Knowledge Of Stroke Warning Signs Research Articles

Abstract WP35: Neighborhood Effects On Knowledge Of Stroke Risk Factors And Stroke Warning Signs

Background: Low socio-economic status has been associated with worse stroke outcomes and longer arrival times to the ED. Objective: To determine whether stroke knowledge is different by neighborhood and if neighborhood socio-economic status (NSES) predicts knowledge of stroke risk factors (RF) or stroke warning signs (WS). Methods: A survey was done in the Greater Cincinnati Northern Kentucky Region in 2016 where participants were targeted to match those of ischemic stroke patients within the same population. The participants were asked open-ended questions regarding stroke WS and RFs. Participants also provided their zip codes. NSES was determined based on zip code and census data. NSES was determined using a previously validated index and divided into quartiles. We used regression to determine the association between NSES and only being able to name 0-1 RF or WS. Results: There were 1902 participants in the surveys with non-missing geographic data who lived in 96 different zip codes. Participants were 66.8±16.4 years old, 56.2% were female, 24.4% were black and 36.0% had less than a HS education. About 20% of participants were unable to name one stroke risk factor or one warning sign. There was substantial heterogeneity of stroke knowledge by zip code (Figure 1). There was no significant association between NSES and knowledge of stroke WS. After adjustment for age, sex, and race, participants who lived in neighborhoods in the lowest quartile of NSES were more likely to be only able to name 0-1 RFs when compared to all other neighborhoods (Lowest Quartile of NSES OR 1.45 (95% CI 1.06-1.98)). Conclusion: We identified geographic disparities of stroke knowledge in a well-defined population, emphasizing the need for targeting public health interventions towards areas most in need. NSES accounted for some of the disparities in stroke RF knowledge, but not stroke WS knowledge. 1

Abstract P714: Knowledge of Stroke Warning Signs and Risk Factors in Minnesota Adults

Background: Global Burden of Disease identified stroke as the second leading cause of death worldwide after ischemic heart disease. Many stroke risk factors are preventable with lifestyle changes. A better understanding of the relationship between demographics and knowledge of stroke risk factors and warning signs may help in identifying target populations for preventative stroke education. Purpose: This study aimed to explore 1)knowledge of stroke risk factors and warning signs among Minnesota adults, 2)association between knowledge of risk factors and presence of risk factors and 3)association between the knowledge of warning signs and family history of stroke. Methods: A cross-sectional survey of 207 consenting adults who completed open-ended questionnaires on identifying stroke risk factors and warning signs per American Stroke Association (ASA) was used. Self-reported demographics, medical/family history and lifestyle behaviors data were combined with measured height, weight and blood pressure to provide an individual stroke risk score per the ASA Stroke Risk Score. Results: Most participants(90.3%) correctly identified at least one stroke warning sign, but <1% identified all warning signs (FAST+Walking+Vision). 58.9% identified ≥3 stroke risk factors while only 2.4% identified 6 risk factors. Of the highest ranked stroke risk factors(hypertension, smoking, diabetes, diet, obesity, exercise, age, gender, atrial fibrillation), hypertension and obesity were the most named, correctly identified by 64.3% and 53.1% respectively. Females were slightly more knowledgeable of risk factors(63.9% females vs. 51.8% males) and warning signs(62.3% females vs. 58.8% males). No statistically significant associations were observed between knowledge of risk factors and presence of them, or between family history of stroke and knowledge of stroke warning signs. Conclusion: The findings of this study identified the need for public education of stroke risk factors and warning signs as a critical first step in behavior change. Gender differences in knowledge was slightly different. Other demographic differences was not identified due to study sample homogeneity. Additional efforts should be made to increase sample diversity in future studies.

Variation in Knowledge of Stroke Warning Signs by Age and Presence of Conventional Risk Factors

It is important to recognize stroke in the general public. The purpose of this study was to investigate factors affecting knowledge of stroke warning signs (SWSs) according to age group in the Korean population. This study is a cross-sectional study. Using data from the Korean Community Health Survey conducted in Korea in 2017, 198 403 subjects were analyzed. Knowledge about SWSs was assessed by face-to-face interviews using structured close-ended questionnaires with 5 items about stroke symptoms (sudden unilateral weakness of face, arm or leg; sudden difficulty in speaking, or trouble understanding speech; sudden visual impairment in 1 eye, or double vision; sudden dizziness or loss of balance; and sudden severe headache). The overall percentage of subjects with good knowledge of SWSs (>4 correct answers to the SWS questionnaire) was 66.5%. It was highest in the middle-aged subjects (72.6%), followed by the young subjects (63.5%) and the older subjects (61.5%). The youngest of the young subjects and the oldest of the older subjects had the least knowledge. Subjects with conventional risk factors generally had more knowledge about SWSs, except for those with diabetes mellitus. However, in the young subjects, knowledge about SWSs was not increased by the presence of conventional risk factors such as hypertension and dyslipidemia. Stoke risk factors are increasing among young people; they still have poor knowledge about SWSs. More education is needed to increase appropriate treatment, especially in young people with stroke-related risk factors.

