{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:56:20Z","timestamp":1781718980529,"version":"3.54.5"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Key Medical Administration Research Project of Sichuan Provincial Hospital Association","award":["No.SCYW25-01"],"award-info":[{"award-number":["No.SCYW25-01"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to investigate the knowledge of stroke management among non-neurological healthcare professionals (HCPs) in an underdeveloped county in western China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study proceeded in two phases. First, the Acute Stroke Management Questionnaire (ASMaQ) underwent a systematic intercultural adaptation into Chinese, followed by an evaluation of its psychometric properties. Second, a cross\u2011sectional survey using the adapted Chinese ASMaQ was administered to non\u2011neurological HCPs working in an underdeveloped county in southwestern China. A convenience sampling method was used in the recruitment. Demographic information, including age, gender, years of service, job position (doctor\/nurse), department, professional level, medical facility level (comprehensive hospital\/noncomprehensive medical facility), and whether the participant had a neurologist partner or not during routine practice, was collected. The internal consistency was then measured with Cronbach\u2019s \u03b1. Further statistical analyses were conducted to identify potential influencing factors of the ASMaQ score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After a standardized intercultural adaptation and evaluation process, a reliable localized Chinese version of ASMaQ was obtained, with an overall Cronbach\u2019s \u03b1 value of 0.77. A total of 252 HCPs completed the questionnaires, and 225 qualified questionnaires were included in the statistical analysis. The results revealed that the rate of good performance of overall ASMaQ among non-neurological HCPs was 69.4%. For the three subscales of ASMaQ, the rates of good performance for general stroke knowledge (GSK), hyperacute stroke management (HSM), and advanced stroke management (ASM) were 73.3%, 64.7%, and 70.1%, respectively. Furthermore, we found that the factors influencing the overall ASMaQ score were primarily gender, job position, medical facility level, and with\/without neurologist partners. Specifically, females performed worse than males did (106.7\u2009\u00b1\u20097.7 vs. 110\u2009\u00b1\u20098.1; P\u2009=\u20090.003), nurses performed worse than doctors did (106.3\u2009\u00b1\u20097.6 vs. 110.0\u2009\u00b1\u20097.9; P\u2009&lt;\u20090.001), the HCPs in noncomprehensive medical facilities performed worse than those in comprehensive hospitals did (105.2\u2009\u00b1\u20099.3 vs. 108.5\u2009\u00b1\u20097.3; P\u2009=\u20090.02), and the HCPs without neurologist partner in the routine clinical practise performed worse than those with (106.1\u2009\u00b1\u20098.1 vs 109\u2009\u00b1\u20097.5, P\u2009=\u20090.005). Multiple regression analysis revealed that the job position and the level of medical facility were the independent influencing factors for the total ASMaQ score (P\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Chinese version of ASMaQ comprehensively assesses the understanding of stroke management knowledge among HCPs. This study reflected the lack of stroke management knowledge among non-neurological HCPs in underdeveloped western regions of China for the first time and revealed that nurses and HCPs in noncomprehensive medical facilities were more likely to have insufficient knowledge of stroke management. Strengthening their training will significantly help improve stroke treatment rates, thereby reducing the burden of stroke-related morbidity and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351499","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:26:06Z","timestamp":1781717166000},"page":"e0351499","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the knowledge of stroke management among the non-neurological healthcare professionals in an underdeveloped county in Southwestern China"],"prefix":"10.1371","volume":"21","author":[{"given":"Xia","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanbin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiquan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xilin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3054-3044","authenticated-orcid":true,"given":"Lili","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"issue":"8","key":"pone.0351499.ref001","doi-asserted-by":"crossref","first-page":"100692","DOI":"10.1016\/j.medj.2025.100692","article-title":"Burden of neurological disorders in China and its provinces, 1990-2021: Findings from the global burden of disease study 2021","volume":"6","author":"C Zhang","year":"2025","journal-title":"Med"},{"issue":"12","key":"pone.0351499.ref002","article-title":"Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019","volume":"6","author":"Q Ma","year":"2021","journal-title":"The Lancet Public Health"},{"issue":"5","key":"pone.0351499.ref003","doi-asserted-by":"crossref","first-page":"465","DOI":"10.26599\/1671-5411.2024.05.009","article-title":"Epidemiology and current management of cerebrovascular disease in China","volume":"21","author":"S-S