Leukemia, a cancer of the blood and bone marrow, continues to pose significant health challenges across the globe. It interferes with the body’s ability to produce healthy blood cells, leading to a range of potentially serious symptoms such as anemia, recurrent infections, fatigue and unexplained bruising. Although advances in diagnosis and treatment have dramatically improved survival rates, awareness and understanding of leukemia remain limited-especially in developing regions where cancer literacy is often low. In India, leukemia ranks among the more prevalent forms of cancer, particularly affecting children and young adults, yet it receives far less public attention compared to other common malignancies [1-3].

This lack of visibility has resulted in widespread misconceptions about the disease. Many individuals are unaware of early warning signs and myths surrounding the nature and transmission of leukemia often delay medical intervention. Misinterpretation of symptoms-often mistaken for general weakness or infection-along with fear of diagnosis, contributes to poor health-seeking behavior and late-stage detection. These challenges are even more pronounced in areas with limited access to specialized healthcare and low levels of health education [4,5].

himla, a hill district in the northern state of Himachal Pradesh, presents a distinctive context for evaluating public awareness of leukemia. With its blend of urban centers and rural villages scattered across mountainous terrain, healthcare outreach in the region faces several barriers, including difficult geography, seasonal inaccessibility and gaps in infrastructure. Despite being served by state healthcare programs and cancer control efforts like the NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke), leukemia awareness remains patchy and poorly understood. Rural populations, in particular, may have limited exposure to health information campaigns or specialized services such as hematology consultations [6,7].

In light of these concerns, this study aims to assess how much people in Shimla know about leukemia-its causes, symptoms, risk factors and available treatments. By examining differences in awareness across age groups, educational levels, occupations and residential areas, the research intends to highlight where the biggest knowledge gaps lie. Ultimately, the goal is to provide evidence-based insights that can guide more effective, locally relevant awareness campaigns and health education initiatives, helping communities respond to the growing challenge of leukemia with greater knowledge and preparedness.

Study Design

This study adopted a descriptive, cross-sectional survey design aimed at evaluating the level of public awareness and understanding of leukemia among the residents of Shimla district, Himachal Pradesh. The primary objective was to assess participants' knowledge related to leukemia symptoms, risk factors, early detection and treatment options, while also capturing public perceptions and beliefs surrounding the disease.

Study Setting and Population

The research was carried out in Shimla, a district characterized by its hilly terrain, semi-urban hubs and remote rural pockets. The diverse geography and mixed population of the region offered an ideal context for exploring disparities in health literacy. The study targeted individuals aged 18 years and above, regardless of gender, educational attainment, or professional background, to ensure a comprehensive understanding of leukemia awareness across socio-demographic segments.

Study Duration

Data collection was conducted over a span of three months, from January to March 2025. This timeline allowed for broad outreach and helped mitigate potential seasonal or accessibility barriers associated with Shimla’s climatic conditions.

Sample Size and Sampling Technique

A total of 400 respondents were selected for the study. The sample size was determined using a 95% confidence level, a 5% margin of error and an estimated awareness prevalence of 50%, ensuring statistical adequacy and representativeness. Convenience sampling facilitated efficient distribution of the survey through online networks.

Inclusion Criteria:

• Adults aged 18 years and above

• Permanent residents of Shimla district

• Ability to comprehend and respond in either Hindi or English

• Willingness to provide informed consent

Exclusion Criteria:

• Individuals with a prior medical diagnosis of leukemia

• Incomplete or inconsistent survey responses

• Participants who declined consent

Data Collection Tool

Data were gathered using a structured, bilingual (Hindi and English) questionnaire, which was developed in collaboration with oncologists, hematologists and public health experts. The questionnaire was pilot-tested for clarity and relevance. It comprised three main sections:

• Socio-Demographic Details: Including age, gender, education level, occupation and area of residence

• Knowledge and Awareness: Consisting of 20 multiple-choice questions assessing understanding of leukemia symptoms (e.g., persistent fatigue, bruising), risk factors (e.g., radiation exposure, genetic predisposition), treatment options (e.g., chemotherapy, bone marrow transplant) and misconceptions

• Perception and Behavior: Focusing on attitudes towards cancer diagnosis, openness to screening and trust in healthcare services

Scoring and Knowledge Classification

Each correct answer in the knowledge section was awarded one point. Based on the total score, participants were classified into four categories of leukemia awareness:

• Very Good Knowledge (≥80%)

• Good Knowledge (60–79%)

• Fair Knowledge (41–59%)

• Poor Knowledge (<40%)

This classification enabled detailed analysis of awareness levels across socio-demographic groups.

