Knowledge Of Stroke Symptoms Research Articles

The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?

ObjectivesTo assess public knowledge of stroke and transient ischaemic attack symptoms, and awareness of the content of a recent national health campaign.DesignInterviewer-administered questionnaire.SettingLeicester, UK.Participants1300 members of a mixed urban/rural, multiethnic...

Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults

BackgroundUnderstanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.MethodsUsing multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.ResultsThe weighted n for this study overall was 103,262,115 U.S. adults > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR = 1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR = 1.353 95%CI 1.352-1.354), >65 years of age (OR = 1.369 95%CI 1.368-1.371), African American (OR = 1.892 95%CI 1.889-1.894), not educated beyond high school (OR = 1.400 955CI 1.399-1.402), uninsured (OR = 1.308 95%CI 1.3-6-1.310), without a HCP (OR = 1.216 95%CI 1.215-1.218), and living in a household with an annual income of < $50,000 (OR = 1.429 95%CI 1.428-1.431).ConclusionsAnalysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.

Brooklyn AWAreness of stRokE in HyperTension (B-AWARE-HT) (P04.064)

Objective: To determine stroke knowledge in individuals with hypertension (HT). Background HT is a major risk factor for stroke but stroke awareness in HT individuals is not known. Given the need for greater administration of thrombolyic therapy, identification of areas of deficiency in high risk groups could permit targeted educational campaigns. Design/Methods: A survey was conducted in October 2011 in a convenience sample of individuals with self-reported HT. Subjects were interviewed in the in-hospital, clinic and community settings in central Brooklyn by trained medical residents, neurology residents, medical students and a nurse practitioner using a structured, closed-ended questionnaire. Results: 300 HT subjects of mean age 57 ±14.6 years were interviewed. 41% of the subjects were male and 79% black. Only 69% had well controlled HT. The subjects had had HT for a mean of 7 years. 59% knew that HT may lead to eye damage, while 86% knew that HT may lead to heart disease with the values for kidney disease being 58% and for stroke 82%. Even though 82% knew that stroke is a complication of HT, only 44% thought they were at risk of stroke and only 21% knew that tissue plasminogen activator (t-PA) treatment is available for acute ischemic stroke. Knowledge regarding the existence of t-PA therapy for stroke was lower in Hispanics (8.8%) and African American (20.3%) than in Caucasians (53.8%). More than 50% thought that chest pain was a symptom of stroke. Knowledge of individual stroke symptoms and stroke risk factors ranged from 65-90%. In a multivariable analysis greater stroke knowledge was associated with having a college education (p Conclusions: In this population some aspects of stroke knowledge are good but there is a specific need for education about the availability of acute stroke therapy. Disclosure: Dr. Panichpisal has nothing to disclose. Dr. Moradiya has nothing to disclose. Dr. Tan has nothing to disclose. Dr. Law has nothing to disclose. Dr. Jirasakuldej has nothing to disclose. Dr. Becker has nothing to disclose. Dr. Memon has nothing to disclose. Dr. Ghody has nothing to disclose. Dr. Diaz has nothing to disclose. Dr. Rosas has nothing to disclose. Dr. Antezana has nothing to disclose. Dr. Khandelwal has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Peters has nothing to disclose. Dr. Ding has nothing to disclose. Dr. Magdalena has nothing to disclose. Dr. McIntyre has nothing to disclose. Dr. Vulkanov has nothing to disclose. Dr. Personna-Policard has nothing to disclose. Dr. Baird has nothing to disclose.

Knowledge of Risk Factors and Stroke Symptoms among Nonstroke Patients

Background and Purpose: This study aimed to evaluate knowledge of stroke warning signs, risk factors, treatment and prevention among patients not suffering from stroke. Methods: Patients admitted to one of five Neurology Departments in Poland for diseases other than stroke were asked to answer a questionnaire regarding awareness of cerebrovascular risk factors and stroke. The study was performed between November 1 and December 31,2008. Results: 481 patients were included in the study (59.7% women). Proper definition of stroke and transient ischemic attack was given by 90.3 and 60.5% of respondents, respectively. Hypertension was reported as a risk factor by 91.1% of participants. Approximately 70% knew that hypercholesterolemia and smoking are risk factors of stroke, but only one third identified diabetes mellitus as a risk factor. Cardiac arrhythmia was recognized as a risk factor by 8.4%. Twenty-five percent of participants did not know any symptom of stroke. Identification of stroke signs was worse by participants from rural areas. Ten percent identified disturbances of consciousness, numbness, and dizziness as stroke symptoms. Conclusions: The knowledge of fundamental risk factors was sufficiently good, but recognition of cardiac arrhythmia and diabetes mellitus was unsatisfactory. The knowledge of stroke symptoms was unsatisfactory, particularly in rural areas. Additional education programs are necessary.

