Abstract
Background:
In Saudi Arabia, stroke is a significant cause of illness and mortality progressively becoming more serious. Studies have indicated that modifiable cardiovascular risk factors are responsible for a significant portion of the burden caused by stroke, which could be targeted through public awareness.
Objective:
We evaluated the level of knowledge about stroke among the general population of the Al-Ahsa, Saudi Arabia. Furthermore, association between stroke level of knowledge and sample characteristics was analyzed.
Methods:
This was a cross-sectional study conducted from February 22, 2023, to March 22, 2023, using a convenience sampling technique. An electronic Google Forms survey was distributed through social media, to reach the maximum number of participants.
Results:
This study included a total of 500 participants from Al-Ahsa, Saudi Arabia. Forty-three percentage of participants were male, while 57% were females. Most participants were of a younger age, where 66.6% were 18–39 years. The most recognized stroke symptom, risk factor, and stroke treatment center were dizziness/vertigo (91%), hypertension (97%), and King Fahad Hospital, respectively. Those with higher education possessed a greater level of stroke-related knowledge than other demographic groupings.
Conclusion:
The general public of Al-Ahsa demonstrated a high level of knowledge about stroke symptoms (82.6%), risk factors (90%), and treatment facilities (80%). However, it was evident that the general public failed to recognize the proper course of action in the event of a stroke.
Keywords: Al-Ahsa, neurology, public knowledge, Saudi Arabia, stroke
Résumé
Contexte:
En Arabie Saoudite, les accidents vasculaires cérébraux sont une cause importante de maladie et de mortalité, qui s’aggrave progressivement. Des études ont indiqué que les facteurs de risque cardiovasculaires modifiables sont responsables d’une part importante du fardeau causé par les accidents vasculaires cérébraux, qui pourraient être ciblés par la sensibilisation du public.
Objectif :
Nous avons évalué le niveau de connaissances sur les accidents vasculaires cérébraux au sein de la population générale d’Al-Ahsa, en Arabie Saoudite. De plus, l’association entre le niveau de connaissance de l’AVC et les caractéristiques de l’échantillon a été analysée.
Méthodes :
Il s’agit d’une étude transversale menée du 22 février 2023 au 22 mars 2023, en utilisant une technique d’échantillonnage de convenance. Une enquête électronique Google Forms a été diffusée sur les réseaux sociaux afin d’atteindre le nombre maximum de participants.
Résultats :
Cette étude a inclus un total de 500 participants d’Al-Ahsa, en Arabie Saoudite. Quarante-trois pour cent des participants étaient des hommes, tandis que 57 % étaient des femmes. La plupart des participants étaient plus jeunes, 66,6 % ayant entre 18 et 39 ans. Les symptômes d’accident vasculaire cérébral, les facteurs de risque et les centres de traitement des accidents vasculaires cérébraux les plus reconnus étaient respectivement les étourdissements/vertiges (91 %), l’hypertension (97 %) et l’hôpital King Fahad. Les personnes ayant fait des études supérieures possédaient un niveau de connaissances plus élevé sur les accidents vasculaires cérébraux que les autres groupes démographiques.
Conclusion :
Le grand public d’Al-Ahsa a démontré un niveau élevé de connaissances sur les symptômes de l’AVC (82,6 %), les facteurs de risque (90 %) et les installations de traitement (80 %). Cependant, il était évident que le grand public ne reconnaissait pas la marche à suivre en cas d’accident vasculaire cérébral.
Mots-clés: Al-Ahsa, neurologie, connaissance publique, Arabie Saoudite, accident vasculaire cérébral
INTRODUCTION
A stroke is an abrupt disturbance in cerebral circulation causing neurological deficits.[1] The two main types of strokes, ischemic and hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, are prominent causes of mortality and disability globally.[2] Around 15 million people in the world suffer from stroke yearly.[3] Physical, psychological, social, and cognitive skills may be impaired by stroke depending on the type, severity, and parts of the brain that are affected. The most frequent risk factors are arterial hypertension (HTN), diabetes mellitus, smoking, microvascular rupture, hyperlipidemia, aging, sickle cell disease, and viral infections, including human immunodeficiency virus and acquired immune deficiency syndrome.[4,5,6] Studies have indicated that modifiable cardiovascular risk factors are responsible for a significant portion of the burden caused by stroke.[7] Stroke prevention focuses on reported modifiable risk factors, including HTN, smoking, diet, and physical inactivity.[8] In addition, numerous high-risk stroke patients are unaware of their risk.[9] Increased community knowledge is one of the most effective preventative interventions and should be the goal of awareness programs. Thus, a full assessment of the population’s knowledge about stroke and the triggers that are associated with stroke is required.[10,11] An aging population and declining deaths from stroke are expected to increase the prevalence of stroke by 3.4 million between 2012 and 2030.[8] However, stroke is not uncommon among the young.[12] Due to the unawareness of stroke risks, younger patients are less likely to seek help for stroke-like symptoms. Even after arriving at the emergency department, a stroke diagnosis is frequently delayed or missed because stroke is still considered an age-related disease, and because young people may lack vascular risk factors that would raise suspicion of stroke.[13] In Saudi Arabia, acute stroke is common, with an incidence of 30–40/100,000 and a prevalence of 186/100,000 per year.[14] The lack of knowledge about stroke is a major issue because awareness can help recognize strokes early. Furthermore, to the best of our knowledge, there have been few published studies about such issues.[15] Therefore, we sought to evaluate the level of knowledge about stroke among the general population of Al-Ahsa, Saudi Arabia.
