Awareness of risk factors and warning symptoms of

stroke in general population

Monaliza,Meena Aggarwal,Achal Srivastava

Abstract : Reduction in the risk of stroke and early admission to the hospital after the onset of stroke
both depends on the knowledge of warning symptoms and risk factors of stroke in general public. The aim of
the study was to assess the awareness of warning symptoms and risk factors of stroke among general
population. A hospital based survey was conducted. The study subjects (N=467) were the general population
who visited (neurology, cardiology, surgery and medicine) selected OPD's of AIIMS, New Delhi. The researcher
interviewed the subjects using an interview schedule. Results indicate that 96.15% of study subjects had
excellent knowledge of warning symptoms of stroke i.e. they knew the most common presentation of stroke
(sudden numbness or weakness of the face, arm, or leg especially one side of the body) plus one other well
established warning symptom of stroke. On the other hand, 52.87% subjects knew hyper tension/
hypercholesterolemia or any other three well established risk factors of stroke. Subjects who were younger in
age, more educated and belonged to higher income group had better knowledge of risk factors and warning
symptoms of stroke. High risk group, who had the personal history of risk factors, had adequate knowledge
of risk factors as well as warning symptoms of stroke. It is recommeded to develop health education programmes
to improve the awareness of stroke at primary and secondary health care levels.

Key words : Introduction

Stroke, Warning symptoms, Risk factors Stroke is one of the most common
neurological disorders in clinical practice. It is
the leading cause of adult disability. According
to WHO, it is the second commonest cause of
death worldwide 1. In 2005, stroke deaths
accounted for 87% of deaths in developing
Correspondence at :
countries and an estimated 5.8 million people
died from stroke worldwide2. It is projected
Monaliza,
that deaths due to stroke will rise to 6.5 million
Clinical Instructor,
NINE,PGIMER, Chandigarh by 2015 and by 20202, stroke and coronary

Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 149
artery disease together are expected to be the
leading cause of lost healthy life years.3
Surveys in different parts of India have shown
that the prevalence of stroke varies in different
regions of India and ranges from 40 to 270
per 100,000 population.4-7
Framingham hear t study and other
international prospective epidemiological
studies identified the major risk factors for
stroke such as hyper tension, diabetes
mellitus, hyperlipidemia, and smoking.8 In
India a hospital based case control study in
the west central region revealed that diabetes
mellitus, hypertension, tobacco and low
hemoglobin rather than the cholesterol are the
most impor tant risk factors of ischemic
stroke.9 Another community based cross
sectional study showed that heart disease,
hypertension, and smoking are significantly
associated with stroke.10 Other well established
risk factors of stroke includes old age, history
or family history of stroke , history or family
history transient ischemic attack, heavy
alcohol consumption ,high fat/high sodium
diet consumption and obesity.
The population in India is now surviving
beyond the peak years (age 55-65 years) for
the risk of stroke .11 With rising trends of
hypertension, diabetes, smoking and stress
in daily life among Indian population India4, is
likely to face enormous socioeconomic
burden to meet the cost of rehabilitation of
stroke victims.
In India many centers have star ted
recombinant tissue plasminogen activator
therapy for treatment of ischemic stroke. The
Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012
effectiveness and safety of this therapy
depends on time of its application and it is
generally accepted that patient should receive
thrombolysis within 3 hours of the first
symptoms12 but, majority of stroke patients
dont reach hospital in time because of inability
of patients and by standers to recognize
warning symptoms of stroke and to get an
emergency room as quickly as possible after
patients have had symptoms of stroke.
Awareness and knowledge in general
population, regarding risk factors and warning
symptoms of stroke are essential for the
prevention and initiation of immediate effective
treatment of stroke. Besides that awareness
of risk factors may also improve adherence
to medical advice regarding lifestyle
modifications. Systematic reviews have shown
that one time advice from healthcare workers
during routine patient interactions can have
an appreciable impact on patients behavior
13-14
. However, persons at risk often tend to
misunderstand their own risk, underestimating
their probability for stroke and assuming that
adverse events will not happen to them15.Sama
et al.reported about one fourth of patients in
their study ,who recalled being informed of
their increased risk by physician did not
perceive themselves to be at risk for stroke.16
The present study is aimed to evaluate
general awareness of risk factors of stroke as
well as warning symptoms in general public
with a view to develop a heath teaching
module for increasing awareness regarding
stroke.
150
The objectives of the study were:
1. To assess the awareness of risk factors
and warning symptoms of stroke in
general population.
2. To associate the level of awareness
with selected variables.
MATERIALS AND METHODS
The study was conducted using
Quantitative, Cross sectional survey approach.
study subjects were conveniently selected
from general population visiting selected
OPDs (medical, surgical, neurology,
cardiology), AIIMS, New Delhi who were
having Age = 18 years, willing to participate
in the study, can understand Hindi or
English.A total 467 subjects were interviewed
from selected OPDs i.e.medical (N=124),
surgical(N=111), neurology (N=143)and
cardiology (N=89). An interview schedule
was developed after extensive review of
literature and discussion with the experts in
neurosciences for collection of data from
study subjects regarding their knowledge of
stroke warning symptoms and risk factors of
stroke. After developing the inter view
schedule, it was submitted to six experts in
the field (four medical and two nursing
experts) for content validity. Content validity
index was 98.15%. Necessary modifications
were made in interview schedule as per the
suggestions received from experts. Try out
of the interview schedule was done on 12
persons in selected OPDs (medical, surgical,
neurology, cardiology) of AIIMS, New Delhi.
It was found to be feasible for administration.
Reliability of the interview schedule was
Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012
established by test retest method with a time
gap of 3 days on 5 study subjects. The
reliability coefficient (Cronbachs Alpha) was
found to be 0.9582.The interview schedule
was translated into Hindi with the help of
experts from Hindi section, AIIMS, New Delhi.
Back translation was done to English and
desired corrections were made in the Hindi
version.
The interview schedule consists of 3
components i.e. 1. Demographic data sheet
having items dealing with demographic
characteristics. 2. Interview schedule to
assess knowledge related to warning
symptoms and risk factors of stroke. It
includes questions related to Risk factors of
stroke, Warning symptoms of stroke and
Personal history/history of illness of risk
factors i.e History of tobacco use, alcoholism,
hypertension, diabetes, heart disease, History
of stroke/ transient ischemic attack
(T.I.A),Family history of stroke/transient
ischemic attack (T.I.A),Histor y of
hypercholesterolemia. Warning Symptoms
refers to the subjective indications of stroke
i.e.Sudden numbness or weakness of face,
arm or leg especially on one side of the body;
Sudden confusion, trouble speaking or
understanding; Sudden trouble in seeing from
one or both eyes; Sudden trouble in walking,
dizziness, loss of balance or coordination;
Sudden, severe headache with no known
cause. Risk factors refers to the established
risk factors contributing to the development
of stroke including Hyper tension, Hear t
disease, TIA/previous stroke, Family history
of stroke, Diabetes mellitus, Tobacco use,
151
Heavy alcohol consumption,
Hypercholesterolemia
Grading of Knowledge of risk factor
was done as follows: Very good knowledge:
refers to the knowledge of both hypertension
and hypercholesterolemia as risk factors of
stroke. Good knowledge: refers to the
knowledge of either hyper tension or
hypercholesterolemia, or any other three well
established risk factors of stroke. Fair
knowledge: refers to the knowledge of any
two risk factors of stroke other than
hypertension and hypercholesterolemia and
Poor knowledge: refers to the knowledge of
any one/no risk factor of stroke other than
hypertension and hypercholesterolemia.
Grading of Knowledge of warning
symptoms of stroke was done as follows: Very
good knowledge: refers to the knowledge of
sudden numbness or weakness of the face,
arm or leg especially one side of the body plus
any one other warning symptom of stroke.
Good knowledge of warning symptoms of
stroke: refers to the knowledge of sudden
numbness or weakness of the face, arm or
leg especially one side of the body as a warning
symptom of stroke. Fair knowledge of warning
symptoms of stroke: refers to the knowledge
of any 2 of the well known warning symptoms
except sudden numbness or weakness of the
face, arm or leg especially one side of the
body. Poor knowledge of warning symptoms
of stroke: refers to the knowledge of one / no
of the well known warning symptoms except
sudden numbness or weakness of the face,
Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012
arm or leg especially one side of the body.
Ethical considerations: Written consent
was obtained from study subjects. Ethical
clearance was obtained from ethics committee
of AIIMS, New Delhi. The confidentiality of
every data collected was maintained.
Study subjects were interviewed by the
researcher. Data was collected for 6 month
period.The subjects were enrolled on the
bases of inclusion criteria (mentioned
earlier).Informed consent was taken from the
patients or relatives after giving explanation
about the study. An interview session took
approximately 15 to 20 minutes to elicit the
information from study participants.
RESULTS
Table 1 Depicts that half of study
subjects were upto age of 18-40 years
(49.68%) while between age group of 40-60
years were 41.11% of study subjects. Mean
age was 37.79 12.86 years and range was
18-76 years. 62.96% were males and 37.04%
were females.
Nearly half (45.82%) of study subjects
were having their highest level of education
as secondary or senior secondary, only
23.34% were graduates/postgraduates /
higher level of education and 16.27% were
illiterates. Nearly half( 47.75%)of study
subjects were from middle income group i.e.
had income between Rs. 5001-20000 and
only 13.06 % of study subjects were from high
income group having income between Rs.
20001 or above
152
Table 1. Demographic distribution of study 8.78% had history of hypercholesterolemia.
subjects. N=467 Table 2:Presence of risk factors of stroke
Demographic variables f (% ) among the subjects. N=467

