Stroke awareness and knowledge in an urban New Zealand population

Assessing the gaps in cardiovascular disease risk assessment and management in primary care for Māori and Pacific peoples in Aotearoa New Zealand- a systematic review

Background

Māori and Pacific peoples carry the highest burden of cardiovascular disease in New Zealand (NZ). This systematic review aimed to determine access to evidence-based cardiovascular disease risk assessment (CVDRA) and management in primary care for Māori and Pacific peoples compared with other ethnicities in NZ, as well as factors contributing to reduced access.

Methods

In this systematic review with a narrative synthesis, keywords related to Māori and Pacific peoples, cardiovascular disease, and primary care were used to search MEDLINE (OVID), EMBASE, Scopus, CINAHL, NZresearch.org, National Library Catalogue (Te Puna), Index New Zealand (INNZ), and Australia/New Zealand Reference Centre, grey literature and hand search sources from 1 January 2000 to 31 December 2024. Two reviewers screened texts and three reviewers extracted data and assessed quality. High quality was defined using Western (Mixed Methods Appraisal Tool, MMAT, ≥80% compliance) and Indigenous (CONSolIDated critERtia for strengthening the reporting of health research involving Indigenous Peoples, CONSIDER) research tools. The protocol for this systematic review was registered at: https://doi.org/10.17605/OSF.IO/VUDE9.

Findings

A total of 2765 texts were identified of which 69 were included. This review identified inadequate levels of CVDRA in Māori and Pacific peoples when measured against the 90% national target. While the provision of primary prevention medications was higher (antihypertensives) or similar (lipid-lowering) compared to that for other ethnic groups, adherence was lower for Māori and Pacific peoples compared to other groups. Māori and Pacific peoples were less likely than others to receive antiplatelets and lipid-lowering therapy for secondary prevention. Evidence for antihypertensives in secondary prevention and combination therapy (in primary or secondary prevention) was mixed. Māori and Pacific peoples experienced reduced access to revascularisation compared with other ethnic groups, an inequity that persisted over time. Factors contributing to CVDRA and management were provision of adequate health literacy, relationships with providers and whānau, access to care, and cultural safety. While 64% of studies were ≥80% compliant with the MMAT, suggesting high quality from a Western research perspective, 71% of studies had an adapted CONSIDER score ≤2, suggesting low quality from an Indigenous perspective. The CONSIDER domains with the highest levels of reporting were Prioritisation, and Analysis and interpretation, while Capacity and Dissemination were the least reported domains. Qualitative studies had generally higher levels of CONSIDER reporting than mixed methods and quantitative studies. Kaupapa Māori Research was of the highest quality, followed by studies focused on Māori and/or Pacific peoples, while studies not focused on Māori and/or Pacific peoples had the lowest levels of CONSIDER reporting.

Interpretation

Extensive and inequitable gaps in CVDRA and management for Māori and Pacific peoples were identified. Opportunities for reducing these gaps include providing adequate CVD literacy, involvement of whanāu, patient-provider relationships, access to care, and enhancing cultural safety. Our findings will contribute to the development of a cardiovascular care equity roadmap in NZ. There are opportunities to improve reporting against the adapted CONSIDER criteria, which involves critical inquiry and a strength-based approach inclusive of Māori and Pacific values, particularly in quantitative research and research including but not focusing on Māori and Pacific peoples.

Funding

The Heart Foundation of New Zealand and Healthier Lives National Science Challenge, grant number 1819.

Factors Associated With Delayed Hospital Arrival After Stroke Onset: An Observational Study in Thanh Hoa Province, Vietnam

BACKGROUND

Delayed hospital arrival lowers the proportion of patients with stroke receiving recanalization therapy and results in poor outcomes. This study investigated the factors associated with pre-hospital delays in hospital arrival after stroke onset in the Thanh Hoa Province, Vietnam.

