Journal Mobile Options
Table of Contents
Vol. 11, No. 1, 2001
Issue release date: January 2001
Cerebrovasc Dis 2001;11:34–43

Community-Based Education Improves Stroke Knowledge

Becker K.J. · Fruin M.S. · Gooding T.D. · Tirschwell D.L. · Love P.J. · Mankowski T.M.
aUniversity of Washington School of Medicine, Harborview Medical Center, Departments of bNeurology and cNeurological Surgery, Seattle, Wash., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background and Purpose: Despite advances in stroke therapy, the public remains uninformed about stroke, and few stroke patients present to the hospital in time to receive treatment. Health education campaigns can increase community awareness and may decrease time to hospital presentation among stroke patients. Methods: We conducted a community-based education campaign utilizing television and newspapers to inform the residents of King County, Wash., USA, about stroke and the need to call 911. The effectiveness of the campaign was assessed, using a pretest-posttest design, through telephone interviews with residents of King County. Results: Prior to the education campaign, 59.6% of persons in King County could name a risk factor for stroke, but only 45.2% knew that the brain was the organ of injury. And while 68.2% of persons stated that they would call 911 in the event of stroke, only 38.6% could name a symptom of stroke. The knowledge deficit was greatest among Asian-Americans, men, the less educated and low-income residents. There was a significant increase in stroke knowledge following the education campaign; respondents were 52% (p = 0.005) more likely to know a risk factor for stroke and 35% (p = 0.032) more likely to know a symptom of stroke after the campaign. Conclusions: Baseline knowledge about stroke among the public is poor, but can be increased through public education campaigns.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Williams GR, Jiang JG, Matchar DB, Samsa GP: Incidence and occurrence of total (first-ever and recurrent) stroke. Stroke 1999;30:2523–2528.
  2. Samsa GP, Cohen SJ, Goldstein LB, Bonito AJ, Duncan PW, Enarson C, DeFriese GH, Horner RD, Matchar DB: Knowledge of risk among patients at increased risk for stroke. Stroke 1997;28:916–921.
  3. Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, Khoury J, Jauch E: Public perception of stroke warning signs and knowledge of potential risk factors. JAMA 1998;279:1288–1292.
  4. Kothari R, Sauerbeck L, Jauch E, Broderick J, Brott T, Khoury J, Liu T: Patients’ awareness of stroke signs, symptoms, and risk factors. Stroke 1997;28:1871–1875.
  5. Goldstein LB, Bonito AJ, Matchar DB, Duncan PW, Samsa GP: US National Survey of Physician Practices for the Secondary and Tertiary Prevention of Ischemic Stroke. Carotid endarterectomy. Stroke 1996;27:801–806.
  6. Howard PA, Duncan PW: Primary stroke prevention in nonvalvular atrial fibrillation: Implementing the clinical trial findings. Ann Pharmacother 1997;31:1187–1196.

    External Resources

  7. Antani MR, Beyth RJ, Covinsky KE, Anderson PA, Miller DG, Cebul RD, Quinn LM, Landefeld CS: Failure to prescribe warfarin to patients with nonrheumatic atrial fibrillation. J Gen Intern Med 1996;11:713–720.
  8. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998;351:1755–1762.
  9. Gorelick PB, Sacco RL, Smith DB, Alberts M, Mustone–Alexander L, Rader D, Ross JL, Raps E, Ozer MN, Brass LM, Malone ME, Goldberg S, Booss J, Hanley DF, Toole JF, Greengold NL, Rhew DC: Prevention of a first stroke: A review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA 1999;281:1112–1120.
  10. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JM, Wun CC, Davis BR, Braunwald E: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 1996;335:1001–1009.
  11. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581–1587.
  12. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Hoxter G, Mahagne MH, et al: Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995;274:1017–1025.
  13. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P: Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998;352:1245–1251.
  14. Zweifler RM, Brody ML, Graves GC, U TT, Drinkard R, Cunningham S, Rothrock JF: Intravenous t-PA for acute ischemic stroke: Therapeutic yield of a stroke code system. Neurology 1998;50:501–503.
  15. Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T: Acute stroke: Delays to presentation and emergency department evaluation. Ann Emerg Med 1999;33:3–8.
  16. Wester P, Radberg J, Lundgren B, Peltonen M: Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: A prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 1999;30:40–48.
  17. Rosamond WD, Gorton RA, Hinn AR, Hohenhaus SM, Morris DL: Rapid response to stroke symptoms: The Delay in Accessing Stroke Healthcare (DASH) study. Acad Emerg Med 1998;5:45–51.
  18. Smith MA, Doliszny KM, Shahar E, McGovern PG, Arnett DK, Luepker RV: Delayed hospital arrival for acute stroke: The Minnesota Stroke Survey. Ann Intern Med 1998;129:190–196.
  19. Fogelholm R, Murros K, Rissanen A, Ilmavirta M: Factors delaying hospital admission after acute stroke. Stroke 1996;27:398–400.
  20. Davalos A, Castillo J, Martinez-Vila E: Delay in neurological attention and stroke outcome. Cerebrovascular Diseases Study Group of the Spanish Society of Neurology. Stroke 1995;26:2233–2237.
  21. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F: Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: A randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282:2003–2011.
  22. Albers GW: Rationale for early intervention in acute stroke. Am J Cardiol 1997;80:4D–10D.
  23. Williams LS, Bruno A, Rouch D, Marriott DJ: Stroke patients’ knowledge of stroke. Influence on time to presentation. Stroke 1997;28:912–915.
  24. King County Profile.
  25. Sacco RL, Kargman DE, Zamanillo MC: Race-ethnic differences in stroke risk factors among hospitalized patients with cerebral infarction: The Northern Manhattan Stroke Study. Neurology 1995;45:659–663.
  26. Thompson DW, Furlan AJ: Clinical epidemiology of stroke. Neurosurg Clin North Am 1997;8:265–269.
  27. Wolinsky FD, Wan GJ, Gurney JG, Bentley DW: The risk of hospitalization for ischemic stroke among older adults. Med Care 1998;36:449–461.
  28. Singh SN, Bendapudin MS, Linville D: Enhancing Memory of Television Commericals through message spacing. J Marketing Res 1994;31:384–392.
  29. Pieters RGMBT: Consumer memory for television advertising: A field study of duration, serial position, and competition effects. J Consumer Res 1997;23:362–372.

