Positive mental health is greatly enhanced by prosocial behavior [1], which is defined as behavior meant to help others [2]. Practicing compassion, sharing, and kindness not only improves the quality of life of those who are receiving support but also makes the provider seem fulfilled and happy. Positive relationships with others have been associated with higher happiness, lower stress levels, and a stronger sense of interpersonal connection [3]. On the other hand, aggressiveness, which is characterized by harm or hostile behavior, has an adverse effect on mental health. People with aggressive tendencies can be more stressed and anxious and have poor relationships with others [4]. A supportive social context is created by fostering prosocial behavior and reducing aggressiveness, which benefits both individual and community mental health outcomes. Promoting an atmosphere of empathy and kindness can act as an effective stimulant for enhancing mental health and building strong, harmonious communities [4].

Prosocial behavior

All prosocial behavior and violence are enduring elements of human behavior that demonstrate an obvious pattern from middle childhood to adulthood [5]. Prosocial behavior is beneficial for both those giving and receiving support. Prosocial behaviors that benefit both individuals or generate positive emotions are beneficial to the welfare of the provider [6]. According to earlier studies, prosocial behavior is positively correlated with better interactions with others, stronger psychological well-being, and better physical health with a longer life expectancy. Prosocial behavior, such as altruism or helping others without expecting reimbursement, is crucial for having a healthy, long life [7]. In our history, there have also been several fewer recognized instances of kindness, sharing, helping, and donating. Strongly adopted, people with these prosociality-based principles are likely to act mainly to help others in need. Today, we have to start our daily activities with knowledge about many antisocial behaviors, such as actions of violence, human hostility, hijackings, and injustice, some of which may even impact us personally. Through human history, there have been numerous instances of cruelty, racial violence, torture, war, crime, and murder. During the past few decades, there has been a lot of research done regarding the development and correlations of prosocial behaviors [8,9]. It is remarkable that there are now barely any measures available for investigating prosocial behaviors, particularly among adult and elderly individuals, considering the importance of comprehending behaviors that contribute to society. There are plenty of evaluations; however, they are usually characterized by an expansive perspective of prosocial behavior. Investigators have still demonstrated that prosocial behaviors come in a broad range of patterns and that these forms communicate with theoretically related dimensions in specific manners [10,11]. Moreover, little is known regarding the characteristics of adults who demonstrate specific prosocial behavioral tendencies [12]. The main goal of this study was to investigate the psychometric qualities of a previously developed, multidimensional evaluation that evaluates prosocial behaviors in adults.

Types of prosocial behaviors

The following types of prosocial behaviors were first notable, based on previous theory and research: public prosocial behaviors, altruistic prosocial behaviors, compliant prosocial behaviors, and emotional prosocial behaviors. Each type's description is presented below.

Altruism: According to Pfattheicher et al., 2022, altruistic prosocial behaviors can be described as spontaneous acts of helping that are mainly motivated by an awareness of the requirements and welfare of others [13]. They are frequently spurred on by empathetic responses and adopted requirements that are consistent with helping others. In addition, these actions may come at an expense to the helper since their primary concern is maintaining the health of the individuals in need. While the existence of altruistic behaviors has been denied by academics, there are at least three pieces of research that point to the existence of altruism [11,14]. First, it has been shown by researchers that empathy is transmissible and regarded as evolutionary advantageous [15,16]. Second, research conducted over time has demonstrated that the prosocial behavior tendency is consistent throughout life [17,18]. Third, studies in various situations have revealed significant associations between personality traits and acts of kindness [19,20]. Scholars have proposed that empathy generates a need to ease the distress of the other person, whereas emotional distress leads to a desire to relieve one's own sense of distress [21]. A number of studies have discovered that altruistic behaviors are associated with sympathy, whereas egoistic responses are tied to individual discomfort [22]. So, it had been expected that mature adults who attributed responsibility to themselves and who were motivated to behave properly towards society would be more likely to support altruistic, prosocial actions.

Compliant: According to Rossi et al., 2023, compliant prosocial behaviors include those in which one helps others in response to a request, either verbal or nonverbal [23]. The vast majority of research on compliant helping has been conducted with children rather than adults, and it is more frequent than spontaneous helping. According to Pastor et al., 2024, adolescents who collaborate often are more inclined to take care of things, ask for help from adults more frequently, and react positively to their peers' prosocial behaviors [24]. When girls comply with requests to take prosocial behavior, teachers, on the other hand, tend to respond with greater favor to their actions than to boys. The particular characteristics associated with compliant support aren't restricted to preschool years; compliant prosocial behavior has been related to typically nonassertive elementary school children [25].

