Thyroid disorders, encompassing a range of conditions such as hypothyroidism, hyperthyroidism, and thyroid nodules, represented a significant yet often under-recognized public health issue. These disorders could lead to a multitude of health complications, including metabolic disruptions, cardiovascular diseases, and impaired cognitive function, thereby affecting the overall well-being and quality of life. In India, thyroid disorders have been increasingly prevalent, necessitating a concerted effort to enhance public awareness and promote early diagnosis and effective management [1-5]

Shimla, the capital of Himachal Pradesh, offered a unique setting for examining the awareness and knowledge of thyroid health among its residents. The district's diverse population, spanning both urban and rural areas, provided a comprehensive perspective on the community's health literacy and access to healthcare resources. The mountainous terrain and lifestyle factors specific to this region may have also influenced the incidence and perception of thyroid disorders, making it imperative to understand local knowledge and attitudes towards these conditions.

The primary objective of this study was to assess the level of awareness and knowledge about thyroid disorders among   the  general  public in  District  Shimla. 

By identifying gaps in knowledge and prevalent misconceptions, this research aimed to support the development of targeted educational and public health initiatives. These initiatives were essential for improving early detection, management, and prevention of thyroid disorders, ultimately enhancing health outcomes for the community.

Given the rising prevalence of thyroid disorders and their potential impact on public health, this study was both timely and crucial. It sought to provide valuable insights into the current state of thyroid health awareness among Shimla's residents, thereby informing future health policies and programs. Understanding community knowledge about thyroid disorders was a key step towards empowering individuals to take proactive measures in maintaining their thyroid health and preventing related complications.

Through this research, we aimed to contribute to the broader effort of addressing thyroid health issues, fostering a more informed and health-conscious community in Shimla. The findings were intended to serve as a foundation for public health strategies designed to mitigate the burden of thyroid disorders and promote better health outcomes across the district.

Objectives of the Study

The primary objective is to gauge awareness and knowledge about Thyroid disorders among general public of District Shimla, Himachal Pradesh.

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area: District Shimla , 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 Shimla 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, 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 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 structured knowledge related questions regarding Thyroid disorders. 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 Shimla 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 aimed to assess the awareness and knowledge regarding thyroid disorders among the general public in District Shimla, Himachal Pradesh. Data was collected from a sample of 400 adults using a structured questionnaire, and the results are presented in three tables: Socio-Demographic Variables, Knowledge Regarding Thyroid Disorders, and Overall Knowledge Score Categories.

Table 1 outlines the socio-demographic characteristics of the study participants. The age distribution shows that 29.3% of participants were aged 18-30 years, 25.5% were 31-40 years, 22.8% were 41-50 years, and 22.5% were over 50 years old. Gender distribution was slightly skewed towards females, with 54.5% female and 45.5% male respondents. Regarding marital status, 39.8% of the participants were single, 55.3% were married, and 5% fell into other categories.

Religious affiliation was predominantly Hindu (84.8%), followed by Muslims (5%), Sikhs (7.5%), and others (2.8%). Employment status indicated that 44.5% of participants were employed, 25.3% were unemployed, and 30.3% were students. Educational attainment varied, with 19.8% having education below high school, 30.5% completing high school, 35% being graduates, and 14.8% having postgraduate or higher qualifications.

Table 2 highlights the participants' knowledge about thyroid disorders. A substantial 80.3% of respondents were knowledgeable about thyroid symptoms, while 72.5% were aware of the risk factors associated with thyroid disorders. Understanding of thyroid function tests was noted in 77% of participants. Knowledge about hypothyroidism symptoms was present in 67.5% and hyperthyroidism symptoms in 70.3%. Awareness regarding thyroid medication was reported by 74.8%, and knowledge of dietary influences on thyroid health by 64.8%. Regular health check-ups were deemed important by 69% of the respondents. The understanding of thyroid's impact on metabolism was known by 60%, and 66.3% recognized   family  history   as    a risk factor. Weight management in the context of thyroid disorders was understood by 71.3% of participants. Stress management for thyroid health was known by 62.5%, and 58% were aware of the symptoms of thyroid nodules. Knowledge about thyroid surgery was present in 61.5% of respondents, while 63.8% were aware of thyroid-related eye problems.

