Awareness about Stroke and Proper Actions to Be Taken; A room for Improvement

Public Awareness and Attitude Towards Stroke in the Southern Region of Saudi Arabia: A Cross-Sectional Study

Introduction Stroke is a leading cause of morbidity and mortality globally. Recognizing risk factors, identifying warning signs, and seeking timely medical intervention are crucial for preventing stroke and improving outcomes. This study aims to assess stroke awareness and attitudes among residents in southern Saudi Arabia and determine predictors of stroke knowledge. Methods A cross-sectional study was conducted among residents aged ≥18 years in the southern region of Saudi Arabia excluding individuals with a history of stroke and healthcare workers. A sample size of 576 participants was calculated. Data were collected conveniently via a self-administered online Arabic questionnaire that was adopted from the literature. The questionnaire assessed demographic characteristics, stroke knowledge, attitudes, and symptom responses. Data analysis was performed using multiple linear regression to identify predictors of awareness of stroke. Results A total of 510 participants (median age: 29 years, interquartile range: 24, 40) were included, with 288 (56%) being male. Stroke was identified as a brain disease by 287 (56%), and 371 (73%) recognized its preventability. Awareness of stroke symptoms ranged from 332 (65%) for sudden dizziness to 399 (78%) for speech difficulties. The most recognized risk factors were hypertension (443, 87%), smoking (395, 77%), and diabetes mellitus (342, 67%). Better general awareness was associated with being married (β: 0.34, 95% CI: 0.07-0.61), divorced (β: 0.34, 95% CI: 0.07-0.61), or having a family history of stroke (β: 0.46, 95% CI: 0.22-0.70). Higher symptom awareness was linked to a family history of stroke (β: 0.92, 95% CI: 0.38-1.50) and earning 3000-10,000 RAS (β: 0.82, 95% CI: 0.11-1.50). For risk factor awareness, family history of stroke (β: 0.96, 95% CI: 0.32-1.60) and earning 3000-10,000 RAS (β: 0.96, 95% CI: 0.12-1.80) were significant predictors. Awareness of stroke's consequence was higher among older participants (β: 0.02, 95% CI: 0.00-0.04) and those with a family history of stroke (β: 0.45, 95% CI: 0.09-0.81), while males (β: -0.32, 95% CI: -0.61 to -0.03) had lower scores. Conclusion The study highlights significant gaps in stroke awareness, particularly in recognizing symptoms with moderate overall knowledge of stroke risk factors. Targeted educational campaigns and community outreach programs for at-risk populations are essential to improving stroke awareness and ensuring timely medical intervention.

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 levels of stroke among hypertensive and diabetic patients in a tertiary hospital

BACKGROUND

Strokes represent a major global health challenge, as they now affect up to 15 million people annually, with increasing mortality rates accompanying growing prevalence. In Saudi Arabia, hypertension (HTN) and diabetes mellitus (DM) have been identified as major contributors to stroke risk, with a combination of HTN and DM significantly magnifying the risk of strokes. While there have been global improvements in stroke prevention, recently knowledge levels vary significantly worldwide, and multiple studies in Saudi Arabia show inconsistent awareness levels.

OBJECTIVES

This study seeks to develop insights for the development of tailored prevention programs that align with Saudi Vision 2030 in terms of enhancing quality of life. Thus, the aim of the study is to assess knowledge levels of stroke risk factors, warning signs, symptoms, and prevention methods among high-risk groups (HTN and DM patients) at King Saud University Medical City (KSUMC).

METHODS

This was an analytical cross-sectional study conducted among 422 participants from June 2022 to January 2023, using a validated Arabic questionnaire taken, with permission, from previous studies. All HTN and T2DM patients in the waiting areas of the outpatient clinics at KSUMC, Riyadh were included as part of the random sampling, though patients below 20-years-old and those with other endocrine disorders were then excluded.

RESULTS

The majority of participants were male (64.5 %). The analysis showed that 66.1 % of participants had "poor total knowledge" of stroke factors. Half of the participants (50.5 %) had "poor knowledge" about stroke risk factors, though the most commonly identified risk factor was "hypertension". Additionally, the findings showed that 46.4 % of participants had "poor knowledge" of stroke warning signs and symptoms, with the most commonly identified warning sign being "difficulty in speaking." Nearly half of participants (46.4 %) had "good knowledge" of stroke prevention methods; however, "regular exercise" was the most commonly identified prevention method.