METHODS

Clinical data were collected from stroke patients within seven days of symptom onset who were prospectively registered in this study. Patients and their relatives were interviewed using a structured questionnaire about patient social demographics, address, post-stroke support actions, and stroke awareness. Pre-hospital delay in hospital arrival was dichotomized into ≤ 4.5 hours and > 4.5 hours, and multivariable logistic regression analysis was used to investigate factors associated with the delay.

RESULT

Of the 328 participants analyzed, 181 (55.4%) arrived at the hospital 4.5 hours after the symptom onset. The patients' and relatives' awareness of stroke was poor, with 298 (91.4%) who had never heard about signs of stroke onset, facial drooping, arm weakness, speech difficulties, and time to call emergency service (FAST). Pre-hospital delays were longer for patients living >10 km away from a healthcare facility and those with secondary or lower education levels, with odds ratios of 2.07 and 1.99, respectively. Seeking care at a district or private hospital as the first point of healthcare or non-use of emergency medical services did not show significant associations with odds ratio and 95% CI of 1.57 (0.93-2.65).

DISCUSSION

The study revealed that most patients with stroke did not arrive at the hospital in time for recanalization therapy. Moreover, the low stroke awareness among patients and their relatives is concerning. Further research is needed to investigate the reasons for pre-hospital delays and develop targeted interventions to improve stroke awareness and reduce these delays.

Knowledge and awareness of stroke and associated factors in the Saudi general population: a cross-sectional study

Introduction

Stroke is a major cause of death and disability globally and in Saudi Arabia as well. Prevention and management of stroke depend highly on raising knowledge and awareness about the disease.

Purpose

The purpose of this study was to evaluate Saudi adult's knowledge and awareness about stroke and determine the associated factors.

Materials and methods

A cross-sectional online survey was conducted in May-July 2022 among Saudi citizens. Assessments of stroke knowledge about risk factors, symptoms, and response to stroke symptoms were evaluated. Logistic regression was conducted to assess the association between the socio-demographic characteristics and knowledge.

Results

A total of 389 participants were enrolled with the majority (81.7%) being male participants. Less than half of the study subjects (43.3%) identified four out of five correct answers related to general knowledge about stroke. Almost all the participants were able to identify at least one risk factor associated with stroke. The majority of the participants (81.2%) believed that physical inactivity was the most common risk factor associated with stroke. Approximately three-quarters of participants considered difficulty speaking and understanding speech, followed by the sudden loss of consciousness as the most common stroke manifestation. Participants with a history of hypertension, dyslipidemia, and obesity had significantly higher odds of identifying at least one early stroke symptom (OR 2.271 [95% CI 1.402 3.677], 2.059 [95% CI 1.273 3.328], and 2.665 [95% CI 1.431 4.963], respectively).

Conclusion

Our study revealed that participants have good knowledge about stroke. Nonetheless, further efforts are required to raise awareness and educate the public to optimize and ensure better treatment outcomes.

Tino rangatiratanga - a rural Māori community's response to stroke: 'I'm an invalid but I'm not invalid'

This article presents a community-led kaupapa Māori research project involving Whakatōhea and neighbouring rohe (areas). This project arose from a moemoeā (dream or vision) of Tawhai, a stroke survivor who wanted to help fellow stroke survivors. We began with a survey of stroke survivors, community members and service providers in Ōpōtiki and surrounding areas, investigating community knowledge of stroke, barriers and facilitators to recovery, and the availability and appropriateness of health services for stroke survivors in the area. The ultimate aim was to facilitate Māori stroke survivors and whānau (family) to support recent stroke survivors, and find funding to allow sustainable employment of stroke survivors in this capacity. Survey results depicted an isolated community with very poor knowledge of stroke and little access to stroke services. However, they also revealed a community that is determined to look after their own, improve outcomes, and has the support of local health and social service providers. Community-based discussions on the survey results resulted in a vision for He Whare Oranga Tonutanga - a place where Māori stroke survivors and whānau could come to contribute what they can and take what they need. Māori stroke survivors could be employed to provide mentoring and run the centre.

