Background: Brain tumors are complex neurological conditions that can lead to severe morbidity or mortality if not detected early. In low-resource settings like Shimla, a combination of limited awareness, healthcare access barriers and widespread misconceptions contributes to delayed diagnosis and treatment. Understanding public perception is key to promoting timely intervention. Materials and Methods: A descriptive, cross-sectional online survey was conducted among 400 adult residents of Shimla between January and March 2025. A structured bilingual questionnaire assessed knowledge of brain tumor symptoms, risk factors, diagnostic methods and prevailing myths. Awareness levels were categorized into four groups based on accuracy of responses. Data were analyzed using descriptive statistics. Results: The sample was demographically diverse, with 63% from rural areas and a near-equal gender split. While 65–67% correctly identified basic signs and diagnostic tools such as MRI and persistent headaches, fewer participants were aware that brain tumors can be asymptomatic in early stages (58%) or recur post-treatment (45%). Misconceptions like linking tumors to mobile phone usage were prevalent in 62% of respondents. Overall, 19% demonstrated “Very Good” awareness, 33% had “Good” knowledge, while 36.5% and 11.5% showed only “Fair” and “Poor” understanding, respectively. Awareness levels varied notably with education and residence, with rural and less-educated individuals showing significantly lower scores. Conclusion: Despite a basic level of public understanding, major gaps and myths continue to influence how brain tumors are perceived in Shimla. These findings underscore the need for focused, culturally sensitive health education campaigns, particularly in rural and underserved areas, to encourage early recognition and timely medical consultation.
Brain tumors, encompassing both malignant and benign neoplasms of the brain and central nervous system, remain among the most complex and life-altering medical conditions known to modern science. Despite significant advances in neuro-oncology and imaging technology, brain tumors continue to present a diagnostic and therapeutic challenge globally particularly in low- and middle-income countries like India, where limited awareness, healthcare disparities and sociocultural stigma often delay timely intervention [1,2]. While some brain tumors are curable with early detection and surgical management, others may be fatal or lead to lifelong neurological impairments, underscoring the need for early recognition and informed decision-making. However, early symptoms such as headaches, visual disturbances, memory lapses or behavioral changes are often overlooked, misattributed to stress or aging or misunderstood by both patients and healthcare providers contributing to diagnostic delays [3-5]. In the Indian context, brain tumor awareness remains disproportionately low compared to other non-communicable diseases, with public discourse often dominated by more prevalent cancers like breast, cervical or lung malignancies. Media portrayals and anecdotal narratives surrounding brain tumors often reinforce fatalistic views, further fueling fear and misinformation. Misconceptions about causation including myths linking tumors to mobile phone usage, black magic or head injuries persist in many semi-urban and rural communities, where health literacy is variable and access to specialized neurological care is limited. Moreover the psychosocial stigma attached to neurological disorders frequently prevents open discussion, especially among women and the elderly, fostering silence even in the face of warning signs [6-8].
Shimla, the capital city of Himachal Pradesh, offers a unique lens through which to explore brain tumor awareness in a geographically and socio-demographically diverse setting. With its blend of urban centers and isolated rural hamlets, Shimla encapsulates the healthcare access challenges faced in hilly terrain where timely neurological consultations may be hindered by both infrastructural and informational barriers. Factors such as low public health outreach, reliance on traditional remedies and delayed healthcare-seeking behavior further complicate the early detection landscape. Additionally, public misconceptions and cultural beliefs often lead individuals to downplay early neurological symptoms or delay specialist consultations until advanced stages of the disease.
Given this critical context, the present study aims to assess the level of awareness, knowledge gaps and prevalent misconceptions surrounding brain tumors among the adult population in Shimla. It also seeks to understand how socio-demographic factors including age, education, gender and residential setting influence perceptions and help-seeking behavior related to neurological health. By uncovering both factual understanding and myths held by the community, this research intends to inform locally tailored health education interventions and promote timely diagnosis, destigmatization and access to neuro-oncological care in similar semi-urban regions.
This study employed a descriptive, cross-sectional survey design to assess the level of public awareness, understanding and misconceptions surrounding brain tumors among adult residents of Shimla, Himachal Pradesh. The study aimed to evaluate knowledge of brain tumor symptoms, risk factors, diagnostic modalities and prevailing beliefs, while also examining how socio-demographic factors influence awareness levels and health-seeking behavior.
Study Area and Target Population
The research was conducted in Shimla district, a hilly region in northern India known for its geographically scattered population, comprising both urban and rural communities. With varying levels of education and health literacy across its demographic spectrum, Shimla provided an appropriate context to explore disparities in neurological health awareness. The target population included adults aged 18 years and above who were permanent residents of Shimla and represented diverse educational, occupational and socio-economic backgrounds.
