Low backache (LBA) is one of the most prevalent musculoskeletal disorders worldwide, affecting individuals across all age groups and socio-economic backgrounds. It is a leading cause of disability and reduced quality of life, often resulting in chronic pain, limited mobility, and psychological distress. The burden of low backache is not only confined to the physical health of individuals but also extends to substantial economic implications, including lost productivity, increased healthcare costs, and a significant impact on both personal and professional life.^1-6

In India, particularly in rural and semi-urban areas such as District Kangra in Himachal Pradesh, the awareness and understanding of low backache remain limited. Despite the high prevalence of low back pain, many individuals do not recognize its causes, risk factors, and prevention strategies. This lack of knowledge often leads to delayed diagnosis, improper management, and reliance on self-medication or traditional remedies that may not be effective, further exacerbating the condition. The increasing incidence of low backache in these regions can be attributed to factors such as sedentary lifestyles, improper lifting techniques, lack of physical activity, and poor ergonomics, coupled with a lack of access to adequate healthcare facilities and information.^5-10

Himachal Pradesh, with its unique demographic and occupational characteristics, presents a significant case for studying low backache awareness. The district of Kangra, one of the most populous regions in the state, offers a representative sample to gauge the public's understanding of low backache. The region's diverse population, which includes individuals engaged in various occupations such as agriculture, construction, and office work, provides a valuable opportunity to explore the awareness and knowledge levels across different occupational groups.

Understanding the level of awareness and knowledge about low backache among the general public is crucial for developing effective public health strategies. By identifying gaps in knowledge and misconceptions surrounding low backache, healthcare providers and public health practitioners can design targeted educational interventions to promote better prevention, early diagnosis, and effective management of this condition. Such interventions are vital for reducing the burden of low backache, improving the quality of life for affected individuals, and minimizing the economic impact on both the individual and the community.

This study aims to assess the awareness and knowledge of low backache among adults in District Kangra, Himachal Pradesh. Through a comprehensive cross-sectional survey, this research seeks to provide insights into the public's understanding of low backache, including its causes, risk factors, prevention, and management. By shedding light on the current state of knowledge, this study will contribute to the development of more informed healthcare practices and better management strategies for low backache at the community level.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Low Backache among general public of District Kangra, Himachal Pradesh. 

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: District Kangra, Himachal Pradesh

• Study duration- between January 2024 to May 2024

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra Himachal Pradesh 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 Low Backache, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Low Backache 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- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structuredknowledge related questions regarding Low Backache.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 study involved 400 participants from District Kangra, Himachal Pradesh, and provided valuable insights into the socio-demographic characteristics and knowledge levels regarding low backache among the general public.

The participants were fairly evenly distributed across different age groups, with 29.8% aged 18-30 years, 25.8% aged 31-40 years, 22.8% aged 41-50 years, and 21.8% above 50 years of age. Gender distribution was balanced, with 49.3% males and 50.8% females. In terms of marital status, the majority were married (56.8%), followed by single individuals (39.8%), and a small percentage (3.5%) categorized as others. The religious composition of the sample showed that 83.5% were Hindu, 6.5% Muslim, 7.8% Sikh, and 2.3% belonged to other religions. Employment status revealed that nearly half of the participants (49.8%) were employed, while 26.8% were unemployed, and 23.5% were students. Regarding education levels, 34.3% were graduates, 26.5% had completed high school, 26.0% had postgraduate or higher education, and 13.3% had education below high school.

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

The awareness of low backache symptoms among participants was relatively high. A significant 80.3% had heard of low backache, and 70.8% knew that it could cause severe pain. Additionally, 67.3% recognized that low backache could limit mobility, 64.8% were aware that it could cause stiffness, and 63.5% knew that it could be a chronic condition. These findings indicate that while most participants were aware of low backache and its primary symptoms, there is still room for improving awareness, especially concerning the chronic nature of the condition.

