Background: Pelvic Inflammatory Disease (PID) remains a significant yet underrecognized reproductive health issue, particularly in rural and semi-urban areas of India. Caused primarily by untreated sexually transmitted infections (STIs), PID can lead to chronic pelvic pain, ectopic pregnancy, infertility, and, in severe cases, surgical interventions. This study aimed to assess public awareness of PID and its surgical implications among adults in Kangra, Himachal Pradesh. Materials and Methods: A descriptive, cross-sectional study was conducted over three months (October–December 2024) using a structured Google Form questionnaire. The survey was disseminated through local online platforms and social media, targeting adults aged 18 years and above residing in Kangra. The questionnaire comprised socio-demographic details, 20 knowledge-based questions on PID and its surgical relevance, and items assessing attitudes and perceptions. A total of 400 valid responses were analyzed using SPSS v26.0, with knowledge scores categorized into four levels: very good, good, fair, and poor. Results: Among 400 participants, 76.8% were female and 56.3% resided in rural areas. Awareness levels were generally high: 75.3% identified PID correctly, 71.0% recognized STIs as a primary cause, and 71.8% understood its link to infertility. However, only 67.0% were aware that surgery is reserved for severe cases, and 65.3% knew that laparoscopy may be performed. While 79.8% expressed willingness to seek care if symptomatic, 65.8% acknowledged the presence of community stigma. Overall, 38.5% of participants demonstrated “Very Good” knowledge, 41.3% “Good,” 14.8% “Fair,” and 5.5% “Poor.” Conclusion: Public awareness of PID in Kangra is encouraging but uneven, with critical gaps in understanding its surgical implications and preventive strategies. Cultural stigma and misconceptions persist, especially in rural and low-education subgroups. Community-driven, culturally sensitive education and integration of PID screening into routine care are essential to improving reproductive health outcomes and reducing the burden of delayed or invasive interventions.
Pelvic Inflammatory Disease (PID) is a significant yet often overlooked public health concern affecting women’s reproductive health, particularly in low- and middle-income countries. Characterized by inflammation of the upper genital tract—including the uterus, fallopian tubes, and ovaries—PID is most commonly caused by untreated sexually transmitted infections (STIs), such as Chlamydia trachomatis and Neisseria gonorrhoeae. If left undiagnosed or inadequately treated, PID can result in serious long-term consequences such as chronic pelvic pain, ectopic pregnancy, and infertility. Despite its impact, awareness and timely recognition of PID remain alarmingly low in many parts of India, especially in rural regions where access to reproductive health education and gynecological services is limited [1-3].
In conservative settings like Kangra district in Himachal Pradesh, socio-cultural taboos, limited STI screening, and the stigma surrounding reproductive tract infections contribute to a lack of open discussion and delay in care-seeking behavior. Women may misinterpret PID symptoms—such as lower abdominal pain, abnormal discharge, and painful intercourse—as routine menstrual discomfort or general weakness, failing to seek appropriate medical intervention. Furthermore, the potential need for surgical management in advanced or recurrent cases, for surgical management in advanced or recurrent cases, including abscess drainage or even hysterectomy, is rarely discussed, leading to unpreparedness and fear when such interventions become necessary [4-6].
As PID remains largely preventable and treatable with early diagnosis and antibiotic therapy, increasing public awareness is critical. Educating communities about its causes, symptoms, risk factors, and possible surgical outcomes can empower women to make informed decisions and seek timely care. This is especially important in regions like Kangra, where traditional beliefs and limited access to specialized gynecological services may hinder effective prevention and management [7,8].
This study aims to assess the level of awareness, perceptions, and attitudes regarding Pelvic Inflammatory Disease and its potential surgical implications among adults in Kangra. By identifying knowledge gaps, barriers to care, and informational needs, the research seeks to inform culturally sensitive educational strategies and strengthen community-based reproductive health programs in underserved areas.
