Acute Stroke and the Public’s Response to Symptoms

Abstract

Stroke is a medical emergency requiring a rapid response by the public. This thesis aims to explore our current understanding of stroke knowledge and the decision-making processes involved at the onset of stroke symptoms. Using this information, and the results from a focus group, the thesis will go on to describe the development and pilot testing of an information leaflet for those at higher risk of stroke. The thesis consists of four phases: an integrative review; semi-structured interviews; a focus group; pilot testing of an intervention.

Phase One is an integrative review of stroke knowledge in stroke patients; relatives; the public and non-stroke patients at risk of stroke. Members of the public frequently state that they would contact the emergency medical services (EMS) if they suspected stroke but few stroke patients reported that they had actually done so.

Through qualitative interviews, Phase Two explored the decision-making process in seeking medical help at the onset of stroke symptoms. The decision about what to do at the onset of symptoms was influenced by multiple factors: knowledge of stroke symptoms; perceived seriousness; emotional reaction to the event; help seeking behaviour and previous experience of seeking medical help. The factors informed a theoretical framework describing the decision-making process for seeking help after stroke.

In Phase Three, a focus group explored the information that would best encourage people with suspected stroke to seek immediate help from the EMS. It was agreed that information should: be informed by stroke survivors; be suitable for everyone; use pictures and images; describe a range of stroke symptoms; indicate that stroke is a medical emergency for which effective treatments are available.

Phase Four was informed by Phases One through Three, and pilot tested an information leaflet, in people at higher risk of stroke. The information leaflet increased the proportions of patients accessing the EMS and reduced time to seeking medical help.

This thesis has made a contribution to knowledge through the development of a theoretical framework that reflects the decision-making process for seeking help after stroke. Using this framework, the thesis has further added to knowledge by demonstrating the potential effectiveness of an information leaflet in a higher risk population.