Knowledge of Stroke Warning Signs, Risk Factors, and Response to Stroke among Lebanese Older Adults in Beirut

Background and objectives: Stroke is a global burden. In Lebanon, recent studies have shown that stroke prevalence may be higher than other developing countries. While older people are particularly vulnerable to stroke, research suggests that they have poor stroke awareness. Since awareness is crucial for early hospital admission, thereby outcome, the main objectives of this study were to assess knowledge of stroke ie, symptoms, risk factors, and intended behavior in case of stroke suspicion. Methods: A community-based survey targeting adults aged 50 and above was conducted at 20 random pharmacies in Beirut from May to October 2018 through face to face interviews utilizing a structured questionnaire composed of open and closed ended questions. Descriptive and multivariable analyses were performed. Main Results: In total, 390 participants completed the questionnaire. Sixty-eight percent were able to spontaneously recall at least 1 stroke symptom, most frequently headache (29.2%), hemiparesis (25.4%), and dizziness (19.5%). Furthermore, 85.4% spontaneously recalled at least 1 risk factor, most frequently hypertension (48.2%), smoking (20.5%), and stress (43.1%). In case of stroke suspicion 57.69% would call an ambulance. Knowing a stroke patient and educational level were predictors for recall of more symptoms and risk factors for stroke. Adequate response to stroke was positively associated with identification of more stroke symptoms but inversely associated with having diabetes. Conclusions and Recommendations: There are major gaps in stroke knowledge among Beirut's older population. Culturally tailored awareness campaigns should be implemented at multiple levels using different media methods to target vulnerable populations at higher risk for stroke and their families. These campaigns should focus on improving stroke symptoms awareness and actions to take when suspecting stroke.

Gender differences in feelings and knowledge about stroke.

To examine gender differences in knowledge and feelings about stroke among ≥40years old population. Knowledge of stroke is consistently found to be poor among both genders in general populations, however, it has been reported to be better among women than men. Gender differences in feelings about stroke in the general population have not been examined. Data were collected from a convenience sample using semi-structured personal interviews. Participants were representative of Israeli sub-populations aged ≥40 with no history of stroke. Knowledge of stroke was studied with quantitative methods while constant comparative analysis was used for the qualitative data analysis of feelings evoked by stroke. One hundred and seventy-seven participants were interviewed, 79/177 (44·6%) men and 98/177 (55·4%) women. Rates of self-reported hypertension [33/79 (41·8%) men, 25/98 (25·5%) women] and current smoking [29/79 (36·7%) men, 18/98 (18·4%) women] were significantly higher in men than women. Over 50% men and women mentioned one-side sudden weakness or paralysis as a stroke symptom, however, other stroke symptoms were not recognised by most participants. Education was associated with the number of identified stroke signs. Knowledge of stroke-warning signs was better in women. The main feelings expressed by both genders were fear of dying and disability, self-concern about survival, blaming fate and self-accusation. Stroke knowledge is poor among men and women. Higher level of education is a predictor of stroke knowledge among both genders. Gender-specific differences in stroke risk factors and feelings about stroke in different sub-populations should be taken into account to improve prevention of stroke through education programmes. Health education on stroke prevention should be tailored to population groups differing in level of education. Health promotion recommendations should be provided by nurses with regard to beliefs of both men and women regarding prevention of stroke.

