In the picturesque landscapes of Himachal Pradesh, nestled amidst the majestic Himalayan ranges, a crucial aspect of public health often goes unnoticed—the awareness and knowledge regarding thyroid disorders. The thyroid gland, a small but potent regulator of various bodily functions, plays a significant role in maintaining overall well-being. However, the level of awareness and understanding of thyroid disorders, encompassing hypothyroidism and hyperthyroidism, among the general public in Himachal Pradesh remains largely unexplored.[1-2]

Thyroid disorders are prevalent worldwide, affecting millions of individuals and significantly impacting their quality of life. The implications of these disorders extend beyond the physical realm, influencing mental health, metabolism, and overall systemic balance. Given the diverse environmental factors and unique lifestyle patterns in Himachal Pradesh, understanding the local population's awareness and knowledge regarding thyroid disorders becomes imperative for public health interventions.[3-4]

This study aims to bridge the existing gap in literature by conducting a comprehensive evaluation of the awareness and knowledge levels concerning thyroid disorders among the general public of Himachal Pradesh. By assessing the current state of awareness, potential gaps in knowledge, and prevalent misconceptions, the findings of this research endeavor will contribute to the development of targeted educational programs and healthcare policies tailored to the specific needs of the region.

This research seeks to shed light on the current status of thyroid disorder awareness in Himachal Pradesh, unraveling the intricacies of knowledge gaps and misconceptions prevalent among the population. By doing so, it aspires to pave the way for informed public health strategies that empower individuals to take charge of their thyroid health, thereby fostering a healthier and more resilient community in the heart of the Himalayas.

OBJECTIVES OF THE STUDY

To evaluate the awareness and knowledge regarding thyroid disorders, including hypothyroidism and hyperthyroidism among general public of Himachal Pradesh.

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area:  State of Himachal Pradesh

• Study duration- between July 2023 to October 2023

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of 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 thyroid disorders, including hypothyroidism and hyperthyroidism, 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 thyroid disorders, including hypothyroidism and hyperthyroidism 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, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structuredknowledge related questions regarding thyroid disorders, including hypothyroidism and hyperthyroidism. 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 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

Table [1] The study aimed to gain insights into the awareness and knowledge of thyroid disorders, including hypothyroidism and hyperthyroidism within this demographic, shedding light on their understanding of these conditions, their symptoms, and potential risk factors.

A total of 400 respondents participated in the study, comprising 219 individuals (54.75%) from urban areas and 181 individuals (45.25%) from rural areas of District Shimla. 

Table-1: Knowledge regardingthyroid disorders among study participants

Table [2] In the present study 30.25% (121)  participants had very good knowledge (16-20 marks) towards thyroid disorders, including hypothyroidism and hyperthyroidism , 36.75% (147) had good knowledge (12-15 marks), 21% (84) had fair knowledge  (8-11 marks) and 12% (48) having poor knowledge  (<8 marks).

Table-2: Knowledge scores towards thyroid disorders among study participants

The present study provides a nuanced understanding of thyroid disorder awareness and knowledge among residents of Himachal Pradesh. With 54.75% of respondents from urban areas and 45.25% from rural areas, this research contributes valuable insights into thyroid-related awareness across diverse settings in the state.

The distribution of knowledge scores reveals varying levels of understanding, with 30.25% displaying very good knowledge, 36.75% showing good knowledge, 21% exhibiting fair knowledge, and 12% indicating poor knowledge. This stratification emphasizes the need for targeted educational interventions.

Analysis of individual knowledge domains highlights both strengths and gaps. While a substantial proportion could define hypothyroidism and hyperthyroidism (61.5%), identify the main thyroid hormone (54.75%), and explain the impact of untreated thyroid disorders on overall health (40.75%), there were lower scores in areas such as naming symptoms of hyperthyroidism (36.25%) and identifying risk factors (24.25%).

Benchmarking against global studies (Smith et al., Li et al.,) [3-4] and Indian studies (Sharma et al., Gupta et al., Patel et al., Khan et al., Das et al., Vermaet al.,) [5-10] allows for a more comprehensive comparison. The findings align with the broader literature on thyroid awareness, emphasizing the universal challenges. Furthermore, insights from regional studies by Joshi et al. [1] and Kumar et al. [2] provide a localized perspective, emphasizing the need for region-specific interventions.

The identified gaps in knowledge offer opportunities for targeted public health interventions. Tailoring awareness campaigns to address specific areas with lower knowledge scores, informed by successful strategies in Indian contexts (Gupta et al., Sharma et al.,) [9,10], regional nuances (Joshi et al., Kumar et al.,)[1,2], and global insights (Li et al.) [3], could lead to significant improvements.

The influence of sociocultural factors on thyroid awareness is crucial. Acknowledging the impact of local traditions, beliefs, and practices on health-seeking behavior is essential for tailoring interventions effectively. Cultural competence, as highlighted in studies by Patel et al.[8] and Khan et al. [7] , plays a pivotal role in enhancing awareness.

LIMITATIONS AND FUTURE RESEARCH:

Limitations, such as self-reported data and an online survey approach, should be considered. Future research could adopt a mixed-methods approach, incorporating qualitative insights to better understand the cultural nuances influencing thyroid awareness in Himachal Pradesh.

In conclusion, this comprehensive study evaluating thyroid disorder awareness among the residents of Himachal Pradesh reveals a diverse landscape of knowledge levels, with a significant proportion demonstrating good to very good awareness. However, notable gaps persist, particularly in recognizing symptoms of hyperthyroidism and identifying risk factors. The findings, benchmarked against global, Indian, and regional studies, underscore the universal challenges in thyroid awareness while emphasizing the unique regional nuances. Tailoring public health interventions to address these specific gaps, drawing insights from successful strategies in India and beyond, holds the key to enhancing thyroid knowledge and empowering individuals in managing their thyroid health effectively. This research contributes not only to the local discourse but also adds valuable perspectives to the broader global conversation on thyroid awareness.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Government Medical College and Rajindra Hospital, Patiala

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9. Sharma, R., Sharma, R. K., and Kapoor, B. "Awareness and Knowledge of Thyroid Disorders in an Indian Community." Thyroid Research and Practice, vol. 17, no. 2, 2019, pp. 58-64.

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