Introduction

The global burden of non-communicable diseases (NCDs) had increased tremendously, causing increased morbidity, mortality and disability among population, which is impeding the standards of health, quality of life and productivity among people at every age as well as affecting the socioeconomic development of the country.^[1] NCDs accounts for about 70% of all global deaths, i.e., about 38 million deaths annually.^[2] In 2019, it accounted for 1.62 billion Disability Adjusted Life Years (DALYs), representing 63.8% of total DALYs.^[3] NCDs are no longer limited as a leading cause of death in high income countries, and the recent statistics by the World Health Organization (WHO) reports that it is a major cause of death in most low-income and middle-income countries, accounting for about 80% of premature deaths, i.e., under 70 years of age.^[4], ^[5], ^[6] By 2030, NCDs are predicted to cause a collective loss of $47 trillion which can affect the young population’s productivity.^[7]

Cardiovascular diseases remain as a major NCD affecting public health, and resulting in mortality among people, accounting for about 17 million deaths approximately in the World,^[8] and 23% and 30% of the total mortality in rural and urban population, respectively, in India.^[9] Rapid urbanization, industrialization, and globalization resulting in economic transition which in turn influences the health risk behaviour of people has been identified as a major trend influencing the risk of burden of disease among the population.^[9] Increased burden of obesity, hypertension, diabetes and dyslipidaemia had risen the risk factors and subsequent development of CVDs in the country.^[9]

Evidence from a recent research study conducted in Himachal Pradesh, India reports a 19.7% and 6.9% of prevalence of hypertension and diabetes respectively in the population, which had increased significantly with increasing age.^[9] This study also reports that while hypertension had been reported in a significantly higher level in men (22.4% vs. 17.5%), diabetes was more prevalent among women (7.6% vs. 6.0%). Moreover, overweight and obesity was also reported at a significantly higher rate among women, compared to that in men. However, research indicates that tobacco use, physical inactivity, unhealthy diets, and harmful use of alcohol can be attributed as common risk factors for the four major NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory disease),^[9], ^[10] along with age.

Health seeking behaviours has been described as a sequence of events undertaken by the individuals as remedial to perceived ill-health,^[11] and can be influenced by various elements, including socio-demographic, economic factors, as well as the accessibility and affordability of medical services.^[12] Health-seeking behaviours in the population can be targeted at modifiable risk factors, such as high blood pressure, smoking, diabetes mellitus, physical inactivity, obesity and high levels of blood cholesterol, in order to improve the health status of the population.^[4], ^[9], ^[13] Health-seeking behaviour is one of the important determinants of women’s health, which can be influenced by their individual knowledge, disease perception, socio demographic factors, and the availability and accessibility of health services.^[14], ^[15] Health-seeking behaviour of women is an important factor in preventing NCDs, as it can -influence the health of the family through influencing lifestyle and related changes.^[16]

Therefore, identifying health-seeking behaviours and risk factors among women is important to determine factors contributing to NCDs and to lessen the incidence of NCDs in the community.

Thus, this study aims to assess the risk factors and health-seeking behaviours in non-communicable diseases among a community sample of women.

Materials and Methods

The study was conducted as a part of the research project, as partial fulfillment of the requirement of completion of the academic degree course in the Bachelor of Science in Nursing Program. The study used a quantitative approach, using a descriptive, cross-sectional survey design. The study was conducted in Kerala, India. The participants were 100 adult women, aged between 35 and 55 years, and having diagnosed with hypertension, diabetes, or dyslipidaemia. The data collection was carried out in October 2022.

The study participants were recruited using a convenience sampling method, after getting permission to perform the study from the local authorities. They were included if they were adult women belonging to the age group of 35 – 55 years, can read and write Malayalam language, if they had been diagnosed with or on treatment for NCDs such as diabetes mellitus, hypertension, and/ or dyslipidaemia, and if they were willing to participate in the study. Participants were excluded if they were deaf and blind, mentally challenged, and a transgender. A written consent was taken from all the participants, who agreed to participate in the study.

Results

Demographic characteristics of the participants

The details of sample characteristics are given in [Table 1].

A total of 100 adult women aged between 35-55 years participated in the survey. A majority of them (39 percent) were aged between 51-55 years, were having primary education (30 percent), married (92 percent), unemployed (71 percent), and home makers (57 percent). A large proportion of them were Hindus (59 percent) and belonged to low-income levels (57 percent). All of them belonged to nuclear families (100 percent).

The clinical parameters are presented in [Table 2]. A majority of the participants (47 percent) had been diagnosed with diabetes mellitus, 45 percent of them had hypertension and 28 percent were having dyslipidaemia. Most of them had developed the disease in less than 5 years (50 percent), and had a normal body mass index between 18.5 – 24.9 Kg/m² (63 percent).

