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Original Article

Knowledge and Awareness Regarding Stroke among General

Population: A Cross‑Sectional Survey
Mamta Choudhary
College of Nursing, AIIMS, New Delhi, India

Abstract
Background: Stroke is one of the major causes of loss of quality‑adjusted life years and inflicts varying degree of physical deficits, psychological
distress, and strained social relationships among stroke survivors. However, knowledge regarding risk factors, warning symptoms, and first
aid management of stroke can help to minimize this burden. Aim: This study aims to assess knowledge and awareness of general population
regarding risk factors, warning symptoms, and first aid management of stroke. Materials and Methods: The cross‑sectional study was conducted
to collect information from general population regarding risk factor, warning symptoms, and first aid management of stroke by administering
a pretested questionnaire. Five hundred patients attending Outpatient Departments of Selected Hospital were selected using simple random
sampling. After explaining purpose of the study and taking written consent from the participants, the participants were requested to fill the
questionnaire. Results: The findings revealed that only 22.6% of participants were having good knowledge, 56.6% were having average
knowledge, and rest 20.8% of them had poor knowledge regarding risk factors, warning symptoms, and first aid management of stroke. The
mean knowledge score was 11.86 ± 3.651. 31.4%, 36.2%, and 33.6% of participants were not aware about even single risk factors, warning
symptoms, and first aid management of stroke, respectively. Conclusion: The low level of knowledge regarding risk factor, warning symptoms,
and first aid management of stroke indicates immense need of initiatives to implement stroke education.

Keywords: Awareness, first aid, knowledge, risk factors, stroke, warning signs

Introduction lack of knowledge regarding warning symptoms and need of

quick response.[6] Research studies from various part of the
Stroke being a considerable burden of disability is among major
world have identified insufficient knowledge of risk factors,
chronic illnesses worldwide causing loss of quality‑adjusted
warning signs, and need of quick response as a major factor
life years. The onset of stroke is sudden, and its ability to
contributing to stroke‑related mortality and morbidity; [7‑9]
affect virtually all human functions is making it the second
however, evidence from Indian setting is very limited; thus,
leading cause of mortality and disability worldwide.[1‑3] As
this study was conducted with an objective to assess knowledge
per the World Health Organization, the prevalence of stroke
and awareness of general population regarding risk factors,
will be increased at faster pace in upcoming years due to the
warning symptoms, and first aid management of stroke. The
aging population and changing lifestyle in the industrialized
findings of the study can contribute to practice of primary care
countries.[4] As the risk of stroke increases with advancing age,
by helping health‑care workers to identify areas to lower level
developing countries like India with increasing life expectancy
of knowledge regarding stroke, which is important to be known
can face enormous rehabilitation burden of stroke victims.
Due to the prolonged recovery time, the stroke survivors
Address for correspondence: Ms. Mamta Choudhary,
suffer from varying degree of physical deficits, psychological
Faculty, College of Nursing, AIIMS, Delhi, India.
distress, strained social relationships, and many times from E‑mail: mamta24.c@gmail.com
poor family support. [5] Rapid evolution has occurred in
stroke therapy in the past few years, but ironically only a
few stroke patients reach to medical facility in time both in Submitted: 11‑Apr‑2021 Accepted: 17‑May‑2021 Published: 19-Aug-2021
the developed and developing countries perhaps due to the
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DOI: How to cite this article: Choudhary M. Knowledge and awareness regarding
10.4103/jascp.jascp_8_21 stroke among general population: A cross-sectional survey. J Appl Sci Clin
Pract 2021;2:42-5.

