Oznur Usta Yesilbalkan  ( Ege University Faculty of Nursing, Internal Medicine Nursing, Izmir )
Ayfer Karadakovan  ( Ege University Faculty of Nursing, Internal Medicine Nursing, Izmir )
Birgul Vural Dogru  ( Mardin Artuklu University Health College, Nursing Department, Mardiri )
Perihan Akman  ( Ege University Hospital, Neurology Clinic, Izmir, Turkey )
Ebru Ozel  ( Ege University Hospital, Neurology Clinic, Izmir, Turkey )
Yucel Bozturk  ( Ege University Hospital, Neurology Clinic, Izmir, Turkey )

Objective: To assess the awareness/knowledge of stroke risk factors and warning signs among caregivers of patients with or without stroke.
Methods: The cross-sectional, descriptive and comparative study was conducted in the neurology clinic and polyclinic of a university hospital in Izmir, Turkey, from March to July 2014, and comprised primary caregivers of patients with stroke in group 1 and those of patients with no stroke in group 2. The subjects were screened and data
was collected using the Participant Information Form and the Questionnaire Form About Stroke. Warning signs and symptoms of stroke were compared between the two sets of caregivers. SPSS 17was used for data analysis.
Results: Of the 203 respondents, 105(52%) were in group 1 and 98(48%) in group 2. Group 1 had better awareness than group 2 (p˂0.05). In group 1, weakness was the most commonly recognised warning sign 101(96.2%), whereas
dyspnoea 41(39%), was the least commonly identified. There was no relationship of stroke knowledge with educational level and age (p>0.05 each).
Conclusion: Caregivers had a moderate knowledge of some of the warning signs and risk factors about stroke.
Keywords: Awareness, Caregiver, Risk factor, Stroke, Warning. (JPMA 69: 1114; 2019)

Introduction

Stroke is one of the leading causes of morbidity and mortality the world over and is a preventable public health problem.1,2 Stroke is one of the major health problems in Turkey. A cerebrovascular disease is the second leading cause of death in Turkey and has the third place in terms of loss of disability adjusted life years (DALYs) at an estimated rate of 5.9% according to the World Health Organisation (WHO) and Turkish Health Statistics. 3  Stroke incidence and prevalence were notified as 69.6 and 310/100,000 populations in a recent study conducted by the Turkish Ministry of Health, which is believed to be an underestimation. 3  Stroke is a preventable public health problem. To reduce the incidence of stroke, there is a need to start with public awareness and to ultimately the review the national health policy. The level of public awareness and knowledge about stroke risk factors and warning signs is critical for ensuing adequate access to preventative treatments.1,4,5 Assessment of public awareness is most important for the development of appropriately targeted health promotion campaigns to prevent stroke among the high-risk population. 4  Several studies have revealed that there is lack of knowledge regarding stroke warning signs and risk factors.1,4,5 Awareness might facilitate a faster realisation of stroke and immediate activation of pre-hospital emergency mechanism.1,2 The current study was planned to assess the awareness/ knowledge of stroke risk factors and warning signs among caregivers of patients with and without stroke.

Subjects and Methods

The cross-sectional, descriptive and comparative study was conducted in the neurology clinic and polyclinic of a university hospital in Izmir, Turkey, from March to July 2014, and comprised primary caregivers of patients with stroke in group 1 and those of patients with no stroke in group 2. Sample size was not calculated and all primary caregivers aged 18 years or more who were cognitively intact to communicate and consented to participate were enrolled using convenience sampling. Those who did not meet any element of the criterion were excluded. The study was approved by the relevant ethical committees, and written consent was obtained from the subjects. Data was collected using Participant Information Form (PIF) and the Questionnaire Form About Stroke (QFAS). PIF had 15 questions about socio-demographic characteristics (9 questions) and disease characteristics (6 questions). The QFAS assessed the caregivers’ awareness/knowledge about risk factors and warning signs of stroke. The questionnaire was designed especially for the current  study-based on literature.5-12 The knowledge level was defined as ‘good’, ‘moderate’ and ‘poor’ according to the  distribution of percentiles of correct answers. The subjects took about 15 minutes to fill the survey forms which was done in Turkish language by trained researchers. SPSS 17 was used for statistical analysis. For continuous variables, mean } standard deviation (SD) were calculated. Chi-square test was used to check the association between the identified risk factors and warning signs of the stroke. The results were evaluated at a 95% level of reliability and p<0.05 was taken as statistically significant.

