Ischaemic stroke is the most frequent form of cerebrovascular disease, the leading cause of disability in older adults, and the second leading cause of death in Colombia, and is associated with significant social, economic, and family costs.1 Most strokes are preventable and are associated with known risk factors.2,3 Furthermore, scientific, pharmacological, and technological advances made in the last 25 years have led to a paradigm shift in the treatment of ischaemic stroke, reducing mortality rates and disability in the long term.2,4 However, successful prevention and acute treatment of ischaemic stroke require understanding of the subject in the community.

The majority of the global population does not recognise the symptoms and risk factors of ischaemic stroke.5,6,7Moreover they are also unaware of management times for optimal treatment, which hospital to travel to, or how to activate the local emergency system to ensure eligibility for cerebral reperfusion treatment.5,6 Among Spanish speakers in Latin America, the small number of studies into knowledge about ischaemic stroke in the community have shown similar results.6 While the community may consult various sources for information on cerebrovascular disease, depending on certain demographic factors, studies show that most of this information is from non-medical sources.5,8,9 Finally, women interviewed about cerebrovascular disease reported that they did not understand and were not well-informed about the disease, and did not perceive cerebrovascular disease as a cause of death.9,10

The first step in implementing public health information strategies is to establish the current understanding of ischaemic stroke. This information will facilitate the development of specific education programmes adjusted to the needs of the community in order to strengthen, modify, and expand understanding of the disease, improving the efficacy of prevention and treatment interventions.

The aim of this study was to evaluate the knowledge about ischaemic stroke in a school community in Bogota (Colombia), in the healthcare district served by the hospitals at which the authors work.

Survey respondents from this school community in Bogota displayed poor knowledge of the risk factors, symptoms, and treatments available for ischaemic stroke. Despite living in an urban setting (100%) and their young age (40 years) and high socioeconomic level (82.2% were residents of stratum 4, 5, or 6 areas), the percentage of respondents who knew any particular symptom or risk factor for ischaemic stroke never surpassed 30%. Furthermore, 74.7% of respondents did not know what treatments for ischaemic stroke were available in Colombia. While all respondents recognised the need to seek medical attention in the event of stroke, with most selecting the first 6 h after onset as the optimal time, most did not know which hospital to attend.

It is noteworthy that stress (a non-conventional or uncommon risk factor for ischaemic stroke) was mentioned so frequently (28.7%), as reported in other studies.11,12 The 10 conventional or common risk factors, associated with 80% of ischaemic strokes, were mentioned by a low percentage of respondents. Despite 91.1% of respondents mentioning at least one risk factor, only one individual was able to list five, and cardiac or cardiovascular disease was only mentioned by one respondent. According to previous studies, 45%–85% of the population knows at least one risk factor.12–14 In the Spanish-speaking population, the most frequently recognised risk factor is arterial hypertension, followed by alcohol consumption and smoking. On the contrary, older age, diabetes mellitus, dyslipidaemia, and heart disease are less well-recognised as risk factors for ischaemic stroke.11 Studies show very heterogeneous levels of knowledge of the risk factors for ischaemic stroke in the community, although they consistently find that very few individuals are able to identify the majority of conventional (common) known risk factors.

While headache only presents in approximately 30% of cases, it was identified by our respondents as a symptom of stroke, as in previous studies.5,10 Other Colombian studies have found that 65%–70% of individuals surveyed do not know the symptoms of ischaemic stroke.8,13 Motor and language symptoms, which present high sensitivity and moderate specificity for recognising stroke, were only mentioned by 10%–20% of respondents. It is also noteworthy that the presence of such systemic symptoms as chest pain is often identified as a symptom of ischaemic stroke.5,11 The poor knowledge of risk factors and symptoms of ischaemic stroke may constitute an obstacle to the implementation of prevention and treatment interventions.

Finally, regarding the treatment of stroke, which was the focus in the last three questions of the survey, all respondents recognised the need to seek medical attention. The majority believed that attention should be sought in the first 6 h after onset, but few respondents (13.9%) knew which hospital to attend. Previous studies report heterogeneous results, with 24%–63% of individuals surveyed knowing that the treatment of ischaemic stroke is time-dependent.5,11 Our survey did not address responses to transient neurological symptoms. However, previous studies have evaluated behaviour in the event of transient symptoms, finding that 13.7%–56.9% of respondents would attend the emergency department on the day that symptoms present.11 In contrast, a study conducted in Colombia in 2011 found that 88% of respondents would not take appropriate action if they presented stroke.13

Most respondents (74.7%) did not know what types of treatment were available for ischaemic stroke in Colombia. Only 8.9% selected cerebral reperfusion measures (6.2% for mechanical thrombectomy and 2.7% for intravenous thrombolysis) as a therapeutic option to treat ischaemic stroke. This is consistent with the results of two previous studies conducted in Colombia: Díaz-Cabezas8 reports that only 1.4% of Colombian survey respondents knew about the existence of thrombolytic treatments.

The strengths and limitations of our study are related to the study population and design. Survey respondents resided in the healthcare district served by the hospitals at which the authors work. The findings will facilitate the creation of targeted, specific public information strategies. We consider the sample size sufficient to ensure reliable results. Finally, the survey was easy to complete and to understand, and the open-ended items did not include leading questions.

The study is not free of limitations. For example, respondents were selected by convenience sampling, and the socioeconomic level of the study population was high (although level of education was not recorded). The survey was only distributed to one school community. The survey focused on ischaemic stroke, but did not address all aspects; likewise, haemorrhagic stroke was not addressed. Furthermore, due to limited resources, the survey was not externally validated, no public information intervention was implemented in the study population, and we have not evaluated changes in knowledge of ischaemic stroke since the survey was conducted (2017).

As in previous studies conducted in the region, our study population showed a poor level of knowledge of various aspects of stroke. Our results underscore the need for public health education strategies to improve knowledge of the risk factors, cardinal symptoms, and available treatments for ischaemic stroke, and to identify the hospitals equipped to treat the disease.

Respondents displayed poor knowledge of the risk factors, symptoms, and available treatments for ischaemic stroke. As the efficacy of prevention and reperfusion interventions for ischaemic stroke depends on this knowledge, it is important to dedicate resources to determining public understanding of the disease in order to implement specific information campaigns adjusted to the needs of each community.

The authors have no conflicts of interest to declare.