INTRODUCTION:

Stroke is a major public health issue worldwide, and it accounts for 15 million people worldwide suffer a stroke. Of these, five million people die, and every other five million people are left completely disabled, creating heavy burden on families and community. Stroke was unusual in humans below forty years; while young stroke is more common nowadays, the principal cause is excessive blood pressure. 10 modifiable risk factors are responsible for 80% of stroke (stroke fact sheet 2025)1 in 4 people have stroke in their life time 53% of stroke occur in people under 70 years of age. The number of people who die from stroke or are disabled by it has almost doubled in the last three decades¹.

The current stroke incidence rate in India ranges from 105 to 152 per 100,000 people per year, with a prevalence rate of 545.10 per 100,000 persons². India will face an enormous socioeconomic burden to meet the costs of rehabilitation of stroke victims because the population is now surviving beyond the peak years (age 55 to 65) for risk of stroke. The best way for patients to receive the most effective stroke treatment is to get to an emergency room as quickly as possible, after they have had symptoms. Few studies from India have investigated the various factors that delay hospitalization in patients with acute ischemic stroke³. Also, there were few studies has done from India and other developing countries regarding public perception of stroke warning symptoms and risk factors.

The knowledge regarding the signs and symptoms, its risk factors are essential for the general population to use the thrombolytic therapy on time within 3 hours for ischemic stroke in many centres which have started using recombinant tissue plasminogen activator for acute ischemic stroke. So, this study was undertaken to assess the level of awareness on risk factors and early identification of stroke among the general population.

NEED FOR THE STUDY:

A study by Hitanshi P. Joshi, Radha Bhattad, Ashok K. Shyam, Parag K. Sancheti on Awareness of risk factors and early signs of stroke in high-risk population of Pune region, showed that 3.3% participants were fully aware about stroke. 24.2% of participants could not be able to identify even a risk factor of stroke. while 79% participants did not have self- risk perception on stroke. Only 2.2% of samples have identified all the signs and symptoms of stroke correctly. Only 2.2% participants identified all the signs and symptoms of stroke correctly⁶

A study by S Kamran, AB Benner Level of awareness of stroke risk factors and symptoms in Gulf Cooperation Council countries. At the end of the study, it was found that most patients had not even heard the term stroke4. Knowledge about stroke was lowest in the group with the young people. Health care workers at PHCs and hospitals will need guidance on how to provide information about stroke to the public. This level of understanding of stroke risk factors and symptoms highlights the need for stroke education efforts in the community.

During our posting, we came to know that there are people who were aware about risk factors, symptoms and stroke prevention and those who are not. There is an increasing rate of stroke in our society, and by talking to them, we realized that there was a lack of awareness about stroke prevention. By assessing their level of awareness, we could be able to provide Information regarding the level of awareness on risk factors and early identification of stroke among general population and thereby increase their knowledge on it and promote stroke management. The present study aimed to document the awareness about the knowledge on risk factors, early identification and prompt action on stroke.

OBJECTIVES:

The study aimed to assess the level of awareness regarding risk factors and early identification of stroke based on the following objectives:

· To assess the level of awareness on risk factors of stroke among the general population.

· To assess the level of awareness on early identification of stroke symptoms among the general population

· To associate the level of awareness of the risk factors and early identification of stroke with selected demographic variables

METHODOLOGY:

A Quantitative research approach with non-experimental descriptive study design was used to assess the level of awareness of risk factors and early identification of stroke. The participants were selected using non- probability convenient sampling technique based on the Inclusion criteria like participants above 18 years of age, who did not have the history of stroke, willing to participate, and comprehend Malayalam and exclusion criteria: previous history or diagnosed as stroke, mentally challenged, and not willing to participate. The data were collected from 60 inpatients and caregivers from medical and surgical wards.

Tools and Techniques:

The instrument used for the study was a self-structured questionnaire comprising of three sections: Socio-demographic and Clinical profile, Knowledge questionnaire related to the awareness on risk factors of stroke and Early identification of stroke. The first parts consist of the demographic profile such as age, gender, occupation, residential area, family history, income, educational status and marital status. The second part consists of self- structured questions on awareness on risk factors of stroke. The third part consists of questions regarding the awareness on early identification and action on stroke symptoms. The scores were interpreted as follows: Adequate knowledge (76% to 100%), Moderate knowledge (51% to 75%), Inadequate knowledge (26% to 50%), and poor knowledge (0% to 25%). The content validity of the tools was established from medical and nursing experts. The reliability of the tools was calculated using test-retest method.

