Colorectal cancer, a significant global health concern, ranks as the third most common cancer worldwide and the second leading cause of cancer-related mortality. This malignancy arises in the colon or rectum, components of the gastrointestinal tract and its impact is profound due to its prevalence, severity and associated mortality rates. Despite advancements in medical science and increasing awareness campaigns, the burden of colorectal cancer remains substantial, with a considerable proportion of cases diagnosed at advanced stages, leading to reduced treatment efficacy and poorer prognoses [1-3].

In India, like many other countries, colorectal cancer poses a significant public health challenge. With the rapid demographic transition and changing lifestyle patterns, there is a growing need to assess the level of awareness and knowledge about colorectal cancer among the general population. Himachal Pradesh, a state nestled in the northern part of India, reflects this epidemiological transition, where urbanization and adoption of Western lifestyles have led to an increased prevalence of non-communicable diseases, including colorectal cancer [4-6].

The District Shimla, as the capital and most populous district of Himachal Pradesh, serves as an ideal microcosm for examining the awareness and knowledge of colorectal cancer within the general public. Evaluating the awareness levels in this region can provide valuable insights into the effectiveness of existing awareness campaigns, identify gaps in knowledge and guide the development of targeted interventions for enhancing early detection and prevention efforts.

Objectives of the Study

The primary objective of this study is to evaluate the level of awareness and knowledge regarding Colorectal Cancer among the general public of District Shimla, Himachal Pradesh.

Research Approach

The present study adopts a descriptive research approach, aiming to comprehensively assess the knowledge levels of the general public in District Shimla, Himachal Pradesh, regarding Colorectal cancer.

Research Design

A cross-sectional survey design was employed to collect data at a specific point in time, providing insights into the knowledge levels of participants.

Study Area

The research was conducted exclusively within District Shimla, Himachal Pradesh, ensuring the relevance and contextuality of the study findings.

Study Duration

The study was conducted over a period extending from April 2023 to July 2023, allowing for an adequate collection of data.

Study Population

The study targeted all adults aged 18 years and above, who had been residing within District Shimla, Himachal Pradesh, for a minimum duration of 12 months.

Sample Size

To ensure robust results, a sample size of 400 adults was determined based on the assumption that 50% of participants possessed adequate knowledge about Colorectal cancer. The sample size estimation considered a 5% absolute error, a 95% confidence level and a 5% non-response rate.

Study Tool

A meticulously designed structured Google Form questionnaire served as the primary data collection instrument. The questionnaire underwent pre-testing among a small group of individuals to ensure its clarity, comprehensibility and suitability for the study's objectives.

Description of Tool

The questionnaire comprised two sections:

• Demographic Data Survey Instrument: This section collected key background information such as participants' age, gender, marital status, religion, employment status and educational background

• Questionnaire: This section encompassed 20 structured questions tailored to assess participants' knowledge of Colorectal cancer. Correct answers were assigned one mark, while incorrect responses received zero marks. The scoring ranged from a minimum of zero to a maximum of 20. Knowledge levels were subsequently categorized into four tiers: >80% (16-20) - very good, 60-79% (12-15) - good, 41-59% (8-11) - fair and <40% (<8) – poor

Validity of Tool

The questionnaire's accuracy and appropriateness were meticulously validated by domain experts, ensuring its reliability as a robust instrument for data collection.

Data Collection

Supervised data collection was executed with vigilance. The Google Form questionnaire was strategically disseminated through diverse online platforms, including emails, social media groups such as WhatsApp, Facebook, Instagram and LinkedIn. Both rural and urban areas of District Shimla were included in the data collection process, ensuring comprehensive coverage. The process was concluded upon obtaining 400 valid responses.

Data Analysis

Collected data were meticulously entered into a Microsoft Excel spreadsheet and subjected to thorough error checks. Epi Info V7 software was employed for data analysis, wherein appropriate statistical methods such as frequencies and percentages were applied.

Ethical Considerations

Stringent adherence to ethical guidelines ensured the protection of participants' privacy and confidentiality throughout the research journey, affirming their trust and safeguarding their personal information.

The goal of the current study was to assess general public knowledge regarding Colorectal Cancer through a non-experimental descriptive survey. A total of 400 respondents took part in the study, with 152 (38%) coming from urban areas and 248 (62%) from rural areas (Table 1).

In the present study 24.5% (98) participants had very good knowledge (16-20 marks) towards Colorectal Cancer, 28.75% (115) had good knowledge (12-15 marks), 30.75% (123) had fair knowledge (8-11 marks) and 16% (64) having poor knowledge (<8 marks) (Table 2).

The findings of this study shed light on the level of awareness and knowledge regarding colorectal cancer among the general public of District Shimla, Himachal Pradesh. The study's objectives were to assess the awareness levels, identify gaps in knowledge and provide insights into the effectiveness of existing awareness campaigns.

