Table 4.
Worldwide lay knowledge of stroke in chronological order of appearance in the literature.
| Authors | Subjects | Study design assessments | Baseline knowledge of stroke |
Conclusions | ||
|---|---|---|---|---|---|---|
| Associated Risk Factors (ARF) | Warning Signs and Symptoms (WSS) | Emergency Medical Services (EMS) | ||||
| Pontes-Neto et al., 2008 [9] Brazil | n = 801 | Cross-sectional | None: ∼19% | None: ∼22% | EMS phone number: ∼35% | Alarming lack of knowledge on EMS activation and patient treatment |
| General public | Interview survey | Hypertension: ∼30% | EMS activation at onset: ∼51% Willingness to go to the emergency department by own means: ∼40% | |||
| Mean age: ∼39 y.o. (range: 18‒80 y.o.) | Diabetes: ∼2% | |||||
| Smoking: ∼50% | ||||||
| ∼54% of women | Dyslipidemia: ∼15% | |||||
| Obesity: ∼5% | ||||||
| Alcohol consumption: ∼21% | ||||||
| Robinson et al., 2013 [10] United Kingdom | n = 1300 | Cross-sectional | Hypertension: ∼90% | Facial droop: ∼89% | Brain (site of stroke): ∼68% | The FAST campaign was effective for raising public stroke awareness |
| General public | Diabetes: ∼51% | Arm weakness: ∼83% | ||||
| Mean age: ∼49 y.o. (range: 10‒87 y.o.) | Interview survey | Smoking: ∼74% | Slurred speech: ∼91% | |||
| Alcohol consumption: ∼54% | ||||||
| ∼61% of women | ||||||
| Panicio et al., 2014 [7] Brazil | n = 104 | Cross-sectional | Not provided | Recognition: ∼66% | Not provided | Lack of knowledge about the therapeutic time window may affect early hospital arrival despite WSS knowledge |
| Acute stroke patients and their families | ||||||
| Mean age: ∼64 y.o. | Interview survey | |||||
| ∼45% of women | ||||||
| Shigehatake et al., 2014 [11] Japan | n = 493 | Cohort | Hypertension: ∼76% | Facial droop: ∼33% | EMS activation at onset: ∼85% | Manga and other educational materials can improve students’ stroke knowledge |
| Questionnaires | Hyperglycemia: ∼52% | Hemiparesis: ∼52% | ||||
| Smoking: ∼54% | Slurred speech: ∼60% | |||||
| Students (10th grade) (range 12‒13 y.o.) | Dyslipidemia: ∼55% | Sudden headache: ∼55% | ||||
| Obesity: ∼22% | ||||||
| Alcohol consumption: ∼72% | ||||||
| Yang et al., 2014 [21] China | n = 1101 | Cross-sectional | Not provided | None: ∼13% | EMS activation at onset: ∼28‒43% | Low stroke awareness and response at the onset, particularly by the lower education level and older people |
| General public | Facial or limb weakness: ∼76% | |||||
| Mean age: ∼58 y.o. (range: 18‒91 y.o.) | Interview survey | |||||
| Slurred speech: ∼69% | ||||||
| ∼62% of women | Sudden headache: ∼36% | |||||
| Ntaios G et al., 2015 [13] Greece | n = 723 | Cross-sectional | Hypertension: ∼66% | Facial droop: ∼38% | EMS activation at onset or willingness to go to the emergency department by own means: ∼69% | Stroke knowledge is moderately poor in general, and it is important to develop new educational strategies to improve stroke risk perception |
| Mean age ∼47 y.o. | Smoking: ∼44% | Arm or leg paralysis: ∼49% | ||||
| General public | Interview survey (by phone) | Obesity: ∼34% | ||||
| ∼58% of women | Slurred speech: ∼44% | |||||
| Matsuzono et al., 2015 [20] Japan | n = 2040 | Cohort | Students and their parents: | Students and their parents: | EMS activation at onset: ∼61% and ∼83% | Manga and other educational materials can improve students’ stroke knowledge, and their parents also learn through the children's communication of what they learned |
| Students (10th‒12th grades) and their parents | Questionnaires | Hypertension: ∼82% and ∼91% | Facial droop: ∼45% and ∼71% | |||
| Diabetes: ∼57% and ∼46% | Arm weakness: ∼58% and ∼73% | |||||
| Smoking: ∼64% and ∼82% | Slurred speech: ∼63% and ∼91% | |||||
| Dyslipidemia: ∼58% and ∼73% | Sudden headache: ∼68% and ∼81% | |||||
| Overweight: ∼28% and ∼51% | ||||||
| Ramírez‑Moreno et al., 2015 [23] Spain | n = 2409 | Cross-sectional | Men and women: | Men and women: | Men and women: | Lack of knowledge in the general public. Women perform better in general. |
| General Public | ||||||
| Mean age: ∼66 y.o. | Hypertension: ∼33% and ∼41% | Paralysis or weakness: ∼32 and ∼31% | EMS activation at onset or willingness to go to the emergency department by own means: ∼45 and 39% | |||
| ∼60% of women | ||||||
| Interview survey | Diabetes: ∼13% and ∼15% | Slurred speech: ∼11% and ∼13% | ||||
| Smoking: ∼54% and ∼48% | Sudden headache: ∼30% and ∼31% | |||||
| Dyslipidemia: ∼25% both | Brain (site of stroke): ∼71 and 72% | |||||
