Bone injuries, particularly fractures, are among the most common musculoskeletal emergencies encountered in both rural and urban populations. Prompt and appropriate first aid management of fractures plays a critical role in minimizing complications such as deformities, nerve damage, and prolonged disability. In mountainous and geographically remote areas like Himachal Pradesh, where access to immediate orthopedic care may be limited, first aid administered by bystanders, family members, or community workers often forms the initial response. Despite the potentially serious consequences of delayed or improper fracture handling, public understanding of fracture first aid and basic bone injury management remains underexplored in such settings [1-4].

The terrain and lifestyle of Himachal Pradesh present a  unique  set  of  risk  factors  for  bone  injuries—ranging from falls on steep slopes and manual labor in agriculture to road traffic accidents on narrow hill roads. These factors increase the vulnerability of residents to fractures and sprains, especially among the elderly and physically active working class. However, anecdotal evidence suggests that fracture first aid is often managed with traditional or non-scientific practices, such as applying tight cloths, massaging, or moving the injured limb, which can exacerbate the injury. Additionally, misconceptions about splinting, immobilization, and transport of injured individuals may delay appropriate medical intervention and worsen outcomes [5-7].

Previous studies in Himachal Pradesh have highlighted gaps in awareness regarding bone health, osteoporosis, and arthritis, revealing a broader trend of musculoskeletal undereducation among the general population.^4-8 However, specific research on the public’s ability to respond to acute bone trauma, including their knowledge of emergency steps, signs of fractures, and do’s and don’ts of handling bone injuries, remains scarce. This knowledge gap is particularly critical given the region’s limited healthcare infrastructure in rural belts and the time-sensitive nature of fracture management.

This study aims to assess the level of knowledge, attitudes, and practices related to fracture first aid and bone injury management among the general population of Himachal Pradesh. By evaluating public awareness, identifying misconceptions, and analyzing the influence of socio-demographic factors, this research seeks to inform region-specific health education initiatives and improve emergency preparedness at the community level. The ultimate goal is to enhance musculoskeletal injury outcomes through timely, informed, and culturally appropriate first-line care.

Study Design

This study employed a descriptive, cross-sectional design to evaluate the level of public knowledge, attitudes, and practices (KAP) regarding fracture first aid and bone injury management among the general population of Himachal Pradesh. The objective was to identify gaps in emergency preparedness and assess the influence of demographic variables on first aid awareness in the context of bone trauma.

Study Area and Target Population

The research was conducted across various districts of Himachal Pradesh, including both urban and rural/hilly regions. The target population comprised adults aged 18 years and above from diverse educational, occupational, and socio-economic backgrounds. Healthcare professionals, paramedics, and students from medical and allied health sciences were excluded to avoid bias related to prior clinical training.

Sampling Method and Sample Size

A sample size of 400 participants was determined using standard statistical estimation for population-based KAP studies, assuming a 50% expected awareness level, 95% confidence interval, and 5% margin of error. Participants were selected using a convenience sampling method. To maximize outreach, especially in remote and hilly areas, the survey was disseminated via digital platforms such as WhatsApp, Facebook, Instagram, and email.

Data Collection Tool

Data were collected through a structured, self-administered Google Form questionnaire developed in collaboration with experts in orthopedics, emergency medicine, and public health. The questionnaire was provided in English and Hindi to ensure linguistic accessibility across a broad population base.

The survey instrument consisted of the following sections:

• Socio-Demographic Details: Age, gender, education level, occupation, and residence (urban or rural)

• Knowledge Component: Multiple-choice questions covering basic recognition of fractures, symptoms, first aid steps (e.g., immobilization, splinting), and what actions should be avoided

• Attitudes and Practices: Questions assessing participants' beliefs about traditional remedies, willingness to seek professional help, prior experience with bone injuries, and reliance on emergency services versus home-based responses

Pilot Testing

Before full deployment, the questionnaire was pilot-tested on 30 participants from a similar demographic to ensure clarity, cultural appropriateness, and ease of digital use. Minor revisions were made based on feedback regarding terminology and user experience.

Scoring and Categorization

Knowledge questions were scored with one point for each correct answer. Total scores were categorized as follows to evaluate knowledge levels:

• Very Good: 17–20 points

• Good: 13–16 points

• Fair: 9–12 points

• Poor: 0–8 points

Attitude and practice responses were summarized descriptively and analyzed for behavioral trends.

