Hernia is a common medical condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. This condition can affect various parts of the body, including the abdomen, groin, and upper thigh. Hernias can cause significant discomfort, pain, and complications if left untreated, necessitating timely medical intervention. The primary types of hernias include inguinal, femoral, umbilical, and hiatal hernias, each with distinct characteristics and risk factors.^1-4

The prevalence of hernia is significant worldwide, affecting individuals across all age groups and demographics. Contributing factors include heavy lifting, persistent coughing, obesity, and congenital defects. Despite the commonality of hernias and the potential severity of their complications, public awareness and understanding of the condition remain limited. Many individuals may not recognize the symptoms of a hernia or understand the importance of seeking prompt medical care, leading to delayed diagnoses and treatment. This lack of awareness can result in complications such as incarceration or strangulation of the herniated tissue, which require emergency surgical intervention.^4-6

District Bilaspur in Himachal Pradesh, like many other rural regions in India, faces significant challenges in healthcare access and education. Limited access to healthcare resources, traditional beliefs, and low levels of health literacy can hinder the timely recognition and management of hernias. Understanding the level of awareness and knowledge about hernias among the general public in Bilaspur is crucial for designing effective educational interventions that can improve health outcomes.

Despite the commonality of hernias, research focusing on rural Indian settings is sparse, particularly concerning the public's understanding of hernias. This study aims to address this gap by evaluating the awareness and knowledge levels of hernias among the general population in Bilaspur. Identifying areas of misconception and knowledge deficits will enable the development of targeted public health strategies and educational initiatives to enhance community understanding of hernias.

By providing an in-depth analysis of the current awareness levels, this study seeks to inform and guide future educational interventions aimed at early diagnosis and effective management of hernias. This approach is essential to reducing the health burden associated with this condition and improving overall community health outcomes in Bilaspur. Through this research, we aim to contribute valuable insights into public health education and emphasize the need for focused awareness campaigns in areas with limited healthcare access.

Objectives of the Study:

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

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area: District Bilaspur , 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 Bilaspur 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 Hernia, 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 Hernia 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, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Hernia. 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 Bilaspur 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 assessed the socio-demographic characteristics and the awareness and knowledge of hernias among the general public in District Bilaspur, Himachal Pradesh. A total of 400 participants were surveyed, providing a comprehensive view of the population's understanding of hernias.

The socio-demographic profile of the study population, as summarized in Table 1, reveals a well-distributed sample across various age groups and other demographic categories. Participants ranged from 18 to over 50 years old, with 31.3% aged 18-30, 24.5% aged 31-40, 21.8% aged 41-50, and 23.0% over 50. Gender distribution was nearly equal, with 49.0% males and 51.0% females. In terms of marital status, 57.5% were married, 37.5% were single, and 5.0% fell into other categories. The majority of participants were Hindus (80.5%), followed by Muslims (10.0%), Sikhs (7.5%), and others (2.0%). Employment status showed that 45.0% were employed, 35.3% were unemployed, and 19.5% were students. Educational attainment varied, with 15.0% having education below high school, 25.5% completing high school, 36.3% holding a graduate degree, and 23.3% having postgraduate or higher education. This diverse socio-demographic profile ensures a broad perspective on the awareness levels within the community.

Table 1: Socio-Demographic Variables of the Study Population (N=400)

Table 2 highlights the participants' knowledge regarding the symptoms of hernias. A significant portion of the population had heard of hernias (80.0%) and knew that hernias can cause pain (76.3%). Additionally, 71.3% of participants were aware that hernias can cause a noticeable bulge, 67.5% knew that hernias can cause discomfort when lifting, and 65.0% recognized that hernias can cause nausea. These findings suggest a relatively high level of awareness regarding the common symptoms associated with hernias. However, there is still room for improvement, particularly in recognizing all symptoms consistently.

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

Table 3 presents the knowledge regarding the causes and risk factors of hernias. Participants' awareness that heavy lifting can cause hernias was relatively high (72.5%). Knowledge about other risk factors was also notable, with 68.8% aware that persistent coughing can cause hernias, 65.0% knowing that obesity is a risk factor, 63.8% understanding the role of congenital defects, and 60.0% aware that hernias are more common in males than females. These results highlight the need for increased education on the various risk factors associated with hernias to promote better prevention strategies.

