Liver cancer, a formidable adversary to public health, continues to pose a significant global burden. Its prevalence has surged in recent decades, with an alarming increase in both incidence and mortality rates. Among the diverse landscapes of cancer epidemiology, understanding the local nuances becomes imperative for effective prevention and management strategies. In this context, District Kangra in Himachal Pradesh emerges as a critical focal point, where the intricate interplay of geographical, cultural, and lifestyle factors may shape the landscape of liver cancer [1-3].

Liver cancer, primarily hepatocellular carcinoma (HCC), is a complex malignancy often diagnosed at advanced stages, contributing to its dismal prognosis. The dynamic nature of risk factors, coupled with the silent progression of the disease, underscores the importance of community awareness, early detection, and preventive measures. While global efforts are underway to combat liver cancer, tailoring interventions to the specific needs of distinct regions is crucial for meaningful impact [4-6]. 

District Kangra, nestled in the picturesque state of Himachal Pradesh, exhibits a blend of traditional lifestyles and emerging socio-economic dynamics. The unique cultural practices, dietary patterns, and prevalent health beliefs may influence the community's perception of liver cancer and its associated factors. Additionally, the geographical diversity and varying accessibility to healthcare resources within the district necessitate a localized approach to address the specific challenge posed by liver cancer [7-9].

Current literature highlights the significance of community awareness in combating liver cancer, emphasizing the role of education in promoting early detection and adopting preventive measures. However, there is a noticeable dearth of studies focusing on the awareness levels within specific regions, hindering the formulation of tailored public health initiatives. This study, therefore, fills a crucial gap by providing insights into the knowledge landscape of liver cancer in District Kangra, thus contributing to the broader understanding of regional cancer epidemiology [10-12].

The findings of this research are anticipated to have several implications for public health policy and practice. By unraveling the existing knowledge gaps and misconceptions surrounding liver cancer, the study will pave the way for targeted educational campaigns. These initiatives can empower the community with the necessary information to make informed choices regarding lifestyle modifications, early detection, and engagement with available healthcare services.

Objectives of the Study

To evaluate the knowledge levels related to Liver 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 Liver 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 about Liver 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 about Liver 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 were maintained.

Table 1 The goal of the current study was to assess general public knowledge regarding Liver Cancer through a non-experimental descriptive survey. A total of 400 respondents took part in the study, with 111 (27.75%) coming from urban    areas    and    289    (72.25%)    from    rural    areas Table 2 In the present study 29.5% (118) participants had very good knowledge (16-20 marks) towards Liver Cancer, 36.75% (147) had good knowledge (12-15 marks), 21.5% (86) had fair knowledge (8-11 marks) and 12.25% (49) having poor knowledge (<8 marks).

The present study provides a comprehensive assessment of the knowledge levels regarding liver cancer among the residents of District Kangra, Himachal Pradesh. The findings underscore the need for targeted interventions and educational campaigns to address the existing gaps in understanding this significant public health concern. Comparisons with existing literature, including studies conducted in India, reveal valuable insights into the specific challenges and opportunities for liver cancer awareness in this unique geographical and cultural context.

The study revealed varying levels of knowledge among the participants, with 29.5% demonstrating very good knowledge, 36.75% having good knowledge, 21.5% with fair knowledge, and 12.25% exhibiting poor knowledge. These findings align with studies conducted in other regions, indicating a need for focused educational initiatives across diverse populations. Notably, demographic factors such as age, education, and rural-urban residence may influence awareness levels, highlighting the importance of tailoring interventions to specific subgroups within the community [13-16].

Table-1: Knowledge regarding Liver Cancer among study participants

Table-2: Knowledge scores towards Liver Cancer among study participants

Participants exhibited moderate awareness of risk factors and preventive measures, with 65.25% identifying known risk factors and 54.5% recognizing preventive measures. This echoes global trends where awareness of risk factors remains a challenge. Notably, initiatives promoting lifestyle modifications and vaccination programs could bridge these knowledge gaps, emphasizing the role of community-level interventions [17,18].

A significant gap in awareness emerged concerning screening methods, with only 25.5% of participants familiar with available screening options. This finding aligns with studies indicating low awareness of screening programs for liver cancer, emphasizing the need for targeted campaigns to promote early detection and routine screenings [19,20].

Participants exhibited limited awareness (25.5%) regarding the connection between viral hepatitis and liver cancer. This underscores the importance of integrated health campaigns, as studies have shown that hepatitis is a significant contributor to liver cancer incidence, especially in regions with a high prevalence of viral hepatitis [21,22].

The study participants demonstrated awareness (54.25%) of social stigma associated with liver diseases, emphasizing the socio-cultural dimensions of health awareness. Additionally, a noteworthy percentage (55.25%) recognized complementary and alternative therapies for liver health, indicating a potential avenue for holistic health promotion [23,24].

Media coverage emerged as a potential influencer, with 58.25% encountering information about liver health through various channels. This underscores the role of media in disseminating health information and its potential impact on public awareness. Furthermore, participants acknowledged the significance of educational programs (61.5%) in enhancing liver cancer awareness, emphasizing the need for multifaceted interventions involving both traditional and digital platforms [18-22].

The study participants expressed a moderate awareness (59.25%) regarding the role of government and non-governmental organizations in promoting awareness about liver cancer. Aligning with this finding, studies emphasize 

the pivotal role of governmental and non-profit organizations in implementing targeted health campaigns [21-24].

Strengths and Limitations

The study's strengths lie in its robust sample size and the inclusion of diverse demographic groups, providing a nuanced understanding of knowledge variations. However, the reliance on an online survey may introduce selection bias, and the cross-sectional design limits the assessment of temporal trends.

In unraveling the intricacies of liver cancer awareness in District Kangra, Himachal Pradesh, this study illuminates critical knowledge gaps and opportunities for targeted public health interventions. The varying levels of awareness among participants underscore the need for context-specific educational campaigns, acknowledging the influence of demographic factors. While the study reveals moderate understanding of risk factors and preventive measures, a substantial gap persists in knowledge concerning screening methods. Importantly, the findings emphasize the imperative of addressing viral hepatitis awareness, given its significant contribution to liver cancer incidence. Social and cultural dimensions, as evidenced by the recognition of social stigma and alternative therapies, further emphasize the importance of holistic health promotion. The study's insights into media influence and the role of educational programs provide a roadmap for enhancing community awareness. As we navigate these findings, the study not only contributes to the understanding of liver cancer epidemiology in District Kangra but also offers valuable lessons for crafting targeted public health initiatives that resonate with the unique socio-cultural fabric of the region, contributing to the global endeavor to alleviate the burden of liver cancer.

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