Background: Hernia is a prevalent condition characterized by the protrusion of an organ through a weakened area in the surrounding tissue or muscle wall. While surgical repair is the most effective treatment, public understanding of hernia—its symptoms, causes, and surgical options—remains limited, particularly in rural and semi-urban regions of India. This study aimed to assess the awareness and knowledge levels regarding hernia and its surgical management among the general public in Kangra district, Himachal Pradesh. Materials and Methods: A descriptive, cross-sectional study was conducted among 400 adults from Kangra using a structured, pre-validated online questionnaire available in Hindi and English. The survey collected socio-demographic data and assessed knowledge through 20 multiple-choice questions focused on hernia symptoms, risk factors, complications, and surgical treatment options. Knowledge levels were classified into four categories: very good (≥80%), good (60–79%), fair (41–59%), and poor (<40%). Descriptive statistics were used to analyze responses. Results: Among the 400 respondents, 51.5% were male and 48.5% female, with the majority aged between 26–45 years. While 40.5% demonstrated very good knowledge and 41.0% had good knowledge, 14.0% showed fair awareness and 4.5% fell into the poor category. Most participants (≥75%) correctly identified common symptoms, causes, and basic surgical procedures. However, knowledge gaps were evident regarding hernia recurrence (68.0%), risk of bowel obstruction (69.0%), and the long-term benefits of laparoscopic repair (76.0%). Conclusion: The findings highlight a generally favorable awareness of hernia in the Kangra population, though misconceptions persist regarding complications and surgical outcomes. There is a need for targeted, community-based educational programs to bridge these gaps, particularly among rural and less educated individuals. Raising awareness through both digital platforms and grassroots initiatives can improve timely diagnosis and enhance health outcomes related to hernia management.
Hernia is a common medical condition that occurs when an internal organ or tissue pushes through a weak spot in the surrounding muscle or connective tissue. It can develop in various parts of the body, with inguinal, umbilical, and incisional hernias being the most frequently observed types.1,2 While some hernias may be painless or minimally symptomatic in the early stages, they can progress and lead to serious complications such as incarceration or strangulation if left untreated. Surgical repair remains the definitive treatment, and advancements in minimally invasive techniques have significantly improved recovery outcomes [3-5].
Despite its prevalence and treatability, awareness about hernia—its symptoms, causes, risk factors, and surgical options—remains limited among the general public, particularly in semi-urban and rural settings. Many individuals misinterpret early signs such as bulges or mild discomfort, often delaying medical consultation until the condition worsens. In areas like Kangra district in Himachal Pradesh, where healthcare access may be limited and health literacy is variable, these delays can result in avoidable complications and increased surgical risk. Cultural taboos, fear of surgery, and lack of knowledge about modern procedures further discourage timely intervention [6-8]
Previous studies in India have shown that public understanding of hernia is often superficial, with many associating it only with physical strain or believing that surgical treatment is risky or unaffordable.9,10 There is also limited community-level engagement in preventive education or screening initiatives related to abdominal wall disorders. Given these challenges, it becomes essential to assess the current state of public awareness and identify specific misconceptions and knowledge gaps.
This study aims to evaluate the level of awareness regarding hernia and its surgical management among the general population of Kangra. By analyzing responses across different age groups, educational levels, and residential settings, the study seeks to provide insights that can inform targeted health education programs and community outreach efforts. Raising awareness about hernia and its safe, effective treatment options is vital to improving health outcomes and encouraging timely healthcare-seeking behavior.
Study Design
This research was conducted as a descriptive, cross-sectional study aimed at assessing the level of public awareness and understanding regarding hernia and its surgical management in Kangra district, Himachal Pradesh. The objective was to evaluate general knowledge about hernia symptoms, risk factors, treatment options, and perceptions surrounding surgical intervention.
Study Area and Population
The study was carried out in Kangra, a district located in the northern Indian state of Himachal Pradesh. The region comprises both rural and urban populations, offering a diverse socio-demographic profile. The target population included residents of Kangra aged 18 years and above, irrespective of gender, educational background, or occupation.
Study Duration
Data collection was conducted over a three-month period from January to March 2025, allowing sufficient time to reach a wide demographic through online platforms.
Sample Size and Sampling Technique
A total of 400 individuals participated in the study. The sample size was determined based on an expected awareness level of 50%, a 95% confidence interval, and a 5% margin of error. Participants were selected through convenience and purposive sampling, using online dissemination methods. The questionnaire link was circulated via social media platforms, community WhatsApp groups, and local digital forums to encourage voluntary participation.