Ethical Considerations

Participation was voluntary and anonymous. An informed consent statement was included at the start of the Google Form, explaining the study's purpose, confidentiality assurances, and the right to withdraw at any time. No personal identifiers were collected, and the study adhered to the ethical principles outlined in the Declaration of Helsinki.

Data Analysis

Collected data were cleaned and exported from Google Forms into Microsoft Excel. Statistical analysis was performed using Epi Info Version 7. Descriptive statistics (frequencies, percentages) were used to summarize responses. Chi-square tests were applied to evaluate associations between knowledge scores and socio-demographic variables. A p-value of less than 0.05 was considered statistically significant.

Table 1 presents the demographic profile of the 400 respondents. The sample exhibited a balanced age distribution, with the largest group aged 46 years and above (31.0%), followed by those aged 26–35 (28.5%) and 36–45 years (24.0%), and a smaller segment of younger adults aged 18–25 (16.5%). Female participants slightly outnumbered males (56.0% vs. 44.0%). Educational attainment varied significantly, with the majority having completed secondary (33.8%) or undergraduate education (27.5%), while a notable 7.5% reported no formal schooling. Occupationally, the most represented categories were homemakers (22.0%), private sector employees (21.0%), and government employees (17.5%), indicating a broad socio-economic spread. Furthermore, the rural population comprised a larger proportion (57.0%) compared to urban residents (43.0%), aligning with the study’s objective to assess fracture-related awareness across diverse geographical settings in Himachal Pradesh.

Table 2 outlines responses to 20 multiple-choice questions assessing participants’ understanding of fracture first aid and bone injury care. Overall, awareness was moderate to high in many key areas. A significant number correctly identified essential first steps such as immobilization  (70.5%),  use  of  splints  (67.3%), and the need for immediate medical attention (72.8%). Knowledge was also strong regarding recognition of symptoms (66.8%), the importance of cold compresses (68.5%), and appropriate responses to bleeding injuries (69.8%). However, misconceptions persisted in areas such as avoiding movement to check pain (only 62.8% correct), safe use of tight bandaging (63.3%), and giving food/water before medical evaluation (61.3%). Notably, questions on vitamin D (70.8%), calcium (73.8%), and imaging for fractures (74.5%) were well-answered, reflecting growing public awareness of bone health basics. Despite overall promising awareness, the presence of dangerous misconceptions underscores the need for targeted first aid education initiatives.

Table 1: Socio-Demographic Characteristics of Participants (n = 400)

Table 2: Awareness and Knowledge Questions on Fracture First Aid and Bone Injury Management (n = 400)

Table 3: Knowledge Score Classification Among Participants (n = 400)

Table 4: Association Between Knowledge Score and Socio-Demographic Variables (n = 400)

Table 3 categorizes participants based on their total knowledge scores out of 20. A majority demonstrated either Good (36.0%) or Very Good (28.8%) knowledge, indicating a solid baseline understanding of fracture first aid and bone injury care among the general population. However, 23.8% of respondents fell into the Fair category and 11.5% had Poor knowledge, collectively representing over one-third of the sample with insufficient understanding to manage fracture-related emergencies effectively. These figures highlight the importance of strengthening public health outreach, particularly in rural or under-educated segments, to bridge the gap between basic recognition and correct application of emergency practices.

Table 4 reveals significant associations between knowledge levels and key demographic factors. Age was notably associated with knowledge (p = 0.022), with participants aged 26–35 showing the highest proportion of Very Good scores (10.5%), while older adults (46+) had higher rates of Fair and Poor scores, possibly due to limited exposure to updated health information. Education level showed a strong positive correlation with knowledge (p < 0.001); individuals with undergraduate or postgraduate qualifications were more likely to demonstrate Very Good knowledge, whereas those with no or primary education were more likely to fall in the Fair or Poor categories. Residence was also significant (p = 0.031), with urban participants outperforming rural counterparts in knowledge scores, reflecting disparities in access to first aid information and healthcare exposure. Gender did not show a significant association (p = 0.215), suggesting that fracture first aid awareness was relatively balanced between males and females across the region.

This study highlights the current state of public awareness and practices regarding fracture first aid and bone injury management in the diverse socio-geographic landscape of Himachal Pradesh. The results reveal a reasonably strong foundational knowledge among the general population, with encouraging levels of correct responses for critical first aid measures. For instance, over 70% of respondents correctly identified that immobilization is the first step in managing a suspected fracture, and a majority demonstrated awareness about splint usage, sling support, and the need for immediate medical attention. These findings suggest a growing awareness of evidence-based first aid practices among the population, potentially influenced by increased digital access, government health programs, and rising public exposure to trauma-related health content.