Table 2: Knowledge Regarding Symptoms of Low Backache (N=400)

Knowledge about the causes and risk factors of low backache was moderate among the participants. About 61.0% understood that poor posture could lead to low backache, and 59.3% were aware of the risks associated with heavy lifting. Moreover, 57.3% knew that prolonged sitting could increase the risk, while 54.8% recognized the role of a lack of exercise. Awareness about age-related changes contributing to low backache was slightly lower, at 53.0%. These results suggest that while there is a general understanding of the common risk factors, public health efforts could focus on emphasizing the importance of maintaining good posture and staying active to prevent low backache.

Table 3: Knowledge Regarding Causes and Risk Factors of Low Backache (N=400)

Participants' knowledge about preventive measures for low backache showed some gaps. While 53.5% knew that maintaining good posture could help prevent low backache, only 52.3% were aware of the benefits of regular exercise. Similarly, 50.5% recognized that ergonomic adjustments at work could be preventive, and 47.8% understood the importance of proper lifting techniques. Knowledge about maintaining a healthy weight as a preventive measure was lower, at 44.8%. These findings highlight the need for targeted educational interventions focusing on practical preventive strategies, such as ergonomics and weight management.

Table 4: Knowledge Regarding Prevention of Low Backache (N=400)

Awareness of treatment and management options for low backache was relatively low among the participants. Only 47.3% knew that physical therapy could help manage low backache, and 45.3% were aware that medications could relieve symptoms. Fewer participants (42.3%) understood the benefits of exercises targeting back muscles, and 39.8% were familiar with hot/cold therapy as a management option. Knowledge about surgical intervention for severe cases was the lowest, at 37.3%. These results suggest a need for better dissemination of information about both conservative and surgical treatment options for low backache, ensuring that individuals are aware of the full range of available management strategies.

Table 5: Knowledge Regarding Treatment and Management of Low Backache (N=400)

The overall knowledge scores for low backache revealed a varied distribution among participants. About 25.3% demonstrated very good knowledge, scoring between 16-20 points. Meanwhile, 29.3% had good knowledge (12-15 points), and 27.8% had fair knowledge (8-11 points). However, 17.8% of participants fell into the poor knowledge category, scoring below 8 points. This distribution indicates that while a portion of the population has a strong understanding of low backache, a significant percentage still requires better education and awareness regarding this common condition.

Table 6: Overall, Knowledge Score Categories for Low Backache (N=400)

This study provides a comprehensive assessment of the awareness and knowledge regarding low backache among the general public in District Kangra, Himachal Pradesh. The findings highlight both strengths and gaps in the public’s understanding of this common and often debilitating condition. Despite the widespread prevalence of low backache, there remains a significant need for improved education and awareness, particularly concerning its causes, prevention, and management.

The study sample was well-distributed across various demographic categories, offering a representative snapshot of the population in District Kangra. The near-equal gender distribution and a broad age range reflect the general population's characteristics, allowing for a comprehensive understanding of how knowledge and awareness of low backache vary across different groups. Notably, the majority of participants were married and employed, indicating that low backache awareness is relevant across both personal and professional contexts. However, the relatively high percentage of participants with higher education levels (graduate and postgraduate) suggests that educational attainment could be a factor influencing awareness and knowledge levels. This demographic distribution underscores the importance of targeted educational interventions that consider the diverse socio-economic and educational backgrounds of the population.^4-7

The study revealed that while a significant majority (80.3%) of participants had heard of low backache, detailed knowledge of its symptoms was somewhat lower. While 70.8% were aware that low backache could cause severe pain, fewer participants recognized that it could limit mobility (67.3%), cause stiffness (64.8%), or become a chronic condition (63.5%). This suggests that although the general concept of low backache is well-known, the full spectrum of its symptoms is not as widely understood. This gap in knowledge may contribute to delayed diagnosis and inadequate management, as individuals may not recognize the early signs of the condition or understand its potential to become chronic.^6-8

