Stroke knowledge and intended care-seeking behavior among adults with hypertension and type 2 diabetes: A cross-sectional study

BACKGROUND: Stroke health literacy refers to the ability of non-medical individuals to recognize stroke symptoms and make timely decisions, which is critical for improving outcomes. However, data on stroke knowledge and intended care-seeking behavior in Bogotá, Colombia, remain limited. OBJECTIVE: To assess stroke symptom knowledge and intended care-seeking behavior among adults with hypertension and type 2 diabetes and to identify sociodemographic predictors of limited knowledge and suboptimal response. METHODS: A cross-sectional study was conducted between October 2023 and April 2024 in Bogotá, Colombia. A structured questionnaire was administered to 5,402 adults with hypertension and/or type 2 diabetes. Participants were recruited using a non-probabilistic sampling strategy, primarily from individuals under routine follow-up within the Bogotá public health network, and were identified through multiple recruitment strategies, including institutional databases. Surveys were conducted either by telephone or in person. Continuous variables were summarized using descriptive statistics, differences in categorical variables were assessed using chi-square tests, and binomial logistic regression models were applied to evaluate adjusted associations. RESULTS: Of 6,050 respondents, 5,402 met inclusion criteria (median age 67 years; 46.3% male). Although most participants recognized that ischemic stroke can cause disability (89.6%) and death (91.1%), 32.5% reported no knowledge of stroke symptoms. Limited symptom knowledge was independently associated with male sex (OR 1.26, 95% CI 1.12-1.42), low educational attainment (OR 1.59, 95% CI 1.38-1.82), and low socioeconomic status (OR 2.20, 95% CI 1.85-2.60). Regarding intended response, 26.6% would not activate emergency medical services, and 52% reported they would schedule an outpatient appointment instead. Lower educational attainment was associated with greater likelihood of reporting non-emergency responses (all p < 0.001). CONCLUSIONS: Despite high awareness that stroke can cause disability and death, substantial gaps in symptom recognition and intended response persist, particularly among socioeconomically disadvantaged individuals. These findings highlight the need for targeted strategies to improve stroke literacy in high-risk populations.