Results

Of the 203 respondents, 105(52%) were in group 1 and 98(48%) in group 2 with an overall mean age of 46.90}12.79 years (Table-1).



In the terms of awareness, 2(1.0%) subjects had good knowledge, 144(70.9%) moderate and 57(28.1%) had poor knowledge regarding the risk factors. Besides, 50(24.6%) subjects had good, 116(57.1%) moderate and 37(18.2%) had poor knowledge of warning symptoms of stroke (Table-2).



Overall, 156(76.8%) subjects recognised brain as the organ affected by stroke. Hypertension was the most commonly identified risk factor 178(87.7%), and gender was the least identified 27(13.3%). There were significant differences in the awareness of some risk factors, with groups 1 caregivers having better awareness (p<0.05). Weakness was the most commonly recognised warning sign 192(94.6%), whereas dyspnoea 72 (35.5%), heart palpitations 88(43.3%) and nause/vomiting 94(46.3%) were the least commonly identified (Table-3).



The questions, “What do you do at first when you realise that you or someone else is having an acute stroke?” was answered as, “I call the ambulance” 127 (62.6%), “I take the patient to hospital”89(43.8%), “I call one of the family members”44(21.7%), and “I apply cold water to the head”41(20.2%), and “I call the doctor”14(12.2%). Regular medical check-up was the most commonly recognised stroke prevention measure 137(67.5%), whereas restriction of alcohol consumption 99(48.8%) and managing ideal weight 102(50.2%) were the least commonly identified. The main sources of information about stroke were patients with stroke 22(10.8%), television 17(8.4%), relatives 16(7.9%), and newspapers and books 11(5.5%). Also, 136(67.0%) respondents wanted to get information about preventive measures and early signs and symptoms of stroke (Table-4).



Discussion

To our knowledge, the current study is the first to assess the awareness/knowledge of stroke risk factors and warning signs among caregivers of patients with and without stroke in Turkey. The primary objective was to assess the awareness/knowledge of stroke risk factors and warning signs among the primary caregivers. Since the study did not aim at developing a tool to measure the knowledge of stroke or its perception, therefore the validity or reliability the questionnaire was not vigorously tested. The majority of group 1 caregivers had better knowledge of stroke warning signs and risk factors than group 2 caregivers. Compared to the findings of other studies12-16 the knowledge level was extremely poor. The majority caregivers correctly identified brain as the affected organ in stroke. The knowledge regarding the organ injured in stroke was better compared to some other studies. 1,17  The majority caregivers in the current study correctly answered weakness on one side of the body as a warning symptoms and hypertension as a risk factor for stroke. This is consistent with other studies.1,2,18,19 A study found that the most common warning sign of stroke listed by respondents was dizziness. 2  Another study revealed that 98.2% participants mentioned weakness and paralysis of one side of the body as the most common presentation in stroke.20 Similarly, the most common symptom (62%) identified in a study was weakness of one side of the body. 17  A number of sociodemographic factors were found to influence patients’ knowledge about stroke risk factors; for example older age and lower educational level. Also, age >75 years negatively influenced patients’ stroke knowledge level and low educational level had a negative   effect. 21  But we didn’t find relationship between stroke knowledge and educational level and age. However, one study showed a positive relationship between stroke knowledge and higher education. 22  There was no significant relation of awareness with residence, gender, social security and stroke risk status.1 Education was found to be playing a significant role in predicting correct response. 4  A study revealed that younger age, female gender, and higher education level were significantly associated with knowledge of stroke warnings. 2  In our study, ‘patients with stroke and their relatives’ was the most commonly cited source of information about stroke. A study found that the main sources of information about stroke were relatives (37.0%), television (31.1%), physicians (8.3%) and newspapers (8.1%).1  Another study revealed that the most frequently named sources were newspapers (67%), television/radio (60%), and pharmacies and at the doctors’ office (61%).22  Community-based studies are required that may include both urban and rural populations to confirm the findings of the current study.

Conclusion

Caregivers had a moderate knowledge about some of the warning signs and risk factors of stroke. The caregiver must be educated. Also, attention should be given to home-based education programmes and to visits by health workers for people who have difficulty accessing healthcare services.

Disclaimer: None.
Conflict of Interest: None.
Source of Funding: None.

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