Recognition of Stroke Warning Signs and Risk Factors Among Rural Population in Central Pennsylvania

Background: Recognition of stroke warning signs and risk factors reduces prehospital delay and increases stroke survival. The goal of this study was to evaluate the public knowledge of stroke warning signs and risk factors in a rural area in Central Pennsylvania. Materials and Methods: In this study, the 2016 Sullivan County Health Fair attendees in central Pennsylvania answered a structured close-ended multiple choice questionnaire about stroke warning signs and risk factors. Further questions were asked about their reaction to acute stroke, the source of their stroke knowledge, and if they had personally known a stroke victim. Results: Out of 163 respondents, 85.3% selected ≥3 (out of 4) correct stroke warning signs and 71.8% of respondents selected ≥3 (out of 5) correct stroke risk factors. Regarding the wrong stroke warning signs, 34.4% mentioned neck pain followed by chest pain (33.1%). Identification of ≥1 (out of 3) wrong stroke warning signs were significantly lower among the respondents of postgraduate level education in comparison with other literacy groups. 95.7% of respondents chose "call 911 immediately" in response to an acute stroke. A relative with a history of stroke was the most cited source of information. Multivariate analysis found that a high level of education increases odds of recognition of ≥3 correct stroke risk factors (0.21; 95% confidence interval, 0.09-0.61). Knowing anyone with stroke was associated with an awareness of the life-threatening nature of stroke (r = 0.21, P < 0.01). Conclusion: Respondents' recognition of stroke warning signs was favorable. About 85% of respondents recognized at least three stroke warning signs with no significant age and literacy effect. Our results provide evidence that the subjects most at risk of stroke are those with the least awareness of stroke risk factors.