PERCEPTION AND BEHAVIOR RELATED TO NON- COMMUNICABLE DISEASES (NCD’S) AMONG URBAN SLUM DWELLERS IN RAWALPINDI: A CROSS-SECTIONAL STUDY

Abstract

Background: Non-communicable diseases (NCDs) represent a rapidly escalating public health challenge, particularly in low-income urban slum settings where poverty, low literacy, and limited healthcare access intersect. In such environments, inadequate awareness, misconceptions about disease causation, and poor preventive practices contribute to delayed diagnosis and adverse health outcomes. Understanding community-level knowledge, perceptions, and behaviors related to NCDs is therefore essential for designing effective, context-sensitive prevention and control strategies.

Objective: This study aimed to assess knowledge, perceptions, and health-related behaviors concerning non-communicable diseases among slum dwellers in Rawalpindi, Pakistan, and to identify socio-demographic and cultural factors influencing these outcomes.

Methods: A mixed-methods cross-sectional study was conducted among 400 adult residents of selected urban slums in Rawalpindi. Quantitative data were collected using a structured questionnaire adapted from the World Health Organization STEPwise approach, covering socio-demographics, NCD awareness, risk behaviors, and screening practices. Qualitative data were obtained through focus group discussions and in-depth interviews to explore cultural beliefs, barriers to care, and health-seeking behavior. Quantitative data were analyzed using SPSS version 26, applying descriptive statistics, chi-square tests, and logistic regression, while qualitative data underwent thematic analysis.

Results: Of the participants, 59% were female, with a mean age of 37.2 ± 10.8 years. Overall, 75.5% had heard of at least one NCD; hypertension (61%) and diabetes (58%) were the most commonly recognized. Only 26.5% correctly defined NCDs, and 21% perceived them as preventable. Tobacco use was reported by 35.5%, low physical activity by 57.3%, and unhealthy dietary practices by 80%. Only 22.5% had ever undergone NCD screening, while 52.5% preferred traditional remedies. Education level was significantly associated with NCD knowledge (p < 0.001) and screening uptake (p = 0.007), and gender was significantly associated with tobacco use (p = 0.003). Qualitative findings revealed widespread misconceptions, financial constraints, and limited trust in formal healthcare services.

Conclusion: The study revealed critical gaps in NCD knowledge, preventive behaviors, and service utilization among urban slum dwellers, underscoring the urgent need for culturally sensitive health education, accessible screening services, and community-based interventions to reduce NCD burden and promote health equity.