METHODS
This cross-sectional study was conducted from the February 22, 2023, to March 22, 2023, using a convenience sampling technique. An electronic Google Forms survey was distributed through social media to reach maximum number of participants for the purpose of evaluating the level of knowledge about stroke among the general population of Al-Ahsa, Saudi Arabia. Furthermore, association between stroke level of knowledge and sample characteristics were analyzed.
The inclusion criteria of the study consisted of (1) general population living in Al-Ahsa, Saudi Arabia, and (2) participants who aged 18 years or older. Subjects who did not fulfill the inclusion criteria, or refused to participate in the study, were directly excluded from the study. A previously used Arabic questionnaire was utilized to execute the study objectives.[16] The questionnaire consisted of three essential divisions: (A) ten questions regarding the participants’ characteristics and demographic data, (B) five questions investigating knowledge about symptoms, risk factors, and general information about stroke, and (C) two questions that aimed to assess the awareness of centers that are capable of treating stroke patients.
Subjects who were able to answer at least three correct stroke symptoms were considered to have good knowledge within that category. Similarly, those who reported three correct risk factors were regarded as possessing good knowledge in the risk factors category, and individuals who were able to identify at least one stroke treatment center were classified as having good knowledge of the stroke treatment centers. Some questions included only one correct answer, and subjects were considered to have good stroke knowledge based on their selection of that answer exclusively. Participants who did not fulfill any of the previously mentioned conditions were described as having poor knowledge of the same assessed topic.
A sample size formula for a single proportion was used to calculate the minimum number of required participants.[17] Assuming a sample proportion of 50%, with a 95% confidence interval, and a sample error of 5%, the sample size was estimated to be 385 subjects. The data were analyzed using the IBM Statistical Package for the Social Sciences (SPSS) Version 27. Descriptive statistics were used to calculate the frequencies. An inference analysis compared the different variables using a Chi-square test and Fisher’s exact test as suitable. P = 0.05 was considered as the cutoff point for the level of significance.
This study is ethically approved by the ethical committee of the deanship of scientific research at King Faisal University, Ref no. KFU-REC-2023-FEB-ETHICS580. Participation in the study was voluntary. The purpose of the study and the expected time were reported, and online consent was obtained before completing the survey.
RESULTS
A total of 503 responses were received through the Google Form survey. Three subjects were excluded due to their refusal to participate in the study. The final number of included participants was 500 subjects, which represents an acceptance rate of 99.4% of the total responses.
Sociodemographic data
As shown in Table 1, this study included a total of 500 participants from Al-Ahsa, Saudi Arabia. There was approximately equal participation of females and males in the study, where 215 (43%) of participants were males and 285 (57%) were females. Most participants were of a younger age, with 333 (66.6%) aged 18–39 years, 137 (27.4%) aged 40–59 years, and 30 (6%) aged 60 years and above. The social status of participants was as follows: 238 (47.6%) were single, 237 (47.4%) were married, 8 (1.6%) were widowed, and 17 (3.4%) were separated. Regarding nationality, almost all participants (497; 99.4%) were Saudi and 3 (0.6%) were non-Saudis. The education of the participants was as follows: 2 (0.4%) were not educated beyond elementary school, 9 (1.8%) had a middle school level of education, 129 (25.8%) had a high school level of education, 39 (7.8%) had a diploma after high school, where 288 (57.6%) had a bachelor’s degree and 33 (6.6%) went through postgraduate studies. Regarding the smoking habits of the participants, 52 (10.4%) were smokers and 448 (89.6%) were nonsmokers. Regarding chronic diseases, 32 (6.4%) suffered from diabetes, while 468 (93.6%) did not. Furthermore, 53 (10.6%) participants suffered from HTN, while 447 (89.4%) were free from HTN. With regard to previous personal or relative incident of stroke, only 7 (1.4%) have had an experience, while 493 (98.6%) did not. Furthermore, 56 (11.2%) of all participants had accompanied a relative as they were having a stroke and 444 (88.8%) did not.
