Cervical spondylitis, characterized by degenerative changes in the cervical spine leading to neck pain, stiffness, and reduced mobility, is a growing concern among working populations, particularly in rural regions like Kangra, Himachal Pradesh. Prolonged poor posture, repetitive strain, and inadequate ergonomic practices, common in occupations like farming and desk-based work, exacerbate this condition, impacting productivity and quality of life. Despite its prevalence, public awareness of cervical spondylitis and preventive measures, such as posture correction and neck exercises, remains limited, often leading to reliance on ineffective remedies or delayed medical intervention [1-4].

In Kangra, where a significant portion of the workforce engages in physically demanding tasks or sedentary office work, cervical spondylitis is a pressing occupational health issue. Rural workers face additional challenges, including limited access to physiotherapy, low health literacy, and cultural practices favoring traditional treatments like hot compresses over evidence-based approaches. Misconceptions, such as attributing neck pain solely to aging or ignoring early symptoms, further complicate management. Global studies emphasize that informed preventive practices reduce musculoskeletal disorders, yet region-specific data on cervical spondylitis awareness in rural India are scarce [5-8].

This study aims to assess the knowledge, perceptions, and preventive practices related to cervical spondylitis and postural hazards among Kangra’s working population, with a focus on rural workers. By identifying gaps and demographic factors influencing awareness, the research seeks to inform targeted workplace interventions that promote ergonomic practices and early intervention. Enhancing understanding can empower workers to adopt effective self-care, reduce reliance on unproven treatments, and improve access to professional care, ultimately alleviating the burden of cervical spondylitis in this occupational context.

The findings will guide occupational health programs and policymakers in designing ergonomic interventions and educational campaigns tailored to Kangra’s diverse workforce. Addressing these knowledge gaps is critical to fostering a healthier working population and reducing the socioeconomic impact of cervical spondylitis in this resource-constrained region.

Study Design

A descriptive, cross-sectional study was conducted to evaluate knowledge, perceptions, and preventive practices for cervical spondylitis and postural hazards among working adults in Kangra, Himachal Pradesh. A structured online questionnaire collected quantitative data, ensuring representation across diverse occupational and demographic groups.

Study Location and Participants

The study targeted Kangra, a district with a mixed rural-urban workforce and limited access to specialized musculoskeletal care. Participants were working adults aged 18–60 years, permanent Kangra residents, with a focus on rural workers to address their occupational and health literacy challenges.

Study Period

Data collection occurred from October to December 2024, providing sufficient time to engage participants across rural and urban settings.

Sample Size and Sampling

A sample size of 520 participants was calculated using a 95% confidence interval, 50% estimated awareness prevalence, and a 5% margin of error, with a 10% buffer for incomplete responses. Convenience and purposive sampling were employed, with the questionnaire distributed via social media (WhatsApp, local forums) and workplace health programs to ensure rural and occupational diversity.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Working adults aged 18–60 years

• Permanent Kangra residents

• Ability to respond in Hindi or English

• Voluntary participation with informed consent
  
   

Exclusion Criteria

• Individuals with unrelated severe musculoskeletal disorders

• Unwilling or unable to provide consent

• Incomplete or ambiguous responses

Data Collection Tool

A validated questionnaire, developed with input from orthopedic specialists, physiotherapists, and occupational health experts, comprised three sections:

• Socio-Demographic Information: Age, gender, education, occupation, and residence (rural/urban).

• Knowledge and Perception Assessment: 20 multiple-choice questions on cervical spondylitis causes, risk factors, preventive practices, and misconceptions.

• Preventive Practices: Questions on workplace ergonomics, personal management of neck pain, and barriers to care. The questionnaire was bilingual (Hindi/English) for accessibility.

Knowledge Scoring

Responses were scored for accuracy and categorized as:

• Superior: ≥80%

• Competent: 60%–79%

• Moderate: 41%–59%

• Deficient: <40%

Data Collection Process

The questionnaire was disseminated via Google Forms, promoted through workplace networks and health workers. Participants were informed of the study’s purpose, anonymity, and voluntary nature, with consent required before participation.

Data Analysis

Data were cleaned in Microsoft Excel and analyzed using SPSS (version 26.0). Descriptive statistics summarized demographics, knowledge, and preventive practices, while chi-square tests assessed associations between socio-demographic variables and knowledge levels (p<0.05).

Ethical Considerations

Ethical approval was obtained from the Institutional Ethics Committee. Participants were assured of confidentiality, voluntary participation, and the right to withdraw. Data were securely stored to protect privacy.

The socio-demographic data provide a detailed overview of Kangra’s working population, highlighting occupational and residential diversity. The slight female majority (52.3%) may reflect higher participation or greater susceptibility to cervical spondylitis among women due to prolonged desk work or domestic tasks. The predominance of participants aged 26–45 years (64.8%) aligns with the condition’s impact on the active workforce, particularly in occupations like office work (26.9%) and farming (24.6%), which involve repetitive neck strain or poor posture. The high rural representation (65.8%) ensures the study captures the challenges of limited ergonomic resources and health literacy in these areas. Education levels, with 5.8% having no formal education, indicate potential barriers to understanding complex preventive practices, emphasizing the need for accessible, occupation-specific interventions.