Emotional: A perspective towards supporting others in challenging situations was an understanding of emotional prosocial behaviors. There are specific situations where support can be extremely emotionally draining. Highly emotionally charged situations may cause overarousal and personal discomfort in particular individuals, while they can provoke sympathy in others [26]. These emotional reactions have been linked to both self-centered and altruistic methods of helping as well as controlling one's emotional capabilities [27]. Helping in highly stressful circumstances is generally believed to be closely associated with others personal characteristics and sympathetic responses [28].

Public

Engaging in prosocial actions in public might be motivated, at least partly, by the desire to boost one's self-worth and gain other people's acceptance and respect. Adjusting whether or not other individuals are witnesses to the possible prosocial act is a standard manipulation used in research on prosocial behavior [29]. Although prosocial behavior and socially desirable considerations are not always incompatible, research has shown that helping others in public is occasionally linked to self-centered motivations. In addition, performing deeds in front of an audience increases the probability of being supported [30]. Since people are frequently anxious about obtaining approval from others, it was suggested that public prosocial behaviors would positively correlate with social desirability and approval-oriented moral reasoning.

Anonymous and dire

The public prosocial behaviors subscale is integrated into two distinct components, public and anonymous prosocial behaviors, based on preliminary factor analyses from three pilot inquiries. Anonymous prosocial behavior is defined as delivering support without revealing the identity of the beneficiary. Public prosocial behaviors were defined as a propensity to engage in prosocial behavior in public. Additionally, the subscale measuring emotional prosocial behaviors is integrated into two distinct factors: serious and emotional prosocial behaviors. Respondents established the distinction between situations that involve emotionally charged indicators and those that require crisis or emergency assistance.

Aggression

The act of harming someone who does not want to be hurt is referred to as aggression [31]. Frustration was the reason for the aggression, defined as an unpleasant feeling that develops when something stands in the way of achieving an important goal [32]. According to the frustration-aggression theory, all painful events result in negative impact, which in effect promotes aggressive and frightened preferences. It is not so much the feeling of dissatisfaction as it is the unpleasant feeling that evokes aggressive behavior [31,33]. In the context of influenced stimulation, archer split stimuli that generated fear or aggression into three groups: pain, novelty, and frustration. He also defined looming, which is the term for an object that shifts swiftly towards a subject's sense of sight and can be categorized according to its magnitude. Numerous classifications and aspects related to aggression have been suggested. They involve the following factors: whether the aggression is verbal or physical; whether interpersonal aggression, such as bullying and social manipulation, takes place; whether or not harm to others is intended; whether the aggression is expressed actively or passively; and whether or not it targets others directly or indirectly. Emotions and mental states linked to aggression may also be incorporated into the classification. Both social and non-social stressors are capable of triggering aggression, and there may be a significant connection between aggression and coping mechanisms for stress. It is feasible to behave aggressively in an effort to intimidating. Political or moral beliefs may influence the practical meaning of aggression. Problems with adjustment and an array of psychopathological symptoms, notably antisocial behaviors, personality disorder, borderline personality disorder, and intermittent explosive disorder are linked to aggressive behaviors. According to biological perspectives, aggressiveness is a result of hormone variations, natural selection during evolution, internal energy generated in response to stimuli from the outside, and heredity. According to psychological viewpoints, aggression originates from a variety of variables that affect both personal and situational settings, including a constructive instinctive reaction to frustration, an affect prompted by negative stimuli, noticeable social learning, as well as different reinforcements.