Table 1.
The participants demographic data and past medical history
| Sociodemographic data | Categories | n (%) |
|---|---|---|
| Gender | Male | 215 (43) |
| Female | 285 (57) | |
| Age (years) | 18–39 | 333 (66.6) |
| 40–59 | 137 (27.4) | |
| 60 and above | 30 (6) | |
| Social status | Married | 237 (47.4) |
| Single | 238 (47.6) | |
| Widowed | 8 (1.6) | |
| Separated | 17 (3.4) | |
| Nationality | Saudi | 497 (99.4) |
| Non-Saudi | 3 (0.6) | |
| Education degree | Elementary school | 2 (0.4) |
| Middle school | 9 (1.8) | |
| High school | 129 (25.8) | |
| Diploma (after high school) | 39 (7.8) | |
| Bachelor | 288 (57.6) | |
| Postgraduate studies | 33 (6.6) | |
| Are you a smoker? | Yes | 52 (10.4) |
| No | 448 (89.6) | |
| Do you suffer from diabetes? | Yes | 32 (6.4) |
| No | 468 (93.6) | |
| Do you suffer from hypertension? | Yes | 53 (10.6) |
| No | 447 (89.4) | |
| Did you or any of your relatives suffer a stroke? | Yes | 7 (1.4) |
| No | 493 (98.6) | |
| Have you accompanied any of your relatives as they were having a stroke? | Yes | 56 (11.2) |
| No | 444 (88.8) |
Participants’ level of knowledge regarding stroke symptoms, risk factors, and stroke centers located in Al-Ahsa
Table 2 demonstrates the number of correct answers from participants when asked about stroke symptoms and risk factors. When participants were challenged with questions about stroke symptoms, 10 participants (2%) were not able to correctly identify any stroke symptoms, 41 (8.2%) were able to identify one stroke symptom, 36 (7.2%) were able to identify two, 55 (11%) were able to identify three, 64 (12.8%) were able to identify four, 94 (18.8%) were able to identify five, 93 (18.6%) were able to identify six, and 107 (21.4%) were able to identify all stroke symptoms mentioned. In addition, when participants were asked about risk factors, 31 participants (6.2%) were not able to identify any of the risk factors mentioned, 19 (3.8%) were able to identify one, 41 (8.2%) were able to identify two, 27 (5.4%) were able to identify three, 40 (8%) were able to identify four, 42 (8.4%) were able to identify five, 55 (11%) were able to identify six, 60 (12%) were able to identify eight, 73 (14.6%) were able to identify nine, 49 (9.8%) were able to identify ten, and 63 (12.6%) were able to identify eleven. Finally, when participants were asked about centers that contain stroke care units and provide treatments, 100 participants (20%) could not identify any of the stroke centers mentioned, 282 (56.4%) were able to identify one, and 118 (23.6%) were able to identify both centers.
Table 2.
Number of correct answers by participants when asked about stroke symptoms, risk factors, and stroke centers
| Sociodemographic data | Categories | n (%) | Cumulative, n (%) |
|---|---|---|---|
| Number of correct answers regarding stroke symptoms in the general population | Zero | 10 (2) | 10 (2) |
| One | 41 (8.2) | 51 (10.2) | |
| Two | 36 (7.2) | 87 (17.4) | |
| Three | 55 (11) | 142 (28.4) | |
| Four | 64 (12.8) | 206 (41.2) | |
| Five | 94 (18.8) | 300 (60) | |
| Six | 93 (18.6) | 393 (78.6) | |
| Seven | 107 (21.4) | 500 (100) | |
| Number of correct answers regarding stroke risk factors in the general population | Zero | 31 (6.2) | 31 (6.2) |
| One | 19 (3.8) | 50 (10) | |
| Two | 41 (8.2) | 91 (18.2) | |
| Three | 27 (5.4) | 118 (23.6) | |
| Four | 40 (8) | 158 (31.6) | |
| Five | 42 (8.4) | 200 (40) | |
| Six | 55 (11) | 255 (51) | |
| Eight | 60 (12) | 315 (63) | |
| Nine | 73 (14.6) | 388 (77.6) | |
| Ten | 49 (9.8) | 437 (87.4) | |
| Eleven | 63 (12.6) | 500 (100) | |
| Number of correct answers regarding stroke treatment centers in Al-Ahsa in the general population | Zero | 100 (20) | 100 (20) |
| One | 282 (56.4) | 382 (76.4) | |
| Two | 118 (23.6) | 500 (100) |
Figure 1 demonstrates that the most recognized stroke symptom was dizziness/vertigo (91%), followed by severe headache (79%), slurred speech (dysarthria or aphasia) (73%), problems with vision (visual alterations) (71%), numbness or prickling sensation/paresthesia (58%), weakness on one side of the body (hemiparesis) (52%), and facial weakness/fallen face (facial palsy) (39%). Cough was the most incorrectly identified stroke symptom with (55%), followed by shortness of breath (48%), chest pain (36%), nausea and vomiting (26%), swollen legs (14%), abdominal ache (5%), diarrhea (3%), and skin rash (3%).
