Assessing Stroke Awareness and Behavioural Response Following the National ‘Act Fast’ Stroke Awareness Campaign – Insights from a Cross-Sectional Survey in Qatar

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Abstract

Evaluating stroke campaigns and associated behavioural changes is crucial to assess intervention effectiveness and inform future strategies. We aimed to evaluate patient's and bystanders’ foreknowledge of stroke signs and symptoms and their response at stroke onset. We interviewed stroke patients using a validated questionnaire or their bystanders if the stroke patient had disabling stroke. The questionnaire was administered to 165 participants, 142 (86.1%) stroke patients and 23 (13.9%) bystanders. The mean age was 52.6 (SD = 11.7), and male–female ratio was 7:1. Among the participants, 33 (20.1%) had foreknowledge of stroke signs, and of these, 27 (16.5%) were aware of the stroke campaign in Qatar. The behavioural responses at stroke onset included; activating Emergency Medical Services (EMS) ( n = 55, 33.3%), calling friends/relatives ( n = 69, 41.8%), driving to hospital ( n = 33, 20%), waiting for improvement in condition ( n = 21, 12.7%). There was no association of ethnicity, marital status, or campaign awareness with EMS activation. Despite limited community awareness of stroke signs and campaign, help-seeking behaviour through EMS activation was generally high, underscoring the need for focused educational efforts and public health interventions.

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Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Catherine Owens Johnson, Minh Tri Nguyen, Gregory A Roth … (2019)

Summary Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Funding Bill & Melinda Gates Foundation

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The Level of Awareness of Stroke Risk Factors and Symptoms in the Gulf Cooperation Council Countries: Gulf Cooperation Council Stroke Awareness Study

S. Kamran, A.B. Bener, D. Deleu … (2008)

Objective: To assess the knowledge of stroke in the general public in the Gulf Cooperation Council (GCC) countries. Background: The Arabian Gulf is a rapidly developing part of the world with major changes in the lifestyle that can increase the risk of stroke. To design effective stroke treatment and prevention strategies, an assessment of the public knowledge of stroke is required. Methods: A cross-sectional community-based survey was conducted at primary health care centers (PHCs), in urban and semi-urban areas, of the GCC countries (Qatar, Saudi Arabia, Kuwait, Bahrain, the United Arab Emirates, Oman) on the level of stroke awareness in the general public. Health care workers completed 3,750 face-to-face interviews. Results: 1,089 (29.0%) were familiar with the term ‘stroke’, and 29.3% considered the age group 30–50 at the highest risk for stroke. The commonest risk factors identified were hypertension (23.1%) and smoking (27.3%). People who did not know the term stroke had a higher incidence of diabetes, hypertension, and had more than one risk factor (p < 0.05). The most frequently identified stroke symptoms were weakness (23%) and speech problems (21.7%). Of those who recognized stroke, blockage of blood vessels was identified as the commonest cause of stroke (22%) followed by tension/worrying (20%). Doctors and nurses were regarded as the best source of stroke information (70%). In the univariate comparison, younger age (p < 0.001), higher level of education (p < 0.001), and female gender (p = 0.008) better predicted stroke recognition. In a multivariate logistic regression analysis, the level of education, monthly income and smoking were independent variables predicting stroke knowledge. Conclusion: The majority of the patients had not even heard the term stroke. Stroke knowledge was poorest among the groups that were at the highest risk for stroke. Stroke education has to focus on the high-risk groups, particularly the younger population. The health care workers at the PHCs and hospitals will need instructions on providing stroke information to the public. The level of knowledge of stroke risk factors and symptoms emphasizes the need for stroke education efforts in the community.

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A Time Series Evaluation of the FAST National Stroke Awareness Campaign in England

Darren Flynn, Gary Ford, Helen Rodgers … (2014)

