Public Stroke Knowledge, Awareness, and Response to Acute Stroke in Isfahan Iran: What is Less or Misinterpreted in Developing Countries

Health literacy in stroke disease: A systematic review

BACKGROUND

Health literacy has been demonstrated to be a factor that influences patients' ability to retain clinical education and counselling.

AIMS

To describe: (1) the importance of health literacy in the prevention of stroke; (2) the correlation of risk factors with health literacy; and (3) the importance of health literacy in post-stroke outcomes.

METHODS

A systematic review was conducted using the following databases: PubMed (via Medline), CINAHL (via EBSCO), PsycINFO (via EBSCO), and Web of Science (via EBSCO) for studies focused on health literacy in stroke. We included qualitative, quantitative and observational studies. The critical appraisal tool of JBI-Checklists was used to assess the methodological quality of the included studies.

RESULTS

Thirty-three studies, involving 35,935 participants, were selected for this systematic review. Most of the studies (41 %) were cross-sectional. Health literacy levels among the general population and stroke patients were found to be relatively low, indicating the need for increased stroke education. Hypertension and stress were the most frequently identified risk factors while pregnancy and oral contraceptives, and anticoagulants were the least. People at risk of stroke have indicated a desire for more practical information and individually tailored behavioral interventions.

CONCLUSIONS

The results of this study highlighted the deficiency in health literacy among different populations. We noticed that even a simple educational intervention can help to improve health literacy. Targeting the general public is important in order to rapidly translate knowledge into action and to reduce the time from symptom onset to hospital arrival as time plays an important role in stroke.

Effects of world stroke campaign on stroke literacy and knowledge in Taiwan

OBJECTIVES

Stroke is a leading cause of death in Taiwan. Poor public knowledge of stroke may lead to delays in prehospital arrival, resulting in unfavorable prognoses. Studies have investigated public knowledge of stroke and highlighted the importance of stroke education, however, few such studies have been conducted in Taiwan. This study assessed the changes in public knowledge of stroke between 2012 and 2020 by conducting a survey during two World Stroke Day events. Furthermore, this study identified areas where educational efforts may have been insufficient.

MATERIALS & METHODS

Questionnaires were distributed to the participants of 2012 and 2020 World Stroke Day events in Taiwan. In total, 328 and 336 questionnaires were completed, respectively. Stroke literacy and knowledge were analyzed between 2012 and 2020. Data were analyzed using the chi-square test or independent t-test. p < 0.05 indicates statistical significance.

RESULTS

Hypertension was the most recognized risk factor for stroke in both years (p < 0.001), and recognition of most of the given risk factors significantly increased. In addition, recognition of more than half of the stroke warning signs significantly increased, awareness of the correct acute stroke response also increased (p < 0.001), and overall stroke literacy in Taiwan increased (p = 0.001).

CONCLUSION

Stroke literacy and knowledge in Taiwan have improved significantly between 2012 and 2020, but many people still lack adequate stroke knowledge and awareness. Government health department must take this sort of intervention continually (campaigns) and novel approaches (e.g. board game…) to improve stroke literacy and knowledge in public health.

REGISTRATION ID

N202109072, approved by the Joint Institutional Review Board of Taipei Medical University on 2021/11/02.

Barriers to Effective Prehospital and Hyperacute Stroke Care in India: A Physician Perspective

Introduction

The incidence of stroke is increasing in India. Prehospital stroke care is crucial for reducing stroke morbidity and mortality, but its implementation in India faces several challenges. Limited original research exists on prehospital stroke care in India, making it essential to identify the problems in implementing effective prehospital stroke care.

Methods

A web-based survey was conducted among registered medical practitioners in India who treat acute stroke. The survey questionnaire was developed in English and included 26 questions divided into five parts: questions about the physician's practice setup/hospital in India, perception of community awareness, existing prehospital care/systems, in-hospital stroke care availability, and specific issues faced.

Results

Eighty-three doctors in India participated in the survey (43% response rate). Most of the respondents worked in private hospitals (68%) and urban areas (76%). While 89% of hospitals had ambulance services, over 33% reported that patients had to pay for ambulance transport. Among respondents, 12% reported a community stroke care network, with infrequent prehospital procedures such as random blood glucose measurement (22%), stroke identification (15.7%), "last seen normal" documentation (14.5%), and low prehospital notification to hospitals (5%). Delays in referral from peripheral centers were reported by 73% of respondents. Most hospitals had standard operating procedures (SOPs) (84%), computed tomography (CT) (94%), magnetic resonance imaging (MRI) (85%), and offered intravenous thrombolysis (IVT) (77%). However, 24 h availability of CT was reported only by 6%, MRI by 19% and IVT by 12%. Nearly half (45%) reported treatment with thrombolysis was not covered by insurance. Mechanical thrombectomy was available in 34% of hospitals and 63% of hospitals conducted in-hospital audits for stroke patients.