Figure 1.
Frequency of stroke symptoms identification. (C) Correct answer
Figure 2 shows that the most recognized stoke risk factor was high blood pressure (97%), followed by high blood cholesterol (84%), heart rhythm disorders (79%), diabetes (76%), previous stroke (68%), family history of stroke (61%), obesity (49%), smoking (49%), increasing age (47%), sedentary lifestyle (42), and heavy alcohol consumption (39%). In addition, varicose veins was the most incorrectly identified stroke risk factor (22%), followed by asthma (19%), Alzheimer’s disease (12%), constipation (8%), fungal infection (7%), gastric ulcers (6%), kidney stones (6%), taking multivitamins (6%), prostatic hypertrophy (5%), osteoporosis (4%), and poor hygiene (3%).
Figure 2.
Frequency of risk factor identification. (C) Correct answer
As shown in Table 3, 381 (76.2%) subjects believed that stroke could lead to permanent disabilities, while 13 (2.6%) did not and 106 (21.2%) did not know. Also, the majority of participants (79.8%) thought that stroke is curable, and (20.2%) did not. When asked about their immediate action if they suffered from a stroke, the most reported response was to go to a hospital immediately (39.2%), followed by call ambulance (34.2%), don’t know (10.4%), tell someone (e.g., a friend, family member, or neighbor) (8.6%), call physician (4.4%), wait and see (e.g., lie down, try to relax, and ignore it) (2.4%), and least one reported self-medication (e.g., aspirin or a headache medication) (0.8%). Moreover, subjects were asked about the determent factor when choosing a hospital to treat a patient with stroke, and the highest percentage was the presence of appropriate treatment for stroke (35.4%), followed by close geographical location (27.8%), a good reputation (23.6%), and the hospital size (13.2%).
Table 3.
Knowledge about general information of stroke
| Question | Response | n (%) |
|---|---|---|
| Do you think a stroke could lead to permanent disability? | Yes | 381 (76.2) |
| No | 13 (2.6) | |
| I don’t know | 106 (21.2) | |
| Do you think a stroke is treatable? | Yes | 399 (79.8) |
| No | 101 (20.2) | |
| What is the first thing that you would do if you thought that you or someone you know were having a stroke? | Wait and see (e.g., lie down, try to relax, and ignore it) | 12 (2.4) |
| Tell someone (e.g., a friend, family member, or neighbor) | 43 (8.6) | |
| Self-medication (e.g., aspirin or a headache medication) | 4 (0.8) | |
| Call physician | 22 (4.4) | |
| Go to hospital immediately | 196 (39.2) | |
| Call ambulance (C) | 171 (34.2) | |
| Don’t know | 52 (10.4) | |
| In case of a stroke emergency, which of the following factors will determine your selection of hospitals? | Close geographical location | 139 (27.8) |
| Size of hospital | 66 (13.2) | |
| Good reputation | 118 (23.6) | |
| Presence of appropriate treatment for stroke (C) | 177 (35.4) |
(C) Correct answer
Figure 3 shows that the most recognized stoke center was King Fahad Hospital (75%), followed by Almoosa Hospital (29%). However, Prince Saud Bin Jalawy Hospital was the most incorrectly identified stroke center (41%), followed by King Abdulaziz bin Saud hospital for National Guard (41%), Alahsa Hospital (21%), King Faisal General Hospital (20%), Omran Hospital (6%), all of the above (4%), and Ayun Hospital (1%).
Figure 3.
Frequency of stroke centers identification (C) Correct answer
Population characteristics and their association with the level of knowledge demonstrated by participants
Table 4 shows the population characteristics and their association with identifying symptoms, risk factors, and centers that provide stroke care. Regarding the identification of symptoms, social status and education level showed a significant association with the ability to identify three or more stroke symptoms. Superiority in education level was correlated with more knowledge in general. Nevertheless, the highest ratio of correct identification was achieved by bachelor’s degree holders. In terms of the identification of risk factors, only gender showed a significant association with the ability to identify three risk factors or more, where females (52.8%) attained better responses than males (37.2%).
Table 4.