42 © 2021 Journal of Applied Sciences and Clinical Practice | Published by Wolters Kluwer - Medknow
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Choudhary: Knowledge and awareness regarding stroke
before the development and implementation of effective health
education programs.
Materials and Methods
The cross‑sectional study was conducted in the Outpatient
Departments of Selected Hospital, New Delhi, over a period
of 6 months. Eligibility criteria for inclusion included adult
Outpatient Department (OPD) patients who can understand
or read Hindi language and were willing to participate in
the study. Five hundred patients were attending medical and
surgical OPDs and no history of stroke were recruited in
the study using simple random sampling. Information was
collected by administering a pretested questionnaire to the
participants. The questionnaire related to sociodemographic
variables and knowledge items related to risk factors,
warning symptoms, and first aid management of stroke was
developed by reviewing literature. The literature review
focused on published articles from the Medline, CINAHL,
Social Sciences Citation Index, Psych INFO, a hand search
through selected published journals, and from references
lists. However, Journals that lacked the authentication of
legitimate scholarly journals such as peer review, editing,
editorial boards, editorial offices, and other editorial standards
were excluded from the review. [10] The questionnaire
comprised three sections: the first section focused on
sociodemographic profile of participants, the second section
comprised questionnaire to assess knowledge regarding
risk factors, warning symptoms, and first aid management
of stroke, and the third section comprised open‑ended
questions to ascertain awareness of participants regarding
stroke. The sociodemographic profile of the study assessed
information regarding age, gender, education, and habitat of
the participants. Questionnaire related to knowledge items
regarding risk factors, warning symptoms, and first aid
management of stroke consisted of twenty multiple‑choice
questions. Questionnaire related to awareness had three
open‑ended questions where participants were asked to list
down risk factors, warning signs, and first aid management
for stroke. They were asked to answer do not know if they
were not aware about these variables.
After establishing content validity of the instrument, it was
translated to vernacular language. Permission to conduct
study was taken from the ethical committee and concern
authority of the selected hospital. After explaining purpose of
the study and taking written consent from the participants, the
participants were asked to fill the questionnaire in the presence
of nursing staff. They were not permitted to communicate with
each other. Data were coded, validated, and analyzed using
SPSS (version 21, IBM corporation, US). Each of the twenty
multiple‑choice questions was rated using a score of one for
correct answer and zero for an incorrect answer, with a total
score ranging from 0 to 20. Participants having a score above
70th percentile, i.e. with score of 15 and above were regarded as
having good level of knowledge. Three open‑ended questions
were analyzed using descriptive analysis.
Journal of Applied Sciences and Clinical Practice  ¦  Volume 2 ¦ Issue 2 ¦ May-August 2021
Results
The majority 67.3% of the participants were of the age
group of <40 years with mean age of 33.86 years and
standard deviation of 12.27. Maximum 54% of participants
were males and 46% were females. The majority 66% of
participants belonged to urban community, and the rest
were from rural community. Maximum 61% of participants
were either graduate or above, and 39% were educated up to
senior secondary or less. The result revealed that only 22.6%
of participants were having good knowledge, 56.6% were
having average knowledge, and rest 20.8% of them had poor
knowledge regarding risk factors, warning symptoms, and first
aid management of stroke [Table 1]. The mean knowledge score
was 11.86 ± 3.651. Association between knowledge regarding
risk factors, warning symptoms, and first aid management
of stroke with selected sociodemographic variable, i.e. age,
gender, habitat, and educational level of participants was found
to be nonsignificant, i.e. P < 0.05.
The majority (62.6%) of participants had described hypertension
as risk factors of stroke followed by cholesterol (61.4%),
age (57.6%), and smoking (45.2%). Almost equal number of
participants, i.e. 40.8% and 39.2% were aware about smoking
and family history, respectively, as risk factors for stroke.
Diabetes (19.6%) and alcohol use (17.4) were least identified
risk factors by the participants. However, 31.4% were not
aware about even any single risk factor of stroke [Table 2].
Maximum 56.8% and 52.2% of participants describe
slurred speech and weakness in arm, respectively, as
warning sign for stroke. Numbness (20.6%) and difficulty in
understanding (17%) were least known as warning signs of
stroke. Moreover, 36.2% of participants were not knowing
even a single warning sign for stroke [Table 3].
The majority 62.2% of participants reported that ambulance
or doctor should be called as first aid management of stroke.
About 29.4% responded to loosen constrictive clothing, and
21.6% identified the need to check the consciousness of stroke
victim as first aid measures. However, 33.6% were unaware
about first aid measures to be taken for stroke victims [Table 4].
Association between awareness regarding risk factor,
warning symptoms, and first aid management of stroke
with selected sociodemographic variable, i.e. age, gender,
habitat, and educational level of participants was found to be
nonsignificant, i.e. P < 0.05.
Discussion
This study aimed to assess knowledge and awareness regarding
risk factor, warning symptoms, and first aid management of
stroke. The study found that <1/4th of the participants (22.6%)
was having good knowledge regarding stroke. Saengsuwan
et al. in their study found that knowledge of stroke in patients
with recurrent stroke was insufficient.[11] Hypertension (62.6%),
cholesterol (61.4), and age (57.6) were the most described risk
factor by the participants. However, 31.4% were not aware
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Choudhary: Knowledge and awareness regarding stroke

