Diabetes mellitus (DM) is a rising public health concern with a projected prevalence of 4.4 percent in 2030 and an estimated global incidence of 2.8 percent in 2000. from 171 million in 2000 to 366 million in 2030, a decline. In India, a developed country going through a rapid epidemiologic transformation, the prevalence of diabetes mellitus increased significantly from 7.1 percent in 2009 to 8.9 percent in 2019. The aetiology of DM is unknown, however a number of risk factors linked to its modifiable lifestyle have been identified and studied [1,2].

A rising body of research indicates that DM might be cured if its risk factors are identified and treated at an early stage. Lifestyle changes, such as increasing physical activity and lowering weight, have been found to be more effective than medicine in preventing or delaying the onset of DM in individuals who are at high risk of developing the condition. To turn such studies into a successful community intervention programme, it is essential to understand the specific requirements of these communities before implementing any type of intervention [3,4].

In order for people to make their own decisions about whether to live a healthy lifestyle, the first step in prevention is educating the public about DM risk factors and preventative measures. Both policymakers and public health professionals need accurate and reliable information about the prevalence and causative causes of DM-related health issues in the general population. These data are necessary to develop, implement, and evaluate successful intervention programmes [5-6].

Numerous researches have been conducted on Diabetes Mellitus in various regions of India, but few of these studies have been conducted in the state of Himachal Pradesh due to its unique customs and cultural patterns. The goal of the study was to gauge people's familiarity with diabetes mellitus, its risk factors, and preventative interventions so that a more culturally appropriate education plan could be developed as a health promotion intervention.

Objectives of the Study

To evaluate the knowledge about Risk factors and Preventive measures for Diabetes Mellitus among general population of Himachal Pradesh

• Research Approach Descriptive

• Research Design: Cross-sectional survey design

• Study area: Whole state of Himachal Pradesh

• Study duration- between April 2022 to May 2022

• Study population: All adults above 18 years of age who were staying in the Himachal Pradesh for 12 months or more

• Sample size: 400 Adults assuming 50% have adequate knowledge regarding Risk factors and Preventive measures for Diabetes Mellitus, 5% absolute error, 95% confidence level, and 5% non-response rate

• Study tool: A google form questionnaire consisting of questions regarding socio- demography, Risk factors and Preventive measures for Diabetes Mellitus was created. The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents

   

• Description of Tool

   

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more

• Questionnaire The questionnaire contains 20 structured questions regarding knowledge about Risk factors and Preventive measures for Diabetes Mellitus (10 each) having three options i.e. Yes, No & Don’t Know. The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 10 and minimum score was zero in each category. Scoring was done on the basis of marks as >80% (9-10) =very good,60- 79% (7-8) = Good,41-59% (4-6) = Fair, <40% (<4) = poor

   

• Validity of tool by the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram and LinkedIn in both rural and urban area of Himachal Pradesh till the 400 responses were collected

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

• Ethical Considerations:Participants confidentiality and anonymity were maintained

The goal of the current study was to assess general community knowledge of risk and preventative variables for diabetes mellitus in Himachal Pradesh through a non-experimental descriptive survey.

A total of 400 respondents including 145 (36.25%) were from urban area and 255 (63.75%) were from rural area were participated in the study. Among the participants of the majority 260 (65.0%) were males, 180 (45%) were between 18-30 years, 154 (38.5%) were Graduate, 279 (69.75%) were employee, 242 (60.5%) were married and 384 (96%) were Hindu (Table 1).

Table 1: Socio-Demographic Characteristics of Study Participants

In the present study 63 (15.75%) study participants had very good knowledge (9-10 marks) towards risk factors for Diabetes, 257 (64.25%) had good knowledge (7-8 marks), 65 (16.25%) had fair knowledge (4-6 marks) and 15 (3.75%) had poor knowledge (<4 marks) towards risk factors for Diabetes (Table 2).

Table 2: Knowledge about Risk Factors of Diabetes Mellitus among Participants

Similarly, 42 (10.5%) study participants had very good knowledge (9-10 marks) towards preventive measures about Diabetes, 284 (71%) had good knowledge (7-8 marks), 56 (14%) had fair knowledge (4-6 marks) and 18 (4.5%) had poor knowledge (<4 marks) towards preventive measures about Diabetes (Table 3,4).

Table 3: Knowledge of Participants towards Preventive Measures of Diabetes Mellitus

Table 4: Knowledge towards Risk Factor and Preventive Measures among Study Participants

Lack of awareness of a disease's risk factors, in this case Diabetes Mellitus, may prevent patients from taking preventative measures like changing their lifestyles for the better. Consequently, a knowledge- based evaluation of an individual's particular risk of illness appears to have an effect on many preventative health actions [6,7].

Many survey respondents were only able to accurately identify two risk factors or preventative actions for diabetes. This ignorance might be a result of both education level and rural upbringing. The general public's inability to identify risk factors may also be a sign of their uninformed understanding of diabetes. It will probably have detrimental effects on avoiding or early diabetes detection. Additionally, it might be extremely detrimental to the economies of developing nations. Similar finding was reported in the studies [7-8]. In particular, the entire state of Himachal Pradesh needs to be made more aware of diabetes, as this study emphasises. Studies from India had revealed that in order to achieve treatment suggestion compliance, constant exposure to information on healthy lifestyles was required [9-12]. There are no facilities for such integrated patient  education  approaches  in  a  state  like   Himachal Pradesh, where the prevalence of diabetes is growing. Increasing awareness of the condition, its risk factors, and preventive measures is the first step in the fight against the disease. Where diabetes is incredibly common, a concerted state or national campaign to raise awareness of the disease should be prioritized as a matter of public health [13,14].

Almost every state of India is experiencing a rapid health transition with a rising burden of Non- Communicable Diseases (NCD) like Diabetes. In order to prevent and control major NCDs, the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010 with focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral. Health promotion through behavior changes with involvement of community, civil society, and community-based organizations; media etc. is an important strategy of this programe. In this regard ASHAs may play a key role in creating more awareness and providing comprehensive and culturally appropriate care to communities [15].

Limitations

We may have underestimated the level of knowledge, as a limitation of having used unaided open-ended questions within the questionnaire as opposed to mentioning specific risk factors. However, we believe that this question type allowed for identification of the most known Diabetes Mellitus risk factors and preventive measures.

Many survey respondents said that they were still unsure about the risk and preventive factors for diabetes mellitus. The results of numerous studies point to community health education programmes as the main priority for initiatives to prevent diabetes mellitus. The programme should take into account each person's distinctive circumstances, allow for interpersonal variations, and, in particular, take local, elderly, and undereducated people's needs into consideration.

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