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ORIGINAL ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 22-27

Knowledge on risk factors and warning signs of stroke in Udupi


1 Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal University, Manipal, Karnataka, India
2 Department of Neurosurgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Date of Submission05-Feb-2020
Date of Acceptance15-Dec-2020
Date of Web Publication02-Sep-2022

Correspondence Address:
Dr. Jyothi Chakrabarty
Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal University of Higher Education, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjmsr.mjmsr_4_20

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  Abstract 


Background: World Health Organization reports that stroke is the third among the top 10 causes of death in India. Despite this, knowledge among general public about stroke and its risk factors is a bare minimum. The objective of this study was to assess the knowledge on risk factors and warning signs of stroke among selected caregivers and students. Materials and Methods: A descriptive survey was conducted in the medical, neurologic and cardiac outpatient departments of a tertiary care hospital. The participants of the survey were students of the allied health sciences, nursing and engineering, and care givers of patients attending the outpatient departments. The data on the knowledge of risk factors and warning signs of stroke were collected using convenient sampling technique. Results: Twenty-five percentage of the students and 65% of the care givers had only less than average knowledge on warning signs and risk factors of stroke. Conclusions: Knowledge level of the students as well as the care givers is not satisfactory considering the increasing incidence and mortality related to stroke in India. Therefore, training the individuals on identification of signs of stroke and immediate management is vital.

Keywords: Awareness, education, health, risk factors, stroke


How to cite this article:
Cutinho MC, Chakrabarty J, Menon G. Knowledge on risk factors and warning signs of stroke in Udupi. Muller J Med Sci Res 2022;13:22-7

How to cite this URL:
Cutinho MC, Chakrabarty J, Menon G. Knowledge on risk factors and warning signs of stroke in Udupi. Muller J Med Sci Res [serial online] 2022 [cited 2022 Dec 5];13:22-7. Available from: https://www.mjmsr.net/text.asp?2022/13/1/22/355295




  Introduction Top


Mortality due to stroke is very high all over the world. Stroke kills about 140,000 Americans each year. Someone is newly diagnosed with stroke every 40 s in the United States. Every 4 min, someone dies of stroke.[1] Stroke is the third among the top 10 causes for mortality in India.[2] The incidence of stroke is steadily rising in India. Millions of Indians are diagnosed with stroke every year and are left with disabilities or die due to stroke.[3] Knowledge about stroke risk factors and warning signs are less around the world.[4],[5] Knowledge about symptoms of stroke and risk factors were lesser in the Indian population as well.[6] Knowledge on risk factors of stroke and early warning signs of stroke among the general public is vital in seeking the prompt treatment. Awareness about stroke is given due importance in many countries of Asia. The objective of this study was to assess the knowledge on risk factors and warning signs of stroke among selected caregivers and students.


  Materials and Methods Top


Design

A descriptive survey method was adopted to collect data from participants attending the medical, neurologic, and cardiac out-patient departments of a tertiary care hospital and from the students of the allied health sciences, nursing, and engineering from the same campus.

Setting

The study was conducted in a university campus. The campus is multi-disciplinary and hosts medical, engineering, allied health, and nursing institutions within it. The campus also has multi-specialty hospital with more than 2400 beds. The hospital has outpatient departments with all specialties with a high foot fall daily.

Participants

Participants were 134 caretakers of patients attending medical, neurologic, and cardiac outpatient departments and 264 students of allied health sciences, nursing and engineering. All the students are high school pass outs. The sample size was calculated using the formula for the estimation of proportion. The undergraduate students of allied health sciences and nursing were expected to have some idea about the warning signs of stroke. Still the authors decided to collect data from them to know their depth of understanding.

Sampling technique

The participants were selected conveniently. The care takers were approached when they accompanied the patients to the outpatient departments for follow-up. Students were approached during the break timings of classes.

Ethical clearance

Ethical clearance was obtained from Institutional Ethics Committee (IEC No. 150/2017) after submitting the consent form and participant information sheet. Both were prepared in English and then translated to the local language Kannada for easiness of understanding among the caretakers. Students could use the English forms. Informed consent was obtained from all participants after explaining the objectives of the study.

Questionnaire

The knowledge questionnaire was prepared by the researchers by reviewing literature and after discussing with the experts. It had questions on risk factors, warning signs and immediate management of stroke. Each item had four options from which participants were asked to choose the correct one. The correct answers were scored one and the incorrect answers as zero. The content validity of the questionnaire was established by experts from medical surgical nursing, neurology, and neurosurgery. The reliability was established by split half method using SPSS and was found to be 0.82. The split half method of reliability assesses the internal consistency of the test.