slurred speech (56.8%), weakness in arm (52.2%), and vision

Table 1: Knowledge regarding risk factor, warning
problems (33.4) as warning signs of stroke. Unfortunately,
symptoms, and first aid management of stroke (n=500)
more than one‑third of participants (36.2%) were not able
Knowledge score Frequency (number of to recall even a single warning sign of stroke finding are
participants ), n (%) consistent with a survey conducted by Slark et al.[14] where
Good knowledge (15-20) 113 (22.6) 34% of 622 stroke survivors in the UK failed to identify any
Average knowledge (8-14) 283 (56.6) of the warning signs of stroke. Agbetou Houessou et  al.[16]
Poor (0-7) 104 (20.8) in their study found that only 4.9% of the participants were
able to cite at least one symptom of stroke. The majority
62.4% that ambulance or doctor should be called as first aid
Table 2: Awareness regarding risk factor of
management of stroke. However, more than one‑third of
stroke (multiple responses) (n=500)
participants (33.6%) were unaware about first aid measures
Variables Number of participants , n (%) to be taken for stroke victims.
Risk factors
Hypertension 313 (62.6)
Conclusion
Cholesterol 307 (61.4)
Increasing age 288 (57.6) The low level of knowledge regarding risk factor, warning
Smoking 226 (45.2) symptoms, and first aid management of stroke identified in
Family history of stroke 204 (40.8) the current study indicates immense need of initiatives to
Obesity 196 (39.2) implement stroke education to general population. Education
Lack of exercise 180 (36.0) programs should focus on those at risk and those who can be
Stress 111 (22.2) used as resource for first aid management of stroke.
Diabetes 98 (19.6)
Alcohol use 87 (17.4)
Acknowledgment
Do not know 157 (31.4)
I am thankful to the nursing staff who supervised patients
while data collection so that they do not interact with each
other to prevent contamination of data. I am thankful to the
Table 3: Awareness regarding warning signs of ethical committee of selected hospital for providing ethical
stroke (multiple responses) permission to conduct the study.
Warning signs Financial support and sponsorship
Response of participants Number of participants , n (%) Nil.
Slurred speech 284 (56.8)
Conflicts of interest
Weakness in arm 261 (52.2)
There are no conflicts of interest.
Vision problems 167 (33.4)
Dizziness 156 (31.2)
Headache 112 (22.4) References
Numbness 103 (20.6) 1. Hadidi NN, Tierney MK, Claeys J. Gurvich OV. Knowledge of stroke
Difficulty in understanding 85 (17.0) warning signs and risk factors in Minnesota adults. Stroke 2021;52:
Do not know 181 (36.2) 714. Available from: https://www.ahajournals.org/doi/10.1161/str.52.
suppl_1.P714.
2. Workina A, Kebede S, Fekadu C, Wubetie Snr A. Knowledge of risk
factors and warning signs of stroke among patients with heart disease
Table 4: Awareness regarding first aid management of at Tikur Anbessa Specialized Hospital. Open Access Emerg Med
stroke (multiple responses) (n=500) 2021;13:57‑66.
3. Mayo NE, Wood‑Dauphinee S, Ahmed S, Gordon C, Higgins J,
First aid management McEwen S, et al. Disablement following stroke. Disabil Rehabil
Response of participants Number of 1999;21:258‑68.
4. Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, et al.
participants , n (%)
Economic burden of stroke: A systematic review on post‑stroke care.
Call ambulance or doctor 312 (62.4) Eur J Health Econ 2019;20:107‑34.
Loosen constrictive clothing 147 (29.4) 5. Choudhary M, Mohanasundari SK, Trivedi SK, Challenges in life after
Check whether patient is conscious or not 108 (21.6) stroke: A metasyntheis. Asian Pac J Nurs 2017;4:31‑6.
Do not give any food or liquid 74 (14.8) 6. Kharbach A, Obtel M, Achbani A, Bouchriti Y, Hassouni K,
Lahlou L, et al. Level of Knowledge on stroke and associated factors:
Do not know 168 (33.6)
A cross‑sectional study at primary health care centers in Morocco. Ann
Glob Health 2020;86:83.
about even any single risk factor of stroke. The findings 7. Sadeghi‑Hokmabadi E, Vahdati SS, Rikhtegar R, Ghasempour K,
Rezabakhsh A. Public knowledge of people visiting Imam Reza
are similar to various previous researches where 8%–52% hospital regarding stroke symptoms and risk factors. BMC Emerg Med
of participants were not able to name any of the stroke risk 2019;19:36.
factor.[12‑15] The majority of participants were able to recall 8. Itzhaki M, Koton S. Knowledge, perceptions and thoughts of stroke

