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Published in: Journal of Neurology 3/2010

01-03-2010 | Original Communication

Gender-specific differences in stroke knowledge, stroke risk perception and the effects of an educational multimedia campaign

Authors: Juergen J. Marx, Bianca Klawitter, Andreas Faldum, Bernhard M. Eicke, Birgit Haertle, Marianne Dieterich, Max Nedelmann

Published in: Journal of Neurology | Issue 3/2010

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Abstract

This study aimed at identifying gender-specific differences in stroke knowledge, stroke risk perception and the educational effects of a multimodal educational intervention. We performed computer-assisted telephone surveys among an average sample of 500 members of the general public (44.0% male, 56.0% female), before and immediately after an intense 3-month educational stroke campaign in a western German area of 400,000 inhabitants. The intervention was comprised of poster advertisements and various print media. Slogans and stroke interest stories appeared regularly in local newspapers, on television and radio and public events focussed on the subject. Even before the intervention, more women than men were able to name at least one stroke warning sign (71.3 vs. 57.8%, p < 0.01), to name the correct emergency call number (33.3 vs. 24.3%, p < 0.05) or to cite the correct action in acute stroke (“call emergency care”, 87.2 vs. 70.1%, p < 0.001). In some aspects women showed a generally better improvement of knowledge after the campaign (e.g. correct emergency call number: +5.7 vs. +1.2%, p < 0.05). Fewer women than men considered themselves as being at risk of stroke (30.9 vs. 36.9%. p < 0.01) with a significant increase following the intervention in both sexes (38.9/46.0%, p < 0.01). The perception of different educational media varied between the sexes. For example, female sex was independently associated with a better recall of poster advertisements and flyers in pharmacies and at the doctor’s office (OR 1.44). Our data indicate that educational programs do have gender-specific effects. Women show a better stroke knowledge and in some aspects a better chance to gain information from classical broad educational interventions. Future campaigns should be tailored economically, and should focus different media and educational messages on the two sexes accordingly.
Literature
1.
go back to reference Barr J, McKinley S, O’Brien E, Herkes G (2006) Patient recognition of and response to symptoms of TIA or stroke. Neuroepidemiology 26:168–175CrossRefPubMed Barr J, McKinley S, O’Brien E, Herkes G (2006) Patient recognition of and response to symptoms of TIA or stroke. Neuroepidemiology 26:168–175CrossRefPubMed
2.
go back to reference Barrett KM, Brott TG, Brown RD Jr, Frankel MR, Worrall BB, Silliman SL, Case LD, Rich SS, Meschia JF (2007) Sex differences in stroke severity, symptoms, and deficits after first-ever ischemic stroke. J Stroke Cerebrovasc Dis 16:34–39CrossRefPubMed Barrett KM, Brott TG, Brown RD Jr, Frankel MR, Worrall BB, Silliman SL, Case LD, Rich SS, Meschia JF (2007) Sex differences in stroke severity, symptoms, and deficits after first-ever ischemic stroke. J Stroke Cerebrovasc Dis 16:34–39CrossRefPubMed
3.
go back to reference Becker K, Fruin M, Gooding T, Tirschwell D, Love P, Mankowski T (2001) Community based education improves stroke knowledge. Cerebrovasc Dis 11:34–43CrossRefPubMed Becker K, Fruin M, Gooding T, Tirschwell D, Love P, Mankowski T (2001) Community based education improves stroke knowledge. Cerebrovasc Dis 11:34–43CrossRefPubMed
4.
go back to reference Bett N, Aroney G, Thompson P (1993) Impact of a national educational campaign to reduce patient delay in possible heart attack. Aust N Z J Med 23:157–161PubMed Bett N, Aroney G, Thompson P (1993) Impact of a national educational campaign to reduce patient delay in possible heart attack. Aust N Z J Med 23:157–161PubMed
5.
