Stroke is a leading cause of death and long-term disability worldwide, posing a significant public health challenge. It occurs when the blood supply to a part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Prompt recognition of stroke symptoms and immediate medical intervention are crucial in minimizing brain damage and improving outcomes. Public awareness and knowledge about stroke symptoms and prevention tactics are essential for reducing the incidence and impact of stroke.^1-5

Shimla, the capital of Himachal Pradesh, offers a distinctive setting for assessing stroke awareness among its residents. The district's diverse demographic, encompassing both urban and rural populations, provides a comprehensive perspective on community health literacy. Understanding how well the general public in Shimla recognizes stroke symptoms and their knowledge of preventive measures can significantly inform public health strategies aimed at combating this debilitating condition.

The primary objective of this study was to gauge awareness and knowledge about stroke among the general public in District Shimla. By identifying gaps in awareness and common misconceptions, this research aimed to support the development of targeted educational programs and public health initiatives. These initiatives are crucial for promoting the early detection of stroke symptoms, encouraging timely medical response, and disseminating effective prevention tactics within the community.

In light of the increasing prevalence of stroke and its severe health implications, this study was both timely and necessary. It sought to provide valuable insights into the current state of stroke awareness among Shimla’s residents, thereby guiding future health policies and community-based intervention programs. The findings from this research were intended to aid in creating a more informed community that is capable of recognizing the early signs of stroke and taking preventive actions to reduce stroke risk.

Through this research, we aimed to contribute to the broader effort of enhancing public health through improved stroke awareness and prevention. By highlighting the importance of recognizing stroke symptoms and identifying key areas for intervention, this study aspired to improve health outcomes and the quality of life for the residents of Shimla. The insights gained would serve as a foundation for sustainable health promotion strategies tailored to the unique needs and cultural context of this region.

The primary objective is to gauge awareness and knowledge about Stroke among general public of District Shimla ,Himachal Pradesh.

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: District Shimla , Himachal Pradesh

• Study duration- between January  2024 to May 2024

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Shimla Himachal Pradesh for a minimum of 12 months

• Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Stroke, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Stroke was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Stroke. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Shimla Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained.

The study conducted in District Shimla, Himachal Pradesh, aimed to assess the awareness and knowledge regarding stroke symptoms and prevention tactics among the general public. Data was collected from a sample of 400 adults using a structured questionnaire, and the results are summarized in three tables: Socio-Demographic Variables, Knowledge Regarding Stroke, and Overall Knowledge Score Categories.

Table 1: Socio-Demographic Variables of the Study Population

Table 1 provides an overview of the socio-demographic characteristics of the participants. The age distribution reveals that 30.3% of participants were aged 18-30 years, 24.5% were 31-40 years, 22.8% were 41-50 years, and 22.5% were over 50 years old. Gender distribution shows that 45% were male and 55% were female respondents. Regarding marital status, 39.5% of the participants were single, 55.5% were married, and 5% fell into other categories.

Religious affiliation was predominantly Hindu (85.3%), followed by Muslims (4.5%), Sikhs (7.3%), and others (3%). Employment status indicated that 44.3% of participants were employed, 25.3% were unemployed, and 30.5% were students. Educational attainment varied, with 20.3% having education below high school, 30% completing high school, 34.5% being graduates, and 15.3% having postgraduate or higher qualifications.

Table 1: Socio-Demographic Variables of the Study Population (N=400)

Table 2 highlights the participants' knowledge about stroke symptoms and prevention tactics. A substantial 80.5% of respondents were knowledgeable about stroke symptoms, while 73% were aware of risk factors associated with stroke. Understanding the importance of immediate medical help was noted in 77.8% of participants, and 70.5% had knowledge about lifestyle changes to prevent stroke.

Awareness of the impact of hypertension on stroke risk was present in 68.3%, and 62.8% understood the role of diet in stroke prevention. Knowledge about diabetes as a risk factor was reported by 65.3%, while 72.3% were aware of smoking and alcohol as risk factors. Understanding the significance of physical activity in stroke prevention was known by 70.5%, and 66.3% had knowledge about stroke rehabilitation methods.

Family history as a risk factor for stroke was recognized by 63.5% of respondents. The importance of regular health check-ups was understood by 69.5%, and 60.5% were knowledgeable about the difference between ischemic and hemorrhagic strokes. Awareness of the FAST (Face, Arms, Speech, Time) mnemonic, used to identify stroke symptoms quickly, was present in 78% of participants.

Knowledge about the importance of controlling cholesterol was reported by 69.3%, and 65.8% understood the role of stress management in stroke prevention. Awareness of the importance of medication adherence was noted in 62%, and 57% were knowledgeable about the signs of mini-strokes (TIAs). Understanding the impact of obesity on stroke risk was present in 61.8%, and 79% were aware of the need for regular blood pressure monitoring.

Table 2: Knowledge Regarding Stroke (N=400)

Table 3 categorizes the overall knowledge scores of the participants. Based on their scores, 26% of participants fell into the "Very Good" category (16-20 points), demonstrating a high level of knowledge. The majority, 36.8%, were classified as having "Good" knowledge (12-15 points). Those with "Fair" knowledge (8-11 points) comprised 24.3% of the respondents, while 13% had "Poor" knowledge, scoring below 8 points.

