Public Awareness of Stroke Risk Factors and Warning Signs


Stroke is defined as a sudden neurological deficit caused by impairment in perfusion to the brain (M. Bornstein, N 2009). The WHO estimates that by year 2030, 80% of all strokes will occur in low and middle income countries and high quality of health statistics are essential for planning and implementing health policy in all countries.

Of all neurological diseases, stroke is the most preventable. The need to increase public awareness of stroke risk factors and warning signs has been identified as critical to addressing the large gaps in knowledge. An important aspect of improving understanding of stroke was to prevent strokes from occurring in the first place, by increasing public awareness of the risk factors (Britain, G 2009). Act F.A.S.T(face, arm, speech, time) campaign was laughed and organized by MOH in most of the countries and which has been effective in improving the public’s recognition of the symptoms of stroke . There are a lot of researches had been done to know the effectiveness of campaign and programs. This paper will review two articles to test the stroke awareness and risk factors in general population.


Two articles were chosen from Bio Med Central, using key words of stroke, awareness, risk factors, warning signs. The criteria were established with articles of data collection strategies, identification of the main study, full text and up to date published in between 2007 to 2008.


The abstract is a brief description of the study placed at the beginning of the article about 100 to 150 words and it allows readers to assess whether to read the full articles of the report (POLIT, D. F., & BECK, C. T 2010). Both articles illustrate background objective, method, results and conclusions in one paragraph clearly and concise, which stimulates the reader to read full articles. In (W Wahab, K. et al. 2008) article, author conducted the cross sectional study of ability to identify one risk factor of stroke warning sign at Irrua Specialist Teaching Hospital in southern Nigeria whereas in (Hickey, A. et al. 2009) article, discovered lack of public awareness about stroke warning signs and risk factors which contribute to reducing mortality and morbidity from stroke.

Introduction/Research problems

Successful fundraising professionals reveal that only 10 percent of their time is actually spent soliciting major gifts whereas the other 90 percent is spent researching prospects and developing strategies. For that reason, it is extremely important for an organization to allocate resources to establish a prospect research program (Ciconte, B. and Jacob, J 2009).

(BASTABLE, S. B. 2006) said an introduction should provide the reader with an understanding of how the study fits into what is already known about the research topic and provides a justification as why this particular piece of research is important. Central phenomena, concepts, the study purpose, the hypotheses (POLIT, D. F., & BECK, C. T. 2010) were briefly described in these two articles.

In Hickey, A. et al. (2009) article, the author has discussed needs of increase public awareness of stroke risk factors and warning signs in older adults, at higher risk for stroke with relevant references and the study was conducted across two jurisdictions the republic of Ireland and northern Ireland.

In (W Wahab, K. et al2008) article, author has discussed due to the spite of high case fatality rate from stroke in Nigeria, the study was designed to assess the knowledge of warning signs in patients with hypertension, diabetes mellitus or both conditions that are modifiable risk factors for stroke.

Research question

Both articles have been introduced in a general way at the end of the introduction, it is worth restating it before the methods section to refocus the reader’s attention though there is no actual research question is posted nor hypothesis.

Literature review

(Gliner, J. and Morgan, G 2000) explained that in most journals, the introduction and literature review are together in one section which is untitled in APA format, but some journals will separate these two titles. As can see, there are no subtitles of literature review in these two articles. However, the reader felt that both articles used primary sources briefly summarize the existing knowledge, which provided a state of evidence and solid basic. Some of the studies mentioned in the literature review for both articles were consider up to date as the oldest reference is dated as 1998.

Research Approach

Both articles, study were conducted using questionnaire by interviewers. In Anne article mentioned the reason why this approach was adopted.

(POLIT, D. F., & BECK, C. T 2010) stated that quantitative researchers use several criteria to assess the quality of a study, referred to as its scientific merit. Quantitative research is identified with traditional scientific method that gathers data objectively in an organized, systematic, controlled manner so that the findings can be generalized to other situations, population which can find in these two articles.

Research Design

Both articles used experimental research; which maintains the greatest control over the research settings and takes the form of randomized controlled trails (RTC) where participants are randomly selected into the different groupings. The RTC is generally considered the ‘gold standard’ of study designs (Kirch, W 2008). In (Hickey, A. et al 2009) article, study involved a cross sectional survey of randomly selected community based older people in the republic of Ireland and Northern Ireland. (Houser, J 2012) described that the quantitative studies, the design will detail how the subject will be selected and assigned to groups, the way the intervention will be applied, a measurement strategy, and a plan for data analysis. Ethic approval has been granted and informed consent was provided in both articles.


In both articles, researches used simple random sampling, which is the most basis form of probability sampling (REIS, H. T., & JUDD, C. M 2000). The sample size was enough in these two studies. However (Offredy, M. and Vicker, P 2010) concludes that there are no simple rules we can apply that is the correct size sample for the research. Sample size depends largely on aims and purpose of the research, as well as the current time and methodology used to undertake the research study (SMART, J. C. 2009


In (W Wahab, K. et al 2008) article, the study was conducted at the Irrua specialist teaching hospital from January to march 2007 with 225 eligible patients was approached for the study. All participants were recruited with a diagnosis of hypertension, diabetes mellitus or both were interviewed about knowledge of stroke warning signs by attending doctors.

