Knowledge
Among Stroke and High Risk Patients Regarding Risk Factors, Warning Signs and
Immediate Treatment of Stroke.
Koushal Dave1,
Nirmala Singh2
1Faculty, College of Nursing, Dr. R. M. L. Hospital,
New Delhi
2Principal,
College of Nursing, Dr. R. M. L. Hospital, New Delhi
*Corresponding
Author’s Email: kaushal442@gmail.com
ABSTRACT:
Reduction in the risk of stroke and increase in the
speed of hospital presentation after the onset of stroke both depend on the
level of knowledge of stroke in the general population. Studies conducted on
stroke patients have revealed inadequate knowledge regarding various aspects of
stroke. The
aim of the present study was to assess knowledge regarding stroke risk factors,
warning signs and immediate treatment. Quantitative, descriptive, comparative cross-sectional survey was
conducted on 402 patients i.e. stroke patients (n=201) and high risk patients
(n=201) in neurology and cardiology wards and outpatient clinics. Demographic
profile, clinical profile and knowledge questionnaire were used for data
collection. Data analysis was done using STATA 11.1, with the level of
significance at p < 0.05. Both the groups were found to be statistically
comparable with respect to age (p=0.280) and sex (p=0.411). 47% of stroke
patients and 32.3% of high risk patients were aware that brain is affected in
stroke. Knowledge regarding desired action after onset of stroke was excellent
(73.63% of stroke patients and 77.11% of high risk patients). Awareness
regarding risk factors and warning signs of stroke was significantly higher (p
= <0.05) in high risk patients as compared to stroke patients. It is concluded that there is a need to educate the patients
with stroke and population at risk regarding risk factors, warning signs and
immediate treatment of stroke.
KEYWORDS: Stroke, high risk patients, knowledge, risk factors,
warning signs
INTRODUCTION:
Stroke is a
global health problem. It is the second commonest cause of death after coronary
heart diseases (7.2 million) and the fourth leading cause of disability
worldwide.1,2 The Indian
Council of Medical Research estimates that stroke contributes to 41% of deaths
and 72% of disability cases. National Commission on Macroeconomics and Health
estimated that the number of strokes will increase from 1.08 million in 2000 to
1.67 million in 20153. Lack of awareness of stroke risk factors and
warning signs leads to delay of the treatment and more risk of disabilities and
death.4
The risk of
recurrent stroke is six times greater than first ever stroke and patients with
hypertension and a trial fibrillation are at a much higher risk of stroke.5A
study on northwest stroke patients and their relatives have found that 73% of
patients did not know that symptoms were due to stroke.6 Another
study in Pittsburgh on personal health behaviors of stroke patients found that
52% of patients could not name any risk factors and warning signs and 35% did
not know the emergency action in the stroke.7 Research in a Nigerian
tertiary hospital among high risk patients revealed that almost half of the
patients did not know any risk factors.8 This suggests a need for
assessment of knowledge about stroke among stroke survivors and the population
at high risk of stroke. In the current study, we assessed the knowledge among
stroke and those at high risk of stroke regarding risk factors, warning signs
and immediate treatment of stroke.
Table 1: Comparison of the
knowledge of stroke patients and high risk patients N=402
|
Variables |
Stroke
patients (n=201) |
High-risk
patients (n=201) |
*p-value |
|
|
Percentage |
||||
|
Risk
factors knowledge |
Median
|
33.33
|
46.67
|
0.0002*
|
|
Mini-max
|
13.33
– 100 |
13.33
– 100 |
||
|
Warning
signs knowledge |
Median
|
42
|
50
|
0.028*
|
|
Mini-max
|
14.3
– 100 |
14.3
– 100 |
||
|
Total
knowledge |
Median
|
37.5
|
45
|
0.023*
|
|
Mini-max
|
10-
87.5 |
10-
90 |
||
Wilcox on sum rank test, *p<0.05
Table 2: Comparison of
Knowledge Score of stroke patients and high risk patients N=402
|
Variables |
Knowledge
score |
Stroke
patients (n=201) |
High-risk
patients (n=201) |
|
Frequency (%) |
|||
|
Excellent |
>75 |
5 (2.5) |
10 (5) |
|
Good |
>50-75% |
67 (33.3) |
75 (37.3) |
|
Fair |
>25-50% |
59 (29.4) |
72 (35.8) |
|
Poor |
<25 |
70 (34.8) |
44 (21.9) |
MATERIALS AND METHODS:
Design and setting:
For this study descriptive,
comparative cross-sectional design was used.
Stroke patients > 18 yrs of age with at least one episode of
stroke and high risk patients diagnosed with Hypertension (HTN), Diabetes
Mellitus (DM), coronary artery disease (CAD), atrial
fibrillation (AF), rheumatic heart disease (RHD), mechanical heart valve
replacement (MVR), who had never experienced stroke or TIA (transient ischemic
attack) visiting neurology, cardiology wards and outpatient clinics were
enrolled. Ethical clearance for the study was obtained from institute ethics
committee. Data collection: A letter
explaining the purpose of the study was given to the subjects. Signed informed
consent was taken from the subjects. Demographic data sheet, Clinical profile
and Knowledge assessment questionnaire
regarding risk factors, warning signs, immediate treatment of stroke were used.
Distracters were added in the questionnaire to increase the reliability of the
questionnaire. Tools were prepared by the researcher in consultation with the
guides and by thorough review of literature and reference of previous studies.
Reliability (0.96, Cronhbach’s alpha) and
validity of the knowledge questionnaire was established prior to use. Measures: Total knowledge score was divided into
excellent (> 75%), good (> 50- 75%), fair (>25 - 50%) and poor (<
25%).Risk factors and warning sign knowledge score was divided into poor
(do not identify any), fair (identify up to 4), good (identify between 5 - 8)
and excellent (identify > 9).
