{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:21:16Z","timestamp":1787844076679,"version":"build-2784847793"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Background and Objectives:<\/jats:title>\n Data on community-level knowledge and attitudes toward stroke are limited in India, particularly in Kerala. This study assessed knowledge and attitudes toward stroke and identified associated factors among adults aged \u226518 years in Kerala.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n In this community-based cross-sectional study, 576 adults (mean age: 43 years; 44% male) were selected through multistage cluster sampling. Data on stroke knowledge and attitudes were collected using a pretested structured interview schedule. Log-binomial regression was used to determine factors associated with higher knowledge and positive attitudes.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Overall, 53.3% identified the brain as the organ affected by stroke, and 26.6% correctly recognized the treatment window (<4.5 hours). High knowledge was observed in 48.9% of participants and was significantly associated with older age (\n P<\/jats:italic>\n < 0.001), female sex (\n P<\/jats:italic>\n = 0.014), urban residence (\n P<\/jats:italic>\n < 0.001), college education (\n P<\/jats:italic>\n = 0.022), health insurance (\n P<\/jats:italic>\n = 0.002), family history of stroke (\n P<\/jats:italic>\n = 0.025), and receiving information from academic sources (\n P<\/jats:italic>\n = 0.015) or interpersonal communication (\n P<\/jats:italic>\n < 0.001). A positive attitude was reported by 44.4% and was more common among females (\n P<\/jats:italic>\n = 0.016), rural residents (\n P<\/jats:italic>\n = 0.030), college-educated adults (\n P<\/jats:italic>\n = 0.022), people with a family history of stroke (\n P<\/jats:italic>\n = 0.007), and those informed through academic sources (\n P<\/jats:italic>\n = 0.028).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Key gaps persisted in recognizing stroke symptoms and the treatment window. Knowledge and attitudes were better among females and educated individuals, highlighting the need for targeted education in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aian.aian_1243_25","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T08:00:08Z","timestamp":1779177608000},"page":"570-578","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge and Attitude Related to Stroke and Factors Associated with them Among Adults Aged 18 Years and Above in Kerala, India: A Community-Based Cross-Sectional Study"],"prefix":"10.4103","volume":"29","author":[{"given":"Sankar S","family":"Sailesh","sequence":"first","affiliation":[{"name":"Department of Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Nambiar","sequence":"additional","affiliation":[{"name":"Department of Stroke Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeby J","family":"Olickal","sequence":"additional","affiliation":[{"name":"Department of Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavumpurathu R","family":"Thankappan","sequence":"additional","affiliation":[{"name":"Department of Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"R1-20260818","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int J Stroke"},{"key":"R2-20260818","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"Feigin","year":"2024","journal-title":"Lancet Neurol"},{"key":"R3-20260818","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S1474-4422(23)00277-6","article-title":"Pragmatic solutions to reduce the global burden of stroke: A World Stroke Organization\u2013Lancet Neurology Commission","volume":"22","author":"Feigin","year":"2023","journal-title":"Lancet Neurol"},{"key":"R4-20260818","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4103\/ijmr.IJMR_516_15","article-title":"Incidence & prevalence of stroke in India: A systematic review","volume":"146","author":"Kamalakannan","year":"2017","journal-title":"Indian J Med Res"},{"key":"R5-20260818","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-024-72551-4","article-title":"Analyzing stroke burden and risk factors in India using data from the Global Burden of Disease Study","volume":"14","author":"Behera","year":"2024","journal-title":"Sci Rep"},{"key":"R6-20260818","first-page":"61","article-title":"Epidemiological profile of stroke in central Kerala","volume":"8","author":"Somasundaran","year":"2020","journal-title":"Int J Sci Stud"},{"key":"R7-20260818","doi-asserted-by":"crossref","first-page":"e061258","DOI":"10.1136\/bmjopen-2022-061258","article-title":"One-year mortality after acute stroke: A prospective cohort study from a comprehensive stroke care centre, Kerala, India","volume":"12","author":"Nambiar","year":"2022","journal-title":"BMJ Open"},{"key":"R8-20260818","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930211027834","article-title":"Stroke in India: A systematic review of the incidence, prevalence, and case fatality","volume":"17","author":"Jones","year":"2022","journal-title":"Int J Stroke"},{"key":"R9-20260818","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1055\/s-0041-1735822","article-title":"Awareness, recognition, and response to stroke among the general public-An observational study","volume":"12","author":"Sirisha","year":"2021","journal-title":"J Neurosci Rural Pract"},{"key":"R10-20260818","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1161\/01.STR.0000154876.08468.a0","article-title":"Public awareness of warning symptoms, risk factors, and treatment of stroke in Northwest India","volume":"36","author":"Pandian","year":"2005","journal-title":"Stroke"},{"key":"R11-20260818","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jocn.2005.12.049","article-title":"Awareness of warning symptoms and risk factors of stroke in the general population and in survivors","volume":"14","author":"Das","year":"2007","journal-title":"J Clin Neurosci"},{"key":"R12-20260818","doi-asserted-by":"crossref","first-page":"488","DOI":"10.4103\/0972-2327.120431","article-title":"Knowledge, attitude, and practice of stroke in India versus other developed and developing countries","volume":"16","author":"Das","year":"2013","journal-title":"Ann Indian Acad