Positive mental health

The term "positive mental health" was first coined by Marie Jahoda, who characterized it as "a less permanent function of personality and the social situation" or "an enduring personality characteristic" [34]. Being positive and mentally well is a lot more than not having psychopathology, a lack of mental wellness, or mental health circumstances such as anxiety or depression; it also means getting a feeling of purpose, being able to maintain relationships, being content, and substantially engaging with life. A crucial component of mental wellness involves maintaining a positive mental state. Positive characteristics like satisfaction, a sense of purpose, maintaining significant relationships, and enjoying life to the fullest are essential elements of mental health. The World Health Organization (2022) defines positive mental health, additionally referred to as good mental health, as a state of wellbeing where people are able to reach their individual potential, work effectively, overcome everyday challenges, and beneficially impact the community [35]. Sapranaviciute et al., (2022) described well-being as a person's psychological state or assessment of satisfaction and pleasure with their own lifestyles [36]. Psychological well-being encourages people to continue pursuing advantageous behaviors for both themselves and other members of the community [37]. Focusing on the "Mental Health (2013–2020)" action strategy, the World Health Organization (WHO) has characterized positive mental health as an aspect of emotional and psychological well-being that enables an individual to become creative by realizing their potential and addressing their own requirements [35]. Psychological well-being is referred to essentially by Patnaik, (2021) as including matters such as happiness, trustworthiness, the ability to control needs or requirements, fulfilment with the resources at hand, being in good physical or mental health, and overall life satisfaction [38]. The ability to form beneficial connections with other people, environmental mastery, autonomy, self-acceptance, and personal advancement are the six elements of psychological well-being defined by Hossen & Salleh, (2024) [39]. This definition expanded the idea of mental health beyond merely the absence of psychological disorders and comprised the existence of positive characteristics, contributing to significant improvements in the field's research and application. They observed that those who practiced had a great deal of consensus. Along with how you feel about yourself, mental and psychological well-being additionally involves how you manage external factors and the quality of your relationships. It's essential to keep in mind that experiencing good mental health encompasses more than just preventing mental health conditions like anxiety or sadness. Maintaining care for our mental health may help in the prevention or treatment of psychological disorders that are occasionally associated with over-time illnesses of the body. Subjective mental health, or psychological well-being, can be affected by a variety of multidimensional variables that encompass mental, emotional, and cognitive aspects, as documented by Nicolini et al., (2021) [40].

According to a study conducted by Tekin et al., (2021), individuals who lack empathy have little interest in prosocial behavior such as altruism and have few chances to engage in altruistic activities such as sharing, helping, donating, and successfully taking care of others [41]. Women are more likely than men to participate in prosocial behaviors, or helping others, in accordance with Kamas & Preston, (2021) experimental findings [42]. In accordance with Singh and Teoh (2014), there is a strong, positive, and significant association between altruistic behavior and the mental health of teenage senior secondary students [43]. According to Feng et al. (2020) and Sparrow et al., (2021), there is a beneficial relationship between mental health concerns and altruism [44,45]. As stated by Fullen et al., (2022), helping provider’s mental health is more affected by their helping acts compared to that of help beneficiaries [46]. Prosocial behavior, such as charitable giving and helping others, is an excellent gauge of mental health, as shown by Hirani et al., 2022 [47]. In the opinion of Aknin et al. (2015), contributing to others has some pleasurable consequences and makes the donors feel good [48]. Beneficial behaviors and kind feelings have a strong connection with our health (mental and physical), well-being, and life span [49]. People who are physically or mentally stressed by the demands of others and who have expertise in significant negative health outcomes, such as dementia, are the ones who are physically or mentally overwhelmed [50,51]. According to Marks et al., (2024), many different kinds of human behaviors and feelings are being studied in a conventional approach in an effort to encourage health and prevent disease [52]. Altruism, or selfish affection, is essential for mental, moral, and physical health, as stated by Kaufman & Jauk (2020) [53]. In accordance with more recent studies, volunteering is positively correlated with mental health [54,55]; additional positive correlations consist of blood donation [56], providing money or wealth to charity [57], and deeper life spans in elderly people [58]. Males are significantly more likely than girls to act aggressively [59,60]. Men seemed to score higher on items related to verbal and physical aggression, as opposed to the marginally stronger gender differences for anger and hostility [61,62]. Additional studies revealed that girls exhibited noticeably more aggression than boys [60,63].

The objectives of this research are to shed light on the complex connections present in various social contexts between prosocial behavior, aggression, and positive mental health. By analyzing the relationships among prosocial behavior, aggression, and positive mental health, the research attempts to discover specific variations influenced by age groups, gender, and type of location. By investigating the possible moderating impact of gender, residency, and age on the complex relationships between these behavioral traits and positive mental health, the research employs an in-depth strategy. The study aims to provide insights through this extensive investigation that can assist in establishing social policies, promoting targeted interventions, and driving mental health promotion activities that are tailored to address the specific needs of people across numerous demographic dimensions. In the end, the findings of this study offer the potential to generate significant improvements to the overall advancement of mental health in a wide range of circumstances.