go back to reference Blohm MB, Hartford M, Karlson BW, Luepker RV, Herlitz J (1996) An evaluation of the results of media and educational campaigns designed to shorten the time taken by patients with acute myocardial infarction to decide to go to hospital. Heart 76:430–434CrossRefPubMed Blohm MB, Hartford M, Karlson BW, Luepker RV, Herlitz J (1996) An evaluation of the results of media and educational campaigns designed to shorten the time taken by patients with acute myocardial infarction to decide to go to hospital. Heart 76:430–434CrossRefPubMed
6.
go back to reference Bushnell CD, Horn P, Colton C, Miller VM, del Zoppo G, Elkind MS, Stern B, Herrington D, Ford-Lynch G, Gorelick P, James A, Brown CM, Choi E, Bray P, Newby LK, Goldstein LB, Simpkins J (2006) Advancing the study of stroke in women––summary and recommendations for future research from an NINDS-sponsored multidisciplinary working group. Stroke 37:2389–2399 Bushnell CD, Horn P, Colton C, Miller VM, del Zoppo G, Elkind MS, Stern B, Herrington D, Ford-Lynch G, Gorelick P, James A, Brown CM, Choi E, Bray P, Newby LK, Goldstein LB, Simpkins J (2006) Advancing the study of stroke in women––summary and recommendations for future research from an NINDS-sponsored multidisciplinary working group. Stroke 37:2389–2399
7.
go back to reference Carandang R, Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, Wolf PA (2006) Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 296:2939–2946CrossRefPubMed Carandang R, Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, Wolf PA (2006) Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 296:2939–2946CrossRefPubMed
8.
go back to reference Cheung RTF (2001) Hong Kong patients’ knowledge of stroke does not influence time-to-hospital presentation. J Clin Neurosci 8:311–314CrossRefPubMed Cheung RTF (2001) Hong Kong patients’ knowledge of stroke does not influence time-to-hospital presentation. J Clin Neurosci 8:311–314CrossRefPubMed
9.
go back to reference Das K, Mondal GP, Dutta AK, Mukherjee B, Mukherjee BB (2007) Awareness of warning symptoms and risk factors of stroke in the general population. J Clin Neurosci 14:12–16CrossRefPubMed Das K, Mondal GP, Dutta AK, Mukherjee B, Mukherjee BB (2007) Awareness of warning symptoms and risk factors of stroke in the general population. J Clin Neurosci 14:12–16CrossRefPubMed
10.
go back to reference Davidson KW, Trudeau KJ, van Roosmalen E, Stewart M, Kirkland S (2006) Gender as a health determinant and implications for health education. Health Educ Behav 33:731–743CrossRefPubMed Davidson KW, Trudeau KJ, van Roosmalen E, Stewart M, Kirkland S (2006) Gender as a health determinant and implications for health education. Health Educ Behav 33:731–743CrossRefPubMed
11.
go back to reference Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, Giroud M, Rudd A, Ghetti A, Inzitari D (2003) Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 34:1114–1119CrossRefPubMed Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, Giroud M, Rudd A, Ghetti A, Inzitari D (2003) Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 34:1114–1119CrossRefPubMed
12.
go back to reference Fang MC, Singer DE, Chang Y, Hylek EM, Henault LE, Jensvold NG, Go AS (2005) Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation. The anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation 112:1687–1691CrossRefPubMed Fang MC, Singer DE, Chang Y, Hylek EM, Henault LE, Jensvold NG, Go AS (2005) Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation. The anticoagulation and risk factors in atrial fibrillation (ATRIA) study. Circulation 112:1687–1691CrossRefPubMed
13.
go back to reference Feldmann E, Gordon N, Brooks JM, Brass LM, Fayad PB, Sawaya KL, Nazareno F, Levine SR (1993) Factors associated with early presentation of acute stroke. Stroke 24:1805–1810PubMed Feldmann E, Gordon N, Brooks JM, Brass LM, Fayad PB, Sawaya KL, Nazareno F, Levine SR (1993) Factors associated with early presentation of acute stroke. Stroke 24:1805–1810PubMed
14.
