Acute stroke patients' knowledge of stroke at discharge in China: a cross-sectional study

Stroke knowledge and health-promoting behaviors: Mediating effect of patient self-esteem

OBJECTIVE

To investigate the levels of and associations between stroke knowledge, self-esteem, and health-promoting behavior (HPB) among stroke patients, and examine the mediating effect of self-esteem in the stroke knowledge-HPB relationship.

METHODS

This descriptive correlational study involved a total of 150 stroke patients. We collected data through questionnaires during outpatient visits at two Korean secondary hospitals, inquiring about general and disease-related characteristics, stroke knowledge, self-esteem, and HPB. Correlation and mediation analyses were performed.

RESULTS

Stroke knowledge significantly increased patients' self-esteem (β = .53, p = .001) and HPB (β = 1.64, p < .001). Self-esteem mediated the relationship between stroke knowledge and HPB, with the mediating effect coefficient determined to be 1.68 [95 % CI (0.56,-2.46)].

CONCLUSION

Education and intervention programs that increase both self-esteem and stroke knowledge need to be developed and evaluated such that stroke patients are motivated to engage in HPB.

PRACTICE IMPLICATIONS

Stroke patients are often physically and mentally impaired, and low self-esteem can be a barrier to engaging in HPB after diagnosis, negatively affecting their health outcomes. Nursing interventions focused on enhancing self-esteem can empower these patients to effectively engage in HPB. Healthcare professionals should adequately communicate and impart disease-related knowledge to patients with poor disease-related knowledge or education.

The Principles of Home Care for Patients with Stroke: An Integrative Review

Background

Patients With Stroke (PWS), like patients with other chronic health conditions, need long-term care in home settings. Patient transfer from hospital to home is associated with challenges such as care quality impairment and ineffective patient need fulfillment. The aim of this study was to assess the principles of Home Care (HC) for PWS.

Materials and Methods

This integrative review was conducted in 2023 using the method recommended by Whittemore and Knafl. The Web of Science, Google Scholar, ScienceDirect, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, PubMed, and specific databases for stroke care guidelines were searched to find relevant articles published between 2010 and 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for document screening and selection. The data were analyzed using the constant comparison method.

Results

Primarily, 2608 documents were retrieved, and 22 of them were included in data analysis. The principles of HC for PWS were categorized into six main categories: principles of transition from hospital care to HC, principles of assessment for HC, principles of education for HC, principles of designing an HC plan, principles of HC measures, and principles of discharge from HC centers.

Conclusions

The present study provides a detailed overview of the principles of HC for PWS, which can be used to develop standard guidelines and improve the quality of HC for PWS.

Development of health literacy assessment scale for Thai stroke patients

BACKGROUND

One important factor influencing the treatment and rehabilitation results for stroke patients is their level of health literacy. In order to acquire comprehensive information for appropriate treatment and rehabilitation programs that will promote the optimal possible health outcomes, health literacy assessment should be done in stroke patients from the earliest stages of stroke onset.

OBJECTIVES

This research aimed to develop a health literacy assessment scale for Thai stroke patients and to evaluate the HL levels of those patients using that assessment scale.

METHODS

A draft version of the scale has been developed based on the literature review and focus group discussions. After tryout, content validity, corrected item-total correlation and internal consistency were examined. A confirmatory factor analysis (CFA) was conducted in 400 patients with stroke to test the construct validity.

RESULTS

The Health Literacy Assessment Scale for Thai Stroke Patients was successfully developed. The complete version featured 50 health literacy-related questions, along with seven demographic-related questions. This tool demonstrated good psychometric properties, including content validity (Item-objective congruence; IOC > 0.50), internal consistency (Cronbach's alpha = 0.951 to 0.955, overall = 0.94). Confirmatory factor analysis (CFA) also revealed good construct validity.

CONCLUSIONS

The Health Literacy Assessment Scale for Thai Stroke Patients (HLS-Th) is measuring five components cover all health literacy aspects necessary for Thai stroke patient. This novel measurement scale is an accurate psychometric tool for assessing the level of health literacy among Thai stroke survivors.

Healthcare providers' perceived acceptability of a warning signs intervention for rural hospital-to-home transitional care: A cross-sectional study

INTRODUCTION

There is a pressing need for transitional care that prepares rural dwelling medical patients to identify and respond to the signs of worsening health conditions. An evidence-based warning signs intervention has the potential to address this need. While the intervention is predominantly delivered by nurses, other healthcare providers may be required to deliver it in rural communities where human health resources are typically limited. Understanding the perspectives of other healthcare providers likely to be involved in delivering the intervention is a necessary first step to avert consequences of low acceptability, such as poor intervention implementation, uptake, and effectiveness. This study examined and compared nurses' and other healthcare providers' perceived acceptability of an evidence-based warning signs intervention proposed for rural transitional care.