  Results Top


Sample characteristics

The data were analyzed using SPSS version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc). The data presented in the [Table 1] show that out of 264 student participants, 55.3% were between the age group of 21–30 years, 242 (91.7%) were female and 245 (92.8%) were undergraduates. Sixty-three percentage of the students (167) said they got information about stroke from internet and 18 (6.8%) reported having history of stroke in the family. [Table 2] shows that out of 134 caregivers, 64 (47.8%) were between the age group of 21–30 years, 69 (51.5%) were females and 71 (53%) had educational qualification below preuniversity. Sixty-six percentage of care givers (89) said that they got information about stroke from newspapers and television. Forty-eight percentage (64) were in private job and 7 (5.2%) reported that they had previous history of stroke in the family.
Table 1: Frequency (f) and percentage (%) distribution of students based on sample characteristics (n=264)

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Table 2: Frequency (f) and percentage (%) distribution of care givers based on sample characteristics (n=134)

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Knowledge scores (students)

[Table 3] and [Figure 1] show knowledge on risk factors of stroke among students. The scores of the knowledge questionnaire were categorized as good, average, and poor. Among students, 74.6% had good knowledge and 24.6% had average knowledge regarding the risk factors, warning signs and immediate management of stroke. Further the data were analyzed area wise. Out of 264 students participated in the study around 263 (99.6%) identified normal blood pressure levels as 120/80 mm of Hg. Normal cholesterol levels were identified by only 165 (62.5%). Around 228 (86.4%) identified brain as the organ affected and 34 (12.9%) said heart was the organ involved. Regarding the immediate management, around 234 (88.6%) students said stroke was a medical emergency, 19 (7.2%) believed that it is not necessary to seek immediate medical assistance. Around three percentages (7) of the students believed that stroke cannot be treated. High blood pressure was identified as the main risk factor of stroke by 220 (83.3%) whereas 21 (8%) said the main risk factor was old age. High cholesterol levels were identified as one of the risk factors by 138 (52.3%). Around 29 (11%) believed heart disease as a nonmodifiable risk factor of stroke. Around 179 (67.8%) identified overweight as a contributing factor for stroke.
Figure 1: Classification of knowledge score of students-risk factors

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Table 3: Knowledge on risk factors of stroke (students) (n=264)

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[Table 4] shows data on knowledge on warning signs of stroke among students. Ninety-six percentage (253) opined that the stroke symptoms that occur for few minutes and disappear as the “warning sign” and 4 (1.5%) said that those symptoms not necessarily be treated. Around 30 (11.4%) identified numbness or weakness in the face, arms or legs as the only sign of stroke, 13 (4.9%) said speech difficulty and 5 (1.9%) said severe headache with no known cause as the only sign of stroke. Around 219 (83%) identified numbness of limbs, double vision and facial drooping as a warning sign of stroke. Around 136 (51.5%) said stroke symptoms can be reversed if the treatment is initiated within 6 h or as early as possible. Sixteen percentage (42) said that stroke symptoms could be reversed if the treatment was initiated even after 24 h. When asked on what they would do if an individual shows signs of stroke, 216 (81.8%) said that they would immediately call for an ambulance whereas 40 (15.2%) said they would seek medical help only if symptoms occur again. Around 14 (5.3%) said stroke can never recur and 18 (6.8%) said stroke occurs only among the ones who consume nonvegetarian diet.
Table 4: Knowledge on warning signs of stroke (students) (n=264)

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Knowledge scores (caregivers)

[Figure 2] shows the knowledge scores of care givers. Among the caregivers, 55.2% had only average knowledge and 35.1% had good knowledge. Out of 134 participants 94 (70.1%) identified the normal blood pressure level and 14 (10.4%) only identified the normal cholesterol levels. 89 (66.4%) identified brain as the organ affected whereas 18 (13.4%) heart, 9 (6.7%) kidneys, and 18 (13.4%) identified lungs as the organ affected by stroke. Around 110 (82.1%) believe stroke as a medical emergency and 10 (7.5%) believe that stroke cannot be treated. About 122 (91%) opine that the symptoms that occur for few minutes and then disappear are the warning signs. Eighty nine (66.4%) identified high blood pressure as the main risk factor and 28 (20.9%) identified low blood pressure as the risk factor. Around 73 (54.5%) said age was nonmodifiable risk factor and 39 (29.1%) said heart disease was a nonmodifiable risk factor. Around 53 (39.6%) said overweight can cause stroke. Twenty-six (19.4%) said high cholesterol levels contribute to stroke. Around 51 (38.1%) identified numbness or weakness in the face, arms, or legs as the only sign of stroke, 9 (6.7%) said speech difficulty and 8 (6%) said severe headache with no known cause as the only sign of stroke. All the three were identified by 66 (49.3%) as the signs of stroke. Numbness of limbs, facial drooping, and double vision was identified as warning signs of stroke by 85 (63.4%) participants. Around 88 (65.7%) said it is necessary to initiate treatment within 6 h or as early as possible to reverse the symptoms. Around 40 (29.9%) treatment could be initiated anytime within 24 h to reverse the symptoms. When asked on what they would do if an individual shows signs of stroke 106 (79.1%) said they would immediately call for an ambulance whereas 18 (13.4%) said they would seek medical help only if symptoms occur again. Fourteen (10.4%) said stroke cannot recur and 21 (15.7%) believe that stroke cannot cause paralysis. Around 92 (68.7%) said that it is necessary to take regular dose of antihypertensive. Eleven (8.2%) said stroke occurs only among the ones who consume nonvegetarian diet.
Figure 2: Classification of knowledge scores of caregivers

