Background: Cholecystitis, an inflammation of the gallbladder often caused by gallstones, is a prevalent gastrointestinal condition that can lead to serious complications if left untreated. While laparoscopic cholecystectomy offers a safe and effective treatment option, public awareness regarding the condition and its surgical management remains inconsistent especially in rural and semi-urban populations. This study was conducted to assess the level of public knowledge about cholecystitis, its symptoms, complications, and surgical interventions in Kangra district, Himachal Pradesh. Materials and Methods: A descriptive, cross-sectional survey was conducted from January to March 2025 among 400 adult residents of Kangra. A structured and pre-validated online questionnaire was used, covering socio-demographic data, awareness of cholecystitis and gallbladder surgery, and health-seeking behavior. Participants were selected via convenience and purposive sampling through digital platforms. Data were analyzed using descriptive statistics to identify knowledge trends and gaps, with scoring categorized into four awareness levels: very good, good, fair, and poor. Results: The majority of participants (77–84%) correctly identified cholecystitis as gallbladder inflammation and recognized its core symptoms, causes, and surgical treatment. Awareness was particularly high regarding the function of the gallbladder (81%), common symptoms like right upper abdominal pain (84.5%), and the necessity of surgery in severe cases (76%). However, knowledge was moderate concerning disease complications such as recurrence after surgery (66%) and jaundice (67%), as well as preventive lifestyle measures (70–75%). Based on scoring, 40.5% of respondents exhibited very good knowledge, 41.5% good knowledge, while 14% and 4% had fair and poor awareness, respectively. Conclusion: While the general public in Kangra exhibits commendable awareness of cholecystitis and its management, significant gaps remain in understanding complications, post-operative outcomes, and preventive factors. These deficiencies, especially prevalent in rural and less-educated groups, highlight the urgent need for targeted, culturally sensitive educational initiatives. Strengthening community health outreach and integrating gallbladder health education into primary care services can significantly improve early diagnosis and surgical outcomes.
`Cholecystitis, an inflammation of the gallbladder, is a commonly encountered gastrointestinal condition that can range from mild, self-limiting episodes to severe cases requiring urgent surgical intervention. Often triggered by gallstones obstructing the cystic duct, cholecystitis may present with symptoms such as abdominal pain, nausea, vomiting, and fever, with complications including infection, gallbladder perforation, or biliary peritonitis if left untreated [1,2]. While acute cases demand prompt management, including antibiotics and cholecystectomy (surgical removal of the gallbladder), chronic cases often progress silently, contributing to delays in diagnosis and treatment [3,4].
Gallbladder surgery, particularly laparoscopic cholecystectomy, is now a widely accepted and minimally invasive procedure with a high success rate and quick recovery period [4]. However, despite advancements in surgical techniques and improved outcomes, public knowledge about cholecystitis, its causes, symptoms, and treatment options remains uneven especially in rural and semi-urban populations. Many individuals tend to misattribute gallbladder-related discomfort to dietary habits or general indigestion, often resorting to self-medication or delaying medical consultation until complications arise [5,6].
In regions like Kangra district in Himachal Pradesh, such gaps in awareness are often compounded by factors such as limited healthcare accessibility, low health literacy, and sociocultural reluctance to seek early surgical advice. Moreover, fear of surgery, misconceptions about gallbladder function, and lack of exposure to preventive health education further contribute to poor understanding of this condition and its treatment [7,8].
Although some studies in India have touched upon gallstone disease and related surgical interventions, there is limited data specifically exploring public awareness about cholecystitis and cholecystectomy in community settings.9-13 Understanding how the general population perceives this condition is critical for developing effective awareness campaigns and promoting early intervention.