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

Table 4 shows the participants' awareness of the preventive measures for hernias. Awareness that maintaining a healthy weight can help prevent hernias was moderate (58.8%), and 57.5% knew that avoiding heavy lifting can help in prevention. Additionally, 55.0% were aware that strengthening abdominal muscles can help prevent hernias, 52.5% recognized that treating chronic cough can prevent hernias, and 50.0% knew that eating a high-fiber diet can help prevent the condition. These findings indicate a need for improved public education on lifestyle modifications that can prevent hernias.

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

Table 5 details the participants' knowledge about the treatment and management of hernias. Awareness of surgical treatment for hernias was 55.0%, and 53.8% knew that untreated hernias can lead to complications. Additionally, 50.0% were aware that lifestyle changes can help manage hernias, 47.5% knew about the temporary relief provided by hernia belts, and 46.3% understood the importance of avoiding strenuous activities post-surgery. These findings suggest that while there is some awareness of treatment options, comprehensive knowledge about all available treatments is insufficient.

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

Table 6 categorizes the overall knowledge scores of the participants regarding hernias. A significant portion of the population demonstrated high knowledge levels, with 23.8% falling into the Very Good category (scores between 16-20) and 28.0% in the Good category (scores between 12-15). The Fair category (scores between 8-11) included 30.3% of respondents, while 18.0% had Poor knowledge (scores below 8). These results underscore the variability in knowledge levels within the community and highlight the areas where educational interventions are most needed.

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

The present study aimed to assess the awareness and knowledge of hernias among the general public in District Bilaspur, Himachal Pradesh. The findings provide a comprehensive understanding of the current knowledge levels and highlight significant gaps that need to be addressed through targeted educational interventions.

The socio-demographic data collected from the 400 participants revealed a well-distributed and diverse sample. The age distribution was well-spread, with participants ranging from 18 to over 50 years. Notably, 31.3% of the participants were aged 18-30 years, 24.5% were aged 31-40 years, 21.8% were aged 41-50 years, and 22.5% were over 50 years old. The nearly equal gender distribution (49.0% male and 51.0% female) ensures a comprehensive understanding of hernia awareness across both genders. Most participants were married (57.5%), reflecting the local demographic composition, and the majority practiced Hinduism (80.5%). Employment and educational status varied significantly, with 45.0% employed and 36.3% holding a graduate degree, ensuring the findings represent a wide spectrum of socio-economic backgrounds.

The knowledge of hernia symptoms among the participants was relatively high. As shown in Table 2, 80.0% had heard of hernias, and 76.3% knew that hernias can cause pain. Awareness of specific symptoms was also substantial, with 71.3% identifying a noticeable bulge, 67.5% recognizing discomfort when lifting, and 65.0% aware that hernias can cause nausea. These findings indicate that basic awareness of hernia symptoms is relatively good among the general public. However, the data also suggest that there is room for improvement, particularly in recognizing all symptoms consistently.

Table 3 highlights the participants' understanding of the causes and risk factors of hernias. While 72.5% knew that heavy lifting can cause hernias, awareness of other risk factors was moderate. Only 68.8% were aware that persistent coughing can cause hernias, 65.0% knew about the impact of obesity, 63.8% recognized the role of congenital defects, and 60.0% were aware that hernias are more common in males than females. These findings underscore the need for increased education on the various risk factors associated with hernias, as a comprehensive understanding of these factors is crucial for effective prevention and management.

The knowledge of hernia prevention, as shown in Table 4, was moderate. Awareness that maintaining a healthy weight can help prevent hernias was 58.8%, and 57.5% knew that avoiding heavy lifting can help in prevention. Additionally, 55.0% were aware that strengthening abdominal muscles can help prevent hernias, 52.5% recognized that treating chronic cough can prevent hernias, and 50.0% knew that eating a high-fiber diet can help prevent the condition. These findings indicate a need for improved public education on lifestyle modifications that can prevent hernias.