Understanding the risk of heart disease with thyroid issues was noted in 67.8% of participants, and knowledge of thyroid's impact on pregnancy in 65.8%. Awareness of the role of thyroid in mental health was reported by 55%, and knowledge of thyroid cancer symptoms by 57.8%. Finally, 79% of respondents were aware of lifestyle changes beneficial for thyroid health. Table 3 categorizes the overall knowledge scores of the participants. Based on their scores, 25.5% of participants fell into the "Very Good" category (16-20 points), demonstrating a high level of knowledge. The majority, 37.3%, were classified as having "Good" knowledge (12-15 points). Those with "Fair" knowledge (8-11 points) comprised 24.8% of the respondents, while 12.5% had "Poor" knowledge, scoring below 8 points. These results indicate that while a significant portion of the population in Shimla has a good understanding of thyroid disorders, there are still areas with notable knowledge gaps. Addressing these gaps through targeted educational programs and public health initiatives could enhance awareness and management of thyroid disorders, ultimately improving health outcomes in the region.

Table 1: Socio-Demographic variables of the study population (N=400)

Table 2: Knowledge regarding thyroid disorders (N=400)

Table 3: Overall knowledge score categories

The findings from this study provide valuable insights into the current state of knowledge and awareness regarding thyroid disorders among the general public in District Shimla, Himachal Pradesh. The results highlight both strengths and areas for improvement in community awareness, underscoring the need for targeted educational initiatives and public health strategies.

Overall, the study revealed a commendable level of awareness about thyroid disorders among Shimla's residents. Specifically, a significant majority of respondents demonstrated a good understanding of thyroid symptoms (80.3%), risk factors (72.5%), and the importance of regular health check-ups (69%). This high level of awareness is encouraging, as it suggests that a substantial portion of the population can recognize early signs of thyroid issues and understand the need for routine monitoring and medical consultations. Such awareness is crucial for early detection and effective management of thyroid disorders, which can prevent complications and improve quality of life.

Despite the generally high awareness, the study identified notable gaps in knowledge that need to be addressed. For instance, only 55% of participants were aware of the role of thyroid disorders in mental health, and 57.8% were knowledgeable about thyroid cancer symptoms. Additionally, knowledge about dietary influences on thyroid health was relatively low (64.8%). These gaps indicate that while the community is well-informed about the basic aspects of thyroid health, there is less understanding of the more complex and less visible consequences of thyroid disorders.

When compared to other studies, the findings of this research align with those observed in similar contexts. For instance, many previous studies found that while there was a high level of general awareness about thyroid disorders, there were significant gaps in understanding specific aspects such as the impact on mental health and the role of dietary management. Similarly, researches highlighted that while patients were aware of basic thyroid functions, there was limited knowledge about the implications of thyroid disorders on overall health. These comparisons suggest that the knowledge gaps identified in Shimla are consistent with broader trends observed in different regions, reinforcing the need for targeted and comprehensive health education programs globally [6,11].

The socio-demographic analysis revealed that knowledge levels varied across different segments of the population. Participants with higher education levels exhibited better awareness and understanding of thyroid disorders, highlighting the importance of educational attainment in health literacy. This underscores the need for public health initiatives to focus on individuals with lower educational backgrounds, ensuring that they receive adequate information and resources to manage thyroid health effectively.

Employment status also influenced knowledge levels, with employed individuals and students showing higher awareness compared to the unemployed. This finding suggests that workplace and educational institutions could serve as effective platforms for disseminating information about thyroid health. Integrating thyroid health education into workplace wellness programs and school curricula could significantly enhance community awareness.

The findings of this study have significant implications for public health policies and educational initiatives in Shimla. The high levels of awareness in some areas are promising, but the identified knowledge gaps highlight the need for continuous education and tailored interventions. Public health initiatives should focus on the less understood aspects of thyroid disorders, such as their impact on mental health and the importance of dietary management. Additionally, targeted programs aimed at lower educational strata and the unemployed could help bridge the knowledge gap and ensure that all segments of the population are equally informed.

Recommendations for Future Interventions

To enhance thyroid health awareness and management in Shimla, the following recommendations are proposed:

• Targeted Education Programs: Develop educational campaigns focusing on the identified knowledge gaps, particularly the mental health impact of thyroid disorders and the role of diet in managing thyroid health

• Community-Based Interventions: Implement community-based health promotion activities that reach diverse population segments, especially those with lower educational levels and the unemployed

• School and Workplace Programs: Integrate thyroid health education into school curricula and workplace wellness programs to leverage these platforms for broader health education

• Regular Health Screenings: Promote regular thyroid health screenings and check-ups, particularly for high-risk groups, to facilitate early detection and management of thyroid disorders

Public Health Campaigns: Utilize various media channels to disseminate information about thyroid health, ensuring that accurate and comprehensive information reaches a wide audience

This study underscores the importance of comprehensive thyroid health education and the need for community-based strategies to enhance awareness and knowledge. By addressing the identified gaps, public health initiatives can improve the early detection and management of thyroid disorders, ultimately leading to better health outcomes for the residents of Shimla. Continuous efforts in education, tailored to the unique demographic and socio-economic characteristics of the region, are essential in combating the burden of thyroid disorders and promoting overall community health.

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