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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 1  |  Page : 54-59

Knowledge and attitude towards stroke among workers in Cairo University Hospitals


1 Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
2 Department of Public Health, Fayoum University, Fayoum, Egypt

Date of Submission07-Jun-2015
Date of Acceptance26-Jul-2015
Date of Web Publication15-Feb-2016

Correspondence Address:
Ahmed M Abdelalim
MD, Department Neurology, Faculty of Medicine, Cairo University, Cairo, 11562
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1083.176374

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  Abstract 

Background
Stroke is a major cause of mortality and morbidity worldwide. Poor knowledge of stroke risk factors, symptoms and appropriate response to stroke are possible causes of poor outcome.
Objective
The aim of this study was to evaluate the knowledge and attitude towards different aspects of stroke in a sample of Cairo University Hospitals' workers.
Patients and methods
A structured self-administered questionnaire was administered by 111 workers who were classified into clinical workers (physicians, house officers, nurses, laboratory technician and pharmacists) and nonclinical workers (administrative, sanitary and security workers).
Results
Out of 111 participants, 92 completed the questionnaire. Most participants had heard of stroke (91.3%), mostly through encountering a family member with a stroke rather than through mass media (10.9%). Hypertension was the most common identified stroke risk factor (66.3%). Clinical workers were more likely to identify risk factors. The most common identified stroke symptoms were slurring of speech (38.5%) and elevated blood pressure (38.5%). Clinical workers were more likely to identify symptoms such as slurring of speech (P = 0.042) and altered state of consciousness (P < 0.001). The most frequent response to an attack of stroke was transferring the patients to a hospital (59.8%).
Conclusion
Knowledge and perception of stroke in Cairo University Hospitals' workers appear to be poor, especially among nonclinical workers. Planning educational programs for raising the level of knowledge and awareness of stroke, both on the level of hospital workers and on the public level, is important to improve stroke management and outcome.

Keywords: Attitude, awareness, hospital workers, knowledge, stroke


How to cite this article:
Shehata HS, Ahmed SM, Abdelalim AM, El Sherbiny N. Knowledge and attitude towards stroke among workers in Cairo University Hospitals. Egypt J Neurol Psychiatry Neurosurg 2016;53:54-9

How to cite this URL:
Shehata HS, Ahmed SM, Abdelalim AM, El Sherbiny N. Knowledge and attitude towards stroke among workers in Cairo University Hospitals. Egypt J Neurol Psychiatry Neurosurg [serial online] 2016 [cited 2017 Jun 26];53:54-9. Available from: http://www.ejnpn.eg.net/text.asp?2016/53/1/54/176374


  Introduction Top


Stroke is a leading cause of death and disability. Only a limited number of studies have addressed the epidemiology of stroke in Egypt [1],[2],[3] with no accurate national estimates of prevalence or incidence of stroke. The annual incidence of stroke in Egypt has been roughly estimated to be 150 000-210 000 [4].

Poor knowledge of stroke risk factors [5], symptoms and appropriate response to acute stroke are causes of delay of stroke treatment and a possible cause of poor outcome [6],[7]. Although awareness of stroke is improving, there is still a gap in public knowledge about stroke even in the developed countries [8],[9],[10],[11],[12].

In the absence of national public stroke education and awareness programs in most developing countries, hospital workers have become an important source for information for the public and are frequently contacted by family, friends and neighbours in this respect [13],[14].


  Aim Top


Our objective was to examine the knowledge and attitude towards different aspects of stroke in a sample of Cairo University Hospitals' workers.


  Patients and methods Top


This study was a hospital-based survey study conducted in Cairo University Hospitals (Egypt). It included hospital workers affiliated to Cairo University Hospitals. Hospital workers were classified into clinical (physicians, house officers, nurses, laboratory technicians, pharmacists), who are involved directly in the healthcare process; and nonclinical workers (administrative, sanitary staff, security staff), who participate indirectly in the healthcare process. This study was approved by the local ethical committee and all participants signed informed consent before inclusion in the study.

Study instrument

The study instrument used was a structured self-administered questionnaire [15], which consisted of four sections: sociodemographic (age, sex, occupation, marital status, education), knowledge of stroke (causes, symptoms, warning signs, risk factors), self-reported risk factors of stroke, and response to an attack of stroke.

Statistical analysis

Data were collected, coded and analysed using SPSS software (version 21; SPSS Inc., Chicago, Illinois, USA). Numeric data were expressed as mean ± SD. The χ2 -test was used to test the differences in responses among clinical and nonclinical subjects. P-value less than or equal to 0.05 was considered statistically significant.


