Journal List > Korean J Adult Nurs > v.31(4) > 1130755

Korean J Adult Nurs. 2019 Aug;31(4):403-413. Korean.
Published online Aug 23, 2019.  https://doi.org/10.7475/kjan.2019.31.4.403
© 2019 Korean Society of Adult Nursing
Factors Influencing Unawareness of Warning Signs of Stroke among Hypertensive Diabetic Patients at a High Risk for Stroke: The 2017 Nationwide Community Health Survey in Korea
Mirae Jo,1 Heeyoung Oh,2 Suk-Yong Jang,3 and Ahra Jo4
1Doctoral Student, Graduate School, College of Nursing, Eulji University, Daejeon, Korea.
2Professor, College of Nursing, Eulji University, Daejeon, Korea.
3Assistant Professor, Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, Korea.
4Assistant Professor, Department of Nursing, Songho University, Hoengseong, Korea.

Corresponding author: Oh, Heeyoung. College of Nursing, Eulji University, 77 Gyeryong-ro, 771 beon-gil, Jung-gu, Daejeon 34824, Korea. Tel: +82-42-259-1713, Fax: +82-42-259-1709, Email: hoh123@eulji.ac.kr
Received Apr 30, 2019; Revised Jun 10, 2019; Accepted Jun 25, 2019.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

The purpose of this study was to assess the awareness of warning signs of stroke and identify the risk factors influencing such awareness among diabetics with hypertension who are at a high risk for stroke.

Methods

Data from the 2017 Korea Community Health Survey were used. A total of 15,536 adults older than 30 years diagnosed with hypertension and diabetes mellitus were included in the final analysis. Data were analyzed using frequency, percentage, χ2 test, and logistic regression with SPSS/WIN 24.0 program.

Results

Among the five warning signs of stroke, “sudden trouble in speaking or understanding” (79.0%) was the most commonly identified one and “sudden severe headache with an unknown cause” (65.2%) was the least. Only 48.8% participants identified all five warning signs and 11.8% could not identify any of them. In the logistic regression model, the risk of unawareness of warning signs of stroke was significantly higher among those aged 30~49 years and 70 years or older, with a lower educational level, without a spouse, and with a heavy alcohol consumption and current smoking status.

Conclusion

The level of awareness of warning signs was low in hypertensive diabetic adults. To improve awareness of warning signs of stroke, a customized educational program should be provided to hypertensive diabetic adults considering the risk factors relevant to unawareness of warning signs of stroke. The education on warning signs of stroke can potentially lead to a reduction in morbidity in the survivors.

Keywords: Stroke; Awareness; Hypertension; Diabetes mellitus

Tables


Table 1
Socio-demographic and Health-related Characteristics of Patients (N=15,536)
Click for larger image


Table 2
Awareness of Warning Signs of Stroke among Hypertensive Diabetic Patients (N=15,536)
Click for larger image


Table 3
Differences in Unawareness of Warning Signs of Stroke according to Socio-Demographic and Health-related Characteristics (N=15,536)
Click for larger image


Table 4
Factors Influencing Unawareness of Warning Signs of Stroke among Hypertensive Diabetic Patients (N=15,536)
Click for larger image

Notes

CONFLICTS OF INTEREST:The authors declared no conflict of interest.

AUTHORSHIP:

  • Study conception and design acquisition - JM, OH and JS-Y.

  • Data collection - None (secondary data analysis).

  • Analysis and interpretation of the data - JM.

  • Drafting and critical revision of the manuscript - JM, OH, JS-Y and JA.