Data Collection Procedure

The survey was primarily disseminated through Google Forms and shared via social media platforms (e.g., WhatsApp, Facebook), email lists and local community forums. Participation was entirely voluntary and anonymity was strictly maintained.

Data Analysis

Responses were compiled and analyzed using Microsoft Excel. Descriptive statistics such as frequencies and percentages were used to summarize data. 

Ethical Considerations

The study adhered to standard ethical guidelines for research involving human participants. Prior to participation, respondents were informed about the study’s purpose and assured of confidentiality. Digital or verbal informed consent was obtained and no personally identifiable information was collected.

The study sample included 400 individuals from the Shimla district, reflecting a balanced distribution across age groups, genders and occupational backgrounds. The majority of participants (31.0%) were between the ages of 26–35 years, followed by 30.0% in the 18–25 group and 26.0% in the 36–45 range, with only 13.0% aged 46 and above-demonstrating a predominantly younger respondent base. Gender distribution was nearly equal, with males representing 51.0% and females 49.0%. Educational levels ranged from no formal schooling (14.0%) to postgraduate qualifications (14.0%), with the highest proportions holding secondary (27.0%) and undergraduate (29.0%) education. The occupational spread included homemakers (22.0%), office workers (21.0%), students (21.0%) and teachers (20.0%), while healthcare professionals and other roles made up 10.0% and 6.0%, respectively. A greater share of participants (59.0%) resided in rural areas compared to 41.0% in urban settings, offering valuable insights into awareness levels across different living environments (Table 1).

Participants demonstrated a generally positive baseline of awareness regarding leukemia and its associated health factors. A strong 75.0% correctly identified leukemia as a cancer of blood-forming tissues and 73.0% recognized genetic predisposition as a key risk factor. Common symptoms such as frequent infections were acknowledged by 77.0%, while 72.0% were aware of the link between radiation exposure and leukemia risk. Awareness of treatment modalities was encouraging, with 74.0% identifying chemotherapy and 75.0% correctly understanding the concept of bone marrow transplants. However, knowledge about early detection was slightly lower, with 70.0% understanding its importance and 68.0% recognizing the possibility of asymptomatic onset. While 76.0% saw value in reporting family history, only 69.0% knew blood tests could aid in early detection. Risks of untreated leukemia and knowledge of complications such as infection were well recognized (73.0% and 70.0% respectively), although fewer respondents (64.0%) linked leukemia with fatigue-a key symptom. Furthermore, 77.0% correctly identified the hematologist as the appropriate specialist, but only 55.0% were aware that leukemia can recur, revealing gaps in understanding disease progression and long-term care (Table 2).

When categorized by awareness levels, 31.0% of respondents fell under the “Very Good Knowledge” bracket, correctly answering 80% or more of the questions. The majority, 37.0%, demonstrated “Good Knowledge” (60–79%), indicating a sound foundational understanding of leukemia. However, 22.5% displayed only “Fair Knowledge,” and 9.5% were classified under “Poor Knowledge,” reflecting minimal awareness. This knowledge distribution suggests that while most participants were generally informed, a significant portion lacked comprehensive understanding, particularly regarding early asymptomatic stages, recurrence and subtle warning signs. The findings emphasize the need for more targeted awareness programs, especially tailored for individuals with limited access to quality health education (Table 3).

Table 1: Socio-Demographic Characteristics of Participants (Shimla)

Table 2: Public Knowledge and Awareness of Leukemia and Its Treatment

Table 3: Knowledge Score Classification on Leukemia and Its Treatment

This cross-sectional study provides a timely and in-depth examination of public knowledge, perceptions and awareness related to leukemia among residents of Shimla, a district with a unique blend of urban and rural populations set against a geographically challenging terrain. Despite being one of the more serious forms of cancer affecting blood and bone marrow, leukemia remains under-discussed in both national and local health conversations, often overshadowed by more publicized malignancies. The results from this study, however, present a nuanced landscape-one that reflects encouraging awareness trends alongside persistent gaps in critical understanding, particularly regarding the early and asymptomatic nature of leukemia, disease recurrence and risk factor comprehension.

