Background: Stroke survivors are at a substantial risk of repeat stroke. Despite this, many stroke survivors continue their unhealthy prestroke lifestyles. Lack of knowledge related to stroke and stroke risk has been proposed as one contributor to the continuance of unhealthy lifestyles. A comprehensive literature currently exists related to knowledge of stroke and its risk factors and recognition of stroke symptoms in the general population, but less is known about these issues among stroke survivors who are at a higher risk for stroke. The purpose of this review was to examine stroke knowledge among stroke survivors. Methods: Data sources were MEDLINE, CINAHL and the Cochrane Library, and the reference lists of published papers were searched to identify relevant studies. We extracted data related to stroke knowledge (general and risk factors) and symptom awareness from studies designed to examine stroke knowledge among stroke survivors. For the study design, we completed a systematic review of stroke knowledge (general information, stroke symptoms and risk factors) among stroke survivors. Standardized and nonstandardized measurements were taken of: (1) general stroke knowledge, i.e. cause, type (ischemic vs. hemorrhage), location, body parts affected and what action to take in the event of having a stroke, (2) stroke awareness (common warning signs and symptoms such as: weakness/numbness, confusion/difficulty speaking, difficulty seeing in one or both eyes, difficulty walking, headache of no known cause) and (3) knowledge or identification of common stroke risk factors (e.g. high blood pressure, high blood sugar,high cholesterol,obesityand smoking). Due to limited information on outcomes and the heterogeneity of the studies, a formal meta-analysis was not conducted. Instead, we completed a qualitative aggregation of study findings. Results: Data from 18 studies spanning 8 countries and including 8,147 participants met the inclusion criteria for this review. These studies offer evidence that many stroke survivors do not have a greater knowledge of stroke despite their having experienced such a life-changing event. Conclusions: Due to their limited knowledge, many stroke survivors may not engage in the required preventive behaviors for good health and reducing the risk of a stroke recurring. More specifically, stroke survivors may understand the cause of their stroke but not be able to identify many stroke symptoms or common stroke risk factors. Stroke education programs should be designed to improve stroke knowledge and facilitate the actions necessary for reducing stroke risk.

1.
World Health Organization: Global burden of stroke. 2012. http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.
2.
Wu CM, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA: Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med 2007;167:2417-2422.
3.
Giles MF, Rothwell PM: Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2007;6:1063-1072.
4.
Pendlebury ST, Rothwell PM: Risk of recurrent stroke, other vascular events and dementia after transient ischaemic attack and stroke. Cerebrovasc Dis 2009;27(suppl 3):1-11.
5.
Allen NB, Holford TR, Bracken MB, Goldstein LB, Howard G, Wang Y, Lichtman JH: Trends in one-year recurrent ischemic stroke among the elderly in the USA: 1994-2002. Cerebrovasc Dis 2010;30:525-532.
6.
Cheng EM, Jolly D, Jones LA, Cohen SN: Modest improvement in risk factor control after admission for a stroke or transient ischemic attack. J Stroke Cerebrovasc Dis 2005;14:174-178.
7.
Qureshi AI, Suri MF, Guterman LR, Hopkins LN: Ineffective secondary prevention in survivors of cardiovascular events in the US population: report from the Third National Health and Nutrition Examination Survey. Arch Intern Med 2001;161:1621-1628.
8.
Sloma A, Backlund LG, Strender LE, Skaner Y: Knowledge of stroke risk factors among primary care patients with previous stroke or TIA: a questionnaire study. BMC Fam Pract 2010;11:47.
9.
Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB: Executive summary: heart disease and stroke statistics - 2012 update: a report from the American Heart Association. Circulation 2012;125:188-197.
10.
Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, Sides EG, Wang C, Stampfer M: Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA 2004;291:565-575.
11.
Hajjar I, Kotchen TA: Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA 2003;290:199-206.
12.
Damush TM, Plue L, Bakas T, Schmid A, Williams LS: Barriers and facilitators to exercise among stroke survivors. Rehabil Nurs 2007;32:253-260, 262.
13.
Greenlund KJ, Neff LJ, Zheng ZJ, Keenan NL, Giles WH, Ayala CA, Croft JB, Mensah GA: Low public recognition of major stroke symptoms. Am J Prev Med 2003;25:315-319.
14.
Schneider AT, Pancioli AM, Khoury JC, Rademacher E, Tuchfarber A, Miller R, Woo D, Kissela B, Broderick JP: Trends in community knowledge of the warning signs and risk factors for stroke. JAMA 2003;289:343-346.
15.
Ellis C, Egede LE: Ethnic disparities in stroke recognition in individuals with prior stroke. Public Health Rep 2008;123:514-522.
16.