Inclusion Criteria
Adults aged 18 years and above
Permanent residents of Kangra district
Individuals able to read and understand Hindi or English
Willingness to provide informed digital consent
Exclusion Criteria
Individuals with a prior diagnosis of complex or recurrent hernia requiring specialized treatment
Incomplete or inconsistent questionnaire responses
Unwillingness to participate or provide consent
Study Tool – Structured Questionnaire
A structured, pre-validated questionnaire was used for data collection. Developed in consultation with general surgeons and public health professionals, the questionnaire was designed to be simple, clear, and accessible in both Hindi and English. It was administered exclusively through Google Forms. The questionnaire included three sections:
Socio-demographic details – Age, gender, education, occupation, and residence
Awareness and knowledge assessment – Twenty multiple-choice questions on hernia symptoms, causes, risk factors, complications, and surgical treatment options
Perceptions and health-seeking behavior – Questions exploring attitudes toward surgery, reasons for delay in seeking care, and perceived barriers
Scoring and Classification
Each correct response in the knowledge section was awarded one point. Based on total scores, participants were grouped into four categories:
Very Good Knowledge (≥80%)
Good Knowledge (60–79%)
Fair Knowledge (41–59%)
Poor Knowledge (<40%)
This classification helped identify patterns of understanding across different segments of the population.
Data Collection Procedure
The questionnaire link was distributed entirely through digital means to ensure a wide reach and to maintain contactless participation. Participants accessed and completed the survey voluntarily after reading a brief description of the study and providing digital consent.
Data Analysis
Responses were cleaned and organized using Microsoft Excel. Descriptive statistical methods were applied to calculate frequencies and percentages for socio-demographic variables and awareness levels. The results were then interpreted to highlight key trends and areas requiring intervention.
Ethical Considerations
The study adhered to ethical standards for community-based survey research. Participation was voluntary, and anonymity and confidentiality of all responses were strictly maintained. Informed digital consent was obtained from all participants before survey initiation, and respondents had the option to exit the survey at any stage without providing a reason.
The study included 400 participants from Kangra district, representing a balanced cross-section of the general population. The majority of respondents were in the 26–35 age group (35.5%), followed by those aged 36–45 years (29.5%), 18–25 years (21.5%), and 46 years and above (13.5%). Gender distribution was nearly even, with males constituting 51.5% and females 48.5%. In terms of education, the largest share had an undergraduate degree (33.5%), followed by secondary education (31.5%), postgraduate degrees (15.0%), primary schooling (14.5%), and a small proportion with no formal education (5.5%). Occupational data revealed that homemakers (23.5%) and office workers (22.5%) were the most common groups, followed by students (15.5%), teachers (16.5%), healthcare professionals (11.5%), and others (10.5%). A slightly greater number of respondents lived in rural areas (56.5%) compared to urban regions (43.5%), ensuring inclusion of diverse backgrounds and living conditions.
Participants demonstrated generally strong awareness of hernia-related knowledge. A large proportion (83.0%) correctly defined hernia as the protrusion of an organ through weak tissue, and 86.0% identified visible bulge in the abdomen or groin as a key symptom. Awareness was also high regarding inguinal hernia as a common type (80.0%), the role of heavy lifting in increasing risk (82.0%), and surgery as the main treatment for symptomatic cases (78.0%). Knowledge about specific surgical terms and procedures was fair to good—81.0% understood herniorrhaphy, 75.0% knew that laparoscopic surgery is minimally invasive, and 80.0% were aware of preoperative fasting requirements. Other important aspects like the role of obesity (77.0%),
Table 1: Socio-Demographic Characteristics of Participants (Kangra)
Variable | Category | Frequency (n) | Percentage |
Age Group (Years) | 18–25 | 86 | 21.5% |
26–35 | 142 | 35.5% | |
36–45 | 118 | 29.5% | |
46 and above | 54 | 13.5% | |
Gender | Male | 206 | 51.5% |
Female | 194 | 48.5% | |
Education Level | No formal education | 22 | 5.5% |
Primary school | 58 | 14.5% | |
Secondary school | 126 | 31.5% | |
Undergraduate degree | 134 | 33.5% | |
Postgraduate degree | 60 | 15.0% | |
Occupation | Homemaker | 94 | 23.5% |
Office Worker | 90 | 22.5% | |
Teacher | 66 | 16.5% | |
Healthcare Professional | 46 | 11.5% | |
Student | 62 | 15.5% | |
Other | 42 | 10.5% | |
Residential Setting | Urban | 174 | 43.5% |
Rural | 226 | 56.5% |
chronic coughing (78.0%), and potential complications such as strangulation (76.0%) and infection (74.0%) were recognized by the majority. However, some misconceptions persisted; fewer respondents correctly answered about hernia recurrence after surgery (68.0%) or the possibility of bowel obstruction (69.0%). Overall, the responses reflected a good foundational understanding, with specific areas needing improvement.