    External Resources

  30. Williams CD, Sallis JF, Calfas KJ, Burke R: Psychosocial and demographic correlates of television viewing. Am J Health Promot 1999;13:207–214.

    External Resources

  31. Bett N, Aroney G, Thompson P: Impact of a national educational campaign to reduce patient delay in possible heart attack. Aust NZ J Med 1993;23:157–161.
  32. Ho MT, Eisenberg MS, Litwin PE, Schaeffer SM, Damon SK: Delay between onset of chest pain and seeking medical care: The effect of public education. Ann Emerg Med 1989;18:727–731.
  33. Safer MA, Tharps QJ, Jackson TC, Leventhal H: Determinants of three stages of delay in seeking care at a medical clinic. Med Care 1979;17:11–29.
  34. Meischke H, Ho MT, Eisenberg MS, Schaeffer SM, Larsen MP: Reasons patients with chest pain delay or do not call 911. Ann Emerg Med 1995;25:193–197.
  35. Salisbury HR, Banks BJ, Footitt DR, Winner SJ, Reynolds DJ: Delay in presentation of patients with acute stroke to hospital in Oxford. QJM 1998;91:635–640.
  36. Morris DL, Rosamond WD, Hinn AR, Gorton RA: Time delays in accessing stroke care in the emergency department. Acad Emerg Med 1999;6:218–223.
  37. Azzimondi G, Bassein L, Fiorani L, Nonino F, Montaguti U, Celin D, Re G, D’Alessandro R: Variables associated with hospital arrival time after stroke: Effect of delay on the clinical efficiency of early treatment. Stroke 1997;28:537–542.
  38. Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS: Factors delaying hospital admission in acute stroke: The Copenhagen Stroke Study. Neurology 1996;47:383–387.
  39. Elkind MS, Chen X, Boden-Albala B, Sacco R: Stroke severity is a predictor of early hospital arrival after stroke: The Northern Manhattan Stroke Study. Neurology 1998;50:A437.
  40. Alberts MJ, Perry A, Dawson DV, Bertels C: Effects of public and professional education on reducing the delay in presentation and referral of stroke patients. Stroke 1992;23:352–356.
  41. Barsan WG, Brott TG, Broderick JP, Haley EC Jr, Levy DE, Marler JR: Urgent therapy for acute stroke. Effects of a stroke trial on untreated patients. Stroke 1994;25:2132–2137.
  42. Fortmann SP, Flora JA, Winkleby MA, Schooler C, Taylor CB, Farquhar JW: Community intervention trials: Reflections on the Stanford Five–City Project Experience. Am J Epidemiol 1995;142:576–586.
  43. Prochaska JO, Velicer WF: The transtheoretical model of health behavior change. Am J Health Promot 1997;12:38–48.
  44. Murray DM, Prokhorov AV, Harty KC: Effects of a statewide antismoking campaign on mass media messages and smoking beliefs. Prev Med 1994;23:54–60.
  45. Wallack LM: Mass media campaigns: The odds against finding behavior change. Health Educ Q 1981;8:209–260.
  46. Eppler E, Eisenberg MS, Schaeffer S, Meischke H, Larson MP: 911 and emergency department use for chest pain: Results of a media campaign. Ann Emerg Med 1994;24:202–208.
  47. Goff DC Jr, Sellers DE, McGovern PG, Meischke H, Goldberg RJ, Bittner V, Hedges JR, Allender PS, Nichaman MZ: Knowledge of heart attack symptoms in a population survey in the United States: The REACT Trial. Rapid Early Action for Coronary Treatment. Arch Intern Med 1998;158:2329–2338.
  48. Brown JD, Bauman KE, Padgett CA: A validity problem in measuring exposure to mass media campaigns. Health Educ Q 1990;17:299–306.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50