A population-based study on awareness of stroke in Turkey E. D. Evci a , S. Memis b , F. Ergin a and E. Beser a a Department of Public Health, Adnan Menderes University, School of Medicine, Aydin, Turkey; and b Department of Medical Nursing, Adnan Menderes University, School of Health, Aydin, Turkey Keywords: awareness, prevention, risk factors, stroke, warning signs Received 15 September 2006 Accepted 13 December 2006 Stroke is the second most common cause of mortality and a major cause of long-term disability of adults in most countries. This study was performed to determine the level of knowledge and awareness regarding risk factors and warning signs of stroke in a selected sample. This cross-sectional study was carried out in Aydin between November and December 2005, utilizing a study sample of 920 people registered at urban health centers. The questionnaire, prepared by the investigators, was adminis- tered by 20 trained students utilizing face-to-face interviews at participantsÕ homes. Two-thirds of the participants knew the organ effected by stroke. The participants reported that stroke was a consequence of occlusion (28.0%) or bleeding (18.0%) in brain arteries. Paralysis/weakness of one side of the body (37.1%), speech impairment (26.8%) and numbness of one side of the body (14.2%) were reported as three major stroke warning signs. Sixty-four percent of the participants knew at least one of these risk factors. Their primary sources of information were family and friends. Our study showed the great need for increasing awareness of risk factors and warning signs for stroke, perhaps utilizing community based education programs and the mass media. Introduction Stroke is the second most common cause of adult mortality in most countries [1–4]. According to WHO, stroke will account for 5.7 million deaths in 2005 worldwide. The National Burden of Disease and Cost- Effectiveness Study, carried out in 2001 suggested that cerebrovascular diseases accounted for 15.0% of mor- tality and were the second most common lethal diseases in Turkey [5]. Stroke is a preventable public health problem [6]. The level of public awareness, and knowledge about stroke risk factors and warning signs is critical for ensuing adequate access to preventative treatments and acute interventions that utilize recombinant tissue plasmino- gen activator (rt-PA) [3, 7–9]. The aim of this study is to determine this level in a selected population sample in a city of Turkey. Materials and methods Sample and setting This cross-sectional study was carried out between November and December 2005 in Aydin, a city in Western Turkey, with 217 558 inhabitants. There are nine health centers in the city centre. The sample was selected from people who were >40 years and regis- tered at these health centers (n ¼ 60117). As there is no published study available to date that documents public awareness of stroke in Turkey, anticipated population proportion was accepted as 50%. The study group was determined by utilization of the cluster sampling method. Health centers were accepted as clusters. For cluster sampling strategy the number of clusters appropriate for this study was determined to be two. Sample size was 920 subjects and was distributed according to the populations of health centers [10]. The subjects were randomized from the clusters and all of them (100%) participated to the study. Procedure This study was been approved by The Provincial Health Directorate. Twenty senior students from The School of Health were trained in data collection for 2 weeks. The questionnaire was completed by students at partici- pantsÕ houses utilizing face-to-face interviews. If there was any difficulty in understanding open-end questions, the questions were repeated without any steering explanation. Participants gave verbal consent for their participation before administration of the question- naire. In case of refusal to participate, the subject was replaced with a substitute. Following completion of the questionnaire, a brochure including basic information about stroke (prepared by the investigators) was given to participants. Correspondence: Dr E. Didem Evci, Department of Public Health, Adnan Menderes University, School of Medicine, Aydin, Turkey (tel.: 0 532 611 08 71; 0 256 225 31 66/139; fax: 0 256 212 31 69; e-mail: devci@yahoo.com). Ó 2007 EFNS 517 European Journal of Neurology 2007, 14: 517–522 doi:10.1111/j.1468-1331.2007.01723.x