Assessment of non-communicable diseases risk factors knowledge, and prevention practices among non-physician healthcare workers in selected primary and secondary hospitals of northern Bangladesh: a facility-based cross-sectional study

Assessment of non-communicable diseases risk factors knowledge, and prevention practices among non-physician healthcare workers in selected primary and secondary hospitals of northern Bangladesh: a facility-based cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of non-communicable diseases risk factors knowledge, and prevention practices among non-physician healthcare workers in selected primary and secondary hospitals of northern Bangladesh: a facility-based cross-sectional study Md Azazul Haque, Ahamed Khairul Basher, Tauhidul Islam, Md Shahjahan Siraj, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9615360/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Non-communicable diseases (NCDs) pose a growing challenge for health systems in low- and middle-income countries (LMICs), where non-physician healthcare workers (NP-HCWs) constitute a substantial proportion of the frontline workforce engaged in prevention and health promotion. However, evidence on NP-HCWs’ knowledge of NCD risk factors and preventive practices in Bangladesh remains limited. Methods: This facility based cross sectional study assessed NCD related knowledge and preventive practices among NP-HCWs, including nurses, community health care providers, health assistants, and support staff, across two secondary and six primary level government healthcare facilities in Nilphamari district, northern Bangladesh, between August 2023 and January 2024. Data were collected using a structured, pretested questionnaire informed by a modified WHO STEPS approach and analysed using descriptive statistics and multivariable logistic regression. Results: Most NP-HCWs were female (59%) with a mean age of 37.1± 9.7 years. Overall, 70% of NP-HCWs demonstrated good knowledge (≥80%), though gaps existed. Over 45% did not recognize NCDs as non-infectious, and 33% of nurses believed they were not preventable. However, only 13% of NP-HCWs practiced stress management, and 27% underwent regular health check-ups. Graduates and those with higher educational degrees were a significant predictor of good preventive practice (aOR: 4.9; 95% CI: 1.13–21.33; p = 0.03). Support staff consistently showed lower odds for both good knowledge and practices in unadjusted analyses. Conclusion: These findings show that while NP HCWs generally have good knowledge of NCDs, preventive practices remain limited. Targeted, cadre specific interventions are needed to improve NCD related knowledge and preventive behaviours among NP HCWs. Non-communicable diseases non-physician healthcare workers knowledge preventive practices education Bangladesh.Keywords: Non-communicable diseases non-physician healthcare workers knowledge preventive practices education Bangladesh Figures Figure 1 Background Non-communicable diseases (NCDs) represent a growing crisis of global health and sustainable development. NCDs are responsible for 42 million deaths each year, equivalent to 73.4% of all fatalities( 1 ). With the rising burden, NCDs have become the leading cause of mortality worldwide( 2 , 3 ). NCDs are diseases that are not transmissible from one person to another, such as hypertension, diabetes mellitus, cardiovascular diseases (CVDs), cancers, and chronic respiratory diseases (CRDs), with the latter four accounting for over 80% of all premature NCD deaths( 3 – 5 ). In Low and middle-income countries (LMICs), the persistent burden of NCDs has demonstrably impeded economic growth, development, and overall progress( 6 – 9 ). It is anticipated that NCDs will be responsible for half of the global disease burden in emerging nations( 10 ). Urbanization, aging populations, lifestyle changes, and rising processed food consumption in LMICs have shifted disease patterns, increasing the NCD burden driven by poor diets, inactivity, obesity, smoking, and alcohol use ( 5 , 11 – 18 ). Bangladesh is undergoing an epidemiological shift toward a double burden of both communicable and non-communicable diseases( 19 – 21 ). The World Health Organization (WHO) estimates a global shortfall of 18 million health workers by 2030 as a result of the escalating NCD burden, underscoring the necessity of involving non-physician healthcare workers (NP-HCWs) in delivering essential NCD-related care. It is therefore imperative that these providers possess sufficient knowledge of NCD risk factors and demonstrate effective preventive practices to support the promotion of healthy behaviors. Between 1990 and 2019, NCD cases in Bangladesh rose from 95.5 to 145 million, while Communicable, Maternal, Neonatal, and Nutritional (CMNN) diseases declined from 104.9 to 88.6 million, with NCDs accounting for 14 of the top 20 causes of death in 2019( 20 ). Non-physician healthcare workers (NP-HCWs)—including nurses, Community Health Care Providers (CHCP), Health Assistants (HA), lab technologists, and support staff —are essential to healthcare services( 22 ). Task sharing has been promoted to address the rising burden of NCDs by involving NP-HCWs in prevention and management efforts( 23 ). Their close community engagement positions them to support self-management( 24 ). However, despite the nature of their work being health promotion and disease prevention, HCWs exhibit a gradual trend toward NCD and have higher NCD levels than those of the general population ( 25 ). As Bangladesh pursues its Sustainable Development Goals (SDGs), addressing NCDs is crucial, with success depending on healthcare workers’ knowledge of risk factors and adoption of preventive practices to promote healthy behavior( 24 , 26 ). Given the health system’s struggle with the long-term demands of NCD care, properly training NP-HCWs is essential to improve outcomes ( 27 , 28 ). To the best of our knowledge, no study in Bangladesh has comprehensively assessed NP-HCWs’ knowledge of NCD risk factors and preventive practices. Existing research has either focused on specific subgroups of NP-HCWs or on other population groups. Therefore, this study aimed to assess knowledge of NCD risk factors and preventive practices among NP-HCWs in Nilphamari district of northern Bangladesh, providing district-level evidence with indicative insights for the wider region. The findings are intended to identify potential areas for intervention and improvement to strengthen NP-HCWs’ capacity in addressing the growing NCD burden, both for the populations they serve and for their own well-being. Materials and Methods Study Design and Setting This facility-based cross-sectional study was conducted from August 1, 2023, to January 30, 2024, in Nilphamari district, northern Bangladesh. To enhance representativeness, Nilphamari was randomly selected from among the northern districts, ensuring that each had an equal chance of inclusion. All government secondary- and primary-level healthcare facilities within the district were included, comprising the Nilphamari 250-bed District Hospital, Saidpur 100-bed Hospital, Upazila Health Complexes (Supplemental Fig. 1). Study population and sampling The study population consisted of all non-physician healthcare workers (NP-HCWs) directly engaged in patient care at the selected facilities during the study period. NP-HCWs working in basic science departments or those not involved in patient care were excluded. Participants were categorized into three groups: nurses, community health care providers (CHCP) / health assistants (HA), and support staff. CHCP, primarily based in community clinics, deliver primary healthcare, family planning, nutrition, and non-communicable disease services to rural populations. HAs provide domiciliary services at the ward or village level and were grouped with CHCP/HA due to the similarity of their roles ( 29 ). A total of 301 NP-HCWs—comprising nurses, CHCP, HA, and support staff—provided verbal consent and were enrolled. This strategy achieved near-complete coverage of the target population within Nilphamari, thereby strengthening the validity of the findings at the district level, while also providing insights that may also provide indicative of broader patterns across northern Bangladesh. Data Collection Instrument Data were collected using a structured interviewer-administered questionnaire developed from the WHO STEP-wise approach to NCD risk factor surveillance and refined with expert input ( 30 ). The questionnaire included four sections: ( 1 ) eligibility criteria; ( 2 ) sociodemographic characteristics, anthropometry, and history of selected NCDs; ( 3 ) knowledge of NCD risk factors; and ( 4 ) preventive practices. Knowledge was scored with one point per correct response and zero for incorrect or "don’t know" answers. Scores were categorized as poor (< 80%) or good (≥ 80%). Preventive practices were scored based on the number of recommended behaviors adopted: poor (0–2 practices) and good (3–6 practices). Study procedure The data collection was conducted in three steps. In the first step, eligible NP-HCWs were interviewed face-to-face at their respective healthcare facilities. Interviewers explained the study objectives, obtained verbal consent, and conducted interviews in private settings to maintain confidentiality and encourage accurate responses. In the second step, physical measurements—including blood pressure, fasting capillary blood glucose, and anthropometry—were taken following standard protocols outlined in the “Non-communicable Disease Risk Factors Survey Bangladesh 201”( 31 ). For blood pressure measurement, participants were asked to sit and relax for five minutes before the reading. Two blood pressure measurements were taken on the right arm using an aneroid sphygmomanometer and a 3M™ Littmann Classic II stethoscope, with diastolic pressure determined using Korotkoff Phase V. A two-minute interval was maintained between measurements, and the average of the two readings was used. Pulse rate was recorded with each reading. Participants were classified as hypertensive if they had a systolic blood pressure of ≥ 140 mmHg, a diastolic blood pressure of ≥ 90 mmHg, or a known history of hypertension( 32 ). Anthropometric data included height and weight. Height was measured to the nearest millimeter using a portable stadiometer, with participants standing barefoot, feet together, and facing forward. Weight was recorded using a portable digital scale, with participants wearing light clothing and no shoes. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Furthermore, BMI was categorized following the WHO and National Institutes of Health guidelines for the general population: underweight (< 18.5), normal weight (18.5–<25.0), overweight (25.0–<30.0), and obese (≥ 30.0) ( 33 ). In the third step, fasting capillary blood glucose was measured using an Accu-Chek® Instant glucometer after confirming that participants had fasted for at least eight hours. All procedures were conducted using aseptic techniques. Participants with fasting blood glucose levels ≥ 7.0 mmol/L or those on antidiabetic medication were classified as diabetic( 34 ). Data Analysis Data quality was ensured through completeness checks, validation, and cleaning. Data from hard copies were entered into Microsoft Excel and subsequently imported into R software (version 4.4.2) with the tidy verse and MASS packages for analysis. