Factors Associated with Response to Stroke Symptoms among Family Members of Acute Ischemic Stroke Persons in Wenzhou, China
Abstract
Objective: To describe the status of response to stroke symptoms and to determine response to stroke symptoms and its relationships with stroke knowledge, perceived risk for stroke, and psychological distress among family members of acute ischemic stroke persons. Methods: This correlational research design, used a simple random sampling to recruit 126 participants. Research instruments consisted of 1) Demographic questionnaire of AIS patients and their family members, 2) The Stroke Pre-hospital Delay Behavior Intention Scale (SPDBI), 3) Stroke Knowledge Questionnaire (SKQ), 4) The Risk Perception Questionnaire for People at High Risk of Stroke (Susceptibility dimension), and 5) the Psychological Distress Scale (K10). The Cronbach’s αcoefficients for the scales were .852, .88, .816 and .895, respectively. Descriptive statistics and Pearson’s product-moment correlation were used for data analysis. Result: The mean score of response to stroke symptoms among the family members of AIS patients was 82.389 (SD = 14.829), it was between 66-96 score, indicating a moderate correct response to stroke symptoms. Pearson’s correlation analysis revealed that stroke knowledge (r = 0.569, p < 0.01), perceived risk for stroke (r = 0.389, p < 0.01) was significantly positively correlated with response to stroke symptoms, and psychological distress (r = - 0.193, p < 0.05) was significantly negatively correlated with response to stroke symptoms among the family members of AIS patients. Conclusion: The findings provide an evidence for nurses and nursing researchers to develop intervention programs to promote stroke knowledge, perceived risk for stroke, and healthier psychological state of the family members of AIS patients which can be encouraged family members to develop an effective response to stroke symptoms, ultimately leading to more effective care for the AIS patients.Downloads
References
Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: global stroke fact sheet 2025. Int J Stroke. 2025;20(2):132-144.
Hay SI, Ong KL, Santomauro DF, et al. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406(10513):1873-1922.
Naghavi M, Kyu HH, Aalipour MA, et al. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406(10513):1811-1872.
Palaniappan LP, Allen NB, Almarzooq ZI, et al. 2026 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2026.
Schumacher AE, Zheng P, Barber RM, et al. Global age-sex-specific all-cause mortality and life expectancy estimates for 204 countries and territories and 660 subnational locations, 1950-2023: a demographic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406(10513):1731-1810.
Li X, Jin T, Bai C, Wang X, Zhang H, Zhang T. Analysis of stroke burden in China from 1990 to 2021 and projections for the next decade. Neuroepidemiology. 2025;59(5):505-516.
Stroke Prevention Project, National Health Commission; Ji X. Brief report on stroke prevention and treatment in China, 2024. 2025;46(6).
Wang LD, Ji X, Kang DZ, et al. Brief report on stroke prevention and treatment in China, 2019-2020. Chin J Cerebrovasc Dis. 2022;19(2):136-144. doi:10.3969/j.issn.1672-5921.2022.02.011
National Health Commission of the People's Republic of China. China Health Statistics Yearbook 2023. Peking Union Medical College Press; 2023.
Zhai Y, Yu F, Li T, Xie Y, Liu G. An integrated analysis of disease burden and economic burden of stroke in China. Chin J Stroke. 2025;20(5):566-580. doi:10.3969/j.issn.1673-5765.2025.05.005
Walter K. What is acute ischemic stroke? JAMA. 2022;327(9):885. doi:10.1001/jama.2022.1420
Zhou F. Strengthen multimodal monitoring of risk factors for secondary brain damage. Chin J Neurotrauma Surg (Electronic Ed). 2021;7(3):129-131. doi:10.3877/cma.j.issn.2095-9141.2021.03.001
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731.
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11-21.
Thomalla G, Gerloff C. Acute imaging for evidence-based treatment of ischemic stroke. Curr Opin Neurol. 2019;32(4):521-529.
