Dewi Rachmawati, Dewi Kartikawati Ningsih, Sri Andarini
  MNJ, pp. 10-18  



The knowledge about stroke risks and early symptoms is pivotal to minimize the arrival delay in the hospital and maximize the effective treatments.


Investigating the factors affecting the knowledge about stroke risks and early symptoms in the emergency department (ED).


The study employed a cross-sectional design by means of a prospective approach. Samples were taken by consecutive sampling technique recruiting in a total of 58 respondents. The respondents were the family or relatives of acute ischemic stroke patients who happened to know and directly involved in taking the patients to the ED. Data analyzed by utilizing univariate analysis, independent t-test, and one-way ANOVA to determine the differences in the knowledge of every respondent based on several characteristics. Multivariate analysis was used to investigate the factors affecting the knowledge about stroke risks and early symptoms.


The average age of the 58 respondents was 34 – 57 years old. 46.5% of whom were graduating from primary school; 51.7% have never been equipped with the necessary information about stroke; 55.2% are female, and 50% of whom were unemployed. There were differences in the knowledge about stroke risks based on the prior information about stroke and education background. As for stroke early symptoms, there were differences towards occupations, prior information about stroke, and education background. The most affecting factor towards the knowledge of stroke risks is education background (p=0.000); while the knowledge about stroke early symptoms were mostly affected by prior information about stroke (p=0.012) and education background (p=0.000).


Most respondents were less equipped with the necessary knowledge about stroke risks and symptoms. The respondents’ knowledge about stroke risks and early symptoms was considered less, while education background was the affecting factor towards the knowledge about stroke risks and symptoms.


Knowledge, risk factors, stroke early symptoms, ED, Indonesia

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Deb P, Sharma S, Hassan KM. Pathophysiologic mechanisms of acute ischemic stroke: An overview with emphasis on therapeutic significance beyond thrombolysis. Pathophysiology; 2010.17:197-218. DOI: 10.1016/j.pathophys.2009.12.001

Crocco T, Goldstein J. Stroke, In: Marx H, Walls R editors. Rosen's Emergency Medicine Concepts and Clinical Practice Neurology. Philadelphia: Saunders Elsevier; 2014.1363-74. eBook ISBN: 9781455749874

Turan TN, Hertzberg V, Weiss P, McClellan W, Presley R, Krompf K, et al. Clinical characteristics of patients with early hospital arrival after stroke symptom onset. Journal of Stroke and Cerebrovascular Diseases; 2005. Nov-Des;14(6):272-7. DOI: 10.1016/j.jstrokecerebrovasdis.2005.07.002

Teuschl Y, Brainin M. Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. International Journal of Stroke; 2010. June;5:187-208. DOI: 10.1111/j.1747-4949.2010.00428.x

Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet; 2010. May;375(15):1695-703. Avalaible from: www.thelancet.com

Yang H, Zhang J, Xie J, Yang C, Dong X, Gong Y, et al. Factors influencing pre-hospital delay among acute ischemic stroke patients in the midlands of China. International Journal of Cardiology; 2014.172(2):533-4. DOI: 10.1016/j.ijcard.2014.01.047

Faiz KW. Prehospital delay and patient knowledge in acute cerebrovascular disease (dissertation). Oslo: University of Oslo; 2014. Available from: https://www.duo.uio.no/bitstream/handle/10852/41024/PhD-Faiz-DUO.pdf?sequence=1&isAllowed=y

Hickey A, Holly D, McGee H, Conroy R, Shelley E. Knowledge of stroke risk factors and warning signs in Ireland: development and application of the Stroke Awareness Questionnaire (SAQ). International Journal of Stroke; 2012. June;7:298-306. DOI: 10.1111/j.1747-4949.2011.00698.x

Fang J, Yan W, Jiang GX, Li W, Cheng Q. Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China. Clinical Neurology and Neurosurgery; 2011.113:85-8. DOI: 10.1016/j.clineuro.2010.09.004

Philip-Ephraim EE, Charidimou A, Otu AA, Eyong EK, Williams UE, Ephraim RP. Factors associated with prehospital delay among stroke patients in a developing African country. International Journal of Stroke; 2015. Jun;10(4):E39. DOI: 10.1111/ijs.12469

Pinzon R. Mengapa Pasien stroke datang terlambat ke rumah sakit? Medicinus; 2012. April;25(1):18-21. ISSN: 1979-39x, Available from: https://www.slideshare.net/sainaledikamal9/jurnal-medicinus

Go'ngora-Rivera F, Gutie´rrez-Jime´nez E, Zenteno MA. Knowledge of ischemic stroke among a Mexico City population. Journal of Stroke and Cerebrovascular Diseases; 2009. May-June;18(3):208-13. DOI :10.1016/j.jstrokecerebrovasdis.2008.10.002

