# Awareness of Stroke Risk Factors, Warning Signs, and Health-Seeking Behaviors Among Adults With Cardio-Metabolic Risk Attending a Primary Care Clinic in Malacca, Malaysia

## TL;DR

This study found that adults with cardio-metabolic risks in Malaysia have poor awareness of stroke signs and risk factors, and show inconsistent health-seeking behaviors.

## Contribution

The study provides new insights into stroke awareness and health-seeking behaviors among high-risk patients in a primary care setting in Malaysia.

## Key findings

- Only 21.3% of participants identified all five stroke warning signs.
- Participants knew an average of 9.2 out of 12 stroke risk factors.
- Health-seeking behavior scores varied widely, with age, heart disease, and knowledge of risk factors influencing behavior.

## Abstract

Background

Early identification of stroke warning signs and risk factors may expedite intervention, thus improving the clinical outcome, which is especially important in individuals who already have risk factors. The main objective of this study is to assess awareness of stroke risk factors, warning signs, and health-seeking behavior related to stroke among adults with cardio-metabolic risk factors attending primary care.

Methods

This cross-sectional study was conducted in a primary care clinic in Malacca, Malaysia, focusing on adults with cardio-metabolic risk factors. A standardized questionnaire, piloted prior to the study, that focused on the domains of warning signs of stroke and risk factors was used, whereas the health-seeking behavior domain was adapted from the Malay version of the Attitudes and Beliefs about Cardiovascular Disease risk (ABCD-M) questionnaire. Descriptive analysis and binary logistic regression were done to analyze the factors using SPSS version 29 (IBM Corp., Armonk, NY).

Results

Out of 230 recruited patients, only 21.3% were able to identify all five stroke warning signs, with the most commonly known sign being sudden numbness or weakness on one side of the body (88.3%), comprising 203 patients, whereas only 23.9% were able to answer all 12 risk factors contributing to stroke. The mean number of warning signs known was 3.2 ± 1.4, and the mean number of risk factors known was 9.2 ± 2.8. There is a huge gap between the health-seeking behavior among this population, with the lowest mark of 8 and the highest mark of 72. The factors that contributed to health-seeking behavior related to stroke were age group (adjusted odds ratio (AOR): -0.293, 95% confidence interval (CI): 0.123-0.696), presence of heart disease (AOR: -0.237, 95% CI: 0.062-0.900), and total number of risk factors of stroke known (AOR: 1.131, 95% CI: 1.024-1.248).

Conclusion

Awareness of stroke warning signs and risk factors was still poor among the targeted population at risk of stroke. A huge gap in health-seeking behavior within this group warrants a better stroke prevention practice among this group of patients, which can be promoted by the primary healthcare provider.