Diabetes mellitus is a major global health concern, significantly impacting both developed and developing nations due to its increasing prevalence and associated morbidity and mortality. The disease contributes notably to the global burden of chronic illnesses, economic stress, and diminished quality of life, making it a critical area for public health intervention. India, often referred to as the diabetes capital of the world, faces an unprecedented rise in the prevalence of diabetes mellitus, driven primarily by rapid urbanization, lifestyle changes, dietary shifts, and demographic transition. Consequently, diabetes-related complications impose enormous strains on healthcare resources and substantially affect societal productivity and quality of life.^1-5

Haryana, a rapidly urbanizing and economically transitioning state in North India, exemplifies these public health challenges, with diabetes prevalence steadily increasing across both urban and rural populations. Despite ongoing governmental and non-governmental efforts, public awareness regarding diabetes, its complications, preventive strategies, and the importance of early diagnosis and management remains suboptimal. Poor awareness and misconceptions about diabetes significantly hinder timely diagnosis, appropriate self-care practices, and effective disease management, exacerbating the risk of complications and long-term disability.^5-7

The present study aims to comprehensively evaluate the current levels of awareness, understanding of diabetes risk factors, management, and complications among the adult population of Haryana. Additionally, it seeks to assess the preventive practices adopted by individuals to mitigate diabetes risk and complications. By identifying knowledge gaps and factors influencing preventive behaviors, this research endeavors to recommend targeted public health interventions and educational strategies. The findings from this study will provide essential evidence for policymakers, healthcare providers, and community stakeholders to formulate focused, culturally appropriate, and effective public health programs, ultimately contributing to reduced diabetes burden and improved quality of life among residents in Haryana and similar settings.

Study Area

This study was carried out across selected districts of Haryana, a rapidly developing state in North India characterized by increasing urbanization, socioeconomic diversity, and a rising prevalence of diabetes mellitus. Haryana was strategically selected due to documented increases in diabetes prevalence, reflecting broader national trends and providing an ideal representative setting for assessing public awareness, risk perceptions, and preventive behaviors related to diabetes mellitus.

Study Design and Sampling Technique

A descriptive cross-sectional study design was employed to evaluate public awareness and knowledge about diabetes mellitus among adults in Haryana. To ensure representativeness, a multistage stratified sampling method was utilized. Initially, districts were purposively selected based on variations in urbanization, socioeconomic status, and documented prevalence of diabetes. Subsequently, from each district, specific urban wards and rural villages were randomly selected, proportionally representing the diverse socio-demographic profiles of the state.

Study Population and Sample Size

The study targeted adults aged 18 years and above who had resided in the selected districts of Haryana for at least one year. The required sample size was calculated using the standard formula for cross-sectional studies, considering a conservative prevalence of adequate diabetes awareness at 50%, with a confidence interval of 95% and margin of error ±5%. Accounting for a non-response rate of approximately 10%, a final sample size of 400 participants was determined, evenly distributed between urban and rural areas for effective comparative analysis.

Data Collection Tool

A structured and pre-tested questionnaire was designed through comprehensive literature review and expert consultation. It was validated by pilot testing among a smaller, representative subset of the population to ensure clarity, cultural appropriateness, and reliability. The questionnaire consisted of four primary sections:

1. Socio-demographic Characteristics: Age, gender, education level, occupation, monthly income, and residence type.
2. Knowledge about Diabetes Mellitus: Understanding of disease symptoms, risk factors, complications, preventive measures, and importance of regular screening.
3. Preventive Practices: Lifestyle behaviors such as dietary practices, physical activity levels, regular screening practices, and adherence to medical advice.
4. Sources of Information: Identifying main information sources such as mass media, health professionals, social networks, and community-based health programs.

The questionnaire was available in both English and local languages (Hindi and Haryanvi dialect) to facilitate clear communication and accuracy of responses.

Data Collection Procedure

Trained field investigators conducted face-to-face interviews after obtaining written informed consent from all participants. Each interview lasted approximately 15–20 minutes, conducted at convenient locations within respondents’ communities. Regular supervision, quality checks, and random validation visits were conducted by senior researchers to ensure data accuracy and integrity.