Analysis of Gender Differences in Knowledge of Stroke Warning Signs

The impact of gender on knowledge of stroke warning signs and preparedness is poorly understood, and gender-specific factors associated with poor knowledge of stroke warning signs have not been identified. This was a cross-sectional study of 132,604 participants in the 2009 Behavioral Risk Factor Surveillance System Survey, a national telephone survey. Adults aged 18 years or older who lived in one of 19 states that administered an optional stroke module asking them to correctly identify stroke symptoms and the correct action to take were included. The primary outcome was a low score (≤ 4 of 7) on the Stroke Symptoms Knowledge Scale (SSKS). Logistic regression was performed for the overall sample and then stratified by gender, with adjustments made for age, race, Hispanic ethnicity, income, and whether respondents had a primary doctor (PMD). Data were weighted as recommended by the Centers for Disease Control. In all, 51.7% of the weighted sample was women. Less women than men had low scores on the SSKS (21% versus 25%, P < .001). After adjusting for age, race, ethnicity, income, and PMD, men had higher odds of having low scores (adjusted odds ratio, 1.36; 95% confidence interval, 1.28-1.45). After stratifying by gender, Hispanic ethnicity, and age younger than 35 years predicted low scores on the scale in women but not in men. Female gender is associated with better knowledge of stroke warning signs, but a gender-specific approach identified Hispanic women, young women, and black participants as subgroups at risk for having poor knowledge, suggesting the need for targeted stroke education to increase stroke preparedness in these groups.

Abstract MP45: National Women’s Knowledge of Stroke Warning Signs, Overall and by Race/Ethnic Group

Background: Early treatment is associated with better clinical outcomes in stroke, but women must recognize the warning signs of a stroke to reduce delays in treatment. The purpose of this study was to evaluate contemporary knowledge of stroke warning signs and intent to call 9-1-1 first if warning signs occur, among a nationally representative sample of women, overall and by race/ethnic group. Methods: A study of cardiovascular disease awareness and knowledge was conducted by the American Heart Association in 2012 among English speaking US women &gt; 25 years identified through random digit dialing (N=1,205; 54% white, 17% black, 17% Hispanic, 12% other). Demographic data, including race/ethnic group, were evaluated using standardized categorical questions. Knowledge about warning signs of stroke, and what to do first if experiencing signs of a stroke, was assessed by standardized unaided questions. Data were weighted to reflect the US population of women based on the US Census Bureau’s March 2011 Current Population Survey, overall and within ethnic strata. Results: In 2012, half of women surveyed (51%) identified sudden weakness/numbness of face/limb on one side as a stroke warning sign; this did not vary by race/ethnic group. Loss of/trouble talking/understanding speech was identified by 44% of women, and more frequently among white versus Hispanic women (48% vs. 36%; p&lt;.05). Fewer than one in four women identified sudden severe headache (23%), unexplained dizziness (20%), or sudden dizziness/loss of vision (18%) as warning signs, and one in five (20%) did not know one stroke warning sign; these results did not vary by race/ethnicity. The majority of women said that they would call 9-1-1 first if they thought they were experiencing signs of a stroke (84%), and this did not vary among black (86%), Hispanic (79%), or white/other (85%) women. Conclusions: Knowledge of stroke warning signs was low among a nationally representative sample of women, especially among Hispanics. In contrast, knowledge to call 9-1-1 when experiencing signs of stroke was high. These data suggest effort to improve recognition of the warning signs of stroke has potential to reduce treatment delay and improve outcomes among women.

Abstract T MP72: Temporal Trends in Public Awareness of Stroke Warning Signs and Risk Factors

Introduction: Delay in seeking medical attention after stroke symptom onset is the most common reason for low rates of thrombolytic use for ischemic stroke. This may be related to poor recognition of stroke symptoms or lack of awareness of time-sensitive stroke treatments. We describe public knowledge of stroke warning signs (WS) and risk factors (RF), and changes over time. Methods: Survey respondents were drawn from our biracial population of 1.3 million using random-digit dialing in 1995, 2000, 2005, and 2011 to reflect the age, race, and gender distribution of stroke patients, based on an ongoing stroke incidence study in the same region. Participants were asked open-ended questions regarding stroke WS and RF. Comparisons over time were made using Armitage test for trend, and multiple logistic regression was used to adjust for covariates. Results: Over the study period, 8245 surveys were completed. As shown in the figure, knowledge of 3 correct WS improved steadily over time from 5.4% to 22.6% (p&lt;0.001), and knowledge of 3 correct RF has also improved over time from 2.6% to 5.8% (p&lt;0.001), but has remained relatively low. These improvements in knowledge persisted after controlling for differences in age and education between study periods. Conclusions: Public awareness of stroke WS and RF steadily improved from 1995 to 2011. These findings highlight the success of increasing community awareness of stroke WS and RF. Further research is needed to determine if increased stroke awareness leads to changes in care-seeking health behavior and improved stroke prevention. Figure 1: Comparison of Knowledge of Stroke Warning Signs and Risk Factors between Survey Years, Greater Cincinnati/Northern Kentucky Population

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.