Conclusions

The capabilities of stroke-catering hospitals in urban settings are encouraging, with many having SOPs, imaging capabilities, and thrombolysis and mechanical thrombectomy services. However, there is much room for improvement, in making the essential stroke care services financially accessible to all and available around the clock.

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.

Awareness of stroke, its signs, and risk factors: A cross-sectional population-based survey in Ghana

Background and Aims

The prevalence of stroke in sub-Saharan Africa is steadily rising, leading to a growing strain on the healthcare system in the region. In the context of Ghana, stroke ranks as the third most prevalent cause of mortality. The current body of scholarly research on stroke awareness in Ghana is quite limited. The aim of this study is to assess the level of awareness of stroke, as well as its signs and symptoms among the Ghanaian population.

Methods

The study employed a cross-sectional quantitative methodology, wherein 1000 participants completed self-administered structured questionnaires. Descriptive statistics were utilized to summarize the participants' socio-demographic characteristics and their responses. To assess the relationship between participants' sociodemographic traits and their awareness of stroke signs, symptoms, risk factors, and perception, the Chi-square test of independence was conducted using IBM SPSS version 26. A significance level of p < 0.05 was established.

Results

The study identified limited awareness regarding stroke symptoms, warning signs, and risk factors. The participants exhibited an overall knowledge range of 25.9% to 47.2% concerning stroke signs and symptoms, and a range of 24%-39% regarding its causes and risk factors. Notably, paralysis (70.8%) and diet (59.9%) were the most easily recognized warning signs and risk factors for stroke, respectively. Sociodemographic characteristics such as age, religion, educational status, exposure to stroke, employment status, and marital status were shown to be associated with participants knowledge of stroke (p < 0.05).

Conclusion

The study's results indicated a widespread lack of knowledge concerning the causes and risk factors of stroke among the Ghanaian population, highlighting the necessity for increased public education efforts to raise awareness about this condition.

Knowledge and awareness of stroke in rural and urban communities

INTRODUCTION

The average stroke morbidity rate, especially in rural communities, is higher when compared to the national average.

OBJECTIVE

Identify the profile of knowledge and awareness of stroke in rural and urban communities and analyze the differences between the two.

METHOD

Respondents who met the requirements answered a questionnaire containing a total of 41 items regarding knowledge and awareness of stroke. Characteristic data obtained includes age, gender, education, occupation, and ethnicity. Differences in characteristics were analyzed using Mann-Whitney, and the profiles of knowledge and awareness of stroke in rural and urban groups were analyzed using independent t tests to see differences between the two.

RESULT

Differences in the characteristics of rural and urban groups were only in education (p = 0.036) and occupation (p = 0.021). The mean score of the knowledge domain for the rural group was 72.53 (SD = 11.04), for the urban group it was 81.06 (SD = 11.12). The mean score awareness of stroke domain in the rural group was 72.18 (SD = 11.01), the urban group was 85.51 (SD = 11.67). The profile of knowledge and awareness of stroke in rural communities was significantly lower than in urban communities. The significance value was (p = 0.004) for knowledge and (p = 0.002) for awareness of stroke.

CONCLUSION

Based on the findings, it is reasonable to suspect that educational and occupational factors contribute to differences in the profile of knowledge and awareness of stroke in the two groups. Therefore, the stroke awareness campaign strategy for rural communities needs to be specifically designed by emphasizing/considering educational and occupational factors.

Addressing disparities in the global epidemiology of stroke

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.

Factors influencing alertness to premonitory symptoms in stroke patients with pre-hospital delay

OBJECTIVE

The purpose was to explore the alertness of premonitory symptoms in stroke patients with prehospital delay, and to analyze the influencing factors.

DESIGN AND SAMPLE

A cross-sectional study using the convenience sampling method was conducted in the neurology department of a general hospital between November 2018 and July 2019. A total of 352 stroke patients were participated in the survey.

MEASURES

A hierarchical multiple regression was performed to analyze the factors related to the alertness of premonitory symptoms (0-9 scores) in stroke patients with prehospital delay.

RESULTS

The alertness score was 6.53 ± 2.377. The lowest score of 0.55 ± 0.498 was for "Continuous yawning occurs continuously despite no tiredness or lack of sleep is okay, and need not be treated." The hierarchical regression results revealed that symptom onset, symptom change before admission, knowledge, social support were the influencing factors delaying the alertness of premonitory symptoms. Knowledge and support from friends could improve the alertness, while support from family and other support had a notable negative impact.

CONCLUSIONS

Stroke patients need to be more alert toward premonitory symptoms. This alertness is related to stroke knowledge and social support. Nurses should formulate interventions and advise stroke patients to improve their stroke knowledge and expand their social network.