European Journal of Cardiovascular Medicine

Stroke is a significant neurological, noncommunicable disease and ranks as the third leading cause of mortality, as well as a major contributor to adult disability worldwide. In India, the incidence of stroke is approximately 1. 5 individuals per 1,000 population, and it ranks third in mortality caused by stroke. Importantly, 12% of all strokes occur in individuals younger than 40 years of age. Disability resulting from a stroke is linked to diminished functional abilities, cognitive deficits, mood alterations, and subsequent decreased work efficiency. Not only does a stroke impact the patients, but nearly 70% of caregivers for stroke patients also report experiencing physical and mental stress. Consequently, stroke is a condition of significant public health relevance with economic and social implications.[1].

Around 87% of the total cases of stroke has been recorded as the ischaemic type. The focus of acute ischaemic stroke treatment and management is to maintain tissue area of oligemia by immediately restoring blood flow to the affected brain areas and enhancing collateral blood flow by using recombinant tissue plasminogen activator (rt-PA) that functionally breaks up the blood clot, and thus, allowing the blood to reach brain. This treatment, however, is only applicable within 4.5 h of stroke onset, whereas administration of rt-PA beyond 4.5 h was reported to be associated with deleterious side effects, notably, hemorrhagic transformation which could lead to high mortality in stroke patients. Therefore, lack of awareness on symptoms, risk factors as well as action towards stroke would result in pre-hospital delay and disqualify the patients for effective reperfusion therapy [2].

Therefore, public awareness campaigns must be used to help people recognise stroke signs quickly and aid fast access to emergency care. The Stroke Association in USA first promoted the FAST acronym in 2005,with the help of campaign- ‘Face, Arms, Speech and Time to call 999’ [3].

The FAST acronym (Face, Arms, Speech, Time) is a test to quickly identify if someone is having a stroke.

• Face weakness: Can the person smile? Has their mouth or eye drooped?
• Arm weakness: Can the person raise both arms?
• Speech problems: Can the person speak clearly and understand what you say?
• Time to call 999: if you see any of these signs [4].

Traditional beliefs about stroke might have a stronger and competing influence than public health campaigns. Only 7.5% of at-risk patients used the medical profession for information and also used friends, family, television and radio. A British paper found that only 15% of stroke patients sought medical help themselves, the remainder relying on those around them and 80% rang their general practitioner (GP) rather than the emergency services. This suggested that most people are unaware of the benefits of rapid hospital-based care following stroke and highlights the need to educate all members of the general population. Small-scale interventions improved knowledge in targeted at-risk USA communities involving teaching lay people, beauticians or teachers the FAST acronym, which they passed on to their clientele or pupils in a ‘culturally and age-appropriate way’. Given that much of the existing literature focuses on other countries, it might be inappropriate to generalize findings to the Indian setting [3].

Therefore, this study aims to assess the public awareness regarding Knowledge of Warning Signs, Risk Factors, and Treatment Responses.

Aim:

The aim of this study is to evaluate the level of public awareness and responsiveness to cerebral stroke, focusing on the identification of warning signs, understanding of stroke risk factors, and knowledge of appropriate treatment actions.

Objectives:

• Evaluate the level of public awareness of cerebral stroke warning signs and symptoms.
• Analyze the public’s awareness of stroke warning signs, treatment responses, and risk factors across different age groups and gender.
• Measure public understanding of stroke risk factors and their relationship to awareness of warning signs and treatment actions.
• Educate the unaware public regarding the warning signs, risk factors, and treatment actions for stroke to improve prompt recognition and response.

A 2-month cross-sectional analytical study was conducted among 500 randomly sampled participants aged 18 to 80 in Ahmedabad district, Gujarat, India, using a Stroke Questionnaire [5] for evaluation with proper ethical consideration.

1. The participant’s consent was taken.
2. The questions in the questionnaire were filled by the participants based on their current knowledge.
3. Once the questionnaire was complete, correct knowledge was provided to the patient regarding the risk factors, warning signs and appropriate action to be taken when encountering a stroke patient.

The study included a total of 500 participants. The demographic distribution by sex showed that 49% were male and 51% were female. In terms of age, the participants were divided into three categories: 66% were in the age group of 18-40 years, 26% in the 40-60 years range, and 6% were above 60 years. The mean age of participants was 22 years.

1. Association Between Age and Sex with Warning Sign Awareness

The association between age and Stroke warning signs awareness was analyzed using the chi-square test. The analysis revealed a non-significant relationship between various age groups and warning sign awareness (χ² = 5.628, p = 0.06).

The association between sex and warning sign awareness was found to be significant (χ² = 5.402, p<0.05). Females showed greater awareness of stroke warning signs compared to their counterparts.

2. Association Between Age and Sex with Treatment Awareness

The chi-square test showed a non-significant association between age and treatment awareness (χ² = 2.865, p = 0.239). No particular age group was more aware of the correct treatment response in the case of a stroke.

For sex, the association with treatment awareness was significant (χ² = 7.374, p<0.01). Females were more aware of the correct treatment steps compared to the other group.

3. Association Between Age and Sex with Risk Factor Awareness-

A non-significant association was found between age and risk factor awareness (χ² = 1.444, p = 0.486). No particular age group was more knowledgeable about the risk factors for stroke.

The association between sex and risk factor awareness was also non-significant (χ² = 0.867 p = 0.352). No particular gender had better awareness of stroke risk factors compared to their counterparts.

