Skin cancer is a significant public health concern globally, with its incidence rising steadily over the years. In the unique context of District Kangra, Himachal Pradesh, the need for an in-depth understanding of the community's knowledge levels regarding skin cancer is paramount. As the second most common cancer in India, skin cancer poses a considerable health threat that demands attention and awareness on multiple fronts [1]. Recognizing this, the "Radiant Health Initiative" has been conceived to explore and assess the understanding of skin cancer among the residents of District Kangra.

Skin cancer encompasses a group of malignancies that originate in the skin cells. The two main types are non-melanoma (basal cell and squamous cell carcinoma) and melanoma. The World Health Organization reports a rising incidence of skin cancer worldwide, attributing it to factors such as increased ultraviolet (UV) radiation

exposure, changing lifestyles, and genetic predispositions [2]. UV radiation, particularly from the sun, is a well-established risk factor for skin cancer [3]. This is especially relevant in India, where the intensity of sunlight is high, contributing to a higher susceptibility to skin cancers.

In India, skin cancer has been steadily on the rise, constituting approximately 2-3% of all cancer cases [4]. A study conducted in Northern India emphasized the changing epidemiological trends of skin cancers, attributing them to lifestyle changes, increased UV exposure, and genetic factors [5]. However, despite this increasing prevalence, there remains a dearth of comprehensive studies evaluating the awareness and knowledge levels of communities regarding skin cancer, especially in specific regions such as Himachal Pradesh.

District Kangra, nestled in the scenic landscapes of Himachal Pradesh, presents a unique demographic and environmental setting. Understanding the specific knowledge gaps, risk perceptions, and preventive practices related to skin cancer in this community is crucial for designing targeted awareness campaigns and preventive interventions. The Radiant Health Initiative seeks to bridge these knowledge gaps by conducting a thorough assessment of the residents' understanding of skin cancer, focusing on risk factors, early signs, available screening methods, and preventive measures.

Objectives of the Study:

To evaluate the knowledge levels related to Skin cancer, including risk factors, early signs, available screening methods, and preventive measures, among the residents of District Kangra, Himachal Pradesh.

Research Methodology

• Research Approach – Descriptive 

• Research Design – Cross-sectional survey design

• Study area:  District Kangra, Himachal Pradesh

• Study duration – between August 2023 to October 2023

Study Population

The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra 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 Skin cancer, 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 Skin Cancer including its risk factors, early warning signs, available screening methods, and preventive measures etc. 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 

Demographic data survey instrument

The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

Questionnaire

The questionnaire contains 20 structured knowledge related questions regarding Skin Cancer including its risk factors, early warning signs, available screening methods, and preventive measures etc. 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 goal of the current study was to assess general public knowledge regarding Skin Cancer through a non-experimental descriptive survey. A total of 400 respondents took part in the study, with 123 (30.75%) coming from urban areas and 277 (69.25%) from rural areas. 

In the present study 27% (108) participants had very good knowledge (16-20 marks) towards skin Cancer, 35.5% (142) had good knowledge (12-15 marks), 24% (96) had fair knowledge (8-11 marks) and 13.5% (54) having poor knowledge (<8 marks).

Skin cancer, a global public health concern, is witnessing a steady increase in incidence worldwide. In the distinctive context of District Kangra, Himachal Pradesh, understanding the community's knowledge levels regarding skin cancer becomes imperative. As the second most common cancer in India, skin cancer poses a substantial health threat that necessitates comprehensive attention and awareness on multiple fronts (Gloster et al., 2015).

Table1: Knowledge regarding skin Cancer among study participants

  Table 2: Knowledge scores towards skin Cancer among study participants

 The "Radiant Health Initiative" was designed to explore and assess the understanding of skin cancer among the residents of District Kangra.

Our findings align with global trends where the incidence of skin cancer is on the rise [1]. The World Health Organization attributes this increase to factors such as heightened ultraviolet (UV) radiation exposure, changing lifestyles, and genetic predispositions [2]. Notably, UV radiation, particularly from the sun, remains a well-established risk factor for skin cancer [3]. In India, with its intense sunlight, the susceptibility to skin cancers is notably high.

Skin cancer in India constitutes approximately 2-3% of all cancer cases, with changing epidemiological trends linked to lifestyle changes, increased UV exposure, and genetic factors [4,5]. Despite this increasing prevalence, there is a notable dearth of comprehensive studies evaluating community awareness, particularly in regions such as Himachal Pradesh.