Table 3: Overall Knowledge Score Categories

These results indicate that while a significant portion of the population in Shimla has a good understanding of stroke symptoms and prevention tactics, there are still areas with notable knowledge gaps. Addressing these gaps through targeted educational programs and public health initiatives could enhance awareness and early detection of stroke, ultimately improving health outcomes in the region.

The present study provides a comprehensive assessment of stroke awareness and knowledge among the general public in District Shimla, Himachal Pradesh. With a sample size of 400 adults, the findings offer valuable insights into the level of stroke literacy within this diverse community, encompassing both urban and rural demographics.

Our findings indicate a substantial level of awareness regarding stroke symptoms among the participants, with 80.5% correctly identifying key symptoms. This high awareness level is encouraging and underscores the effectiveness of previous health education initiatives in the region. However, it is noteworthy that 19.5% of the respondents still lack adequate knowledge of stroke symptoms, highlighting the need for ongoing educational efforts.

The study also reveals a strong understanding of stroke risk factors among the participants. A significant 73% of respondents were aware of the various risk factors associated with stroke, such as hypertension, diabetes, smoking, and alcohol consumption. This awareness is crucial for prevention, as it empowers individuals to take proactive measures in managing these risk factors. Notably, awareness about the impact of hypertension (68.3%) and the role of diet (62.8%) in stroke prevention was lower than overall risk factor awareness, suggesting specific areas for targeted education.

Understanding the importance of immediate medical intervention following a stroke is critical for improving patient outcomes. In this study, 77.8% of participants recognized the necessity of seeking prompt medical help, indicating a relatively high level of awareness. However, nearly a quarter of the respondents were not fully aware of this, which could delay critical treatment and worsen health outcomes. Therefore, emphasizing the urgency of medical response in future educational campaigns is essential.

Preventive measures, including lifestyle changes, are pivotal in reducing stroke risk. While 70.5% of participants were knowledgeable about lifestyle modifications to prevent stroke, there remains a gap in knowledge among nearly 30% of the population. This gap presents an opportunity for health educators to focus on promoting healthy lifestyles, regular exercise, and dietary adjustments as preventive strategies.

The overall knowledge scores categorized participants into very good, good, fair, and poor levels. While 26% demonstrated very good knowledge, and 36.8% had good knowledge, a concerning 24.3% fell into the fair category, and 13% had poor knowledge. These figures indicate that although a majority possess a reasonable understanding of stroke, there is a substantial proportion of the population with insufficient knowledge.

Specific areas requiring improvement include the understanding of the difference between ischemic and hemorrhagic strokes (60.5%), signs of mini-strokes (TIAs) (57%), and the role of medication adherence (62%). Enhancing knowledge in these areas is crucial, as recognizing the type of stroke can influence treatment decisions, and understanding TIAs can prompt early intervention to prevent full-blown strokes.

The results of this study highlight the need for tailored public health strategies to address the identified knowledge gaps. Targeted educational programs focusing on the importance of immediate medical intervention, the impact of hypertension, dietary habits, and the significance of medication adherence could significantly improve stroke literacy in Shimla. Utilizing various communication platforms, including social media, local community centers, and healthcare facilities, can enhance the reach and effectiveness of these programs.^6-8

Moreover, incorporating stroke education into regular health check-ups and community health initiatives can reinforce the importance of prevention and early detection. Collaboration with local healthcare providers to disseminate information and provide resources for managing risk factors is also recommended.^9,10

The findings from this study emphasize the critical need for continuous public education on stroke symptoms, risk factors, and preventive measures. While a significant portion of Shimla's residents are aware of stroke-related information, there remain important gaps that need addressing. Focused educational interventions are essential to bridge these gaps, leading to better health outcomes and a decrease in stroke occurrences and their severity. These insights lay the groundwork for developing and implementing effective health promotion strategies tailored to the specific needs of Shimla’s population, ultimately improving overall public health and quality of life in the region.

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2. Stroke [Internet]. Johns Hopkins Medicine. [cited 2024 Jul 2]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke

3. Stroke [Internet]. Cleveland Clinic. [cited 2024 Jul 2]. Available from: https://my.clevelandclinic.org/health/diseases/5601-stroke

4. Stroke: Symptoms, causes, and treatment [Internet]. Healthline. [cited 2024 Jul 2]. Available from: https://www.healthline.com/health/stroke

5. Recognizing the signs of stroke: BE FAST [Internet]. Sancheti Hospital. [cited 2024 Jul 2]. Available from: https://sanchetihospital.org/recognizing-the-signs-of-stroke-be-fast/

6. Chhabra M, Gudi SK, Rashid M, Rohit R, Sharma P, Khan H. Assessment of Knowledge on Risk Factors, Warning Signs, and Early Treatment Approaches of Stroke among Community Adults in North India: A Telephone Interview Survey. J Neurosci Rural Pract. 2019 Jul;10(3):417-22.

7. Kapoor D, Gupta P, Sundar S, Sharma R, Dhiman A, Agarwal V. Study of the profile of stroke in a tertiary-care hospital in the sub-Himalayan region in north India. Int J Med Sci Public Health. 2015;4:124-8.

8. Gupta G, Negi D, Mahesh R. Mind Matters in the Mountains: A Comprehensive Exploration of Stroke Awareness and Prevention among the Public of District Shimla, Himachal Pradesh. IAR J Anaesthesiol Crit Care. 2023 Nov;4(6):12-6.