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to analyze demographic variables. Multivariable logistic regression was done, and chi-square tests and Pearson’s correlation tests were used to assess associations between dependent and independent variables, with a p-value < 0.05 considered statistically significant. Results were presented using frequency tables, graphs, maps. Ethical Considerations Ethical approval was obtained from the Ethical Review Committee of the State University of Bangladesh, and permission was secured from the Civil Surgeon of Nilphamari District Hospital. Verbal consent was obtained from all respondents before data collection, and privacy and confidentiality were strictly maintained. Proper aseptic measures were maintained during blood collection through instant glucometer. Participants had the right to withdraw from the study at any time without providing a reason. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Results Sociodemographic and health-related characteristics: We interviewed 301 NP-HCWs, most of them were female 179(59%). Mean age of the participants was 37.1 ± 9.7 years, and the largest age group was 30–44 years, comprising 125 (42%) NP-HCWs. Nurses 135 (45%) constituted the largest professional group, followed by CHCP/HA 108 (36%), and support staff58 (19%). Nearly half of the respondents earned between 25,000–50,000 BDT (≈ 410 USD), and the majority had completed graduation or above educational level. Among the NP-HCWs, 88 (29%) reported having at least one NCDs (Table 1 ). Table 1 Sociodemographic characteristics of NP-HCWs in Nilphamari district, northern Bangladesh (August 1, 2023 – January 30, 2024; N = 301) Characteristics Frequency n (%) Gender Male 122 (41%) Female 179 (59%) Age (years) < 30 64 (21%) 30–44 125 (42%) ≥ 45 112 (37%) Mean ± SD 37.1 ± 9.7 Marital Status Single 15 (5%) Married 285 (95%) Divorced/Widowed 1 (0%) Religion Muslim 245 (81%) Hindu 53 (18%) Christian 3 (1%) Body mass index (BMI) Underweight 11 (3.7%) Normal 91 (30.2%) Overweight 121 (40.2%) Obese 73 (24.3%) Professional Category Nurse 135 (45%) CHCP/HA 108 (36%) Support Staff 58 (19%) Income Category Under 25,000 BDT 63 (21%) 25,000–50,000 BDT 142 (47%) Above 50,000 BDT 92 (31%) Education Category Up-to Primary 13 (4%) Completed Secondary 14 (5%) Completed graduation and Above 273 (91%) Non-Communicable Disease Absent 213 (71%) Present 88 (29%) Knowledge of NCDs: Overall, 70% (212) NP-HCWs had good knowledge (score ≥ 80%). Most showed good knowledge of well-known NCD risk factors like tobacco use, inactivity, and alcohol. However, over 45% lacked understanding regarding infection-related NCD risks, and 67% of nurses, 96% of CHCP/HA, and 84% of support staff correctly responded that NCDs cannot be prevented (Table 2 ). Table 2 Knowledge scores on non-communicable diseases among NP-HCWs in Nilphamari district, northern Bangladesh (August 1, 2023 – January 30, 2024; N = 301) NCD risk factors Correct responses n (%) Nurse (n = 135) CHCP/HA (n = 108) Support staff (n = 58) Total (N = 301) NCDs are not transmissible 122 (90) 99 (92) 28 (48) 249 (83) Tobacco use as a risk factor 129 (96) 107 (99) 53 (91) 289 (96) Physical inactivity as a risk factor 125 (93) 107 (99) 52 (90) 284 (94) Fruits & vegetables lower the risk 109 (81) 103 (95) 49 (84) 261 (87) Alcohol increases the risk 130 (96) 107 (99) 57 (98) 294 (98) Obesity as a risk factor 126 (93) 105 (97) 48 (83) 279 (93) High BP as a risk factor 130 (96) 106 (98) 53 (91) 289 (96) Anxiety & stress impact NCDs 125 (93) 103 (95) 48 (83) 276 (92) The belief that NCDs are primarily caused by infections 77 (57) 64 (59) 26 ( 45 ) 167 (55) Belief that NCDs cannot be prevented 91 (67) 104 (96) 49 (84) 244 (81) Air pollution increases NCDs risk 122 (90) 94 (87) 48 (83) 264 (88) High sugary drink consumption 124 (92) 107 (99) 54 (93) 285 (95) Family history/genetics as a risk factor 128 (95) 108 (100) 50 (86) 286 (95) Age as a risk factor 126 (93) 105 (97) 49 (84) 280 (93) Overall Knowledge Score Good knowledge (≥ 80%) 100 (74) 86 (80) 26 ( 45 ) 212 (70) Poor knowledge (< 80%) 35 ( 26 ) 22 ( 20 ) 32 (55) 89 ( 30 ) Preventive practice: NP-HCWs most commonly reported preventive practices were maintaining a balanced diet 230 (76%) and engaging in physical activity 143 (48%). However, only 39 (13%) practiced stress management, and 80 (27%) underwent regular health check-ups. Nurses showed greater adherence to healthy behaviors than CHCP/HA and support staff, particularly in physical activity, check-ups, and weight control (Fig. 1 ). Overall, 118 (41%) participants reported poor preventive practices (engaging in 0–2 practice), with the highest among support staff, 29 (50%) (Supplementary table 1). Predictors of NCD knowledge: NP-HCWs with graduation and above education level showed better knowledge of NCD risk factors (aOR: 2.89; 95% CI: 0.66–12.68; p = 0.16), though not statistically significant. Support staff had significantly lower odds in unadjusted analysis (uOR: 0.28; 95% CI: 0.15–0.53; p < 0.01), but this association attenuated after adjustment (aOR: 0.44; 95% CI: 0.16–1.22; p = 0.11). Other demographic or health factors were not significantly associated (Table 3 ). Table 3 Predictors associated with knowledge level on non-communicable diseases among NP-HCWs in Nilphamari district, northern Bangladesh (August 1, 2023 – January 30, 2024; N = 301) Variable uOR (95% CI) p-value aOR (95% CI) p-value Age in years < 30 Reference Reference 30–44 1.19 (0.68–2.11) 0.55 1.11 (0.54–2.27) 0.77 ≥ 45 1.14 (0.56–2.31) 0.71 0.83 (0.32–2.14) 0.7 Sex Female 1.68 (1.01–2.8) 0.04 1.4 (0.67–2.92) 0.37 Male Reference Reference Education Up to primary Reference Reference Completed Secondary 5.12 (1.43–18.25) 0.01 2.89 (0.71–11.82) 0.14 Completed graduation and above 7.08 (2.15–23.47) < 0.01 2.89 (0.66–12.68) 0.16 Occupational-level Nurse Reference Reference CHCP/HA 1.37 (0.73–2.5) 0.31 1.68 (0.73–3.86) 0.22 Support Staff 0.28 (0.15–0.53) < 0.01 0.44 (0.16–1.22) 0.11 BMI Underweight 0.66 (0.18–2.35) 0.52 1.51 (0.34–6.69) 0.59 Normal Reference Reference Overweight 0.85 (0.5–1.45) 0.56 0.76 (0.42–1.38) 0.36 Obese 0.59 (0.22–1.6) 0.31 0.59 (0.19–1.8) 0.35 Marital Status Married 1.68 (1.01–2.8) 0.15 1.77 (0.54–5.75) 0.34 Single Reference Reference Non-Communicable Disease Absent 0.73 (0.41–1.28) 0.27 0.54 (0.27–1.09) 0.09 Present Reference Reference Level of preventive practice Good practice (3–6 practices) 1.08 (0.64–1.79) 0.77 0.9 (0.52–1.57) 0.72 Poor practice (1–2 practices) Reference Reference Bold values indicated that the findings are significant. ‡χ2 test was run between risk factors, statistical significance p < 0.05, and presented as bold values. NP-HCWs, Non-physician Healthcare workers; OR, Odds ratio; NCD, Non-Communicable Disease; BMI, Body Mass Index. Predictors of preventive practices : NP-HCWs with a graduation and above degree had a significant association with good preventive practice (aOR: 4.9; 95% CI: 1.13–21.33; p = 0.03). Support staff had lower odds in unadjusted analysis (uOR: 0.52; 95% CI: 0.27–0.99; p = 0.04), but this association was not significant after adjustment (aOR: 0.7; 95% CI: 0.26–1.86; p = 0.48) (Table 4 ). Table 4 Predictors associated with preventive practices for NCDs among NP-HCWs in Nilphamari district, northern, Bangladesh (August 1, 2023 – January 30, 2024; N = 301) Variable uOR (95% CI) p-value aOR (95% CI) p-value Age in years < 30 Reference Reference 30–44 0.79 (0.46–1.38) 0.41 0.93 (0.48–1.8) 0.83 ≥ 45 0.89 (0.45–1.78) 0.74 1.36 (0.56–3.29) 0.5 Sex Female 1.27 (7.09–2.03) 0.32 1.01 (0.53–1.92) 0.99 Male Reference Reference Education Up to primary Reference Reference Completed Secondary 3.37 (0.95–11.76) 0.06 3.86 (0.96–15.49) 0.06 Completed graduation and above 4.39 (1.33–14.52) 0.01 4.9 (1.13–21.33) 0.03 Occupational-level Nurse Reference Reference CHCP/HA 0.78 (0.46–1.32) 0.36 0.78 (0.38–1.6) 0.49 Support Staff 0.52 (0.27–0.99) 0.04 0.7 (0.26–1.86) 0.48 BMI Underweight 0.97 (0.27–3.47) 0.97 1.36 (0.33–5.58) 0.67 Normal Reference Reference Overweight 0.68 (0.42–1.12) 0.12 0.75 (0.44–1.27) 0.28 Obese 1.11 (0.4–3.15) 0.84 1.33 (0.44–4.01) 0.61 Marital Status Married 1.38 (0.49–3.89) 0.55 1.7 (0.54–5.42) 0.37 Single Reference Reference Non-Communicable Disease Absent 1.18 (0.71–1.97) 0.52 1.09 (0.6–1.97) 0.78 Present Reference Reference Knowledge Good knowledge (≥ 80% correct) 1.08 (0.64–1.79) 0.77 0.86 (0.5–1.49) 0.59 Poor knowledge (< 80% correct) Reference Bold values indicated that the findings were significant. ‡χ2 test was run between risk factors, statistical significance p < 0.05, and presented as bold values. NP-HCWs, Non-physician Healthcare workers; OR, Odds ratio; NCD, Non-Communicable Disease; BMI, Body Mass Index. Discussion This study found that NP-HCWs in northern Bangladesh generally possessed good knowledge of NCD risk factors, particularly tobacco use, physical inactivity, and alcohol consumption, findings that are consistent with previous research in low- and middle-income countries (LMICs) ( 5 , 12 , 35 – 37 ). However, notable misconceptions persisted—nearly half of the participants believed NCDs are caused by infections, and about one-fifth thought they are not preventable. These misconceptions reflect incomplete understanding of NCD etiology and prevention, similar to patterns reported in other LMICs where awareness of NCD preventability remains limited ( 28 , 35 ). Differences in knowledge levels may be influenced by sociodemographic factors, professional roles, work experience, and exposure to NCD-specific training. Addressing these disparities through focused capacity-building initiatives is essential to foster a comprehensive understanding of NCDs among NP-HCWs and improve community-level prevention efforts. In terms of preventive practices, 48–76% of NP-HCWs reported engaging in physical activity and maintaining a balanced diet. Similar activity levels among healthcare professionals have been reported ( 38 ). However, a study reported from Bangladesh among healthcare workers showed only 13.1% physically active and 43.7% maintaining a balanced diet ( 39 ). These contrast findings may be due to occupational differences, healthcare settings, or sample characteristics. To enhance such practices, targeted education and awareness of their long-term health benefits are critical ( 40 ). Only 13% and 27% of participants reported practicing stress management and undergoing regular health check-ups, respectively. These results mirror previous findings showing low participation in such practices ( 41 ). Time constraints, heavy workloads, and a perceived sense of good health likely contribute to these low rates ( 42 ). This highlights a critical gap in the adoption of preventive strategies necessary to reduce NCD risk. Over two-fifths of NP-HCWs, particularly support staff, demonstrated poor engagement in preventive practices. This trend has also been reported elsewhere, where lower-level healthcare workers face barriers such as limited resources, time, and institutional support ( 13 ). There is a clear need for policies and interventions that support the adoption of comprehensive health practices, especially in low-resource settings, to ensure NP-HCWs can effectively serve as role models for the community. NP-HCWs with a graduate-level education or higher emerged as significant predictors of both knowledge and preventive practices regarding NCDs, consistent with literature linking education to health literacy and healthy behavior ( 28 , 35 ). Furthermore, the level of occupation is also associated with better knowledge and preventive practices of NP-HCWs, and prior research found similar findings ( 28 , 35 , 38 ). This may relate to differences in training exposure or involvement in NCD-related activities. In this study, we did not find a significant association between knowledge and preventive practice and factors such as age, sex, BMI, marital status, and history of NCDs. Although some studies have found such associations ( 43 – 45 ), our differing results may stem from sample size, contextual variation, or population characteristics. This study highlights the need for targeted interventions to enhance NP-HCWs' knowledge and practices related to NCDs, emphasizing accurate, up-to-date information and promoting healthy