A Multicentre Study Comparing Cerebrovascular Disease Profiles in Pacific Islander and Caucasian Populations Presenting with Stroke and Transient Ischaemic Attack

INTRODUCTION

In a multicentre study, we contrasted cerebrovascular disease profiles in Pacific Island (PI)-born patients (Indigenous Polynesian [IP] or Indo-Fijian [IF]) presenting with transient ischaemic attack (TIA), ischaemic stroke (IS) or intracerebral haemorrhage (ICH) with those of Caucasians (CSs).

METHODS

Using a retrospective case-control design, we compared PI-born patients with age- and gender-matched CS controls. Consecutive patients were admitted to 3 centres in South Western Sydney (July 2013-June 2020). Demographic and clinical data studied included vascular risk factors, stroke subtypes, and imaging characteristics.

RESULTS

There were 340 CS, 183 (27%) IP, and 157 (23%) IF patients; mean age 65 years; and 302 (44.4%) female. Of these, 587 and patients presented with TIA/IS and 93 (13.6%) had ICH. Both IP and IF patients were significantly more likely to present >24 h from symptom onset (odds ratios [ORs] vs. CS 1.87 and 2.23). IP patients more commonly had body mass indexes >30 (OR 1.94). Current smoking and excess alcohol intake were higher in CS. Hypertension, diabetes, and chronic kidney disease were significantly higher in both IP and IF groups in comparison to CS. IP patients had higher rates of AF and those with known AF were more commonly undertreated than both IF and CS patients (OR 2.24, p = 0.007). ICH was more common in IP patients (OR 2.32, p = 0.005), while more IF patients had intracranial arterial disease (OR 5.10, p < 0.001).

DISCUSSION/CONCLUSION

Distinct cerebrovascular disease profiles are identifiable in PI-born patients who present with TIA or stroke symptoms in Australia. These may be used in the future to direct targeted approaches to stroke prevention and care in culturally and linguistically diverse populations.

Effect of Community Education Program on Stroke Symptoms and Treatment on School and College Students from South India: A Longitudinal Observational Study

Community awareness regarding stroke signs, risk factors, and actions that help reduce the risk and complications of stroke is poorly addressed, as it is thought to be the best approach to control and prevent stroke. Aim: To establish the awareness of stroke and its management among high school and college students using an educational intervention. A questionnaire was administered to students from five high schools and four colleges with different areas of focus, (arts, science and commerce), types (public, semi-public and private), and economic locations before and after an educational lecture on stroke. The lecture covered the following elements: stroke definition, signs, risk factors, actions, time window for thrombolytic therapy, and types of rehabilitation interventions. This study included 1036 participants, of whom 36.3% were male and 56.4% were high school students, and the mean age was 17.15 ± 1.29 (15-22) years. Before the lecture, 147 participants were unaware of a single sign of stroke, and 124 did not know the risk factors. After the intervention, 439 participants knew four signs of stroke, and 196 knew 12 risk factors. Female students had better knowledge about stroke signs (odds ratio (OR), 3.08; 95% confidence interval (95% CI), 2.15-4.43). Hypertension (52.7%) and weakness (59.85%) were the most known signs and risk factors. The proportion of students who selected traditional medicine as the mode of treatment decreased from 34.75% to 8.59% after the lecture. Other rehabilitation methods (e.g., physical therapy, occupational therapy, speech therapy and counseling) were chosen by more than 80% of the students. The results of the current study showed that the awareness on stroke risk factors and management among the school and college students can be significantly improved with regular educational interventions, and therefore stroke can be prevented to some extent.

Community Knowledge and Awareness of Stroke in New Zealand

INTRODUCTION

Community knowledge and stroke awareness is crucial for primary prevention of stroke and timely access to stroke treatments including acute reperfusion therapies. We conducted a national telephone survey to quantify the level of community stroke awareness.