Study Design
This research utilized a descriptive, cross-sectional study design to assess public awareness and perceptions related to Pelvic Inflammatory Disease (PID) and its surgical implications among adults in Kangra district, Himachal Pradesh. The cross-sectional format allowed for data collection at a single point in time, offering a snapshot of existing knowledge levels, attitudes, and behavioral patterns within the community.
Study Area and Population
The study was conducted in Kangra, a district located in the northwestern Indian state of Himachal Pradesh. Known for its predominantly rural population interspersed with semi-urban settlements, Kangra presents a relevant context for exploring reproductive health literacy in underserved settings. The target population comprised adults aged 18 years and above, including both females and males to capture broader community insights into PID awareness. Healthcare professionals and those with specialized training in gynecology or STI management were excluded to ensure that responses reflected general community understanding.
Study Duration
Data collection was carried out over a three-month period from October to December 2024.
Sample Size and Sampling Technique
A total of 400 respondents were included in the study. The sample size was determined using a 95% confidence interval, 5% margin of error, and an estimated 50% prevalence of PID awareness, with an additional buffer to accommodate incomplete submissions. A purposive-convenience sampling technique was employed to ensure representation across age groups, education levels, and residential backgrounds. Participants were reached through online platforms, including local community WhatsApp groups and social media networks.
Inclusion and Exclusion Criteria
Inclusion Criteria
Adults aged 18 years and above
Permanent residents of Kangra district
Able to read and respond in Hindi or English
Provided informed digital consent
Exclusion Criteria
Individuals with formal medical or paramedical training in gynecology or STI care
Incomplete or duplicate Google Form submissions
Respondents with cognitive or communication difficulties
Data Collection Tool
Data were collected using a structured, pre-tested questionnaire hosted on Google Forms. The questionnaire was developed in both Hindi and English, and reviewed by public health experts and gynecologists for relevance and clarity. It consisted of three sections.
Socio-Demographic Information: Including age, gender, education, marital status, occupation, and residence (urban/rural).
Knowledge Assessment: Multiple-choice and true/false questions related to PID causes, symptoms, risk factors, diagnosis, complications, and treatment—including awareness of possible surgical interventions.
Attitudes and Perceptions: Questions assessing beliefs, stigma, barriers to care, and willingness to seek treatment, including surgical options when necessary.
The tool was piloted on a small sample of 30 individuals prior to full deployment to ensure clarity and user-friendliness.
Scoring and Classification
Each correct answer in the knowledge section was awarded one point. The total score was converted to a percentage and classified into four categories:
Very Good Knowledge: ≥80%
Good Knowledge: 60–79%
Fair Knowledge: 41–59%
Poor Knowledge: <40%
Perception and attitude responses were interpreted using frequency distribution and thematic analysis.
Data Analysis
Data from Google Forms were exported to Microsoft Excel and analyzed using IBM SPSS version 26.0. Descriptive statistics were used to summarize demographic data and awareness levels.
Ethical Considerations
Informed consent was embedded at the beginning of the Google Form, and participation was entirely voluntary. Anonymity and confidentiality of all responses were strictly maintained. Participants were informed of their right to exit the form at any time without consequence.
Table 1: Socio-Demographic Characteristics of Participants (Kangra)
Variable | Category | Frequency (n) | Percentage |
Age Group (Years) | 18–25 | 85 | 21.3% |
26–35 | 139 | 34.8% | |
36–45 | 118 | 29.5% | |
46 and above | 58 | 14.5% | |
Gender | Female | 307 | 76.8% |
Male | 93 | 23.3% | |
Education Level | No formal education | 18 | 4.5% |
Primary school | 54 | 13.5% | |
Secondary school | 126 | 31.5% | |
Undergraduate degree | 147 | 36.8% | |
Postgraduate degree | 55 | 13.8% | |
Occupation | Homemaker | 103 | 25.8% |
Office Worker | 90 | 22.5% | |
Teacher | 61 | 15.3% | |
Healthcare Professional | 49 | 12.3% | |
Student | 56 | 14.0% | |
Other | 41 | 10.3% | |
Residential Setting | Urban | 175 | 43.8% |
Rural | 225 | 56.3% |
The study surveyed 400 participants from Kangra district, offering a broad socio-demographic representation. A majority of respondents (34.8%) were between 26–35 years, followed by 29.5% in the 36–45 age group and 21.3% aged 18–25, highlighting a primarily reproductive-aged population. Female participants made up 76.8% of the sample, while 23.3% were male, ensuring gender-diverse perspectives on reproductive health. Educational attainment was relatively high, with 36.8% having undergraduate degrees, 31.5% secondary education, and 13.8% postgraduate degrees; only 4.5% reported having no formal education. Homemakers (25.8%) and office workers (22.5%) represented the most common occupational categories, followed by teachers (15.3%), healthcare professionals (12.3%), and students (14.0%). Rural residents constituted 56.3% of the sample, ensuring significant input from underserved areas, while 43.8% were from urban settings.
