Background: Cervical cancer remains a major public health concern globally, particularly in low- and middle-income countries like India, where access to screening and preventive services is limited. Persistent infection with high-risk human papillomavirus (HPV) is the principal cause of cervical cancer, yet awareness about its prevention through vaccination and screening is inadequate in many regions. Himachal Pradesh, a largely rural and geographically challenging state, faces unique barriers that can hinder early detection and public understanding of the disease. Materials and Methods: This descriptive cross-sectional study was conducted over a three-month period in 2025 among 400 residents of Himachal Pradesh aged 18 years and above. A self-administered bilingual Google Form questionnaire was used to assess socio-demographic characteristics and knowledge regarding cervical cancer, its causes, symptoms, prevention methods, and related misconceptions. Participants were recruited via convenience sampling through online platforms. Knowledge was scored based on 20 multiple-choice questions, with cumulative scores categorized into four levels: very good, good, fair, and poor. Statistical analysis was conducted using SPSS to explore associations between knowledge scores and demographic variables. Results: Among the 400 participants, 58% were female, 53% resided in rural areas, and a majority had secondary or higher education. While 66.3% demonstrated good to very good knowledge, significant misconceptions persisted—especially around Pap smear frequency (only 54.5% answered correctly), HPV transmission, and the belief that cervical cancer is hereditary. Statistically significant associations were observed between knowledge scores and age (p = 0.021), education level (p< 0.001), and residence (p = 0.009), with younger, urban, and more educated respondents displaying higher awareness levels. Gender differences were not statistically significant (p = 0.198). Conclusion: The study reveals a moderately satisfactory level of cervical cancer awareness among Himachal Pradesh’s population, with notable disparities based on age, education, and geographic location. Although basic awareness regarding prevention and curability exists, gaps in understanding key preventive practices highlight the urgent need for region-specific, culturally sensitive educational interventions. Strengthening community outreach, dispelling myths, and integrating awareness campaigns into existing public health frameworks are essential for reducing the cervical cancer burden in this Himalayan region.
Cervical cancer is one of the most preventable yet persistently prevalent malignancies affecting women worldwide. According to the World Health Organization (WHO), it ranks as the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020 alone. The overwhelming majority of these cases occur in low- and middle-income countries (LMICs), where access to screening and preventive healthcare services remains limited. Persistent infection with high-risk types of human papillomavirus (HPV) has been established as the primary cause of cervical cancer, making it a largely preventable disease through timely vaccination, regular screening, and treatment of precancerous lesions [1-5].
In India, cervical cancer poses a significant public health challenge, accounting for nearly one-fifth of the global disease burden. While national programs such as the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and the recently launched Ayushman Bharat Health and Wellness Centres have integrated cervical cancer screening services, their reach and impact are often constrained by inadequate awareness, socio-cultural barriers, and logistical limitations. Myths and misconceptions—such as the belief that Pap tests are painful or dangerous, that only promiscuous women are at risk, or that cervical cancer is hereditary—continue to deter women from participating in screening programs [6-10].
Himachal Pradesh, a mountainous state in northern India, presents a unique healthcare landscape where geographical isolation, challenging terrain, and limited healthcare infrastructure contribute to low screening uptake. The socio-cultural fabric, marked by modesty-related stigma, gender norms, and limited discussion on reproductive health, further restricts timely prevention and detection efforts. While government and non-government initiatives have sought to raise awareness and improve access to HPV vaccination and cervical cancer screening, there remains a paucity of state-specific data assessing public knowledge, attitudes, and misconceptions.
Previous studies in India have shown that cervical cancer awareness is influenced by multiple socio-demographic factors, including education, age, occupation, and rural–urban residence [9-13]. However, in regions like Himachal Pradesh—where rural populations constitute a majority and healthcare access is hindered by distance and seasonal weather constraints—these determinants may exert an even stronger influence. Understanding the awareness levels, screening knowledge, and misconceptions prevalent among the general population is therefore crucial for designing effective, culturally sensitive, and geographically feasible interventions.