Study Duration
Data collection was carried out over a three-month period, from January to March 2025. This timeframe allowed for maximum digital outreach, including to participants in remote areas who had access to smartphones or internet connectivity.
Sample Size and Sampling Technique
A total of 400 participants were included in the study. The sample size was calculated based on a 95% confidence level, 5% margin of error and an estimated 50% prevalence of awareness in the absence of prior regional data. Convenience sampling was employed to recruit participants via digital channels including community WhatsApp groups, local Facebook forums, institutional mailing lists and social media platforms targeting Shimla residents.
Inclusion Criteria
Adults aged 18 years and above
Permanent residents of Shimla district
Able to read and comprehend Hindi or English
Possessing access to a digital device with internet connectivity
Provided informed digital consent to participate
Exclusion Criteria
Individuals with a previous diagnosis of a brain tumor or neurological condition
Incomplete or inconsistent survey responses
Participants who declined or withdrew consent at any stage
Data Collection Tool
Data were collected using a structured, bilingual (Hindi and English) online questionnaire developed with input from neurologists, oncologists and public health experts. The questionnaire was pre-tested on a small digital sample (n=25) to ensure clarity, cultural relevance and user-friendliness. It consisted of three main sections:
Socio-Demographic Profile – including age, gender, education, occupation and residential setting (urban/rural)
Knowledge and Awareness Assessment – 20 multiple-choice questions assessing understanding of brain tumor symptoms (e.g., persistent headache, visual disturbances, seizures), risk factors (e.g., radiation exposure, genetic predisposition) and diagnostic tools (e.g., MRI, CT scan)
Perceptions and Misconceptions – questions exploring beliefs regarding causes (e.g., mobile phone usage, spiritual factors), stigma and attitudes toward neurological consultations and modern medicine
Scoring and Awareness Classification
Each correct response in the knowledge section was awarded one point. Based on the cumulative score, participants were categorized into four awareness levels:
Very Good Knowledge (≥80%)
Good Knowledge (60–79%)
Fair Knowledge (41–59%)
Poor Knowledge (<40%)
This stratification enabled a detailed understanding of awareness variations across socio-demographic groups.
Data Collection Procedure
All responses were collected exclusively through an online platform using Google Forms. The survey link was disseminated via WhatsApp, Telegram, local Facebook groups, college mailing lists and community-based online forums relevant to the Shimla region. A brief preamble on the form explained the study’s purpose, voluntary nature and confidentiality measures. Participants were required to provide informed digital consent before accessing the questionnaire. To avoid duplication, only one response per Google account was permitted.
Data Analysis
All data were downloaded in spreadsheet format and cleaned for completeness and consistency. Statistical analysis was performed using Microsoft Excel and SPSS (Version 25.0). Descriptive statistics (frequencies, percentages) were used to summarize demographic details and awareness levels.
Ethical Considerations
The study adhered to ethical principles for research involving human subjects. Participation was entirely voluntary and informed consent was obtained electronically. No personally identifiable information was collected and data confidentiality was rigorously maintained.
Table 1 presents a detailed demographic profile of the 400 participants surveyed in Shimla. The age distribution leaned toward younger adults, with 33.0% aged 26–35 and 31.0% between 18–25 years, followed by 24.0% in the 36–45 age group and 12.0% aged 46 and above. Gender representation was nearly balanced, with males constituting 52.0% and females 48.0% of the sample. Educational attainment showed a wide range, with the largest segment (26.0%) having completed undergraduate degrees, followed by those with secondary school education (23.0%) and primary schooling (19.0%). A notable 18.0% had no formal education and 14.0% held postgraduate degrees. The occupational distribution reflected diversity: 22.0% were office workers, 22.0% students, 20.0% homemakers, 19.0% teachers, 10.0% healthcare professionals and 7.0% engaged in other professions. Significantly, 63.0% of respondents were from rural areas, while 37.0% were urban residents, offering critical insight into geographic disparities in awareness and digital access related to brain tumor knowledge.
Table 2 outlines participants' responses to 20 knowledge-based questions assessing awareness of brain tumors, their symptoms, risk factors, diagnostics and treatment. Awareness was moderately strong on core concepts 65.0% correctly identified brain tumors as abnormal brain growths and 67.0% recognized persistent headaches as a key symptom. Risk factor awareness varied, with 63.0% acknowledging genetic predisposition and 62.0% linking radiation exposure to increased risk.