The knowledge assessment revealed encouraging but varied levels of awareness regarding PID and its surgical implications. The majority correctly identified PID as an infection of the reproductive organs (75.3%) and understood its common cause to be sexually transmitted infections (71.0%). Knowledge of key complications such as infertility (71.8%) and ectopic pregnancy (69.5%) was moderate, as was understanding of symptoms like lower abdominal pain (78.0%) and asymptomatic cases (69.8%). While 79.3% recognized the importance of early treatment, only 67.0% correctly identified when surgery is needed, and 65.3% knew that laparoscopy may be performed in severe cases. Most participants were aware that antibiotics can treat PID (73.8%), but misconceptions persisted—only 67.5% understood the risks of self-medication. Encouragingly, 80.5% supported routine PID screening, and 79.8% reported willingness to seek medical care if symptoms occurred. However, stigma remained a concern, with 65.8% acknowledging its presence in their communities, highlighting the need for public education and destigmatization efforts.
Based on their quiz performance, knowledge scores were classified into four levels. A combined 79.8% of respondents demonstrated satisfactory awareness, with 38.5% achieving “Very Good” scores (≥80%) and 41.3% categorized under “Good” (60–79%). However, 14.8% of respondents scored in the “Fair” range (41–59%), and 5.5% had “Poor” knowledge (<40%), indicating persistent gaps among certain subgroups. These results underscore the importance of targeted reproductive health education in Kangra, particularly for individuals with limited formal education or those residing in rural areas. The findings present an opportunity for health educators to address misinformation, emphasize preventive care, and normalize timely medical intervention for PID and related complications.
This cross-sectional study conducted in Kangra district provides valuable insights into the current levels of public knowledge, attitudes, and awareness regarding Pelvic Inflammatory Disease (PID) and its potential surgical implications. PID, though preventable and treatable in most cases, continues to contribute significantly to reproductive morbidity among women, particularly in underserved areas where socio-cultural taboos, low health literacy, and limited access to gynecological care obstruct timely diagnosis and intervention. The findings of this study reveal both encouraging levels of baseline awareness and critical gaps that warrant targeted educational and public health interventions.
The socio-demographic profile of respondents aligns closely with the population most at risk for PID-related complications. A large proportion (64.3%) of participants were aged between 26 and 45 years, an age group that coincides with peak reproductive activity and heightened vulnerability to sexually transmitted infections (STIs)—the primary etiological factor for PID. The predominance of female participants (76.8%) reflects the direct relevance of the topic to women’s health, although the inclusion of male respondents (23.3%) is notable and essential, given that male partners play a pivotal role in the transmission of STIs and often influence women’s health-seeking behavior in patriarchal societies. The relatively high level of educational attainment—with 36.8% of respondents holding undergraduate degrees and 13.8% possessing postgraduate degrees—may partially explain the overall good knowledge levels observed in the survey. Nevertheless, the 18% of participants with only primary or no formal education are particularly at risk of misinformation and delayed care, highlighting the need for inclusive and simplified health education strategies.