Menon B, Swaroop JJ, Deepika HKR, Conjeevaram J, Munisusmitha K. Poor awareness of stroke-a hospital-based study from South India: an urgent need for awareness programs. Journal of Stroke and Cerebrovascular Diseases; 2014. Sep;23(8):2091-8. DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.017

Kaddumukasa M, Kayima J, Kaddumukasa MN, Ddumba E, Mugenyi L, Pundik S, et al. Knowledge, attitudes and perceptions of stroke: a cross‑sectional survey in rural and urban Uganda. BMC Research Notes; 2015.8:819-26. DOI 10.1186/s13104-015-1820-6

Yadav PK, Simerleen, Shewta, Kumar KV, Joshua A, Krishnan S, et al. Survey of knowledge and awareness about cerebro-vascular stroke, its risk factors, warning signs and immediate treatment among Mangalore urban population - a cross-sectional study. International Journal of Health and Rehabilitation Sciences; 2013. April;2(2):116-22. Available from: https://www.scopemed.org/mnsfulltext/20-1376672252.pdf?t=1564555597

Jones SP, Jenkinson AJ, Leathley M, Watkins CL. Stroke knowledge and awareness: an integrative review of the evidence. Age and Ageing; 2010.39:11-22. DOI: 10.1093/ageing/afp196

Chang KC, Tseng MC, Tan TY. Prehospital delay after acute stroke in Kaohsiung, Taiwan. Stroke; 2004.35:700-4. DOI: 10.1161/01.STR.0000117236.90827.17

Sundseth A, Faiz KW, Rønning OM, Thommessen B. Factors related to knowledge of stroke symptoms and risk factors in a Norwegian stroke population. Journal of Stroke and Cerebrovascular Diseases; 2014. Aug;23(7):1849-55. DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.026

Pandian JD, Kalra G, Jaison A, Deepak SS, Shamsher S, Singh Y, et al. Knowledge of stroke among stroke patients and their relatives in Northwest India. Neurology India; 2006. June; 54(2):152-6. Available from: http://www.bioline.org.br/pdf?ni06044

Obembe AO, Olaogun MO, Bamikole AA, Komolafe MA, Odetunde MO. Awareness of risk factors and warning signs of stroke in a Nigeria university. Journal of Stroke and Cerebrovascular Diseases; 2014. Apr;23(4):749-58. DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.03

Notoatmodjo S. Promosi kesehatan dan ilmu perilaku kesehatan Jakarta: Rineka Cipta; 2007. ISBN: 978-979-518-882-7

Gutie´rrez-Jime´nez E, Go´ngora-Rivera F, Martínez HR, Escamilla-Garza JM, Villarreal HJ, GECEN Investigators. Knowledge of ischemic stroke risk factors and warning signs after a health education program by medical students. Stroke; 2011. Apr;42:897-901. DOI: 10.1161/STROKEAHA.110.597062

Hodgson C, Lindsay P, Rubini F. Can mass media influence emergency department visits for stroke?. Stroke; 2007. Jul;38:2115-22. DOI: 10.1161/STROKEAHA.107.484071

Fogle CC, Oser CS, McNamara MJ, Helgerson SD, Gohdes D, Harwell TS. Impact of media on community awareness of stroke warning signs: a comparison study. Journal of Stroke and Cerebrovascular Diseases; 2010. Sep-Okt;19(5):370-5. DOI: 10.1016/j.jstrokecerebrovasdis.2009.06.007

Taylor J, Uchino K, Hussain MS, Carlson JN. Factors associated with delayed evaluation of patients with potential stroke in US EDs. American Journal of Emergency Medicine; 2014.32:1373-7. DOI: 10.1016/j.ajem.2014.08.047

Bergman K, Kindler D, Pfau L, Kalamazoo. Assessment of stroke: a review for ED nurses. Journal of emergency nursing; 2012. Jan;38(1):36-42. DOI: 10.1016/j.jen.2011.08.006

Siddiqui M, Siddiqui SR, Zafar A, Khan FS. Factors delaying hospital arrival of patients with acute stroke. Journal Pakistan Medical Association; 2008. Apr;58(4):178-81. Available from: https://www.researchgate.net/publication/51428645_Factors_delaying_hospital_arrival_of_patients_with_acute_stroke

Johnson. Behavioral system model. In: Alligood, editor. Nursing theorists and their work. Missouri: Mosby; 2010.332-5. ISBN: 978-0-323-09194-7

Das K, Mondal GP, Dutta AK, Mukherjee B, Mukherjee BB. Awareness of warning symptoms and risk factors of stroke in the general population and in survivors stroke. Journal of Clinical Neuroscience; 2007.14:12-6. DOI: 10.1016/j.jocn.2005.12.049