Abstract 2478: Hip Hop Stroke: The Standalone Effect of Musical Cartoons on Stroke Knowledge of Fourth Grade Children Living in a Low-Income Neighborhood

Objectives: To evaluate the effect of two novel three and half minute-long musical cartoons on stroke knowledge of fourth grade children. Methods: We recruited 72 fourth grade children from a single elementary school in Harlem to view musical cartoons designed to increase stroke literacy (knowledge of stroke symptoms, appropriate action, and prevention measures). Baseline testing to evaluate knowledge of stroke symptoms and response was performed immediately prior to viewing the cartoons. Each cartoon was viewed a total of three times over two consecutive days. No additional stroke education was provided. Posttests were conducted immediately following completion of viewing. A composite score was created from five stroke symptoms, which included blurry vision/loss of vision, sudden headache, unilateral facial weakness, clumsiness/incoordination, slurred/confused speech, and a distracter (chest pain). Knowledge of stroke localization (where a stroke occurs in the body) and appropriate action when presented with hypothetical stroke scenarios (calling 911) were also evaluated. Data was analyzed using SAS 9.2. Results: A total of 64 students completed both pretests (PT) and immediate posttests (IP) [89% retention rate]. At PT, 12.5% were able to identify stroke localization, and 47.2% were able to identify calling 911 for suspected stroke. The stroke symptom composite score at baseline was 2.62. Immediately following viewing, children’s stroke knowledge increased significantly with regards to stroke localization (71.9%, P&lt;.05) and calling 911 (87.5%, p&lt;.05). Knowledge of stroke symptoms also improved significantly across three out of five items (with the exception of blurry vision and sudden headache), and the composite score was 4.2 (p&lt;.05). Conclusions: Viewing two novel three and half minute musical cartoons, three times, significantly improved knowledge of stroke symptoms and response among fourth grade public school children, living in a high stroke risk neighborhood.

Abstract 2476: Hip Hop Stroke: Long-Term Retention of Stroke Knowledge Among Sixth Graders Living in a Low-Income Neighborhood.

Objectives: To evaluate the effect Hip Hop Stroke TM, a novel multi-media and musical school-based stroke literacy (knowledge of stroke symptoms, appropriate action, and prevention measures) intervention targeting children aged 8-12, on long-term retention of stroke knowledge. Methods: We enrolled 107 sixth grade children from one school in Harlem into a single dose of our Hip Hop Stroke intervention - three, one-hour classroom sessions, delivered over three consecutive days. Stroke knowledge surveys to evaluate stroke symptoms, appropriate response when presented with hypothetical stroke scenarios (calling ‘911’) and stroke localization (where a stroke occurs in the body) were conducted at baseline, immediately following the intervention, and 15-months following the intervention. A composite score was created from five stroke symptoms, which included blurry vision/loss of vision, sudden headache, facial weakness, clumsiness/incoordination, slurred/confused speech, and a distracter (chest pain). Data was analyzed using SAS 9.2. Results: A total of 105 students complete both pretests (PT) and immediate post tests (IP), and 85 students completed all three tests, which included a 15-month delayed post test (DP) [79.4% retention rate]. At PT, 36.2% correctly identified stroke localization, and 55.2% appropriately identified calling 911. The stroke knowledge composite score at baseline was 3.21. At IP, stroke knowledge increased significantly across all items: stroke localization (90.5%, p&lt;.05), calling 911 (84.8%, p&lt;.05), and composite score (5.25, p&lt;.05). At 15 months, all items except headache were significantly retained by children, with a composite score of 4.73 (p&lt;.05, PT vs. DP). Knowledge of stroke localization (80%, p&lt;.05, PT vs. DP) and calling 911 (72.8%, p&lt;.05, PT vs. DP) were also retained significantly. Conclusion: Three one-hour Hip Hop Stroke sessions significantly improved knowledge of stroke symptoms and response of sixth grade children, living in a high stroke risk neighborhood. This knowledge was significantly retained up to 15 months post-intervention.

