Chronic low back pain (CLBP), defined as pain persisting beyond three months, is a major public health challenge, particularly in rural regions like Kangra, Himachal Pradesh, where occupational hazards and limited healthcare access amplify its impact. CLBP impairs daily functioning, reduces productivity, and affects mental health, yet public understanding of effective self-care such as posture correction, exercise, and weight management remains inadequate. Misconceptions, such as over-reliance on rest or unproven remedies, often lead to delayed care and worsened outcomes, underscoring the need for enhanced awareness [1-3].

In Kangra, where agriculture and manual labor dominate, CLBP is prevalent due to repetitive physical strain and poor ergonomics. Rural communities face unique barriers, including distant healthcare facilities, low health literacy, and cultural practices favoring traditional treatments like herbal applications over evidence-based approaches. While global research shows that informed self-management improves CLBP outcomes, region-specific studies in rural India are limited, leaving a critical gap in understanding local perceptions and practices [4-6].

This study aims to assess public knowledge, perceptions, and self-care strategies for CLBP in Kangra, with a focus on rural populations. By identifying gaps and demographic factors influencing awareness, the research seeks to inform targeted, culturally relevant interventions. Enhancing community understanding can empower residents to adopt effective self-care, reduce reliance on ineffective treatments, and improve access to professional care, ultimately alleviating CLBP’s burden in this resource-constrained region.

The findings will guide health policymakers and educators in designing programs that address Kangra’s socio-cultural context, promoting sustainable improvements in CLBP    management.    Addressing    these    knowledge  gaps is essential to enhancing quality of life and reducing the socioeconomic impact of CLBP in rural communities. 

Study Design 

A descriptive, cross-sectional study was conducted to evaluate public knowledge, perceptions, and self-care practices for chronic low back pain (CLBP) among adults in Kangra, Himachal Pradesh. A structured online questionnaire collected quantitative data, ensuring diverse demographic representation. Study Location and Participants: The study targeted Kangra, a district with a predominantly rural population and limited access to specialized pain management services. Participants were adults aged 18 years or older, permanent Kangra residents, with an emphasis on rural communities to address their unique health literacy challenges.

Study Period 

Data collection spanned Jan to March 2025, allowing ample time to engage participants across rural and urban settings.

Sample Size and Sampling: A sample size of 500 participants was calculated using a 95% confidence interval, 50% estimated awareness prevalence, and a 5% margin of error, with a 10% buffer for incomplete responses. Convenience and purposive sampling were employed, with the questionnaire distributed via social media (WhatsApp, local forums) and community health workers to ensure rural inclusion.

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 disorders

• Unwilling or unable to provide consent

• Incomplete or ambiguous responses Data

Collection Tool

A validated questionnaire, developed with input from orthopedic specialists, physiotherapists, and public health experts, comprised three sections.

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

• Knowledge and Perception Assessment: 20 multiple-choice questions on CLBP causes, risk factors, self-care strategies, and misconceptions.

• Self-Care Practices: Questions on personal CLBP management, healthcare-seeking behaviors, and barriers to care.

            The questionnaire was bilingual (Hindi/English) for accessibility. 

Knowledge Scoring

Responses were scored for accuracy and categorized as

• Exceptional: ≥80%

• Proficient: 60%–79%

• Fair: 41%–59%

• Limited: <40% 

Data Collection Process 

The questionnaire was disseminated 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, knowledge, and self-care practices, while chi-square tests assessed associations between socio-demographic variables and knowledge levels (p<0.05).

Ethical Considerations 

Ethical approval was obtained from the Institutional Ethics Committee. Participants were assured of confidentiality, voluntary participation, and the right to withdraw. Data were securely stored to protect privacy.

The socio-demographic profile of the 500 respondents revealed a balanced gender distribution, with 51.8% female and 48.2% male participants. The majority were in the economically active age groups, with 35.0% aged 26–35 years and 29.2% aged 36–45 years, followed by 17.0% aged 18–25 years and 18.8% aged 46 years and above. Education levels were diverse, with 35.8% having secondary school qualifications, 30.6% holding undergraduate degrees, 16.4% with primary school education, 11.2% with postgraduate degrees, and 6.0% with no formal education. Occupations included farmers (27.4%), homemakers (25.6%), laborers(15.8%), teachers (13.0%), and others (18.2%). Rural residents (66.4%) significantly outnumbered urban residents (33.6%), aligning with the study’s focus on rural communities.