This study, therefore, aims to assess the level of awareness among the general public in Kangra regarding cholecystitis and its surgical management. By analyzing variations across age, education, gender, and rural-urban demographics, this study seeks to identify prevailing misconceptions and inform future public health strategies aimed at improving early diagnosis, timely surgical care, and overall outcomes related to gallbladder disease
Study Design
This study employed a descriptive, cross-sectional survey design to assess the level of awareness among the general public regarding cholecystitis and gallbladder surgery in the Kangra district of Himachal Pradesh. The study aimed to evaluate public knowledge about symptoms, causes, complications, and treatment options particularly surgical management like cholecystectomy.
Study Area and Population
The research was conducted in Kangra, a geographically diverse district located in the northern Indian state of Himachal Pradesh. Known for its blend of rural and semi-urban communities, Kangra provides an appropriate setting to investigate public awareness in both well-connected and underserved regions. The study targeted adults aged 18 years and above, regardless of gender, educational qualification, or occupation.
Study Period
Data collection was carried out over a period of three months, from January to March 2025. This timeframe ensured broad community outreach and sufficient participation for robust data analysis.
Sample Size and Sampling Technique
A total of 400 respondents participated in the study. The sample size was calculated based on an assumed awareness prevalence of 50%, a 95% confidence interval, and a 5% margin of error. To account for potential non-responses or incomplete data, a slightly higher sample was targeted. Participants were selected using a purposive and convenience sampling method, and recruitment was conducted digitally through social media platforms, community forums, WhatsApp groups, and local digital notice boards.
Inclusion Criteria
Participants were eligible if they met the following criteria:
Aged 18 years or older
Permanent residents of Kangra district
Able to read and understand Hindi or English
Willing to provide informed digital consent
Exclusion Criteria
Participants were excluded if they:
Had a previously diagnosed complex hepatobiliary condition requiring specialized care
Submitted incomplete or inconsistent questionnaire responses
Declined to give informed consent
Study Tool – Structured Questionnaire
Data were collected using a structured, pre-validated questionnaire developed in consultation with public health experts and gastrointestinal surgeons. The questionnaire was designed to be simple, clear, and user-friendly, and was available in both Hindi and English to ensure accessibility. It was divided into three main sections:
Socio-Demographic Information: Age, gender, education level, occupation, and place of residence (rural or urban)
Awareness Assessment: Twenty multiple-choice questions assessing knowledge of cholecystitis symptoms, causes, risk factors, treatment options (including surgery), and potential complications
Health-Seeking Behavior: Questions exploring past personal or family experiences, sources of health information, and attitudes toward gallbladder surgery
Scoring and Knowledge Classification
Each correct answer in the awareness section was awarded one point. Based on the total score, knowledge levels were classified into four categories:
Very Good Knowledge: ≥80% correct responses
Good Knowledge: 60–79% correct
Fair Knowledge: 41–59% correct
Poor Knowledge: <40% correct
This scoring system enabled stratified analysis and identification of key knowledge gaps across different segments of the population.
Data Collection Procedure
The questionnaire was disseminated exclusively via digital platforms, allowing wide and contactless participation. Participants accessed the survey through a secure Google Forms link after reading a brief overview of the study and submitting informed consent. No face-to-face interviews were conducted.
Data Analysis
All responses were compiled, cleaned, and organized using Microsoft Excel. Descriptive statistics such as frequencies and percentages were used to present demographic profiles and awareness levels. The results were interpreted to identify trends, disparities, and areas of low awareness that could be addressed through public health interventions.
Ethical Considerations
The study strictly adhered to ethical principles. Participation was voluntary, and anonymity was maintained throughout. Informed digital consent was obtained from all respondents. Participants were informed of their right to withdraw from the survey at any point without any consequence.