Age in years Risk factors of stroke present f(%)

18-40 232 (49.68) Hypertension 168 (35.97)
40-60 192 (41.11)
60 and above 43 (9.21) Diabetes 131 (28.05)
Tobacco users 118 (25.27)
Gender
History of Stroke/TIA 95 (20.34)
Male 294 (62.96)
Female 173(37.04) Heart diseases 79 (16.92)
Education Family history of Stroke/TIA 67 (14.35)
Illiterate 76 (16.27) Alcohol use 61 (13.06)
Primary/middle 68 (14.56)
History of Hypercholesterolemia 41 (8.78)
Sec./senior sec. 214 (45.83)
Grad/p.grad/higher 109 (23.34) Subjects had more than one risk factors
Monthly family income Table 3 Depicts that hyper tension
in Rupees (58.45%) was the most commonly reported
<5000 183 (39.19) risk factor followed by Alcohol consumption
5001-20000 223 (47.75) (48.82%), tobacco use (48.39%), diabetes
20001 and above 61 (13.06) mellitus 204 (43.68),family history of stroke
(42.61%), TIA/previous stroke (26.98%).
Hypercholesterolemia was reported by least
Mean age SDS = 39.79 12.86 ,.Range 18-76 years
(19.27%) study subjects. Other risk factors
Table 2 depicts the analysis of the which were reported by 82.22% of study
sample distribution pertaining to the high risk subjects were High fat, high sodium diet
group. It shows that majority (35.97%) of consumption, Obesity ,Lack of exercise /
study subjects had hypertension, 28.05 % had sedentary life style, Old age ,Mental stress,
diabetes, 25.27% were tobacco users, 20.34% Gender, Risk factors, Polycythemia (raised
had history of Stroke/TIA, 16.92 % had of level of red blood cells in blood),Use of
Heart diseases, 14.35% had family history of contraceptive drugs, bite of snake, winter
Stroke/TIA, 13.06 % were alcohol users and season, low blood pressure.

Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 153
Table3: Knowledge of risk factors of stroke in study subjects. N=467

Risk factors f(%)*

1. Hypertension 273 (58.45)

2. Alcohol consumption 228 (48.82)
3. Tobacco use (smoking or any other form) 226 (48.39)
4. Diabetes mellitus 204 (43.68)
5. Family history of stroke 199 (42.61)
6. Transient ischemic attack(TIA)/ previous Stroke 126 (26.98)
7. Heart disease 109 (23.34)
8. Hypercholesterolemia 90 (19.27)
9. Others (High fat/high sodium diet consumption,Obesity ,Lack of exercise 384 (82.22)
/sedentary life style, Old age, Mental stress, Gender, Risk factors, Polycythemia
(raised level of red blood cells in blood),Use of contraceptive drugs, bite of
snake, winter season, low blood pressure.)
*Multiple responses from study subjects.
Table 4 depicts that sudden numbness loss of balance or coordination (88.22%)
or weakness of the face, arm or leg, especially ,sudden trouble in seeing with one or both
on one side of the body was the most eyes(29.12%). Sudden severe headache of
common warning sign reported by majority unknown cause was repor ted by least
of the study subjects (98.28), followed by number of study subjects (4.9%) and another
sudden confusion /sudden difficulty in 57% repor ted other signs i.e.
speaking/ sudden difficulty in understanding unconsciousness, pain in limbs, tremors,
written and spoken words(94.64%), sudden difficulty in breathing, difficulty in eating, fever,
trouble in walking /Sudden dizziness/ Sudden chest pain, incontinence.
Table: 4 Knowledge of warning symptoms of stroke in study subjects. N=467

Risk warning symptoms of stroke f(%)*

1. Sudden numbness or weakness of the face, arm or leg, especially on one side of the body 459(98.28)
2. Sudden confusion /Sudden difficulty in speaking/ Sudden difficulty in 442(94.64)
understanding written and spoken words
3. Sudden trouble in walking /Sudden dizziness/ Sudden loss of balance or coordination 412(88.22)
4. Sudden trouble in seeing with one or both eyes 136(29.12)
5. Sudden severe headache with no known cause 23(4.90)
6. Others (Unconsciousness, pain in limbs, tremors, difficulty in breathing, 57(12.20)
difficulty in eating, fever, chest pain, incontinence.)
*Multiple responses from study subjects.
Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 154
 Table 5 Depicts the level of awareness 50% of subjects in all the three age groups
of risk factors and warning symptoms of had good knowledge about risk factors of
stroke as per the criteria mentioned .It shows stroke and 37.21 % of study subjects
that only 15.41% of study subjects had v.good belonging to age group 60 and above had
knowledge, 52.89% had good knowledge, poor knowledge related to risk factors of
3.63% had fair and 28.47% had poor stroke. No significant relationship was found
knowledge regarding risk factors of stroke. It between age and knowledge of risk factors
also shows that 96.15% of study subjects had of stroke (p=0.276, as per chi square).
very good, 2.35% had good knowledge and In comparison of knowledge of risk
merely 0.64% subjects were having fair, and factors related to gender, it was found that
0.86% subjects had poor knowledge of nearly 50% of subjects in both the categories
warning symptoms of stroke respectively. had adequate knowledge and it was not
Table 5: Level of awareness regarding the significant (p=0.338, as per chi square)
risk factors and warning symptoms of Majority of subjects in each education category
stroke. N = 467 had good knowledge of risk factors of stroke
but 60.53 % of study subjects who were
Knowledge of risk factors illiterate had poor knowledge on the contrary,
and warning signs f(%) only 16.51% of the study subjects who were
Knowledge of risk factors graduates /post graduates/ or higher had poor
knowledge of risk factors of stroke. The
V good 72 (15.41) relationship was found to be significant
Good 245 (52.89) (p=0.001, as per fishers exact test) i.e.
higher was the education level; better was the
fair 17 ( 3.63)
knowledge about risk factors of stroke.
poor 133 (28.47)
Majority of study subjects in all the three
Knowledge of warning symptoms income groups had good knowledge of risk
V good 449 (96.15) factors of stroke. The subjects (62.30%). in
the high income group income group had
Good 11 ( 2.35) more knowledge about risk factors of stroke
fair 3 ( 0.64 ) .A significant relationship was observed
(p=0.006,as per fishers exact test) between
poor 4 ( 0.86)
monthly income and knowledge of risk factors
of stroke i.e. higher the monthly income, better
Table 6 reveals the comparison of was the knowledge regarding risk factors of
demographic characteristics and knowledge stroke.
of risk factors of stroke. It depicts that nearly

Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 155
Table 6: Comparison of Demographic variables and knowledge about risk factors among
study subjects. N=467

Demographic variables Knowledge of Risk factors of stroke P value

V .good f(%) Goodf(%) Fairf(%) Poorf(%) (+) chi square,
(++) fishers exact

Age in years
18-40 31 (13.36) 118 (50.86) 10(4.31) 73 (31.47) 0.276
40-60 36 (18.75) 106 (55.21) 6(3.13) 44 (22.92) (+)
60 and above 5 (11.63) 21 (48.84) 1 (2.33) 16 (37.21)

Gender
Male 52 (17.69) 148 (50.34) 11 (3.74) 83 (28.23) 0.338
female 20 (11.56) 97 (56.07) 6 (3.47) 50 (28.90) (+)

Education
Illiterate 2 (2.63) 25 (32.89) 3 (3.95) 46 (60.53) 0.001*
Primary/middle 5 (7.35) 37 (54.41) 2 (2.94) 24 (35.29) (++)
Sec./senior sec. 29 (13.55) 130 (60.75) 10 (4.67) 45 (21.03)
Grad/p.grad/higher 36 (33.03) 53 (48.62) 2 (1.83) 18 (16.51)

Monthly income in Rupees

<5000 20 (10.93) 92 (50.27) 9 (4.92) 62 (33.88) 0.006* (++)
5001-20000 38 (17.04) 115 (51.57) 5 (2.24) 65 (29.15)
20001 and above 14 (22.95) 38 (62.30) 3 (4.92) 6 (9.84)

*P value significant at p<0.05

Table 7 shows comparison of knowledge of stroke and P value was again not found to
of warning symptoms of stroke according to be significant (p=0.115,as per fishers exact
demographic distribution of study sample. It test)
depicts that that more than 95% study
More than 95% in each education
subjects in all the three age groups had
category had very good knowledge of
excellent knowledge of warning symptoms of
warning symptoms of stroke. A statistically
stroke so P value was not found to be
significant relationship was observed between
significant( p=0.750, as per fishers exact
education and knowledge of warning
test) In comparison of knowledge about
symptoms of stroke (p=0.003) i.e. higher was
warning symptoms of stroke related to gender
the education level better was the knowledge
more than 95% of both the categories had
about warning symptoms of stroke.
very good knowledge of warning symptoms

Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 156
Table 7: Comparison of Demographic variables and level of knowledge of warning
symptom of stroke among study subjects . N=467

Demographic variables Knowledge Warning symptoms of stroke P value

V .good f(%) Good f(%) Fair f(%) Poor f(%) (+) chi square,
(++) fishers exact

Age in years
18-40 225 (96.98) 4 (1.73) 1 (0.43) 2 (0.86) 0.750 (++)
40-60 183 (95.31) 6 (3.13) 1 (0.52) 2 (1.04)
60 and above 41 (95.34) 1 (2.33) 1 (2.33) 0 (0.00)

Gender
Male 281 (95.58) 9 (3.06) 3 (1.02) 1 (0.34) 0.115 (++)
female 168 (97.11) 2 (1.16) - 3 (1.73) 0.003* (++)