behaviors. Educational programs on NCD prevention and management should address misconceptions and include stress management and regular health check-ups. Additionally, strengthening the capacities of lower-tier NP-HCWs, such as CHCP/HA and support staff, through training and supportive policies is essential to improving their engagement in preventive care. These findings can inform Bangladesh’s national NCD control strategy and WHO PEN implementation framework. Strengths and limitations of this study This is the first study in Bangladesh to comprehensively assess knowledge of NCD risk factors and preventive practices among NP-HCWs. The random selection of Nilphamari district and inclusion of nearly all eligible NP-HCWs ensured strong district level representativeness, although the single district design limits generalizability and provides only indicative insights for northern Bangladesh. The inclusion of multiple cadres of NP HCWs and use of a modified WHO STEPS based tool, incorporating objective measures such as blood pressure, body mass index, and fasting glucose, strengthened the reliability of the findings. However, reliance on self-reported information and glucometer-based diabetes measurements may have introduced bias, although similar methodological approaches and findings have been reported in other LMICs settings. Conclusion This study provides valuable insights into the knowledge and practices regarding NCDs among NP-HCWs in Nilphamari district, northern Bangladesh. While the overall knowledge related to NCDs was relatively good, there are notable gaps, particularly in the understanding of NCDs preventability and the role of infections and the adoption of certain preventive behaviors, particularly stress management and health check-ups, and two-fifths of them reported 0–2 preventive practices. Education and designation or position in the occupation were found to be significant predictors of both knowledge and preventive practices. Addressing these gaps through targeted educational programs and interventions could improve NP-HCWs knowledge and preventive behaviors of NCDs, ultimately benefiting both the NP-HCWs and the communities they serve. Abbreviations NP HCWs-Non-physician Health Care Workers LMICs Low-and middle-income countries NCDs Non-communicable diseases CVDs Cardiovascular diseases BMI Body Mass Index Declarations Ethics approval and consent to participate: Ethical approval was granted by the Ethical Review Committee of the State University of Bangladesh, and permission was obtained from the Civil Surgeon of Nilphamari District Hospital. Verbal consent was provided by all participants, with privacy and confidentiality maintained throughout. Participants were free to withdraw from the study at any time without explanation. The study adhered to the ethical principles of the Declaration of Helsinki. Consent for publication: Not applicable. Availability of data and materials: All relevant data are provided in the manuscript. Dataset access can be requested from the corresponding author through the State University of Bangladesh's research administration, in line with institutional policy. Competing interests: The authors declare that they have no competing interests relevant to this study. Funding: Not applicable Authors' contributions : MAH conceived and designed the study, coordinated data collection, performed the analyses, and drafted the manuscript. AKB and MT contributed to study design, data collection, analysis, and manuscript review. MSS provided methodological input, assisted with data interpretation, and critically revised the manuscript. MRK, SH, and MTR contributed to data collection, management, and preparation of tables/figures. IH supported supervision, ensured data quality, and reviewed the manuscript. SN supervised the overall study and critically revised the manuscript. Acknowledgments: We thank the State University of Bangladesh and the study hospitals for their support and express our gratitude to the participants for their valuable contributions. Patient and public involvement: Patients or members of the public were not involved in the design, conduct, reporting, or dissemination plans of this research. References Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. Tsolekile L. Urbanization and lifestyle changes related to non-communicable diseases: An exploration of experiences of urban residents who have relocated from the rural areas to Khayelitsha, an urban township in Cape Town. In 2007 [cited 2025 Apr 12]. Available from: https://www.semanticscholar.org/paper/Urbanization-and-lifestyle-changes-related-to-An-of-Tsolekile/272be6df8bf7737d680d5846b68468ddc2201301 Gamage AU, Jayawardana PL. Knowledge of non-communicable diseases and practices related to healthy lifestyles among adolescents, in state schools of a selected educational division in Sri Lanka. BMC Public Health 2017 July 26;18(1):64. Urbanization. and lifestyle changes related to non-communicable diseases: an exploration of experiences of urban residents who have relocated from the rural areas to Khayelitsha, an urban township in Cape Town [Internet]. [cited 2025 Apr 12]. Available from: https://datacatalog.ihsn.org/citations/7200?utm_source=chatgpt.com Non communicable diseases [Internet]. [cited 2025 Apr 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases Burden of non-communicable disease. Global overview - ScienceDirect [Internet]. [cited 2025 Mar 10]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1871402108000489 UN High-Level Meeting on Non-Communicable Diseases. addressing four questions - The Lancet [Internet]. [cited 2025 May 6]. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60879-9/abstract Mirelman AJ, Rose S, Khan JA, Ahmed S, Peters DH, Niessen LW et al. The relationship between non-communicable disease occurrence and poverty—evidence from demographic surveillance in Matlab, Bangladesh. Health Policy and Planning. 2016 July 1;31(6):785–92. Biswas T, Islam MS, Linton N, Rawal LB. Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh. PLoS ONE. 2016;11(11):e0167140. Wang Y, Wang J. Modelling and prediction of global non-communicable diseases. BMC Public Health. 2020 June 1;20(1):822. Belachew A, Cherbuin N, Bagheri N, Burns R. A Systematic Review and Meta-analysis of the Socioeconomic, Lifestyle, and Environmental Factors Associated with Healthy Ageing in Low and Lower-Middle-Income Countries. Population Ageing. 2024 June 1;17(2):365–87. He W, Kowal P, An Aging W. 2015. [Internet]. [cited 2024 Aug 28]. Available from: https://www.academia.edu/30886740/An_Aging_World_2015 Faruque M, Barua L, Banik PC, Sultana S, Biswas A, Alim A, et al. Prevalence of non-communicable disease risk factors among nurses and para-health professionals working at primary healthcare level of Bangladesh: a cross-sectional study. BMJ Open. 2021;11(3):e043298. Wagner KH, Brath H. A global view on the development of non communicable diseases. Prev Med. 2012;54(Suppl):S38–41. Guerrero-López CM, Serván-Mori E, Miranda JJ, Jan S, Orozco-Núñez E, Downey L et al. Burden of non-communicable diseases and behavioural risk factors in Mexico: Trends and gender observational analysis. Journal of Global Health [Internet]. 2023 [cited 2023 Dec 1];13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10274265/ Biswas T, Townsend N, Huda MM, Maravilla J, Begum T, Pervin S et al. Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study. eClinicalMedicine [Internet]. 2022 Oct 1 [cited 2025 Jan 27];52. Available from: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00321-2/fulltext Shimbo D, Levitan EB, Booth JN, Calhoun DA, Judd SE, Lackland DT, et al. The contributions of unhealthy lifestyle factors to apparent resistant hypertension: findings from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Hypertens. 2013;31(2):370–6. ResearchGate [Internet]. [cited 2025 Mar 10]. (PDF) Knowledge and Preventive Practice Towards Non-Communicable Diseases Risk Factors Among Civil Servants of Kellem Wollega Zone, Western Ethiopia in. Available from: https://www.researchgate.net/publication/365476196_Knowledge_and_Preventive_Practice_Towards_Non-Communicable_Diseases_Risk_Factors_Among_Civil_Servants_of_Kellem_Wollega_Zone_Western_Ethiopia_in Ahsan Karar Z, Alam N, Kim Streatfield P. Epidemiological transition in rural Bangladesh, 1986–2006. Glob Health Action 2009 June 19;2: 10.3402/gha.v2i0.1904 GBD 2019 Bangladesh Burden of Disease Collaborators. The burden of diseases and risk factors in Bangladesh, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health. 2023;11(12):e1931–42. Global status report on noncommunicable. diseases 2014 [Internet]. [cited 2025 May 6]. Available from: https://www.who.int/publications/i/item/9789241564854 Healthcare industry - Wikipedia [Internet]. [cited 2022 Dec 15]. Available from: https://en.wikipedia.org/wiki/Healthcare_industry Joshi: Task shifting for non-communicable disease… Google Scholar [Internet]. [cited 2023 Aug 21]. Available from: https://scholar.google.com/scholar_lookup?title=Task+shifting+for+non-communicable+disease+management+in+low+and+middle+income+countries--A+systematic+review&publication_year=2014&author=R+Joshi&author=M+Alim&author=AP+kengne&author=S+Jan&author=Pk+Maulik&author=D+Peiris. Leveraging role of. non-physician health workers in prevention and control of non-communicable diseases in India: Enablers and challenges - PubMed [Internet]. [cited 2024 Aug 27]. Available from: https://pubmed.ncbi.nlm.nih.gov/34041047/ Vallasamy SK, Umairah Muhadi S, Murali B, Sathaisivam J. Combating Non- Communicable Disease Among HCW: ‘The Broken Soldiers.’ ScienceOpen Posters [Internet]. 2022 July 19 [cited 2025 Aug 5]; Available from: https://www.scienceopen.com/hosted-document?doi=10.14293/S2199-1006.1.SOR-.PPM1YH1.v2 Bangladesh makes consistent. progress achieving SDGs health indicators [Internet]. [cited 2025 May 6]. Available from: https://www.who.int/bangladesh/news/detail/05-03-2020-bangladesh-makes-consistent-progress-achieving-sdgs-health-indicators (PDF) Prevalence of modifiable and non-modifiable risk factors and lifestyle disorders among health care professionals [Internet]. [cited 2025 Feb 1]. Available from: https://www.researchgate.net/publication/277976131_Prevalence_of_modifiable_and_non-modifiable_risk_factors_and_lifestyle_disorders_among_health_care_professionals Onagbiye S, Tsolekile L, Puoane T. Knowledge of Non-communicable Disease Risk Factors among Community Health Workers in South Africa. Open Public Health J 2020 Sept 22;13:430–7. 2025-04-10-. 07-32-f2d00a006b462fe3ad2d9f6a3318ea3f.pdf [Internet]. [cited 2025 Sept 29]. Available from: https://dghs.portal.gov.bd/sites/default/files/files/dghs.portal.gov.bd/page/9b9f86da_6c99_4581_8039_1a 56daf8166b/2025-04-10-07-32-f2d00a006b462fe3ad2d9f6a3318ea3f.pdf Standard STEPS. instrument [Internet]. [cited 2025 Mar 24]. Available from: https://www.who.int/publications/m/item/standard-steps-instrument Bangladesh WHOCO. for. Non-communicable disease risk factor survey, Bangladesh 2010 [Internet]. World Health Organization. Country Office for Bangladesh; 2011 [cited 2025 Feb 8]. Available from: https://iris.who.int/handle/10665/279484 Hypertension [Internet]. [cited 2025 Apr 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension Chowdhury MAB, Adnan MM, Hassan MZ. Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys. BMJ Open. 2018 July 1;8(7):e018468. The need for international consensus on. prediabetes - PubMed [Internet]. [cited 2025 Feb 8]. Available from: https://pubmed.ncbi.nlm.nih.gov/27863980/ Saini A, Agarwal M. Combating non-communicable diseases in rural Lucknow: Are the skills and knowledge of female health workers adequate? Int J Community Med Public Health. 