Impact of Multimedia Campaigns on Recognition and Response to Stroke

Main Article Content

Elizabeth O’ Connell Vicki Livingstone Geraldine McCarthy Irene Hartigan


Background: Timely recognition of stroke symptoms and appropriate emergency response offers those who experience stroke an increased chance of physical and psychosocial recovery. International research suggests there is a lack of knowledge amongst the general population of the signs and symptoms of stroke, this may impact on seeking treatment. Public awareness campaigns are designed to educate the public on how to recognise and respond to symptoms of stroke

Aim: To investigate recognition and response to stroke and associated factors. 

Design: A cross-sectional study was designed, a researcher developed questionnaire sought information related to previous experience of stroke, knowledge of risk factors, recognition of stroke symptoms, awareness of treatment available and the ability to identify what the letters of the FAST acronym represent. The Stroke Action Test (STAT)41 was used to investigate how participants would respond to specific symptoms of stroke.

Sample: A convenient sample (n=243) which included older people attending an outpatients’ clinic in a large teaching hospital were included. A mixed method of data collection of online and paper version was used.

Findings: Results identified that 41% of participants recognised all six stroke symptoms as defined by the American Heart and Stroke Association. The symptom most frequently recognised by participants was numbness of the face, arm and leg (97%). The mean STAT score for participants was 9 which indicated that most participants would respond appropriately, by contacting the emerging services, to 9 out of a total of 21 items describing stroke in the STAT. Multivariate analysis identified that having previously had a stroke and knowledge of risk factors for stroke were significantly associated with recognition of stroke symptoms.  Participants were most likely to respond to items which described classic stroke symptoms such as limb weakness and difficulty speaking.

Conclusion Awareness of treatment available for stroke is a predictor of appropriate response to stroke. Future stroke awareness campaigns should include information on the availability, benefits and timelines for treatment of stroke to help individuals who experience stroke overcome delays in their response to the recognition of stroke symptoms.

Keywords: Stroke, Stroke knowledge, Stroke symptoms, Stroke action test, stroke awareness campaign

Article Details

How to Cite
CONNELL, Elizabeth O’ et al. Impact of Multimedia Campaigns on Recognition and Response to Stroke. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 18 apr. 2024. doi:
Research Articles