Against this backdrop, the present study aims to assess the level of awareness, knowledge, and misconceptions related to cervical cancer and its prevention among the general population of Himachal Pradesh. By examining socio-demographic determinants of knowledge and identifying gaps in understanding, this research seeks to inform region-specific health education strategies, promote early detection, and contribute to the reduction of cervical cancer morbidity and mortality in this Himalayan region.
This study was a descriptive, cross-sectional survey designed to assess the level of awareness, knowledge, and misconceptions regarding cervical cancer and its prevention among the general population of Himachal Pradesh, India. Given the state's diverse geography and increasing digital connectivity, an online approach was selected using a structured Google Form to facilitate broad, inclusive, and time-efficient data collection.
Study Duration
The study was conducted over a period of three months, from Jan to March, 2025, allowing sufficient time for survey distribution, response collection, and data analysis.
Study Population and Sampling
The target population included individuals aged 18 years and above residing in Himachal Pradesh, from both rural and urban areas, encompassing all genders and occupational backgrounds. A convenience sampling method was adopted to recruit 400 participants, aiming for wide geographical representation. The survey link was disseminated through multiple online platforms, including WhatsApp, Facebook, Instagram, and community WhatsApp groups, as well as via informal networks of healthcare professionals, NGOs, and local influencers to maximize reach across districts and minimize sampling bias.
Survey Instrument
Data were collected using a bilingual (English and Hindi) self-administered Google Form questionnaire, specifically developed for this study based on literature review and adaptation of validated cervical cancer awareness tools. The questionnaire comprised the following two sections:
Socio-Demographic Information: Captured age, gender, education level, occupation, and place of residence (urban or rural).
Knowledge and Awareness Section: Included 20 multiple-choice questions focused on:
Basic knowledge of cervical cancer (e.g., preventability, symptoms, curability)
Awareness of causative factors (especially HPV)
Knowledge of preventive methods (Pap smear, HPV vaccination, hygiene)
Misconceptions and cultural beliefs
Understanding of screening practices and healthcare access
The questionnaire was reviewed for content validity by a panel of experts, including public health professionals and gynecologists. A pilot test was conducted among 25 individuals from diverse backgrounds to assess clarity, internal consistency, and ease of comprehension. Based on feedback, minor revisions were incorporated before large-scale distribution.
Scoring Criteria
Each correct response was assigned 1 point, while incorrect or “not sure” responses received 0 points. The total knowledge score ranged from 0 to 20. Based on cumulative scores, participants were categorized as follows:
Very Good Knowledge: 17–20
Good Knowledge: 13–16
Fair Knowledge: 9–12
Poor Knowledge: 0–8
This classification allowed for clear stratification of awareness levels and helped in identifying knowledge gaps across different demographic groups.
Ethical Considerations
Participation in the study was entirely voluntary. Informed digital consent was obtained at the beginning of the Google Form. The survey emphasized confidentiality, anonymity, and non-collection of any personally identifiable information. Participants could withdraw at any time without consequence.
Data Management and Statistical Analysis
Survey responses were automatically compiled through Google Forms and exported into Microsoft Excel for initial processing. Statistical analysis was conducted using SPSS software, version 25.
Descriptive statistics (frequencies and percentages) were used to summarize demographic variables and response distributions.
Chi-square (χ²) tests were performed to assess associations between knowledge score categories and socio-demographic factors (age, gender, education, occupation, and residence).
A p-value of <0.05 was considered statistically significant.
The analysis aimed to identify demographic trends influencing cervical cancer awareness and highlight at-risk subgroups with low knowledge levels.
The study included a total of 400 participants from Himachal Pradesh, encompassing a diverse demographic profile. The age distribution was relatively even, with the highest proportion falling in the 26–35 age group (26.5%), followed closely by those aged 36–45 (26%) and 46 and above (30.5%), while 17% were aged 18–25. Females comprised the majority of respondents (58%), reflecting the gender relevance of the topic, although male participation was substantial (42%). In terms of educational attainment, 32% had completed secondary education, and 30.5% held undergraduate degrees, while 14% were postgraduates. However, a significant segment (23.5%) reported having only primary or no formal education. Occupationally, the sample included homemakers (24%), private sector employees (21%), students (18%), and government employees (16%), ensuring representation from varied social strata. The rural–urban divide was also well represented, with 53% of respondents residing in rural areas and 47% in urban settings—highlighting the importance of assessing awareness across geographic and socio-economic lines in the region (Table 1).