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  Discussion Top


Few studies have assessed the knowledge level of caregivers on stroke and whether they understand the urgency in managing the situation in case of an impending stroke. The studies reported that many understand stroke as preventable, as noninfectious and as a life-threatening condition.[7]

[Table 5] summarizes the studies conducted in Asia during the last 5 years exploring the knowledge on warning signs of stroke. The population of the studies varied from students to general public in different countries of Asia. Results show varied understanding of study subjects about the warning signs of stroke. One sided limb weakness was identified by more than 90% of the participants of a study done in India, only 13% of the same study participants could identify one sided facial weakness as a symptom of stroke.[6] This survey was conducted on a population consisting of both students and caregivers. Students' cross section included both from the medical and nonmedical backgrounds. The caregivers' cross-section included those attending medical, neurologic, and cardiac outpatient departments of the hospital.
Table 5: Summary studies conducted on warning signs of stroke in Asia

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Seven students (2.7%) opined that it is not necessary to seek immediate medical attention to treat stroke and they also believed that stroke is not treatable. Thirteen (4.9%) said speech difficulty with no known cause as the only sign of stroke. This is in contrary to the previous reports where participants identified speech disturbances or slurred speech as one of the symptoms of stroke.[7],[8],[9],[10],[11] One sided limb weakness as a symptom was identified by around 50% of the participants.[12]

Few students could not identify the warning signs correctly though 99% of them had either good or average knowledge. Few students also had the myth that stroke will never recur and stroke occurred to only those who consume nonvegetarian diet. The findings are contrary to the previous reports where the knowledge of the students was very poor.[16],[17] Students' knowledge level improves after focused educational interventions.[15] It is important to attain knowledge regarding stroke among 100% of students in health sciences. The engineering and management students should be provided with electives of diseases of national importance.

Although there is a lack of understanding about the risk factors and warning signs of stroke among the care givers, it is also appreciable to note that a large number of them could identify numbness or weakness in the face, arms, or legs as signs of stroke. The care takers who accompany the patients to the outpatient departments and the patients themselves mostly do not have college education and they usually receive information about health-related matters and about diseases from newspapers, magazine, television, and from health-care workers visiting their homes. Considering the educational background of the care givers, the number of people who could identify the signs of stroke were substantial. However, there is an urgent need for population based educational programs for the adults regarding the warning signs and risk factors of stroke in this region. Similar studies were reported from Singapore and Japan whereas reports from developed countries like Ireland, says warning signs could not be identified by many.[7],[16],[18]

In this study, 89 (66.4%) caregivers identified brain as the organ involved and high blood pressure as the main risk factor. The people of the district receive many out-reach educational and health programs from the different institutions of the university which might have enhanced the care givers' level of understanding about stroke. They also receive information from the media. This is in contrast to another study reported from South India.[12] There are signs of increasing awareness among the general public in some parts of India probably because they have stroke affected persons in the families or because of the media.[6],[9]

Hence, we conclude that knowledge of general public on prevention and early treatment is vital is reducing the disability caused by stroke. In an era where we are trying to emphasize on the concept of “Time is brain” and the need to start emergency intervention on stroke patients, education of the general populations regarding stroke symptoms is very important. Simple concepts about stroke, its risk factors, and warning symptoms should be introduced in high school syllabus. Awareness about the same should be distributed extensively though audio-visual media, social media, and other public awareness programs.

Limitations

The study had limitations in the sampling method. The participants included a heterogeneous population of students and care givers. Students were also from medical and nonmedical backgrounds and were selected conveniently.


  Conclusion Top


The knowledge regarding the risk factors, warning signs and immediate management of stroke among students was inadequate. A small percentage of students think that immediate intervention is not needed for stroke and that warning signs necessarily not be treated. Many care givers also had same kind of misconceptions regrading risk factors, warning signs and management of stroke. This shows that aggressive educational measures are necessary in our country to reduce the occurrence of stroke and to prevent stroke related complications. Students from disciplines other than healthcare should have opportunities for short elective courses for such important health related topics.