In (Hickey, A. et al 2009) article, the study involved 2033 participants of a cross sectional survey of randomly selected aged of 65 + in the republic of Ireland and Northern Ireland. Interviews were conducted in participant’s own homes asking knowledge and warning signs of stroke by trained market researchers. This article did not mention duration of the study has been conducted. Both articles declared ethical considerations and consent taken.

Data Collection and Analysis

In both articles, the researchers used the questionnaire that was used and re corrected in pilot study to collect the data. In (Hickey, A. et al 2009) article, no information is given as when the data was collected. But the researcher has clearly explained the appropriateness of the methods and survey data was statistically adjusted prior to analysis to avoid potential bias. Descriptive and comparative analyses were carried out using the Stata version 8.2. The chi square test was used to examine differences between the Republic of Ireland and Northern Ireland in recognition of stroke risk factors and warning signs. Logistic regression analysis was used to examine the effects of demographic variables and the presence of risk factors on stroke.

In (W Wahab, K. et al 2008)article, researcher excluded those who participated in the pilot and history of stroke to avoid bias as they have been primed to seek for information. Researcher failed to describe the appropriateness of methods. Data was analyzed with statistical package for the social sciences version 11( SPSS Inc), a very widely used computer program designed to aid the statistical analysis of data in the course of research (KEMP, R., & SNELGAR, R 2006) , means and standard deviations were determined. Means were compared using Chi-Square Test to analyze variances. A multivariate logistic regression analysis was done to determine independent predictor of ability to identify warning sign from among baseline variables.

Reliability and Validity

Validity is the one if the obtained results are truthful and believable. In order to determine the validity, the researcher generally poses a series of questions, and will often look for the answers in the research of others to know the measurements accurately.( Kirk and Miller 1986) identified three types of reliability referred to in quantitative research, which relates to: (1) producing the same results under same measurement conditions (2) the stability of a measurement with respect to time; and (3) the similarity of measurements in a given time period. This has not been discussed by the researchers in both articles.


Overall, both articles results was statistically analyzed and presented in a way that average reader could understand. Tables are clear and promote clarity of the text. (Hickey, A. et al 2009) article’s table 1 showed significant demographic differences between the samples. Adjusted odds ratio analysis indicates that higher levels of knowledge were significantly associated with having second level education or grater and geographic location. Less than half of the population correctly identified stroke risk factors in table 2.

In (W Wahab, K. et al 2008) article, table 1 results showed that primary education was the highest educational attainment in 30.2% of the respondents. In table 2, no warning sign was identified by 60.4% while 39.6% was one sign identified. Gender (Male), 11 or more years of education emerged as the independent predictors of ability to identify at least one warning sign in table 3 on multiple logistic regression analysis.


In(W Wahab, K. et al 2008) article, the authors have interpreted the findings and made comparisons with India, Australia and Developed countries studies. The authors have discussed the finding related to research questions, aim clearly and stated that their study has potential limitations as its cross sectional and hospital based nature that the results might not be completely generalized to the community. They also suggested for further community based study to ascertain the generalizability of their results and there is no obvious bias seen in the discussion.

In (Hickey, A. et al 2009) article, the discussions were clearly explained the findings related to research hypotheses and analyze with US and mass media campaigns to be more effective. Limitations of their study is possible bias however the research team sought to minimize the possibility by having all interviewers receive the same training and work from a standardized script. Also suggested that need more longitudinal study investment in future. The authors had brought attentions to the National Health Service in UK system to provide a similar program me in Republic of Irelands.


The authors had suggested the need for substantial population health education with regard to stroke prevention and management is critical to a future reduction in Anne article. Recommendations were clear, relate to findings and encouraged for further study in (Hickey, A. et al 2009) article.

In (W Wahab, K. et al 2008) article,conclusion were mentioned clearly includes the finding, suggestions related to aims. Also recommended to do regular community education programs through mass media, radio and television using the appropriate local language. Both articles references were accurate and well written for overall.


Time is brain, May is the National stroke awareness month, a month dedicated to raise awareness about the nation’s fourth leading cause of death and disability ( 2013). This annual event is sponsored by the National Stroke Association, intended to engage individuals, community organizations and business in the effort to educate the public about how to prevent stroke through risk factor management, response to stroke symptoms and spread hope from stroke recovery.

I am working in an acute local hospital; medical unit specialized of gastro logy and neurology. From my experiences, most of the family members are not aware of stroke. Today, patient education is a topic of significant interest to nurses in every setting in which they practice. As teaching is a major aspect of nurse’s professional role, I do explore information to patient or family members regarding the stroke and awareness of stroke, risk factors provide with booklet from the hospital. There are also stroke specialize nurses in my hospital, who are giving moral support, needs for the patients and family members. Health promotion role of hospital nurses was to emphasize the need to influence, and help patients modify health beliefs and lifestyle together with disease related teaching (Piper, S 2009)

The focus of care is on outcomes that demonstrate the extent to which patients and their significant other have learned the knowledge and skills necessary for independent living (BASTABLE, S. B. 2006). It is important for every nurse to teach public and learning will continue to increase in this era of healthcare reform.