Wang W, Li M, Chen Q, Wang J. Hemorrhagic transformation after tissue plasminogen activator reperfusion therapy for ischemic stroke: mechanisms, models, and biomarkers. Mol Neurobiol. 2015;52:1572-1579.
Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379(9834):2364-2372.
Campbell BCV, Mitchell PJ, Churilov L, et al. Effect of intravenous tenecteplase dose on cerebral reperfusion before thrombectomy in patients with large vessel occlusion ischemic stroke: the EXTEND-IA TNK Part 2 randomized clinical trial. JAMA. 2020;323(13):1257-1265.
Lee EJ, Kim SJ, Bae J, et al. Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke. PLoS One. 2021;16(3):e0247829.
Menon BK, Buck BH, Singh N, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. Lancet. 2022;400(10347):161-169.
Powers WJ, Rabinstein AA, Ackerson T, et al. 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. Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.0000000000000211
Royan R, Stamm B, Lin T, et al. Disparities in emergency medical services use, prehospital notification, and symptom onset to arrival in patients with acute stroke. Circulation. 2024;150(18):1428-1440. doi:10.1161/CIRCULATIONAHA.124.070694
Wangqin R, Laskowitz DT, Wang Y, et al. International comparison of patient characteristics and quality of care for ischemic stroke: analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines-Stroke Program. J Am Heart Assoc. 2018;7(20):e010623.
Luo Z, Zhou Y, He Y, et al. Treatment with intravenous alteplase in ischaemic stroke patients with onset time between 4.5 and 24 hours (HOPE): protocol for a randomised, controlled, multicentre study. Stroke Vasc Neurol. 2024;9(3):318-323. doi:10.1136/svn-2022-002154
Srinivasa SK, Basavegowda M, Chakrashali SB, Manjunath SB, Manivasagan MS. Determinants of the time period from stroke onset to arrival at the emergency department: a GIS integrated hospital-based cross-sectional study. Sci Rep. 2025;15(1):12726. doi:10.1038/s41598-025-95371-6
Chen B, TA, Song Z, et al. Integrated emergency care scheme for stroke: application value analysis in pre-hospital emergency treatment of patients. Med Theory Pract. 2018;31(7):1054-1056. doi:10.19381/j.issn.1001-7585.2018.07.067
Peng X, WS, Xie H, et al. Pre-hospital emergency care pathway for stroke patients: the application of international emergency care concepts. Int J Med Health. 2018;24(24):3883-3885. doi:10.3760/cma.j.issn.1007-1245.2018.24.053
Zhao Q, Zhang X, Zuo Q, et al. Symptoms of pre-hospital stroke among community residents: analysis of the current situation and influencing factors of processing knowledge mastery. China Nurs Manag. 2015;15(7):865-869. doi:10.3969/j.issn.1672-1756.2015.07.027
Hordijk PM, Broekhuizen BDL, Butler CC, et al. Illness perception and related behaviour in lower respiratory tract infections: a European study. Fam Pract. 2015;32(2):152-158.
Khoury NM, Marvar PJ, Gillespie CF, et al. The renin-angiotensin pathway in posttraumatic stress disorder: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are associated with fewer traumatic stress symptoms. J Clin Psychiatry. 2012;73(6):e17451.
Lan M, Zhang L, Zhang Y, Yan J. The relationship among illness perception, coping and functional exercise adherence in Chinese breast cancer survivors. J Adv Nurs. 2019;75(1):75-84.
Fladt J, Meier N, Thilemann S, et al. Reasons for prehospital delay in acute ischemic stroke. J Am Heart Assoc. 2019;8(20):e013101.
García Ruiz R, Silva Fernández J, García Ruiz RM, et al. Factors related to immediate response to symptoms in patients with stroke or transient ischaemic attack. Neurologia (Engl Ed). 2020;35(8):551-555.
