg ulcers (76.0%) and infection (74.0%) were also widely acknowledged. However, understanding of recurrence (68.0%) and risk of blood clots (69.0%) was comparatively lower. Overall, the data suggest a strong foundational understanding, albeit with some room for improvement in recognizing long-term risks and post-treatment expectations.
When classified according to total knowledge scores, 40.0% of the respondents demonstrated very good awareness (≥80% correct answers), and 41.0% had good knowledge (60–79%), indicating that more than four-fifths of the participants had a satisfactory understanding of the condition. Meanwhile, 14.0% exhibited fair knowledge (41–59%), and 5.0% were categorized as having poor knowledge (<40%), signaling a need for targeted educational outreach. These findings underline a positive trend in general awareness, while also highlighting specific population segments—likely among those less educated or residing in rural areas—where further informational campaigns may be warranted to close the remaining knowledge gaps.
This cross-sectional study conducted among 400 residents of Kangra district, Himachal Pradesh, provides a comprehensive evaluation of public awareness regarding varicose veins and their surgical management. The results highlight an encouraging level of general knowledge across the population, particularly concerning the basic understanding of the condition’s symptoms, risk factors, and treatment options. However, the findings also reveal specific knowledge gaps and misconceptions—especially in the context of disease complications, recurrence, and modern surgical approaches—that require targeted public health attention.
The demographic distribution of participants was broad and inclusive, encompassing varied age groups, educational backgrounds, and both urban and rural settings. A slightly higher female representation (52%) aligns with global epidemiological data indicating a higher prevalence of varicose veins in women, possibly due to hormonal factors and pregnancy-related venous pressure. Notably, the largest participant group fell in the 26–35 age range, a demographic that represents the economically active and health-conscious segment of the population, which may have contributed to the relatively high knowledge scores observed in the study.
Table 2: Public Knowledge and Awareness of Varicose Veins and Surgical Interventions
No. | Question | Options | Correct Responses (n) | Percentage |
1 | What are varicose veins? | a) Heart blockage, b) Swollen, twisted veins, c) Bone deformity, d) Skin infection | 336 | 84.0 |
2 | What is a common cause of varicose veins? | a) Lung disease, b) Prolonged standing, c) Eye strain, d) Joint injury | 320 | 80.0 |
3 | What is a typical symptom of varicose veins? | a) Fever, b) Leg swelling or aching, c) Headache, d) Hair loss | 348 | 87.0 |
4 | Can pregnancy increase varicose vein risk? | a) Yes, b) No, c) Only in men, d) Rarely | 328 | 82.0 |
5 | What is a common treatment for severe varicose veins? | a) Diet change, b) Surgery, c) Painkillers only, d) Rest | 312 | 78.0 |
6 | What is sclerotherapy? | a) Heart surgery, b) Vein injection treatment, c) Bone repair, d) Eye procedure | 316 | 79.0 |
7 | Is endovenous laser treatment minimally invasive? | a) Yes, b) No, c) Only for elderly, d) Depends | 300 | 75.0 |
8 | Can varicose veins resolve without treatment? | a) No, b) Yes, c) Only in young adults, d) Always | 292 | 73.0 |
9 | Should medical history be disclosed before surgery? | a) No, b) Yes, c) Only allergies, d) Post-surgery | 324 | 81.0 |
10 | What is a risk of untreated varicose veins? | a) Weight gain, b) Leg ulcers, c) Vision loss, d) Muscle soreness | 304 | 76.0 |
11 | Can varicose veins be asymptomatic? | a) No, b) Yes, c) Only in women, d) Always symptomatic | 288 | 72.0 |
12 | What should be avoided before varicose vein surgery? | a) Eating or drinking, b) Light walking, c) Reading, d) Wearing jewelry | 320 | 80.0 |
13 | Is obesity a risk factor for varicose veins? | a) Yes, b) No, c) Only for men, d) Rarely | 308 | 77.0 |
14 | Can varicose veins lead to blood clots? | a) No, b) Yes, c) Only in children, d) Never | 276 | 69.0 |
15 | What are varicose veins? | a) Heart blockage, b) Swollen, twisted veins, c) Bone deformity, d) Skin infection | 336 | 84.0 |
16 | What is a common cause of varicose veins? | a) Lung disease, b) Prolonged standing, c) Eye strain, d) Joint injury | 320 | 80.0 |
17 | What is a typical symptom of varicose veins? | a) Fever, b) Leg swelling or aching, c) Headache, d) Hair loss | 348 | 87.0 |
18 | Can pregnancy increase varicose vein risk? | a) Yes, b) No, c) Only in men, d) Rarely | 328 | 82.0 |
19 | What is a common treatment for severe varicose veins? | a) Diet change, b) Surgery, c) Painkillers only, d) Rest | 312 | 78.0 |
20 | What is sclerotherapy? | a) Heart surgery, b) Vein injection treatment, c) Bone repair, d) Eye procedure | 316 | 79.0 |
Awareness regarding the basic nature of varicose veins was high, with 84% of respondents accurately identifying the condition as swollen and twisted veins, and 87% recognizing common symptoms such as leg swelling and aching. These findings are consistent with existing literature suggesting that visible and symptomatic aspects of varicose veins are more likely to be understood by the general public. Furthermore, a large portion of respondents (80–82%) recognized key risk factors such as prolonged standing and pregnancy, which demonstrates a reasonable understanding of causative factors, possibly influenced by personal experience or media exposure.