Knowledge levels regarding PID were encouraging but inconsistent across domains. A majority (75.3%) correctly identified PID as an infection of the female reproductive organs, and 71.0% understood STIs as the most common cause. These findings suggest that awareness campaigns, health curricula, and digital media may be playing a positive role in disseminating foundational information. However, the deeper clinical nuances of PID remain inadequately understood. For instance, only 67.0% of participants recognized that surgical intervention is typically reserved for advanced cases involving abscesses or extensive damage. Moreover, just 65.3% were aware that laparoscopy—a minimally invasive surgical technique—is commonly used in complicated PID cases. This suggests that while many understand the disease at a basic level, there is insufficient awareness about disease progression, treatment escalation, and the circumstances under which surgery becomes necessary.
Table 2: Public Knowledge and Awareness of Pelvic Inflammatory Disease (PID) and Surgical Implications
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What is Pelvic Inflammatory Disease (PID)? | a) Urinary tract infection, b) Infection of female reproductive organs, c) Vaginal itching, d) Hormonal disorder | 301 | 75.3 |
2 | What is a common cause of PID? | a) Stress, b) Sexually transmitted infections (STIs), c) Poor diet, d) Diabetes | 284 | 71.0 |
3 | Can PID lead to infertility? | a) No, b) Yes, c) Only if pregnant, d) Only post-menopause | 287 | 71.8 |
4 | Is PID contagious through casual contact? | a) No, b) Yes, c) Only with blood, d) Only in teens | 276 | 69.0 |
5 | What is a common symptom of PID? | a) Frequent urination, b) Headache, c) Lower abdominal pain, d) Hair loss | 312 | 78.0 |
6 | Can PID be asymptomatic in some women? | a) Never, b) Yes, c) Only in rural areas, d) Rarely | 279 | 69.8 |
7 | How is PID diagnosed? | a) Urine test, b) X-ray, c) Pelvic exam and lab tests, d) ECG | 289 | 72.3 |
8 | Is early treatment important in PID? | a) No, b) Yes, c) Only during pregnancy, d) Not sure | 317 | 79.3 |
9 | Can PID be treated without surgery? | a) No, b) Yes, with antibiotics, c) Only with hysterectomy, d) Requires blood transfusion | 295 | 73.8 |
10 | When is surgery considered for PID? | a) Always, b) When abscesses or severe damage occur, c) If unmarried, d) Only in teens | 268 | 67.0 |
11 | Which surgery may be performed in severe PID cases? | a) Endoscopy, b) Laparoscopy, c) Colonoscopy, d) Angioplasty | 261 | 65.3 |
12 | Can untreated PID increase ectopic pregnancy risk? | a) No, b) Yes, c) Only in menopause, d) Only if obese | 278 | 69.5 |
13 | Is PID a concern only for sexually active women? | a) Yes, b) Mostly but not exclusively, c) Only with PCOS, d) Only with fibroids | 273 | 68.3 |
14 | Can PID symptoms worsen after periods? | a) Never, b) Yes, c) Only during ovulation, d) Only after 40 | 266 | 66.5 |
15 | Is partner treatment important in managing PID? | a) No, b) Yes, c) Only if they show symptoms, d) Only after pregnancy | 288 | 72.0 |
16 | Is self-medication safe for PID symptoms? | a) No, b) Yes, c) Only if mild pain, d) For a few days | 270 | 67.5 |
17 | Can PID recur after treatment? | a) Never, b) Yes, c) Only after 40, d) Only in hospital patients | 279 | 69.8 |
18 | Should PID be screened during regular checkups? | a) No, b) Yes, c) Only in government hospitals, d) After menopause | 322 | 80.5 |
19 | Is there stigma around PID in communities? | a) No, b) Yes, c) Only in youth, d) Only in men | 263 | 65.8 |
20 | Would you seek care if you had PID symptoms? | a) No, b) Maybe, c) Yes, d) Only if pain is severe | 319 | 79.8 |
The study also uncovered misconceptions that could adversely impact health-seeking behavior. Although 73.8% of respondents knew that PID could be managed with antibiotics, 32.5% still held misconceptions around surgery being the primary or only treatment pathway. Furthermore, nearly 35% either believed or were unsure if PID could be spread through casual contact, a misunderstanding that may contribute to social stigma and isolation of affected individuals. One of the most concerning findings was the high prevalence of stigma surrounding PID—65.8% of respondents acknowledged the presence of stigma in their communities. This stigma, coupled with cultural silence around sexual health and gynecological conditions, may lead to underreporting of symptoms and reluctance to undergo screening or treatment.