METHODS

A cross-sectional design was used. The convenience sample included 45 nurses and 32 other healthcare providers (e.g., physical and occupational therapists, physicians) who self-identified as delivering transitional care to patients in rural Ontario, Canada. In an online survey, participants were presented with a description of the warning signs intervention and completed established measures of intervention acceptability. The measures captured 10 intervention acceptability attributes (effectiveness, appropriateness, risk, convenience, relevance, applicability, usefulness, frequency of current use, likelihood of future use, and confidence in ability to deliver the intervention). Ratings ≥ 2 indicated acceptability. Data analysis included descriptive statistics, independent samples t-tests, as well as effect sizes to quantify the magnitude of any differences in acceptability ratings between nurses and other healthcare providers.

RESULTS

Nurses and other healthcare providers rated all intervention attributes > 2, except the attributes of convenience and frequency of current use. Differences between the two groups were found for only three attributes: nurses' ratings were significantly higher than other healthcare providers on perceived applicability, frequency of current use, and the likelihood of future use of the intervention (all p's < .007; effect sizes .58 - .68, respectively).

DISCUSSION

The results indicate that both participant groups had positive perspectives of the intervention on most of the attributes and suggest that initiatives to enhance the convenience of the intervention's implementation are warranted to support its widespread adoption in rural transitional care. However, the results also suggest that other healthcare providers may be less receptive to the intervention in practice. Future research is needed to explore and mitigate the possible reasons for low ratings on perceived convenience and frequency of current use of the intervention, as well as the between group differences on perceived applicability, frequency of current use, and the likelihood of future use of the intervention.

CONCLUSIONS

The intervention represents a tenable option for rural transitional care in Ontario, Canada, and possibly other jurisdictions emphasizing transitional care.

Rural caregivers' preparedness for detecting and responding to the signs of worsening health conditions in recently hospitalised patients at risk for readmission: a qualitative descriptive study

OBJECTIVES

This study aimed to explore informal rural caregivers' perceived preparedness to detect and respond to the signs of worsening health conditions in patients recently discharged from hospital and at risk for readmission.

DESIGN

A qualitative descriptive design and semistructured interviews were used. Data were thematically analysed.

SETTING

Data collection occurred in 2018 and 2019 in rural communities in Southwestern and Northeastern Ontario, Canada.

PARTICIPANTS

The study included sixteen informal caregivers who were all family members of a relative discharged from hospital at high risk for readmission following hospitalisation mostly for a medical illness (63%). Participants were mostly women (87.5%), living with their relative (62.5%) who was most often a parent (56.3%).

RESULTS

Three themes were identified: (1) warning signs and rural communities, (2) perceived preparedness, and (3) improving preparedness. The first theme elucidates informal caregivers' view that they needed to be prepared because they were taking over care previously provided by hospital healthcare professionals yet lacked accessible medical help in rural communities. The second theme captures informal caregivers' perceptions that they lacked knowledge of how to detect warning signs and how to respond to them appropriately. The last theme illuminates informal caregivers' suggestions for improving preparation related to warning signs.

CONCLUSIONS

Informal caregivers in rural communities were largely unprepared for detecting and responding to the signs of worsening health conditions for patients at high risk for hospital readmission. Healthcare professionals can anticipate that informal caregivers, particularly those whose relatives live far from medical help, need information on how to detect and respond to warning signs, and may prioritise their time to this aspect of postdischarge care for these caregivers.

Current Situations and Challenges in the Development of Health Information Literacy

Health information literacy (HIL) is a significant concept that has gradually become known to the broader public in recent years. Although the definitions of HIL and health literacy seem to overlap, as an independent subconcept, HIL still shows a unique influence on improvements in people's health and health education. Remarkable evidence indicates that online health information (OHI) can effectively enrich people's knowledge and encourage patients to actively join the medical process, which is also accompanied by the emergence of various assessment tools. Although the current assessment tools, to a certain extent, can help people identify their shortcomings and improve their HIL, many studies have indicated that the deficiencies of the scales induce incomplete or unreal results of their HIL. In addition, continuing research has revealed an increasing number of influencing factors that have great effects on HIL and even regulate the different trends in doctor-patient relationships. Simultaneously, most of the uncensored OHI broadcasts have also affected the improvement in HIL in various ways. Thus, this review aims to summarize the assessment tools, influencing factors and current situations and challenges related to HIL. Further studies are required to provide more trusted and deeper references for the development of HIL.

Perception of recurrent risk versus objective measured risk of ischemic stroke in first-ever stroke patients from a rural area in China: A cross-sectional study

OBJECTIVE

Risk perception is critical to the formation of individual health prevention behaviors. A long-term accurate perception of stroke recurrent risks is imperative for stroke secondary prevention. This study aims to explore the level of recurrence risk perceptions and the influential factors of inaccuracy between perceived and objective risk in first-ever ischemic stroke patients from a rural area.