CONCLUSION

Although the participants displayed decent knowledge of stroke prevention methods, several notable deficits in overall knowledge of stroke factors emerged. In particular, knowledge of stroke risk factors and warning signs and symptoms among participants was inadequate. This implies that healthcare providers should seek to launch campaigns addressing stroke knowledge mainly among high-risk groups, potentially distributing brochures about stroke knowledge in the relevant clinics and seeking to provide a range of educational content by means of social media.

Stroke Knowledge and Response Among the General Population in Saudi Arabia: A Population-Based Survey

INTRODUCTION

Stroke, a condition that disrupts brain function and can result in long-lasting clinical symptoms or death, remains a substantial global health concern. General awareness of stroke leads to a proper response to stroke, pursuit of medical treatment, and a better outcome. Our study aims to explore how the general Saudi Arabian population responds to stroke, investigate the relationship between stroke knowledge and appropriate actions, and identify the most relied upon medical information source about stroke among the public. By highlighting these aspects, we aspire to contribute to the development of effective stroke prevention and management strategies in Saudi Arabia.

METHODOLOGY

This descriptive, cross-sectional, web-based study was carried out across multiple regions in Saudi Arabia. Data collection involved a validated online questionnaire (STAT) in Arabic, targeting adults aged 18 and older. Data analysis was performed using SPSS software.

RESULTS

The study included 390 participants. Notable findings emerged regarding the recognition of stroke symptoms and the factors influencing this recognition. A substantial proportion of respondents correctly identified visual disturbances (55.9%), motor impairment (39.5%), cardiac symptoms (56.2%), sensory symptoms (32.8%), chest pain (62.6%), and arm weakness (36.7%) as indicators requiring immediate medical attention. However, there were lower correct response rates for symptoms such as sudden dizziness (22.8%), confusion (16.9%), difficulty understanding (27.9%), and urinary symptoms (26.9%). Older individuals and retirees generally scored higher in correctly identifying these symptoms.

CONCLUSION

Our study highlights a commendable level of awareness of certain stroke symptoms, such as visual disturbances and chest pain, among the general population of Saudi Arabia. Nonetheless, notable gaps remain in recognizing other symptoms, such as sudden dizziness and confusion. This identification gap presents a clear opportunity for targeted educational initiatives that are essential to improving public recognition of these symptoms. By addressing these gaps, we aim to enhance the response to stroke incidents, potentially improving outcomes and reducing morbidity rates.

Canadian Stroke Best Practice Recommendations: Acute Stroke Management, 7th Edition Practice Guidelines Update, 2022

The 2022 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management, 7th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by an interdisciplinary team of healthcare providers and system planners caring for persons with an acute stroke or transient ischemic attack. These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments, and management strategies, proven to reduce mortality and morbidity. The topics covered include prehospital care, emergency department care, intravenous thrombolysis and endovascular thrombectomy (EVT), prevention and management of inhospital complications, vascular risk factor reduction, early rehabilitation, and end-of-life care. These recommendations pertain primarily to an acute ischemic vascular event. Notable changes in the 7th edition include recommendations pertaining the use of tenecteplase, thrombolysis as a bridging therapy prior to mechanical thrombectomy, dual antiplatelet therapy for stroke prevention, the management of symptomatic intracerebral hemorrhage following thrombolysis, acute stroke imaging, care of patients undergoing EVT, medical assistance in dying, and virtual stroke care. An explicit effort was made to address sex and gender differences wherever possible. The theme of the 7th edition of the CSBPR is building connections to optimize individual outcomes, recognizing that many people who present with acute stroke often also have multiple comorbid conditions, are medically more complex, and require a coordinated interdisciplinary approach for optimal recovery. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca.

Analysis of the Factors Intervening in the Prehospital Time in a Stroke Code

INTRODUCTION

Strokes continue to be considered public health problems due to the great social and health impact they entail. They are the second cause of death in the world, with a high incidence and prevalence. They are time-dependent diseases, and more than 80% of cases could be avoidable with greater management of risk factors.

OBJECTIVE

to analyze the factors that influence prehospital time in a stroke code. Assess the population's knowledge of stroke symptoms and teach them how to act when a case is suspected. Document the continued training of health professionals for the early identification of patients with a suspected stroke. Demonstrate the importance of calling EMS as the first contact to reduce delays in prehospital time in a stroke.