Table 1: Knowledge Regarding Colorectal Cancer Among Study Participants

Table 2: Knowledge Scores Towards Colorectal Cancer Among Study Participants

The study revealed that while a substantial proportion of participants had heard about colorectal cancer (58.25%), the understanding of the term and its implications varied. This indicates that there is a need for more comprehensive awareness campaigns that not only introduce the concept but also provide detailed information about the disease.

A notable percentage of participants correctly identified where colorectal cancer occurs in the body 55% and recognized the importance of early detection for better outcomes 55.5%. However, there were gaps in knowledge regarding risk factors, lifestyle contributions and screening methods. Only 36.25% were able to name some risk factors and merely 31.75% were familiar with screening methods. These findings suggest that efforts to educate the public about the risk factors associated with colorectal cancer need to be strengthened, along with increasing awareness about available screening options.

Furthermore, while a significant number of participants were aware of common symptoms and signs 54.5% and the role of genetics in development 49.5%, a relatively lower percentage understood treatment options 35.5% and the specifics of surgery, chemotherapy and radiation therapy 32%. This indicates a need for more comprehensive education about the different aspects of colorectal cancer, including treatment modalities and their potential impacts.

Comparing the findings of this study with similar research conducted in other regions can provide valuable insights into the effectiveness of awareness campaigns and the level of knowledge across different populations. In a study conducted by Abdul Kareem et al. [7], in an urban area of India, the authors reported that only 37.4% of participants had good knowledge regarding colorectal cancer. This supports the current study's observation that knowledge levels remain suboptimal, even in urban settings.

In contrast, Alkatheri et al. [8], conducted a study in Saudi Arabia and found that 83.3% of participants correctly identified colorectal cancer as a disease of the digestive system. While this percentage is higher than the current study's findings, it is important to consider cultural and regional differences that might influence awareness levels.

The findings of this study highlight the urgent need for targeted interventions to enhance knowledge and awareness about colorectal cancer in District Shimla. Efforts should focus on improving understanding of risk factors, symptoms, screening methods and treatment options. Awareness campaigns should be tailored to address specific gaps identified in this study, ensuring that information is accessible, accurate and culturally sensitive.

Collaboration with healthcare providers, community leaders and local organizations can facilitate the dissemination of accurate information and debunk any prevalent misconceptions or myths. Moreover, leveraging technology and social media platforms, as demonstrated in the data collection process, can be a powerful tool for raising awareness and educating the population.

Limitations

This study is not without limitations. The survey-based approach might introduce response bias, as participants might provide socially desirable answers or not fully disclose their level of knowledge. Additionally, the study's cross-sectional design provides a snapshot of knowledge at a specific time, without accounting for potential changes or trends over time.

The study findings emphasize the need for targeted awareness campaigns to bridge the gaps in knowledge regarding colorectal cancer in District Shimla, Himachal Pradesh. The relatively low levels of awareness about risk factors, screening methods and treatment options highlight areas that require immediate attention. By addressing these gaps and misconceptions, healthcare providers, policymakers and community leaders can work together to reduce the burden of colorectal cancer and improve outcomes in this region.

1. Bray, F. et al. "Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries." CA: A Cancer Journal for Clinicians, vol. 68, no. 6, November 2018, pp. 394–424.

2. Arnold, M. et al. "Global patterns and trends in colorectal cancer incidence and mortality." Gut, vol. 66, no. 4, January 2017, pp. 683–691.

3. Ferlay, J. et al. "Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods." International Journal of Cancer, vol. 144, no. 8, August 2019, pp. 1941–1953.

4. Ministry of Health and Family Welfare. National Cancer Control Programme. Government of India, https://www.mohfw.gov.in/. Accessed 15 July 2023.

5. World Health Organization. Cancer. https://www.who.int/health-topics/cancer#tab=tab_1. Accessed 15 July 2023.

6. Sharma, R. et al. "Urbanisation, lifestyle changes and the incidence of colorectal cancer in Himachal Pradesh, India." The Open Colorectal Cancer Journal, vol. 4, no. 1, June 2011, pp. 54–59.

7. Abdul Kareem, A.A. et al. "Knowledge, attitude and practice of colorectal cancer screening among the general population in northern Saudi Arabia." Saudi Journal of Gastroenterology, vol. 25, no. 5, 2019, pp. 317–323.

8. Alkatheri, A.M. et al. "Knowledge and awareness of colorectal cancer among undergraduate students in king Abdulaziz university, Jeddah, Saudi Arabia: A Survey-Based Study." Asian Pacific Journal of Cancer Prevention, vol. 16, no. 18, 2015, pp. 8191–8196.