Stroke is a leading cause of death and disability worldwide, profoundly affecting individuals, families, and healthcare systems. Often described as a "brain attack," a stroke occurs when blood flow to the brain is interrupted, either due to a blockage (ischemic stroke) or a rupture (hemorrhagic stroke) of a blood vessel. The resulting lack of oxygen and nutrients can lead to significant neurological damage, affecting mobility, speech, and cognition. Timely recognition of stroke symptoms and immediate response measures, such as accessing emergency medical care, are critical to reducing mortality, minimizing long-term disability, and improving recovery outcomes.[1-4]^.Public awareness of stroke symptoms, encapsulated by the FAST acronym (Facial drooping, Arm weakness, Speech difficulty, and Time to call emergency services), plays a vital role in ensuring prompt medical intervention. Despite advances in medical technology and increased awareness campaigns, studies have consistently shown that knowledge of stroke symptoms and response measures remains inadequate, particularly in rural and underserved regions. Delays in recognizing symptoms and seeking medical attention are common, often resulting in missed opportunities for lifesaving interventions such as thrombolysis or surgical management.[5-8]

Shimla, the capital of Himachal Pradesh, provides a unique setting to study stroke awareness due to its geographic, socio-economic, and healthcare access disparities. The hilly terrain, scattered rural populations, and variations in education and income levels create barriers to timely healthcare access. Limited infrastructure, long travel times to medical facilities, and a lack of comprehensive public health campaigns further compound the challenges. These factors make it imperative to assess the community's knowledge of stroke symptoms and response measures, identify gaps, and develop targeted interventions.

Misinformation, stigma, and cultural beliefs surrounding stroke often delay recognition and action, exacerbating the burden of disease. Factors such as education, age, gender, and residence (urban versus rural) significantly influence perceptions and practices related to stroke. Previous studies indicate that awareness campaigns tailored to specific communities can bridge these gaps, fostering timely healthcare-seeking behavior and improving outcomes.

This study aims to evaluate the awareness and perception of stroke symptoms and immediate response measures among residents of Shimla. By identifying knowledge gaps and examining socio-demographic factors influencing awareness, this research seeks to provide evidence-based insights for designing effective community health interventions. Strengthening public knowledge of stroke could play a pivotal role in reducing the burden of this preventable and treatable condition, ultimately enhancing health outcomes and quality of life for Shimla's residents.

Aims and Objectives

Aims:

To evaluate public knowledge and awareness regarding stroke symptoms and immediate response measures among the residents of Shimla, with a focus on identifying knowledge gaps and socio-demographic factors influencing understanding. This study aims to provide actionable insights for the development of targeted community health education initiatives and strategies to enhance stroke recognition, timely medical response, and prevention of stroke-related complications in the region.

Objectives:

1. To assess the level of awareness among residents about stroke symptoms, including the FAST acronym (Facial drooping, Arm weakness, Speech difficulty, and Time to act).

2. To evaluate public knowledge of immediate response measures and the importance of emergency medical services.

3. To identify misconceptions and barriers that hinder the recognition of stroke symptoms and timely healthcare-seeking behavior.

4. To provide evidence-based recommendations for improving public knowledge and accessibility to healthcare services for stroke prevention and management.

Research Approach:

This was a descriptive cross-sectional study aimed at evaluating public awareness and understanding of stroke symptoms and response measures among residents of Shimla.

Research Design:

A community-based cross-sectional survey design was employed to capture a snapshot of public knowledge and practices regarding stroke recognition and response.

Study Area:

The study was conducted in Shimla, Himachal Pradesh, covering both urban and rural regions to ensure diverse representation.

Study Duration:

The study was carried out over three months, from August 2024 to October 2024.

Study Population:

The target population comprised adults aged 18 and above who had been residents of Shimla for at least one year. The inclusion of both urban and rural residents ensured a representative sample reflecting Shimla’s socio-demographic diversity.

Sample Size:

Based on a 95% confidence level, a 50% estimated awareness level regarding stroke symptoms and response measures, and a 5% margin of error, a sample size of 400 participants was determined. An additional 5% was factored in to account for non-responses, ensuring robust data collection.