2020;7:3480. Elnaem MH, Jamshed S, Qasim, Elkalmi R. Knowledge of the risk factors of non-communicable diseases (NCDs) among pharmacy students: findings from a Malaysian University. Int J Health Promotion Educ 2019 July 4;57(4):217–28. Meena S, Rathore M, Gupta A, Kumawat P, Singh A. Knowledge and attitude of peripheral health workers regarding Non-Communicable diseases in a Rural area of Rajasthan. Indian J Community Health 2022 June 30;34(2):306–10. Marques-Sule E, Miró-Ferrer S, Muñoz-Gómez E, Bermejo-Fernández A, Juárez-Vela R, Gea-Caballero V, et al. Physical activity in health care professionals as a means of primary prevention of cardiovascular disease: A STROBE compliant cross-sectional study. Medicine. 2021 June;4(22):e26184. Banik PC, Barua L, Ali L, Faruque M, Sultana S, Biswas A et al. Prevalence of non-communicable disease risk factors among nurses and para-health professionals working at primary healthcare level of Bangladesh: a cross-sectional study. BMJ Open [Internet]. 2021 Mar 1 [cited 2025 Apr 9];11(3). Available from: https://bmjopen.bmj.com/content/11/3/e043298.full Saridi M, Filippopoulou T, Tzitzikos G, Sarafis P, Souliotis K, Karakatsani D. Correlating physical activity and quality of life of healthcare workers. BMC Res Notes. 2019;12(1):208. Mehrotra R, Gupta M, Bhagwati M, Jain D. The Prevalence, Causes, and Management Strategies for Stress Among Health-Care Professionals of Delhi-National Capital Region. J Clin Prev Cardiol. 2021 Sept;10(3):85. Bing [Internet]. [cited 2025 May 6]. Risk Factors for Stress and Burnout (CDC). Available from: https://www.bing.com/search?pglt=41&q=Risk+Factors+for+Stress+and+Burnout+(CDC)&cvid=57f65f8b688043628304e1ee629582c5&gs_lcrp=EgRlZGdlKgYIABBFGDkyBggAEEUYOdIBBzkxOGowajGoAgCwAgA&FORM=ANNTA1&PC=WSEDDB Hossain MM, Roy A, Hanif AAM, Akter F, Hasan M, Khan MSA, et al. Distribution and disparities of healthy lifestyles and noncommunicable diseases risk factors between men and women aged 20–59 years in Bangladesh: Evidence from a nationwide survey. Chronic Dis Transl Med. 2024;10(4):312–26. Moniruzzaman M, Ahmed MSAM, Zaman MM. Physical activity levels and associated socio-demographic factors in Bangladeshi adults: a cross-sectional study. BMC Public Health. 2017;17(1):59. Karoli P, Mayige M, Kagaruki G, Mori A, Macha E, Mutagaywa R, et al. Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment. BMC Health Serv Res. 2024;24(1):612. Generative AI-statement. Grammarly was used to support language editing, grammar, and clarity. The authors reviewed and approved all changes and take full responsibility for the content of the manuscript. AI was not used for data analysis, interpretation, or generation of scientific content. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9615360","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":636747538,"identity":"7a2632e8-8444-4c09-934f-dd47a280f3b0","order_by":0,"name":"Md Azazul Haque","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACNvmD7Z95GxgS29h7zD98MGBgbDjAg18LP8PhA8YgLf08Z8wYZxCjRbLhWAJYy8wZOWbMQMWEtRgc7DFIBmnZcAOoxabATrbv9tkDDB/31OLWcpjH4DBQSz1Qi/njHINk45nn8hIYZzw7jlvLMR7DZrgtOQYHEjec4TFg5jlwDKcW+zP8n5lBWvbfBmqxIEaLwQ0eM7CWDTffmDEzILTU4NXCOLNBAqjyWBpjD8gvZ/gSDs44cAC3lvtnzD98/GOTuOH44uMffvwBhtgZ3oMPPhyow6kFCiRQuUArDhPSggkI2jIKRsEoGAUjBwAAGZxnJu58vkoAAAAASUVORK5CYII=","orcid":"","institution":"State University of Bangladesh","correspondingAuthor":true,"prefix":"","firstName":"Md","middleName":"Azazul","lastName":"Haque","suffix":""},{"id":636747540,"identity":"59af769b-fafa-4d45-86cd-5e78af197f2d","order_by":1,"name":"Ahamed Khairul Basher","email":"","orcid":"","institution":"icddr,b","correspondingAuthor":false,"prefix":"","firstName":"Ahamed","middleName":"Khairul","lastName":"Basher","suffix":""},{"id":636747542,"identity":"ca1ad3a9-271d-45a4-82dc-dc30e0097bc5","order_by":2,"name":"Tauhidul Islam","email":"","orcid":"","institution":"State University of Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Tauhidul","middleName":"","lastName":"Islam","suffix":""},{"id":636747544,"identity":"db2214f0-bfb4-40e6-848e-f5ca0d29e916","order_by":3,"name":"Md Shahjahan Siraj","email":"","orcid":"","institution":"icddr,b","correspondingAuthor":false,"prefix":"","firstName":"Md","middleName":"Shahjahan","lastName":"Siraj","suffix":""},{"id":636747545,"identity":"8df74349-11d7-4eb2-92a0-1637eb5f6220","order_by":4,"name":"Masudur Rahman Kanchon","email":"","orcid":"","institution":"State University of Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Masudur","middleName":"Rahman","lastName":"Kanchon","suffix":""},{"id":636747546,"identity":"b9e1705b-22cf-4ca8-8d35-ad3ca80e33dc","order_by":5,"name":"Saleh Haider","email":"","orcid":"","institution":"icddr,b","correspondingAuthor":false,"prefix":"","firstName":"Saleh","middleName":"","lastName":"Haider","suffix":""},{"id":636747547,"identity":"08d1dad8-65fd-45ff-8f18-a62c10cc0195","order_by":6,"name":"Mallik Tanjim Rafi","email":"","orcid":"","institution":"icddr,b","correspondingAuthor":false,"prefix":"","firstName":"Mallik","middleName":"Tanjim","lastName":"Rafi","suffix":""},{"id":636747548,"identity":"585a02f5-8acc-4312-add5-bfc5cc6346c9","order_by":7,"name":"Imran Hasan","email":"","orcid":"","institution":"icddr,b","correspondingAuthor":false,"prefix":"","firstName":"Imran","middleName":"","lastName":"Hasan","suffix":""},{"id":636747549,"identity":"9057c8f6-989b-47ae-843f-e729c1f3a1b4","order_by":8,"name":"Shamsun Nahar","email":"","orcid":"","institution":"State University of Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Shamsun","middleName":"","lastName":"Nahar","suffix":""}],"badges":[],"createdAt":"2026-05-05 07:40:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9615360/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9615360/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109067263,"identity":"1716b930-2edc-4e07-8e8c-c8e6f5d53dbb","added_by":"auto","created_at":"2026-05-12 09:30:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54527,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePractices for managing Non-communicable disease risk factors among NP-HCWs in Nilphamari district, northern Bangladesh.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9615360/v1/afb8cf6668eaefaec74df251.png"},{"id":109068520,"identity":"e3d27114-8499-482d-878a-d6db6013923b","added_by":"auto","created_at":"2026-05-12 10:13:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":565050,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9615360/v1/9975d140-f9af-4893-9c16-a00c029b4963.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of non-communicable diseases risk factors knowledge, and prevention practices among non-physician healthcare workers in selected primary and secondary hospitals of northern Bangladesh: a facility-based cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eNon-communicable diseases (NCDs) represent a growing crisis of global health and sustainable development. NCDs are responsible for 42\u0026nbsp;million deaths each year, equivalent to 73.4% of all fatalities(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). With the rising burden, NCDs have become the leading cause of mortality worldwide(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). NCDs are diseases that are not transmissible from one person to another, such as hypertension, diabetes mellitus, cardiovascular diseases (CVDs), cancers, and chronic respiratory diseases (CRDs), with the latter four accounting for over 80% of all premature NCD deaths(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In Low and middle-income countries (LMICs), the persistent burden of NCDs has demonstrably impeded economic growth, development, and overall progress(\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It is anticipated that NCDs will be responsible for half of the global disease burden in emerging nations(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Urbanization, aging populations, lifestyle changes, and rising processed food consumption in LMICs have shifted disease patterns, increasing the NCD burden driven by poor diets, inactivity, obesity, smoking, and alcohol use (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBangladesh is undergoing an epidemiological shift toward a double burden of both communicable and non-communicable diseases(\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The World Health Organization (WHO) estimates a global shortfall of 18\u0026nbsp;million health workers by 2030 as a result of the escalating NCD burden, underscoring the necessity of involving non-physician healthcare workers (NP-HCWs) in delivering essential NCD-related care. It is therefore imperative that these providers possess sufficient knowledge of NCD risk factors and demonstrate effective preventive practices to support the promotion of healthy behaviors. Between 1990 and 2019, NCD cases in Bangladesh rose from 95.5 to 145\u0026nbsp;million, while Communicable, Maternal, Neonatal, and Nutritional (CMNN) diseases declined from 104.9 to 88.6\u0026nbsp;million, with NCDs accounting for 14 of the top 20 causes of death in 2019(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNon-physician healthcare workers (NP-HCWs)\u0026mdash;including nurses, Community Health Care Providers (CHCP), Health Assistants (HA), lab technologists, and support staff \u0026mdash;are essential to healthcare services(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Task sharing has been promoted to address the rising burden of NCDs by involving NP-HCWs in prevention and management efforts(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Their close community engagement positions them to support self-management(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, despite the nature of their work being health promotion and disease prevention, HCWs exhibit a gradual trend toward NCD and have higher NCD levels than those of the general population (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). As Bangladesh pursues its Sustainable Development Goals (SDGs), addressing NCDs is crucial, with success depending on healthcare workers\u0026rsquo; knowledge of risk factors and adoption of preventive practices to promote healthy behavior(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Given the health system\u0026rsquo;s struggle with the long-term demands of NCD care, properly training NP-HCWs is essential to improve outcomes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, no study in Bangladesh has comprehensively assessed NP-HCWs\u0026rsquo; knowledge of NCD risk factors and preventive practices. Existing research has either focused on specific subgroups of NP-HCWs or on other population groups. Therefore, this study aimed to assess knowledge of NCD risk factors and preventive practices among NP-HCWs in Nilphamari district of northern Bangladesh, providing district-level evidence with indicative insights for the wider region. The findings are intended to identify potential areas for intervention and improvement to strengthen NP-HCWs\u0026rsquo; capacity in addressing the growing NCD burden, both for the populations they serve and for their own well-being.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis facility-based cross-sectional study was conducted from August 1, 2023, to January 30, 2024, in Nilphamari district, northern Bangladesh. To enhance representativeness, Nilphamari was randomly selected from among the northern districts, ensuring that each had an equal chance of inclusion.\u003c/p\u003e \u003cp\u003eAll government secondary- and primary-level healthcare facilities within the district were included, comprising the Nilphamari 250-bed District Hospital, Saidpur 100-bed Hospital, Upazila Health Complexes (Supplemental Fig.\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and sampling\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of all non-physician healthcare workers (NP-HCWs) directly engaged in patient care at the selected facilities during the study period. NP-HCWs working in basic science departments or those not involved in patient care were excluded.