In Search of a Gold Standard Tool for Assessing Knowledge of Stroke: A Systematic Review

Background: Knowledge of stroke is essential to empower people to reduce their risk of events. However, valid tools are required for accurate and reliable measurement of stroke knowledge. We aimed to systematically review contemporary stroke knowledge assessment tools and appraise their content validity, feasibility, and measurement properties. Methods: The protocol was registered in PROSPERO (CRD42023403566). Electronic databases (MEDLINE, PsycInfo, CINAHL, Embase, Scopus, Web of Science) were searched to identify published articles (01/Jan/2015-01/Mar/2023), in which stroke knowledge was assessed using a validated tool. Two reviewers independently screened titles and abstracts prior to undertaking full-text review. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods guided the appraisal of content validity (relevance, comprehensiveness, comprehensibility), feasibility, and measurement properties. Results: After removing duplicates, the titles and abstracts of 718 articles were screened; 323 reviewed in full; with 42 included (N=23 unique stroke knowledge tools). For content validity, all tools were relevant, two were comprehensive, and six were comprehensible. Validation metrics were reported for internal consistency (n=20 tools), construct validity (n=17 tools), cross-cultural validity (n=15 tools), responsiveness (n=9 tools), reliability (n=7 tools), structural validity (n=3 tools), and measurement error (n=1 tool). The Stroke Knowledge Test met all content validity criteria, with validation data for six measurement properties (n=3 rated 'Sufficient'). Conclusion: Assessment of stroke knowledge is not standardised and many tools lacked validated content or measurement properties. The Stroke Knowledge Test was the most comprehensive, but requires updating and further validation for endorsement as a gold standard.