4. Association Between Risk Factor Awareness and Treatment Awareness

The relationship between risk factor awareness and treatment awareness was examined. A non-significant association was found (χ² = 1.265, p = 0.261). Participants who were aware of stroke risk factors were not more likely to be aware of the correct treatment response.

5. Association Between Risk Factor Awareness and Warning Sign Awareness-

The chi-square test revealed a significant association between risk factor awareness and warning sign awareness (χ² = 12.04, p<0.001). Participants who were aware of stroke risk factors were more likely to recognize stroke warning signs.

6. Association Between Warning Sign Awareness and Treatment Awareness

Finally, the association between warning sign awareness and treatment awareness was analyzed. The results showed a significant association (χ² = 10.578, p<0.01). Participants who were aware of the warning signs of stroke were more likely to be knowledgeable about the correct treatment response.

7. After completing the questionnaire, all participants were provided with accurate information regarding stroke risk factors, warning signs, symptoms, and the correct treatment response. Any queries raised by the participants were addressed and resolved promptly.

A stroke occurs due to bleeding in the brain or blocked blood flow, leading to rapid brain cell death. Immediate medical intervention is crucial, as timely treatment can significantly reduce damage [6]. Thus, ongoing public awareness about stroke is essential. This study evaluates the general population's knowledge of stroke risk factors, warning signs, symptoms, and treatment protocols.

Our study reports that 95% of participants (475 out of 500) were aware of the term “stroke.” This is in contrast to a 2019 study in South India where only 56.9% of participants knew what stroke was [1]. The increased awareness in our study may be attributed to the COVID-19 pandemic and its vaccination drives, which heightened public engagement with healthcare information due to the widespread occurrence of illnesses and their side effects during that period.

When assessing knowledge of stroke risk factors, we found that 53.8% of participants were aware, with the most commonly cited factors being high blood pressure, smoking, stress, high cholesterol, and heart disease. This result aligns with a study conducted in Uganda, where the majority also identified hypertension and stress as key contributors to stroke [7]. These risk factors are prevalent in today's society due to the growing incidence of sedentary lifestyle diseases, which are largely caused by such conditions.

Only 25% of participants were aware of the warning signs of stroke, with the most frequently mentioned signs being loss of balance or coordination, dizziness, sudden numbness or weakness, and sudden confusion or difficulty speaking. This finding contrasts with a study conducted in urban Australia, where a majority of participants reported being familiar with these symptoms [8]. One possible explanation for this difference is that the healthcare system in Australia prioritizes regular public health campaigns and education about stroke, which might not be as prevalent in our study population.

In terms of treatment knowledge, over 41% of participants in our study knew the appropriate treatment protocols for stroke. This is higher than the 34.6% reported in a 2017 study from North India [9]. The increased awareness in our study could be partly due to the geographic location of Gujarat, which has a high prevalence of lifestyle-related diseases like diabetes, often referred to as the "diabetes capital" of India. This has likely led to greater awareness of vascular health, including stroke, as people in this region may be more exposed to healthcare interventions, routine screenings, and discussions surrounding related conditions such as hypertension and cardiovascular diseases. This regional focus on managing lifestyle diseases may indirectly contribute to better awareness of stroke treatment protocols.

Interestingly, female participants were significantly more aware of both stroke warning signs and treatment protocols (p<0.05), consistent with findings from a study in Thailand [10]. One possible reason for this is that women tend to have more social engagement, which may expose them to more health-related information.

We did not find a significant association between stroke awareness and different age groups, and this observation was not well-supported by available literature. However, it may indicate that stroke awareness campaigns have reached people of all ages relatively equally in our study population.

A unique finding in our study was the significant association between awareness of risk factors and warning signs (p<0.001). This suggests that individuals who are knowledgeable about stroke risk factors are also likely to recognize its warning signs. One possible reason for this could be that individuals who are more informed about health risks are generally more proactive in educating themselves about related medical conditions, leading to better overall awareness. Furthermore, a significant association (p<0.01) was found between awareness of warning signs and knowledge of the appropriate treatment response, indicating a strong link between understanding stroke symptoms and knowing how to act in a timely manner. This could be because those familiar with the warning signs are more likely to understand the urgency of the situation and take the necessary steps for prompt treatment. No other articles were found that specifically investigate the association between these variables, making our findings particularly valuable in this area.

While public awareness programs enhance knowledge about stroke risk factors, warning signs, and treatment protocols, they often fail to motivate timely emergency action. Many people mistakenly believe that stroke symptoms will resolve on their own, leading to delays in seeking medical help [1, 11-12]. This underscores the need for educational initiatives that not only raise awareness but also emphasize the importance of immediate response in stroke situations. To foster reliable information dissemination and enhance user engagement on a global scale, particularly in low-income countries, the promotion of social media use is essential [13].

In conclusion, our study highlights a significant level of awareness about stroke among participants, particularly regarding the term itself and risk factors. However, the low recognition of warning signs and the need for timely emergency responses remain concerning. These findings emphasize the necessity for targeted educational campaigns that not only enhance general knowledge but also motivate prompt action in stroke situations. Improving public health literacy is crucial for reducing stroke-related morbidity and mortality in our communities.

Statements and Declarations:

The authors declare that there are no competing financial or non-financial interests related to the work submitted for publication. There was no conflict of interest throughout the study.

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