Association between symptoms, risk factors, and identification of stroke treatment centers based on population characteristics
| Factor | Category | Identify symptoms of stroke (≥3) |
Identify risk factors of stroke (≥3) |
Identify hospitals to treat stroke (≥1) |
||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Good, n (%) | Poor, n (%) | P | Good, n (%) | Poor, n (%) | P | Good, n (%) | Poor, n (%) | P | ||
| Gender | Male | 170 (34) | 45 (9) | 0.075 | 186 (37.2) | 29 (5.8) | 0.034ο | 174 (34.8) | 41 (8.2) | 0.735 |
| Female | 243 (48.6) | 42 (8.4) | 264 (52.8) | 21 (4.2) | 226 (45.2) | 59 (11.8) | ||||
| Age (years) | 18–39 | 284 (56.8) | 49 (9.8) | 0.081 | 304 (60.8) | 29 (5.8) | 0.315† | 262 (52.4) | 71 (14.2) | 0.341† |
| 40–59 | 106 (21.2) | 31 (6.2) | 119 (23.8) | 18 (3.6) | 111 (22.2) | 26 (5.2) | ||||
| 60 and above | 23 (4.6) | 7 (1.4) | 27 (5.4) | 3 (0.6) | 27 (5.4) | 3 (0.6) | ||||
| Social Status | Married | 184 (36.8) | 53 (10.6) | 0.046†,ο | 207 (41.4) | 30 (6) | 0.067† | 197 (39.4) | 40 (8) | 0.273† |
| Single | 207 (41.4) | 31 (6.2) | 222 (44.4) | 16 (3.2) | 185 (37) | 53 (10.6) | ||||
| Widowed | 7 (1.4) | 1 (0.2) | 7 (1.4) | 1 (0.2) | 6 (1.2) | 2 (0.4) | ||||
| Separated | 15 (3) | 2 (0.4) | 14 (2.8) | 3 (0.6) | 12 (2.4) | 5 (1) | ||||
| Nationality | Saudi | 412 (82.4) | 85 (17) | 0.080† | 447 (89.4) | 50 (10) | 1.000† | 399 (79.8) | 98 (19.6) | 0.103† |
| Non-Saudi | 1 (0.2) | 2 (0.4) | 3 (0.6) | 0 | 1 (0.2) | 2 (0.4) | ||||
| Education | Elementary school | 1 (0.2) | 1 (0.2) | 0.017†,ο | 2 (0.4) | 0 | 0.550† | 2 (0.4) | 0 | 0.014†,ο |
| Middle school | 6 (1.2) | 3 (0.6) | 7 (1.4) | 2 (0.4) | 7 (1.4) | 2 (0.4) | ||||
| High school | 111 (22.2) | 18 (3.6) | 116 (23.2) | 13 (2.6) | 97 (19.4) | 32 (6.4) | ||||
| Diploma (after high school) | 26 (5.2) | 13 (2.6) | 35 (7) | 4 (0.8) | 27 (5.4) | 12 (2.4) | ||||
| Bachelor | 244 (48.8) | 44 (8.8) | 262 (52.4) | 26 (5.2) | 245 (49) | 43 (8.6) | ||||
| Postgraduate studies | 25 (5) | 8 (1.6) | 28 (5.6) | 5 (1) | 22 (4.4) | 11 (2.2) | ||||
| Smoking | Yes | 41 (8.2) | 11 (2.2) | 0.562 | 49 (9.8) | 3 (0.6) | 0.461† | 42 (8.4) | 10 (2) | 1.000 |
| No | 372 (74.4) | 76 (15.2) | 401 (80.2) | 47 (9.4) | 358 (71.6) | 90 (18) | ||||
| DM | Yes | 26 (5.2) | 6 (1.2) | 1.000 | 29 (5.8) | 3 (0.6) | 1.000† | 26 (5.2) | 6 (1.2) | 1.000 |
| No | 387 (77.4) | 81 (16.2) | 421 (84.2) | 47 (9.4) | 374 (74.8) | 94 (18.8) | ||||
| HTN | Yes | 43 (8.6) | 10 (2) | 0.848 | 49 (9.8) | 4 (0.8) | 0.636† | 48 (9.6) | 5 (1) | 0.045ο |
| No | 370 (74) | 77 (15.4) | 401 (80.2) | 46 (9.2) | 352 (70.4) | 95 (19) | ||||
| Did you or any of your relatives suffer a stroke? | Yes | 4 (0.8) | 3 (0.6) | 0.105† | 6 (1.2) | 1 (0.2) | 0.524† | 5 (1) | 2 (0.4) | 0.631† |
| No | 409 (81.8) | 84 (16.8) | 444 (88.8) | 49 (9.8) | 395 (79) | 98 (19.6) | ||||
| Have you accompanied any of your relatives as they were having a stroke? | Yes | 43 (8.6) | 13 (2.6) | 0.260 | 52 (10.4) | 4 (0.8) | 0.636† | 47 (9.4) | 9 (1.8) | 0.484 |
| No | 370 (74) | 74 (14.8) | 398 (79.6) | 46 (9.2) | 353 (70.6) | 91 (18.2) | ||||
οSignificant P value, †Fisher’s exact test was used when the cell counts were <5. DM=Diabetes mellitus, HTN=Hypertension
Concerning the identification of stroke treatment centers, higher education level and no history of HTN showed a significant association with the ability to identify at least one stroke center.