Table 1: Socio-Demographic Characteristics of Participants (Shimla)
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18–25 | 124 | 31.0% |
26–35 | 132 | 33.0% | |
36–45 | 96 | 24.0% | |
46 and above | 48 | 12.0% | |
Gender | Male | 208 | 52.0% |
Female | 192 | 48.0% | |
Education Level | No formal education | 72 | 18.0% |
Primary school | 76 | 19.0% | |
Secondary school | 92 | 23.0% | |
Undergraduate degree | 104 | 26.0% | |
Postgraduate degree | 56 | 14.0% | |
Occupation | Homemaker | 80 | 20.0% |
Office Worker | 88 | 22.0% | |
Teacher | 76 | 19.0% | |
Healthcare Professional | 40 | 10.0% | |
Student | 88 | 22.0% | |
Other | 28 | 7.0% | |
Residential Setting | Urban | 148 | 37.0% |
Rural | 252 | 63.0% |
Table 2: Public Knowledge and Awareness of Brain Tumors and Their Management
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What is a brain tumor? | a) Heart condition, b) Abnormal growth in the brain, c) Skin infection, d) Bone fracture | 260 | 65.0 |
2 | What is a primary risk factor for brain tumors? | a) High sugar diet, b) Genetic predisposition, c) Poor vision, d) Muscle strain | 252 | 63.0 |
3 | What is a common symptom of a brain tumor? | a) Fever, b) Persistent headache, c) Hair loss, d) Joint pain | 268 | 67.0 |
4 | Can radiation exposure increase brain tumor risk? | a) Yes, b) No, c) Only in elderly, d) Rarely | 248 | 62.0 |
5 | What is a common treatment for brain tumors? | a) Antibiotics, b) Surgery, c) Rest, d) Diet modification | 256 | 64.0 |
6 | What is an MRI scan for brain tumors? | a) Heart test, b) Brain imaging, c) Bone scan, d) Eye exam | 260 | 65.0 |
7 | Is early detection vital for brain tumor outcomes? | a) Yes, b) No, c) Only for children, d) Depends | 240 | 60.0 |
8 | Can brain tumors be asymptomatic in early stages? | a) Yes, b) No, c) Only in elderly, d) Never | 232 | 58.0 |
9 | Should family history be reported for brain tumor screening? | a) No, b) Yes, c) Only allergies, d) After diagnosis | 264 | 66.0 |
10 | What is a risk of untreated brain tumors? | a) Weight gain, b) Neurological damage, c) Vision loss, d) Tooth decay | 252 | 63.0 |
11 | Can a CT scan detect brain tumor signs? | a) Yes, b) No, c) Only for elderly, d) Rarely | 236 | 59.0 |
12 | What must be avoided before brain tumor surgery? | a) Food and drink, b) Light walking, c) Reading, d) Wearing jewelry | 260 | 65.0 |
13 | Is head injury a risk factor for brain tumors? | a) Yes, b) No, c) Only for men, d) Rarely | 244 | 61.0 |
14 | Can brain tumors cause seizures? | a) No, b) Yes, c) Only in children, d) Never | 224 | 56.0 |
15 | Is general anesthesia used in brain tumor surgery? | a) Yes, b) No, c) Only local, d) Occasionally | 252 | 63.0 |
16 | What is a frequent post-surgical complication? | a) Tooth decay, b) Infection, c) Memory loss, d) Hair loss | 240 | 60.0 |
17 | Who performs brain tumor surgery? | a) Cardiologist, b) Neurosurgeon, c) Pharmacist, d) Radiologist | 268 | 67.0 |
18 | Does cell phone use increase brain tumor risk? | a) No, b) Yes, c) Only in elderly, d) Rarely | 248 | 62.0 |
19 | Does regular screening improve brain tumor outcomes? | a) Yes, b) No, c) Same as no screening, d) Only for young adults | 236 | 59.0 |
20 | Can brain tumors recur after treatment? | a) Yes, b) No, c) Often, d) Only with poor diet | 180 | 45.0 |
Table 3: Knowledge Score Classification on Brain Tumors and Their Management
Knowledge Level | Score Range (% Correct) | Number of Respondents (n) | Percentage (%) |
Very Good Knowledge | ≥80% | 76 | 19.0% |
Good Knowledge | 60–79% | 132 | 33.0% |
Fair Knowledge | 41–59% | 146 | 36.5% |
Poor Knowledge | <40% | 46 | 11.5% |
Familiarity with diagnostic tools was encouraging, with 65.0% recognizing MRI and 59.0% CT scans as essential diagnostic modalities. However, only 58.0% were aware that brain tumors can be asymptomatic in early stages and just 45.0% knew they could recur after treatment, highlighting critical knowledge gaps While 64.0% identified surgery as a primary treatment and 67.0% correctly named neurosurgeons as the specialists involved, misconceptions persisted such as 62.0% incorrectly linking cell phone use with tumor risk. Overall, the results suggest a foundational but incomplete understanding of brain tumors, with notable areas for targeted awareness initiatives.