Based on the scoring system, 40.5% of participants demonstrated very good knowledge (≥80% correct answers), and 41.0% fell into the good knowledge category (60–79%). A smaller portion (14.0%) showed fair knowledge, while only 4.5% were categorized as having poor understanding of hernia and its surgical management. These results indicate that while the majority of the population holds a reasonable level of awareness, targeted health education strategies are still needed to address gaps, particularly among individuals with lower knowledge scores.
This cross-sectional study aimed to assess the public’s awareness of hernia and its surgical management in Kangra district, Himachal Pradesh, and yielded valuable insights into the prevailing knowledge levels, perceptions, and potential areas for health education. The findings indicate a generally favorable awareness landscape, with most participants demonstrating a good to very good understanding of the condition. However, the study also uncovered gaps in knowledge, particularly regarding complications, asymptomatic presentation, and post-surgical outcomes—underscoring the need for more targeted public health interventions.
The socio-demographic profile of respondents showed balanced representation across gender, age, education, and residence. Notably, individuals aged 26–45 years made up a substantial portion of the study population, aligning with the most active and economically productive age groups—those more likely to engage in physical labor and thus at increased risk of developing hernias. Furthermore, the inclusion of participants from both rural (56.5%) and urban (43.5%) areas ensured a diverse representation of the district’s population. The fact that over 30% had only secondary education or less may have implications for the design of future health education campaigns, which should emphasize simplicity and cultural relevance.
Regarding awareness, participants demonstrated strong basic knowledge about hernia, with 83% correctly identifying it as the protrusion of an organ through weak tissue, and 86% recognizing visible bulges as a key symptom. These figures are encouraging and reflect a broad foundational understanding among the public. Similar trends were observed in awareness of inguinal hernia (80%), the impact of heavy lifting (82%), and the need for surgical treatment in symptomatic cases (78%). These results align with findings from earlier Indian studies which suggest growing public familiarity with common health conditions due to expanded internet access and mobile health information campaigns [1,2].
Table 2: Public Knowledge and Awareness of Hernia and Its Surgical Management
No. | Question | Options | Correct Responses (n) | Percentage |
1 | What defines a hernia? | a) Lung infection, b) Organ protrusion through weak tissue, c) Bone dislocation, d) Fever | 332 | 83.0 |
2 | What is a common hernia type? | a) Heart hernia, b) Inguinal hernia, c) Spine hernia, d) Muscle hernia | 320 | 80.0 |
3 | What is a key symptom of a hernia? | a) Sore throat, b) Visible bulge in abdomen/groin, c) Chest pain, d) Hair loss | 344 | 86.0 |
4 | Can heavy lifting increase hernia risk? | a) Yes, b) No, c) Only in elderly, d) Rarely | 328 | 82.0 |
5 | What is the main treatment for symptomatic hernias? | a) Rest only, b) Surgery, c) Antibiotics, d) Diet modification | 312 | 78.0 |
6 | What does herniorrhaphy refer to? | a) Liver surgery, b) Hernia repair, c) Eye procedure, d) Joint replacement | 324 | 81.0 |
7 | Is laparoscopic hernia repair minimally invasive? | a) Yes, b) No, c) Only for women, d) Depends | 300 | 75.0 |
8 | Can hernias heal without intervention? | a) No, b) Yes, c) Only in infants, d) Always | 292 | 73.0 |
9 | Should physical exertion history be reported before surgery? | a) No, b) Yes, c) Only injuries, d) After surgery | 316 | 79.0 |
10 | What is a danger of untreated hernia? | a) Weight gain, b) Strangulation, c) Vision loss, d) Muscle soreness | 304 | 76.0 |
11 | Can hernias be asymptomatic initially? | a) No, b) Yes, c) Only in women, d) Always painful | 288 | 72.0 |
12 | What must be avoided before hernia surgery? | a) Food and drink, b) Reading, c) Light walking, d) Bathing | 320 | 80.0 |
13 | Is obesity a risk factor for hernia development? | a) Yes, b) No, c) Only for men, d) Rarely | 308 | 77.0 |
14 | Can a hernia lead to bowel obstruction? | a) No, b) Yes, c) Only in children, d) Never | 276 | 69.0 |
15 | Is general anesthesia common in hernia repair? | a) Yes, b) No, c) Only local, d) Occasionally | 328 | 82.0 |
16 | What is a frequent post-surgical complication? | a) Tooth decay, b) Infection, c) Memory loss, d) Skin rash | 296 | 74.0 |
17 | Who conducts hernia surgery? | a) Dermatologist, b) General surgeon, c) Nurse, d) Radiologist | 340 | 85.0 |