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[Downloaded free from http://www.jascp.org on Friday, August 20, 2021, IP: 10.232.74.23]

Choudhary: Knowledge and awareness regarding stroke

among Arab‑Muslim Israelis. Eur J Cardiovasc Nurs 2014;13:78‑85.
9. Kamran S, Bener AB, Deleu D, Khoja W, Jumma M, Al Shubali A,
et al. The level of awareness of stroke risk factors and symptoms in the
Gulf Cooperation Council countries: Gulf Cooperation Council stroke
awareness study. Neuroepidemiology 2007;29:235‑42.
10. Choudhary M, Kurien N. Predatory journals: A threat to evidence‑based
science. Indian J Health Sci Biomed Res 2019;12:12‑4.
11. Saengsuwan J, Suangpho P, Tiamkao S. Knowledge of stroke risk factors
and warning signs in patients with recurrent stroke or recurrent transient
ischaemic attack in Thailand. Neurol Res Int 2017;2017:8215726.
12. Weltermann BM, Homann J, Rogalewski A, Brach S, Voss S,
Ringelstein EB. Stroke knowledge among stroke support group
members. Stroke 2000;31:1230‑3.
13. Kothari R, Sauerbeck L, Jauch E, Broderick J, Brott T, Khoury J et al.,
Patients’ awareness of stroke signs, symptoms, and risk factors. Stroke
1997;28:1871‑75.
14. Slark J, Bentley P, Majeed A, Sharma P. Awareness of stroke
symptomatology and cardiovascular risk factors amongst stroke
survivors. J Stroke Cerebrovasc Dis 2012;21:358‑62.
15. Maasland L, Koudstaal PJ, Habbema JD, Dippel DW, Knowledge and
understanding of disease process, risk factors and treatment modalities
in patients with a recent TIA or minor ischemic stroke. Cerebrovasc
Dis 2007;23:435‑40.
16. Agbetou Houessou M, Hountada H, Yahouédéou B, Choki B,
Kossi O, Adoukonou T. Knowledge of stroke risk factors and signs
in Parakou, a Northern City of Benin in West Africa. Cerebrovasc Dis
2021;50:88‑93.

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