Conjunctivitis, widely known as "pink eye," is among the most prevalent ocular conditions globally, characterized by inflammation or infection of the conjunctiva—the transparent membrane covering the white of the eye and inner eyelid. Common symptoms include redness, swelling, itching, tearing, and discharge, resulting in substantial discomfort and interruption of daily activities [1,2]. Despite being typically mild and easily treatable, conjunctivitis frequently triggers anxiety and stigma, largely due to widespread public misconceptions and misinformation about its contagiousness, transmission, and effective management. Such misunderstandings can lead to delayed diagnosis, inappropriate self-medication, and potentially preventable complications [3-5].

In India, conjunctivitis remains notably prevalent, exacerbated by varying levels of public health awareness, inadequate healthcare infrastructure, and socio-cultural barriers, particularly within rural and underserved communities. Himachal Pradesh, a northern Indian state characterized by remote mountainous terrain, limited access to ophthalmological services, and diverse socio-economic conditions, represents a context where public misconceptions about conjunctivitis can significantly impede effective management. Traditional beliefs and misinformation, including misconceptions about transmission through casual contact or myths surrounding home remedies, frequently guide public responses, resulting in reluctance to seek timely professional medical intervention [6,7].

Enhancing community-level understanding about conjunctivitis, including accurate information about its causes, symptoms, and evidence-based treatment options, is crucial for reducing anxiety and stigma, encouraging early healthcare-seeking behavior, and preventing unnecessary complications. Previous research indicates that improved public awareness correlates directly with better health outcomes, highlighting the critical role of targeted educational interventions. Yet, in Himachal Pradesh, systematic assessment of public awareness and misconceptions specifically regarding conjunctivitis remains limited [7,8].

Therefore, this study aims to comprehensively examine public perceptions, knowledge gaps, and prevailing misconceptions about conjunctivitis among residents of Himachal Pradesh. By identifying demographic and socio-cultural factors associated with awareness levels, this research will inform culturally sensitive, targeted public health strategies. Ultimately, enhancing accurate knowledge and debunking myths about conjunctivitis will facilitate timely diagnosis, appropriate treatment-seeking behavior, reduced stigmatization, and overall improvement in ocular health across this geographically challenging region.

Research Design

A descriptive cross-sectional study design was adopted to systematically assess public awareness, perceptions, and common misconceptions regarding conjunctivitis ("pink eye") among the general population of Himachal Pradesh. The research utilized quantitative data collected through a structured online questionnaire, ensuring comprehensive socio-demographic representation.

Study Area and Population

The study was conducted across multiple districts of Himachal Pradesh, a northern Indian state known for its mountainous terrain, scattered rural communities, and varying healthcare access. Selected districts represented diverse geographic and socio-economic contexts, including urban centers, semi-urban towns, rural villages, and remote mountainous settlements. Participants included adults aged 18 years and above, permanently residing within Himachal Pradesh, with a targeted emphasis on rural and underserved populations known to experience limited healthcare access and higher vulnerability to misinformation.

Study Duration

Data collection spanned a period of three months, from October to December 2024, allowing adequate time for broad geographic coverage and robust participation.

Sample Size and Sampling Technique

A total sample size of 400 participants was determined based on a 95% confidence interval, assuming 50% prevalence of public awareness regarding conjunctivitis, and a 5% margin of error. To account for potential incomplete or unusable responses, an additional 10% buffer was included. Convenience and purposive sampling methods were employed, utilizing electronic dissemination via widely used social media platforms such as WhatsApp groups, Facebook community pages, and local online forums, ensuring diverse demographic representation across urban and rural areas.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Adults aged 18 years or above

• Permanent residents of Himachal Pradesh

• Ability to understand and respond to the questionnaire in either Hindi or English

• Willingness to provide informed consent and participate voluntarily

• Exclusion Criteria:

• Individuals with previously diagnosed severe ocular conditions unrelated to conjunctivitis

• Participants unable or unwilling to provide informed consent

• Respondents submitting incomplete or ambiguous questionnaire responses

Data Collection Instrument

A structured, validated questionnaire specifically designed for this study was developed in consultation with ophthalmologists, public health experts, and community healthcare professionals. The questionnaire comprised three distinct sections:

• Socio-Demographic Information: Including age, gender, educational qualification, occupational status, and residential setting (urban or rural).