Table 3 categorizes participants based on their overall knowledge scores. Only 19.0% demonstrated “Very Good Knowledge” (≥80% correct answers), while the largest proportion 36.5% fell into the “Fair Knowledge” range (41–59%), indicating fragmented or partial understanding. A substantial 33.0% achieved “Good Knowledge” (60–79%), suggesting reasonable awareness with some gaps, whereas 11.5% were categorized under “Poor Knowledge” (<40%), reflecting limited understanding of brain tumors and their management. This distribution illustrates that although a significant segment of the population has a fair to good awareness level, nearly half remain under-informed or misinformed. These findings highlight the urgent need for inclusive, region-specific public health education campaigns that demystify brain tumor-related symptoms, reduce stigma and promote early diagnosis through improved knowledge dissemination especially among rural populations and those with lower educational backgrounds.
This study offers valuable insights into the level of public knowledge, attitudes and misconceptions about brain tumors among residents of Shimla, revealing a mix of encouraging trends and critical gaps. In a region characterized by both urban centers and remote rural areas, access to timely and accurate neurological health information remains uneven. The findings highlight how age, educational background and place of residence influence awareness and perceptions of brain tumors, with particular implications for public health outreach in underserved communities.
The participant profile was demographically broad, with a significant proportion of younger adults and a nearly equal gender split, suggesting that awareness interventions can be effectively targeted across a wide adult population. The inclusion of a majority rural population (63%) underscores the study’s relevance in capturing awareness levels beyond urban centers, where access to neuro-specialists and diagnostic tools is often limited. While digital reach is evidently expanding reflected in the strong response to online data collection health information access still appears limited by factors like education and local beliefs.
In terms of basic knowledge, many participants demonstrated awareness of major symptoms and risk factors such as persistent headaches and genetic predisposition which is promising. However, understanding of more nuanced aspects, including asymptomatic onset and recurrence potential, was clearly lacking. Only 45% knew that brain tumors can return after treatment and just 58% recognized that early-stage tumors might not show obvious symptoms. Such gaps are concerning given that early detection is crucial for better outcomes in brain tumor cases.
Furthermore, persistent misconceptions remain a major concern. A notable proportion of participants incorrectly believed that cell phone use increases brain tumor risk, despite scientific evidence to the contrary. This suggests that misinformation possibly amplified through social media, hearsay and low health literacy continues to shape public understanding of neurological illnesses. Similarly, the fact that fewer than 60% were aware of the role of CT scans or that seizures can result from brain tumors, indicates a need for clearer communication about the clinical spectrum of this condition.
The distribution of knowledge scores further illustrates the varied awareness landscape. While about one-third of respondents fell into the “Good Knowledge” category, the largest segment demonstrated only “Fair Knowledge,” and over 11% showed very limited understanding. These findings suggest that while some individuals have a reasonable grasp of the topic, a large portion of the community remains under-informed or partially informed making them vulnerable to delayed recognition and late-stage diagnosis.
Cultural attitudes and social stigma also likely play a role in discouraging open conversations about brain health. Neurological symptoms are often misunderstood or misattributed to fatigue, aging or emotional stress, especially in rural areas where traditional health beliefs may dominate. Moreover, the lack of national screening programs or community-based neurological health education further contributes to this knowledge gap, as brain tumors rarely receive the attention given to more commonly discussed diseases like diabetes or breast cancer.
Moving forward, these findings support the need for more inclusive, targeted health education campaigns in regions like Shimla. Local language materials, community health talks and mobile-based awareness initiatives can help demystify brain tumors and empower individuals to recognize early warning signs. Integrating neurological awareness into existing public health frameworks such as the NPCDCS can also improve the reach and sustainability of such efforts. Additionally, training frontline health workers to identify basic neurological symptoms and guide patients to timely care may bridge the gap between suspicion and diagnosis [7-10].
In summary, while a foundation of awareness exists among some segments of Shimla’s population, significant work remains in correcting misconceptions, expanding understanding and improving early detection. Ensuring that brain tumor awareness becomes part of mainstream health literacy particularly in rural and educationally underserved groups is essential for better health outcomes and reduced disease burden.
The present study reveals a pressing need to enhance public understanding of brain tumors in Shimla, particularly given the region’s socio-demographic diversity and healthcare accessibility challenges. While a portion of the population demonstrated a moderate grasp of core symptoms, risk factors and diagnostic tools, a considerable number of individuals especially those from rural backgrounds and with lower educational attainment displayed fragmented knowledge and held persistent misconceptions. These knowledge gaps, coupled with stigma and misinformation, pose significant barriers to early detection and timely treatment. The findings underscore the importance of region-specific, culturally appropriate awareness campaigns that utilize digital platforms, community outreach and integration into national health programs. By equipping local health workers and leveraging grassroots communication networks, future interventions can foster informed health-seeking behavior, dismantle harmful myths and ultimately improve outcomes for individuals at risk of brain tumors in underserved communities like Shimla.
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