Participants

A total of 405 participants were in the investigation's sample. Participants had been selected from several Bangladeshi cities, including Bogura, Sirajganj, Naogaon, and Chapainawabganj (see details in Figure 1). Their age ranged from 30 to 75 years (215 men, 190 women; M age=48, SD=11.61). A multi-stage random sampling approach was employed in this study for selecting study participants.

Instruments

Prosocial tendencies measure: The prosocial tendencies measure (PTM) is a multifaceted scale that includes 23 items [64,65]. It can be classified through 6 subscales: public (4 items, Cronbach's α = 0.78), anonymous (5 items, Cronbach's α = 0:85), dire (3 items, Cronbach's α = 0:63), emotional (4 items, Cronbach's α = 0:75), compliant (2 items, Cronbach's α = 0:80), and altruism (5 items, Cronbach's α = 0:74). On a 5-point scale ranging from 1 (does not describe me at all) to 5 (describes me greatly), participants were tasked with assessing how much the statements represented them. For the sole purpose of this study, the PTM was adapted into Bengali, and its validity and reliability were evaluated.

Brief aggression questionnaire: This is a simplified and altered version of the 29-item Aggression Questionnaire [66]. The original BAQ featured four subscales: physical aggression, verbal aggression, anger, and hostility, each containing three items. The BAQ currently includes twelve items. The only item with an opposite score is the number seven. There are five ratings on the response scale: 1 being very unusual of me and 5 being extremely characteristic of me. The Bangla version of the BAQ was employed in the current research [67]. Bangla version of the Brief Aggression Questionnaire also used many previous research in Bangladesh [68].

Positive mental health scale: A quick and easy single-dimensional instrument for analyzing mental health is the positive mental health scale (PMH). There is a total of nine Likert-type items on the scale. On a Likert scale, the PMH will range from 1 (not true) to 4 (true). A higher number implies the presence of greater mental health. The total score appears to range from 9 to 36. One-dimensionality, numerical consistency across samples and over time, great internal coherence, good retest reliability, good discriminate and convergent validity, and sensitivity to modification in treatment had all been demonstrated by the scale's investigators. Additionally, it appears that the PMH-Scale can, in actuality, measure a single concept and facilitate cross-group and cross-temporal score evaluations. Consequently, the PMH scale is a brief and simple to understand instrument for assessing PMH across an array of relevant groups. In addition, the PMH was adapted into Bangla, and its initial psychometric characteristics have been studied [69]. The International Test Commission's (ITC, 2017) guidelines were adhered to in the translation and adaptation procedures.

Procedure

The input from the respondents in the present investigation was gathered using randomized data collection procedures. First, a rapport was developed, and the objective of the research was made clear to the respondents. The previously mentioned devices were subsequently distributed to each respondent. They were given assurances about the privacy of their responses. Instructions were provided to the respondents to make sure they read the questionnaire items carefully and responded honestly. Additionally, they were told that there was neither a right nor incorrect answer to any of the questionnaire questions, which encouraged them to respond to all of the questions thoroughly. They provided explanations for any queries they may have had about how to respond to the questions or about the instructions. The respondents were directed to finish the work without wasting any of their time, despite the fact that there was no set time limitation. The task took an average of thirty minutes to accomplish. They were thanked for their genuine participation after completing the work.

Statistical analysis

The descriptive test, parametric analysis (t-test if the data normality was passed), and non-parametric analysis (u- test if the data normality was not passed) were among the statistical methods used for analyzing the data. For the purpose of enhancing the quality of our findings and providing a more accurate evaluation of the connections and dependencies among the collected data, correlation analysis has been applied in this study. GraphPad 8.0.1 was employed to interpret the data, providing a reliable and accurate statistical assessment of the findings of the study.

A comprehensive analysis of descriptive statistics uncovers differences between verbal aggression and hostility, which fall into distinct groups based on gender (see details in Table 1). A detailed review of descriptive qualities according to residence indicates significant differences between seven separate groups: dire, anonymous, compliant, emotional, physical, verbal, and positive mental health (details in Table 2). An in-depth review of age based descriptive attributes showed distinctions among two main categories: positive mental health and anonymous (see Table 3 for more details).