Abstract NS 9: An Educational Intervention to Enhance Acute Stroke Symptom Recognition Skills Among Nursing Home Nursing Assistants

Background: Treatment of stroke requires a coordinated effort by clinicians educated to identify and transfer presumed acute stroke patients to hospital Emergency Departments (EDs) for expedited evaluation. With the aging of the population and the increasing demand for nursing home (NH) services, the community of clinicians educated to identify acute symptoms of stroke needs to be inclusive of Nursing Assistants (CNAs) in NH settings, who provide 70 to 80% of direct-care hours to NH residents. Approximately 25% of NH residents are referred to EDs for emergency care each year. Poorly executed transitions between EDs and NHs have the potential to delay assessment and intervention in a context in which “time is brain.” Purpose: The goal of this educational intervention was to integrate evidence-based messages for acute stroke symptom recognition into NH CNA practice and to assess knowledge change by comparing stroke-related knowledge at baseline to knowledge acquired immediately post-intervention. Methods: An educational module on acute stroke symptom recognition based on the Massachusetts Department of Public Health’s “Stroke Heroes Act FAST Education Guide” was delivered live by an advanced practice nurse to a convenience sample of 39 CNAs from 4 of an urban NH’s skilled nursing units. Pre- and post-test surveys, based on the “Hip Hop Stroke” survey questions, were administered to participants and results were analyzed using descriptive statistics. Results: Mean age of participants was 43.2 years (SD = 8.1), 82.1% were female, and 74.4% were Black. Mean years of clinical experience were 12.6 (SD = 8.2). Most (94.7%) described stroke as involving the brain on the pre-test, but only 22.2% of CNAs could select all 4 signs of stroke from the eight options offered on the pre-test. Post-intervention, 100% indicated that a stroke involves the brain and 33.3% correctly selected all 4 signs of stroke. In addition, 78.6% accurately described the meaning of all 4 “FAST” letters on the post-test. Conclusions: This educational intervention improved NH CNA knowledge of stroke symptoms. While this intervention could be replicated in other NH settings, the effect of early stroke symptom recognition on the quality of the emergency care provided to NH residents, and the impact of that emergency care on stroke-related morbidity and mortality among NH residents, warrant further study. It is notable that most participants were Black, as it is well documented that racial-ethnic minorities are less likely to be aware of acute stroke symptoms and the need for urgent treatment. Further research is needed to determine the optimal design of educational interventions in at-risk populations.

Correction

HomeStrokeVol. 43, No. 1Correction Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published1 Jan 2012https://doi.org/10.1161/STR.0b013e3182422ab5Stroke. 2012;43:e17The article entitled, “Effects of Public Education by Television on Knowledge of Early Stroke Symptoms Among a Japanese Population Aged 40 to 74 Years: A Controlled Study” by Miyamatsu et al, which published ahead of print on November 3, 2011 (DOI: 10.1161/STROKEAHA.111.634196) included the below error. This error has been corrected in the online version of this article and will be corrected in the print version.In the Acknowledgments section, Ms Yamada's first name should appear as: Sakiko. Previous Back to top Next FiguresReferencesRelatedDetails January 2012Vol 43, Issue 1 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/STR.0b013e3182422ab5 Originally publishedJanuary 1, 2012 PDF download Advertisement

Effects of Public Education by Television on Knowledge of Early Stroke Symptoms Among a Japanese Population Aged 40 to 74 Years

An educational campaign by mass media has been associated with great increases in the knowledge about early symptoms of stroke. However, few studies were conducted with a controlled community intervention study. To clarify the effects of a 1-year television campaign for the whole population on improvement of knowledge about stroke symptoms in 2 cities, a campaign area and a control area in Japan were selected. Before and after the campaign, 1960 randomly selected residents aged 40 to 74 years answered a telephone survey regarding knowledge of early stroke symptoms. We calculated the percentage and 95% CIs of participants who correctly chose all 5 early symptoms of stroke in each area and in each year. Before the campaign, 53% of participants (95% CI, 50%-55%) in the campaign area and 46% (95% CI, 44%-49%) in the control area correctly chose 5 early symptoms. After the 1-year television campaign, knowledge was significantly improved only in the campaign area (campaign area, 63%; 95% CI, 60%-66%; control area, 51%; 95% CI, 48%-54%). After sex stratification, only women showed improved knowledge of early symptoms. The audience rate for the campaign television programs was found to be higher in women than in men. A 1-year stroke educational television campaign effectively improved knowledge about early stroke symptoms among Japanese women aged 40 to 74 years. No impact was found among men in this age group. Future studies should examine the impact of this approach on stroke knowledge among younger individuals and whether there are any behavioral changes that contribute to earlier presentation for treatment.