METHODS

From May to November 2020, 284 first-ever ischemic stroke patients were conveniently recruited in a rural area of Henan Province, China. Perceived risk was measured based on self-reported using a numerical rating scale, whereas the objective risk was measured by the Essen Stroke Risk Score. Patients' perceived risk was compared with their objective risk and categorized as "Accurate," "Underestimated," and "Overestimated." The influencing factors of inaccuracy were further evaluated using multivariate regression analyses.

RESULTS

46% of the participants underestimated their stroke risk, while 15.9% overestimated their risks. Patients who were younger (≤65 years), didn't worry about recurrent stroke, and had a low actual recurrent risk were more likely to underestimate their recurrent risk. Patients who were employed, had lower independence, and had greater anxiety were more likely to overestimate their recurrent risk.

CONCLUSIONS

The majority of participants were unable to accurately perceive their own risk of stroke recurrence. Patients' age, working status, worry about recurrent stroke, actual recurrent risk, level of dependence, and anxiety played a role in perception inaccuracy.

PRACTICE IMPLICATIONS

The findings could help healthcare providers gain a better understanding of the level and accuracy of recurrence risk perceptions among first-ever stroke patients in the rural area. Future counseling on the perceived risk of stroke recurrence and individual objective risk assessment could be conducted to help patients better understand their risk of recurrence. Individualized risk communication and multidisciplinary teamwork can be developed to improve the accuracy of recurrence risk perceptions and health behaviors.

Emergency medical service utilization among acute ischemic stroke patients in Beijing: An observational study

Objective

To investigate emergency medical service (EMS) utilization and its associated factors in patients with acute ischemic stroke (AIS), and further explore the urban-rural differences.

Methods

Medical records for AIS in all emergency departments in Beijing were obtained from the Beijing Emergency Care Database from January 2018 to December 2021. EMS utilization was described and factors associated with EMS use were examined by multivariable logistic regression models with the generalized estimating equations. Results were compared between urban and rural districts.

Results

A total of 24,296 AIS patients were included in the analysis, and 11,190 (46.1%) were transported to hospitals by EMS. The percentage of EMS usage in urban areas was significantly higher than that in rural areas (53.6 vs. 34.4%, P < 0.001). From 2018 to 2021, EMS utilization was on the increase (P-value for trend <0.001) with a higher average annual growth rate in rural areas (12.6%) than in urban (6.4%). Factors associated with EMS utilization were age (OR: 1.20 per 10-year increase, 95% CI: 1.17–1.23), NIHSS scores, off-hour arrival (OR: 1.32, 95% CI: 1.23–1.37), treatment in tertiary hospitals (OR: 1.75, 95% CI: 1.60–1.92), and possessing comorbidities such as coronary artery disease (OR: 1.15, 95% CI: 1.17–1.24), atrial fibrillation (OR: 1.56, 95% CI: 1.41–1.73), prior stroke (OR: 0.84, 95% CI: 0.78-0.90) or dyslipidemia (OR: 0.78, 95% CI: 0.71–0.85).

Conclusion

This study demonstrated an inadequate use of EMS among AIS patients in Beijing, especially in rural areas, and revealed several associated factors. Enhanced education programs and EMS accessibility are necessary particularly for high-risk individuals and regions.

Public knowledge of stroke and heart attack symptoms in China: a cross-sectional survey

OBJECTIVE

Stroke and ischaemic heart disease have become the leading causes of death in China. We evaluated recognition of stroke and heart attack symptoms and stroke treatment-seeking behaviour in a large representative sample of the Chinese adult population and explored characteristics associated with recognition rates.

DESIGN

Cross-sectional survey.

SETTING

Household interviews.

PARTICIPANT

3051 Chinese adults aged between 18 and 69 (50.7% female) were interviewed between January and March 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary measures include recognitions of stroke and heart attack symptoms and stroke treatment-seeking behaviour. Secondary measures include numeracy level, sociodemographics and prior history of cardiovascular diseases and high blood pressure.

RESULTS

Participants on average recognised 5.2 out of 14 stroke symptoms and 2.6 out of 6 heart attack symptoms. In the presence of stroke symptoms, three quarters of participants would take immediate action and call an ambulance, yet the second most common action was to advise the person to see a doctor (59%) rather than to consult a doctor immediately (34%). Recognition of atypical heartattack symptoms, such as nausea and feeling of anxiety, was poor. Symptom recognition rates were higher in females, people with a personal or family/friend history of cardiovascular events, those with higher numeracy scores, and for stroke symptoms, participants with high (versus low) education level. Furthermore, symptom recognition rate was negatively correlated with burden of cardiovascular diseases across the four economic regions of China.