The study surveyed 400 residents of Kangra district, presenting a diverse sample in terms of age, gender, education, occupation, and residence. The largest proportion of participants fell within the 26–35 years age bracket (35.5%), followed by those aged 36–45 years (28.0%), 18–25 years (22.0%), and 46 years and above (14.5%). Female respondents slightly outnumbered males, making up 53.0% of the sample. Educational attainment varied, with a notable proportion holding undergraduate degrees (34.5%) or having completed secondary school (30.5%), while 15.0% held postgraduate qualifications. A small portion (5.5%) had no formal education. In terms of occupation, homemakers constituted the largest group (25.5%), followed by office workers (22.0%), teachers and students (each 15.5%), healthcare professionals (12.0%), and others (9.5%). The rural population was slightly more represented, accounting for 58.0% of the sample, compared to 42.0% from urban areas. This distribution supports the study's aim of capturing awareness across a broad community spectrum.
The survey responses revealed a generally strong understanding of gallbladder-related health issues among participants. A high percentage (81.0%) correctly identified the gallbladder’s function as bile storage, and 77.0% accurately defined cholecystitis as inflammation of the gallbladder. Awareness of typical symptoms, such as right upper abdominal pain, was very high (84.5%), and a majority recognized the role of gallstones in causing cholecystitis (82.0%). Knowledge of treatment options was also commendable, with 76.0% acknowledging surgery as the primary intervention for severe cases, and 80.0% correctly identifying cholecystectomy as gallbladder removal. Understanding of laparoscopic surgery as minimally invasive (73.0%) and the impact of lifestyle on prevention (70.0%) was moderate. Notably, 74.0% were aware that untreated cholecystitis could lead to gallbladder rupture, while 67.0% recognized jaundice as a possible complication. Awareness of anesthesia use (80.0%) and common post-surgical risks like infection (72.0%) was also strong. However, fewer respondents correctly identified recurrence possibilities post-surgery (66.0%) or asymptomatic gallstones (71.0%). Overall, while foundational knowledge was robust, targeted education is still needed to address certain nuanced aspects of disease progression and post-operative expectations.
Based on the scoring framework, 40.5% of respondents exhibited very good awareness (≥80% correct answers), while 41.5% demonstrated good knowledge (60–79%). These two groups together made up over 80% of the sample, suggesting a relatively informed general population. On the other hand, 14.0% of participants fell into the fair category, and 4.0% displayed poor knowledge, scoring below 40%. This distribution highlights an encouraging trend in public understanding, though it also signals the need for continued health education, particularly targeting those with lower scores most likely individuals from rural backgrounds or lower educational strata. Focused interventions in these segments could help close the awareness gap and improve early identification and treatment-seeking behavior related to gallbladder disease.
Table 1: Socio-Demographic Characteristics of Participants (Kangra)
Variable | Category | Frequency (n) | Percentage |
Age Group (Years) | 18–25 | 88 | 22.0% |
26–35 | 142 | 35.5% | |
36–45 | 112 | 28.0% | |
46 and above | 58 | 14.5% | |
Gender | Male | 188 | 47.0% |
Female | 212 | 53.0% | |
Education Level | No formal education | 22 | 5.5% |
Primary school | 58 | 14.5% | |
Secondary school | 122 | 30.5% | |
Undergraduate degree | 138 | 34.5% | |
Postgraduate degree | 60 | 15.0% | |
Occupation | Homemaker | 102 | 25.5% |
Office Worker | 88 | 22.0% | |
Teacher | 62 | 15.5% | |
Healthcare Professional | 48 | 12.0% | |
Student | 62 | 15.5% | |
Other | 38 | 9.5% | |
Residential Setting | Urban | 168 | 42.0% |
Rural | 232 | 58.0% |
Table 2: Public Knowledge and Awareness of Cholecystitis and Gallbladder Surgery
No. | Question | Options | Correct Responses (n) | Percentage |