Table 3: Knowledge Score Classification on PID Awareness
Knowledge Level | Score Range (Correct) | Number of Respondents (n) | Percentage |
Very Good Knowledge | ≥80% | 154 | 38.5% |
Good Knowledge | 60–79% | 165 | 41.3% |
Fair Knowledge | 41–59% | 59 | 14.8% |
Poor Knowledge | <40% | 22 | 5.5% |
The attitudes and perceptions captured in the study, however, provide hope. A substantial 79.8% of participants expressed a willingness to seek care if they experienced PID symptoms, and 80.5% agreed that PID screening should be integrated into routine health check-ups. These figures suggest a strong underlying readiness among the population to engage with healthcare services, provided that awareness, affordability, and accessibility barriers are addressed. Additionally, the recognition of PID’s link to infertility (71.8%) and ectopic pregnancy (69.5%) highlights an emerging understanding of the disease’s long-term consequences, which could serve as an entry point for more in-depth community education campaigns.
The classification of knowledge levels reinforces these mixed trends. While nearly 80% of respondents fell into the “Good” or “Very Good” knowledge categories, 20.3% still demonstrated “Fair” or “Poor” knowledge. This segment represents a crucial demographic that is likely underserved in health communication efforts and may include individuals from rural areas (56.3% of the sample) or those with limited educational attainment. These findings make a compelling case for tailored educational interventions—leveraging community health workers, Accredited Social Health Activists (ASHAs), and peer educators—to reach vulnerable groups with clear, culturally appropriate, and stigma-free information.
Furthermore, the knowledge gap surrounding the recurrence of PID (69.8%) and the importance of partner treatment (72.0%) points to the need for a more holistic approach to PID education that includes both preventive strategies and treatment compliance. The risk of reinfection and the role of untreated male partners are often overlooked in public messaging, yet are critical to breaking the cycle of chronic or recurrent PID that can ultimately lead to surgical complications.
The digital methodology employed in this study via Google Forms offered accessibility and ease of data collection; however, it may have skewed the sample toward more tech-literate and educated individuals, potentially underrepresenting those most in need of intervention. Nonetheless, the online approach also highlights an opportunity: digital platforms—particularly WhatsApp, Instagram, and local language YouTube content—can be harnessed to deliver targeted awareness campaigns on PID, reproductive health, and available treatment options in remote and semi-urban areas.
This study highlights a moderate to high level of awareness about Pelvic Inflammatory Disease among adults in Kangra, particularly concerning its symptoms and general treatment. However, significant misconceptions persist regarding its causes, surgical management, transmission, and recurrence. These gaps are compounded by stigma, limited dialogue around reproductive health, and inadequate integration of PID screening into primary care systems. Moving forward, a multipronged strategy is essential—one that includes community-based education, digital outreach, inclusion of male partners in awareness campaigns, and systematic integration of PID screening and counseling into government and private health services. Strengthening these components will not only improve health outcomes for women but also help normalize reproductive healthcare in regions like Kangra, where silence and stigma still cloud access to timely intervention.
This study reveals that while public awareness of Pelvic Inflammatory Disease (PID) in Kangra is moderately strong—especially regarding symptoms, treatment, and consequences like infertility—gaps persist in understanding its surgical implications, recurrence, and the importance of partner treatment. Misconceptions, stigma, and cultural barriers continue to hinder open dialogue and timely care, particularly in rural and less-educated populations. Encouragingly, the willingness to seek care and support for routine screening indicates a readiness for change. To translate awareness into action, targeted, culturally sensitive health education and integration of PID screening into primary care are essential steps toward improving reproductive health outcomes in underserved regions.
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