• Vol. 43 No. 9, 454–463
  • 15 September 2014

Stroke Literacy in Singapore: Data From a Survey of Public Housing Estate Residents



Introduction: Knowledge of stroke symptoms is associated with seeking medical attention early, and knowledge of risk factors is an essential factor in stroke prevention. In this study, we evaluated the level of stroke literacy in Singapore.

Materials and Methods: A cross-sectional study of Singapore citizens and permanent residents aged 21 years and above was conducted in a public housing estate. Participants were randomly sampled using multi-stage stratified sampling. Assessment of awareness of stroke symptoms and risk factors was performed using open-ended questions. In total, 687 respondents were recruited, with a response rate of 69.7%.

Results: Overall, 52.4% of respondents identified the brain as the source of pathology, and 47.6% could cite at least 1 of the 3 FAST symptoms (facial droop, arm weakness and speech difficulty), while 40% could name 2 or more of 7 established risk factors for stroke (high blood pressure, high cholesterol, cigarette smoking, diabetes mellitus, older age, previous heart attacks and stroke). Respondents at higher risk of stroke (older individuals and those with stroke risk factors) did not have greater awareness of stroke symptoms and risk factors. The majority of respondents reported they would seek immediate medical care if they experienced stroke symptoms. Only 59.4% knew the emergency ambulance service telephone number.

Conclusion: In a sample of Singaporean adults residing in a public housing estate, we found evidence of poor stroke literacy, highlighting the need for comprehensive population-based education efforts. There is a role for opportunistic education among those at higher risk of stroke.

Stroke is a leading cause of adult disability worldwide and the second most common cause of disease burden for Singaporeans aged 65 years and older. Acute thrombolytic treatment with intravenous tissue plasminogen activator (rtPA) within 4.5 hours of stroke onset is proven to reduce poststroke disability. However its utilisation in many parts of the world, including Singapore, is very low, with the main reason being delayed arrival to hospital due to patients’ failure to recognise stroke symptoms and realise the urgency of the situation. Stroke risk can be reduced with control of known modifiable risk factors such as hypertension and healthy lifestyle measures. Hence improved stroke literacy can reduce stroke incidence and improve stroke outcomes, but there are currently limited data on stroke literacy in Singapore. So far, there has only been one published study comparing public awareness of sepsis and stroke in Singapore. However, this study did not explore comprehensively the various dimensions of stroke literacy (for example using vignettes to explore participants’ responses to specific stroke-related scenarios), nor did it explore comprehensively potential factors associated with stroke literacy. We aimed to study the level of awareness of stroke symptoms and risk factors among Singapore residents in a public housing estate and its associations with sociodemographic factors, and personal and family medical history.

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