Introduction

Materials and Methods

Results

Discussion

Summary and Conclusions

References

Abstract

Introduction: Community knowledge and stroke awareness is crucial for primary prevention of stroke and timely access to stroke treatments including acute reperfusion therapies. We conducted a national telephone survey to quantify the level of community stroke awareness. Methods: A random sample of 400 adults in New Zealand (NZ), stratified by the 4 main ethnic groups, was surveyed. Eligible participants answered stroke awareness questions using both unprompted (open-ended) and prompted questions (using a list). Proportional odds logistic regression models were used to identify factors associated with stroke awareness. Results: Only 1.5% of participants named stroke as a major cause of death. The stroke signs and symptoms most frequently identified from a list were sudden speech difficulty (94%) and sudden 1-sided weakness (92%). Without prompting, 78% of participants correctly identified at least 1 risk factor, 62% identified at least 2, and 35% identified 3 or more. When prompted with the list, scores increased 10-fold compared with unprompted responses. Ethnic disparities were observed, with Pacific peoples having the lowest level of awareness among the 4 ethnic groups. Higher education level, higher income, and personal experience of stroke were predictive of greater awareness (P ≤ .۰۵). Conclusions: Stroke was not recognized as a major cause of death. Although identification of stroke risk factors was high with prompting, awareness was low without prompting, particularly among those with lower education and income. Nationwide, culturally tailored public awareness campaigns are necessary to improve knowledge of stroke risk factors, recognition of stroke in the community and appropriate actions to take in cases of suspected stroke.

Introduction

Primary prevention and acute care of stroke requires community awareness of the risk factors and their management. Effective community-based educational and preventive programmes are predicated on accurate assessment of the knowledge of stroke and its risk factors within these communities. For these measures to be effective and to guide targeted strategies to maximize prevention and treatment, it is important to know if differences exist in stroke knowledge between different sociodemographic groups. Stroke awareness in the community is important given the recent advances in stroke reperfusion therapies, and evidence on primary stroke prevention based on lifestyle and behaviour. Previous studies have shown that stroke awareness in the community setting is relatively low. An integrated review of the literature in 2009 found that knowledge of stroke prevention and symptoms of stroke were poor even amongst those who had experienced a stroke.4 Variable results have been reported across a range of countries and regions (Europe, North America, United Kingdom, Asia, and Australia). For example, the proportion of participants correctly identifying a risk factor ranged from as low as 18% up to a high of 94%, while only 25%-72% were able to name 1 symptom when asked open-ended questions. The observed variation is likely due to differences in correct responses between prompted and open-ended questions, as a greater proportion (95%-100%) correctly identified symptoms and risk factors when asked closed (prompted) questions. More recently, a convenience sample survey in an urban population found that 43% of respondents associated stroke with the brain and blood, and 42% were unable to identify any of the F.A.S.T. campaign components (Face, Arm, Speech, and Time). Ethnic differences in risk factor identification were also reported: compared to New Zealand Europeans, Pacific Island respondents were less likely to identify a number of stroke risk factors, while Maori, Pacific Island, and Asians were less likely to identify stroke symptoms. A 2015 literature review looking at stroke knowledge in Spanish-speaking populations in America, Latin America, and Spain also identified that stroke knowledge, language, and socioeconomic status (SES) were potential barriers to stroke awareness in these populations.