| Obesity: ∼15% and ∼13% | ||||||
| Alcohol consumption: ∼48% and ∼40% | ||||||
| Kilkenny et al., 2016 [14] Australia | n = 591 | Cohort | Hypertension: ∼89% | Facial droop: ∼86% | EMS activation if observed facial droop: ∼92% | Educational programs towards stroke awareness can effectively improve the general public knowledge of stroke |
| General Public | Questionnaires | Diabetes: ∼36% | Arm weakness: ∼81% | |||
| ∼68% of women | Smoking: ∼62% | Slurred speech: ∼91% | ||||
| Dyslipidemia: ∼58% | ||||||
| Alcohol consumption: ∼27% | ||||||
| Park et al., 2017 [15] Korea | n = 1052 | Cohort | Hypertension: ∼57% | Arm or leg paralysis: ∼26% | EMS activation at onset: ∼80% | Associated risk factors and warning signs and symptoms are important areas to address |
| Students (11‒12th grade) | Questionnaires | Diabetes: ∼36% | ||||
| Smoking: ∼49% | Sudden headache: ∼6% | Brain (site of stroke): ∼74% | ||||
| Dyslipidemia: ∼63% | ||||||
| Obesity: ∼51% | ||||||
| Alcohol consumption: ∼51% | ||||||
| Marto et al., 2017 [16] Portugal | n = 1108 | Randomized trial | Students and their parents: | Students and their parents: | Students and their parents: | Lectures at school for students and their parents increased stroke knowledge |
| Students (8th grade) and their parents | Questionnaires | Hypertension: ∼63% and ∼80% | Facial droop: ∼25% and ∼63% | EMS activation at onset: ∼45% and ∼56% | ||
| Mean age: ∼23 y.o. | Diabetes: ∼21% and ∼29% | Arm weakness: ∼40% and ∼65% | ||||
| Smoking: ∼37% and ∼61% | Slurred speech: ∼40% and ∼65% | Brain (site of stroke): ∼84% and ∼75% | ||||
| Dyslipidemia: ∼53% and ∼77% | ||||||
| Obesity: ∼39% and ∼76% | ||||||
| Alcohol consumption: ∼37% both | ||||||
| Umar et al., 2019 [8] United States | n = 603 | Cross-sectional | Recognition: ∼11% | FAST acronym: ∼56% | EMS phone number: ∼65% | Mothers´ educational level and race were associated with greater stroke knowledge with an alarming lack of knowledge on risk factors and symptoms at middle and high school |
| Students (7th‒12th grade) | ||||||
| Mean age: ∼15 y.o. (range: 12‒18 y.o.) | Paper-and-pencil survey | Brain (site of stroke): ∼50% | ||||
| ∼50% of women | ||||||
| Dossi et al., 2019 [17] Argentina | n = 12,710 | Cross-sectional | Hypertension: ∼69% | Recognition: ∼73% | EMS activation at onset: ∼26% | Stroke knowledge is moderate with poor-risk perception, requiring educational programs |
| General public | Household survey | Dyslipidemia: ∼69% | Sudden headache: ∼66% | |||
| Mean age: ∼51 y.o. | Stroke is preventable: ∼67% | Willingness to go to the emergency department by own means: ∼52% | ||||
| ∼69% of women | Lifestyle measures are useful: ∼58% | |||||
| Houessou et al., 2021 [18] Benin | n = 4671 | Cross-sectional | None: ∼91% | None: ∼95% | Not provided | Age, educational level, and prior experience were associated with stroke knowledge |
| General public | ||||||
| Mean age: ∼28 y.o. (range: 15‒99 y.o.) | Household survey | |||||
| ∼51% of women | ||||||
| Calderaro et al., 2021 [current] Brazil | n = 3954 | Cross-sectional | (a) Elementary/Middle School: | (a) Elementary/Middle School | (a) Elementary/Middle School: | Having a higher educational level, being female, and having prior experience increase the identification of associated risk factors and warning signs and symptoms. Stroke awareness should be emphasized among schoolchildren and adolescents. |
| Students (2nd to 18th grade) | Paper-and-pencil and online survey | None: ∼51% | None: ∼46% | EMS phone number: ∼63% | ||
| Mean age: ∼18 y.o. (range: 7‒69 y.o.) | Hypertension: ∼18% | Facial droop: ∼33% | ||||
| ∼58% of women | Dyslipidemia: ∼33% | Arm weakness: ∼32% | Brain (site of stroke): ∼56% | |||
| Diabetes: ∼22% | Slurred speech: ∼34% | |||||
| Smoking: ∼28% | Sudden headache: ∼15% | |||||
| (b) High School: | (b) High School: | (b) High School: | ||||
| None: ∼46% | None: ∼32% | EMS phone number: ∼76% | ||||
| Hypertension: ∼33% | Facial droop: ∼51% | |||||
| Dyslipidemia: ∼39% | Arm weakness: ∼47% | Brain (site of stroke): ∼78% | ||||
| Diabetes: ∼27% | Slurred speech: ∼49% | |||||
| Smoking: ∼21% | Sudden headache: ∼22% | |||||
| (c) University: | (c) University: | (c) University: | ||||
| None: ∼14% | None: ∼6% | |||||
| Hypertension: ∼80% | Facial droop: ∼86% | EMS phone number: ∼66% | ||||
| Dyslipidemia: ∼69% | Arm weakness: ∼86% | |||||
| Diabetes: ∼36% | Slurred speech: ∼90% | EMS phone number: ∼66% | ||||
| Smoking: ∼55% | Sudden headache: ∼68% | |||||