The World Health Organization defines a stroke as a clinical condition of rapidly manifesting symptoms of a focal impairment of brain function that lasts longer than 24 hours or may even result in death and has no known cause outside a vascular origin [1].

By reducing risk factors for stroke include diabetes, hypertension, smoking, alcohol use, and drug misuse, stroke can be avoided. Despite the improved advances in stroke therapeutic therapy, the illness burden is increasing daily as stroke patients delay seeking immediate medical assistance, leading to subpar therapeutic results [2-5].

Numerous studies have shown that stroke patients' hospitalizations are delayed because people are less aware of the signs and symptoms of a stroke early on. According to numerous studies, individuals who receive thrombolysis early have better therapeutic outcomes; however, this relies on how soon after the onset of symptoms a patient arrives at the hospital to seek treatment. Patients must report within 4.5 hours of the onset of symptoms in order to qualify for thrombolysis because the window period is shorter. However, 90% of the patients are not suitable for thrombolysis because they lack sufficient understanding of the symptoms and warning signs of a stroke [6-9].

Knowing the risk factors, early signs and symptoms of stroke could potentially prevent morbidity and mortality among the people. Thus the present study was carried out to evaluate this knowledge among general population of Himachal Pradesh             

Objectives of the Study

To evaluate the Knowledge about Risk factors and warning Signs of Stroke among the general population of Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area:Hilly state of Himachal Pradesh

• Study duration- between September 2021 to November 2021

• Study population: All adults above 18 years of age who were staying in the Himachal Pradesh for 12 months or more. 

• Sample size: 400 Adults assuming 50% have adequate knowledge regarding Risk factors and warning signs of Stroke, 5% absolute error, 95% confidence level, and 5% non response rate.

• Sampling Technique: convenience & snowball Sampling technique

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

Description of Tool

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

• Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about Risk factors and warning signs of Stroke (10 each) having three options i.e. Yes, No & Don’t Know. The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 10 and minimum score was zero in each category. Scoring was done on the basis of marks as >80% (9-10) = very good,60-79% (7-8) = Good,41-59% (4-6) = Fair<40% (< 4) = poor

• Validity of tool: by the experts in this field

• Inclusive Criteria: who were willing to participate in the study.

• Exclusion Criteria: who were not willing to participate in the study

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin in both rural and urban area of Himachal Pradesh till the 400 responses were collected. Responses were then recorded in a Google Excel spreadsheet.

• 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 present study was cross sectional descriptive study carried out to evaluate knowledge of risk and warning sign of Stroke among general population of Himachal Pradesh

A total of 400 respondents including 163(40.75%) were from urban area and 237(59.25%) were from rural area were participated in the study. Among the participants of the majority 269(67.25%) were males, 173(43.25%) were between 18-30 years, 155(38.75%) were Graduate, 266 (66.5%) were employed, 238(59.5%) were married and 387 (96.75%) were Hindu. (Table 1)

In the present study 54 (13.5%) study participants had very good knowledge (9-10 marks) towards risk factors for Stroke , 221 (55.25%) had good knowledge (7-8 marks), 73(18.25%) had fair knowledge (4-6 marks) and 52(13.0%) had poor knowledge (<4 marks) towards risk factors for Stroke. Similarly, 49(12.25%) study participants had very good knowledge (9-10 marks) towards warning signs of Stroke , 241(65.25%) had good knowledge (7-8 marks), 72(18.0%) had fair knowledge (4-6 marks) and 38 (9.5%) had poor knowledge (<4 marks) towards warning signs of Stroke.

Stroke is an alarming issue in developing countries as compared with the developed countries, and it is considered as the primary cause of morbidity and mortality among noncommunicable diseases. Stroke can be prevented and treated if its risk factors are modified and if warning signs are recognized earlier. In recent times, thrombolysis has added as a cornerstone in the history of treatment of stroke, and it is believed that there is a maximum chance of recovery with early initiation of thrombolysis among ischemic stroke patients. Astonishingly, many studies in the past had reported that patients suffering from a stroke fail to arrive at the hospital within the window period of thrombolysis due to the lack of recognition of stroke symptoms, and they were not aware of the actions to react if anyone is suffering from a stroke [10-12].

Table 1: Socio-Demographic Characteristics of Study Participants

Table 2: Knowledge about Risk Factors of Stroke Among Participants

Table 3: knowledge of Participants Towards Warning Signs of Stroke

Table 4: Knowledge towards Risk Factor and warning signs among study participants

This survey results have proven that there exists a poor awareness regarding stroke among the public of Himachal Pradesh. Similar to our survey results, in the study Manik Chhabra et al [13] by 28.85% of the study participants were not aware of the risk factors, whereas 46% of the participants were not aware of warning signs of stroke. There is a need for organizing health awareness camps on stroke risk factors and their management. Educating the public on signs and symptoms of stroke would make patients receive early medical care by attaining the window period of thrombolysis.

Limitations

The sample size and duration of the study are restricted to 400 respondents and 3 months in time; thus, the scope and extent of the conducted research might be minimized. This survey was conducted only in one state of India, and hence, these findings cannot be generalized all over India.

From the survey results, we conclude that there exists a poor awareness among the general population of Himachal Pradesh toward risk factors and warning signs of stroke. As this is a serious concern and proves to be a significant cause of increased mortality and morbidity due to stroke, there is a need to initiate stroke awareness camps to make the community aware which can eventually prevent disability and increase the chances of recovery among stroke patients.

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