In rural regions like Kangra, Himachal Pradesh, fractures are a common consequence of occupational hazards, falls and limited infrastructure, yet public knowledge about effective first-aid and bone health remains insufficient. Immediate actions, such as immobilizing a fractured limb, can significantly influence recovery, but misconceptions and reliance on traditional remedies often lead to complications like delayed healing or permanent disability. This study seeks to illuminate the extent of awareness and identify gaps in understanding fracture first-aid and bone health among Kangra’s rural population [1,2].

Bone health, supported by adequate calcium, vitamin D and physical activity, is crucial for preventing fractures and ensuring robust recovery. However, rural communities face challenges such as low nutritional awareness, restricted healthcare access and cultural practices that may prioritize ineffective treatments over medical intervention. In Kangra, where agriculture and manual labor dominate, the risk of fractures is heightened, yet systematic evaluations of community knowledge are lacking, leaving a critical gap in public health planning [3,4].

The rugged terrain and dispersed settlements of Kangra exacerbate delays in accessing orthopedic care, making community-level preparedness essential. Misunderstandings, such as the belief that fractures heal without professional care or that topical applications suffice, can worsen outcomes. By assessing knowledge, attitudes and demographic factors influencing awareness, this study aims to provide actionable insights for tailored health interventions, ultimately enhancing fracture management and bone health in this underserved region [5, 6].

This research addresses a pressing need to empower rural communities with accurate information, fostering timely first-aid responses and proactive bone health practices. The findings will guide policymakers and health educators in designing interventions that resonate with Kangra’s socio-cultural context, reducing the burden of fracture-related morbidity.

Study Design

A cross-sectional, descriptive study was implemented to explore knowledge, attitudes and misconceptions regarding fracture first-aid and bone health among rural adults in Kangra, Himachal Pradesh. Quantitative data were gathered using a structured online questionnaire to ensure diverse participation.

Study Location and Participants

The study focused on rural areas of Kangra, a district marked by socioeconomic diversity and limited orthopedic care access. Eligible participants were adults aged 18 years or older, permanent residents of Kangra, with a focus on rural communities to address their unique health literacy challenges.

Study Period

Data collection spanned Jan to March 2025, providing ample time to engage participants across rural Kangra.

Sample Size and Sampling

A sample of 460 participants was determined using a 95% confidence interval, 50% estimated awareness prevalence and a 5% margin of error, with a 10% buffer for incomplete responses. Purposive and convenience sampling ensured rural representation, with the questionnaire distributed via social media platforms (WhatsApp, community forums) and local health workers.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Adults aged ≥18 years
• Permanent Kangra residents
• Ability to respond in Hindi or English
• Voluntary participation with informed consent

Exclusion Criteria

• Individuals with unrelated severe musculoskeletal conditions
• Unwilling or unable to consent
• Incomplete or unclear responses

Data Collection Tool

A validated questionnaire, designed with input from orthopedic specialists and public health experts, included three sections:

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

• Knowledge Evaluation: 20 multiple-choice questions on fracture first-aid (e.g., immobilization techniques) and bone health (e.g., nutrition, risk factors)

• Health-Seeking Practices: Questions on experiences with orthopedic care, attitudes toward medical consultation and access barriers. The questionnaire was offered in Hindi and English for inclusivity.

• Knowledge Scoring: Responses were scored based on accuracy and grouped as:

• Excellent:                     ≥80%
• Satisfactory:                60%–79%
• Moderate:                     41%–59%
• Low:                                               <40%

Data Collection Process

The questionnaire was shared via Google Forms, promoted through local networks and health workers. Participants were informed of the study’s purpose, anonymity and voluntary nature, with consent required before participation.

Data Analysis

Data were cleaned in Microsoft Excel and analyzed using SPSS (version 26.0). Descriptive statistics summarized demographics and knowledge levels, while chi-square tests assessed associations between socio-demographic variables and knowledge categories (p<0.05).

The 460 respondents showed a balanced gender distribution (51.7% female, 48.3% male). Most were aged 26–35 years (33.5%) or 36–45 years (29.1%), with fewer in the 18–25 (17.8%) and ≥46 (19.6%) groups. Education levels included secondary school (35.9%), undergraduate (30.4%) and no formal education (6.1%). Occupations were predominantly farmers (27.6%), homemakers (25.2%) and laborers (15.9%). Rural participants (68.7%) outnumbered urban (31.3%), aligning with the study’s rural focus (Table 1).