Table 5 details the knowledge about the treatment and management of hernias. Awareness of surgical treatment for hernias was 55.0%, and 53.8% knew that untreated hernias can lead to complications. Additionally, 50.0% were aware that lifestyle changes can help manage hernias, 47.5% knew about the temporary relief provided by hernia belts, and 46.3% understood the importance of avoiding strenuous activities post-surgery. These findings suggest that while there is some awareness of treatment options, comprehensive knowledge about all available treatments is insufficient.

The overall knowledge scores, categorized in Table 6, reveal significant variability in the participants' understanding of hernias. While 23.8% demonstrated very good knowledge (scores between 16-20) and 28.0% had good knowledge (scores between 12-15), a considerable portion (30.3%) had fair knowledge (scores between 8-11), and 18.0% had poor knowledge (scores below 8). These results highlight the disparities in knowledge levels within the community and indicate that a substantial number of individuals lack essential information about hernias.

Comparing these findings with similar studies conducted in other regions reveals a consistent pattern of knowledge gaps concerning hernias. Studies from various rural and semi-urban areas have shown that while there is a general awareness of hernias, detailed knowledge about symptoms, risk factors, prevention, and treatment remains limited. This consistent gap underscores the universal need for enhanced public health education and awareness programs.^7-10

The findings of this study underscore the critical need for targeted educational interventions to improve public awareness and knowledge of hernias in Bilaspur. Public health campaigns should focus on increasing awareness about the symptoms, causes, risk factors, preventive measures, and treatment options for hernias. Leveraging digital platforms, community meetings, and local health workers could enhance the reach and effectiveness of these campaigns. Educational programs should emphasize the importance of early diagnosis and treatment, the role of lifestyle changes in managing hernias, and the potential complications of untreated hernias.

In conclusion, this study provides valuable insights into the awareness and knowledge of hernias among the general public in Bilaspur, Himachal Pradesh. Despite a relatively high level of basic awareness, there is a critical need for comprehensive education on the condition's various aspects. The variability in knowledge levels underscores the importance of targeted educational interventions to improve public health literacy. By addressing these gaps through well-designed public health campaigns and educational programs, it is possible to promote early diagnosis, effective management, and prevention of hernias, ultimately enhancing health outcomes and quality of life for the affected individuals in the community. The study lays the groundwork for future interventions and highlights the necessity of continuous public health education in rural and semi-urban areas to ensure better health awareness and management of common conditions like hernias.

1. WebMD. Understanding Hernia - The Basics. Available from: https://www.webmd.com/digestive-disorders/understanding-hernia-basics

2. Cleveland Clinic. Hernia. Available from: https://my.clevelandclinic.org/health/diseases/15757-hernia

3. Narayana Health. Hernia. Available from: https://www.narayanahealth.org/diseases/hernia

4. Healthline. Hernia. Available from: https://www.healthline.com/health/hernia

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6. Iqbal MN, Akhter S, Irfan M. Prevalence of hernia in relation to various risk factors in Narowal, Pakistan. Sci Lett. 2015;3(1):29-32.

7. Yadav RN, Maharjan JS, Bajracharya J, Pradhan GBN, Shrestha S. Hernia among Patients Admitted to the Department of Surgery of a Tertiary Care Centre. JNMA J Nepal Med Assoc. 2023 Dec 1;61(268):911-914.

8. Dhiman S, Jhagta J, Thakur RS. Hernia Horizons: Mapping Public Awareness and Knowledge on Risk Factors, Preventive Measures, and Treatment Options in Himachal Pradesh. IAR Journal of Anaesthesiology and Critical Care. 2023 Nov;3(6):18-22.

9. Chaudhary A, Bhardwaj BB. A Cross Sectional Study to Investigate the Understanding and Attitudes Regarding Hernia among the Patients Attending Outpatient Department of Civil Hospital, Nurpur, Himachal Pradesh. IAR Journal of Anaesthesiology and Critical Care. 2023 May;3(3):21-26.

10. Jiménez DR, López-Cano M, Gonçalves VR, Tremolosa MV, Serra JS, Bravo-Salva A, Rodríguez JAP. Understanding patient-reported knowledge of hernia surgery: a quantitative study. Hernia. 2022 Jun;26(3):761-768