Public Perception of Stroke Warning Signs and Knowledge of Potential Risk Factors.

Pancioli AM, Broderick J, Kothari R, et al (Departments of Emergency Medicine, Neurology, and Environmental Health, and the Institute for Policy Research, University of Cincinnati, Cincinnati, Ohio), JAMA. 1998;279:1288-1292.

The greatest opportunities for effective stroke prevention and treatment lie in controlling the risk factors for stroke and decreasing the time between the onset of stroke and hospital arrival. These factors depend on public knowledge of prodromal signs and the risk factors for stroke. To assess this public knowledge, the researchers conducted a telephone survey of randomly selected households in the Greater Cincinnati and northern Kentucky regions. According to 1990 data [Yom the US Bureau of the Census, the study population was similar to that of the United States in general in terms of economic status, age, sex, and proportion of African Americans.

Random digit telephone sampling identified 2,642 demographically eligible respondents, and the researchers completed 1,880 interviews (71.2% response rate). The 29 survey questions used were designed to elicit the following information: (1) lists of stroke warning signs, risk factors, and sources of information; (2) whether the respondent had any risk factors for stroke; and (3) demographic information. The questions concerning the respondent's risk factors were similar to those of the third National Health and Nutrition Examination Survey. A pretest determined the reliability of the survey tool for the study population.

The 5 warning signs of stroke identified by the National Institute of Neurological Disorders and Stroke were considered acceptable answers. These 5 warning signs are (1) sudden weakness or numbness in the face, arm, or leg; (2) sudden dimness or loss of vision, particularly in one eye; (3) sudden severe headache with no known cause; (4) sudden difficulty speaking or understanding speech; and (5) unexplained dizziness, unsteadiness, or sudden falls, especially with any of the other signs. Fifty-seven percent of the respondents correctly listed 1 warning sign, 28% listed 2 or more signs, and 8% listed 3. Age was significantly associated with knowledge of stroke warning signs; fewer persons 75 years or older listed 1 correct warning sign (47%) compared with those respondents younger than 75 years (60%).

Risk factors for stroke that were considered acceptable answers were developed in consultation with Jack Whisnant, MD. These risk factors include hypertension, stress, smoking, poor eating, and cholesterol level. The survey results show that knowledge of stroke risk factors was significantly associated with age, sex, race, education, and history of hypertension. The researchers found that persons who were female, Caucasian, highly educated, or younger than 75 years or who had a history of hypertension had increased knowledge of stroke risk factors.

The subjects indicated that, in addition to their physicians, their primary sources of information regarding stroke were television, newspapers, and magazines. Among African Americans and persons 75 years or older, the most commonly cited source of information about stroke was "doctors." However, people with the greatest risk for stroke--those more than 75 years of age--were the least knowledgeable about stroke warning signs and risk factors. The authors encouraged primary care physicians to expand their patient education about stroke, particularly for persons with increased risk. They also suggested focusing educational efforts through the mass media.

Sondra E Dunkle, EdD, PT Consultant Pocatello, Idaho