Table1: Socio-Demographic Characteristics of Participants

The knowledge assessment reveals a moderate understanding of CLBP, with strengths in recognizing key risk factors and management strategies. The high recognition of poor posture (84.6%) and exercise benefits (81.2%) suggests some penetration of basic health messages, likely through community health workers or media. However, significant gaps exist, particularly in understanding weight management (64.8%) and avoiding prolonged sitting (62.4%), which are critical for preventing CLBP exacerbation. The limited awareness of complications like chronic disability (66.2%) and reduced mobility (66.8%) indicates a lack of appreciation for CLBP’s long-term consequences, potentially leading to delayed care. These gaps are concerning in a rural context, where    access     to     physiotherapists     and    ergonomic resources is limited, emphasizing the need for education on practical self-care strategies like lumbar supports (77.6%) and posture correction (76.0%) (Table 2).

Table 2: Awareness and Knowledge of Chronic Low Back Pain

The knowledge score classification highlights a generally positive trend, with 76.0% of participants achieving "Exceptional" or "Proficient" knowledge, indicating a solid foundation in CLBP awareness among Kangra residents. This suggests that some health education efforts, possibly through local health campaigns, have been effective. However, the 16.8% with "Fair" and 7.2% with "Limited" knowledge represent a significant minority, particularly among rural residents and those with lower education levels. These groups are more likely to rely on ineffective remedies or delay seeking care, increasing the risk of chronicity and disability. The distribution underscores the urgency of targeted interventions, such as community workshops and mobile health units, to bridge these gaps and ensure equitable access to CLBP education. The rural-urban and educational disparities in scores further emphasize the need for culturally sensitive and accessible resources to address systemic barriers (Table 3).

Table 3: Knowledge Score Classification

This study offers a detailed exploration of public perceptions and self-care practices for chronic low back pain (CLBP) in Kangra, revealing a blend of encouraging awareness and concerning deficiencies. Participants demonstrated strong recognition of poor posture (84.6%) as a risk factor and regular exercise (81.2%) as beneficial, aligning with findings from studies in other rural settings where basic health messages have gained traction. These strengths suggest that community health workers and limited media exposure have partially succeeded in disseminating key concepts. However, critical gaps in understanding weight management (64.8%) and avoiding prolonged sitting (62.4%) highlight missed opportunities for effective self-care, potentially prolonging pain and functional limitations.

The socio-demographic profile underscores the study’s focus on rural residents (66.4%), who face systemic barriers like geographic isolation, limited access to physiotherapists, and reliance on traditional remedies such as herbal liniments. Lower knowledge scores among rural participants and those with no formal education (6.0%) reflect the interplay of low health literacy and resource constraints, consistent with research in rural India showing delayed care due to misinformation. Farmers (27.4%) and laborers (15.8%), prevalent in the sample, are particularly vulnerable due to repetitive strain, yet their awareness of ergonomic practices (75.6%) and core strengthening (73.6%) remains suboptimal, indicating a need for occupation-specific education.

Significant deficiencies in recognizing CLBP complications, such as reduced mobility (66.8%) and chronic disability (66.2%), suggest a lack of appreciation for the condition’s long-term impact. Similarly, limited understanding of lifestyle factors like sedentary behavior (63.2%) and the role of physiotherapy (70.4%) points to gaps in proactive management. These issues may stem from cultural beliefs prioritizing immediate relief such as overusing painkillers over preventive strategies, compounded by inadequate health outreach in rural Kangra. The bilingual questionnaire and community-based distribution mitigated some literacy barriers, but the persistence of “Fair” (16.8%) and “Limited” (7.2%) knowledge levels underscores the need for sustained, accessible education.

Urban participants (33.6%) 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 lumbar supports, posture correction, and exercise routines. Addressing misconceptions, such as the belief that complete bed rest cures CLBP, is critical to encourage evidence-based self-care. Community workshops, mobile clinics, and digital health tools could enhance accessibility, particularly for rural residents with limited connectivity [7-9].

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 behavioral changes over time. Despite these constraints, the study’s robust sample size and rural focus provide a strong foundation for health policy. Longitudinal research evaluating the impact of educational interventions on CLBP management and quality of life is needed to ensure sustainable improvements.

This investigation illuminates a moderate yet uneven understanding of chronic low back pain in Kangra, with notable deficiencies among rural and less-educated residents hindering effective self-care. To transform this landscape, comprehensive, community-tailored educational campaigns, bolstered by expanded access to physiotherapy and ergonomic resources, are imperative. By empowering residents with actionable knowledge and fostering proactive management, these efforts can significantly alleviate CLBP’s debilitating effects, paving the way for enhanced health outcomes and a brighter, pain-free future for Kangra’s communities.

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