Table 1: Socio-Demographic Characteristics of Participants (n = 400)
| Variable | Category | Frequency (n) | Percentage |
| Age Group (Years) | 18–25 | 68 | 17.0% |
| 26–35 | 106 | 26.5% | |
| 36–45 | 104 | 26.0% | |
| 46 and above | 122 | 30.5% | |
| Gender | Male | 168 | 42.0% |
| Female | 232 | 58.0% | |
| Education Level | No formal education | 36 | 9.0% |
| Primary school | 58 | 14.5% | |
| Secondary school | 128 | 32.0% | |
| Undergraduate | 122 | 30.5% | |
| Postgraduate | 56 | 14.0% | |
| Occupation | Homemaker | 96 | 24.0% |
| Student | 72 | 18.0% | |
| Government Employee | 64 | 16.0% | |
| Private Sector | 84 | 21.0% | |
| Self-Employed | 48 | 12.0% | |
| Retired/Other | 36 | 9.0% | |
| Residence | Urban | 188 | 47.0% |
| Rural | 212 | 53.0% |
Participant responses to the 20 awareness and misconception questions on cervical cancer revealed mixed levels of understanding. Encouragingly, 71% were aware that Pap smear tests can detect cervical cancer early, and 70.8% recognized that the disease is curable if detected early. Moreover, 69.5% correctly identified cervical cancer as preventable, and 67.3% acknowledged the availability of the HPV vaccine in India. However, only 60.8% knew the recommended age to start screening (21 years), and just 54.5% were aware of the appropriate Pap test frequency, pointing to gaps in screening-related knowledge. Misconceptions were also evident: only 50.5% understood that HPV infection does not always lead to cancer, and fewer than 55% correctly identified that HPV can affect non-sexually active women. Nearly half the participants (49.3%) believed cervical cancer awareness is low in India, underlining the broader challenge of public health communication. While a majority demonstrated awareness of symptoms, hygiene practices, and vaccination, the data suggest persistent confusion around hereditary factors, risk behaviors, and screening logistics, indicating the need for targeted education to dispel myths and encourage preventive practices (Table 2).
Table 2: Awareness and Misconception Questions on Cervical Cancer and Its Prevention (n = 400)
| Q. No. | Question | Options (Correct in Bold) | Correct (n) | Correct (%) |
| 1 | Is cervical cancer preventable? | a) No b) Yes d) Not sure c) Only in early stage | 278 | 69.5% |
| 2 | What virus is commonly associated with cervical cancer? | a) HIV b) HPV d) Dengue c) Hepatitis | 256 | 64.0% |
| 3 | Can regular Pap smear tests detect cervical cancer early? | a) No b) Yes d) Not sure c) Only in severe cases | 284 | 71.0% |
| 4 | At what age should women begin cervical cancer screening? | a) 15 b)21 d) After menopause c) 30 | 243 | 60.8% |
| 5 | How frequently should Pap tests be done (in normal results)? | a) Every year b) Every 3 years d) Never c) Every 10 years | 218 | 54.5% |
| 6 | Does HPV infection always lead to cancer? | a) Yes b) No d) Not sure c) Always in women | 202 | 50.5% |
| 7 | Is there a vaccine for HPV available in India? | a) No b) Yes d) Experimental only c) Only for men | 269 | 67.3% |
| 8 | Can men be carriers of HPV? | a) Nob) Yes d) Never c) Only if symptomatic | 234 | 58.5% |
| 9 | Does good genital hygiene help in preventing HPV infections? | a) No b) Yes d) Rarely c) Not related | 288 | 72.0% |
| 10 | Is cervical cancer hereditary? | a) No d) Always c) Some times b) Yes | 222 | 55.5% |
