Educational inequalities in stroke knowledge and symptom recognition following a national Danish stroke campaign: a cross-sectional study

INTRODUCTION: Public stroke campaigns may have informational gaps, which are essential to identify to improve outcomes in stroke awareness and response. We evaluated the impact of a national stroke campaign on knowledge of stroke, and symptom recognition, in relation to educational level.

METHODS: Six cross-sectional post-campaign surveys were conducted (2019-2022) using a Danish responder panel (n = 2000 first survey, n = 1000 each of the following) after the launch of a stroke awareness campaign. Using logistic regression analysis we tested associations between campaign recall and each of the three parameters: knowledge of stroke, symptom recognition, and knowledge of correct call-to-action. Analyses were stratified by educational level.

RESULTS: Of 7001 individuals (56.7% women) 44.8% recalled the campaign during the period, and knowledge of stroke, symptom recognition and correct call-to-action increased over time. Campaign recall was associated with increased knowledge of stroke (OR: 1.57, 95% CI: 1.42-1.74) and symptom recognition (OR: 2.11, 95% CI: 1.89-2.36). The stratified analyses showed that individuals with a master's degree had higher OR for symptom recognition (OR: 2.59 95% Cl: 1.95-3.44) compared to individuals with vocational education (OR 1.93, 95% Cl: 1.59-2.35).

CONCLUSIONS: Initiation of a national stroke campaign was associated with improved knowledge of stroke and symptom recognition. Among individuals with lower educational level the association between campaign recall and recognition of stroke symptoms appeared weaker. The impact of educational levels may be considered in the design of future stroke campaigns. Whether stroke recognition and knowledge of correct call-to-action translate into appropriate responses remains to be fully evaluated.