1 | What is the gallbladder’s main function? | a) Break down sugars, b) Store bile, c) Produce enzymes, d) Regulate blood pressure | 324 | 81.0 |
2 | What is cholecystitis? | a) Pancreas infection, b) Gallbladder inflammation, c) Heart inflammation, d) Skin rash | 308 | 77.0 |
3 | What is a primary symptom of cholecystitis? | a) Leg pain, b) Right upper abdominal pain, c) Dizziness, d) Hair thinning | 338 | 84.5 |
4 | Can gallstones lead to cholecystitis? | a) Yes, b) No, c) Only in elderly, d) Rarely | 328 | 82.0 |
5 | What is the primary treatment for severe cholecystitis? | a) Diet modification, b) Surgery, c) Antibiotics only, d) Exercise | 304 | 76.0 |
6 | What is a cholecystectomy? | a) Spine surgery, b) Gallbladder removal, c) Liver transplant, d) Eye procedure | 320 | 80.0 |
7 | Is laparoscopic cholecystectomy minimally invasive? | a) Yes, b) No, c) Only for men, d) Depends | 292 | 73.0 |
8 | Can cholecystitis be prevented through lifestyle? | a) No, b) Yes, c) Only genetically, d) Never | 280 | 70.0 |
9 | Should dietary habits be shared before surgery? | a) No, b) Yes, c) Only food allergies, d) After surgery | 308 | 77.0 |
10 | What is a risk of untreated cholecystitis? | a) Cough, b) Gallbladder rupture, c) Vision impairment, d) Joint pain | 296 | 74.0 |
11 | Can gallstones be present without symptoms? | a) No, b) Yes, c) Only in women, d) Always painful | 284 | 71.0 |
12 | What should be avoided before gallbladder surgery? | a) Eating or drinking, b) Sleeping, c) Light exercise, d) Wearing glasses | 316 | 79.0 |
13 | Is obesity a risk factor for gallstones? | a) Yes, b) No, c) Only for elderly, d) Rarely | 300 | 75.0 |
14 | Can cholecystitis cause jaundice? | a) No, b) Yes, c) Only in children, d) Never | 268 | 67.0 |
15 | Is general anesthesia used for cholecystectomy? | a) Yes, b) No, c) Only local, d) Rarely | 320 | 80.0 |
16 | What is a common post-surgical complication? | a) Memory loss, b) Infection, c) Tooth decay, d) Weight gain | 288 | 72.0 |
17 | Who performs gallbladder surgery? | a) Dermatologist, b) General surgeon, c) Nurse, d) Radiologist | 336 | 84.0 |
18 | Can diet impact gallstone formation? | a) No, b) Yes, c) Only in men, d) Rarely | 304 | 76.0 |
19 | Does laparoscopic surgery offer faster recovery? | a) Yes, b) No, c) Same as open surgery, d) Only for women | 296 | 74.0 |
20 | Can cholecystitis recur after gallbladder removal? | a) Yes, b) No, c) Frequently, d) Only with poor diet | 264 | 66.0 |
Table 3: Knowledge Score Classification on Cholecystitis and Gallbladder Surgery Awareness
Knowledge Level | Score Range (% Correct) | Number of Respondents (n) | Percentage (%) |
Very Good Knowledge | ≥80% | 162 | 40.5% |
Good Knowledge | 60–79% | 166 | 41.5% |
Fair Knowledge | 41–59% | 56 | 14.0% |
Poor Knowledge | <40% | 16 | 4.0% |
This cross-sectional study provides critical insights into the public awareness and understanding of cholecystitis and gallbladder surgery among residents of Kangra district, Himachal Pradesh. The findings reveal that while the general awareness regarding the gallbladder's function, common symptoms of cholecystitis, and surgical treatment options is notably high, certain important gaps persist particularly in relation to disease complications, post-operative outcomes, and recurrence after surgery. These gaps highlight the importance of continued health education, particularly among less-informed segments of the population.
The demographic composition of the study population was diverse, with balanced representation across gender, age groups, educational levels, and urban-rural residence. The predominance of young to middle-aged adults (26–45 years) aligns with the active working population, which is often more exposed to digital health resources and hence more receptive to awareness campaigns. Interestingly, women formed a slight majority (53%) of the sample, which is important considering their key role in healthcare decision-making within families, especially in rural India. The educational profile also showed promise, with more than two-thirds of the participants having at least secondary education, potentially contributing to the relatively good knowledge levels observed in the survey.