With the exception of verbal and physical aggression, Table 4 demonstrates an overall connection between prosocial behavior and aggression affecting positive mental health. A convoluted interaction between these factors appears in the extremely significant values exhibited by all the elements. Table 5 highlights the gender-based relationship between aggression, prosocial behavior, and positive mental health. Despite the exception of verbal and physical aggression for both males and females, all variables revealed significant variations, hinting at distinct patterns in the gender-based connection between these variables. The residence-based correlation between aggression, prosocial behavior, and positive mental health is shown in Table 6. It's interesting to note that the data shows no significant correlation between positive mental health and emotional prosocial behavior in rural areas and physical aggression, verbal aggression, and hostility in metropolitan areas and anger for both resident areas. But when these particular factors are excluded from the analysis, prosocial behavior, aggression, and positive mental health are consistently and significantly correlated in all residence-based interactions. The age-based relationships between aggression, prosocial behavior, and positive mental health are presented in Table 7. Additionally, the results show that there is no significant link between positive mental health and other characteristics, such as physical aggression in all age groups, hostility in age groups 2 and 3, anger in age group 3, and verbal aggression in all age groups. However, when these particular factors are removed from the research, a significant and consistent relationship between prosocial behaviour, aggression, and positive mental health remains applicable to all age groups.

This research conducts a thorough exploration of the intricate relationships among gender, residency, and age, revealing how prosocial behavior and aggression collectively influence positive mental health. The disparities between verbal aggression and hostility, discerned through gender-based descriptive features. Table 1 establish a foundational understanding of the distinct behavioral patterns exhibited by different genders, where men showed higher verbal aggression and hostility than women. The finding that men exhibit higher levels of verbal aggression and hostility compared to women may be attributed to a combination of biological, social, and cultural factors also support existing literature [70]. From a biological standpoint, some research suggests that hormonal differences, particularly higher levels of testosterone in men, may contribute to increased aggression.

However, it is essential to acknowledge that the role of biology is complex and interacts with various environmental influences. Socially, traditional gender norms and expectations may shape behavior, with societal perceptions often associating assertiveness and dominance with masculinity. Additionally, cultural factors, such as the normalization of certain communication styles, can play a role in shaping how individuals express themselves verbally. It is crucial to interpret these findings with caution, recognizing the diversity within each gender and the potential influence of contextual factors. Further research and a nuanced understanding of the complexities surrounding gender differences in communication are necessary to draw more comprehensive conclusions. Boys are much more prone than girls to engage in aggressive behavior [59,60]. Another investigation indicated that the quantity of explicit verbal aggression used by both genders is identical [71]. As opposed to the slight strength of the gender differences for anger and hostility, men appeared to score higher on items associated with verbal and physical aggression [62]. Other research showed that, compared to boys, girls displayed significantly greater hostility [60,63].

In this Bangladeshi social and environmental context, it might offer an explanation for this discovery. Bangladesh has been reported to be an economically developing country. Similarly, to the way boys do it, girls are now actively participating in improving and developing their careers through higher education. Girls are consequently starting to develop a sense of self-respect and autonomy. When competing against their opponent, the girls face multiple challenges. Therefore, it is feasible that the females use aggression as a form of protest behavior against inequity and sloppy treatment. Prosocial behavior was substantially predicted by gender, with women demonstrating more prosocial behavior compared to males [24]. Another conclusion reinforced conclusions from previous studies investigating prosocial behavior in practice, which revealed that men are more likely to help others when there is a crowd present [72]. There are no significant gender variations in prosocial behaviors, as reported by Gregori et al., (2025) [18]. Adolescent boys expressed having a greater tendency than did adolescent girls to engage in gatherings of prosocial behavior, as opposed to these gender disparities [17,18]. Adolescent girls were able to report more submissive and prosocial behaviors than did adolescent boys [17,18]. This ought to come as no surprise considering that men and women have had different social roles for a great deal of the history of humanity and that different behaviors are anticipated of them based on their social context in nearly every society on the planet [73].When there is a context that subjects can associate with the appropriate social setting, we are likely to identify comparable variations in the laboratory if men and women follow specific standards for behavior in different social contexts [74]. Another study discovered that patients with schizophrenia-related illnesses varied by gender in their PMH total and domain scores, with women performing higher than males [75]. However, as we apply the PMH scale to people who are healthy and there are no further investigations on PMH, our research is not directly relevant to the previous findings. Initially, the majority of research has been on young people; this study is the first one of its organizations that aim at adults.