Ethical Considerations

Ethical approval was secured from the Institutional Ethics Committee prior to initiating the study. Confidentiality and privacy were strictly maintained. Participants were informed about the study objectives, voluntary participation, their right to withdraw at any point, and the confidentiality of their responses. All collected data were anonymized and stored securely.

Statistical Analysis

Collected data were systematically coded, entered, and analyzed using SPSS (Statistical Package for Social Sciences), version 25.0. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were computed for socio-demographic variables, knowledge indicators, and preventive practices. Chi-square tests assessed the associations between socio-demographic variables (e.g., education, gender, residence, age) and knowledge or preventive practices regarding diabetes mellitus. Logistic regression analysis was performed to identify independent predictors associated with adequate knowledge and positive preventive behaviors. Results were considered statistically significant at a p-value less than 0.05.

The study included 400 adult respondents from Haryana, evenly split between urban and rural settings. Males slightly outnumbered females (52% versus 48%). Most participants were within the age group of 31–45 years (36%), followed by those aged 46–60 years (28%), and young adults aged 18–30 years (27%). Individuals aged above 60 years constituted the smallest segment (9%). Educationally, the majority had secondary education (33%) or were graduates and above (31%), with fewer respondents being illiterate (12%). Regarding occupation, a significant proportion was employed (43%), while unemployed/housewives represented 37%, and both retired persons and students accounted for 10% each.

Table 1: Socio-demographic Characteristics of Respondents (n=400)

Respondents exhibited varied knowledge levels regarding diabetes mellitus. A considerable percentage (72%) could correctly identify common diabetes symptoms, while awareness of risk factors such as diet and obesity was relatively lower (65%). Approximately 51% were knowledgeable about long-term complications related to diabetes, and exactly half (50%) understood the importance of regular screening and check-ups. Awareness about lifestyle and dietary modifications as preventive measures was moderate, with 56% demonstrating adequate knowledge.

Table 2: Knowledge Regarding Diabetes Mellitus (n=400)

Television emerged as the primary source of diabetes-related information for the respondents, cited by two-thirds (66%), followed closely by healthcare professionals (60%), indicating that both mass media and healthcare providers are crucial in raising diabetes awareness. Print and digital media such as newspapers (45%) and social media platforms (40%) were moderately effective. Family members and friends were also influential, providing information to nearly half of respondents (49%), whereas community-based health campaigns were the least cited source (38%), suggesting potential areas for improved outreach.

Table 3: Sources of Information about Diabetes (Multiple responses allowed)

Participants exhibited varying degrees of adherence to preventive practices against diabetes mellitus. The most common preventive measure was avoidance of tobacco and alcohol, practiced by nearly 58% of respondents. Adopting healthy dietary habits (48%) and regular physical exercise (45%) were practiced moderately, whereas regular blood sugar monitoring was comparatively low (38%). Only about one-third of respondents (34%) underwent regular health check-ups, highlighting a significant gap in proactive health-seeking behavior within the community.

Table 4: Preventive Practices Adopted by Respondents (n=400)

Significant associations were identified between adequate diabetes knowledge and several socio-demographic variables. Younger respondents (≤45 years) exhibited significantly better knowledge compared to older respondents (p=0.005). Urban residents displayed significantly higher levels of diabetes awareness compared to rural participants (p=0.003). Education level was also a critical determinant, with higher educational attainment strongly correlating with better diabetes awareness (p<0.001). Occupation showed significant associations, with employed respondents and students demonstrating better knowledge compared to unemployed or retired individuals (p=0.003). However, gender did not significantly influence diabetes knowledge levels among participants.

Table 5: Association between Socio-demographic Factors and Knowledge (n=400)

Preventive behaviors related to diabetes were significantly associated with residence type, education level, and occupation, whereas associations with age and gender were less prominent. Urban respondents were significantly more engaged in preventive practices than rural respondents (p<0.001). Participants with higher education (graduates and above) adopted preventive behaviors more consistently than those with lower education levels (p<0.001). Employed and retired respondents adopted preventive behaviors more frequently than unemployed individuals and students (p=0.008). Interestingly, gender showed only borderline significance (p=0.053), indicating that both males and females were similarly engaged in diabetes prevention practices, while age did not significantly affect preventive practices (p=0.415). These findings underscore the need for tailored interventions particularly targeting rural communities and less educated segments of the population to enhance preventive behaviors effectively.