METHODOLOGY

A bibliographic review was carried out focusing on articles published between December 2014 and August 2023. The following databases were consulted: Pubmed (Medline), Dialnet, Google Scholar, Web of Science (WOS), Scielo, Scopus, and ScienceDirect.

RESULTS

After applying the article selection criteria and evaluating the quality of the methodology, a total of 18 articles were obtained. The results affirm that the importance of achieving a reduction in prehospital time is based mainly on knowledge of the symptoms and the use of new technologies.

CONCLUSIONS

The evidence supports that the prehospital time of action in the stroke code is affected by numerous factors. These factors are determining factors in the time of action to achieve good effectiveness in the treatment of the pathology.

Gap between recognition and response to stroke scenarios among Saudi population: Cross-sectional survey study

OBJECTIVES

Recognition of stroke symptoms and emergency medical services (EMS) calls have a significant impact on patient management and outcome after acute strokes. The objective of this study is to assess the presence of a gap in the Saudi population between the recognition of stroke symptoms and the appropriate response to call EMS.

MATERIALS AND METHODS

This questionnaire-based, cross-sectional survey study was conducted among the Saudi population with 563 total participants. The data were collected using a self-administered, web-based questionnaire. It was distributed randomly via social media platforms and emails to the general population of Saudi Arabia (SA). A series of 12 vignettes of stroke scenarios and four non-stroke scenarios was adapted from validated instruments.

RESULTS

Our study revealed that 8% (n = 533) of the responses were appropriately recognized and resulted in calls to EMS while 38% (n = 2,639) did not respond by calling EMS despite their correct recognition. However, 9% (n = 608) chose to call EMS regardless of their incorrect recognition of the stroke scenario, and the plurality, 45% (n = 3,096), did not recognize the stroke scenario or respond by calling EMS. Furthermore, we found a statistically significant association among appropriate response, recognition, and self-efficacy.

CONCLUSIONS

A recognition-response gap has been found among the Saudi population. Future campaigns should focus on the identification of common stroke symptoms and reinforce the importance of calling the EMS to apply the knowledge appropriately. Consequently, such actions could decrease mortality and chronic disability among stroke patients.

Awareness of stroke among patients with chronic kidney disease on hemodialysis: a cross-sectional study

BACKGROUND

Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke.

OBJECTIVE

To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis.

DESIGN AND SETTING

Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil.

METHODS

A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression.

RESULTS

A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke.

CONCLUSIONS

Patients on hemodialysis, especially women and older people, have little knowledge about stroke.

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research

OBJECTIVES

to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo.

METHODS

this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation.

RESULTS

qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke.

FINAL CONSIDERATIONS

the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

Level of awareness regarding stroke among Riyadh population

BACKGROUND

Stroke is known to be the second leading cause of death and persistent disability worldwide, with 5.5 million deaths each year. Public knowledge regarding risk factors, signs and symptoms and the prevention of stroke is an important factor in reducing the incidence of stroke.

OBJECTIVE

This study aimed to determine the level of awareness regarding stroke in Riyadh, Saudi Arabia.

METHODS

This study recruited 150 participants from primary health care (PHC) centres, based on the methodology of a similar cross-sectional study conducted in Riyadh. The study group included adult male and female PHC visitors and excluded visitors with mental illness and medical personnel. Systematic random sampling was used to select participants. Data were collected using a self-administered questionnaire and analysed using SPSS. Microsoft Excel was used to generate tables and charts. Consent was obtained before data collection, with emphasis on each participant's right to withdraw from the study at any time.

RESULT

A total of 150 respondents were included in this study. We found that the majority of the participants had a high level of awareness regarding the risk factors of stroke (n = 115, 76.66%). More than half of the participants (n = 95, 63.3%) had a moderate level of awareness of the signs and symptoms of stroke. The study also revealed that there was no statistically significant relationship between education level and level of awareness regarding risk factors of stroke (p = 0.334).

CONCLUSION

This study found that the majority of participants had a high level of awareness regarding stroke. Regarding the education level of the participants, we found that the majority of participants with primary school-level education had a high level of awareness regarding stroke risk factors. Furthermore, we found that the level of awareness about prevention of stroke was moderate among participants. Thus, further studies should explore how to improve levels of awareness regarding the prevention of stroke.