Ethical consideration:

Permission was obtained from the research committee of Jubilee Mission College of Nursing. Permission was obtained from the institution. Informed consent was obtained from all the participants. Participants confidentiality was guarded.

Data Collection Procedure:

The pilot study was conducted to assess the awareness of risk factors and early identification of stroke. The pilot study was conducted on 6 participants who met the inclusion criteria were selected to assess the feasibility for conducting the study. The pilot study was conducted in male medical ward and main study was done in female medical, male surgical and female surgical wards of Jubilee Mission Medical College and Research Institute, Thrissur.

The researcher obtained a written consent from the concerned authority of the institution prior to the data collection. Informed consent was obtained from each sample. Researchers selected the participants using a non-probability convenience sampling technique.60 participants were selected above 18 years of age from patients who were admitted in male and female medical and surgical wards of Jubilee Mission Medical College and Research Institute. The data collection process was completed in 5 days. Maximum number of samples collected each day was 12. Researchers met the participants and then explained to them about the purpose of study and pamphlets were given with adequate explanation immediately after the data collection process. They were assured that all the data would be kept confidential and would only be used for the study purpose. The participants were thanked for the cooperation after data collection.

RESULTS:

The results, regarding the distribution of socio demographic variables reveals that, more than half of the samples 34(56.7%) belongs to 29 to 48 years of age, most of the participants 42(70%) of them were females. majority of the samples 44(73.3%) are residing in rural areas, Only 13(21.67%) had a family history of stroke and most of the samples have no family history of stroke (78.33%), 46(76.7%) were married, more than half of the samples are employed 35(58.33%) and 25(41 .66%) don't have any job, majority of the samples have income of above 5000(53.3%) and income of below 5000(46.66%). Half of the samples 30(50%) have high school education, 23(38.33%) of samples were graduates. Regarding the level of awareness on risk factors and early identification of stroke shows that 27(45%) had moderate awareness, 17(28.3%) had adequate awareness, and 16(26.6%) had inadequate awareness. There is a significant association was found between levels of awareness on the risk factors and early identification of stroke with selected demographic variables such as age with (p= 0.019) and family history (p=0.018) of stroke.

DATA ANALYSIS:

Table1: Distribution of participants based on socio demographic variables n=60

Socio demographic variables

Frequency (f)

Percentage %

Age in years

18- 28

29- 48

49- 58

59 and above

56.7

15.3

Gender

Male

Female

Occupation

Daily wager

Private Job

Government Job

No Job

Others

8.3

28.3

3.3

41.7

8.3

Residential Area

Urban

Rural

26.7

73.3

Family history

Yes

21.67

78.33

Income

Below 5000

5001- 10000

10000 and above

46.7

31.7

21.7

Marital Status

Married

Unmarried

Divorced

Widow or widower

76.7

1.7

Educational status

Non formal education

Primary education

High school and Secondary education

Degree and Masters education

11.7

38.33

Table 1 shows that, more than half of the samples 34(56.7%) belongs to the age group of 29 to 48 years. Majority of the samples 47(78.33and) have no family history of stroke

Figure 1: Distribution of frequency and percentage of samples based on their age

Figure 2: Distribution of frequency and percentage of samples based on the family history of stroke

Table 2: Distribution of level of awareness on risk factors and early identification of stroke based on the objectives of the study.

n=60

S. no	Components	Inadequate		Moderate		Adequate
S. no	Components	n	%	n	%	n	%
1	Level of awareness on risk factors of stroke	17	28.4	25	41.6	18	30
2	Level of awareness on early identification of stroke	16	26.6	29	48.3	15	25

Data presented in table 2: shows that 17(28.4%) of samples have inadequate level of awareness, 25 (41.6%) have moderate level of awareness and 18 (30%) have adequate level of awareness regarding the risk factors of stroke. Regarding the level of awareness on early identification of stroke symptoms, 16 (26.6%) have inadequate level of awareness, 29(48.3%) moderate level of awareness and 15(25%) have adequate level of awareness.

