Public Awareness of Stroke Recognition, Risk factors and Access to Appropriate Treatment: A Hospital-based Cross-sectional Survey from a Tertiary Referral Centre in Southern India

Introduction : Despite recent advances in treatment, awareness regarding stroke remains low. Only a fraction of eligible patients reach hospital within the window period for thrombolysis. Aim: To assess the public awareness of stroke symptoms, risk factors and access to treatment which will help to design effective and targeted stroke education programs. Materials and Methods: This cross-sectional hospital-based survey was conducted in the neurology outpatient department in Government Medical College, Trivandrum, Kerala, India from October 2020 to March 2021. Adult relatives of patients, attending the neurology outpatient department, were included in the study. Relatives of patients who had current or previous stroke and individuals who had a personal history of stroke were excluded. Participants had to fill out a structured study questionnaire adapted to local socio-cultural practices assessing awareness of organ involved in stroke, warning symptoms, risk factors and treatment seeking behaviour. Descriptive analysis, Chi-square tests and logistic regression were used to analyse awareness about organ involved in stroke, signs and symptoms, risk factors and treatment for stroke. Results: A total of 700 completed questionnaires were collected from the respondents. More than 80% of respondents belonged to the low income group and were from rural areas. Overall, 43.3% of the subjects could not identify the brain as the organ identified in stroke, and 28.9% were able to identify only one symptom of stroke. The most common warning symptom of stroke recognised was difficulty in speaking (59.4%). Hypertension was the most common risk factor for stroke identified (77.7%). Total 31.6% were able to identify only one risk factor for stroke, and 82.4% patients were aware that stroke requires immediate treatment with majority preferring to consult the nearest doctor. Only 15.9% of respondents were aware of the stroke helpline. Only 55.9% of respondents were aware about ambulance services in their region. Conclusion: This study demonstrated low awareness regarding common risk factors like diabetes and smoking on increasing stroke risk. Knowledge regarding stroke helplines, ambulance services and need to rush to hospital emergency department was low. Public stroke education programs should focus on reducing the knowledge gap in these areas.