1. Feigin, V., Norrving, B. and Mensah, G. Global Burden of Stroke. Circulation Research. 2017;120: 439-448.
2. Betts, K., Hurley, D., Song, J., Sajeev, G., Guo, J., Xiaoyan Du, E., Paschoalin, M. and Wu, E. Real-World Outcomes of Acute Ischemic Stroke Treatment with Intravenous Recombinant Tissue Plasminogen Activator. Journal of Stroke and Cerebrovascular Diseases. 2017; 26 (9): 1996-2003.
3. O’ Connell, E. and Hartigan, I. Recognition of stroke symptoms by stroke survivors. British Journal of Neuroscience Nursing. 2011; 7 (3): 168-173.
4. Hickey, A., Holly, D., McGee, H., Conroy, R. and Shelley, E. Knowledge of Stroke Risk Factors and Warning Signs in Ireland: Development and Application of the Stroke Awareness Questionnaire (SAQ). International Journal of Stroke 2012;7 (4): 298-306.
5. Caruso, D., Akly, M., Costantini, P., Fridman, S. And Esnaola, M. Do elderly patients call 911 when presented with clinical scenarios suggestive of acute stroke? A cross-sectional study. Cerebrovascular Disease 2015;39: 87-93.
6. Ramirez-Moreno, J., Alonso-Gonzalez, R., Peral-Pacheco, Millan-Nunez, M. and Aguirre-Sanchez. Knowledge of stroke: a study from a sex perspective. BMC Resident Notes. 2015; 8: 604-610.
7. Hickey, A., Mellon, L., Williams, D., Shelley, E. and Conroy, R. Does stroke health promotion increase awareness of appropraite behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. European Stroke Journal. 2018; 0 (0): 1-9.
8. Fussman, C., Rafferty, A., Lyon-Callo, S., Morgenstern, L. And Reeves, M. Lack of Association between Stroke Symptom Knowledge and Intent to Call 911: A population-based survey. Stroke 2010;41: 1501-1507.
9. Jones, S., Jenkinson, A., Leathley, M. And Watkins, C. Stroke knowledge and awareness: an integrtive review of the evidence. Age and Aging. 2010; 39 (1): 11-22.
10. Dombrowski, S., Mackintosh, J., Sniehotta, F., Araujo-Soares V. and Rodgers, H. The impact of the UK ‘ActFAST’ stroke awareness campaign: content analysis of patients, witness and primary care clinicians’ perceptions. BMC Public Health 2013 doi: 10.1186/1471-2458-13-915.
11. Hartigan, I., O’ Connell, E., O’ Brien, S., Weathers, E., Cornally, N., Kilonzo, B. And McCarthy, G. The Irish National Stroke Awareness Campaign: A stroke of success? Applied Nursing Research 2014;27: e13-e19.
12. Mellon, L., Doyle, F., Williams, D., Brewer, L., Hall, P. and Hickey, A. Patient behaviour at the time of stroke onset: a cross -sectional survey of patient response to stroke symptoms. Emergency Medical Journal. 2016; 33: 396-402.
13. Moriera, E., Correla, M., Magalhaes, R. and Silva, C. Stroke awareness in urban and rural populations from Northern Portugal: knowledge and action are independant. Neuroepidemiology. 2011; 36: 265-273.
14. Cossi, M., Preux, P., Chabriat, H., Gobron, C. and Houinato, D. Knowledge of stroke among an urban population in Cotonou (Benin). Neuroepidemiolgy 2012;38: 172-178.
15. Lundelin, K., Graciani, A., Garcia-Puig, J., Guallar-Castillon, P., Taboada, J., Rodriguez-Artalejo and Banegas, J. Knowledge of stroke symptoms and intended action in response to stroke in Spain: a nationwide population based study. Cerebrovascular Diseases. 2012; 34:161-168.
16. Madaeen, S., Bulatova, N., Al=Qhewii, T., Sakran, L., El-Zayyat, H., Kamar, M., Al-Haqeesh, H and Younes, A. Stroke Awareness in the General Opoulation: A study from Jordan. Tropical Journal of Pharaceutical Research. 2013; 12 (6): 1071-1076.
17. Mochari-Greenberger, H., Towfighi, A. And Mosca, L. National Womens knowledge of stroke warning signs overall and by race/ethnic group. Stroke. 2014; 45: 1180-1182.
18. Yang, J., Zheng, M., Cheng, S., Ou, S., Z Hang, J., Wang, N., Cao, Y. and Wang, J. Knowledge of Stroke Symptoms and Treatment among Community Residents in Western Urban China. Journal of Stroke and Cerebrovascular Diseases. 2014; 23 (5): 1216-1224.
19. Grady, A., Cary, M. and Sanson-Fisher, R . Assessing awareness of appropriate responses to symptoms of stroke. Patient Education and Counseling. 2014; 95: 400-405.