Table 6: Association between Socio-demographic Factors and Preventive Practices (n=400)

This cross-sectional study provides critical insights into awareness, knowledge, and preventive practices related to diabetes mellitus among the general adult population of Haryana, highlighting substantial knowledge gaps and variations linked to socio-demographic characteristics. Despite widespread public health initiatives, significant deficiencies persist in community understanding of diabetes symptoms, risk factors, complications, and the importance of preventive practices. Similar findings have been documented globally, emphasizing the ongoing need for targeted diabetes awareness interventions, particularly within developing regions experiencing rapid urbanization and lifestyle changes.

Educational status was identified as a crucial determinant of both knowledge and preventive behavior, with higher education significantly associated with improved awareness and the adoption of beneficial practices. This result aligns with existing literature, underscoring the role of education in enhancing health literacy, enabling individuals to make informed decisions regarding their health. Urban residents also exhibited significantly greater awareness and were more engaged in preventive practices compared to rural populations, reflecting disparities possibly related to better healthcare accessibility, information dissemination, and resource availability in urban areas. This urban-rural gap mirrors broader national and international trends, highlighting the need for focused public health initiatives targeting rural populations.^8-12

Interestingly, age was significantly associated with knowledge levels but did not strongly predict the adoption of preventive behaviors. Younger respondents (≤45 years) demonstrated higher levels of awareness compared to older respondents, possibly due to greater access to diverse information sources, including digital platforms. However, this knowledge advantage among younger respondents did not consistently translate into better preventive actions, suggesting a disconnect between awareness and behavioral change. This may indicate gaps in translating awareness into practical health behaviors, underscoring the need for interventions that effectively bridge knowledge and practice, possibly by emphasizing practical skills training and health behavior modeling.^13-15

Gender did not significantly influence overall knowledge or preventive practices, though a borderline trend suggested females might adopt preventive practices slightly more frequently than males. This finding aligns with prior studies indicating that women may be more proactive about health management due to their traditional caregiving roles within families. Despite the lack of significant gender differences, this finding points towards potential opportunities to leverage female networks in community-based education and prevention programs, thereby indirectly influencing household health behaviors.^14-16

Occupation emerged as an influential socio-demographic variable, with employed and retired respondents exhibiting better knowledge and preventive practices compared to unemployed individuals or students. This suggests that workplace-related health initiatives and structured health awareness programs for employees and retirees could effectively enhance community-wide diabetes prevention efforts. Conversely, unemployed populations might benefit from targeted outreach programs emphasizing the economic and health benefits of preventive practices.^17,18

The reliance on television and healthcare professionals as primary sources of diabetes information highlights their continued importance in public health education. However, relatively moderate use of community-based campaigns and digital platforms suggests significant untapped potential. Enhancing community-based interventions and optimizing social media usage could bridge existing gaps, particularly among younger and rural populations, to improve health literacy and proactive health behaviors.^19,20

Overall, this study identifies critical socio-demographic determinants influencing diabetes awareness and preventive practices among the general population in Haryana. The evident disparities linked to educational attainment and urban-rural residence underscore the necessity of targeted educational campaigns, community engagement programs, and improved healthcare accessibility, particularly in rural and less educated populations. Health policymakers, stakeholders, and practitioners should strategically leverage influential media channels, strengthen community-based programs, and emphasize culturally relevant health education approaches to effectively reduce the prevalence of diabetes and its complications. These efforts can significantly contribute to improving health outcomes, reducing healthcare costs, and enhancing quality of life in Haryana and similar contexts facing similar public health challenges.

This study highlights critical knowledge gaps and suboptimal preventive practices concerning diabetes mellitus among adults in Haryana, significantly influenced by educational level, residential area, and occupation. To effectively address the rising diabetes burden, tailored public health interventions focusing on rural communities, less educated populations, and unemployed individuals are essential. Enhancing the role of healthcare professionals, mass media, and community-based campaigns in diabetes education can substantially improve health literacy, promote preventive behaviors, and reduce diabetes-related complications, ultimately improving quality of life across Haryana and comparable regions.

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