Awareness and barriers to healthcare seeking among patients with nonalcoholic fatty liver disease: A cross-sectional study

ABSTRACT Background: Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver condition associated with metabolic disorders. Despite its increasing prevalence and potential complications, awareness remains limited, and healthcare-seeking behavior is often inadequate. Materials and Methods: A cross-sectional analytical study was conducted among 400 diagnosed NAFLD patients attending a tertiary care hospital in Shimla. Data were collected using a pretested semi-structured questionnaire assessing sociodemographic characteristics, awareness, barriers, and healthcare-seeking behavior. The awareness level was assessed using self-reported confidence in understanding NAFLD. Statistical analysis included descriptive measures and chi-square tests for unadjusted associations. Results: Among the participants, 60.5% were male, with most belonging to the 41- to 60-year age group. The overall awareness was moderate, with 52.3% having heard of NAFLD before diagnosis; however, only 36.5% were aware of its association with cardiovascular risk. Knowledge of risk factors was suboptimal, with fewer than half identifying an unhealthy diet (44.5%) and obesity (43.0%) and only 15.5% recognizing diabetes as a risk factor. A substantial proportion reported delayed healthcare seeking (62.5%) and missed follow-up appointments (62.8%). The major barriers included time constraints (58.5%), medication costs (49.3%), and financial challenges (37.8%). In unadjusted bivariate analyses, the awareness level was significantly associated with education, income, occupation, age, gender, area of residence, cardiovascular disease, and dyslipidemia ( P < 0.05), whereas type of NAFLD and other assessed comorbidities were not significantly associated. Conclusion: Awareness of NAFLD remains incomplete. Unadjusted analyses demonstrated significant associations between awareness level and several sociodemographic characteristics. Barriers to healthcare seeking were common, highlighting the need for targeted education and improved patient-engagement strategies.