References
1. Statistics Korea. Cause of death statistics [Internet]. Daejeon: Statistics Korea; 2017 [cited 2018 Nov 22].
2. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation 2011;123(4):e18–e209.
3. Statistics Korea. Estimated future population [Internet]. Daejeon: Statistics Korea; 2017 [cited 2018 Sept 27].
4. Jeong SW, Kim K-J, Jeong HS, Kim S-K, Kim J-T, Kim J-S, et al. Present and future of neurologist: do we have enough neurologists? - in the aspect of stroke care. Journal of the Korean Neurological Association. 2018;36(3):159–164. [doi: 10.17340/jkna.2018.3.4]
5. Ho SH, Ahn BK, Yang JH, Kim HJ, Lee S, Kim JH, et al. In: A study on the system and policy improvement of rehabilitation medical service. Research Report. Seoul: National Rehabilitation Research Institute; 2018 Mar.
Report No.: 11-1352297-000260-01.
6. Korean Stroke Society. Textbook of stroke. 2nd ed. Seoul: Pan Mun Education; 2015. pp. 3-4.
7. Gumbinger C, Reuter B, Stock C, Sauer T, Wiethölter H, Bruder I, et al. Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retro-spective analysis of hospital quality assurance data with comparison with results from randomised clinical trials. BMJ 2014;348:g3429
10.1136/bmj.g3429.
8. National Medical Center. Status of time required for emergency room arrival after stroke [Internet]. Seoul: National Medical Center; 2017 [cited 2018 September 25].
9. Kim YS, Park SS, Bae HJ, Cho AH, Cho YJ, Han MK, et al. Stroke awareness decreases prehospital delay after acute ischemic stroke in Korea. BMC Neurology 2011;11:2 [doi: 10.1186/1471-2377-11-2]
10. Lee YH, Park HY, Lee HS, Ha YS, Cheong JS, Cho KH, et al. Effects of community-based stroke education and advocacy on the time from stroke onset to hospital arrival in ischemic stroke patients. Journal of the Korean Neurological Association 2015;33(4):265–271. [doi: 10.17340/jkna.2015.4.4]
11. Lee YM, Kim KY, Kim KS. Awareness of stroke warning symptoms and related factors among residents in a province. Journal of the Korea Academia-Industrial cooperation Society 2014;15(8):5116–5123. [doi: 10.5762/KAIS.2014.15.8.5116]
12. Yang J, Zheng M, Cheng S, Ou S, Zhang J, Wang N, et al. Knowledge of stroke symptoms and treatment among community residents in western urban China. Journal of Stroke and Cerebrovascular Diseases 2014;23(5):1216–1224. [doi: 10.1016/j.jstrokecerebrovasdis.2013.10.019]
13. Lee YH, Shin MH, Kweon SS, Choi JS, Park MS, Cho KH, et al. Awareness of stroke warning signs and risk factors: result of a 2010 community survey in Gwangju metropolitan city. Journal of the Korean Neurological Association 2012;30(1):26–32.
14. Sallar AM, Williams PB, Omishakin AM, Lloyd DP. Stroke prevention: awareness of risk factors for stroke among African American residents in the Mississippi delta region. Journal of the National Medical Association 2010;102(2):84–94. [doi: 10.1016/S0027-9684(15)30495-8]
15. Miyamatsu N, Okamura T, Nakayama H, Toyoda K, Suzuki K, Toyota A, et al. Public awareness of early symptoms of stroke and information sources about stroke among the general Japanese population: the acquisition of stroke knowledge study. Cerebrovascular Diseases 2013;35(3):241–249. [doi: 10.1159/000347066]
16. Lee YH, Kim YT, Oh GJ, Kim NH, Cho KH, Park HY, et al. Effects of community-based education and advocacy intervention on public awareness about the warning signs of stroke and the golden window of time. Korean Journal of Health Education and Promotion 2015;32(1):1–10. [doi: 10.14367/kjhep.2015.32.1.1]
17. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360(9349):1903–1913. [doi: 10.1016/S0140-6736(02)11911-8]
18. The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010;375(9733):2215–2222. [doi: 10.1016/S0140-6736(10)60484-9]
19. Wang MD, Wang Y, Mao L, Xia YP, He QW, Lu ZX, et al. Acute stroke patients' knowledge of stroke at discharge in China: a cross-sectional study. Tropical Medicine & International Health 2018;23(11):1200–1206. [doi: 10.1111/tmi.13148]
20. Ramírez-Moreno JM, Alonso-González R, Peral-Pacheco D, Millán-Núñez MV, Aguirre-Sánchez JJ. Stroke awareness is worse among the old and poorly educated: a population-based survey. Journal of Stroke and Cerebrovascular Diseases 2015;24(5):1038–1046. [doi: 10.1016/j.jstrokecerebrovasdis.2014.12.031]
21. Lundelin K, Graciani A, Garcia-Puig J, Guallar-Castillón P, Taboada JM, Rodríguez-Artalejo F, et al. Knowledge of stroke warning symptoms and intended action in response to stroke in Spain: a nationwide population-based study. Cerebrovascular Diseases 2012;34(2):161–168. [doi: 10.1159/000341408]
22. Kim HR. Creating a healthy society without worrying about cardiovascular disease [Internet]. Sejong: Ministry of Health and Welfare; 2018 [cited 2019 Jan 10].
23. World Health Organization Western Pacific Region. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000. pp. 15-18.
24. Korea Centers for Disease Control and Prevention. Community health survey [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2017 [cited 2018 Sept 27].
25. Choi YO, Lee JH. Impact of stroke knowledge, fear of recurrence on health behavior in patients with ischemic stroke. Korean Journal of Adult Nursing 2017;29(3):302–312. [doi: 10.7475/kjan.2017.29.3.302]
26. Kim YS, Park SS, Bae HJ, Heo JH, Kwon SU, Lee BC, et al. Public awareness of stroke in Korea: a population-based national survey. Stroke 2011;43(4):1146–1149. [doi: 10.1161/STROKEAHA.111.638460]
27. Baldereschi M, Di Carlo A, Vaccaro C, Polizzi B, Inzitari D. Stroke knowledge in Italy. Neurological Sciences 2015;36(3):415–421. [doi: 10.1007/s10072-014-1964-5]
28. Lee YH, Noh SE. Factors related to awareness of cardio-cerebrovascular disease among Korean adults: the 2013 community health survey. Korean Journal of Health Promotion 2017;17(2):99–108. [doi: 10.15384/kjhp.2017.17.2.99]
29. Thun MJ, Carter BD, Feskanich D, Freedman ND, Prentice R, Lopez AD, et al. 50-year trends in smoking-related mortality in the United States. The New England Journal of Medicine 2013;368(4):351–364. [doi: 10.1056/NEJMsa1211127]
30. Tang L, Xu T, Li H, Zhang M, Wang A, Tong W, et al. Hypertension, alcohol drinking and stroke incidence: a population-based prospective cohort study among inner Mongolians in China. Journal of Hypertension 2014;32(5):1091–1096. [doi: 10.1097/HJH.0000000000000142]
31. Wahab KW, Okokhere PO, Ugheoke AJ, Oziegbe O, Asalu AF, Salami TA. Awareness of warning signs among suburban Nigerians at high risk for stroke is poor: a cross-sectional study. BMC Neurology 2008;8:18. [doi: 10.1186/1471-2377-8-18]