METHODS

A random sample of 400 adults in New Zealand (NZ), stratified by the 4 main ethnic groups, was surveyed. Eligible participants answered stroke awareness questions using both unprompted (open-ended) and prompted questions (using a list). Proportional odds logistic regression models were used to identify factors associated with stroke awareness.

RESULTS

Only 1.5% of participants named stroke as a major cause of death. The stroke signs and symptoms most frequently identified from a list were sudden speech difficulty (94%) and sudden 1-sided weakness (92%). Without prompting, 78% of participants correctly identified at least 1 risk factor, 62% identified at least 2, and 35% identified 3 or more. When prompted with the list, scores increased 10-fold compared with unprompted responses. Ethnic disparities were observed, with Pacific peoples having the lowest level of awareness among the 4 ethnic groups. Higher education level, higher income, and personal experience of stroke were predictive of greater awareness (P ≤ .05).

CONCLUSIONS

Stroke was not recognized as a major cause of death. Although identification of stroke risk factors was high with prompting, awareness was low without prompting, particularly among those with lower education and income. Nationwide, culturally tailored public awareness campaigns are necessary to improve knowledge of stroke risk factors, recognition of stroke in the community and appropriate actions to take in cases of suspected stroke.

A Scoping Review of Health Literacy Measurement Tools in the Context of Cardiovascular Health

Background. Despite the strong link between health literacy and cardiovascular health outcomes, health literacy measurements remain flawed and fragmented. There exists a gap in the knowledge when formulating a valid measurement to capture the broad concept of health literacy. The existence of various tools for health literacy measurement also hampers the availability of health literacy data. Additionally, little research is available on a valid measurement tool for cardiovascular health literacy. Objective. This study aims to provide an overview of the health literacy measurement tools used in the context of cardiovascular health. Method. A scoping review was conducted. Two electronic databases, Medline and Embase, were searched to identify studies that described a tool for the measurement of health literacy in the context of cardiovascular health. Results. After reviewing the available studies, 53 studies met the inclusion criteria. A total of 26 health literacy measurement tools were identified in the studies. Among the 26 tools, 16 used an objective measurement approach, 9 adopted a subjective approach, and 1 employed a mixed approach. Additionally, 28 studies used tools to measure print literacy, 15 studies measured print literacy and numeracy, and 5 studies measured print literacy, oral literacy, and numeracy. Conclusions. STOFHLA, TOFHLA, and REALM were the mostly commonly used tools in the selected studies. The majority of tools were based heavily on reading skills and word recognition. Researchers should focus on the development of more comprehensive and reliable health literacy measurement tool(s) specific to cardiovascular health to assist health care providers to more efficiently and accurately identify people with cardiovascular problems who have inadequate health literacy.

Heart Attack and Stroke Symptoms Knowledge of Native Hawaiians and Pacific Islanders in the United States: Findings From the National Health Interview Survey

Native Hawaiians and other Pacific Islanders (NHPI) suffer disproportionate rates of death from heart attack and stroke; however, little is known about NHPI heart attack and stroke symptoms knowledge. We used multivariable logistic regression to examine associations between heart attack and stroke symptoms knowledge and electronic health (eHealth) use, education, engaging in health risk behaviors, and having an at-risk diagnosis or a past heart attack and/or stroke. The analytic sample included 2,172 NHPI adults responding to the 2014 NHPI-National Health Interview Survey. NHPI reported moderate to high levels of heart attack and stroke symptoms knowledge. NHPI with an at-risk diagnosis were significantly more likely to know three of five heart attack symptoms. Engaging in health risk behaviors increased the odds of knowing one heart attack symptom. Neither a prior heart attack nor a prior stroke increased the likelihood of recognizing most symptoms of heart attack or stroke. eHealth use was associated with increased likelihood for knowing heart attack and stroke symptoms. The findings of this study can be used to inform interventions that support the Healthy People 2020 goals to increase the proportion of adults who are aware of the symptoms of heart attack and stroke and to reduce heart attack and stroke disparities.