The socio-demographic composition of the study cohort was well balanced, ensuring inclusivity across gender (51.0% male and 49.0% female), educational levels and professional backgrounds. Most participants fell within the 18–35 age range (61.0%), highlighting a relatively young, working-age population. Educational diversity was also broad, with over half of the respondents having completed secondary or undergraduate education. While this might explain the generally promising knowledge levels, the presence of 14.0% with no formal education and 16.0% with only primary schooling helps contextualize the areas of lower awareness observed in the study. Notably, a majority of the participants (59.0%) were from rural settings, which is essential in understanding regional disparities in leukemia literacy.

Awareness of leukemia's basic characteristics and treatment modalities was reasonably strong. Most participants correctly identified leukemia as a cancer of blood-forming tissues (75.0%), with similar proportions recognizing key symptoms such as frequent infections (77.0%) and treatment options like chemotherapy (74.0%) and bone marrow transplants (75.0%). Furthermore, over 70.0% of participants were aware of contributing risk factors such as genetic predisposition, radiation and chemical exposure-reflecting a foundational level of understanding. Encouragingly, 76.0% acknowledged the importance of disclosing family history for screening and 77.0% correctly recognized the hematologist as the appropriate specialist for managing leukemia cases.

However, deeper analysis reveals critical areas of concern. Only 68.0% of respondents were aware that leukemia can initially present without symptoms-an especially dangerous knowledge gap, given that early-stage leukemia often mimics benign infections or fatigue. Similarly, less than three-fourths of participants understood the significance of early diagnosis (70.0%) or knew that leukemia could recur after treatment (55.0%). These deficiencies suggest a limited understanding of the disease's progression and long-term management, which may contribute to delays in seeking care or discontinuation of follow-up treatment. Awareness of subtler symptoms such as chronic fatigue was relatively low (64.0%) and misconceptions about diagnostics, such as the role of blood tests, were evident in 31.0% of responses.

The knowledge classification further underscored these disparities. While a combined 68.0% of respondents demonstrated good to very good knowledge of leukemia, a significant 22.5% had only fair knowledge and 9.5% fell into the poor knowledge category. These groups likely include individuals from lower educational backgrounds or rural settings with limited access to reliable health information. Such findings align with previous research conducted in similarly stratified populations, where health literacy often correlates strongly with education, gender, occupation and access to healthcare infrastructure.

Cultural beliefs, stigma and misinformation also play a role in shaping public responses to leukemia. The fear of cancer as a terminal diagnosis, myths surrounding its causes and limited trust in treatment outcomes can discourage proactive behavior, especially in rural communities. Furthermore, logistical barriers such as transportation difficulties, long waiting times at urban hospitals and lack of nearby diagnostic centers exacerbate the situation in geographically remote parts of Shimla.

From a policy and public health standpoint, this study signals the need for a more focused and context-sensitive approach to leukemia education in Shimla. First, health promotion campaigns must move beyond basic awareness and address deeper knowledge gaps-particularly those related to early asymptomatic stages, long-term disease monitoring and recurrence. Second, communication must be tailored to overcome literacy barriers, utilizing vernacular languages, visual aids and community influencers to build trust and understanding. Third, grassroots health workers such as ASHAs and Anganwadi workers can be trained to deliver leukemia-related health education, especially in rural areas where digital outreach has limited penetration. Lastly, integrating leukemia education into broader non-communicable disease frameworks under NPCDCS could help streamline resource use and widen impact [6-8].

While this study offers an optimistic view of baseline leukemia awareness in Shimla, it also reveals that significant work remains to be done. Bridging the gap between surface-level awareness and actionable knowledge requires strategic intervention, culturally sensitive messaging and inclusive healthcare delivery. With focused public health efforts, improved education and community engagement, it is possible to transform leukemia from a misunderstood threat into a manageable and treatable condition for the people of Shimla.

This study underscores a moderately encouraging yet incomplete understanding of leukemia among the residents of Shimla, with over two-thirds of participants demonstrating good to very good awareness of its causes, symptoms and treatment options. While foundational knowledge-such as the role of genetic predisposition, chemotherapy and the importance of specialist care-was relatively strong, critical gaps persist in public comprehension of early asymptomatic onset, disease recurrence and subtle clinical manifestations like fatigue. These deficiencies, particularly evident among respondents with lower education levels and rural backgrounds, highlight the pressing need for more inclusive, contextually relevant health education strategies. Strengthening community-based outreach, enhancing access to accurate information and integrating leukemia awareness into broader public health initiatives will be pivotal in improving early diagnosis, fostering timely treatment and ultimately reducing the disease burden. Empowering communities with knowledge and reducing stigma surrounding leukemia will not only save lives but also promote a more proactive and informed approach to blood cancer care in Shimla.

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