go back to reference Fogle CC, Oser CS, Troutman TP, McNamara M, Williamson AP, Keller M, McNamara S, Helgerson SD, Gohdes D, Harwell TS (2008) Public education strategies to increase awareness of stroke warning signs and the need to call 911. J Public Health Manag Pract 14:e17–e22PubMed Fogle CC, Oser CS, Troutman TP, McNamara M, Williamson AP, Keller M, McNamara S, Helgerson SD, Gohdes D, Harwell TS (2008) Public education strategies to increase awareness of stroke warning signs and the need to call 911. J Public Health Manag Pract 14:e17–e22PubMed
15.
go back to reference Gargano JW, Wehner S, Reeves M (2008) Sex differences in acute stroke care in a state wide stroke registry. Stroke 39:24–29CrossRefPubMed Gargano JW, Wehner S, Reeves M (2008) Sex differences in acute stroke care in a state wide stroke registry. Stroke 39:24–29CrossRefPubMed
16.
go back to reference Greenlund KJ, Neff LJ, Zheng ZJ, Keenan NL, Giles WH, Ayala CA, Croft JB, Mensah GA (2003) Low public recognition of major stroke symptoms. Am J Prev Med 25:315–319CrossRefPubMed Greenlund KJ, Neff LJ, Zheng ZJ, Keenan NL, Giles WH, Ayala CA, Croft JB, Mensah GA (2003) Low public recognition of major stroke symptoms. Am J Prev Med 25:315–319CrossRefPubMed
17.
go back to reference Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Höxter G, Mahagne MH et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA 274:1017–1025CrossRefPubMed Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Höxter G, Mahagne MH et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA 274:1017–1025CrossRefPubMed
18.
go back to reference Harwell TS, Blades LL, Oser CS, Dietrich DW, Okon NJ, Rodriguez DV, Burnett AM, Russell JA, Allen MJ, Fogle CC, Helgerson SD, Gohdes D (2005) Perceived risk for developing stroke among older adults. Prev Med 41:791–794CrossRefPubMed Harwell TS, Blades LL, Oser CS, Dietrich DW, Okon NJ, Rodriguez DV, Burnett AM, Russell JA, Allen MJ, Fogle CC, Helgerson SD, Gohdes D (2005) Perceived risk for developing stroke among older adults. Prev Med 41:791–794CrossRefPubMed
19.
go back to reference Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV (2000) Sex differences and similarities in the management and outcome of stroke patients. Stroke 31:1833–1837PubMed Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV (2000) Sex differences and similarities in the management and outcome of stroke patients. Stroke 31:1833–1837PubMed
20.
go back to reference Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS (1996) Factors delaying hospital admission in acute stroke: the Copenhagen Stroke Study. Neurology 47:383–387PubMed Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS (1996) Factors delaying hospital admission in acute stroke: the Copenhagen Stroke Study. Neurology 47:383–387PubMed
21.
go back to reference Koçer A, İnce N, Koçer E, Taşçi A (2006) Factors influencing treatment compliance among Turkish people at risk for stroke. J Prim Prev 27:81–88CrossRefPubMed Koçer A, İnce N, Koçer E, Taşçi A (2006) Factors influencing treatment compliance among Turkish people at risk for stroke. J Prim Prev 27:81–88CrossRefPubMed
22.
go back to reference Kraywinkel K, Heindrich J, Heuschmann PU, Wagner M, Berger K (2007) Stroke risk perception among participants of a stroke awareness campaign. BMC Public Health 7:39–45CrossRefPubMed Kraywinkel K, Heindrich J, Heuschmann PU, Wagner M, Berger K (2007) Stroke risk perception among participants of a stroke awareness campaign. BMC Public Health 7:39–45CrossRefPubMed
23.