Hu","year":"2024","journal-title":"J Geriatr Cardiol"},{"issue":"4","key":"pone.0351499.ref004","doi-asserted-by":"crossref","first-page":"251","DOI":"10.4103\/bc.bc_198_25","article-title":"China stroke prevention and control report 2024: an executive summary","volume":"11","year":"2025","journal-title":"Brain circulation"},{"issue":"1","key":"pone.0351499.ref005","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s40779-023-00463-x","article-title":"China stroke surveillance report 2021","volume":"10","author":"WJ Tu","year":"2023","journal-title":"Military Medical Research"},{"issue":"5","key":"pone.0351499.ref006","first-page":"595","article-title":"Two Decades of the Construction of Stroke Prevention and Control System in China","volume":"20","author":"YX Dai Liye","year":"2025","journal-title":"Chinese Journal of Stroke"},{"issue":"4","key":"pone.0351499.ref007","first-page":"355","article-title":"Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: a tertiary referral center experience","volume":"18","author":"HHR Hashim","year":"2013","journal-title":"Neurology Asia"},{"issue":"12","key":"pone.0351499.ref008","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S1474-4422(03)00586-6","article-title":"In-hospital stroke","volume":"2","author":"DJ Blacker","year":"2003","journal-title":"Lancet Neurol"},{"issue":"1","key":"pone.0351499.ref009","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1161\/STROKEAHA.113.003617","article-title":"Quality of care and outcomes for in-hospital ischemic stroke: findings from the National Get With The Guidelines-Stroke","volume":"45","author":"E Cumbler","year":"2014","journal-title":"Stroke"},{"issue":"7","key":"pone.0351499.ref010","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1161\/STROKEAHA.113.000945","article-title":"Comparison of short-term outcomes of thrombolysis for in-hospital stroke and out-of-hospital stroke in United States","volume":"44","author":"Y Moradiya","year":"2013","journal-title":"Stroke"},{"issue":"12","key":"pone.0351499.ref011","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1136\/neurintsurg-2015-012145","article-title":"Comparison of outcomes of patients with inpatient or outpatient onset ischemic stroke","volume":"8","author":"K Bekelis","year":"2016","journal-title":"J Neurointerv Surg"},{"issue":"9","key":"pone.0351499.ref012","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1177\/1747493018790029","article-title":"Improving care for acute in-hospital ischemic strokes-A narrative review","volume":"13","author":"S Chen","year":"2018","journal-title":"Int J Stroke"},{"issue":"11","key":"pone.0351499.ref013","doi-asserted-by":"crossref","first-page":"2926","DOI":"10.1161\/STROKEAHA.123.042868","article-title":"Nursing and Institutional Responsibilities for In-Hospital Stroke","volume":"54","author":"J Snavely","year":"2023","journal-title":"Stroke"},{"issue":"2","key":"pone.0351499.ref014","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1159\/000098551","article-title":"Inpatient and community ischemic strokes in a university hospital","volume":"28","author":"D Dulli","year":"2007","journal-title":"Neuroepidemiology"},{"issue":"1","key":"pone.0351499.ref015","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/j.1468-1331.2010.03105.x","article-title":"In-hospital stroke: a multi-centre prospective registry","volume":"18","author":"R Vera","year":"2011","journal-title":"Eur J Neurol"},{"issue":"3","key":"pone.0351499.ref016","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1177\/1941874415588319","article-title":"In-Hospital Ischemic Stroke","volume":"5","author":"E Cumbler","year":"2015","journal-title":"The Neurohospitalist"},{"issue":"4","key":"pone.0351499.ref017","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1097\/00002727-200310000-00005","article-title":"Code gray--an organized approach to inpatient stroke","volume":"26","author":"S Nolan","year":"2003","journal-title":"Crit Care Nurs Q"},{"issue":"1","key":"pone.0351499.ref018","doi-asserted-by":"crossref","first-page":"105421","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.105421","article-title":"Knowledge of Acute Stroke Management Among Healthcare Professionals: Development and Validation of Acute Stroke Management Questionnaire (ASMaQ)","volume":"30","author":"CY Sim","year":"2021","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"2","key":"pone.0351499.ref019","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research","volume":"28","author":"DJ Buysse","year":"1989","journal-title":"Psychiatry Res"},{"issue":"8","key":"pone.0351499.ref020","doi-asserted-by":"crossref","first-page":"107832","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107832","article-title":"Evaluating the knowledge of stroke management among Nigerian medical doctors","volume":"33","author":"A Yakubu","year":"2024","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"pone.0351499.ref021","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.13310","article-title":"Knowledge of acute stroke management and the predictors among Malaysian healthcare professionals","volume":"10","author":"SA Albart","year":"2022","journal-title":"PeerJ"},{"issue":"12","key":"pone.0351499.ref022","doi-asserted-by":"crossref","DOI":"10.1002\/brb3.70191","article-title":"Reliability