Child-Mediated Stroke Communication

Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

Perceived Emotional Support and Frequent Social Contacts Are Associated with Greater Knowledge of Stroke Warning Signs: Evidence from Two Cross-sectional US Population Surveys

Public knowledge of acute stroke symptoms is a goal of public health policy. Similarly, general health knowledge is a hypothesized pathway for the salutary effects of social ties. This study examined the association of stroke warning sign knowledge with the quantity (number of recent social contacts) and/or quality (perceived emotional support) of social ties in two population-based cross-sectional surveys (Ns = 33,326 and 80,454). Both higher levels of emotional support and more frequent social contacts were independently associated with greater stroke warning sign knowledge. Social isolation is a novel marker of poor knowledge of stroke warning signs.

Stroke Knowledge in an Irish Semi-Rural Community-Dwelling Cohort and Impact of a Brief Education Session

Poor knowledge of stroke risk factors and failure to recognize and act on acute symptoms hinders efforts to prevent stroke and improve clinical outcomes. Levels of stroke knowledge are poorly established within Ireland. This study was conducted to establish levels of knowledge among men and women aged >40 years in an Irish community, and also to determine the impact of a single education session on stroke knowledge. Subjects from 2 separate geographical locations were allocated to an intervention group (n = 200), who received stroke information over a 90-minute session, or a control group (n = 200). Both groups completed a stroke knowledge questionnaire at baseline and at 4 weeks after the educational session. Overall, the initial response rate was 70% (280/400); 52% of the respondents knew that the brain is affected by stroke, 58% could list 2 or more risk factors but only 27% could list 2 or more warning signs, 50% would call 999 (emergency number in Ireland) in response to stroke, 17% had heard of thrombolytic therapy, but only 1% knew the time frame for receiving thrombolytics. The response rate to the resurvey following the educational session was 57%, with 47 of 117 subjects in the intervention group (40%) attending the session. Stroke knowledge scores improved by 50% in the intervention group (P < .001). Overall, the knowledge of stroke risk factors, warning signs, and thrombolytic therapy was poor in this Irish community-dwelling cohort. Our study demonstrates that a single educational session can improve short-term knowledge of stroke symptoms and thrombolytic therapy.

Knowledge of Stroke and Heart Attack Symptoms and Risk Factors Among Rural Elderly People: A Questionnaire Survey

Background and ObjectivesTo determine the level of knowledge of stroke and heart attack (HA) symptoms and risk factors of cardiovascular disease (CVD) in rural elderly people who are at risk for CVD.Subjects and MethodsA total of 444 adults over the age of 60 living in a rural province of Korea with at least one CVD risk factor participated in this survey.ResultsA total of 72.5% of the participants had hypertension and 28.4% had diabetes, whereas approximately 40% exhibited over two CVD risk factors. The mean knowledge scores for HA symptoms (4.3/9) were lower than scores for stroke symptoms (5.8/9), and the mean knowledge score for risk factors was 7.3/11. Stepwise multiple regression analyses showed that old age, low level of education, and low income level were the determining factors for low knowledge levels of stroke and HA symptoms as well as CVD risk factors. A low perceived risk of stroke or HAs also predicted a low knowledge of CVD risk factors.ConclusionCommunity-wide public campaigns are needed, which are designed to help elderly people in rural areas with low education levels and socioeconomic status at risk for CVD to improve the awareness of stroke and HA.

Knowledge of heart disease and stroke among cardiology inpatients and outpatients in a Canadian inner-city urban hospital

Heart disease and stroke are leading causes of death in North America. Nevertheless, in 2003, the Heart and Stroke Foundation of Canada reported that nearly two-thirds of Canadians have misconceptions regarding heart disease and stroke, echoing the results of similar American studies. Good knowledge of these conditions is imperative for cardiac patients who are at greater risk than the general population and should, therefore, be better educated. The present study evaluated the awareness of heart disease and stroke among cardiac patients to assess the efficacy of current education efforts. Two hundred fifty-one cardiac inpatients and outpatients at St Michael's Hospital (Toronto, Ontario) were surveyed in July and August 2004. An unaided questionnaire assessed respondents' knowledge of cardiovascular risk factors, symptoms of heart attack and stroke, and actions in the event of cardiovascular emergency. Demographic data and relevant medical history were also obtained. Cardiac patients demonstrated relatively adequate knowledge of heart attack warning symptoms. These patients also demonstrated adequate awareness of proper actions during cardiovascular emergencies. However, respondents were not aware of the most important risk factors for cardiovascular disease. Knowledge of stroke symptoms was also extremely poor. Socioeconomic status, and personal history of heart attack and stroke were positively correlated with good knowledge. Future patient education efforts should address the awareness of the important cardiovascular risk factors and knowledge of cardiovascular warning symptoms (especially for stroke), as well as inform patients of appropriate actions during a cardiovascular emergency. Emphasis should be placed on primary and secondary prevention, and interventions should be directed toward low-income cardiac patients.