• Knowledge and Awareness Assessment: Consisting of 20 multiple-choice questions focused explicitly on conjunctivitis, covering symptoms, causes, modes of transmission, preventive measures, standard treatment options, myths, and misconceptions.

• Healthcare-Seeking Behavior: Evaluating participants' past experiences, attitudes towards professional healthcare seeking for conjunctivitis, perceived barriers to accessing care, and preferred sources of health information.

The questionnaire was made available bilingually (Hindi and English), ensuring accessibility and comprehension among respondents from varying educational backgrounds.

Scoring and Knowledge Classification

Participants' responses to the knowledge assessment section were quantitatively scored, with total scores categorized into four clearly defined knowledge categories:

• Very Good Knowledge: ≥80% correct responses

• Good Knowledge: 60%–79% correct responses

• Fair Knowledge: 41%–59% correct responses

• Poor Knowledge: <40% correct responses

This classification enabled precise identification of groups requiring targeted educational interventions.

Data Collection Procedure

The questionnaire was disseminated electronically through Google Forms, widely shared via social media platforms and community groups in Himachal Pradesh. Clear instructions accompanied each link, emphasizing voluntary participation, anonymity, confidentiality, and the right to withdraw at any time. Informed consent was explicitly obtained from all participants prior to survey completion.

Data Analysis

Collected data were thoroughly reviewed, cleaned, and organized using Microsoft Excel. Descriptive statistics and analyses were performed using SPSS (version 26.0). Frequencies, percentages, means, and standard deviations summarized socio-demographic characteristics, knowledge scores, and healthcare-seeking behaviors. 

Ethical Considerations

Ethical approval was secured prior to study initiation. Participants were informed clearly about the study’s purpose, their voluntary participation, confidentiality assurance, and freedom to withdraw at any stage without repercussions. All collected data were managed confidentially and used strictly for research purposes, ensuring complete participant anonymity.

The socio-demographic characteristics of the 400 participants showed balanced gender representation, with slightly more females (51.5%) than males (48.5%). Most respondents were within the age groups of 26–35 years (35.5%) and 36–45 years (29.8%), highlighting active participation among working-age adults. Educationally, a significant portion of participants held undergraduate degrees (34.3%) or secondary school qualifications (32.8%), while only a small fraction had no formal education (4.5%). Occupationally, homemakers comprised the largest group (27.3%), followed by office workers (22.8%) and teachers (15.8%), with students also representing a notable portion (12.8%). More than half of the respondents (57.8%) resided in rural areas, underscoring the importance of assessing conjunctivitis awareness within rural communities Regarding awareness and knowledge about conjunctivitis, participants generally demonstrated good foundational understanding. A majority correctly identified conjunctivitis as "pink eye" (80.8%), recognized its contagious nature (85.3%), and knew to consult a doctor when symptoms appeared (77.8%). Many respondents identified preventive measures, such as avoiding eye contact (79.8%) and frequent handwashing (73.3%). Nevertheless, important knowledge gaps emerged, particularly around identifying vitamin A's role in overall eye health (63.5%), understanding that ear wax is not a conjunctivitis cause (63.3%), and recognizing potential risks such as corneal damage from untreated conjunctivitis (65.3%). These findings indicate key areas requiring focused public health education.

Table 1: Socio-Demographic Characteristics of Participants

Table 2: Awareness and Knowledge of Conjunctivitis Among the General Population

The classification of overall knowledge scores further revealed valuable insights into public understanding. A substantial proportion of participants exhibited either "Very Good" (37.8%) or "Good" (39.8%) knowledge levels, highlighting a generally strong baseline awareness among the population. However, a notable segment of respondents still displayed only "Fair" (16.8%) or "Poor" (5.8%) knowledge, suggesting the presence of critical misconceptions and inadequate awareness among specific groups.  These findings initiatives, particularly directed toward less-underscore the necessity for targeted educational educated and rural communities, to improve public understanding, dispel misconceptions, and encourage timely medical consultations for conjunctivitis, ultimately reducing preventable ocular morbidity.

