title: Poststroke knowledge and symptom awareness: a global issue for secondary stroke prevention.
abstract: 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.
authors.affiliation: Departments of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425,USA. ellisc@musc.edu
authors.forename: Charles
authors.initials: C
authors.lastname: Ellis
authors.forename: Jessica
authors.initials: J
authors.lastname: Barley
authors.forename: Anouk
authors.initials: A
authors.lastname: Grubaugh
mesh_terms: D001364:Awareness; D002986:Clinical Trials as Topic; D006801:Humans; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D017741:Survivors / Q000706:statistics & numerical data