  Results Top


Out of 111 participants, 92 completed the questionnaire. The participants included 42 (45.7%) men and 50 (54.3%) women, their ages ranging from 18 to 52 years with a mean age of 30.89 ± 8.303 years. There were 32 (34.8) clinical workers and 60 (65.2) nonclinical workers. The mean age of nonclinical workers (33.37 ± 8.17 years) was significantly higher than that of clinical workers (26.25 ± 6.43 years) (P < 0.001). Level of education was significantly higher in the clinical group (P < 0.001). The demographic characteristics of the study group is shown in [Table 1].
Table 1: Demographic characteristics of study participants

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Knowledge of stroke

The majority of the participants had heard of stroke (n = 84, 91.3%), with no significant difference between clinical and nonclinical workers (P > 0.05). Yet, only 45 (48.9%) could successfully define stroke or how it happens with significantly better knowledge in the clinical group (P < 0.001).

The most frequent source of information was encountering a patient with a stroke (n = 24, 26.1%), which was mostly a family member (52.4%). Mass media represented the source for only 10 (10.9%) participants. Nonclinical workers were more likely to know about stroke from a friend in comparison with clinical workers (P = 0.013). Other sources were mentioned by 34 (37%) participants, mostly clinical workers (P = 0.007) [Table 2].
Table 2: Knowledge and source of information about stroke among participants

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Causes and risk factors of stroke

The risk factors and causes of stroke identified by participants in order of frequency were hypertension (n = 61, 66.3%), stress (n = 44, 47.8%), smoking (n = 40, 43.5%), high blood cholesterol (n = 36, 39.1%), obesity (n = 30, 32.6%), diabetes mellitus (n = 17, 18.5%), drug/alcohol intake/abuse (n = 16, 17.4%), lack of exercise (n = 12, 13%), old age (n = 10, 10.9%), unhealthy diet (n = 7, 7.6%) and genetic causes (n = 6, 6.5%). Clinical workers significantly identified risk factors and causes such as smoking (P = 0.029), obesity (P < 0.001), high blood cholesterol (P < 0.001), diabetes mellitus (P = 0.001), lack of exercise (P = 0.021) and genetic causes (P = 0.018) in comparison with nonclinical workers [Table 3].
Table 3: Knowledge of stroke causes and risk factors in adults

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Warning signs and symptoms of stroke

The warning signs and symptoms of stroke identified by participants in order of frequency were slurring of speech (n = 35, 38.5%), elevated blood pressure (n = 35, 38.5%), fainting (n = 23, 25%), headache (n = 21, 22.8%), altered consciousness (n = 20, 38.5%), weakness of a part or one side of the body (n = 18, 19.6%) and dizziness (n = 17, 18.5%). Clinical workers were more likely to identify symptoms such as slurring of speech (P = 0.042), altered state of consciousness (P < 0.001), fainting (P < 0.001) and dizziness (P = 0.027) compared with nonclinical workers who more frequently answered 'I don't know' (P = 0.007) [Table 4].
Table 4: Knowledge of stroke symptoms in adults

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Response and action taken towards an attack of stroke

The most frequent response to an attack of stroke was transferring the patients to a hospital (n = 55, 59.8%), followed by calling a specialist (n = 23, 25%), calling a nurse (n = 12, 13%) and go to a pharmacy (n = 4, 4.3%), with no significant differences in response among clinical and nonclinical participants [Table 5]. Women were more likely to answer 'Go to hospital' compared with men (P = 0.011).
Table 5: Response and actions taken towards an attack of stroke

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Self-reported risk factors of stroke

The most self-reported risk factor was hypertension (n = 17, 18.5%) and smoking (n = 17, 18.5%), followed by high cholesterol (n = 11, 12%), obesity (n = 10, 10.9%) and diabetes mellitus (n = 9, 9.8%). Smoking was significantly more prevalent in male participants (n = 15, P < 0.001). The lifetime risk of developing stroke was identified by 60 (65.2%) participants, whereas 41 (44.6%) believed it could be recurrent. Perception of lifetime risk of stroke was not significantly associated with self-reporting of stroke risk factors (P > 0.05).


  Discussion Top


In this study we evaluated knowledge and attitude towards stroke in a sample of Cairo University Hospital workers. Limited studies have evaluated stroke awareness among hospital workers or stroke awareness campaign participants [16],[17],[18], and most of these studies rather focused on community awareness.

Most participants (91.3%) had heard about stroke, yet only 45 (48.9%) could successfully define a stroke or how it happens. While the most frequent source of information was encountering a patient suffering a stroke (26.1%) (mostly family members), mass media represented the source for only 10 (10.9%) participants, and nonclinical workers were more likely to know about stroke from a friend. Surprisingly, 'other sources' were mentioned by 37% of the participants. More or less, similar results were shown in Fayoum University and Ain Shams University Hospital workers in Egypt [15],[19] and in other developing countries [16],[20],[21] where mass media was lagging behind as a source for stroke awareness.