Figure 3: Distribution of participants according to the level of awareness on risk factors and early identification of stroke

DISCUSSION:

An observational study was conducted by Sai Sirisha et al. to evaluate the awareness, recognition and response to stroke among the general public. The sample size includes 2000 consecutive participants who visited the outpatient clinic of a tertiary care hospital. The results showed that the awareness of stroke was higher in people in cities (71.0 vs. 8.5 percent; p<0.001). Samples who were aware of stroke knew a greater number of risk factors and warning signs⁵.

In the present study, the alternative hypothesis (H) was rejected. There was no significant association between socio demographic data such as gender, marital status, educational status, residential area and income and there was a significant association between age and family history of stroke.

In our study, the major findings were:

· Majority of the participants 56.7% belong to the age group 29 to 48 years. More than half of them 70% were females and 30% were males and majority of the samples 76.7% were married.

· Majority of the samples 50% have high school and Secondary education, 38.33% of samples were graduated, and 11.67% have primary education.

· Majority of the samples 58.33% have a job and 41.66% don’t have any job. Majority of the samples 78.33% have no family history of stroke and 21.67% have family history of stroke.

· More than half of the samples 73.3% were from rural areas and 26.7% were from urban areas.

· Majority of the samples 53.3% have income above 5000 and 46.7% have income below 5000.

· From the data collected, it was found that 28.4% of samples have inadequate awareness, 41.6% have moderate awareness and 30% have adequate awareness regarding the risk factors of stroke. 26.6% have inadequate awareness, 48.3% moderate awareness and 25% have adequate awareness regarding the level of awareness on risk factors of stroke. 26.6% have inadequate awareness, 48.3% have moderate awareness and 25% have adequate awareness regarding the level of awareness on early identification of stroke.

· There was no significant association found between socio demographic data such as gender, marital status, educational status, family history, residential area and income and there was a significant association found between between age and occupation at (p=0.019 and p=0.018 respectively)

LIMITATIONS:

The study was only conducted on 60 samples who were admitted in male and female medical and surgical wards of Jubilee Mission Medical College and Research Institute.

CONCLUSION:

The present study aimed to assess the level of awareness regarding risk factors and early identification of stroke among the general population. The findings revealed that while a proportion of the participants demonstrated moderate to adequate awareness, a considerable number still lacked essential knowledge about stroke risk factors and warning signs. Specifically, 28.4% had inadequate awareness of stroke risk factors, and 26.6% lacked sufficient understanding of early identification of stroke symptoms.

The significant association between awareness and demographic variables such as age and family history of stroke highlights the importance of health education. This study underscores the importance of continuous public health education and community outreach to enhance stroke awareness, encourage preventive practices, and promote early intervention. Broader, multi-centric studies with larger sample sizes are recommended to generalize findings and guide future health education policies.

NURSING IMPLICATIONS:

This study was drawn for implication in the field of nursing education, nursing service, nursing administration and nursing research.

CONFLICTS OF INTEREST:

There were no conflicts of interest.

REFERENCE:

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2. Stroke incidence ,mortality ,sub types in rural and urban populations in five geographic areas of (2018 - 2019) : results from National Stroke Registry Programme

3. Subha PP, Pillai Geethakumari SM, Athira M, Nujum ZT. Pattern and risk factors of stroke in the young among stroke patients admitted in medical college hospital, Thiruvananthapuram. Ann Indian Acad Neurol. 2015; 18(1): 20-3.

4. Kamran S, Berner AB, Deleu D, Khoja W, Jumma M, Al Shubaili A, Inshashi J, Sharouq I, Al Khabouri J. The level of awareness of stroke risk factors and symptoms in the Gulf Cooperation Council countries: Gulf Cooperation Council stroke awareness study. Neuroepidemiology. 2007; 29(3-4): 235-42.

5. Sirisha S Jala S, Vooturi S ,Yada PK, Kaul S, Awareness, Recognition, Response, to stroke among the general public : An observational study. J Neurosci Rural Pract . 2021 Sep 23; 12(4): 704-710.

6. Hitanshi P. Joshi, Radha Bhattad, Ashok K. Shyam, Parag K. Sancheti. Awareness of risk factors and early signs of stroke in high-risk population of Pune region. International Journal of Community Medicine and Public Health. 2022 March; 9 (3): 2022.

Received on 24.11.2025 Revised on 19.12.2025

Accepted on 09.01.2026 Published on 30.07.2026

Available online from August 05, 2026

Int. J. Nursing Education and Research. 2026;14(3):240-244.

DOI: 10.52711/2454-2660.2026.00048

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