20. Magin, P., Dunbabin, J., Goode, S., Valaderas, J., Levi, C., D’Souza, M., Marshall, M., Bardi, D. and Lasserson, D. Patient response to transient inshaemic attack symptoms. British Journal of General Practice. 2015; Jan: e24-e31.
21. Dombrowski, S., Ford, G., Morgenstern, L., White, M., Sniehotta, F., Mackintosh, J., Gellert, P. and Skolarus, L. Differences between US and UK adults in stroke preparedness: Evidence from parallel population-based community surveys. Stroke 2015;46: 3220-3225
22. Fogle, C., Oser, C., McNamara, M., Helgerson, S., Gohdes, D. and Harwell, T. Impact of Media on Community Awareness of Stroke Warning Signs: A Comparison Study. Journal of Stroke and Cerebrovascular Diseases. 2010;19 (5): 370-375.
23. Pierce, C., Fahs, P., Dura, A., Fronczek, A., Morgan, L., Leppert, T., Srnka-Debnae, F., Terriquez-Kasey, L., Hamilton, B. and Buel, V. Raising stroke awareness among rural dwellers with a Facts for Action to Stroke Treatment-based educational program. Applied Nursing Research. 2011; 24: 82-87.
24. Tedim, V., Araujo, I., Alves, I.,Magano, A. And Coutinho, P. Freeze the Stroke: Public awareness program for immediate detection of first symptoms. Stroke. 2012; 43: 2510-2512.
25. Miyamatsu, N., Kimura, K., Okumara, T., Iguchi, Y., Nakayama, H., Toypta, A., Watanabe, M., Morimoto, A., Morinage, M. and Yamaguchi, T. Effects of Public Education by Television on Knowledge of Early Stroke Symptoms among a Japanese Population aged 40 to 74 years. Stroke. 2011; 43: 545-549.
26. O’ Callaghan, G., Murphy, S., Loane, D. and Horgan, F. Stroke knowledge in an Irish semi-rural community dwelling cohort and impact of a brief education session. Journal of Stroke and Cerebrovascular Diseases. 2012; 21 (8): 629-638.
27. Worthmann, H., Schwartz, A., Heidenreich, F., Sindern, E., Lorenz, R., Adams, H., Flemming, A., Luettje, K., W alter, U., Haertle, B. and Dengler, R. Educational campaign on stroke in an urban opoulation in Northern Germany : influence on public stroke awareness and knowledge. International Journal of Stroke. 2013; 8: 286-292.
28. Bray, J., Johmson, R., Trobbiani, K., Mosley, I., Lalor, E. and Cadhilac, D. Austrailian public’s awareness of stroke symptoms improves after national multimedia campaigns. Stroke. 2013; 44: 3540- 3543.
29. Flynn, D., Ford, G., Rodgers, H., Price, C., Steen, N. and Thompson, R. A Time Series Evaluation of the FAST-National Stroke Awareness Campaign in England. PLOS 2014;9 (8): e104289.
30. Truelsen, T. and Krarup, L. Stroke awareness in Denmark. Neuroepidemiology. 2010; 35: 165-170.
31. Hickey, A., O’Hanlon, A., McGee, H., Donnellan, E.S., Horgan, F. and O’ Neill, D. Stroke awareness in the general population: knowledge of stroke risk factors and warding signs in older adults. BMC Geriatrics. 2009; 9 (35):1-8.
32. Milulik, R., Bunt, L., Hrdlicke, D., Dusek, L., Vaclavik, D. and Kyrza, J. Calling 911 in response to stroke. A nationwide study assessing definitive individual behaviour. Stroke. 2008 39: 1844-1849.
33. Falavigna, A., Teles, A., Vedana, V., Kleber, F., Mosena, G., Velho, M., Mazzocchin, T., da Sinva, R., Lucena, L., Santin, J. and Roth, F. Awareness of stroke risk factors and symptoms in Southern Brazil. Arq Neuropsiquiate. 2009;67 (4): 1076-1081.
34. Neau, J., Ingrand, P. and Godeneche, G. Awareness within the French population concerning stroke signs, symptoms and risk factors. Clinical Neurology and Neurosurgery. 2009; 111: 659-664.
35. Salar, A., Williams, P., Omishakin, A., Lloyd, D. 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.
36. Nansseu, J., Atangana, C., Saint-Just, P., Kamtchum-Tatuene, J. and Noubiap, J. Assessment of the general public’s knowledge of stroke: A cross-sectional study in Yaounde, Cameroon. Journal of Neurological Sciences. 2017; 378: 123-129.
37. Connor Desai, S., & Reimers, S. Comparing the use of open and closed questions for Web-based measures of the continued-influence effect. Behaviour Research Methods. 2019; 51(3): 1426-1440.
38. Baldereschi, M., Di Carlo, A., Vaccaro, C., Polizzi, B., Inzitari, D. Stroke knowledge in Italy. Neurological Sciences. 2015; 36: 415-421.