Neurol"},{"key":"R13-20260818","doi-asserted-by":"crossref","first-page":"735","DOI":"10.25259\/JNRP_222_2023","article-title":"Stroke awareness among community health workers from rural health blocks of Thiruvananthapuram, India","volume":"14","author":"Renjith","year":"2023","journal-title":"J Neurosci Rural Pract"},{"key":"R14-20260818","first-page":"878","article-title":"Study on the public awareness of stroke risk factors, symptoms, treatment, and rehabilitation: A community-based cross-sectional survey from a tertiary referral centre in South India","volume":"2","author":"Balasundaram","year":"2024","journal-title":"Natl Board Exam J Med Sci"},{"key":"R15-20260818","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1161\/STROKEAHA.108.531293","article-title":"Incidence, types, risk factors, and outcome of stroke in a developing country: The Trivandrum stroke registry","volume":"40","author":"Sridharan","year":"2009","journal-title":"Stroke"},{"key":"R16-20260818","doi-asserted-by":"crossref","first-page":"e51178","DOI":"10.2196\/51178","article-title":"Effectiveness of a health education program for patients who had a stroke and their caregivers by controlling modifiable risk factors to reduce stroke recurrence in a tertiary hospital in Bangladesh: Protocol for a randomized controlled trial","volume":"12","author":"Afrin","year":"2023","journal-title":"JMIR Res Protoc"},{"key":"R17-20260818","doi-asserted-by":"crossref","first-page":"1593802","DOI":"10.3389\/fpubh.2025.1593802","article-title":"Patients\u2019 knowledge, attitude, and practice toward stroke rehabilitation: A web-based cross-sectional study","volume":"13","author":"Qian","year":"2025","journal-title":"Front Public Health"},{"key":"R19-20260818","first-page":"9","article-title":"Public awareness of stroke recognition, risk factors and access to appropriate treatment: A hospital-based cross-sectional survey from a tertiary referral centre in Southern India","volume":"16","author":"Deepthi","year":"2022","journal-title":"J Clin Diagn Res"},{"key":"R20-20260818","first-page":"98","article-title":"A simplified general method for cluster-sample surveys of health in developing countries","volume":"44","author":"Bennett","year":"1991","journal-title":"World Health Stat Q"},{"key":"R22-20260818","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1080\/01621459.1949.10483314","article-title":"A procedure for objective respondents selection within the household","volume":"44","author":"Kish","year":"1949","journal-title":"J Am Stat Assoc"},{"key":"R23-20260818","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1310\/RED5-V47T-8MJN-JY9H","article-title":"Development and validation of the stroke knowledge test","volume":"11","author":"Sullivan","year":"2004","journal-title":"Top Stroke Rehabil"},{"key":"R24-20260818","doi-asserted-by":"crossref","first-page":"221","DOI":"10.4103\/0972-2327.176857","article-title":"Knowledge, attitude, and practice in relation to stroke: A community-based study from Kolkata, West Bengal, India","volume":"19","author":"Das","year":"2016","journal-title":"Ann Indian Acad Neurol"},{"key":"R25-20260818","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"JAMA"},{"key":"R26-20260818","doi-asserted-by":"crossref","first-page":"1658947","DOI":"10.3389\/fpubh.2026.1658947","article-title":"Stroke awareness and response among university students in five Middle Eastern and North African countries: A multicenter cross-sectional study","volume":"14","author":"Alnajjar","year":"2026","journal-title":"Front Public Health"},{"key":"R27-20260818","doi-asserted-by":"crossref","first-page":"1758191","DOI":"10.3389\/fmed.2026.1758191","article-title":"Knowledge, practice, and awareness of stroke warning signs and potential risk factors among future rehabilitation specialists in Saudi Arabia","volume":"13","author":"Albishi","year":"2026","journal-title":"Front Med (Lausanne)"},{"key":"R28-20260818","doi-asserted-by":"crossref","first-page":"100134","DOI":"10.1016\/j.ssmhs.2025.100134","article-title":"Performance and challenges of Accredited Social Health Activists (ASHAs) in delivering key maternal and newborn health (MNH) services in India: A systematic review and meta-analyses","volume":"5","author":"Chawla","year":"2025","journal-title":"SSM Health Syst"},{"key":"R29-20260818","doi-asserted-by":"crossref","first-page":"e0004860","DOI":"10.1371\/journal.pgph.0004860","article-title":"Implementing community-based interventions for the management of chronic conditions in low- and middle-income countries: A scoping review of qualitative evidence","volume":"5","author":"Hassan","year":"2025","journal-title":"PLoS Glob Public Health"},{"key":"R31-20260818","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1186\/s12913-025-13441-x","article-title":"Health-seeking behavior and healthcare utilization among patients with non-communicable diseases in India: Insights from a systematic review","volume":"25","author":"Siva","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"R32-20260818","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1186\/s12982-025-01252-8","article-title":"Electronic health literacy, associated factors, and its correlation with non-communicable disease risk factors in Kerala, India: A cross-sectional study","volume":"22","author":"Surendran","year":"2025","journal-title":"Discov Public Health"},{"key":"R33-20260818","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1186\/s12939-024-02231-2","article-title":"Kerala\u2019s progress towards universal health coverage: The road travelled and beyond","volume":"23","author":"Adithyan","year":"2024","journal-title":"Int J Equity Health"}],"container-title":["Annals of Indian Academy of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_1243_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:04:44Z","timestamp":1787843084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_1243_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aian.aian_1243_25","relation":{},"ISSN":["0972-2327","1998-3549"],"issn-type":[{"value":"0972-2327","type":"print"},{"value":"1998-3549","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"assertion":[{"value":"2025-11-26","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}