The residency-based descriptive characteristics (Table 2) shed light on positive differences within diverse groups, encompassing dire, anonymous, compliant, emotional, physical, verbal, and positive mental health categories. This thorough exploration provides a nuanced perspective on how varied residential environments can influence and mould expressions of aggression, prosocial behavior, and PMH. This study stands as a trailblazing investigation, being the first to delve into the relationships between prosocial behavior, aggression, and positive mental health based on residence, thereby filling a notable gap in prior research. This is the first finding that provides insight into potential future directions, as no prior results have been found in relation to residence for prosocial behavior. According to research by Rhoads et al., (2021), there is no statistically significant difference in respondent's levels of hostility between those who reside in rural as well as urban areas [76]. This study is the initial attempt to look into the connection between residential settings and positive mental health; no other research has been done in this specific field previously. The investigation, which is the first of its sort, provides a framework to conduct additional research and provides guidance for future studies with the goal of understanding the relationship between mental health and residence.

Considering age-based descriptive characteristics (Table 3), this investigation finds significant variations, especially in the anonymous and positive mental health categories. The findings emphasize the importance of age as a crucial factor regulating the dynamics of prosocial and aggressive behavior. Despite previous studies that mostly relied on single-scale categories, this study constitutes a breakthrough effort as the first to fully investigate the combined impact of prosocial behavior, aggressiveness, and positive mental health across age groups. Our approach is unique, and we ensure that the findings we obtain are unique and relevant in relation to previous research. The greatest amounts of prosocial behavior were demonstrated by older participants, intermediate levels by middle-aged participants, and the lowest levels by young participants [77,78]. Another study discovered that as individuals aged, their prosocial behavior increased [79]. Investigators observed that the stability of aggression decreases as measurement times remain longer [80,81] and improves with increasing age [60]. A further investigation concluded that both men and women's aggressive behavior stayed stable from childhood to middle life [82]. There have not been any previous investigations into the connection between age and positive mental health (PMH). This study is the first of its kind in this field, establishing a foundation for future investigators to look into previously unexplored aspects and advance our knowledge of the relationship between positive mental health and age.

With the exception of verbal and physical aggression, the analysis that follows in Table 4 shows a general connection between prosocial behavior, aggressiveness, and positive mental health. The extremely important results for each of the elements indicate an intricate connection, demonstrating how complex these relationships are. Evaluating the gender-based correlation in Table 5 in more detail reveals significant disparities across variables, indicating the complex influence of gender on the relationship between prosocial behavior, aggressiveness, and positive mental health.

In a comparable way, the residence-based relationship (Table 6) and age-based relationship (Table 7) highlight the complex nature of these relationships in particular contexts and provide significant insights into the manner in which environmental and developmental factors influence psychological health in general. This comprehensive study not only improves our understanding of the connections between these factors, but it also provides possibilities for specific interventions and focused approaches that promote positive mental health in a broad range of demographic circumstances.

This study aimed to examine the relationships between aggressive behavior, prosocial behavior, and mental health. The findings supported the hypothesis: prosocial behavior was positively correlated with mental health, while aggression showed a negative association. These results confirm that behavioral tendencies significantly influence psychological well-being. However, variations across gender, age, and geographic location suggest that these relationships are not uniform and may limit the generalizability of the findings. The findings provide administrators and policymakers with helpful recommendations that will impact the development of welcoming educational settings and comprehensive laws intended for improving community mental health Future studies should explore these variables further to enhance contextual understanding.

The ethical approval was obtained from the Ethical Review Committee-Research and Publication (ERCRP), Department of Psychology, University of Rajshahi, Rajshahi-6205, Bangladesh [approval code: ERCRP-PSYRU-7(12)24; Date: October 17, 2024]. The researchers completely declare that all methods carried out in studies involving human participants were in accordance with institutional and national ethical guidelines as well as the Helsinki Declaration (1979). The researchers have an intense commitment to research ethics.

Informed consent was obtained from all participants prior to their inclusion in the study. Participants were informed of their rights to confidentiality, voluntary participation, and the ability to withdraw from the study at any time without any consequences.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

The authors declare that they have no conflicting interests.

There was no grant, technical or corporate support for this study.

The authors thank all study participants and special thanks go to the data collectors who were involved in this study.

Conceptualization: Md. Muzahid Islam; Methodology: Md. Muzahid Islam, Afshana Mimi, Masom Mia; Formal analysis and investigation: Md. Muzahid Islam, Afshana Mimi, Murshida Khatun, Masom Mia, Palash Kumar Sarker; Writing - original draft preparation: Md. Muzahid Islam, Afshana Mimi, Masom Mia, Md. Nazmul Haque, Palash Kumar Sarker; Writing - review and editing: Md. Muzahid Islam, Masom Mia, Md. Nazmul Haque, Murshida Khatun, Palash Kumar Sarker.