CONCLUSION

Recognition of stroke and heart-attack symptoms was moderate and there remains a gap between recognising symptoms and taking immediate action. Interventions focusing on simple symptom detection tools and on building numerical competencies may help reduce the burden of cardiovascular diseases in China.

Increasing Health Literacy in China to Combat Noncommunicable Diseases

Health literacy involves knowledge, motivation, and competence to access, understand, appraise, and apply health information to make judgments and make decisions every day to maintain or improve quality of life. It is of great importance to the health and wellbeing of individuals, families, and society and plays a crucial role in noncommunicable disease (NCD) prevention and control. Recognizing that health literacy is a public health challenge in China, the Chinese government has been making great effort to address this issue. This paper presented a general overview of health literacy status in China with a focus on NCDs, described China's challenges and practices in improving health literacy, and provided suggestions to decision makers, practitioners, and researchers to address the needs of health literacy in China.

Knowledge on Signs and Risk Factors in Stroke Patients

Background: There is a pressing need to contribute evidence to the improvement in the early identification of signs and symptoms associated with strokes, and address the treatment-seeking delays. The objective of this study is to describe the knowledge regarding the warning signs and risk factors (RFs) among stroke patients, as well as of their attitudes toward a suspected event, and the analysis of its possible relationship with the socio-demographic and clinical characteristics of these patients. Method: A cross-sectional study was designed, in which all stroke patients admitted consecutively to the Burgos University Hospital (Spain) were included. The principal outcomes were the patient’s ability to identify two RFs and two warning signs and the patient’s hypothetical response to a possible stroke event. The possible factors associated with the knowledge of warning signs, RFs, and the correct response to a new event were studied using univariate and multivariate regression analysis. Results: A total of 529 patients were included. Having a higher education level or a history of prior stroke were associated with a greater degree of knowledge of warning signs (odds ratio (OR) 3.19, 95% confidence interval (CI) 1.70–5.74, p = 0.003; OR 3.54, 95%CI 2.09–5.99, p ≤ 0.001, respectively), RFs (OR 3.15, 95%CI 1.75–5.67, p = 0.008; OR 4.08, 95%CI 2.41–6.91, p = 0.002, respectively), and the correct response to a possible stroke (OR 1.82, 95%CI 1.16–2.86; p = 0.030; OR 2.11, 95%CI 1.29–3.46, p = 0.022, respectively). Conclusion: Knowledge of warning signs or stroke RFs is low in the hospitalized patients. A previous stroke or secondary/higher education levels are the predictor factors that increase the probability of knowledge of warning signs, RFs, or reaction to possible event.

Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco

Background:

Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients.

Objective:

The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco.

Methods:

This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke.

Findings:

A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4–13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI_95%: 1.08–3.44) primary education (OR 3.43; CI_95%: 1.63–7.21), rural residential (OR 1.67; CI_95%: 1.07–2.59), no history of stroke among respondents (OR 16.41; CI_95%: 4.37–61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI_95%: 2.81–6.96), were independently associated with a lower level of knowledge of stroke (Table 4).

Conclusions:

The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.

Increased recurrent risk did not improve cerebrovascular disease survivors' response to stroke in China: a cross-sectional, community-based study

Background

Cerebrovascular disease (CVD) survivors are at a high risk of recurrent stroke. Although it is thought that survivors with higher risk of stroke respond better to stroke onset, to date, no study has been able to demonstrate that. Thus, we investigated whether the intent to call emergency medical services (EMS) increased with recurrent stroke risk among CVD survivors.

Methods

A cross-sectional community-based survey was conducted from January 2017 to May 2017, including 187,723 adults (age ≥ 40 years) across 69 administrative areas in China. A CVD survivor population of 6290 was analyzed. According to the stroke risk score based on Essen Stroke Risk Score, CVD survivors were divided into three subgroups: low (0), middle (1–3) and high (4–7) recurrent risk groups. Multivariable logistic regression models were used to identify the association between the stroke risk and stroke recognition, as well as stroke risk and EMS calling.

Results

The estimated stroke recognition rate in CVD survivors with low, middle, and high risk was 89.0% (503/565), 85.2% (3841/4509), and 82.5% (1001/1213), respectively, while the rate of calling EMS was 66.7% (377/565), 64.3% (2897/4509), and 69.3% (840/1213), respectively. The CVD survivors’ knowledge of recognizing stroke and intent to call EMS did not improve with recurrent stroke risk, even after adjustment for multiple socio-demographic factors.

Conclusions

Despite being at a higher risk of recurrent stroke, Chinese CVD survivors showed poor knowledge of stroke, and their intent to call EMS did not increase with recurrent stroke risk. Enhanced and stroke risk-orientated education on stroke recognition and proper response is needed for all CVD survivors.