Financial support sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Homestatistics C, States U, States U. Stroke Statistics by Race and Ethnicity Stroke Risk Varies by Age. p. 2-3. Available from: 1. https://www.cdc.gov/stroke/facts.htm. [Last accessed on 2020 Jan 27].  Back to cited text no. 1
    
2.
World Health Organization. WHO Statistical Profile. India: World Health Organization; 2015. p. 3. Available from: https://apps.who.int/gho/data/node.country.country-IND?lang=en. [Last accessed on 2020 Jan 27].  Back to cited text no. 2
    
3.
Dalal P, Bhattacharjee M. Stroke-transient cerebral ischaemic attacks (TIAs) a medical emergency-preventable and treatable. J Assoc Physicians India 2014;62:12-7.  Back to cited text no. 3
    
4.
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: 1-7.  Back to cited text no. 4
    
5.
Le Bonniec A, Haesebaert J, Derex L, Porthault S, Préau M, Schott AM. Why patients delay their first contact with health services after stroke? A qualitative focus group-based study. PLoS One 2016;11:1-10.  Back to cited text no. 5
    
6.
Das S, Hazra A, Ray B, Ghosal M, Chaudhury A, Banerjee T, et al. Knowledge, attitude, and practice in relation to stroke: A community-based study from Kolkata, West Bengal, India. Ann Indian Acad Neurol 2016;19:221.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Lim W, Chuang DF, Chue KM in, Lee DZ, Leong NJ, Ng ZG, et al. Stroke literacy in Singapore: data from a survey of public housing estate residents. Ann Acad Med Singapore 2014;43:454-63.  Back to cited text no. 7
    
8.
Matsuzono K, Yokota C, Takekawa H, Okamura T, Miyamatsu N, Nakayama H, et al. Effects of stroke education of junior high school students on stroke knowledge of their parents: Tochigi project. Stroke 2015;46:572-4.  Back to cited text no. 8
    
9.
Lipilekha Patnaik, Sumitra Pattanaik, Trilochan Sahu, Bijan K Panda. Awareness of symptoms and risk factors of myocardial infarction among adults seeking health care from a rural hospital of India. J Cardiovasc Dis Res 2016;7:83-5.  Back to cited text no. 9
    
10.
Nishikawa T, Okamura T, Nakayama H, Miyamatsu N, Morimoto A, Toyoda K, et al. Effects of a public education campaign on the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke Onset: The Acquisition of Stroke Knowledge (ASK) Study. J Epidemiol 2016;26:115-22.  Back to cited text no. 10
    
11.
Yang J, Zhang J, Ou S, Wang N, Wang J. Knowledge of community general practitioners and nurses on pre-hospital stroke prevention and treatment in Chongqing, China. PLoS One 2015;10:e0138476.  Back to cited text no. 11
    
12.
Menon B, Swaroop JJ, Deepika HK, Conjeevaram J, Munisusmitha K. Poor awareness of stroke--a hospital-based study from South India: an urgent need for awareness programs. J Stroke Cerebrovasc Dis 2014;23:2091-8.  Back to cited text no. 12
    
13.
Oh GJ, Moon J, Lee YM, Park HK, Park KS, Yun YW, et al. Public awareness of stroke and its predicting factors in Korea: A national public telephone survey, 2012 and 2014. J Korean Med Sci 2016;31:1703-10.  Back to cited text no. 13
    
14.
Itzhaki M, Melnikov S, Koton S. Gender differences in feelings and knowledge about stroke. J Clin Nurs 2016;25:2958-66.  Back to cited text no. 14
    
15.
Kawano H, Yokota C, Yamamoto F, Mori Y, Mihara Y, Ando Y, et al. Stroke education for multidisciplinary medical personnel in a rural area of japan for promotion of hospital visit of acute stroke patients. J Stroke Cerebrovasc Dis 2014;23:2372-7.  Back to cited text no. 15
    
16.
Komolafe MA, Obembe AO, Olaogun MO, Adebiyi AM, Ugalahi T, Dada O, et al. Awareness of stroke risk factors and warning signs in nigerian adolescents compared with adults. J Stroke Cerebrovasc Dis 2015;24:687-93.  Back to cited text no. 16
    
17.
Islam S, Geum Oh E, Lee TW, Kim S. Stroke management awareness and behavior among nursing students in Bangladesh. Open J Nurs 2017;07:1-14.  Back to cited text no. 17
    
18.
Hickey A, Holly D, McGee H, Conroy R, Shelley E. Knowledge of stroke risk factors and warning signs in Ireland: Development and application of the stroke awareness questionnaire (SAQ). Int J Stroke 2012;7:298-306.  Back to cited text no. 18
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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