| 11 | Are abnormal vaginal bleeding and pain symptoms of cervical cancer? | a) No b) Yes d) Not sure c) Only in late stages | 286 | 71.5% |
| 12 | Can HPV affect women who are not sexually active? | a) No d) Depends c) Always b) Yes | 219 | 54.8% |
| 13 | Can smoking increase the risk of cervical cancer? | a) No b) Yes d) Not relatedc) Only heavy smokers | 251 | 62.8% |
| 14 | Is cervical cancer curable if detected early? | a) No b) Yes d) Rarely c) Only in hospitals | 283 | 70.8% |
| 15 | Can women over 50 stop getting Pap tests? | a) Yes b) No d) Not sure c) After menopause | 212 | 53.0% |
| 16 | Is pelvic examination part of cervical cancer screening? | a) No b) Yes d) Never c) Only if pregnant | 246 | 61.5% |
| 17 | Is cervical cancer awareness high in India? | a) Yes b) No d) Don’t know c) Moderate | 197 | 49.3% |
| 18 | Does early marriage and multiple pregnancies increase risk of cervical cancer? | a) No b) Yes d) Not sure c) Not proven | 238 | 59.5% |
| 19 | Can HPV vaccine be given to girls before sexual debut? | a) No b) Yes d) Not recommended c) After 18 only | 266 | 66.5% |
| 20 | Are Pap tests painful and dangerous? | a) Yes b) No d) Slightly c) Always | 258 | 64.5% |
Based on their responses, participants were classified into four knowledge levels. Overall, 66.3% of respondents had good to very good knowledge regarding cervical cancer, with 29.5% achieving a “very good” score (17–20 out of 20) and 36.8% classified as “good” (13–16). A further 22.3% fell into the “fair” category (9–12), while 11.5% exhibited poor knowledge (scores of 0–8). These findings reflect a moderately encouraging awareness level across the study population but also signal that approximately one-third of participants had only fair or poor knowledge. This suggests a clear opportunity for public health stakeholders to scale up outreach efforts, especially focusing on reinforcing comprehensive understanding and correcting misconceptions in under-informed groups (Table 3).
Table 3: Knowledge Score Classification Among Participants (n = 400)
| Knowledge Level | Score Range (out of 20) | Frequency (n) | Percentage (%) |
| Very Good | 17–20 | 118 | 29.5% |
| Good | 13–16 | 147 | 36.8% |
| Fair | 9–12 | 89 | 22.3% |
| Poor | 0–8 | 46 | 11.5% |
Statistical analysis revealed significant associations between cervical cancer knowledge levels and several socio-demographic factors. Age was notably significant (p = 0.021), with younger adults (18–35 years) demonstrating higher levels of knowledge compared to older age groups, especially those aged 46 and above, who had the highest proportion of poor scores. Education level showed the strongest correlation with knowledge (p< 0.001), with postgraduate and undergraduate respondents achieving the highest awareness, while those with no formal or only primary education were most likely to have poor knowledge. Residence was another significant factor (p = 0.009), with urban participants performing better than rural counterparts—highlighting disparities in information access. Interestingly, gender differences were not statistically significant (p = 0.198), although females slightly outperformed males. These associations underscore the need for geographically and educationally inclusive interventions, particularly for older, rural, and less-educated populations who remain at risk of being underserved in awareness initiatives (Table 4).