The knowledge assessment reveals a moderate understanding of cervical spondylitis, with notable strengths and gaps. The high recognition of poor posture (85.2%) and neck exercises (80.8%) as key factors suggests that basic health messages, possibly through workplace health talks or media, have reached the working population. However, significant deficiencies in understanding ergonomic workstations (65.4%) and avoiding forward head posture (63.1%) highlight critical gaps in workplace-specific knowledge, which are essential for preventing exacerbation. The limited awareness of complications like chronic pain (67.3%) and reduced neck mobility (66.5%) indicates a lack of appreciation for the condition’s long-term impact, potentially leading to delayed care. These gaps are particularly concerning in a workforce with high occupational risk, emphasizing the need for education on practical preventive tools like ergonomic chairs (76.7%) and posture breaks (75.8%).

The knowledge score classification reflects a generally positive trend, with 76.3% of participants achieving "Superior" or "Competent" knowledge, suggesting a reasonable foundation in cervical spondylitis awareness among Kangra’s workforce. This indicates that some occupational health initiatives, such as basic ergonomic training, may have had an impact. However, the 17.3% with "Moderate" and 6.4% with "Deficient" knowledge represent a significant minority, particularly among rural workers and those with lower education levels, who are more likely to rely on ineffective remedies or delay seeking care. These groups face heightened risks due to occupational demands and limited access to ergonomic resources. The distribution highlights the urgency of targeted workplace interventions, such as ergonomic workshops and accessible health campaigns, to address rural-urban and educational disparities and ensure equitable prevention of cervical spondylitis.

Table 1: Socio-Demographic Characteristics of Participants

This study provides a comprehensive evaluation of awareness and preventive practices for cervical spondylitis and postural hazards among Kangra’s working population, revealing a mix of encouraging understanding and critical gaps. Participants demonstrated strong recognition of poor posture (85.2%) as a risk factor and neck exercises (80.8%) as beneficial, aligning with findings from occupational health studies in other developing regions where basic musculoskeletal health messages have gained traction. These strengths suggest that workplace health programs or limited media exposure have partially succeeded in disseminating key concepts. However, significant deficiencies in understanding ergonomic workstations (65.4%) and avoiding forward head posture (63.1%) highlight missed opportunities for workplace-specific prevention, potentially exacerbating neck pain and reducing productivity.

The socio-demographic profile underscores the study’s focus on rural workers (65.8%), who face systemic barriers like geographic isolation, limited access to physiotherapists, and reliance on traditional remedies such as hot fomentation. Lower knowledge scores among rural participants and those with no formal education (5.8%) reflect the interplay of low health literacy and resource constraints, consistent with research in rural India showing delayed care due to misinformation. Office workers (26.9%) and farmers (24.6%), prevalent in the sample, are particularly vulnerable due to prolonged sitting or repetitive neck strain, yet their awareness of ergonomic practices (75.4%) and cervical collar use (73.5%) remains suboptimal, indicating a need for occupation-specific education tailored to these high-risk groups.

Notable gaps in recognizing complications, such as reduced neck mobility (66.5%) and chronic pain (67.3%), suggest a lack of appreciation for cervical spondylitis’s long-term impact. Similarly, limited understanding of workplace factors like improper desk height (65.4%) and the role of physiotherapy (70.4%) points to deficiencies in proactive management. These issues may stem from cultural beliefs prioritizing immediate relief—such as overusing painkillers—over preventive strategies, compounded by inadequate occupational health outreach in rural Kangra. The bilingual questionnaire and workplace-based distribution mitigated some literacy barriers, but the persistence of “Moderate” (17.3%) and “Deficient” (6.4%) knowledge levels underscores the need for sustained, accessible education.

Urban participants (34.2%) showed higher awareness, likely due to better access to ergonomic resources and media, highlighting a rural-urban divide. This disparity suggests that interventions should leverage local resources, such as Accredited Social Health Activists (ASHAs) and workplace health committees, to deliver practical training on ergonomic chairs, posture breaks, and neck exercises. Addressing misconceptions, such as the belief that cervical spondylitis is an inevitable part of aging, is critical to encourage early intervention. Community workshops, mobile physiotherapy units, and digital health tools could enhance accessibility, particularly for rural workers with limited connectivity [8,9].

Table 2: Awareness and Knowledge of Cervical Spondylitis and Postural Hazards

Table 3: Knowledge Score Classification

Limitations include potential selection bias from online questionnaire distribution, which may have excluded workers without internet access, and the cross-sectional design, which limits insights into behavioral changes over time. Despite these constraints, the study’s robust sample size and focus on the working population provide a strong foundation for occupational health policy. Longitudinal research evaluating the impact of ergonomic interventions and educational campaigns on cervical spondylitis management and workplace productivity is needed to ensure sustainable improvements.

This study reveals a fair yet uneven understanding of cervical spondylitis and postural hazards among Kangra’s working population, with critical gaps among rural and less-educated workers hindering effective prevention. By implementing workplace-focused educational initiatives, promoting ergonomic practices, and expanding access to physiotherapy, Kangra can empower its workforce to combat neck pain, enhance occupational well-being, and forge a healthier, more resilient future for its communities.

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