Awareness of Stroke Symptomatology and Cardiovascular Risk Factors Amongst Stroke Survivors

Effective treatments exist for the acute management and prevention of stroke, but their uptake depends upon public awareness of stroke symptoms and cardiovascular risk factors. We evaluated the extent of both types of knowledge amongst high-risk individuals. Furthermore, we determined whether knowledge of risk factors, and appreciation of personal risk, influences risk avoidance behaviour. A validated comprehensive questionnaire assessing knowledge of stroke symptoms and personal risk factors was completed by stroke survivors across the United Kingdom. Questionnaires were completed by 622 stroke survivors (age range, 18-91 yrs; mean, 55.4 yrs). Recall of all 3 cardinal stroke symptoms (face, arm or leg, and speech disturbance) was made by only 14% of respondents, with 34% citing none of these symptoms. Knowledge of any established stroke risk factor was cited by 55% of respondents, with the remainder believing that stroke occurs because of chance. Similarly, 45% did not acknowledge that having had a previous stroke predisposed to future cardiovascular disease. Respondents recognising their own personal future risk were more likely to consume less alcohol (P < .0001) and salt (P < .005) and to eat more fruits and vegetables (P < .02). Knowledge of stroke symptoms and cardiovascular risk factors is poor amongst high-risk stroke patients. However, an awareness of personal risk of future stroke increased the likelihood of adopting secondary prevention behaviours after stroke. Our results have important implications for the prevention of secondary vascular disease in stroke patients and the effects of public health campaigns on high-risk stroke groups.

Stroke Awareness in Denmark

Background: This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke. Methods: A total of 3,520 subjects were invited to participate in the study, using a web-based, closed questionnaire. The recruitment was stratified by region, age and gender to represent the composition of the general Danish population aged 40+ years. Enrolment was competitive with a predefined target of 800 responses. The subjects were asked to rank the 4 most important acute stroke symptoms, and the 3 most important risk factors for stroke. Multivariable ordinal logistic regression was used for assessing factors associated with awareness of stroke symptoms and major stroke risk factors. Results: From December 12 to December 17, 2008, a total of 811 subjects (mean age: 58 years; SD: 11 years) were included, of which 405 (50%) were women. The 4 most frequently identified stroke symptoms were sudden onset of: speech disturbances (n = 636; 78.4%), facial palsy (n = 450; 55.5%), hemiparesis (n = 435; 53.6%) and visual disturbances (n = 429; 52.9%). The 3 most frequently identified stroke risk factors were: hypertension (n = 586; 72.3%), history of cerebrovascular disease (n = 401; 49.5%) and high concentration of cholesterol (n = 269; 33.2%). Compared with men, women had better knowledge of major stroke symptoms (OR = 1.33; 95% CI: 1.12–1.50) and stroke risk factors (OR = 1.33; 95% CI: 1.10–1.51) in multivariable analyses. Conclusions: The awareness of major stroke symptoms is insufficient. Whereas hypertension was the most often mentioned stroke risk factor, few subjects recognized tobacco smoking and diabetes mellitus as major risk factors for stroke.

Stroke Education: Discrepancies among Factors Influencing Prehospital Delay and Stroke Knowledge