Study Tool:

A structured questionnaire was developed for data collection. The questionnaire was divided into two sections:

1. Socio-Demographic Information: Included variables such as age, gender, education, occupation, area of residence (urban/rural), and duration of residence in Shimla.

2. Stroke Awareness Assessment: Included 20 structured questions covering topics such as:

   • Recognition of stroke symptoms, including the FAST acronym.

   • Awareness of immediate response measures and the importance of timely medical intervention.

   • Knowledge of risk factors such as hypertension, diabetes, smoking, and sedentary lifestyle.

   • Awareness of stroke prevention strategies, including lifestyle changes and regular health check-ups.

   • Identification of misconceptions and barriers to seeking timely care.

Each correct answer was awarded one point, with total scores categorized as:

• Very Good (>80%): 16–20 points.

• Good (60–79%): 12–15 points.

• Fair (41–59%): 8–11 points.

• Poor (<40%):<8 points.

The questionnaire was pre-tested on a small sample to ensure reliability and clarity and reviewed by healthcare professionals specializing in neurology and public health.

Data Collection:

• Data were collected via a Google Forms-based survey, distributed through online platforms such as WhatsApp, Facebook, and Instagram to maximize reach across urban and rural populations.

• Responses were collected until the target sample size of 400 was achieved.

Data Analysis:

• Collected data were organized and cleaned using Microsoft Excel.

• Statistical analysis was performed using Epi Info V7 software, including:

  • Frequency and percentage distribution for socio-demographic variables.

  • Descriptive statistics for awareness scores.

  • Cross-tabulations to explore correlations between socio-demographic factors and knowledge levels.

Ethical Considerations:

• Participation was voluntary, with informed consent obtained from all respondents.

• Confidentiality and anonymity of participants were maintained, with no identifying information recorded.

• The study adhered to ethical guidelines for research involving human participants, and participants were informed of their right to withdraw at any time.

RESULTS

The aim of this study was to evaluate public knowledge and awareness regarding stroke symptoms, risk factors, and immediate response measures among the residents of Shimla. A total of 400 participants provided data for analysis, offering insights into the socio-demographic diversity and varying levels of stroke awareness in the region.

Table 1: Socio-Demographic Profile of Study Participants

This table reflects a balanced representation of gender, with slightly more female participants. The majority were aged 26–35 years (31.25%) and had attained at least a secondary school education (30.50%), with a notable proportion holding undergraduate degrees (38.25%). Rural residents formed the majority (60.50%), highlighting the regional demographic diversity.

Table 2: Knowledge Regarding Stroke Symptoms and Response Measures

The table highlights moderate awareness, with 62.00% recognizing smoking as a key risk factor and 61.50% aware of blood pressure control as a preventive measure. However, knowledge gaps remain in recognizing specific stroke symptoms and the urgency of treatment.

Figure-1: Distribution of Knowledge Scores on Stroke Awareness

The majority of participants scored in the "Good" (36.00%) and "Fair" (32.00%) categories, indicating moderate awareness of stroke symptoms and response measures. Only 21.50% demonstrated comprehensive knowledge ("Very Good"), while 10.50% scored poorly, underscoring the need for targeted health education initiatives in Shimla.

This study provides a comprehensive evaluation of public awareness and perception regarding stroke symptoms, risk factors, and immediate response measures among residents of Shimla, Himachal Pradesh. The findings highlight a mix of foundational knowledge and critical gaps, underscoring the need for targeted public health education to improve stroke recognition, response, and prevention. These insights are vital for reducing the burden of stroke-related morbidity and mortality in the region.