Nestled in the scenic landscapes of Himachal Pradesh, District Kangra presents a unique demographic and environmental setting. The knowledge gaps, risk perceptions, and preventive practices related to skin cancer in this community are crucial for designing targeted awareness campaigns and preventive interventions. The Radiant Health Initiative seeks to bridge these knowledge gaps by conducting a thorough assessment of the residents' understanding of skin cancer, focusing on risk factors, early signs, available screening methods, and preventive measures.

Comparing our findings with existing studies, our approach goes beyond assessing changing epidemiological trends, directly measuring community knowledge levels. A study in Southern India found low awareness about skin cancer, especially in rural areas [4]. In contrast, our study in District Kangra, encompassing both urban and rural participants, demonstrates a relatively higher overall awareness level. However, specific areas for improvement, such as knowledge about different types of skin cancer and available support resources, have been identified.

In Northern India, a study emphasized changing epidemiological trends in skin cancers, linking them to lifestyle changes and increased UV exposure [5]. Our study complements this by providing a more nuanced understanding of where awareness interventions can be targeted, directly addressing community knowledge.

The findings underscore the need for targeted public health interventions to bridge knowledge gaps in District Kangra. Education campaigns should focus on specific aspects like recognizing different types of skin cancer, understanding the significance of early detection, and increasing awareness of available support resources [6-9].

Limitations:

While valuable, this study has limitations. The online survey method may introduce bias, favoring participants with internet access. Additionally, the cross-sectional design provides a snapshot, limiting the establishment of causal relationships.

In conclusion, the “Radiant Health Initiative” has provided valuable insights into the awareness levels of skin cancer among the residents of District Kangra, Himachal Pradesh. The study, set against the backdrop of a rising global incidence of skin cancer, particularly in India, illuminates the unique dynamics of knowledge, risk perception, and preventive practices in this specific community. While the participants demonstrated commendable awareness in certain aspects, such as the nature of skin cancer and the benefits of sunscreen use, identified gaps in knowledge, especially regarding specific types of skin cancer and available support resources, indicate targeted areas for intervention. The findings underscore the need for community-specific educational campaigns to enhance awareness, dispel misconceptions, and promote preventive measures. This study contributes to the broader discourse on skin cancer awareness in India, emphasizing the importance of context-specific initiatives to address the unique needs of District Kangra’s residents.

1. Reference 1 Gloster, H. M., K. Neal, and B. Ragsdale. "Dermatology and cancer in individuals with skin of color." Journal of the American Academy of Dermatology, vol. 72, no. 5, 2015, pp. 867–882.

2. World Health Organization. "Ultraviolet radiation and the INTERSUN Programme." WHO, www.who.int/ uv/ faq/ uvhealtfac/en/. Accessed 21 Nov. 2023.

3. Kricker, A., et al. "Ambient UV, personal sun exposure and risk of multiple primary melanomas: a population-based study." European Journal of Cancer, vol. 51, no. 3, 2015, pp. 306–315.

4. Lakshmaiah, K. C., et al. "Dermatological malignancies: an Indian perspective." Indian Journal of Dermatology, vol. 64, no. 1, 2019, pp. 64–71.

5. Grover, S., et al. "Changing epidemiological trends of skin cancers in a rapidly growing center in North India: a 5-year study." Indian Journal of Dermatology, vol. 63, no. 5, 2018, pp. 419–423.

6. Rai, R., et al. "A cross-sectional study on knowledge and awareness of skin cancer in rural North India: a preliminary study." Journal of Cancer Research and Therapeutics, vol. 13, no. 2, 2017, pp. 286–290.

7. Khullar, G., and D. Pushkar. "Knowledge, attitude, and practices related to skin cancer among general practitioners in Northern India: a cross-sectional survey." Indian Dermatology Online Journal, vol. 11, no. 4, 2020, pp. 541–546.

8. Gupta, S., and P. Krishna. "Skin cancer awareness in India: challenges and perspectives." Indian Journal of Dermatology, vol. 61, no. 4, 2016, pp. 373–375.

9. Thomas, N. E., A. Kricker, and W. T. Waxweiler. "The association between occupational sun exposure and non-melanoma skin cancer: clinical and molecular evidence." The European Journal of Cancer, vol. 76, 2017, pp. 170–182.