Table 1: Socio-Demographic Characteristics of Participants

Knowledge of fracture first-aid and bone health was moderate. Most participants (84.3%) correctly identified immobilization as essential for fracture care and 80.2% recognized calcium’s role in bone health. However, only 62.8% knew to avoid moving a fractured limb and 60.4% linked vitamin D deficiency to bone weakness. Awareness of complications, such as infection (65.2%), was limited, highlighting critical gaps (Table 2).

Table 2: Awareness and Knowledge of Fracture First-Aid and Bone Health

Knowledge scores indicated 36.1% of participants had "Excellent" and 38.5% "Satisfactory" knowledge, reflecting moderate awareness. However, 17.4% had "Moderate" and 8.0% "Low" knowledge, particularly among rural and less-educated groups, signaling the need for targeted interventions (Table 3).

Table 3: Knowledge Score Classification

This study offers a detailed exploration of fracture first-aid and bone health knowledge among Kangra’s rural communities, revealing a blend of encouraging awareness and concerning gaps. Participants demonstrated strong recognition of immobilization (84.3%) as a cornerstone of fracture first-aid and calcium’s importance (80.2%) for bone health, aligning with findings from studies in other developing regions where basic health concepts are partially disseminated. However, critical deficiencies, such as limited understanding of avoiding limb movement (62.8%) and vitamin D’s role (60.4%), highlight areas requiring urgent educational focus to prevent mismanagement and long-term complications.

The socio-demographic profile underscores the study’s emphasis on rural residents (68.7%), who face systemic barriers like geographic isolation and scarce orthopedic services. Lower knowledge scores among rural participants and those with minimal education (6.1% with no formal education) reflect the challenges of health literacy in resource-constrained settings. Farmers (27.6%) and laborers (15.9%), prevalent in the sample, are particularly at risk due to occupational hazards, yet their awareness of preventive measures, such as weight-bearing exercise (73.9%), remains suboptimal. These findings echo research in rural India, where traditional remedies, like herbal applications, often delay professional care.

Significant gaps in recognizing complications, such as infection (65.2%) and malunion (67.4%), suggest a lack of appreciation for fractures’ long-term impacts. Similarly, limited awareness of environmental factors like low sunlight exposure (63.5%) and lifestyle factors like smoking (75.9%) indicates missed opportunities for proactive bone health. These deficiencies may stem from cultural practices prioritizing immediate relief over prevention, compounded by inadequate health outreach in rural Kangra. The bilingual questionnaire and community-based distribution mitigated some access barriers, but the persistence of “Moderate” (17.4%) and “Low” (8.0%) knowledge levels underscores the need for sustained efforts.

Urban participants (31.3%) showed higher awareness, likely due to better healthcare access and media exposure, highlighting a rural-urban divide. This disparity suggests that interventions should leverage local resources, such as Accredited Social Health Activists (ASHAs), to deliver practical training on splinting and nutritional guidance. Addressing misconceptions, such as the belief that fractures heal without intervention, is critical to encourage timely medical consultation. Future programs should integrate community workshops and mobile health units to enhance accessibility.

Limitations include potential selection bias from online questionnaire distribution, which may have excluded those without internet access and the cross-sectional design, which limits insights into knowledge changes over time. Nonetheless, the study’s large sample and rural focus provide a robust baseline for health policy. Further research should evaluate the efficacy of educational interventions and explore longitudinal impacts on fracture management and bone health behaviors.

This investigation highlights a moderate level of understanding of fracture first-aid and bone health in rural Kangra, overshadowed by notable gaps among rural and less-educated residents. Strategic health campaigns, bolstered by accessible orthopedic services and community-driven education, are vital to empower these communities, minimize fracture-related disabilities and foster resilient bone health, paving the way for improved well-being in this challenging region.

Ethical Approval

The study received ethical approval from the Institutional Ethics Committee. Participants were assured of confidentiality, voluntary participation and the right to withdraw. Data were securely stored to protect privacy.

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2. Rashmi, P. et al. "A Descriptive study to assess the awareness on first aid of fracture among selected rural public of Mysuru." International Journal of Orthopaedic Nursing Practice, vol. 1, no. 1, 2023, pp. 1–5.

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