DISCUSSION
Stroke directly affects health systems, imposing substantial costs and is also seen as a global public health issue since it causes severe disability, functional restrictions, and a reduction in quality of life.[18] In Saudi Arabia, stroke is a significant cause of illness and mortality that is progressively getting more serious.[19] Evaluation of the knowledge about stroke in the general population is extremely vital as it may prevent stroke development, limit complications, and help in achieving a better quality of life.
Knowledge about stroke symptoms
Fortunately, this study demonstrated that the participants have good knowledge about stroke symptoms where 82.6% of the participants were able to identify at least three stroke symptoms, 15.7% only identified one or two symptoms, and 2% did not identify any. Overall, these results are in accordance with a Lebanese study that showed a highly satisfactory level of stroke symptom knowledge, with 93% of their sample identifying at least three correct answers.[16] Nonetheless, a similar study that assessed the knowledge about symptoms of stroke conducted in Taif city, Saudi Arabia, and included a total of 3456 subjects reported that only 300 (8.7%) were classified as having good knowledge, 746 (21.6%) as having fair knowledge, and 2410 (69.7%) as having poor knowledge.[20] The discrepancy between these studies is dramatically large, although both studies’ demographic data shared a similar composition and overall association patterns. This major difference in results may be due to variations in the construction of the assessment method, as ours included separate sections with more available options.
Malaeb et al. reported that the most recognized stroke symptom was sudden difficulty in speaking, followed by sudden weakness or numbness, loss of consciousness or fainting, sudden blindness or double vision, sudden severe headache, sudden dizziness, and the sudden onset of memory loss.[16] However, this current study demonstrated that the most recognized stroke symptom was dizziness/vertigo (91%), followed by severe headache (79%), slurred speech (dysarthria or aphasia) (73%), problems with vision (visual alterations) (71%), and numbness or prickling sensation/paresthesia. The least wrongly identified symptoms were diarrhea (3%) and skin rash (3%) [Figure 1].
Knowledge about stroke risk factors
Regarding the identification of stroke risk factors, only 6.3% of participants were not able to identify any stroke risk factors, which shows a better level of knowledge compared to a study conducted in Southwest India by Pandian et al., where 20.7% of participants failed to recognize a single stroke risk factor. Our results are also consistent with a study in Riyadh, Saudi Arabia, in which 10% of the respondents could not identify any risk factors of stroke.[21] This discrepancy could be explained by the fact that the majority of our participants are of higher education levels, as reported in a recent Saudi study.[20] In the study by Malaeb et al. in Lebanon, 26.1% of the participants were able to identify all stroke risk factors.[16] The percentage reported in this study is slightly higher than ours, as only 12.6% of our participants managed to correctly identify all risk factors.
This study revealed that the three most correctly identified risk factors among our population were HTN, hypercholesteremia, and heart rhythm disorders [Figure 2]. This is similar to the Lebanese study conducted by Khalil and Lahoud where the most recognized risk factor was HTN, followed by stress and smoking.[22] However, an Australian study showed that high blood pressure was among the least identified risk factors, where only 31.8% of their sample identified it, compared to our study, where the great majority (97%) identified it as a risk factor.[10]
Knowledge about general information of stroke
According to Table 3, 381 participants (76.2%) believed that having a stroke could result in permanent disability, while 13 (2.6%) did not think so, and 106 people (21.2%) were unsure. Similarly, the Lebanese study reported that the majority of their participants thought that a stroke could result in such an outcome.[16] When asked what they would do in the event of a stroke, the majority of participants said they would go to the hospital right away (39.2%), followed by calling an ambulance (34.2%), saying they did not know (10.4%), and saying they would not know what to do. This result is considered extremely low when compared to similar studies that investigated people’s actions toward acute stroke.[23]
Knowledge about stroke treating centers in Al-Ahsa
This population demonstrated that (80%) of the participants were able to identify at least one of the two facilities that are equipped to manage stroke patients, with King Fahad Hospital being the most recognized [Figure 3]. This result is highly reassuring, as early management is the strongest predictor for stroke prognosis outcomes.[24] Furthermore, subjects who were suffering from HTN were significantly more aware of stroke treatment centers when compared to nonhypertensive participants [Table 4].
