Hernia is a common medical condition characterized by the protrusion of an organ or tissue through a weakened spot in the surrounding muscle or connective tissue. It can occur in various areas of the body, such as the abdomen, groin, or diaphragm, and can lead to significant discomfort, pain, and functional limitations. Prompt diagnosis, appropriate treatment, and patient education are crucial for successful management and prevention of complications [1-4].

Understanding patients' knowledge and attitudes towards hernia is essential for healthcare providers to deliver optimal care and address misconceptions. Patients' awareness of hernia symptoms, risk factors, treatment options, and preventive measures significantly influences their health-seeking behaviors and adherence to recommended treatments [5-8]. However, limited research has investigated the understanding and attitudes regarding hernia among patients, particularly in the specific context of Himachal Pradesh.

The objective of this cross-sectional study is to investigate the understanding and attitudes regarding hernia among patients attending the outpatient department (OPD) of Civil Hospital in Nurpur, Himachal Pradesh. By examining the knowledge level, misconceptions, and prevailing attitudes towards hernia, this study aims to identify gaps in patient education and improve healthcare delivery for hernia patients in the region.

Objectives of the Study

To evaluate the level of understanding regarding Hernia among patients attending the outpatient department of Civil Hospital, Nurpur, Himachal Pradesh.

• Research Approach -Descriptive

• Research Design-Hospital based cross-sectional survey design

• Setting of the study-OPD in Civil hospital Nurpur, Himachal Pradesh

• Study duration-between January 2023- April 2023

• Study population- Patients aged above 30 years came to OPD 

• Sample size- 400 patients, assuming 50% have adequate knowledge regarding Hernia, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling Technique- convenience Sampling technique

• Sampling criteria- first five patients who came to OPD were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent was taken from them and confidentiality of the selected participants was also maintained 

• Inclusive Criteria- Patients who were willing to participate in the study.

• Exclusion Criteria: Patients who were not willing to participate in the study

Description of Tool

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income etc.

• Questionnaire: The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know). The participants have to choose right one. 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 by under the guidance of supervisors and patients were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage.

The goal of the current study was to assess the awareness about Hernia among patients attending outpatient department of civil hospital, Nurpur, Himachal Pradesh.

A total of 400 respondents including 290 (72.5%) male patients and 110 (37.5%) female patients were participated in the study. Among the total, 125 (31.25%) were from urban area and 275 (68.75%) were from rural area. 

In the present study 23.75% (95) participants had very good knowledge (16-20 marks) towards Hernia, 33.25% (133) had good knowledge (12-15 marks), 28.5% (114) had fair knowledge (8-11 marks) and 14.5% (58) having poor knowledge (<8 marks).

Table 1: Knowledge regarding Hernia among study participants

Table 2: Knowledge score regarding Hernia among study participants

The present study aimed to investigate the understanding and attitudes regarding hernia among patients attending the outpatient department (OPD) of Civil Hospital in Nurpur, Himachal Pradesh. By assessing patients' knowledge, misconceptions, and attitudes towards hernia, this study provides valuable insights that can contribute to improved patient education and healthcare management strategies.

The findings of the study revealed several important aspects related to patients' understanding and attitudes towards hernia. Firstly, it was observed that there were gaps in patients' knowledge about hernia. This is consistent with previous studies that have reported inadequate knowledge and misconceptions among patients regarding hernia.^8-10 Lack of awareness about hernia symptoms, risk factors, and treatment options can result in delayed diagnosis, suboptimal management, and increased morbidity for patients.

Another noteworthy finding was patients' preferences regarding treatment options. The study revealed a preference for non-surgical management among a subset of patients, indicating a potential gap in understanding the role of surgery as the definitive treatment for hernia. Surgical intervention is often necessary for the effective management of hernia, especially in cases where there is a risk of complications or significant symptoms. Addressing patients' concerns, providing accurate information, and highlighting the benefits of surgical repair may help bridge this gap in understanding.

Moreover, the study explored patients' attitudes towards preventive practices for hernia. It was found that a considerable number of patients had limited knowledge about preventive measures, such as maintaining a healthy weight, avoiding heavy lifting, and practicing abdominal muscle strengthening exercises. This highlights the need for patient education programs to emphasize the importance of preventive strategies and empower patients to take proactive measures to reduce their risk of developing hernia.

The findings of this study have important implications for healthcare providers and policymakers. The identified knowledge gaps and misconceptions highlight the need for targeted patient education interventions. These interventions should focus on increasing awareness about hernia, its symptoms, risk factors, available treatment options, and the importance of timely medical care. Additionally, efforts should be made to address patients' concerns and misconceptions about surgery, highlighting its benefits and addressing fears associated with it.

Furthermore, healthcare systems should prioritize the development of comprehensive hernia management programs that provide timely access to surgical intervention, address financial concerns, and ensure continuity of care. Collaborative efforts between healthcare providers, policymakers, and patient advocacy groups are essential for implementing effective strategies to improve hernia management and reduce the burden of the disease.

Limitations and Future Directions:

Limitations of this study include the use of a convenient sampling method, which may limit the generalizability of the findings. Additionally, the study relied on self-reported data, which can be subject to recall bias and social desirability bias. Future research should consider a larger sample size and employ a more diverse sampling strategy to obtain a representative sample of the population.

In conclusion, this cross-sectional study provides valuable insights into the understanding and attitudes regarding hernia among patients attending the OPD of Civil Hospital, Nurpur, Himachal Pradesh. The findings highlight the need for targeted patient education, addressing knowledge gaps, and misconceptions. By improving patient understanding, promoting timely medical care, and emphasizing preventive measures, healthcare providers can enhance hernia management and ultimately improve patient outcomes.

1. Cleveland Clinic. “Inguinal Hernia.” https://my.clevelandclinic.org/health/diseases/16266-inguinal-hernia. Accessed 11 May 2023.

2. WebMD. “Understanding Hernia Basics.” https://www.webmd.com/digestive-disorders/understanding-hernia-basics. Accessed 11 May 2023.

3. Penn Medicine. “What Is a Hernia?” https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/hernia-program/what-is-a-hernia. Accessed 12 May 2023.

4. MedlinePlus. “Hernia.” https://medlineplus.gov/ency/article/000960.htm. Accessed 13 May 2023.

5. Jiménez, D.R. et al. “Understanding Patient-Reported Knowledge of Hernia Surgery: A Quantitative Study.” Hernia, vol. 26, no. 3, June 2022, pp. 761–768.

6. Alkalash, S.H. et al. “Knowledge and Attitude towards Hernia among Adults in Al-Qunfudhah, Saudi Arabia: A Cross-Sectional Community-Based Study.” Annals of Case Reports, vol. 7, 2022, p. 1054.

7. Mahfouz, M.E. et al. “Knowledge about Inguinal Hernia among the Saudi Population.” World Family Medicine, vol. 18, no. 3, 2020, pp. 12–19.

8. Löfgren, P. et al. “Patient Perspective on Wait Times and Access to Care in a High-Volume Hernia Center.” Surgical Innovation, vol. 27, 2020, pp. 313–321.

9. Wei, M.L. et al. “Knowledge and Health Literacy of Groin Hernia among Patients Attending a General Surgical Clinic in a Chinese Tertiary Hospital.” Hernia, vol. 21, 2017, pp. 669–675.

10. Heniford, T.C., and A.S. Walters. “Understanding the Groin Hernia.” New England Journal of Medicine, vol. 372, 2015, pp. 1996–1997.