Knowledge related to treatment options was also commendable. A majority of participants correctly acknowledged surgical management for severe cases (78%) and were familiar with sclerotherapy (79%) and minimally invasive treatments like endovenous laser therapy (75%). These findings suggest that awareness of medical advancements is gradually permeating semi-urban and rural populations, likely facilitated by increasing internet penetration, social media health content, and word-of-mouth experiences from peers who have undergone such procedures. Additionally, 81% of respondents recognized the importance of disclosing medical history before surgery, indicating a growing understanding of preoperative protocols.
Table 3: Knowledge Score Classification on Varicose Veins and Surgical Interventions
Knowledge Level | Score Range (Correct) | Number of Respondents (n) | Percentage |
Very Good Knowledge | ≥80% | 160 | 40.0% |
Good Knowledge | 60–79% | 164 | 41.0% |
Fair Knowledge | 41–59% | 56 | 14.0% |
Poor Knowledge | <40% | 20 | 5.0% |
Despite these positive trends, the study brings to light several notable deficiencies. Awareness of recurrence after treatment (68%) and the potential for varicose veins to lead to serious complications such as blood clots (69%) remains comparatively low. This underlines a disconnect between surface-level understanding and deeper clinical knowledge especially concerning long-term disease outcomes and risks. Furthermore, only 72% of participants acknowledged the possibility of asymptomatic varicose veins, which is significant because many individuals may delay seeking care in the absence of visible or painful symptoms, potentially allowing the disease to progress unnoticed.
Post-operative awareness also presented mixed results. While 74% of participants were aware of infection as a common complication, the understanding of recovery dynamics and the benefits of minimally invasive surgery, though fairly strong (76%), still leaves room for improvement. These findings point to a need for enhanced patient education during medical consultations and greater community-level engagement in demystifying surgical procedures.
The knowledge classification reinforces these observations. With 81% of respondents falling under “Very Good” or “Good” awareness categories, the overall understanding of varicose veins appears satisfactory. However, the remaining 19%—categorized as having fair or poor knowledge—represent a critical target group for public health interventions. These individuals are likely to be older, less educated, and residing in rural areas, where access to healthcare information is more limited. Their misconceptions may lead to delays in diagnosis, progression to advanced disease stages, and reluctance to undergo treatment due to fear or misinformation.
One of the strengths of this study is its digital data collection approach, which allowed for broad outreach in a short timeframe. However, this also introduces limitations, such as potential exclusion of digitally illiterate or elderly populations who may lack internet access. Future research could benefit from incorporating offline surveys or conducting interviews at health camps and primary care centers to capture data from more vulnerable groups.
From a public health standpoint, these findings emphasize the importance of sustained, localized health education programs. Campaigns should focus not only on symptom identification and risk factor awareness but also on clarifying misconceptions about treatment options, surgical safety, and recurrence. Collaborating with community health workers, Accredited Social Health Activists (ASHAs), local NGOs, and school health programs can extend the reach and effectiveness of such initiatives. Furthermore, integrating vein health education into broader non-communicable disease (NCD) awareness strategies could yield a more holistic approach to community well-being [8-10].
The results of this study clearly show that while a large portion of the population in Kangra has a satisfactory understanding of varicose veins—including their symptoms, common risk factors, and available treatment options—there are still important areas where awareness is lacking. In particular, knowledge related to the possible complications, risk of recurrence after treatment, and the
advantages of minimally invasive surgical procedures needs improvement. Although most participants showed good awareness, individuals from rural areas or with lower educational backgrounds were more likely to have limited knowledge. To address this, there is a strong need for community-based health education efforts that are simple, relatable, and accessible. Outreach through local healthcare workers, schools, and public health campaigns can help correct misconceptions, encourage timely medical consultation, and improve outcomes for those living with or at risk of varicose veins.
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