Objective In February 2009, the Department of Health in England launched the Face, Arm, Speech, and Time (FAST) mass media campaign, to raise public awareness of stroke symptoms and the need for an emergency response. We aimed to evaluate the impact of three consecutive phases of FAST using population-level measures of behaviour in England. Methods Interrupted time series (May 2007 to February 2011) assessed the impact of the campaign on: access to a national stroke charity's information resources (Stroke Association [SA]); emergency hospital admissions with a primary diagnosis of stroke (Hospital Episode Statistics for England); and thrombolysis activity from centres in England contributing data to the Safe Implementation of Thrombolysis in Stroke UK database. Results Before the campaign, emergency admissions (and patients admitted via accident and emergency [A&E]) and thrombolysis activity was increasing significantly over time, whereas emergency admissions via general practitioners (GPs) were decreasing significantly. SA webpage views, calls to their helpline and information materials dispatched increased significantly after phase one. Website hits/views, and information materials dispatched decreased after phase one; these outcomes increased significantly during phases two and three. After phase one there were significant increases in overall emergency admissions (505, 95% CI = 75 to 935) and patients admitted via A&E (451, 95% CI = 26 to 875). Significantly fewer monthly emergency admissions via GPs were reported after phase three (−19, 95% CI = −29 to −9). Thrombolysis activity per month significantly increased after phases one (3, 95% CI = 1 to 6), and three (3, 95% CI = 1 to 4). Conclusions Phase one had a statistically significant impact on information seeking behaviour and emergency admissions, with additional impact that may be attributable to subsequent phases on information seeking behaviour, emergency admissions via GPs, and thrombolysis activity. Future campaigns should be a0ccompanied by evaluation of impact on clinical outcomes such as reduced stroke-related morbidity and mortality.

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Author and article information

Journal

Journal ID (nlm-ta): J Patient Exp

Journal ID (iso-abbrev): J Patient Exp

Journal ID (publisher-id): JPX

Journal ID (hwp): spjpx

Title: Journal of Patient Experience

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 2374-3735

ISSN (Electronic): 2374-3743

Publication date (Electronic): 5 August 2024

Publication date Collection: 2024

Volume: 11

Electronic Location Identifier: 23743735241242717

Affiliations

[1 ]Department of Emergency Medicine, Ringgold 36977, universityHamad Medical Corporation; , Doha, Qatar

[2 ]Department of Emergency Medicine and Services, Ringgold 3835, universityHelsinki University Hospital and University of Helsinki; , Helsinki, Finland

[3 ]Blizard Institute of Barts & The London School of Medicine, Ringgold 105711, universityQueen Mary University of London; , London, UK

[4 ]Ringgold 161667, universitySchool of Public Health and Preventive Medicine, Monash University; , Melbourne, Australia

[5 ]Department of Neurology, Neuroscience Institute, Ringgold 36977, universityHamad Medical Corporation; , Doha, Qatar

[6 ]Department of Emergency Medicine, Ringgold 1859, universityBeth Israel Deaconess Medical Center and Harvard Medical School; , Boston, USA

[7 ]Department of Medicine, Division of Neurology, Ringgold 3158, universityUniversity of Alberta; , Edmonton, Canada

[8 ]Ringgold 601203, universityThe Alfred Hospital, Emergency and Trauma Centre; , School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Author notes

[*]Zain A. Bhutta, Doctoral School of Health Sciences, Doctoral Program of Clinical Research, University of Helsinki, Helsinki, Finland; Clinical Research Specialist, Emergency Department, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. Email: zain.bhutta@ 123456helsinki.fi ; zbhutta@ 123456hamad.qa

Author information

Zain A. Bhutta https://orcid.org/0000-0003-4269-5077

Stephen H. Thomas https://orcid.org/0000-0003-2833-5921

Article

Publisher ID: 10.1177_23743735241242717

DOI: 10.1177/23743735241242717

PMC ID: 11301737

PubMed ID: 39108995

SO-VID: 4e93d4c1-ecd2-4404-8a0d-355b87baba7d

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This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Funded by: Hamad Medical Corporation, FundRef https://doi.org/10.13039/100007833;

Award ID: MRC/1606/2017

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typesetter ts19

cover-date January-December 2024

Keywords: stroke campaign,awareness of stroke,patient response,ems activation,public health interventions

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Keywords: stroke campaign, awareness of stroke, patient response, ems activation, public health interventions

Assessing Stroke Awareness and Behavioural Response Following the National ‘Act Fast’ Stroke Awareness Campaign – Insights from a Cross-Sectional Survey in Qatar

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Most cited references 36

Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

The Level of Awareness of Stroke Risk Factors and Symptoms in the Gulf Cooperation Council Countries: Gulf Cooperation Council Stroke Awareness Study

A Time Series Evaluation of the FAST National Stroke Awareness Campaign in England

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