The socio-demographic profile of the participants revealed important factors influencing stroke awareness. A slightly higher proportion of female participants (51.50%) compared to males (48.50%) reflects the region’s gender distribution. The majority of participants belonged to the 26–35 age group (31.25%), followed by the 36–45 age group (27.25%), indicating that stroke awareness campaigns could benefit from targeting this working-age demographic. Educational levels were diverse, with 38.25% of participants holding undergraduate degrees and a smaller proportion (4.50%) having no formal education. Rural residents comprised 60.50% of the sample, highlighting disparities in healthcare access and information dissemination between urban and rural populations. These socio-demographic patterns significantly influenced awareness levels, with urban residents and those with higher educational attainment demonstrating better stroke knowledge and response understanding.[9,10]

The study revealed moderate awareness of stroke symptoms. While 45.50% of participants recognized facial drooping as a key indicator of stroke, fewer identified arm weakness (51.00%) and speech difficulty (46.50%), both critical components of the FAST acronym. Awareness of lifestyle risk factors such as smoking (62.00%) and hypertension (59.00%) was relatively high, indicating the partial success of public health efforts. However, knowledge of other risk factors, such as diabetes (43.50%), and the urgency of treatment within the critical window (44.00%) remains limited. These gaps suggest that while basic awareness exists, there is insufficient depth in understanding the multifaceted nature of stroke risk factors and symptoms, potentially delaying early recognition and treatment.

Preventive knowledge showed encouraging results, with 61.50% of participants identifying blood pressure control as a key measure and 57.00% recognizing the role of physical activity in reducing stroke risk. However, significant gaps were noted in understanding immediate response measures; only 47.25% of participants were aware of the importance of calling emergency services upon recognizing stroke symptoms, and just 42.00% understood the critical time window for stroke treatment (within 4.5 hours). This disconnect between symptom recognition and action suggests the need for public health campaigns emphasizing the importance of prompt medical attention.

Awareness of treatment methods and complications associated with stroke was moderate. Nearly half of the participants (48.00%) correctly identified thrombolysis as a treatment for dissolving blood clots, while 46.00% were aware of paralysis as a common complication of stroke. However, only 44.00% recognized hemorrhagic stroke as being caused by a ruptured blood vessel, reflecting a limited understanding of different stroke types and their management. Furthermore, only 51.00% identified the primary goal of stroke treatment—restoring blood flow to the brain—indicating misconceptions that could delay appropriate care.

The distribution of knowledge scores revealed that only 21.50% of participants demonstrated comprehensive awareness, scoring in the "Very Good" category. The majority fell into the "Good" (36.00%) and "Fair" (32.00%) categories, with 10.50% scoring poorly. These findings highlight substantial gaps in stroke awareness, particularly among rural residents and individuals with lower educational attainment. Targeted health education initiatives are urgently needed to address these disparities and ensure that underserved communities receive accurate and accessible information about stroke recognition and response.[11,12]

The results of this study have significant implications for public health strategies in Shimla. First, improving symptom recognition through focused awareness campaigns that highlight the FAST acronym is essential. These campaigns should also address gaps in recognizing the urgency of stroke treatment, emphasizing the critical 4.5-hour treatment window and the importance of seeking emergency care. Second, public health initiatives must bridge the gap between symptom recognition and timely response by educating the community on the role of emergency medical services and the risks of delaying treatment. Third, rural populations and less-educated groups should be prioritized in outreach efforts, leveraging local leaders, healthcare workers, and community events to improve awareness. Finally, integrating stroke education into existing health programs for hypertension and diabetes management could help amplify the reach of these initiatives, fostering a more holistic approach to stroke prevention and management.[12-14]

Strengths and Limitations

The strengths of this study include its representative sample, which captured diverse populations across urban and rural Shimla, and its structured approach to evaluating stroke awareness comprehensively. However, reliance on online data collection platforms may have excluded individuals without internet access, potentially underrepresenting older and rural populations. Future research should incorporate in-person surveys and qualitative methods, such as focus groups, to provide a more inclusive and detailed understanding of the socio-cultural factors influencing stroke awareness and response behavior.

This study underscores critical gaps in public awareness of stroke symptoms, risk factors, and timely response measures among Shimla residents. While moderate understanding was observed, particularly regarding lifestyle risk factors, deficiencies in recognizing key symptoms and acting within the critical 4.5-hour window remain significant, especially among rural and less-educated populations. Targeted health education campaigns emphasizing the FAST acronym, timely medical intervention, and prevention strategies are essential. Prioritizing underserved communities through tailored, community-based initiatives can significantly reduce stroke-related morbidity and mortality, improving health outcomes and quality of life in the region.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by theJawaharlal Nehru Medical College, Aligarh Muslim University(AMU).

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