Stroke, characterized by the sudden disruption of blood flow to the brain, is a significant public health concern globally, contributing to considerable morbidity and mortality. In the unique context of District Shimla, Himachal Pradesh, this study aims to investigate the awareness and knowledge levels regarding stroke risk factors and preventive measures among the general public[1-2].

District Shimla, nestled in the scenic state of Himachal Pradesh, presents a distinctive demographic and geographic setting. The challenges associated with delivering healthcare services in mountainous regions underscore the need for a profound understanding of stroke awareness in this community. Stroke, often preventable through lifestyle modifications and risk factor management, necessitates an assessment of existing knowledge to tailor interventions effectively [3-4].

This study is rooted in the potential to identify gaps in awareness that may contribute to the incidence of strokes in District Shimla. By comprehending prevailing knowledge and awareness levels, targeted interventions can be developed, potentially reducing the burden of stroke-related cases and enhancing overall public health in the region [4-5].

This research holds immense significance in the context of public health planning for the unique challenges posed by the Himalayan region. By identifying gaps in stroke awareness and prevention, policymakers and healthcare providers can develop targeted strategies to enhance community education, potentially reducing the burden of stroke-related morbidity and mortality in District Shimla [5-6].

The scope of this research extends beyond a mere assessment of awareness levels. It encompasses a comprehensive exploration of the socio-demographic factors influencing awareness, potential barriers to information dissemination, and community-specific nuances that may impact stroke prevention initiatives.

Objectives of the Study

The primary objective is to gauge awareness and knowledge about risk and preventive factors for stroke among the general public of District Shimla, Himachal Pradesh. Specific objectives include assessing the understanding of common risk factors, recognizing early signs and symptoms, and evaluating knowledge regarding lifestyle modifications for stroke prevention.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: District Shimla, Himachal Pradesh

• Study Duration: Between August 2023 to November 2023

• Study Population: The study's target population encompassed all adults aged 18 and above who had been residents of District Shimla for a minimum of 12 months

• Sample Size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Risk and Preventive factors for Stroke , a precise 5% absolute error margin, and a conservative 5% non-response rate

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Risk and Preventive factors for Stroke was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Risk and Preventive factors for Stroke. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% ( 8-11) = Fair, <40% (< 8) = poor

• Validity of Tool: By the experts in this field

• Data Collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Shimla, Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The goal of the current study was to assess general public knowledge regarding Stroke risk and prevention through a non-experimental descriptive survey. A total of 400 respondents took part in the study, with 119 (29.75%) coming from urban areas and 281 (70.25%) from rural areas (Table 1).

In the present study 33.25% (133) participants had very good knowledge (16-20 marks) towards Risk and Preventive factors for Stroke, 39.25% (157) had good knowledge (12-15 marks), 17.25% (69) had fair knowledge (8-11 marks) and 10.25% (41) having poor knowledge (<8 marks) (Table 2).

Table 1: Knowledge Regarding Risk and Preventive Factors for Stroke among Study Participants

Table 2: Knowledge Scores towards Risk and Preventive Factors for Stroke among Study Participants

The findings of this study provide valuable insights into the levels of awareness and knowledge regarding stroke risk factors and preventive measures among the residents of District Shimla, Himachal Pradesh. The results, demonstrating a commendable level of awareness with 33.25% of participants exhibiting very good knowledge, 39.25% displaying good knowledge, 17.25% possessing fair knowledge, and 10.25% having poor knowledge regarding stroke, align with existing literature on stroke awareness in India.

The study by Dalal et al. [5] in Mumbai emphasizes the necessity of tailored educational programs for stroke prevention, echoing the regional nuances evident in our findings. Similarly, Das et al. [6] underscores the importance of understanding socio-demographic factors influencing awareness, further highlighting the need for context-specific interventions.

Comparisons with national studies reveal consistent themes. The study by Pandian et al. [6] on stroke epidemiology in India emphasizes the variability in stroke patterns across regions, reinforcing the importance of region-specific interventions. Our study echoes this sentiment, recognizing the distinctive demographic and geographic setting of District Shimla.

Additionally, the present findings align with global efforts, as seen in the INTERSTROKE study [7], emphasizing the significance of community education on risk factors and preventive measures for strokes. The American Heart Association/American Stroke Association guidelines [8-9] provide a framework for stroke prevention, and the relevance of these guidelines is evident in the participants' recognition of preventive measures (66.5%) and the role of a balanced diet (63.75%) in reducing stroke risk.

Incorporating insights from other Indian studies, such as the work by Kalkonde et al. [10] on stroke knowledge in rural Maharashtra and Kapoor et al. [11] on stroke awareness in North Indian urban population, reveals consistent challenges and opportunities for improvement in stroke awareness programs across diverse Indian communities. Our study reinforces the importance of a comprehensive understanding of socio-demographic factors, emphasizing that successful awareness campaigns must be tailored to the unique needs of each region.

In conclusion, this study sheds light on the commendable levels of awareness and knowledge regarding stroke risk factors and preventive measures among the residents of District Shimla, Himachal Pradesh. The findings, with a substantial percentage demonstrating very good and good knowledge, underscore the success of existing awareness initiatives. However, the study also highlights specific areas, such as recognizing stroke symptoms and immediate response actions, where targeted interventions are crucial. Overall, the study contributes to the broader discourse on stroke awareness in India, emphasizing the necessity for comprehensive, context-specific approaches to enhance public health outcomes and mitigate the burden of stroke-related morbidity and mortality.

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