Time is essential for the treatment of acute stroke. Much time is lost outside the hospital, either due to failure in identifying stroke symptoms or due to a delay in notification or transport. We review studies reporting factors associated with better stroke knowledge and shorter time delays. We summarise the evidences for the effect of stroke knowledge and education on people's reaction in the acute situation of stroke. We searched MEDLINE for studies reporting factors associated with prehospital time of stroke patients, or knowledge of stroke symptoms. Further, we searched for studies reporting educational interventions aimed at increasing stroke symptom knowledge in the population. We included a total of 182 studies. Surprisingly, those factors associated with better stroke knowledge such as education and sociodemographic variables were not related to shorter time delays. Few studies report shorter time delays or better stroke knowledge in persons having suffered a previous stroke. Factors associated with shorter time delays were more severe stroke and symptoms regarded as serious, but not better knowledge about the most frequent symptoms such as hemiparesis or disorders of speech. Only 25-56% of patients recognised their own symptoms as stroke. While stroke education increases the knowledge of warning signs, a few population studies measured the impact of education on time delays; in such studies, time delays decreased after education. This may partly be mediated by better organisation of EMS and hospitals. There is a discrepancy between theoretical stroke knowledge and the reaction in an acute situation. Help-seeking behaviour is more dependent on the perceived severity of symptoms than on symptom knowledge. Bystanders play an important role in the decision to call for help and should be included in stroke education. Education is effective and should be culturally adapted and presented in a social context. It is unclear which educational concept is best suited to enhance symptom recognition in the acute situation of stroke, especially in view of discrepancies between knowledge and action.

Stroke Knowledge: How is it Impacted by Rural Location, Age, and Gender?

Background and Research Objective Stroke, the third-leading cause of Americans' deaths, is often not recognized causing fatal or disabling delays in receiving effective, time-sensitive treatment. To understand the delay in seeking treatment, a sample of rural and non-rural adult residents were surveyed using the Stroke Recognition Questionnaire (SRQ) to assess their level of knowledge of stroke symptoms and risk factors. Sample and Method Five hundred and sixty-six individual (283 rural and 283 non-rural) from six East Central Illinois counties responded to the self-administered SRQ mail survey. The five-element design method for mail surveys guided this survey implementation procedure. Results Rural and younger (20-64 years) respondents had significantly higher stroke symptom knowledge scores (M = 9.32) compared to non-rural and older (> 65 years) respondents (M = 9.0; t =2.181, p 65 years), who have the greatest stroke risk but who appear to be least informed. Educational interventions are needed in both rural and urban settings which improve the general public’s stroke symptom recognition and response, and help the public sort out which symptoms are associated with stroke versus myocardial infarction.

Lack of Association Between Stroke Symptom Knowledge and Intent to Call 911

Excessive prehospital delay between acute stroke onset and hospital arrival is an ongoing problem. Translating knowledge of stroke warning signs into appropriate action is critical to decrease prehospital delay. Our objectives were to estimate the proportion of Michigan adults who would react appropriately by calling 911 when presented with hypothetical stroke-related scenarios and to examine the association between knowledge of warning signs and calling 911. In 2004, questions regarding initial response to health-related scenarios were added to the Michigan Behavioral Risk Factor Survey, a population-based telephone survey of adults. We calculated the proportion of respondents who would call 911 in response to 3 stroke-related scenarios and examined the association between stroke warning sign knowledge and 911 activation. Among 4841 adults, 27.6% (95% CI, 26.2 to 29.0) had adequate knowledge of stroke warning signs (defined as reporting 3 correct warning signs), and 14.0% (95% CI, 12.9 to 15.1) reported they would call 911 for all 3 stroke-related scenarios. Knowledge of specific stroke warning signs was only modestly associated with calling 911 in response to medical scenarios that involved the same stroke symptom (OR, 1.17 to 1.39). Even among those with adequate knowledge of stroke warning signs, only 17.6% (95% CI, 15.5 to 20.0) would call 911 for all 3 stroke scenarios. In this population-based survey, stroke symptom knowledge was not associated with the intent to call 911 for stroke. This study emphasizes the critical role of motivation in addition to symptom knowledge to reducing delay time to hospital arrival for stroke.

Stroke literacy in high-risk populations

African Americans and Hispanic Americans may not get optimal care for stroke even though they have a greater stroke risk.1 Some reports have found that minority groups in the United States are less likely to receive thrombolytic therapy (recombinant tissue plasminogen activator [rt-PA]) for their strokes than whites.2 The single largest exclusionary factor for rt-PA is delayed patient arrival time,3 so it is of considerable importance that African Americans and Hispanic Americans have greater out-of-hospital delays for stroke and are less likely to be aware of rt-PA as a potential treatment for their strokes than whites.4,5 Clearly, there is a need to improve stroke prevention and access to acute stroke therapy for high-risk minorities. In this issue of Neurology ®, Willey et al.6 explore stroke literacy, defined as knowledge of stroke risk factors and symptoms, in a multiethnic urban population in Central Harlem. This study demonstrated that Hispanic Americans in this community were less likely to identify several key stroke symptoms compared with whites. Notably, only 15% of Hispanic Americans and 25% of African Americans could identify all 5 …