This paper reports knowledge of stroke risk factors and warning signs for stroke in national community samples of older adults in two neighbouring jurisdictions.
Consistent with the findings of other studies, this survey found that knowledge of stroke warning signs was poor. When presented with a list of warning signs, only one (slurred speech) was identified by more than half of respondents. This finding confirms previous studies, in which dizziness and numbness were identified [5
], and contrasts somewhat with other study findings, where disturbance of vision was found to be the most commonly identified warning sign [11
]. Notably, one in ten could identify no warning signs despite being presented with a list.
Hypertension was identified most frequently as a risk factor for stroke, followed by stress, hypercholesterolaemia, smoking and obesity, findings similar to those reported by Pancioli and colleagues [5
]. However, while hypertension was identified as a stroke risk factor by three-quarters of the respondents in this survey, all other risk factors were identified by less than half with 6% of the sample unable to identify any risk factor. Thus, while this Irish population had greater awareness of stroke risk factors than a younger US sample [8
], albeit in a recognition-type task of identifying factors from a list, there were still considerable gaps in awareness. In addition, factors such as stress and obesity were commonly identified, although they are not established as risk factors for stroke. In contrast, established risk factors such as diabetes and alcohol use were identified by approximately one in ten respondents. Health promotion in this area could provide clarification of the similarities in risk factors for stroke and MI, with more specific information on factors that increase risk specifically for stroke.
The poorer level of awareness of stroke warning signs relative to risk factors is consistent with previous reports [7
] and is cause for concern, given that most of the common early symptoms or signs of stroke were recognised as such by less than half of the older adults surveyed. As such, many older adults in this study may not recognise that they, or a significant other, are having a stroke when symptoms emerge, thus losing vital time in presenting for medical attention. Mass media campaigns to improve public awareness of stroke warning signs have been found to be effective in improving knowledge of warning signs [8
], particularly in younger age groups, although producing little change in knowledge of risk factors [10
]. However, in many studies, these campaigns have been found to be less effective for those aged 65+ [10
], although this is not a universal finding [20
]. People in younger age groups have been shown to be more knowledgeable than older people prior to intervention with public health promotion campaigns and to remain more knowledgeable after the campaign [16
]. However, there is evidence that television based advertising may contribute to a reduction in age-related differences in knowledge of stroke warning signs [21
]. Older people – who are at greater risk for stroke because of their age – are a particularly important population sub-group to target in relation to awareness of stroke warning signs. To date, evidence indicates that stroke awareness campaigns are least effective in increasing knowledge in this older age group. A lack of public awareness in relation to these factors will translate into failure to reduce mortality and morbidity from stroke over time [14
]. In addition, research evidence indicates that increasing public awareness of stroke warning signs does not translate necessarily to improving timely access to medical care [20
]. Almost 40% of this study sample lived in rural areas [22
]. The inability to identify and respond to stroke warning signs in a rural context, where distance from hospital is an added obstacle to accessing rapid medical care, highlights an area of specific need for health promotion intervention.
Limitations of this study include that two different market research companies gathered data in two different jurisdictions, yielding a different response rate in each jurisdiction. It is possible that there was variation between interviewers. However, the research team sought to minimize this possibility by having all interviewers receive the same training and work from a standardised script. The issue of non-response bias was greater in the Republic of Ireland, where the response rate was lower (64%) than in Northern Ireland (89%). The use of a list format in identifying stroke risk factors and warning signs may have resulted in an over-estimate of knowledge of stroke risk factors and warning signs than if open-ended questions had been used. There is evidence that respondents are better at recognition of risk factors and warning signs than they are at identifying them in response to an open-ended ("unaided") question [19
]. Research evidence about stroke knowledge in older populations in other countries is relatively sparse and so comparisons with this study are limited. Also limited is evidence from this survey of the benefits of knowledge, such as impact on recognition and action concerning signs and symptoms of stroke or on changes in risk behaviours (e.g., adopting more healthy lifestyle choices). Such questions cannot be addressed by cross-sectional studies such as this and need more longitudinal study investment.
Reasons for differences in the two jurisdictions are unclear. Neither had a concerted campaign promoting knowledge of stroke in the community at the time of the survey. However, since both groups surveyed have poor records regarding stroke awareness, there is little to be gained from determining why one fared worse than the other. Public campaigns are clearly needed in both jurisdictions. A new campaign (FAST) has been launched by the National Health Service in the UK system, including Northern Ireland. Plans are underway to provide a similar programme in the Republic of Ireland. This survey thus provides a useful baseline for these programmes.