Demographic Variables	Frequency (Percent, N= 100)
Age (in Years)
35-40	9
41-45	22
46-50	30
51-55	39
Education
No formal Education	4
Primary School Education	30
Secondary School Education	29
Pre-degree/ Plus two	19
Degree/Post-graduation	18
Marital Status
Married	92
Unmarried	1
Widow	7
Types of Employment
Government Sector	9
Private Sector	21
Retired	12
Home Maker	57
Own Business	1
Nature of Job
Household Work	71`
Manual labour	11
Professional	7
Office Job	10
Technical Field	1
Religion
Hindu	59
Christian	36
Muslim	5
Income
≤ Rs. 10,000/-	57
Rs. 10,000-≤Rs. 50,000	41
Rs. 50,000- ≤ 1,00,000	2

Table 1 Demographic characteristic of the participants

Variables	Frequency (Percent, N= 100)
Non-Communicable Diseases Present
Diabetes Mellitus	47
Hypertension	45
Dyslipidaemia	28
Duration of Illness
≤ 5 Years	50
5-≤10 Years	36
10- -≤15 Years	9
≥ 15 Years	5
Body Mass Index (Kg/m2) and Category
≤ 18.5 (Underweight)	2
18.5-≤ 24.9 (Normal Weight)	63
25-≤ 29.9 (Over Weight)	25
≥ 30 (Obese)	10

Table 2 Clinical parameters of the participants

Pattern of Activity/ Exercise	Frequency (Percent, N= 100)
Perform Regular Exercise
Yes	68
No	32
Usage of Stairs on a Regular Basis
Yes	59
No	41
Type of Exercise Performed
Walking	52
Workout in Gym	8
Household Activities	4
Workout using Internet/ Web-based	6
Frequency of Performing Exercises
Daily	55
Weekly	3
Once in a While	6
No Fixed Pattern	4

Table 3 Activity and exercise patterns present among the participants

Discussion

The study results suggests that the reported hypertension in our participants were higher than it was reported in a study conducted in Vellore, Tamil Nadu, whereas diabetes is slightly less than it was reported in the same study,^[17] but is higher than the reported figure in a study conducted in Kerala.^[18] A rural-urban difference in high blood pressure was noted among females in a study conducted by Bhagyalaxmi (2013),^[16] which was between 20-40% and 12-17 % in urban and rural adults, respectively.

The genetic risk factors in the present study were much less than it was reported in a previous study conducted by Saboo in 2021,^[19] where 60% of the participants from all age groups reported to have a positive family history of NCDs. A positive family history is found to be a significant predictor for the development of NCDs, and reported to have 1.23 times more higher odds of suffering from NCDs.^[20] Data reported from a research study collected from secondary data sources had reported that hypertension is one of the leading risk factors in the development of NCDs, which is showing an increased trend with urbanization, increased consumption of poultry and meat among the population.^[18]

Twenty five percent of our study participants were overweight and 10 percent were obese, whereas 32.4% of the participants were reported to be obese, in a study conducted by Thomas (2020).^[18] Similar to the present study results, obesity was reported among 29.9% of participants in Manipur.^[20] In a study conducted in Gujarat, a high prevalence of overweight and obesity was observed both in men and women in all age-groups.^[15]

A majority of the study participants were performing regular exercises, in contrast to a study where urban females had been reported to have low physical activity.^[17] Sedentary lifestyle was reported among 45% of the participants and cited as a contributing factor for the development of diabetes in a large cohort study conducted among 22,921 participants from 623 sites in India.^[19]

Similar to the study conducted by Poftte (2021),^[20] the participants in the current study were also were consuming less junk foods, which is high in salt and dietary fat.

In the current study, the participants demonstrated good health seeking behaviours, especially with regard to their treatment regime and follow up. Similar study results have been reported by a study conducted in Kenya,^[21] where females sought significantly qualified care for chronic NCDs. The same study had also reported an association of formal employment and socioeconomic predictors like higher education, marital status and having a health insurance as important predictors for health-seeking behaviours. The current study did not explore the association of socioeconomic factors for health-seeking behavioural practices.

Conclusion

The present study assessed the risk factors and health-seeking behaviours in women residing in a selected community of Kerala, India. The results suggested that the NCD risk factors are high in women, in spite of them engaging in various health-seeking behaviours. This gives an insight into exploring other factors contributing to NCDs, such as stress in the family, exercise pattern, dietary habits, other lifestyle related factors, and the time spent on gadgets using modern technology. Apart from awareness, mobilizing and participation of the community in engaging behaviours to tackle NCDs, making community- friendly areas for physical activity without fear, providing areas for walking and exercising, can make the whole community healthy. Future studies can explore research in areas like motivating factors for performing activities and the prevailing dietary habits in young generation as well.

Source of Funding

None.

Conflict of Interest

None.