Parahoo K, Thompson K, Cooper M, Stringer M, Ennis E, McCollam P: Stroke: awareness of the signs, symptoms and risk factors - a population-based survey. Cerebrovasc Dis 2003;16:134-140.
17.
Lundelin K, Graciani A, Garcia-Puig J, Guallar-Castillon P, Taboada JM, Rodriguez-Artalejo F, Banegas JR: Knowledge of stroke warning symptoms and intended action in response to stroke in Spain: a nationwide population-based study. Cerebrovasc Dis 2012;34:161-168.
18.
Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S: Prehospital and emergency department delays after acute stroke: the Genentech Stroke Presentation Survey. Stroke 2000;31:2585-2590.
19.
Smith MA, Doliszny KM, Shahar E, McGovern PG, Arnett DK, Luepker RV: Delayed hospital arrival for acute stroke: the Minnesota Stroke Survey. Ann Intern Med 1998;129:190-196.
20.
Rosamond WD, Gorton RA, Hinn AR, Hohenhaus SM, Morris DL: Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study. Acad Emerg Med 1998;5:45-51.
21.
Morris DL, Rosamond WD, Hinn AR, Gorton RA: Time delays in accessing stroke care in the emergency department. Acad Emerg Med 1999;6:218-223.
22.
Williams JE, Rosamond WD, Morris DL: Stroke symptom attribution and time to emergency department arrival: the delay in accessing stroke healthcare study. Acad Emerg Med 2000;7:93-96.
23.
Lacy CR, Suh DC, Bueno M, Kostis JB: Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke 2001;32:63-69.
24.
Schroeder EB, Rosamond WD, Morris DL, Evenson KR, Hinn AR: Determinants of use of emergency medical services in a population with stroke symptoms: the second Delay in Accessing Stroke Healthcare (DASH II) study. Stroke 2000;31:2591-2596.
25.
Williams LS, Bruno A, Rouch D, Marriott DJ: Stroke patients' knowledge of stroke. Influence on time to presentation. Stroke 1997;28:912-915.
26.
Hiraga A: Perception of recurrent stroke risk among stroke survivors. Neuroepidemiology 2011;37:88-89.
27.
Sandercock P: The authors say: ‘The data are not so robust because of heterogeneity' - so, how should I deal with this systematic review? Meta-analysis and the clinician. Cerebrovasc Dis 2011;31:615-620.
28.
Wellwood I, Dennis MS, Warlow CP: Perceptions and knowledge of stroke among surviving patients with stroke and their carers. Age Ageing 1994;23:293-298.
29.
Weltermann BM, Homann J, Rogalewski A, Brach S, Voss S, Ringelstein EB: Stroke knowledge among stroke support group members. Stroke 2000;31:1230-1233.
30.
Stein J, Shafqat S, Doherty D, Frates EP, Furie KL: Patient knowledge and expectations for functional recovery after stroke. Am J Phys Med Rehabil 2003;82:591-596.
31.
Kothari R, Sauerbeck L, Jauch E, Broderick J, Brott T, Khoury J, Liu T: Patients' awareness of stroke signs, symptoms, and risk factors. Stroke 1997;28:1871-1875.
32.
Croquelois A, Bogousslavsky J: Risk awareness and knowledge of patients with stroke: results of a questionnaire survey 3 months after stroke. J Neurol Neurosurg Psychiatry 2006;77:726-728.
33.
Slark J, Bentley P, Majeed A, Sharma P: Awareness of stroke symptomatology and cardiovascular risk factors amongst stroke survivors. J Stroke Cerebrovasc Dis 2012;21:358-362.
34.
Travis LH, Flemming KD, Brown RD Jr, Meissner I, McClelland RL, Weigand SD: Awareness of stroke risk factors, symptoms, and treatment is poor in people at highest risk. J Stroke Cerebrovasc Dis 2003;12:221-227.
35.
Koenig KL, Whyte EM, Munin MC, O'Donnell L, Skidmore ER, Penrod LE, Lenze EJ: Stroke-related knowledge and health behaviors among poststroke patients in inpatient rehabilitation. Arch Phys Med Rehabil 2007;88:1214-1216.
36.
Sullivan K, Waugh D: Stroke knowledge and misconceptions among survivors of stroke and a non-stroke survivor sample. Top Stroke Rehabil 2005;12:72-81.
37.
Sullivan K, Dunton NJ: Development and validation of the stroke knowledge test. Top Stroke Rehabil 2004;11:19-28.
38.
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. J Clin Neurosci 2007;14:12-16.
39.
Brenner DA, Zweifler RM, Gomez CR, Kissela BM, Levine D, Howard G, Coull B, Howard VJ: Awareness, treatment, and control of vascular risk factors among stroke survivors. J Stroke Cerebrovasc Dis 2010;19:311-320.
40.