Falavigna A, Teles AR, Vedana VM, Kleber FD, Mosena G, Velho MC, et al. Awareness of stroke risk factors and warning sign in Southern Brazil. Arquivos de Neuro-Psiquiatria; 2009. 7(4): 1076-81. Avalaible from: http://www.scielo.br/pdf/anp/v67n4/22.pdf

Amen MR. Assessment of hypertensive patients’ knowledge about lifestyle risk factors and warning sign of stroke. Journal of Contemporary Medical Sciences; 2016. Winter; 2(5): 28-32. Available from:


Al Shafaee MA, Ganguly SS, Al Asmi AR. Perception of stroke and knowledge of potential risk factors among Omani patients at increased risk for stroke. BMC Neurology; 2006. Octr;6:38-44. DOI: 10.1186/1471-2377-6-38

Saengsuwan J, Suangpho P, Tiamkao S. Knowledge of Stroke Risk Factors and Warning Sign in Patients with Recurrent Stroke or Recurrent Transient Ischaemic Attack in Thailand. Hindawi Neurology Research International; 2017. October; 2017:1-7. DOI: https://doi.org/10.1155/2017/8215726. Available from: http://downloads.hindawi.com/journals/nri/2017/8215726.pdf

Pandian JD, Jaison A, Deepak SS, Kalra G, Shamsher S, Lincoln DJ, et al. Public awareness of warning symptoms, risk factors, and treatment of stroke in Northwest India. Stroke; 2005. Mar;36:644-8. DOI: 10.1161/01.STR.0000154876.08468.a0

Brenner DA, Zweifler RM, Gomez CR, Kissela BM, Levine D, Howard G, et al. Awareness, treatment, and control of vascular risk factors among stroke survivors. Journal of Stroke and Cerebrovascular Diseases; 2010. Jul-Aug;19(4):311-20. DOI: 10.1016/j.jstrokecerebrovasdis.2009.07.001

Monaliza, Aggarwal M, Srivastava A. Awareness of risk factors and warning symptoms of stroke in general population. Nursing and Midwifery Research Journal; 2012. Apr;8(2):149-62. Available from: http://medind.nic.in/nad/t12/i2/nadt12i2p149.pdf

Duque AS, Fernandes L, Correia AF, Calvinho I, Cardoso G, Marta P, et al. Awareness of stroke risk factors and warning signs and attitude to acute stroke. International Archives of Medicine; 2015. 8(195):1-18. DOI: 10.3823/1794

Vincent-Onabajo G, Moses T, Knowledge of stroke risk factors among stroke survivors in Nigeria. Handawi Publishing Corporation Stroke Research and Treatment; 2016.2:1-6. DOI: http://dx.doi.org/10.1155/2016/1902151

Nicol MB, Thrift AG. Knowledge of risk factors and warning signs of stroke. Vascular Health and Risk Management; 2005.1(2):137-47. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993942/pdf/vhrm0102-137.pdf

Neau J-P, Ingrand P, Godeneche G. Awareness within the French population concerning stroke signs, symptoms, and risk factors. Clinical neurology and neurosurgery; 2009. Jul;111:659-64. DOI: 10.1016/j.clineuro.2009.05.015

Chiamaka OE, Hemamalini. Assessment of knowledge on risk factors and warning sign of stroke among patient with hypertension in selected village Kancheepuram District. International Journal of Pharmacy and Biological Sciences; 2016. January-March; 6(1):178-84.

ISSN: 2321-3272 (Print), ISSN: 2230-7605 (Online).

Available from: https://pdfs.semanticscholar.org/95fb/3f3e01cf1db4a4f758c2b067fda463e81250.pdf

Stroebele N, Muller-Riemenschneider F, Nolte CH. Knowledge of risk factors, and warning signs of stroke: A Systematic review from a Gender Perspective. International Journal of Stroke; 2011. January; 6(1): 60-66. DOI:https://doi.org/10.1111%2Fj.1747-4949.2010.00540.x.

Fogle CC, Oser CS, Troutman TP, McNamara M, Williamson AP, Keller M, et al. Public education strategies to increase awareness of stroke warning signs and the need to call 911. Journal of Public Health Management Practice; 2008. 14(3): E17-E22. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=

Miyamatsu N, Kimura K, Okamura T, Iguchi Y, Nakayama H, Toyota A, et al. Effects of public

education by television on knowledge of early stroke symptoms among a Japanese population aged 40 to 74 years. Stroke; 2012. 43:545-9. DOI: 10.1161/STROKEAHA.111.634196

Nursalam, Efendi. Pendidikan dalam Keperawatan. Jakarta: Salemba Medika; 2008. ISBN: 978-979-3027-66-1


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