Document is current

Article History

Received: 24 June 2026

Accepted: 17 September 2026

First Online: 25 September 2026

Declarations

Ethics approval and consent to participate: The study was approved by the Institutional Ethics Committee (IEC) of JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India, on 4th September 2025 (IEC Approval No. JSSMC/IEC/492025/56 NCT/2025-26). Informed consent was obtained in a manner appropriate to each recruitment route. For participants recruited in person at OPD waiting areas and field practice areas, the study was explained verbally by the investigator before questionnaire administration. Written consent was waived by the IEC given the observational, non-interventional, and anonymous nature of the study; this waiver was approved in general terms, and the specific procedural elements below were implemented by the investigator consistent with the waiver and with ICMR (2017) guidance. Consent was documented electronically: following the verbal explanation, the participant (or the investigator, with verbal translation as needed) proceeded through the same participant-information screen embedded in the Google Forms instrument used for the online component, and this through the form constitutes the record of consent. No separate signed document was used. This approach was consistent with the general waiver of written consent granted by the IEC for this minimal-risk study. No independent witness was designated for the consent process; consistent with ICMR (2017) and comparable international guidance, a witness is not generally required for verbal consent procedures in minimal-risk research. Audio or video recording of verbal consent was not undertaken, as the IEC deemed this unnecessary for a low-risk observational study, consistent with ICMR National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017). For participants who completed the questionnaire independently online, the same information screen was displayed before the first question, describing the study purpose, the voluntary nature of participation, the anonymity of responses, and the right to withdraw at any time. Voluntary progression past this screen and completion of the questionnaire constituted implied consent, in accordance with the IEC-approved protocol for the online component. Participation was voluntary, with the right to withdraw at any time without consequence. Anonymity and data confidentiality were assured; no personal identifiers were retained. The study adhered to the principles of the Declaration of Helsinki (2013 revision) and was conducted under institutional academic ethics oversight for a low-risk observational project.

Consent for publication: Not applicable. No person’s identifiable data are included in this manuscript.

Competing interests: The authors declare no competing interests.