However, despite the overall positive trend, the data also underscore the persistence of several misconceptions that could severely compromise patient outcomes in emergency scenarios. A significant number of participants failed to recognize the risks associated with tight bandaging, the dangers of attempting to realign protruding bones, and the contraindications of offering food or massage immediately after injury. These gaps highlight the enduring influence of traditional practices and the lack of structured community-level first aid education. The belief that massages or herbal treatments are suitable immediate responses to fractures, though culturally embedded, can delay appropriate care and aggravate injuries. The data therefore reflect not only a partial understanding but also an urgent need to replace potentially harmful practices with accurate, first-line management protocols.

An important finding from the association analysis is the significant role of education and age in influencing knowledge levels. Participants with higher education, particularly those with undergraduate and postgraduate degrees, exhibited the best understanding of fracture management. Similarly, the age group of 26–35 years showed the highest percentage of Very Good knowledge scores, likely due to a combination of higher digital literacy, recent academic exposure, and active engagement in information-seeking behaviors. In contrast, older adults and those with minimal or no formal education were more likely to fall into the Fair or Poor categories, signaling the need for targeted outreach to these demographics. Residence also showed a significant association, with urban participants demonstrating greater knowledge than rural residents. This discrepancy likely reflects disparities in healthcare access, health promotion infrastructure, and exposure to educational resources in rural areas. Interestingly, gender did not significantly impact knowledge levels, indicating that men and women had similar access to and understanding of fracture-related first aid information. This suggests that health messaging—whether through social media, family experiences, or community discussions—may be reaching both genders with comparable frequency and effectiveness. Nonetheless, further exploration is needed to determine whether attitudes and actual practice behaviors differ by gender, even if the knowledge base appears similar.

                These findings underscore the dual challenge faced by healthcare planners and educators: maintaining momentum in areas where awareness is growing, while urgently addressing the information deficits among vulnerable groups. The data provide a compelling argument for developing localized, language-appropriate, and culturally sensitive first aid training programs, especially in rural communities and among older adults. Empowering laypersons with simple, accurate, and practical guidance on fracture first aid could significantly reduce the burden of preventable complications, particularly in a terrain where timely medical access is often compromised by distance and infrastructure [7-9].

Limitations

Despite offering valuable insights into public knowledge and practices regarding fracture first aid in Himachal Pradesh, this study had several limitations. First, the use of an online Google Form may have excluded individuals without internet access, particularly in remote or economically disadvantaged regions, potentially skewing the sample toward more educated and digitally literate participants. Second, the reliance on self-reported data may introduce response bias, with participants potentially overestimating their knowledge or choosing socially desirable answers. Third, the cross-sectional design captures awareness at a single point in time and cannot assess long-term behavior or the effectiveness of interventions. Lastly, the study did not include clinical validation of participants' responses, limiting the ability to correlate knowledge with actual first aid competence during real emergencies.

This study highlights a moderately high level of awareness regarding fracture first aid and bone injury management among the general population of Himachal Pradesh, with notable strengths in recognizing the need for immobilization, timely medical attention, and nutritional support for bone health. However, significant gaps remain in understanding the risks associated with traditional remedies, improper handling, and inappropriate home interventions. Knowledge disparities based on age, education, and rural-urban residence further emphasize the need for tailored educational strategies. Enhancing public preparedness through accurate and accessible health education could play a critical role in reducing complications from bone injuries and improving outcomes, particularly in resource-limited and geographically challenging settings.

Recommendations

To improve public response to bone injuries, especially in remote and rural areas, it is recommended that region-specific first aid training programs be developed and implemented at the community level. These programs should be culturally sensitive, delivered in local languages, and integrated into existing health outreach efforts, such as those led by ASHA workers, community health volunteers, and school programs. Inclusion of fracture first aid modules in school curricula, radio broadcasts, and mobile-based awareness campaigns can further enhance reach. Additionally, periodic hands-on workshops or simulations should be organized to reinforce practical skills. Policymakers and public health departments must prioritize fracture first aid education as a critical component of emergency preparedness and musculoskeletal health promotion in hilly and underserved regions.

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