\u003c/p\u003e \u003cp\u003eParticipants were categorized into three groups: nurses, community health care providers (CHCP) / health assistants (HA), and support staff. CHCP, primarily based in community clinics, deliver primary healthcare, family planning, nutrition, and non-communicable disease services to rural populations. HAs provide domiciliary services at the ward or village level and were grouped with CHCP/HA due to the similarity of their roles (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e A total of 301 NP-HCWs\u0026mdash;comprising nurses, CHCP, HA, and support staff\u0026mdash;provided verbal consent and were enrolled. This strategy achieved near-complete coverage of the target population within Nilphamari, thereby strengthening the validity of the findings at the district level, while also providing insights that may also provide indicative of broader patterns across northern Bangladesh.\u003c/p\u003e\n\u003ch3\u003eData Collection Instrument\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured interviewer-administered questionnaire developed from the WHO STEP-wise approach to NCD risk factor surveillance and refined with expert input (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe questionnaire included four sections: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) eligibility criteria; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) sociodemographic characteristics, anthropometry, and history of selected NCDs; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) knowledge of NCD risk factors; and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) preventive practices. Knowledge was scored with one point per correct response and zero for incorrect or \"don\u0026rsquo;t know\" answers. Scores were categorized as poor (\u0026lt;\u0026thinsp;80%) or good (\u0026ge;\u0026thinsp;80%). Preventive practices were scored based on the number of recommended behaviors adopted: poor (0\u0026ndash;2 practices) and good (3\u0026ndash;6 practices).\u003c/p\u003e\n\u003ch3\u003eStudy procedure\u003c/h3\u003e\n\u003cp\u003eThe data collection was conducted in three steps. In the first step, eligible NP-HCWs were interviewed face-to-face at their respective healthcare facilities. Interviewers explained the study objectives, obtained verbal consent, and conducted interviews in private settings to maintain confidentiality and encourage accurate responses. In the second step, physical measurements\u0026mdash;including blood pressure, fasting capillary blood glucose, and anthropometry\u0026mdash;were taken following standard protocols outlined in the \u0026ldquo;Non-communicable Disease Risk Factors Survey Bangladesh 201\u0026rdquo;(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). For blood pressure measurement, participants were asked to sit and relax for five minutes before the reading. Two blood pressure measurements were taken on the right arm using an aneroid sphygmomanometer and a 3M\u0026trade; Littmann Classic II stethoscope, with diastolic pressure determined using Korotkoff Phase V. A two-minute interval was maintained between measurements, and the average of the two readings was used. Pulse rate was recorded with each reading. Participants were classified as hypertensive if they had a systolic blood pressure of \u0026ge;\u0026thinsp;140 mmHg, a diastolic blood pressure of \u0026ge;\u0026thinsp;90 mmHg, or a known history of hypertension(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnthropometric data included height and weight. Height was measured to the nearest millimeter using a portable stadiometer, with participants standing barefoot, feet together, and facing forward. Weight was recorded using a portable digital scale, with participants wearing light clothing and no shoes. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Furthermore, BMI was categorized following the WHO and National Institutes of Health guidelines for the general population: underweight (\u0026lt;\u0026thinsp;18.5), normal weight (18.5\u0026ndash;\u0026lt;25.0), overweight (25.0\u0026ndash;\u0026lt;30.0), and obese (\u0026ge;\u0026thinsp;30.0) (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the third step, fasting capillary blood glucose was measured using an Accu-Chek\u0026reg; Instant glucometer after confirming that participants had fasted for at least eight hours. All procedures were conducted using aseptic techniques. Participants with fasting blood glucose levels\u0026thinsp;\u0026ge;\u0026thinsp;7.0 mmol/L or those on antidiabetic medication were classified as diabetic(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData quality was ensured through completeness checks, validation, and cleaning. Data from hard copies were entered into Microsoft Excel and subsequently imported into R software (version 4.4.2) with the tidy verse and MASS packages for analysis. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to analyze demographic variables. Multivariable logistic regression was done, and chi-square tests and Pearson\u0026rsquo;s correlation tests were used to assess associations between dependent and independent variables, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant. Results were presented using frequency tables, graphs, maps.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eEthical approval was obtained from the Ethical Review Committee of the State University of Bangladesh, and permission was secured from the Civil Surgeon of Nilphamari District Hospital. Verbal consent was obtained from all respondents before data collection, and privacy and confidentiality were strictly maintained. Proper aseptic measures were maintained during blood collection through instant glucometer. Participants had the right to withdraw from the study at any time without providing a reason. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic and health-related characteristics:\u003c/h2\u003e \u003cp\u003eWe interviewed 301 NP-HCWs, most of them were female 179(59%). Mean age of the participants was 37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7 years, and the largest age group was 30\u0026ndash;44 years, comprising 125 (42%) NP-HCWs. Nurses 135 (45%) constituted the largest professional group, followed by CHCP/HA 108 (36%), and support staff58 (19%). Nearly half of the respondents earned between 25,000\u0026ndash;50,000 BDT (\u0026asymp;\u0026thinsp;410 USD), and the majority had completed graduation or above educational level. Among the NP-HCWs, 88 (29%) reported having at least one NCDs (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of NP-HCWs in Nilphamari district, northern Bangladesh (August 1, 2023 \u0026ndash; January 30, 2024; N\u0026thinsp;=\u0026thinsp;301)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (41%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e179 (59%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (42%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (37%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e285 (95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e245 (81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody mass index (BMI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (30.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121 (40.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfessional Category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHCP/HA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport Staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome Category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder 25,000 BDT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25,000\u0026ndash;50,000 BDT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142 (47%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 50,000 BDT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (31%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp-to Primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted graduation and Above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e273 (91%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-Communicable Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e213 (71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge of NCDs:\u003c/h2\u003e \u003cp\u003eOverall, 70% (212) NP-HCWs had good knowledge (score\u0026thinsp;\u0026ge;\u0026thinsp;80%). Most showed good knowledge of well-known NCD risk factors like tobacco use, inactivity, and alcohol. However, over 45% lacked understanding regarding infection-related NCD risks, and 67% of nurses, 96% of CHCP/HA, and 84% of support staff correctly responded that NCDs cannot be prevented (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge scores on non-communicable diseases among NP-HCWs in Nilphamari district, northern Bangladesh (August 1, 2023 \u0026ndash; January 30, 2024; N\u0026thinsp;=\u0026thinsp;301)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNCD risk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eCorrect responses n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse (n\u0026thinsp;=\u0026thinsp;135)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCHCP/HA (n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupport staff (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;301)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNCDs are not transmissible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e249 (83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTobacco use as a risk factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e289 (96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical inactivity as a risk factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e284 (94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFruits \u0026amp; vegetables lower the risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e261 (87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol increases the risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e294 (98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity as a risk factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e279 (93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh BP as a risk factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e289 (96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety \u0026amp; stress impact NCDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e276 (92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe belief that NCDs are primarily caused by infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e167 (55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelief that NCDs cannot be prevented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e244 (81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAir pollution increases NCDs risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e264 (88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh sugary drink consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e285 (95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history/genetics as a risk factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e286 (95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge as a risk factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e280 (93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall Knowledge Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood knowledge (\u0026ge;\u0026thinsp;80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e212 (70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor knowledge (\u0026lt;\u0026thinsp;80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePreventive practice:\u003c/h2\u003e \u003cp\u003eNP-HCWs most commonly reported preventive practices were maintaining a balanced diet 230 (76%) and engaging in physical activity 143 (48%). However, only 39 (13%) practiced stress management, and 80 (27%) underwent regular health check-ups. Nurses showed greater adherence to healthy behaviors than CHCP/HA and support staff, particularly in physical activity, check-ups, and weight control (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Overall, 118 (41%) participants reported poor preventive practices (engaging in 0\u0026ndash;2 practice), with the highest among support staff, 29 (50%) (Supplementary table 1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePredictors of NCD knowledge:\u003c/h2\u003e \u003cp\u003eNP-HCWs with graduation and above education level showed better knowledge of NCD risk factors (aOR: 2.89; 95% CI: 0.66\u0026ndash;12.68; p\u0026thinsp;=\u0026thinsp;0.16), though not statistically significant. Support staff had significantly lower odds in unadjusted analysis (uOR: 0.28; 95% CI: 0.15\u0026ndash;0.53; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but this association attenuated after adjustment (aOR: 0.44; 95% CI: 0.16\u0026ndash;1.22; p\u0026thinsp;=\u0026thinsp;0.11). Other demographic or health factors were not significantly associated (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors associated with knowledge level on non-communicable diseases among NP-HCWs in Nilphamari district, northern Bangladesh (August 1, 2023 \u0026ndash; January 30, 2024; N\u0026thinsp;=\u0026thinsp;301)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003euOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19 (0.68\u0026ndash;2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.11 (0.54\u0026ndash;2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.14 (0.56\u0026ndash;2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83 (0.32\u0026ndash;2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.68 (1.01\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 (0.67\u0026ndash;2.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp to primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.12 (1.43\u0026ndash;18.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.89 (0.71\u0026ndash;11.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted graduation and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.08 (2.15\u0026ndash;23.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.89 (0.66\u0026ndash;12.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupational-level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHCP/HA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.37 (0.73\u0026ndash;2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.68 (0.73\u0026ndash;3.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport Staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.28 (0.15\u0026ndash;0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44 (0.16\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.66 (0.18\u0026ndash;2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.51 (0.34\u0026ndash;6.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85 (0.5\u0026ndash;1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76 (0.42\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.59 (0.22\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59 (0.19\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.68 (1.01\u0026ndash;2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.77 (0.54\u0026ndash;5.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-Communicable Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73 (0.41\u0026ndash;1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54 (0.27\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of preventive practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood practice (3\u0026ndash;6 practices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.64\u0026ndash;1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9 (0.52\u0026ndash;1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor practice (1\u0026ndash;2 practices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBold values indicated that the findings are significant.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026Dagger;χ2 test was run between risk factors, statistical significance p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and presented as bold values.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eNP-HCWs, Non-physician Healthcare workers; OR, Odds ratio; NCD, Non-Communicable Disease; BMI, Body Mass Index.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePredictors of preventive practices\u003c/b\u003e: NP-HCWs with a graduation and above degree had a significant association with good preventive practice (aOR: 4.9; 95% CI: 1.13\u0026ndash;21.33; p\u0026thinsp;=\u0026thinsp;0.03). Support staff had lower odds in unadjusted analysis (uOR: 0.52; 95% CI: 0.27\u0026ndash;0.99; p\u0026thinsp;=\u0026thinsp;0.04), but this association was not significant after adjustment (aOR: 0.7; 95% CI: 0.26\u0026ndash;1.86; p\u0026thinsp;=\u0026thinsp;0.48) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors associated with preventive practices for NCDs among NP-HCWs in Nilphamari district, northern, Bangladesh (August 1, 2023 \u0026ndash; January 30, 2024; N\u0026thinsp;=\u0026thinsp;301)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003euOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79 (0.46\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93 (0.48\u0026ndash;1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89 (0.45\u0026ndash;1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36 (0.56\u0026ndash;3.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.27 (7.09\u0026ndash;2.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01 (0.53\u0026ndash;1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp to primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.37 (0.95\u0026ndash;11.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.86 (0.96\u0026ndash;15.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompleted graduation and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.39 (1.33\u0026ndash;14.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9 (1.13\u0026ndash;21.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupational-level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHCP/HA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78 (0.46\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78 (0.38\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport Staff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52 (0.27\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7 (0.26\u0026ndash;1.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.97 (0.27\u0026ndash;3.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.36 (0.33\u0026ndash;5.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68 (0.42\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75 (0.44\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11 (0.4\u0026ndash;3.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.33 (0.44\u0026ndash;4.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.38 (0.49\u0026ndash;3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7 (0.54\u0026ndash;5.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-Communicable Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.18 (0.71\u0026ndash;1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.09 (0.6\u0026ndash;1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood knowledge (\u0026ge;\u0026thinsp;80% correct)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.64\u0026ndash;1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86 (0.5\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor knowledge (\u0026lt;\u0026thinsp;80% correct)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBold values indicated that the findings were significant.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026Dagger;χ2 test was run between risk factors, statistical significance p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and presented as bold values.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eNP-HCWs, Non-physician Healthcare workers; OR, Odds ratio; NCD, Non-Communicable Disease; BMI, Body Mass Index.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found that NP-HCWs in northern Bangladesh generally possessed good knowledge of NCD risk factors, particularly tobacco use, physical inactivity, and alcohol consumption, findings that are consistent with previous research in low- and middle-income countries (LMICs) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). However, notable misconceptions persisted\u0026mdash;nearly half of the participants believed NCDs are caused by infections, and about one-fifth thought they are not preventable. These misconceptions reflect incomplete understanding of NCD etiology and prevention, similar to patterns reported in other LMICs where awareness of NCD preventability remains limited (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Differences in knowledge levels may be influenced by sociodemographic factors, professional roles, work experience, and exposure to NCD-specific training. Addressing these disparities through focused capacity-building initiatives is essential to foster a comprehensive understanding of NCDs among NP-HCWs and improve community-level prevention efforts.\u003c/p\u003e \u003cp\u003eIn terms of preventive practices, 48\u0026ndash;76% of NP-HCWs reported engaging in physical activity and maintaining a balanced diet. Similar activity levels among healthcare professionals have been reported (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). However, a study reported from Bangladesh among healthcare workers showed only 13.1% physically active and 43.7% maintaining a balanced diet (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). These contrast findings may be due to occupational differences, healthcare settings, or sample characteristics. To enhance such practices, targeted education and awareness of their long-term health benefits are critical (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Only 13% and 27% of participants reported practicing stress management and undergoing regular health check-ups, respectively. These results mirror previous findings showing low participation in such practices (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Time constraints, heavy workloads, and a perceived sense of good health likely contribute to these low rates (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). This highlights a critical gap in the adoption of preventive strategies necessary to reduce NCD risk.\u003c/p\u003e \u003cp\u003eOver two-fifths of NP-HCWs, particularly support staff, demonstrated poor engagement in preventive practices. This trend has also been reported elsewhere, where lower-level healthcare workers face barriers such as limited resources, time, and institutional support (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). There is a clear need for policies and interventions that support the adoption of comprehensive health practices, especially in low-resource settings, to ensure NP-HCWs can effectively serve as role models for the community.\u003c/p\u003e \u003cp\u003eNP-HCWs with a graduate-level education or higher emerged as significant predictors of both knowledge and preventive practices regarding NCDs, consistent with literature linking education to health literacy and healthy behavior (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Furthermore, the level of occupation is also associated with better knowledge and preventive practices of NP-HCWs, and prior research found similar findings (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). This may relate to differences in training exposure or involvement in NCD-related activities. In this study, we did not find a significant association between knowledge and preventive practice and factors such as age, sex, BMI, marital status, and history of NCDs. Although some studies have found such associations (\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), our differing results may stem from sample size, contextual variation, or population characteristics.