RESULTS:
Data was collected from 402 subjects, i.e. 201 stroke
patients and 201 high risk patients. The groups were comparable with respect to
age (p=0.280) and sex (p=0.411). 25% stroke patients and 38% high risk patients
were educated above 12th standard. 5% stroke patients and 49% high
risk patients were vegetarian. 88.6% patients had ischemic stroke and 11.4% had
a hemorrhagic stroke. 10% of stroke patients were aware that their symptoms
were due to a stroke. 51% had stroke within the last 6 months The co-morbid
illness found in stroke patients was HTN (60.7%), prior stroke (24.4%), DM
(21.9%), hyperlipidemia (16.42%), CAD (10.92%), RHD
(7.46%), MVR (4.98%) and AF (4.98%). High risk patients included were having
HTN (50%), CAD (43.28%), DM (22.39%), RHD (15.92%), AF (14.43%) and MVR (14.43%)
and hyperlipidemia (13.43%) as co-morbid illness.
Around 50% of patients had these illnesses from >18 months. 97% of patients
had heard of stroke and 87% of patients had interacted with stroke patients. A
significant difference (p = 0.0003) between the group as stroke patients were
more aware of affected organ in stroke. 40% subjects in both the groups were
aware about causes of the stroke. 73% of stroke patients and 77% high risk
patients were aware that sroke treatment should be
started within 3 hours. As shown in Table 1, High risk patients had
significantly higher knowledge (p=<0.05) regarding risk factors and warning
signs of stroke. 15.4% of stroke patients and 25.9% of high risk patients had
excellent knowledge of risk factors, 18.9% of stroke patients and 26.4% of high
risk patients had excellent knowledge of warning signs. A shown in Table 2,
more than half of the patients in both groups had < 50% of stroke knowledge.
There was a significantly higher (p=0.015) knowledge among stroke patients as
compared to high risk patients with respect to aspirin. Whereas significantly
higher (p=0.034) knowledge among high risk patients regarding
anti-hypertensive. There was a significant association between gender,
education, occupation, monthly income and stroke knowledge in stroke patients.
There was a significant association between educations, occupation, monthly
income and stroke knowledge score in high risk patients.
DISCUSSION:
The high risk patients were more
knowledgeable than stroke patients. Similar results have been reported
previously10 in which stroke risk factor knowledge was poor in
stroke patients as compared to general population, at risk population and
nurses (p=<0.05). Possible explanations of this discrepancy in stroke
knowledge could be the cognitive deficits of the acute brain insult among
patients with stroke and frequent visits of high risk patients to the physician
resulting in better awareness. In our study, majority of the patients in both
the groups had inadequate knowledge regarding various aspects of stroke and the
findings were consistent with other studies.6, 8 In the present study majority of patients
i.e. 63.18% stroke patients and 66.17% high risk patients were able to
differentiate heart attack from stroke. Studies conducted in northern India6
reported 90% of patients and in Tanzania13 52.3% of patients were
able to differentiate the same. In this study, knowledge regarding desired
action after onset of stroke was excellent. The result is in line with other
studies on stroke patients7 and high risk patients10, 14
and in contrast to the study by Zeng Y and
colleagues9, in which only 9.2% reported to visit emergency.
In current study, 36.3% of stroke patients did not know any risk factor and
23.3% did not know any warning sign .This is in contrast with other studies on
post stroke patients as more patients were unaware. In the present study 19.4% and 10.5% of high risk patients did not aware
any risk factor and warning sign respectively. Study by Gill R and colleagues12
reported 8% and 48% of patients were not aware of any risk factor and warning
sign respectively. This study also reported that most common identified
risk factors by high risk patients were increased blood pressure (54.7%) and
stress (52.7%). The results are in contrast to the previous studies which
reported higher knowledge.14, 15 A significant association was found
between gender and knowledge (p=0.046) in stroke patients which showed that
males had higher knowledge. Similar results were observed by Koenig KL and colleagues7.
There was a significant association (p=0.0001) between higher educational status and stroke knowledge score
of both the groups. These findings are supported by studies done on stroke
patients6, 11 and high risk patients.14, 16 In some
studies a significant association was found between younger age and stroke
knowledge9, 15 and this is in line with current study. Based on the
knowledge gap among stroke and high risk patients regarding stroke an
informational material was developed. Informational material was validated by
experts and was translated to Hindi. The informational material constituted
Stroke definition, Types of stroke, Risk factors of stroke (modifiable and
non-modifiable), Warning signs of stroke, immediate treatment of stroke and
Lifestyle changes to prevent stroke.
STRENGTH
AND LIMITATION OF THE STUDY:
Strengths of the study were age and sex matching was
done. One to one data collection was done which reduces the chances of getting
influenced by the group. Within group analysis was done. Informational material
prepared and distributed to the patients. Limitations like smaller sample size
from a single setting was taken, so the results may not be generalizable.
Convenience sample was taken.
FUTURE RECOMMENDATION:
Similar study can be replicated with a larger sample
size in different settings. Qualitative studies can be undertaken to further
explore how patients perceive their symptoms and to find out the decision
making patterns with regard to stoke.
CONCLUSION:
In both the groups, majority of the patients i.e. more
than 55% had knowledge score of less than 50%, which is not adequate. There is
an intense need to educate the population at risk for stroke regarding risk
factors, warning signs and immediate treatment.
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Received on 22.06.2016 Modified on 30.06.2016
Accepted on 17.07.2016 © A & V Publications all right reserved
Int. J. Adv. Nur. Management. 2016; 4(4): 331-333.
DOI: 10.5958/2454-2652.2016.00074.3