Table 4: Association Between Knowledge Score and Socio-Demographic Variables (n = 400)
| Variable | Category | Very Good | Good | Fair | Poor | p-value |
| Age Group | 18–25 | 22 (5.5%) | 31 (7.8%) | 8 (2.0%) | 3 (0.8%) | 0.021 |
| 26–35 | 44 (11.0%) | 42 (10.5%) | 13 (3.3%) | 3 (0.8%) | ||
| 36–45 | 29 (7.3%) | 43 (10.8%) | 18 (4.5%) | 6 (1.5%) | ||
| 46 and above | 23 (5.8%) | 31 (7.8%) | 50 (12.5%) | 34 (8.5%) | ||
| Gender | Male | 57 (14.3%) | 66 (16.5%) | 38 (9.5%) | 19 (4.8%) | 0.198 |
| Female | 61 (15.3%) | 81 (20.3%) | 51 (12.8%) | 27 (6.8%) | ||
| Education Level | No formal education | 2 (0.5%) | 4 (1.0%) | 10 (2.5%) | 16 (4.0%) | <0.001 |
| Primary school | 5 (1.3%) | 9 (2.3%) | 20 (5.0%) | 17 (4.3%) | ||
| Secondary school | 31 (7.8%) | 46 (11.5%) | 31 (7.8%) | 15 (3.8%) | ||
| Undergraduate | 45 (11.3%) | 55 (13.8%) | 20 (5.0%) | 7 (1.8%) | ||
| Postgraduate | 35 (8.8%) | 33 (8.3%) | 8 (2.0%) | 4 (1.0%) | ||
| Residence | Urban | 72 (18.0%) | 79 (19.8%) | 20 (5.0%) | 5 (1.3%) | 0.009 |
| Rural | 46 (11.5%) | 68 (17.0%) | 69 (17.3%) | 41 (10.3%) |
This study provides valuable insight into the current status of cervical cancer awareness and related misconceptions among the general population of Himachal Pradesh. The findings indicate a moderately satisfactory level of knowledge overall, with nearly two-thirds (66.3%) of participants demonstrating good to very good awareness. However, the persistence of certain misconceptions and the influence of socio-demographic disparities underscore the urgent need for more targeted, community-centered educational interventions.
The relatively high proportion of participants who were aware of fundamental aspects—such as cervical cancer being preventable (69.5%), detectable through Pap smear (71%), and curable if identified early (70.8%)—reflects a growing penetration of public health messages and possibly improved access to online health information. Encouragingly, 67.3% were aware of the HPV vaccine's availability in India, and 72% recognized the role of genital hygiene in prevention. These findings suggest progress in disseminating basic preventive knowledge, potentially attributable to government programs, NGO-led campaigns, and digital awareness initiatives.
Despite these gains, significant knowledge gaps remain. Only 54.5% correctly identified the recommended Pap test frequency, and barely over half (50.5%) knew that HPV infection does not inevitably lead to cancer. This lack of understanding can contribute to fatalism or unnecessary fear. Moreover, the misconception that Pap tests are painful or dangerous—still believed by over one-third—poses a barrier to screening uptake. Notably, awareness about HPV's transmission in non-sexually active individuals and the risk among men remained suboptimal, indicating a need to broaden the scope of educational efforts beyond women of reproductive age.
Socio-demographic analysis revealed clear and statistically significant associations between awareness and variables such as age, education level, and residence. Participants aged 18–35 had significantly higher knowledge scores compared to older adults, particularly those over 46, who had the highest rates of poor awareness. This age-related trend could reflect generational differences in access to digital platforms and health education exposure. Education emerged as the strongest predictor of knowledge, consistent with findings from similar studies in other Indian states and LMICs. Those with undergraduate and postgraduate education consistently outperformed others, while individuals with no formal schooling had the lowest scores—highlighting education as a powerful determinant of health literacy.
The urban–rural divide was also evident. Urban participants displayed better awareness across most knowledge parameters, likely due to enhanced access to health services, higher education levels, and greater exposure to digital or media-based health campaigns. Although gender differences were not statistically significant, females marginally outperformed males, possibly due to greater personal relevance and engagement with reproductive health topics. Still, the substantial participation of men (42%) underscores the growing recognition that male awareness is also critical in breaking down stigma, supporting vaccination, and encouraging women to seek preventive care.
The presence of misconceptions, particularly regarding the hereditary nature of cervical cancer, pain during screening, and misunderstanding of HPV transmission, warrants attention. These misconceptions, if unaddressed, can discourage participation in preventive programs and perpetuate stigma. Our findings align with previous studies conducted in other Indian regions, where similar cultural beliefs and knowledge barriers have been documented.
Overall, the study highlights both progress and persisting challenges in cervical cancer awareness in Himachal Pradesh. While many participants possess a foundational understanding of the disease and its prevention, gaps remain in depth of knowledge, especially among older adults, rural residents, and the less educated. Addressing these disparities requires regionally tailored awareness campaigns that consider linguistic, cultural, and logistical barriers. Integrating cervical cancer education into existing health and wellness programs, leveraging Accredited Social Health Activists (ASHAs) and local influencers, and utilizing digital platforms may help extend reach, especially in hard-to-reach areas.