\u003c/p\u003e \u003cp\u003eThis study highlights the need for targeted interventions to enhance NP-HCWs' knowledge and practices related to NCDs, emphasizing accurate, up-to-date information and promoting healthy behaviors. Educational programs on NCD prevention and management should address misconceptions and include stress management and regular health check-ups. Additionally, strengthening the capacities of lower-tier NP-HCWs, such as CHCP/HA and support staff, through training and supportive policies is essential to improving their engagement in preventive care. These findings can inform Bangladesh\u0026rsquo;s national NCD control strategy and WHO PEN implementation framework.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of this study\u003c/h2\u003e \u003cp\u003eThis is the first study in Bangladesh to comprehensively assess knowledge of NCD risk factors and preventive practices among NP-HCWs. The random selection of Nilphamari district and inclusion of nearly all eligible NP-HCWs ensured strong district level representativeness, although the single district design limits generalizability and provides only indicative insights for northern Bangladesh. The inclusion of multiple cadres of NP HCWs and use of a modified WHO STEPS based tool, incorporating objective measures such as blood pressure, body mass index, and fasting glucose, strengthened the reliability of the findings. However, reliance on self-reported information and glucometer-based diabetes measurements may have introduced bias, although similar methodological approaches and findings have been reported in other LMICs settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable insights into the knowledge and practices regarding NCDs among NP-HCWs in Nilphamari district, northern Bangladesh. While the overall knowledge related to NCDs was relatively good, there are notable gaps, particularly in the understanding of NCDs preventability and the role of infections and the adoption of certain preventive behaviors, particularly stress management and health check-ups, and two-fifths of them reported 0\u0026ndash;2 preventive practices. Education and designation or position in the occupation were found to be significant predictors of both knowledge and preventive practices. Addressing these gaps through targeted educational programs and interventions could improve NP-HCWs knowledge and preventive behaviors of NCDs, ultimately benefiting both the NP-HCWs and the communities they serve.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHCWs-Non-physician Health Care Workers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-and middle-income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNCDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-communicable diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiovascular diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Ethical approval was granted by the Ethical Review Committee of the State University of Bangladesh, and permission was obtained from the Civil Surgeon of Nilphamari District Hospital. Verbal consent was provided by all participants, with privacy and confidentiality maintained throughout. Participants were free to withdraw from the study at any time without explanation. The study adhered to the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll relevant data are provided in the manuscript. Dataset access can be requested from the corresponding author through the State University of Bangladesh's research administration, in line with institutional policy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests relevant to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eMAH conceived and designed the study, coordinated data collection, performed the analyses, and drafted the manuscript. AKB and MT contributed to study design, data collection, analysis, and manuscript review. MSS provided methodological input, assisted with data interpretation, and critically revised the manuscript. MRK, SH, and MTR contributed to data collection, management, and preparation of tables/figures. IH supported supervision, ensured data quality, and reviewed the manuscript. SN supervised the overall study and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe thank the State University of Bangladesh and the study hospitals for their support and express our gratitude to the participants for their valuable contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient and public involvement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients or members of the public were not involved in the design, conduct, reporting, or dissemination plans of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsolekile L. Urbanization and lifestyle changes related to non-communicable diseases: An exploration of experiences of urban residents who have relocated from the rural areas to Khayelitsha, an urban township in Cape Town. In 2007 [cited 2025 Apr 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.semanticscholar.org/paper/Urbanization-and-lifestyle-changes-related-to-An-of-Tsolekile/272be6df8bf7737d680d5846b68468ddc2201301\u003c/span\u003e\u003cspan address=\"https://www.semanticscholar.org/paper/Urbanization-and-lifestyle-changes-related-to-An-of-Tsolekile/272be6df8bf7737d680d5846b68468ddc2201301\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGamage AU, Jayawardana PL. Knowledge of non-communicable diseases and practices related to healthy lifestyles among adolescents, in state schools of a selected educational division in Sri Lanka. BMC Public Health 2017 July 26;18(1):64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrbanization. and lifestyle changes related to non-communicable diseases: an exploration of experiences of urban residents who have relocated from the rural areas to Khayelitsha, an urban township in Cape Town [Internet]. [cited 2025 Apr 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://datacatalog.ihsn.org/citations/7200?utm_source=chatgpt.com\u003c/span\u003e\u003cspan address=\"https://datacatalog.ihsn.org/citations/7200?utm_source=chatgpt.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNon communicable diseases [Internet]. [cited 2025 Apr 13]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurden of non-communicable disease. Global overview - ScienceDirect [Internet]. [cited 2025 Mar 10]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/abs/pii/S1871402108000489\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/abs/pii/S1871402108000489\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUN High-Level Meeting on Non-Communicable Diseases. addressing four questions - The Lancet [Internet]. [cited 2025 May 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60879-9/abstract\u003c/span\u003e\u003cspan address=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60879-9/abstract\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirelman AJ, Rose S, Khan JA, Ahmed S, Peters DH, Niessen LW et al. The relationship between non-communicable disease occurrence and poverty\u0026mdash;evidence from demographic surveillance in Matlab, Bangladesh. Health Policy and Planning. 2016 July 1;31(6):785\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiswas T, Islam MS, Linton N, Rawal LB. Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh. PLoS ONE. 2016;11(11):e0167140.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Wang J. Modelling and prediction of global non-communicable diseases. BMC Public Health. 2020 June 1;20(1):822.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelachew A, Cherbuin N, Bagheri N, Burns R. A Systematic Review and Meta-analysis of the Socioeconomic, Lifestyle, and Environmental Factors Associated with Healthy Ageing in Low and Lower-Middle-Income Countries. Population Ageing. 2024 June 1;17(2):365\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe W, Kowal P, An Aging W. 2015. [Internet]. [cited 2024 Aug 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.academia.edu/30886740/An_Aging_World_2015\u003c/span\u003e\u003cspan address=\"https://www.academia.edu/30886740/An_Aging_World_2015\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaruque M, Barua L, Banik PC, Sultana S, Biswas A, Alim A, et al. Prevalence of non-communicable disease risk factors among nurses and para-health professionals working at primary healthcare level of Bangladesh: a cross-sectional study. BMJ Open. 2021;11(3):e043298.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagner KH, Brath H. A global view on the development of non communicable diseases. Prev Med. 2012;54(Suppl):S38\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuerrero-L\u0026oacute;pez CM, Serv\u0026aacute;n-Mori E, Miranda JJ, Jan S, Orozco-N\u0026uacute;\u0026ntilde;ez E, Downey L et al. Burden of non-communicable diseases and behavioural risk factors in Mexico: Trends and gender observational analysis. Journal of Global Health [Internet]. 2023 [cited 2023 Dec 1];13. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10274265/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10274265/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiswas T, Townsend N, Huda MM, Maravilla J, Begum T, Pervin S et al. Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study. eClinicalMedicine [Internet]. 2022 Oct 1 [cited 2025 Jan 27];52. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00321-2/fulltext\u003c/span\u003e\u003cspan address=\"https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00321-2/fulltext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShimbo D, Levitan EB, Booth JN, Calhoun DA, Judd SE, Lackland DT, et al. The contributions of unhealthy lifestyle factors to apparent resistant hypertension: findings from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Hypertens. 2013;31(2):370\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eResearchGate [Internet]. [cited 2025 Mar 10]. (PDF) Knowledge and Preventive Practice Towards Non-Communicable Diseases Risk Factors Among Civil Servants of Kellem Wollega Zone, Western Ethiopia in. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/365476196_Knowledge_and_Preventive_Practice_Towards_Non-Communicable_Diseases_Risk_Factors_Among_Civil_Servants_of_Kellem_Wollega_Zone_Western_Ethiopia_in\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/365476196_Knowledge_and_Preventive_Practice_Towards_Non-Communicable_Diseases_Risk_Factors_Among_Civil_Servants_of_Kellem_Wollega_Zone_Western_Ethiopia_in\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhsan Karar Z, Alam N, Kim Streatfield P. Epidemiological transition in rural Bangladesh, 1986\u0026ndash;2006. Glob Health Action 2009 June 19;2:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3402/gha.v2i0.1904\u003c/span\u003e\u003cspan address=\"10.3402/gha.v2i0.1904\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD 2019 Bangladesh Burden of Disease Collaborators. The burden of diseases and risk factors in Bangladesh, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health. 