go back to reference Labiche LA, Chan W, Saldin KR, Morgenstern LB (2002) Sex and acute stroke presentation. Ann Emerg Med 40:453–460CrossRefPubMed Labiche LA, Chan W, Saldin KR, Morgenstern LB (2002) Sex and acute stroke presentation. Ann Emerg Med 40:453–460CrossRefPubMed
24.
go back to reference Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y (2009) Heart disease and stroke statistics––2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119:480–486CrossRefPubMed Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y (2009) Heart disease and stroke statistics––2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119:480–486CrossRefPubMed
25.
go back to reference Marx JJ, Nedelmann M, Haertle B, Dieterich M, Eicke BM (2008) An educational multimedia campaign has differential effects on public stroke knowledge and care-seeking behaviour. J Neurol 255:378–382CrossRefPubMed Marx JJ, Nedelmann M, Haertle B, Dieterich M, Eicke BM (2008) An educational multimedia campaign has differential effects on public stroke knowledge and care-seeking behaviour. J Neurol 255:378–382CrossRefPubMed
26.
go back to reference Marx JJ, Gube C, Faldum A, Kuntze H, Nedelmann M, Haertle B, Dieterich M, Eicke BM (2009) An educational multimedia campaign improves stroke knowledge and risk perception in different stroke risk groups. Eur J Neurol 16:612–618CrossRefPubMed Marx JJ, Gube C, Faldum A, Kuntze H, Nedelmann M, Haertle B, Dieterich M, Eicke BM (2009) An educational multimedia campaign improves stroke knowledge and risk perception in different stroke risk groups. Eur J Neurol 16:612–618CrossRefPubMed
27.
go back to reference Menon SC, Pandey DK, Morgenstern LB (1998) Critical factors determining access to acute stroke care. Neurology 51:427–432PubMed Menon SC, Pandey DK, Morgenstern LB (1998) Critical factors determining access to acute stroke care. Neurology 51:427–432PubMed
28.
go back to reference Montaner J, Vidal C, Molina C, Alvarez-Sabin J (2001) Selecting the target and the message for a stroke public education campaign: a local survey conducted by neurologists. Eur J Epidemiol 17:581–586CrossRefPubMed Montaner J, Vidal C, Molina C, Alvarez-Sabin J (2001) Selecting the target and the message for a stroke public education campaign: a local survey conducted by neurologists. Eur J Epidemiol 17:581–586CrossRefPubMed
29.
go back to reference Morgenstern LB, Bartholomew LK, Grotta JC, Staub L, King M, Chan W (2003) Sustained benefit of a community and professional intervention to increase acute stroke therapy. Arch Intern Med 163:2198–2202CrossRefPubMed Morgenstern LB, Bartholomew LK, Grotta JC, Staub L, King M, Chan W (2003) Sustained benefit of a community and professional intervention to increase acute stroke therapy. Arch Intern Med 163:2198–2202CrossRefPubMed
30.
go back to reference Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S (2000) Prehospital and emergency department delays after acute stroke: the Genentech Stroke Presentation Survey. Stroke 31:2585–2590PubMed Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S (2000) Prehospital and emergency department delays after acute stroke: the Genentech Stroke Presentation Survey. Stroke 31:2585–2590PubMed
31.
go back to reference Müller-Nordhorn J, Nolte CH, Rossnagel K, Jungehülsing GJ, Reich A, Roll S, Villringer A, Willich SN (2006) Knowledge about risk factors for stroke: a population-based survey with 28,090 participants. Stroke 37:946–950CrossRefPubMed Müller-Nordhorn J, Nolte CH, Rossnagel K, Jungehülsing GJ, Reich A, Roll S, Villringer A, Willich SN (2006) Knowledge about risk factors for stroke: a population-based survey with 28,090 participants. Stroke 37:946–950CrossRefPubMed
32.
go back to reference Niewada M, Kobayashi A, Sandercock PA, Kaminski B, Czlonkowska A (2005) Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the international stroke trial. Neuroepidemiology 24:123–128CrossRefPubMed Niewada M, Kobayashi A, Sandercock PA, Kaminski B, Czlonkowska A (2005) Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the international stroke trial. Neuroepidemiology 24:123–128CrossRefPubMed
33.
