Knowledge of Stroke and Planned Response among Patients Living with Diabetes Mellitus and Hypertension in a Primary Care Unit

Abstract

Background: Stroke is an important worldwide public health problem. Lack of knowledge in prevention methods, warning symptoms and planned response of acute stroke are associated with a longer prehospital time, which affect the morbidity and mortality of patients.Objective: The primary objective was to assess knowledge of stroke prevention methods and warning symptoms among patients living with diabetes and/or hypertension. The secondary objectives were to define planned responses when suspecting acute stroke, and identify associated factors with stroke knowledge scores and planned responses.Materials and Methods: A cross-sectional study was conducted in patients living with diabetes and/or hypertension, who had continuous follow up at the primary care unit of Songklanagarind Hospital. The outcomes of this study were assessed by a questionnaire, which was developed from a literature review.Results: This study included 312 participants. Median age was 64.0 years (Q1, Q3 = 58.0, 71.0), and 59.6% were female. Median score of knowledge of stroke prevention methods were 9, from 12 points (Q1, Q3 = 8, 10), and warning symptoms were 7, from 10 points (Q1, Q3 = 6, 8); with 80.1% of them knowing all 3 warning symptoms, according to the acronym FAST. Only 22.8% of participants would go to the hospital immediately, by calling an ambulance when they experienced symptoms of a suspected acute stroke. Participants who had income had statistically significant higher knowledge of stroke prevention methods; while participants under 60 years of age, who had a longer duration of diagnosed diabetes mellitus were associated with appropriate planned responses when suspecting acute stroke.Conclusion: Patients living with diabetes mellitus and hypertension, who are at a high risk for developing cardiovascular diseases, still do not have enough knowledge about acute stroke and had little concern about developing a stroke; especially the elderly and those with a short duration of having been diagnosed with diabetes mellitus.

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

“…Of the 23 included tools, 18 were developed or validated in English language, and a further four had English translations available from the study article or authors. One tool [20] was translated from Thai to English by a bilingual expert for this review. The Stroke Action Test [21], Stroke Knowledge Test [22], and Stroke Preparedness Vignettes [23] were the most commonly used tools in the published literature, post-2015.…”

“…The Stroke Knowledge Assessment Tool [45] and the Stroke Knowledge Test [22] fulfilled our comprehensiveness criteria and covered ≥85% (7/8) of the concepts deemed important for assessing stroke knowledge. In terms of comprehensibility, seven tools fulfilled at least 4/5 criteria related to instruction wording, item wording, response option wording, grammar and spelling, and ease of reading [17‒20, 22, 23, 28]. The Knowledge of Stroke Risk survey [28] and Salam 2022 tool [17] fulfilled all five comprehensibility criteria.…”

“…Notably, Stroke Knowledge Test [22] scores were shown to improve following exposure to stroke information (vs. non-stroke information), and were greater among people with (vs. without) a family member with stroke. In contrast, an inverse relationship was observed in several studies, whereby having pre-existing stroke, risk factors for stroke, or knowing someone with stroke, resulted in poorer stroke knowledge [20, 23, 25, 27, 28, 32, 55].…”

“…Evidence on test-retest reliability was available for seven tools (Table 3). Three tools had an intra-class correlation coefficient ≥0.7 [20,25,45], one had a high Spearman's correlation coefficient ≥0.7 [24], and one had a Pearson's correlation coefficient ≥0.7 [22]. The Chinese Stroke Action Test had the greatest test-retest reliability metric of 0.86 [42].…”