The knowledge of causes and risk factors for low backache among participants was moderate, with notable gaps. While a majority understood that poor posture (61.0%) and heavy lifting (59.3%) could lead to low backache, fewer participants were aware of the risks associated with prolonged sitting (57.3%), lack of exercise (54.8%), and age-related changes (53.0%). These findings highlight a critical area for public health intervention. Given that many of these risk factors are modifiable, increasing awareness about them could play a significant role in reducing the incidence of low backache. Public health campaigns should emphasize the importance of maintaining proper posture, avoiding prolonged sitting, and incorporating regular exercise into daily routines to mitigate the risk of developing low backache.^9,10

The study also identified gaps in participants' knowledge about the prevention of low backache. While more than half of the participants knew that maintaining good posture (53.5%) and regular exercise (52.3%) could help prevent low backache, awareness of other preventive measures was lower. For example, only 50.5% recognized the importance of ergonomic adjustments at work, and even fewer (47.8%) understood the value of proper lifting techniques. The lowest awareness was related to maintaining a healthy weight as a preventive measure (44.8%). These results suggest that while some preventive strategies are known, there is a need for broader education on the full range of measures that can prevent low backache, particularly in workplace settings where ergonomic practices and proper lifting techniques are crucial.^5,8,9

The participants' knowledge regarding the treatment and management of low backache was relatively limited. Less than half of the participants were aware that physical therapy (47.3%) and medications (45.3%) could help manage low backache. Even fewer understood the benefits of exercises targeting the back muscles (42.3%) and hot/cold therapy (39.8%). The lowest awareness was regarding surgical intervention for severe cases (37.3%). These findings suggest that while conservative treatment options like physical therapy and medication are somewhat recognized, there is a lack of comprehensive understanding of the full range of management strategies. This limited knowledge may lead to suboptimal treatment outcomes, as individuals may not seek or adhere to appropriate treatment plans. Therefore, there is a need for better dissemination of information about both conservative and surgical treatment options for low backache, ensuring that individuals are aware of all available management strategies.^7,8

The overall knowledge scores for low backache revealed a wide distribution, with 25.3% of participants demonstrating very good knowledge, while 17.8% fell into the poor knowledge category. This variability underscores the fact that while some individuals possess a strong understanding of low backache, a significant proportion of the population still lacks adequate knowledge. These results point to the need for targeted educational interventions that address specific gaps in knowledge, particularly among those with lower overall awareness. Such interventions should focus on enhancing understanding of the condition’s symptoms, causes, prevention, and treatment options to ensure that all segments of the population are well-informed.^9,10

Implications For Public Health

The findings of this study have important implications for public health strategies in District Kangra and similar regions. First, there is a clear need for comprehensive educational campaigns that address both the general awareness of low backache and the specific knowledge gaps identified in this study. Public health initiatives should prioritize the dissemination of information on modifiable risk factors, prevention strategies, and treatment options, with a focus on practical, actionable advice that can be easily implemented by the general public.

Second, healthcare providers in the region should be equipped with the tools and resources to educate their patients about low backache, emphasizing early diagnosis and effective management. Community-based interventions, such as workshops, health camps, and workplace ergonomic assessments, could be effective in raising awareness and promoting healthy practices that prevent and manage low backache.

Finally, the use of digital platforms, as demonstrated in this study, can be a powerful tool for reaching a broader audience. By leveraging social media and other online resources, public health campaigns can engage a wide range of individuals and disseminate information more effectively.

This study underscores the significant gaps in awareness and knowledge of low backache among the general public in District Kangra, Himachal Pradesh, despite its prevalence and impact. While basic awareness exists, there is a clear need for targeted educational interventions that address the full spectrum of low backache symptoms, causes, prevention, and management strategies. Enhancing public health campaigns, promoting early diagnosis, and encouraging evidence-based management through community initiatives and healthcare providers are crucial steps in reducing the burden of low backache. Additionally, leveraging digital platforms to disseminate information can further broaden outreach and foster a more informed and proactive approach to managing this common condition, ultimately improving the quality of life for those affected and minimizing its broader societal impact.

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