39. Kitco, L. and Hupcey, J. Factors that influence health-seeking behaviours of patients experiencing acute stroke. Journal of Neuroscience Nursing. 2008;40 (6): 333-340.
40. Beckett, J., Barley and Ellis, C. Patient Perspectives on Barriers and Facilitators of Treatment-Seeking Behaviors for Stroke Care. Journal of Neuroscience Nursing. 2015; 47 (3): 154-159.
41. Billings-Gagliardi, S. and Mazor, K. Development and validation of the Stroke Action Test. Stroke. 2005;36: 1035-1039.
42. Kleindorfer, D., Khourey, J., Broderick, J.P., Rademacher, E., Woo, D., Flaherty, M.L., Alwell, K., Moomaw, C.J., Schneider, A., Pancioli, A., Miller, R. and Kissela, B.M. Temporal Trends in Public Awareness of Stroke ; symptoms, risk factors and treatments. Stroke. 2009; 40: 2505-2506.
43. Sirisha, S., Jala, S., Vooturi, S., Yada, S., Kaul, S. Awareness, Recognition and Response to Stroke among the General Public – An Observational Study. Journal of Neurosciences in Rural Practice. 2021; 12 (4): 704-710.
44. Irish Heart Foundation. Act FAST Stroke Awareness Campaign. 2020. accessed July 14th 2020 accessed July 14th 2020.
45. Irish Heart Foundation. Heart and Stroke Conditions Explained.2020.
46. National Stroke Association. Stroke Facts. 2016. accessed September 14th 2018.
47. American Heart and Stroke Association. Stroke Fact Sheet.2018 accessed Aug 20th 2018.
48. Dombrowski, S., Sniehotta, F., Mackintosh, J., White, M., Rodgers, H., Thompson, R., Murtagh, M., Ford, G., Eccles, M. and Araujo-Soares, V. Witness response at acute onset of stroke: A Qualitative Theory -Guided Study. PLOS ONE 2012;7 (7): e39852
49. Age Action. Supporting Digital Literacy among Older People. 2018. accessed Jan 25th 2019.
50. Mellon, L., Doyle, F., Rohde, D., Williams, D. and Hickey, A. Stroke warning campaigns: delivering better patient outcomes? A systematic review. Patient Related Outcome Measures. 2015;6: 61-73.
51. Beckett, J., Barley, and Ellis, C. Patient Perspectives on Barriers and Facilitators of Treatment-Seeking Behaviors for Stroke Care. Journal of Neuroscience Nursing 2015; 47 (3): 154-159.
52. Fang, J., Yan, W., Jiang, G. Li, W. and Cheng, Q. Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shangai, China. Clinical Neurology and Neurosurgery. 2011;113: 85-88
53. Gargano,J., Wehner, S. And Reeve, M. Presenting symptoms and onset –to-arrival time in patients with acute stroke and transient ischemic attack. Journal of Stroke and Cerebrovascular Diseases. 2011;20 (6): 494-502.
54. Faiz, K., Sundseth, A., Thommessen, B. and Ronning, O. Factors related to Decision Delay in Acute Stroke. Journal of Stroke and Cerebrovascular Diseases. 2014;23 (3): 534-539.
55. Kim, K., Park, S., Bae, H., Cho, A., Cho, Y., Han, M., Heo, J., Kang, K., Kim, D., Kim, H., Kim, G., Kwon, S., Kwon, H., Lee, B., Lee, K., Lee, S., Lee, S., Lee, Y., Nam, H., Oh, M., Park, J., Rha, J., Yu, K. and Yoon, B. Stroke awareness decreases pre hospital delay after acute ischemic stroke in Korea. BMC Neurology. 2011:11 (2): 1-8.
56. Wakefield, M., Loken, B. and Hornick, R. Use of mass media campaigns to change health behaviour. Lancet. 2010; 376: 1261-1271.
57. Marteau, T., Hollands, G. and Kelly, M. Changing population behavior and reducing health disparities:exploring the potential of ‘choice architecture’intervention. In Kaplan, R., Spittle, M. David, D. Eds.Emerging behavioral and social science perspectives on population health 2015: Bethseda MD: National Institutes of Health/Agency for Healthcare Research and Quality.
58. Kelly, M. and Barker, B. Why is changing health-related behaviour so difficult? Public Health 2016;136: 109-116.
59. Becker, M. The Health Belief Model and personal health behaviour. Health Education Monographs. 1974; 2 (4): 324-473.
60. Wendelboe, A., Raskob, G., Angchaisuksiri, P., Blanco, A., Buller, H., Ddungu, H., Dvorak, J., and Hunt, B. (2017) Global public awareness about atrial fibrillation. Research and Practice in Thrombosis and Haemostasis 2017; 2 (1): 49-57.