The present study underscores a moderately promising yet incomplete landscape of cervical cancer awareness among the general population of Himachal Pradesh, with two-thirds of participants demonstrating good to very good knowledge. While the findings reflect encouraging levels of understanding regarding prevention, symptoms, and early detection, critical gaps persist—particularly in awareness of screening frequency, vaccine timing, HPV transmission, and the non-hereditary nature of the disease. These gaps are more pronounced among older, rural, and less-educated individuals, suggesting the need for targeted, inclusive health education strategies. The significant associations between knowledge scores and socio-demographic variables such as age, education, and residence reinforce the imperative for context-specific interventions. For cervical cancer prevention to be truly effective in Himachal Pradesh, public health stakeholders must prioritize culturally sensitive awareness campaigns, expand outreach in rural and underserved areas, and integrate accurate information into existing community health frameworks. By addressing misconceptions and improving access to information and screening services, such efforts have the potential to substantially reduce the burden of cervical cancer in this Himalayan region.
Ghosh, S., et al. "Awareness, attitude, and practice towards cancer cervix prevention among rural women in southern India: a community based study." Clinical Epidemiology and Global Health, vol. 26, Mar.–Apr. 2024, p. 101546.
Taneja, N. and Chawla, B. "Knowledge, attitude, and practice on cervical cancer and screening among women in India: A review." Cancer Control, vol. 28, Jan.–Dec. 2021, p. 10732748211010799.
Reichheld, A., et al. "Prevalence of cervical cancer screening and awareness among women in an urban community in South India—a cross-sectional study." Annals of Global Health, vol. 86, no. 1, 2020, p. 30.
Chandrika, K., Naik, B.N. and Kanungo, S. "Awareness on cancer cervix, willingness, and barriers for screening of cancer cervix among women: A community-based cross-sectional study from urban Pondicherry." Indian Journal of Public Health, vol. 64, no. 4, Oct.–Dec. 2020, pp. 374-380.
Yadav, R., et al. "Awareness data on cervical cancer among females of rural and urban areas of Haryana, India." Data in Brief, vol. 53, Apr. 2024, p. 110168.
Agarwal, R. and Sharma, M. "Level of cervical cancer awareness among hospital visitors." Journal of Family Medicine and Primary Care, vol. 8, no. 10, 31 Oct. 2019, pp. 3452-3453.
Shah, V., Vyas, S., Singh, A. and Shrivastava, M. "Awareness and knowledge of cervical cancer and its prevention among the nursing staff of a tertiary health institute in Ahmedabad, Gujarat, India." ecancermedicalscience, vol. 6, 2012, p. 270.
Yadav, S.K., et al. "A study on knowledge, screening, and associated risk factors for cervical cancer among women in eastern Uttar Pradesh, India." International Journal of Medical Research and Health Sciences, vol. 12, no. 9, 2023, pp. 1-11.
Maheshwari, V., et al. "Prevalence and predictors of cervical cancer screening among married women in India: A cross-sectional analysis of National Family Health Survey-5 data." Cancer Research, Statistics, and Treatment, vol. 8, no. 1, Jan.–Mar. 2025, pp. 30-38.
Saini, N.K., et al. "A comparative study to assess knowledge, health beliefs and preventive practices among women with cervical cancer and general population at tertiary care hospital, New Delhi." International Journal of Community Medicine and Public Health, vol. 4, no. 8, 2017, pp. 2989-2994.
Prashanth, H., et al. "Cervical cancer risk factor awareness and utilization of screening program among women in United Arab Emirates." Journal of Oncology, vol. 3, no. 2, 2023, p. 1100.
Kumari, R., et al. "A study on knowledge, screening, and associated risk factors for cervical cancer among women in eastern Uttar Pradesh, India." International Journal of Medical Research and Health Sciences, vol. 12, no. 6, 2023, pp. 1-11.
Khanna, D. "Evaluating knowledge regarding cervical cancer and its screening among women in rural India." South Asian Journal of Cancer, vol. 9, no. 3, 2020, pp. 141-146.
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