Carroll C, Hobart J, Fox C, Teare L, Gibson J: Stroke in Devon: knowledge was good, but action was poor. J Neurol Neurosurg Psychiatry 2004;75:567-571.
41.
Stark Casagrande S, Rios Burrows N, Geiss LS, Bainbridge KE, Fradkin JE, Cowie CC: Diabetes knowledge and its relationship with achieving treatment recommendations in a national sample of people with type 2 diabetes. Diabetes Care 2012;35:1556-1565.
42.
Viera AJ, Cohen LW, Mitchell CM, Sloane PD: High blood pressure knowledge among primary care patients with known hypertension: a North Carolina Family Medicine Research Network (NC-FM-RN) study. J Am Board Fam Med 2008;21:300-308.
43.
Dickson VV, Riegel B: Are we teaching what patients need to know? Building skills in heart failure self-care. Heart Lung 2009;38:253-261.
44.
Sit JW, Yip VY, Ko SK, Gun AP, Lee JS: A quasi-experimental study on a community-based stroke prevention programme for clients with minor stroke. J Clin Nurs 2007;16:272-281.
45.
Maasland E, Koudstaal PJ, Habbema JD, Dippel DW: Effects of an individualized multimedia computer program for health education in patients with a recent minor stroke or transient ischemic attack - a randomized controlled trial. Acta Neurol Scand 2007;115:41-48.
46.
Lowe DB, Sharma AK, Leathley MJ: The CareFile Project: a feasibility study to examine the effects of an individualised information booklet on patients after stroke. Age Ageing 2007;36:83-89.
47.
Hoffmann T, McKenna K, Worrall L, Read SJ: Randomised trial of a computer-generated tailored written education package for patients following stroke. Age Ageing 2007;36:280-286.
48.
Rodgers H, Atkinson C, Bond S, Suddes M, Dobson R, Curless R: Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. Stroke 1999;30:2585-2591.
49.
Mant J, Carter J, Wade DT, Winner S: The impact of an information pack on patients with stroke and their carers: a randomized controlled trial. Clin Rehabil 1998;12:465-476.
50.
Smith J, Forster A, Young J: A randomized trial to evaluate an education programme for patients and carers after stroke. Clin Rehabil 2004;18:726-736.
51.
Green T, Haley E, Eliasziw M, Hoyte K: Education in stroke prevention: efficacy of an educational counselling intervention to increase knowledge in stroke survivors. Can J Neurosci Nurs 2007;29:13-20.
52.
Maasland L, Koudstaal PJ, Habbema JD, Dippel DW: Knowledge and understanding of disease process, risk factors and treatment modalities in patients with a recent TIA or minor ischemic stroke. Cerebrovasc Dis 2007;23:435-440.
53.
Reeves MJ, Rafferty AP, Aranha AA, Theisen V: Changes in knowledge of stroke risk factors and warning signs among Michigan adults. Cerebrovasc Dis 2008;25:385-391.
54.
Mikulik R, Goldemund D, Reif M, Brichta J, Neumann J, Jarkovsky J, Kryza J: Calling 911 in response to stroke: no change following a four-year educational campaign. Cerebrovasc Dis 2011;32:342-348.
55.
Smith J, Forster A, Young J: Cochrane review: information provision for stroke patients and their caregivers. Clin Rehabil 2009;23:195-206.
56.
Lorig KR, Holman HR: Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med 2003;26:1-7.
57.
Lorig KR, Ritter PL, Laurent DD, Plant K: Internet-based chronic disease self-management: a randomized trial. Med Care 2006;44:964-971.
58.
Cadilhac DA, Hoffmann S, Kilkenny M, Lindley R, Lalor E, Osborne RH, Batterbsy M: A phase II multicentered, single-blind, randomized, controlled trial of the stroke self-management program. Stroke 2011;42:1673-1679.
59.
Lorig K, Ritter PL, Plant K: A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Rheum 2005;53:950-957.
60.
Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL: Stroke knowledge and awareness: an integrative review of the evidence. Age Ageing 2010;39:11-22.
61.
Sullivan K, White K, Young R, Chang A, Roos C, Scott C: The nature and predictors of stroke knowledge amongst at risk elderly persons in Brisbane, Australia. Disabil Rehabil 2006;28:1339-1348.
62.
Croquelois A, Assal G, Annoni JM, Staub F, Gronchi A, Bruggimann L, Dieguez S, Bogousslavsky J: Diseases of the nervous system: patients' aetiological beliefs. J Neurol Neurosurg Psychiatry 2005;76:582-584.
63.
Boden-Albala B, Carman H, Moran M, Doyle M, Paik MC: Perception of recurrent stroke risk among black, white and Hispanic ischemic stroke and transient ischemic attack survivors: the SWIFT study. Neuroepidemiology 2011;37:83-87.
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