Colorectal cancer (CRC) encompasses malignancies of the colon and rectum represents a formidable challenge to global public health, ranking as the third most prevalent cancer worldwide and the fourth leading cause of cancer-related mortality [1]. The impact of CRC is diverse, and its incidence and outcomes vary across regions, necessitating context-specific approaches to address this health concern. This study aims to illuminate the awareness and knowledge levels concerning colorectal cancer among the residents of District Kangra, Himachal Pradesh, contributing valuable insights for tailored interventions.

Understanding the distribution and determinants of CRC is essential for effective prevention and early intervention strategies [1]. Indian studies have emphasized the rising incidence of CRC in the country, underscoring the need for context-specific research [2].

District Kangra, nestled in the scenic landscapes of Himachal Pradesh, presents a unique demographic and geographic context. India's diverse population calls for nuanced investigations, as evidenced by studies highlighting regional disparities in CRC incidence and outcomes [3]. The study's findings will inform targeted interventions aligned with the specific needs of the community. In the Indian context, research by Singh et al. [4] emphasizes the need for increased public awareness to address the rising burden of CRC.  Our investigation aims to identify gaps and propose context-specific strategies for enhancing awareness and early detection. In the Indian healthcare landscape, studies such as that by   Mohandas et al.    [5]    stress the importance of community-based interventions to improve awareness and reduce the burden of CRC.

Limited awareness and knowledge about colorectal cancer often contribute to delayed diagnosis and treatment initiation, impacting patient outcomes. This study addresses a critical gap in understanding colorectal cancer awareness at the local level, emphasizing the need for context-specific interventions. By unraveling the intricacies of awareness in District Kangra, this research contributes to the broader effort of reducing the impact of colorectal cancer on public health.

Objectives of the Study

The primary objective of this study is to evaluate the level of awareness and knowledge regarding Colorectal Cancer among the general public 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 Colorectal Cancer, a precise 5% absolute error margin, and a conservative 5% non-response rate 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 structuredknowledge related questions regardingabout Colorectal 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 was maintained

The goal of the current study was to assess knowledge of general public of Kangra regarding Colorectal Cancer through a non-experimental descriptive survey. A total of 

Table 1: Knowledge regarding Colorectal Canceramong study participants

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

400 respondents took part in the study, with 136 (34%) coming from urban areas and 266 (66%) from rural areas.

In the present study 22.75% (91) participants had very good knowledge (16-20 marks) towards Colorectal Cancer, 38% (152) had good knowledge (12-15 marks), 24.5% (98) had fair knowledge (8-11 marks) and 14.75% (59) having poor knowledge (<8 marks).

The findings of our study provide valuable insights into the level of awareness and knowledge regarding colorectal cancer (CRC) among the residents of District Kangra, Himachal Pradesh. The overall knowledge levels revealed a diverse range, with a significant portion of the population demonstrating varying degrees of awareness.

In our study, a substantial proportion (59.5%) of respondents had heard about colorectal cancer, indicating a reasonable baseline awareness. However, there is room for improvement, as a noteworthy percentage remained unfamiliar with this form of cancer. This aligns with the observations of Singh et al. [4], who emphasized the need for increased public awareness in the Indian context to address the rising burden of CRC.

The study revealed varying levels of understanding concerning the risk factors and symptoms of colorectal cancer. While a considerable number of participants were able to identify common symptoms and risk factors, such as changes in bowel habits and family history, there were notable gaps in knowledge. Similar findings were reported in a study by Gupta et al. [2], emphasizing the need for targeted education on specific risk factors.

The positive recognition (56.5%) of the importance of early detection for better outcomes is promising. However, the awareness of screening methods was relatively lower (32.5%), suggesting a potential area for intervention. This echoes the findings of Mohandas et al. [5], emphasizing the importance of community-based interventions to enhance awareness and knowledge.

The study participants exhibited varying levels of knowledge regarding treatment options and lifestyle factors related to colorectal cancer. These findings underscore the need for comprehensive educational campaigns that cover not only prevention but also treatment aspects. Similar observations were made in studies by Patel et al. [6] and Malhotra et al. [7], highlighting the multifaceted approach required for effective awareness programs.

A quarter of the participants reported engaging in awareness campaigns or discussions related to colorectal cancer, and a significant majority recognized the need for more accessible information. These results align with the studies conducted by Ghoshal et al. [3], emphasizing the importance of community engagement and government initiatives to bridge the information gap.

Comparing our findings with other Indian studies reveals common trends in the need for increased awareness, knowledge dissemination, and community involvement. The diverse population and regional variations observed in our study are consistent with the regional disparities highlighted by Ghoshal et al. [3] and the rising incidence of CRC emphasized by Gupta et al. [2].

Our study's results underscore the importance of targeted interventions addressing specific gaps in knowledge and awareness. Tailored educational programs, community engagement initiatives, and increased accessibility to information, as suggested by Mohandas et al. [5], are crucial components for mitigating the impact of colorectal cancer in District Kangra.

Limitations and Future Directions

It's important to acknowledge certain limitations, including the reliance on self-reported data and the use of an online survey tool. Future research could explore the impact of socio-demographic factors on knowledge levels and evaluate the long-term effectiveness of awareness campaigns.

In conclusion, this study sheds light on the awareness and knowledge levels regarding colorectal cancer among the residents of District Kangra, Himachal Pradesh. The findings underscore both the existing awareness and the critical gaps in knowledge, emphasizing the need for targeted public health interventions. Tailored educational campaigns, community engagement initiatives, and improved accessibility to information are essential components for enhancing colorectal cancer awareness in this unique demographic context. By addressing these specific challenges, we can contribute to reducing the burden of colorectal cancer in District Kangra, aligning with broader efforts to enhance public health outcomes and promote early detection and prevention strategies.

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2. Gupta, S., et al. "An Overview of Colorectal Cancer in India: Evidence from Studies on Fecal Occult Blood Test and Colonoscopy." Indian Journal of Cancer, vol. 56, no. 3, 2019, pp. 221–226.

3. Ghoshal, U.C., et al. "Burden of Colorectal Cancer in India: Still a Long Way to Go!" Indian Journal of Medical Research, vol. 153, no. 2, 2021, pp. 160–162.

4. Singh, et al. "Knowledge, Attitude, and Practice of Colorectal Cancer Screening Among Healthcare Providers: A Cross-Sectional Study from a Tertiary Care Center in North India." Indian Journal of Cancer, vol. 57, no. 3, 2020, pp. 278–283.

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6. Patel, T., et al. "Knowledge, Attitude, and Practice of the General Population Towards Colorectal Cancer in Saurashtra Region, Gujarat, India." Journal of Family Medicine and Primary Care, vol. 8, no. 5, 2019, pp. 1610–1617.

7. Malhotra, C., et al. "Knowledge, Awareness, and Prevention of Colorectal Cancer Among Urban and Rural Populations in North India." Canadian Journal of Gastroenterology and Hepatology, 2017, Article ID 1–9.