Education
Illiterate 72 (94.74) - - 4 (5.26)
Primary/middle 64 (94.12) 3 (4.41) 1 (1.47) -
Sec/senior sec 208 (97.20) 5 (2.33) 1 (0.47) - 0.787 (++)
Grad/p.grad/higher 105 (96.33) 3 (2.75) 1 (0.92) -

Monthly income in Rupees

<5000 174 (95.08) 6 (3.28) 1 (0.55) 2 (1.09)
5001-20000 216 (96.86) 3 (1.34) 2 (0.90) 2 (0.90)
20001 and above 59 (96.72) 2 (3.28) - -

*P value significant at p<0.05

Table 8 Depicts the level of awareness
of risk factors in study subjects who had
history of any risk factor of stroke,as per
the criteria mentioned .It shows that majority
of the study subjects who were at high
risk (history of tobacco use, alcohol use,
hypertension, heart diseases, hyperchole-
sterolemia, history of stroke /TIA, diabetes,
family history of stroke /TIA) of getting stroke
had adequate knowledge of risk factors of
stroke. The study subjects who had
hypertension, diabetes, History of stroke / TIA,
heart diseases, hypercholes-terolemia, family
history of stroke/ TIA had better knowledge
of risk factors of stroke and the relationship
was found to be significant with p values
specified.(chi square test and fishers exact
test)

Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 157
Table 8: Comparison of Personal history of risk factors and level knowledge about risk
factors of stroke among study subjects. N=467

variables Knowledge of risk factors of stroke P value

V. Good f(%) Good f(%) Fair f(%) Poorf(%) (+) chi square,
(++) fishers exact

Tobacco use
Yes 21 (17.80) 54 (45.76 ) 7 (5.93 ) 36 (30.51) 0.218(+)
No 51(14.61) 191(54.73) 10 (2.87 ) 97 (27.79 )
Alcohol use
Yes 11 (18.03) 36 (59.02) 3 (4.92) 11 (18.03) 0.274(++)
No 61 (15.02) 209 (51.48) 14 (3.45) 122 (30.05)
Hypertension
Yes 32 (19.05) 94 (55.95) 2 (1.19) 40 (23.81) 0.027*(++)
No 40 (13.38) 151(50.50) 15 (5.02) 93(31.10)
Diabetes
Yes 28 (21.37) 79 (60.31) 4 (3.05) 20 (15.27) 0.001*(++)
No 44 (13.10) 166 (49.40) 13 (3.87) 113 (33.63)
History of Stroke/TIA
Yes 18(18.95) 61 (64.21) 2 (2.11) 14 (14.74) 0.005* (++)
No 54(14.52) 184 (49.46) 15 (4.03) 119 (31.99)
History of Heart diseases
Yes 20(25.32) 42 (53.16) 1 (1.27) 16(20.25) 0.020* (++)
No 52 (13.40) 203 (52.32) 16 (4.12) 117 (30.15)
History of Hypercholesterolemia
Yes 13 (31.71) 21 (51.22) 0( 0.00) 7 (17.07) 0.010* (++)
No 59 (13.85) 224 (52.58) 17 (3.99) 126 (29.58)
Family history of Stroke/TIA
Yes 13 (19.40) 45 (67.16) 0 (0.00) 9 (13.43) 0.004* (++)
No 59 (14.75) 200 (50.00) 17 (4.25) 124 (31.00)
*p significant at p<0.5

DISCUSSION incidence of stroke has been observed owing

Stroke continues to be a leading cause to an increase in life span with rising trends
of death and long term disability in adults of hypertension, diabetes, smoking and stress
worldwide. In India and other developing in daily life17. Previous studies have shown a
countries, an alarming increase in the poor knowledge of stroke among patients

Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012 158
with established risk factors for stroke and in
community at large17-20. Most of the patients
and caregivers did not recognize the onset of
stroke and their knowledge of risk factors was
poor21. Awareness of risk factors and warning
symptoms of stroke in general population is
essential for prevention and initiation of
prompt treatment.
The major findings of the present study
revealed that majority of study subjects had
very good knowledge of warning symptoms
of stroke (>95%) and nearly 50% were well
informed of risk factors of stroke. These
findings from present study were similar to
the findings from Pandian JD et al. (2005)22
who, in a hospital based survey among
relatives of outpatients found better
knowledge about risk factors and warning
symptoms of stroke. These findings from the
present study may be biased because the
survey was conducted among the subjects
who visited hospital, as they come to hospital
they gain some knowledge about disease
entity and hence were well informed
The findings of the present study
showed that younger age and higher level of
education were associated with better
knowledge about risk factors and warning
symptoms of stroke. This finding is similar to
the findings from few western studies by
Pancioli AM et al.(1998)18 and Yoon SS et
al.(2001) 19 in which it was found that
knowledge about stroke varies positively with
education and age .
Under the present study in relation to
gender the knowledge about risk factors and
Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012
warning symptoms of stroke was found to
be equally distributed among both the
genders. This finding is in contrast with the
finding by Pancoili AM et al.(1998)18 and
Yoons SS et al.(2001) 19who found lower
knowledge among men than women.
In the present study, it was found that
higher was the economic status better was
the knowledge of subjects related to risk
factors and warning symptoms of stroke. This
finding could be because the higher
socioeconomic status subjects often have
better education background hence were well
informed about risk factors and warning
symptoms of stroke. This finding is consistent
with the findings from Pandian JD et al.
(2005)22 who also found better awareness of
risk factors (65.1%) and warning symptoms
(81.3%) of stroke among higher income
group respondents.
In this survey majority of (98.28%)
study subjects mentioned weakness and
paralysis of one side of body as most
common presentation of stroke. Similarly,
Pandian JD et al. (2005)22 found the most
common (62.2%) symptom identified by
respondents was weakness of one side of
body. Kothari et al.(1997)23 in a study of
patients with acute stroke also reported that
most commonly documented stroke warning
sign was weakness of one side of body.
In the present study, other well known
symptoms were less frequently recognized by
the subjects. This finding is consistent with
the finding of other studies conducted in
India22, Australia19, and US16
159
 Hypertension(58.20%) is recognized as
the most common risk factor in this study This
finding is similar to the observation made in
other studies from India(45.1%)22, Michigan
(32.3%) 24 , Australia (31.8%) 19 and Ohio
(49%)18. On the contrary, in this study the
proportion of subject, who mentioned other
established risk factors such as diabetes
mellitus ,heart disease, increased cholesterol
were higher as compared to the other
community based studies22,19
Yoon SS et al.(2001)19and Pandian JD
et al.(2005)22 reported that the awareness of
risk factors in high risk individuals was poor
and did not differ significantly from those who
had no risk factors. But in the present study
52.89% of study subjects have good
knowledge regarding risk factors of stroke
and 28.49% of study subjects have poor
knowledge of risk factors and the knowledge
of risk factors in high risk group was found
to be adequate in this study and this finding
is consistent with Gupta et al. (2000)25 who
reported that 65% of elderly patients who
comprises high risk group for stroke, in their
study correctly identified at least one risk factor
for stroke.
The survey reveals good knowledge of
stroke risk factors and warning symptoms of
stroke among majority of study subjects.
Younger persons with higher levels of
education and higher income group subjects
have more knowledge about risk factors and
warning symptoms of stroke. High risk
group, who has the personal history of risk
factors, has good knowledge of risk factors
Nursing and Midwifery Research Journal, Vol-8, No. 2, April 2012
as well as warning symptoms of stroke. There
is a need to develop health education
modules, programs to improve the awareness
of stroke both at primary and secondary
health care levels. It is recommended that a
similar study on larger sample can be
replicated so that the findings can be
generalized and future studies are needed
which focus on community surveys including
rural and urban population especially focusing
on indigenous treatment and myths about
stroke and its potential complications.
References
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