2023;11(12):e1931\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlobal status report on noncommunicable. diseases 2014 [Internet]. [cited 2025 May 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241564854\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241564854\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealthcare industry - Wikipedia [Internet]. [cited 2022 Dec 15]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://en.wikipedia.org/wiki/Healthcare_industry\u003c/span\u003e\u003cspan address=\"https://en.wikipedia.org/wiki/Healthcare_industry\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoshi: Task shifting for non-communicable disease\u0026hellip; Google Scholar [Internet]. [cited 2023 Aug 21]. Available from: https://scholar.google.com/scholar_lookup?title=Task+shifting+for+non-communicable+disease+management+in+low+and+middle+income+countries--A+systematic+review\u0026amp;publication_year=2014\u0026amp;author=R+Joshi\u0026amp;author=M+Alim\u0026amp;author=AP+kengne\u0026amp;author=S+Jan\u0026amp;author=Pk+Maulik\u0026amp;author=D+Peiris.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeveraging role of. non-physician health workers in prevention and control of non-communicable diseases in India: Enablers and challenges - PubMed [Internet]. [cited 2024 Aug 27]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/34041047/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/34041047/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVallasamy SK, Umairah Muhadi S, Murali B, Sathaisivam J. Combating Non- Communicable Disease Among HCW: \u0026lsquo;The Broken Soldiers.\u0026rsquo; ScienceOpen Posters [Internet]. 2022 July 19 [cited 2025 Aug 5]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scienceopen.com/hosted-document?doi=10.14293/S2199-1006.1.SOR-.PPM1YH1.v2\u003c/span\u003e\u003cspan address=\"https://www.scienceopen.com/hosted-document?doi=10.14293/S2199-1006.1.SOR-.PPM1YH1.v2\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBangladesh makes consistent. progress achieving SDGs health indicators [Internet]. [cited 2025 May 6]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/bangladesh/news/detail/05-03-2020-bangladesh-makes-consistent-progress-achieving-sdgs-health-indicators\u003c/span\u003e\u003cspan address=\"https://www.who.int/bangladesh/news/detail/05-03-2020-bangladesh-makes-consistent-progress-achieving-sdgs-health-indicators\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e(PDF) Prevalence of modifiable and non-modifiable risk factors and lifestyle disorders among health care professionals [Internet]. [cited 2025 Feb 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/277976131_Prevalence_of_modifiable_and_non-modifiable_risk_factors_and_lifestyle_disorders_among_health_care_professionals\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/277976131_Prevalence_of_modifiable_and_non-modifiable_risk_factors_and_lifestyle_disorders_among_health_care_professionals\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnagbiye S, Tsolekile L, Puoane T. Knowledge of Non-communicable Disease Risk Factors among Community Health Workers in South Africa. Open Public Health J 2020 Sept 22;13:430\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2025-04-10-. 07-32-f2d00a006b462fe3ad2d9f6a3318ea3f.pdf [Internet]. [cited 2025 Sept 29]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dghs.portal.gov.bd/sites/default/files/files/dghs.portal.gov.bd/page/9b9f86da_6c99_4581_8039_1a\u003c/span\u003e\u003cspan address=\"https://dghs.portal.gov.bd/sites/default/files/files/dghs.portal.gov.bd/page/9b9f86da_6c99_4581_8039_1a\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e56daf8166b/2025-04-10-07-32-f2d00a006b462fe3ad2d9f6a3318ea3f.pdf\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStandard STEPS. instrument [Internet]. [cited 2025 Mar 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/m/item/standard-steps-instrument\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/m/item/standard-steps-instrument\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBangladesh WHOCO. for. Non-communicable disease risk factor survey, Bangladesh 2010 [Internet]. World Health Organization. Country Office for Bangladesh; 2011 [cited 2025 Feb 8]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/279484\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/279484\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHypertension [Internet]. [cited 2025 Apr 13]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/hypertension\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/hypertension\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChowdhury MAB, Adnan MM, Hassan MZ. Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys. BMJ Open. 2018 July 1;8(7):e018468.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe need for international consensus on. prediabetes - PubMed [Internet]. [cited 2025 Feb 8]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/27863980/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/27863980/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaini A, Agarwal M. Combating non-communicable diseases in rural Lucknow: Are the skills and knowledge of female health workers adequate? Int J Community Med Public Health. 2020;7:3480.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElnaem MH, Jamshed S, Qasim, Elkalmi R. Knowledge of the risk factors of non-communicable diseases (NCDs) among pharmacy students: findings from a Malaysian University. Int J Health Promotion Educ 2019 July 4;57(4):217\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeena S, Rathore M, Gupta A, Kumawat P, Singh A. Knowledge and attitude of peripheral health workers regarding Non-Communicable diseases in a Rural area of Rajasthan. Indian J Community Health 2022 June 30;34(2):306\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarques-Sule E, Mir\u0026oacute;-Ferrer S, Mu\u0026ntilde;oz-G\u0026oacute;mez E, Bermejo-Fern\u0026aacute;ndez A, Ju\u0026aacute;rez-Vela R, Gea-Caballero V, et al. Physical activity in health care professionals as a means of primary prevention of cardiovascular disease: A STROBE compliant cross-sectional study. Medicine. 2021 June;4(22):e26184.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanik PC, Barua L, Ali L, Faruque M, Sultana S, Biswas A et al. Prevalence of non-communicable disease risk factors among nurses and para-health professionals working at primary healthcare level of Bangladesh: a cross-sectional study. BMJ Open [Internet]. 2021 Mar 1 [cited 2025 Apr 9];11(3). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmjopen.bmj.com/content/11/3/e043298.full\u003c/span\u003e\u003cspan address=\"https://bmjopen.bmj.com/content/11/3/e043298.full\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaridi M, Filippopoulou T, Tzitzikos G, Sarafis P, Souliotis K, Karakatsani D. Correlating physical activity and quality of life of healthcare workers. BMC Res Notes. 2019;12(1):208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehrotra R, Gupta M, Bhagwati M, Jain D. The Prevalence, Causes, and Management Strategies for Stress Among Health-Care Professionals of Delhi-National Capital Region. J Clin Prev Cardiol. 2021 Sept;10(3):85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBing [Internet]. [cited 2025 May 6]. Risk Factors for Stress and Burnout (CDC). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bing.com/search?pglt=41\u0026amp;q=Risk+Factors+for+Stress+and+Burnout+(CDC)\u0026amp;cvid=57f65f8b688043628304e1ee629582c5\u0026amp;gs_lcrp=EgRlZGdlKgYIABBFGDkyBggAEEUYOdIBBzkxOGowajGoAgCwAgA\u0026amp;FORM=ANNTA1\u0026amp;PC=WSEDDB\u003c/span\u003e\u003cspan address=\"https://www.bing.com/search?pglt=41\u0026amp;q=Risk+Factors+for+Stress+and+Burnout+(CDC)\u0026amp;cvid=57f65f8b688043628304e1ee629582c5\u0026amp;gs_lcrp=EgRlZGdlKgYIABBFGDkyBggAEEUYOdIBBzkxOGowajGoAgCwAgA\u0026amp;FORM=ANNTA1\u0026amp;PC=WSEDDB\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHossain MM, Roy A, Hanif AAM, Akter F, Hasan M, Khan MSA, et al. Distribution and disparities of healthy lifestyles and noncommunicable diseases risk factors between men and women aged 20\u0026ndash;59 years in Bangladesh: Evidence from a nationwide survey. Chronic Dis Transl Med. 2024;10(4):312\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoniruzzaman M, Ahmed MSAM, Zaman MM. Physical activity levels and associated socio-demographic factors in Bangladeshi adults: a cross-sectional study. BMC Public Health. 2017;17(1):59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaroli P, Mayige M, Kagaruki G, Mori A, Macha E, Mutagaywa R, et al. Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment. BMC Health Serv Res. 2024;24(1):612.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGenerative AI-statement. Grammarly was used to support language editing, grammar, and clarity. The authors reviewed and approved all changes and take full responsibility for the content of the manuscript. AI was not used for data analysis, interpretation, or generation of scientific content.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Non-communicable diseases, non-physician healthcare workers, knowledge, preventive practices, education, Bangladesh.Keywords: Non-communicable diseases, non-physician healthcare workers, knowledge, preventive practices, education, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-9615360/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9615360/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: Non-communicable diseases (NCDs) pose a growing challenge for health systems in low- and middle-income countries (LMICs), where non-physician healthcare workers (NP-HCWs) constitute a substantial proportion of the frontline workforce engaged in prevention and health promotion. However, evidence on NP-HCWs’ knowledge of NCD risk factors and preventive practices in Bangladesh remains limited.\nMethods: This facility based cross sectional study assessed NCD related knowledge and preventive practices among NP-HCWs, including nurses, community health care providers, health assistants, and support staff, across two secondary and six primary level government healthcare facilities in Nilphamari district, northern Bangladesh, between August 2023 and January 2024. Data were collected using a structured, pretested questionnaire informed by a modified WHO STEPS approach and analysed using descriptive statistics and multivariable logistic regression.\nResults: Most NP-HCWs were female (59%) with a mean age of 37.1± 9.7 years. Overall, 70% of NP-HCWs demonstrated good knowledge (≥80%), though gaps existed. Over 45% did not recognize NCDs as non-infectious, and 33% of nurses believed they were not preventable. However, only 13% of NP-HCWs practiced stress management, and 27% underwent regular health check-ups. Graduates and those with higher educational degrees were a significant predictor of good preventive practice (aOR: 4.9; 95% CI: 1.13–21.33; p = 0.03). Support staff consistently showed lower odds for both good knowledge and practices in unadjusted analyses.\nConclusion: These findings show that while NP HCWs generally have good knowledge of NCDs, preventive practices remain limited. Targeted, cadre specific interventions are needed to improve NCD related knowledge and preventive behaviours among NP HCWs.","manuscriptTitle":"Assessment of non-communicable diseases risk factors knowledge, and prevention practices among non-physician healthcare workers in selected primary and secondary hospitals of northern Bangladesh: a facility-based cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-12 09:26:48","doi":"10.21203/rs.3.rs-9615360/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d7af2558-ad88-4eac-9fbe-0e06bb5bb84f","owner":[],"postedDate":"May 12th, 2026","published":true,"recentEditorialEvents":[{"type":"editorAssigned","content":"","date":"2026-05-08T09:07:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-08T09:06:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-05-05T07:22:14+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T09:26:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-12 09:26:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9615360","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9615360","identity":"rs-9615360","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}