and Validity of the Turkish Version of the Acute Stroke Management Questionnaire","volume":"14","author":"\u00d6 Adad\u0131o\u011flu","year":"2024","journal-title":"Brain and Behavior"},{"issue":"12","key":"pone.0351499.ref023","doi-asserted-by":"crossref","DOI":"10.1002\/nop2.70106","article-title":"What Are the Predictors of Acute Care Nurses\u2019 Stroke Knowledge?: Empirical Research Quantitative","volume":"11","author":"CT Leach","year":"2024","journal-title":"Nurs Open"},{"issue":"2","key":"pone.0351499.ref024","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1365-2753.2010.01434.x","article-title":"Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline","volume":"17","author":"VD Sousa","year":"2011","journal-title":"J Eval Clin Pract"},{"issue":"1","key":"pone.0351499.ref025","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S1474-4422(16)30283-6","article-title":"Stroke 1-2-0: a rapid response programme for stroke in China","volume":"16","author":"J Zhao","year":"2017","journal-title":"Lancet Neurol"},{"key":"pone.0351499.ref026","doi-asserted-by":"crossref","DOI":"10.1002\/9780470316771","volume-title":"Statistical intervals","author":"GJ Hahn","year":"1991"},{"issue":"13","key":"pone.0351499.ref027","doi-asserted-by":"crossref","first-page":"3236","DOI":"10.1080\/03610926.2018.1473882","article-title":"Simultaneous estimation of Cronbach\u2019s alpha coefficients","volume":"48","author":"S Lisawadi","year":"2018","journal-title":"Communications in Statistics - Theory and Methods"},{"issue":"12","key":"pone.0351499.ref028","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"50","author":"WJ Powers","year":"2019","journal-title":"Stroke"},{"key":"pone.0351499.ref029","article-title":"2026 guideline for the early management of patients with acute ischemic stroke: A guideline from the American Heart Association\/American Stroke Association","author":"S Prabhakaran","year":"2026","journal-title":"Stroke"},{"issue":"5","key":"pone.0351499.ref030","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1161\/STROKEAHA.106.480889","article-title":"Usefulness of checking platelet count before thrombolysis in acute ischemic stroke","volume":"38","author":"BL Cucchiara","year":"2007","journal-title":"Stroke"},{"issue":"23","key":"pone.0351499.ref031","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1212\/WNL.0b013e3181c5b46d","article-title":"Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke","volume":"73","author":"NS Rost","year":"2009","journal-title":"Neurology"},{"issue":"5","key":"pone.0351499.ref032","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1159\/000345702","article-title":"Waiting for platelet counts causes unsubstantiated delay of thrombolysis therapy","volume":"69","author":"L Breuer","year":"2013","journal-title":"Eur Neurol"},{"issue":"6","key":"pone.0351499.ref033","first-page":"523","article-title":"Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023","volume":"57","author":"Chinese Society of Neurology CSS","year":"2024","journal-title":"Chin J Neurol"},{"key":"pone.0351499.ref034","doi-asserted-by":"crossref","first-page":"100776","DOI":"10.1016\/j.cegh.2021.100776","article-title":"Evaluation of hypertension treatment in acute ischemic stroke","volume":"11","author":"L Haidar","year":"2021","journal-title":"Clinical Epidemiology and Global Health"},{"issue":"4","key":"pone.0351499.ref035","first-page":"15","article-title":"Awareness of stroke among general practitioners","volume":"13","author":"WMH Shahzad","year":"2018","journal-title":"Pakistan Journal of Neurological Sciences"},{"issue":"8","key":"pone.0351499.ref036","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1007\/s00415-017-8570-4","article-title":"In-hospital ischaemic stroke treated with intravenous thrombolysis or mechanical thrombectomy","volume":"264","author":"F Caparros","year":"2017","journal-title":"J Neurol"},{"issue":"12","key":"pone.0351499.ref037","doi-asserted-by":"crossref","first-page":"104398","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104398","article-title":"Effectiveness of an Interdisciplinary, Nurse Driven In-Hospital Code Stroke Protocol on In-Patient Ischemic Stroke Recognition and Management","volume":"28","author":"SJ Yang","year":"2019","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"5","key":"pone.0351499.ref038","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.10.003","article-title":"Nurses Are as Specific and Are Earlier in Calling In-Hospital Stroke Alerts Compared to Physicians","volume":"26","author":"P George","year":"2017","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"4","key":"pone.0351499.ref039","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000402","article-title":"Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association","volume":"53","author":"A Nouh","year":"2022","journal-title":"Stroke"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351499","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:26:12Z","timestamp":1781717172000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351499"}},"subtitle":[],"editor":[{"given":"Maher Abdelraheim","family":"Titi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351499","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]}}}