18 | Can chronic coughing contribute to hernia formation? | a) No, b) Yes, c) Only in elderly, d) Rarely | 312 | 78.0 |
19 | Does laparoscopic repair offer faster recovery? | a) Yes, b) No, c) Same as open surgery, d) Only for men | 304 | 76.0 |
20 | Can hernias recur after surgery? | a) Yes, b) No, c) Often, d) Only with injury | 272 | 68.0 |
However, while the baseline knowledge appears adequate, the study reveals several critical misconceptions and knowledge deficiencies. For instance, only 68% of participants were aware that hernias can recur even after surgical repair, and just 69% knew that untreated hernias can result in bowel obstruction—both potentially life-threatening complications. Furthermore, awareness of the asymptomatic nature of hernias in early stages (72%) and the long-term benefits of laparoscopic repair (76%) was comparatively modest. Such knowledge gaps are concerning because they may lead to delays in seeking care or underestimating the seriousness of the condition.
The results also highlight a limited understanding of broader risk factors. While obesity (77%) and chronic coughing (78%) were recognized by a majority as contributing factors, a significant portion of respondents still lacked clarity on these aspects. Importantly, 74% of participants correctly identified infection as a common post-surgical complication, but this leaves room for improvement in post-operative education and patient counseling. Additionally, only 75% knew that laparoscopic hernia repair is a minimally invasive option, suggesting the need to raise public awareness about advancements in surgical techniques that offer shorter recovery times and fewer complications.
Table 3: Knowledge Score Classification on Hernia and Its Surgical Management
Knowledge Level | Score Range (Correct) | Number of Respondents (n) | Percentage |
Very Good Knowledge | ≥80% | 162 | 40.5% |
Good Knowledge | 60–79% | 164 | 41.0% |
Fair Knowledge | 41–59% | 56 | 14.0% |
Poor Knowledge | <40% | 18 | 4.5% |
Knowledge scores further reinforce these patterns: 81.5% of participants fell into the “Very Good” or “Good” knowledge categories, while 14% had only a fair understanding, and 4.5% showed poor awareness. Although these figures are comparatively positive, they still signal that one in five individuals lacks adequate knowledge, particularly in rural and less educated populations—demographics typically underserved by health promotion campaigns.
One strength of this study lies in its use of an online platform for data collection, which facilitated wide and diverse participation. However, this methodology may have introduced bias by excluding individuals with limited digital literacy or internet access, often those with the greatest need for health education. Future research using community based and in-person surveys could help bridge this digital divide and provide a more inclusive assessment of awareness across the entire population.
From a public health perspective, the study emphasizes the urgent need for locally adapted, community-driven awareness initiatives. Health authorities, primary care providers, and local influencers should collaborate to deliver hernia education that is simple, engaging, and culturally appropriate. Integrating hernia awareness into routine health checkups, school health programs, Anganwadi centers, and village health and nutrition days could significantly improve understanding. Additionally, given the strong awareness among women respondents, their role as caregivers and decision-makers in households should be leveraged for broader community sensitization [10-12].
Based on the findings of this study, it is evident that while a significant portion of the population in Kangra possesses good to very good awareness regarding hernia and its surgical management, critical gaps in knowledge still exist—particularly concerning complications, recurrence, and risk factors. The high level of awareness about symptoms and surgical treatment options is encouraging; however, misconceptions about the asymptomatic nature of early hernias and the long-term benefits of minimally invasive surgery highlight the need for focused educational interventions. These insights underline the importance of implementing targeted community health programs that are inclusive, easy to understand, and culturally relevant, especially for rural and less educated populations. Strengthening public knowledge through both digital outreach and ground-level awareness campaigns will be essential in promoting timely diagnosis, dispelling myths, and encouraging informed decision-making, ultimately leading to better surgical outcomes and reduced morbidity associated with untreated hernias.
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