go back to reference O’Keefe-McCarthy S (2008) Women’s experiences of cardiac pain: a review of the literature. Can J Cardiovasc Nurs 18:18–25PubMed O’Keefe-McCarthy S (2008) Women’s experiences of cardiac pain: a review of the literature. Can J Cardiovasc Nurs 18:18–25PubMed
34.
go back to reference Prochaska JO, Velieer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12:38–48PubMed Prochaska JO, Velieer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12:38–48PubMed
35.
go back to reference Reeves MJ, Bushnell CD, Howard G, Warner Gargano J, Duncan PW, Lynch G, Khatiwada A, Lisabeth (2008) Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcome. Lancet Neurol 7:915–926CrossRefPubMed Reeves MJ, Bushnell CD, Howard G, Warner Gargano J, Duncan PW, Lynch G, Khatiwada A, Lisabeth (2008) Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcome. Lancet Neurol 7:915–926CrossRefPubMed
36.
go back to reference Roquer J, Rodriguez Campello A, Gomis M (2003) Sex differences in first-ever acute stroke. Stroke 34:1581–1585CrossRefPubMed Roquer J, Rodriguez Campello A, Gomis M (2003) Sex differences in first-ever acute stroke. Stroke 34:1581–1585CrossRefPubMed
37.
go back to reference Rosamond WD, Gorton RA, Hinn AR, Hohenhaus SM, Morris DL (1998) Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study. Acad Emerg Med 5:45–51CrossRefPubMed Rosamond WD, Gorton RA, Hinn AR, Hohenhaus SM, Morris DL (1998) Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study. Acad Emerg Med 5:45–51CrossRefPubMed
38.
go back to reference Rosenstock IM, Strecher VJ, Becker MH (1988) Social-learning theory and the health belief model. Health Educ Q 15:175–183PubMed Rosenstock IM, Strecher VJ, Becker MH (1988) Social-learning theory and the health belief model. Health Educ Q 15:175–183PubMed
39.
go back to reference Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, Redgrave JN, Bull LM, Welch SJ, Cuthbertson FC, Binney LE, Gutnikov SA, Anslow P, Banning AP, Mant D, Mehta Z (2005) Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 366:1773–1783CrossRefPubMed Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, Redgrave JN, Bull LM, Welch SJ, Cuthbertson FC, Binney LE, Gutnikov SA, Anslow P, Banning AP, Mant D, Mehta Z (2005) Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 366:1773–1783CrossRefPubMed
40.
go back to reference Silver FL, Rubini F, Black D, Hodgson CS (2003) Advertising strategies to increase public knowledge of the warning signs of stroke. Stroke 34:1965–1969CrossRefPubMed Silver FL, Rubini F, Black D, Hodgson CS (2003) Advertising strategies to increase public knowledge of the warning signs of stroke. Stroke 34:1965–1969CrossRefPubMed
41.
go back to reference Stern EB, Berman ME, Thomas JJ, Klassen AC (1999) Community education for stroke awareness: an efficacy study. Stroke 30:720–723PubMed Stern EB, Berman ME, Thomas JJ, Klassen AC (1999) Community education for stroke awareness: an efficacy study. Stroke 30:720–723PubMed
42.
go back to reference Wester P, Radberg J, Lundgren B, Peltonen M (1999) Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 30:40–48PubMed Wester P, Radberg J, Lundgren B, Peltonen M (1999) Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 30:40–48PubMed
Metadata
Title
Gender-specific differences in stroke knowledge, stroke risk perception and the effects of an educational multimedia campaign
Authors
Juergen J. Marx
Bianca Klawitter
Andreas Faldum
Bernhard M. Eicke
Birgit Haertle
Marianne Dieterich
Max Nedelmann
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
Journal of Neurology / Issue 3/2010
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-009-5326-9

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