Association between symptoms, risk factors, and identification of stroke centers based on population characteristics
A higher education level among participants correlated with better identification of stroke symptoms. This result is in agreement with previous studies by Yoon et al. and Pancioli et al.[10,25] However, a study conducted in South Korea by Kim et al. showed that education level did not significantly impact stroke awareness. In the same study, however, people of higher education levels had more knowledge about thrombolysis as a treatment modality for stroke.[26]
No predictors of better identification of stroke risk factors were found in our study except gender, where females displayed a higher level of knowledge about stroke risk factors. This result is similar to the study by Malaeb et al.[16] However, previous studies in Turkey and Brazil showed no gender differences.[27,28]
CONCLUSION
In conclusion, the public population of Al-Ahsa governance showed an overall good knowledge about symptoms (82.6%), risk factors (90%), and treatment centers (80%) of stroke. However, the public appeared to be lacking knowledge about correct emergency action in case of stroke. Individuals with higher education levels were more knowledgeable than other demographic groups. Some studies in Saudi Arabia revealed a major disparity in results. Therefore, further national studies with a wider sample size that is more representative of the population and unified in assessment are needed. In addition, awareness campaigns that enhance the level of education and knowledge about stroke and accurate, rapid responses are warranted.
Limitations
This study has a few limitations that need to be taken into consideration. First, as the majority of our participants are from a higher socioeconomic and education level, our study might show biased results with an under-representation of certain rural areas, which hinders our ability to generalize our results as representative of the whole Al-Ahsa population. This difference in demographics could be attributed to the fact that we used convenience sampling with recruitment through social media platforms which may have participated in having you more participants who are of the young age groups and familiar with using social media. It also, could had an under-representation effect of the elderly population who are the ones most at risk for stroke. Second, the method of data collection was through an online survey, which means that answers were self-reported, and thus verifying participants’ claims was not possible. Finally, as our questionnaire contained questions that were close-ended, this might have contributed to a recall bias that overestimated the level of stroke knowledge among our population.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
We would like to express our deepest gratitude to all the authors and researchers whose significant contributions in the form of previously published papers and studies have made this work possible. The breadth and depth of the insights presented in their work have been instrumental in shaping our research. Their meticulous efforts and pioneering work in this field have provided a solid foundation upon which our study stands. Their contributions to the body of knowledge surrounding this topic are not only appreciated but crucial for the advancement of this field of study. It is our honor to build upon their work and continue the dialogue that they have so capably initiated.
REFERENCES
- 1.Frizzell JP. Acute stroke: Pathophysiology, diagnosis, and treatment. AACN Clin Issues. 2005;16:421–40. doi: 10.1097/00044067-200510000-00002. [DOI] [PubMed] [Google Scholar]
- 2.Campbell BC, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019;5:70. doi: 10.1038/s41572-019-0118-8. [DOI] [PubMed] [Google Scholar]
- 3.WHO EMRO Stroke, Cerebrovascular Accident | Health Topics. Available from: https://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html. [Last accessed 2023 Jan 22] [Google Scholar]
- 4.Al Zahrani FM, Al Amri AA, Al Shehri J. Awareness of Stroke among Teachers in Asser Region, Saudi Arabia. La Prensa Medica Argentina. 2019;105(4) [Google Scholar]
- 5.Jowi JO, Mativo PM. Pathological sub-types, risk factors and outcome of stroke at the Nairobi Hospital, Kenya. East Afr Med J. 2008;85:572–81. doi: 10.4314/eamj.v85i12.43535. [DOI] [PubMed] [Google Scholar]
- 6.Benamer HT, Grosset D. Stroke in Arab countries: A systematic literature review. J Neurol Sci. 2009;284:18–23. doi: 10.1016/j.jns.2009.04.029. [DOI] [PubMed] [Google Scholar]