 

Figure 1: Knowledge Score Classification

The current study provides an extensive evaluation of public awareness, perceptions, and misconceptions regarding conjunctivitis among the general population in Himachal Pradesh, offering critical insights that can inform targeted public health interventions. Overall, participants displayed commendable foundational knowledge about conjunctivitis, commonly identifying it as "pink eye," recognizing its contagious nature, and understanding the necessity for medical consultation when symptoms appear. However, despite these positive findings, significant knowledge gaps and misconceptions were evident, particularly concerning the understanding of underlying causes, transmission modes, preventive strategies, potential complications, and appropriate treatment methods. Such misconceptions represent key barriers that could contribute to delayed treatment, inappropriate self-medication, increased disease transmission, and preventable ocular complications.

Socio-demographic analysis underscored the representativeness of the study sample, comprising balanced gender distribution and active participation from economically productive age groups (26–45 years). The study’s notable inclusion of a substantial rural population (57.8%) highlights the importance of addressing conjunctivitis awareness specifically within rural communities. Given Himachal Pradesh's challenging terrain and limited healthcare infrastructure, rural residents often encounter significant barriers in accessing timely healthcare, increasing their susceptibility to misinformation and reliance on traditional beliefs. Consequently, targeted educational interventions, especially those leveraging community health workers and local communication channels, become particularly critical in addressing these rural-specific knowledge deficits.

Regarding specific knowledge about conjunctivitis, the majority of respondents successfully recognized the primary symptoms (e.g., red, itchy eyes), understood its contagious nature, and correctly identified ophthalmologists as the appropriate specialists for treatment. Nevertheless, detailed knowledge regarding preventive practices was somewhat inconsistent, with some participants unaware of simple yet crucial hygiene measures such as regular handwashing or avoiding the sharing of personal items. Additionally, there was noticeable uncertainty about specific causes, including the roles of bacterial infections and allergies. This gap in understanding could contribute significantly to inadequate preventive behaviors, potentially exacerbating outbreaks of conjunctivitis, especially in communal settings such as schools or workplaces.

One critical area where misconceptions were particularly prominent involved understanding the potential risks and complications associated with untreated conjunctivitis. A notable proportion of participants underestimated serious consequences such as corneal damage, which can lead to impaired vision if untreated. Misunderstandings around nutritional aspects such as vitamin A's role in eye health and confusion over irrelevant factors (e.g., ear wax as a cause of conjunctivitis) further demonstrate the need for more precise public health messaging. Misconceptions about conjunctivitis resolving spontaneously without professional intervention might discourage timely healthcare seeking, potentially increasing the risk of complications.

The study’s knowledge score classification revealed that while a substantial proportion of participants (approximately 78%) exhibited either "Good" or "Very Good" levels of awareness, a concerning number still fell into "Fair" (16.8%) or "Poor" (5.8%) knowledge categories. These lower-knowledge groups typically represent rural populations and individuals with lower educational attainment, emphasizing the significant role of socio-demographic determinants in shaping conjunctivitis awareness. Therefore, public health strategies must not only address general misconceptions but also directly target vulnerable groups, utilizing culturally sensitive educational materials, visual aids, and accessible language to ensure effective information dissemination.

The identified knowledge gaps and misconceptions align with broader research findings, both nationally and internationally, indicating widespread confusion about conjunctivitis symptoms, transmission routes, treatment methods, and prevention strategies. To effectively address these gaps, public health initiatives in Himachal Pradesh must be multifaceted, integrating educational campaigns delivered through community-based programs, local media, schools, healthcare facilities, and digital platforms. Strengthening rural healthcare services by integrating conjunctivitis screening and education into existing primary care networks could significantly enhance early detection and appropriate treatment-seeking behavior.8,9

Furthermore, leveraging community healthcare workers such as Accredited Social Health Activists (ASHAs) and Anganwadi workers could enhance trust and efficacy in educational outreach, particularly in rural or underserved areas. Clear communication emphasizing accurate transmission modes, preventive behaviors, and recognizing early warning symptoms requiring immediate medical consultation can mitigate stigma and anxiety associated with conjunctivitis outbreaks.9,10