In terms of disease-specific knowledge, the majority of respondents correctly identified the gallbladder's role (81%) and recognized cholecystitis as inflammation of the gallbladder (77%). These foundational understandings are encouraging and suggest a fair degree of baseline familiarity. Notably, over 84% of respondents identified right upper abdominal pain as a key symptom, and 82% recognized gallstones as a leading cause of cholecystitis both figures that underscore public sensitivity to common clinical manifestations. Awareness regarding surgical management was similarly high, with 76% recognizing surgery as the primary treatment in severe cases and 80% correctly defining cholecystectomy as gallbladder removal.
However, the study also uncovered knowledge deficits in several important areas. Only 66% of participants were aware of the possibility of cholecystitis recurrence even after gallbladder removal, and 67% recognized jaundice as a potential complication suggesting limited understanding of the condition’s progression and systemic effects. Furthermore, awareness about the asymptomatic nature of gallstones (71%) and the role of diet and obesity as modifiable risk factors (75–76%) was moderate, indicating the need for better community-level education on preventive aspects. These misconceptions can delay diagnosis and treatment, increasing the risk of complications such as gallbladder rupture or biliary sepsis.
Post-operative aspects, too, showed room for improvement. While 80% were familiar with the use of general anesthesia, and 72% could identify infection as a common complication, understanding of laparoscopic surgery and its benefits was somewhat limited. Only 73% knew it to be minimally invasive, and 74% understood its association with faster recovery. Given the shift in surgical practice toward minimally invasive techniques, these gaps could lead to unwarranted fear or resistance toward surgery due to outdated beliefs or lack of exposure to medical advances.
The knowledge score classification further reflects these trends. A combined 82% of respondents fell into the “Very Good” or “Good” knowledge categories, suggesting that basic awareness is relatively widespread. Nonetheless, the 18% who scored in the “Fair” or “Poor” categories represent a significant minority whose lack of awareness could pose barriers to timely healthcare-seeking behavior. These groups are likely concentrated among rural populations and those with lower educational backgrounds, who may be underserved by digital and formal health education channels.
One of the study's notable strengths is its use of digital data collection, which allowed for efficient and safe engagement with a large and varied sample. However, this methodology may have inadvertently excluded individuals without internet access or digital literacy, such as elderly residents or those from marginalized rural backgrounds populations that may actually benefit the most from awareness initiatives. Future research could incorporate hybrid models, including door-to-door surveys or health camps, to ensure more inclusive coverage.
From a public health perspective, the findings stress the urgent need for structured, culturally tailored health education programs focusing on gallbladder disease. These programs should address not just symptom recognition but also clarify misconceptions about surgical risks, recurrence, and lifestyle modifications. Primary healthcare providers, Accredited Social Health Activists (ASHAs), school teachers, and community leaders can be instrumental in spreading this information. Integration of cholecystitis awareness into village health and nutrition days (VHNDs), local health fairs, and public service messaging through local radio or social media could amplify impact. Moreover, empowering women through education could further enhance awareness within households and influence earlier healthcare engagement [7,9,11].
Based on the findings of this study, it is evident that the general public in Kangra district possesses a reasonably good level of awareness regarding cholecystitis and gallbladder surgery, particularly in identifying core symptoms, understanding the gallbladder's function, and recognizing the need for surgical treatment in severe cases. However, notable knowledge gaps remain in areas such as disease complications, recurrence post-surgery, asymptomatic gallstones, and the benefits of laparoscopic procedures. These deficiencies, especially among rural and less-educated populations, underscore the need for more inclusive, accessible, and culturally sensitive health education initiatives. By addressing these gaps through community-based awareness programs and integrating gallbladder health education into routine primary care outreach, policymakers and healthcare providers can promote earlier diagnosis, reduce surgical hesitation, and ultimately improve treatment outcomes for gallbladder-related conditions.
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