- 7.O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. Lancet. 2016;388:761–75. doi: 10.1016/S0140-6736(16)30506-2. [DOI] [PubMed] [Google Scholar]
- 8.Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res. 2017;120:472–95. doi: 10.1161/CIRCRESAHA.116.308398. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL. Stroke knowledge and awareness: An integrative review of the evidence. Age Ageing. 2010;39:11–22. doi: 10.1093/ageing/afp196. [DOI] [PubMed] [Google Scholar]
- 10.Sug Yoon S, Heller RF, Levi C, Wiggers J, Fitzgerald PE. Knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population. Stroke. 2001;32:1926–30. doi: 10.1161/01.str.32.8.1926. [DOI] [PubMed] [Google Scholar]
- 11.Trobbiani K, Freeman K, Arango M, Lalor E, Jenkinson D, Thrift AG. Comparison of stroke warning sign campaigns in Australia, England, and Canada. Int J Stroke. 2013;8(Suppl A100):28–31. doi: 10.1111/j.1747-4949.2012.00917.x. [DOI] [PubMed] [Google Scholar]
- 12.Elwood D, Rashbaum I, Bonder J, Pantel A, Berliner J, Yoon S, et al. Length of stay in rehabilitation is associated with admission neurologic deficit and discharge destination. PM R. 2009;1:147–51. doi: 10.1016/j.pmrj.2008.10.010. [DOI] [PubMed] [Google Scholar]
- 13.Kuruvilla A, Bhattacharya P, Rajamani K, Chaturvedi S. Factors associated with misdiagnosis of acute stroke in young adults. J Stroke Cerebrovasc Dis. 2011;20:523–7. doi: 10.1016/j.jstrokecerebrovasdis.2010.03.005. [DOI] [PubMed] [Google Scholar]
- 14.Eltemamy MA, Tamayo A, Altarsha E, Sedghi A, Pallesen LP, Barlinn J, et al. Cerebrovascular risk profiles in a Saudi Arabian Cohort of young stroke patients. Front Neurol. 2021;12:736818. doi: 10.3389/fneur.2021.736818. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Nicol MB, Thrift AG. Knowledge of risk factors and warning signs of stroke. Vasc Health Risk Manag. 2005;1:137–47. doi: 10.2147/vhrm.1.2.137.64085. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Malaeb D, Dia N, Haddad C, Hallit S, Sacre H, Barakat M, et al. Factors associated with knowledge and awareness of stroke among the Lebanese population: A cross-sectional study. F1000Res. 2022;11:425. doi: 10.12688/f1000research.108734.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Thompson S. Hoboken, N.J: Wiley; 2012. Sampling. [Google Scholar]
- 18.Ramos-Lima MJ, Brasileiro IC, Lima TL, Braga-Neto P. Quality of life after stroke: Impact of clinical and sociodemographic factors. Clinics (Sao Paulo) 2018;73:e418. doi: 10.6061/clinics/2017/e418. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Robert AA, Zamzami MM. Stroke in Saudi Arabia: A review of the recent literature. Pan Afr Med J. 2014;17:14. doi: 10.11604/pamj.2014.17.14.3015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Mubaraki AA, Alqahtani AS, Almalki AA, Almalki AH, Alamri HM, Aburass MK, et al. Public knowledge and awareness of stroke among adult population in Taif city, Saudi Arabia. Neurosciences (Riyadh) 2021;26:339–45. doi: 10.17712/nsj.2021.4.20210057. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke. 2013;15:128–34. doi: 10.5853/jos.2013.15.3.128. doi: 10.5853/jos.2013.15.3.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Khalil HM, Lahoud N. Knowledge of stroke warning signs, risk factors, and response to stroke among Lebanese older adults in Beirut. J Stroke Cerebrovasc Dis. 2020;29:104716. doi: 10.1016/j.jstrokecerebrovasdis.2020.104716. [DOI] [PubMed] [Google Scholar]
- 23.Williams LS, Bruno A, Rouch D, Marriott DJ. Stroke patients’ knowledge of stroke. Influence on time to presentation. Stroke. 1997;28:912–5. doi: 10.1161/01.str.28.5.912. [DOI] [PubMed] [Google Scholar]
- 24.Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: A systematic review of the literature. Arch Phys Med Rehabil. 2002;83:1629–37. doi: 10.1053/apmr.2002.35473. [DOI] [PubMed] [Google Scholar]
- 25.Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998;279:1288–92. doi: 10.1001/jama.279.16.1288. [DOI] [PubMed] [Google Scholar]
- 26.Kim YS, Park SS, Bae HJ, Cho AH, Cho YJ, Han MK, et al. Stroke awareness decreases prehospital delay after acute ischemic stroke in Korea. BMC Neurol. 2011;11:2. doi: 10.1186/1471-2377-11-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Koçer A, Ince N, Koçer E, Taşçi A. Factors influencing treatment compliance among Turkish people at risk for stroke. J Prim Prev. 2006;27:81–9. doi: 10.1007/s10935-005-0020-x. [DOI] [PubMed] [Google Scholar]
- 28.Pontes-Neto OM, Silva GS, Feitosa MR, de Figueiredo NL, Fiorot JA, Jr., Rocha TN, et al. Stroke awareness in Brazil: Alarming results in a community-based study. Stroke. 2008;39:292–6. doi: 10.1161/STROKEAHA.107.493908. [DOI] [PubMed] [Google Scholar]