This study highlights commendable baseline awareness regarding conjunctivitis among residents of Himachal Pradesh while identifying critical knowledge deficits that require targeted, culturally tailored interventions. Addressing these gaps through comprehensive educational campaigns, enhancing rural healthcare infrastructure, and ensuring consistent, accessible, and accurate public health messaging are crucial for reducing the incidence, severity, and complications associated with conjunctivitis. Future studies should evaluate the long-term effectiveness of these interventions, focusing on sustained improvements in community awareness, reductions in disease transmission, and enhanced ocular health outcomes across diverse populations in the region.

This study highlights that although residents of Himachal Pradesh possess generally sound foundational knowledge regarding conjunctivitis, significant misconceptions persist, particularly concerning causes, preventive practices, complications, and the necessity of timely medical intervention. These knowledge gaps disproportionately affect rural and educationally disadvantaged populations, underscoring the need for targeted, culturally sensitive educational initiatives and enhanced healthcare accessibility. Addressing these issues through focused public awareness campaigns, strengthening primary healthcare infrastructure, and leveraging   local   healthcare   workers   will  significantly  improve early diagnosis, reduce stigma, and prevent unnecessary complications associated with conjunctivitis. Future research should assess the effectiveness of such interventions to sustain improvements in public knowledge and ocular health outcomes across this geographically challenging region.

1. Maxwell, Silva et al. “Assessing knowledge, attitude, and practice regarding conjunctivitis among patients.” J Clin Ophthalmol Res, vol. 12, no.2, May 2024, pp.91–5. https://journals.lww.com/jcor/fulltext/2024/12020/assessing_knowledge,_attitude,_and_practice.6.aspx.

2. Ismail, Galal Mohamed et al. “Knowledge and awareness of allergic conjunctivitis among population: a systematic review.” Gen Med, vol. 26, no.1, January 2024, pp.1137–42. 378866556_Knowledge_and_awareness_of_allergic_conjunctivitis_among_population_A_Systematic_Review

3. Tyagi, Rupali, et al. “A prospective observational study on viral conjunctivitis: An exasperating entity.” JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, vol. 19, no. 3, March 2025, pp. 6-9. http://dx.doi.org/10.7860/jcdr/2025/76392.20759.

4. O’brien, Terrence P, et al. “Acute conjunctivitis: Truth and misconceptions.” Current Medical Research and Opinion, vol. 25, no. 8, June 2009, pp. 1953-1961. http://dx.doi.org/10.1185/03007990903038269.

5. Bashir, Mahadi, et al. “Evaluation of allergic conjunctivitis prevalence and attitude toward prevention and control in Saudi Arabia.” Cureus, vol. 16, no. 4, April 2024. http://dx.doi.org/10.7759/cureus.57711.    

6. Kyei, Samuel, et al. “Knowledge and awareness of ocular allergy among undergraduate students of public universities in Ghana.” BMC Ophthalmology, vol. 16, no. 1, October 2016. http://dx.doi.org/10.1186/s12886-016-0366-2.     

7. Song, Ke, et al. “Knowledge attitude and practice of patients with allergic conjunctivitis towards their disease.” Scientific Reports, vol. 15, no. 1, February 2025. http://dx.doi.org/10.1038/s41598-025-87518-2.    

8. Thakur, Chandresh and Swati Dhiman. “Allergic eyes unveiled: enhancing awareness and management of eye allergies in District Kangra, Himachal Pradesh.” Himal J Appl Med Sci Res, vol. 4, no. 2, December 2023, pp.2–8. https://www.himjournals.com/hjamr/948/1294/articleID%3D1353/

9. Al-Ghofaili, Reema Saleh et al. “Assessment of knowledge and awareness of ocular allergy among undergraduate students, University of Tabuk, Tabuk City, Saudi Arabia.”  Int J Med Res Prof, vol. 4, no.1, 2018, pp.459–64. https://www.europub.co.uk/articles/ assessment-of-knowledge-and-awareness-of-ocular -allergy-among-undergraduate-students-university -of-tabuk-tabuk-city-saudi-arabia-A-531030