The role of mass media in raising public awareness of stroke is of utmost importance [22] and would positively influence emergency department visits by stroke patients [23]. Mass media has been shown to be the main source of stroke awareness in developed countries [8],[24] and effectively impacts knowledge of stroke in younger generations [25]. This may reflect the discrepancy in stroke education and awareness programs or approach to the public through mass media among developed and developing countries.

The most frequently reported risk factors were hypertension (66.3%), stress (47.8%), smoking (43.5%), high blood cholesterol (39.1%) and obesity (32.6%). Surprisingly, diabetes mellitus was less identified than was expected (18.5%), especially by nonclinical workers. The least reported risk factors were old age, unhealthy diet and genetic causes. Clinical workers were more likely to identify smoking, obesity, high blood cholesterol, lack of exercise and genetic causes (in addition to diabetes mellitus) as compared with nonclinical workers. In agreement with these results, Hamdy et al. [15] in their study showed that hypertension, stress, obesity and smoking were the most common reported stroke risk factors, and that age and lack of exercise were among the least recognized risk factors. In addition, diabetes mellitus was reported only by one-third of the participants and age and lack of exercise were among the least recognized risk factors [15]. Other studies of hospital workers in Fayoum [19] and Nigeria [16] also reported hypertension to be the most common risk factor; although diabetes mellitus was reported more frequently than in our study, it was much less reported relative to hypertension. Diabetes mellitus seems to be generally undermined as a risk factor for stroke by public [24],[26].

The most common warning signs and symptoms of stroke as identified by participants were slurring of speech (38.5%), elevated blood pressure (38.5%), whereas only 19.6% identified weakness of the body or one side as a symptom of stroke. Clinical workers were more likely to identify symptoms as slurring of speech, altered state of consciousness, fainting and dizziness compared with nonclinical workers who more frequently answered 'I don't know'. These results are in agreement with those of previous studies [15],[19], but recognition of weakness as a warning sign of stroke was less identified compared with other studies [16],[27]. Generally, knowledge of stroke warning signs seems to be suboptimal even in some developed countries [8],[24], and is linked to older age and poor education [16],[28].

The most frequent response to an attack of stroke was transferring the patient to a hospital (59.8%), followed by calling a specialist (25%), calling a nurse (13%) and go to a pharmacy (4.3%), with no significant differences in response among clinical and nonclinical participants and with no influence of age group or level of education. This is more or less similar to the results obtained by previous studies [15],[19],[24]. Knowledge and awareness of proper measures that should be taken when identifying an attack of stroke has been shown to significantly decrease prehospital delay [29]. Some studies reported differences in responses on the basis of ethnic or sociodemographic factors [16],[30],[31], but this was not the case in the current study.

In the current study females were more likely to answer 'Go to hospital' compared with males. Many studies have shown better knowledge and attitude towards stroke in females [13],[28],[32].

The most self-reported risk factor was hypertension (18.5%) and the lifetime risk of developing stroke was identified by 65.2% of participants, whereas 44.6% believed it could be recurrent. Perception of lifetime risk of developing stroke has been linked to awareness of self-reported risk factor in some studies [26], but in other studies respondents with self-reported risk factor were unaware of an increased risk of stroke especially in the elderly [8],[33].

In the current study there were no significant differences in knowledge or attitude towards stroke among different age groups and levels of education.

The results of our study point towards a big gap between having 'heard about stroke', identifying stroke warning signs, and taking the right action towards an attack of stroke. Unless having encountered a patient with stroke, within the family or from friends, the overall knowledge and attitude towards stroke among workers in Cairo University Hospitals remains poor.

The main limitation of the current study is the limited number of hospital-based studies in the literature and the differences in study design when compared with population-based studies. In addition, clinical workers were significantly younger than were nonclinical workers, which may have augmented the discrepancies in awareness or knowledge of some aspects of stroke in the study.


  Conclusion Top


The knowledge and attitude towards stroke in Cairo University Hospitals' workers appears to be relatively poor. Clinical workers seem to have better knowledge but still inadequate to effectively improve public stroke awareness. There is a gap that needs to be filled through planning and implementation of educational and orientation programs targeting hospital workers and further the community to improve the stroke awareness and knowledge and to avoid delay in seeking medical help, which in return would improve stroke management and outcome in Egypt.

Acknowledgements

Many thanks to Dr Sherine El-Mously Assistant professor of Neurology, Fayoum University, Dr Ramez Moustafa Assistant Professor of Neurology, Ain Shams University, Dr Hadeer Abdelghaffar Professor of Pediatrics, Fayoum University for their help and support. Many thanks to house officers of Neurology Department, Cairo University, for their help in organizing and implementing the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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