Luan S, Yang Y, Huang Y, McDowell M. Public knowledge of stroke and heart attack symptoms in China: a cross-sectional survey. BMJ Open. 2021;11(1):e043220. doi:10.1136/bmjopen-2020-043220
Li S, Cui LY, Anderson C, et al. Public awareness of stroke and the appropriate responses in China: a cross-sectional community-based study (FAST-RIGHT). Stroke. 2019;50(2):455-462.
Leventhal H, Phillips LA, Burns E. Modelling management of chronic illness in everyday life: a common-sense approach. Psychol Top. 2016;25(1):1-18.
Brooke J. Exploration of illness representation dimensions and coping strategies in the acute phase of stroke. Presented at: European Congress of Neurorehabilitation; 2015.
Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev. 2021;11(11):CD001919. doi:10.1002/14651858.CD001919.pub4
Della Vecchia C, Préau M, Carpentier C, Viprey M, Haesebaert J, et al. Illness beliefs and emotional responses in mildly disabled stroke survivors: a qualitative study. PLoS One. 2019;14(10):e0223681. doi:10.1371/journal.pone.0223681
Murtagh MJ, Burges Watson DL, Jenkings KN, Lie MLS, Mackintosh JE, et al. Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. PLoS One. 2012;7(6):e37066. doi:10.1371/journal.pone.0037066
Das K, Mondal GP, Dutta AK, Mukherjee B, Mukherjee BB. Awareness of warning symptoms and risk factors of stroke in the general population and in survivors stroke. J Clin Neurosci. 2007;14(1):12-16.
Hickey A, Holly D, McGee H, Conroy R, Shelley E. Knowledge of stroke risk factors and warning signs in Ireland: development and application of the Stroke Awareness Questionnaire (SAQ). Int J Stroke. 2012;7(4):298-306. doi:10.1111/j.1747-4949.2011.00698.x
Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL. Stroke knowledge and awareness: an integrative review of the evidence. Age Ageing. 2010;39(1):11-22.
Faiz KW, Sundseth A, Thommessen B, Rønning OM. Patient knowledge on stroke risk factors, symptoms and treatment options. Vasc Health Risk Manag. 2018;14:37-40.
Sirisha S, Jala S, Vooturi S, Yada PK, Kaul S. Awareness, recognition, and response to stroke among the general public: an observational study. J Neurosci Rural Pract. 2021;12(4):704-710.
Willey JZ, Williams O, Boden-Albala B. Stroke literacy in Central Harlem: a high-risk stroke population. Neurology. 2009;73(23):1950-1956.
Soares JM, Sampaio A, Ferreira LM, Santos N, Marques F, Palha JA, et al. Stress-induced changes in human decision-making are reversible. Transl Psychiatry. 2012;2(7):e131.
Dhand A, Luke D, Lang C, Tsiaklides M, Feske S, Lee JM. Social networks and risk of delayed hospital arrival after acute stroke. Nat Commun. 2019;10(1):1206.
Mellon L, Doyle F, Williams D, Brewer L, Hall P, Hickey A. Patient behaviour at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms. Emerg Med J. 2016;33(6):396-402.
Zhao Q, Yang L, Zuo Q, et al. Instrument development and validation of the stroke pre-hospital delay behavior intention scale in a Chinese urban population. Health Qual Life Outcomes. 2014;12:1-9.
Wan L, Zhang X, Hong H. Study on health behaviors of cerebral apoplexy patients and its influencing factors. Chin Nurs Res. 2010;24(1):1-4.
Zhou, et al. The relationship between perceived risk and objective risk of stroke and nursing strategies. Chin J Nurs. 2025;60(7):779-785. doi:CNKI:SUN:ZHHL.0.2025-07-002
Zhou C, Chen J, Tian W. Reliability and validity of 10-item Kessler Scale (K10) Chinese version in evaluation of mental health status of Chinese population. Chin J Clin Psychol. 2008;16(6):627-629.
Lim SH, Tan TL, Ngo PW, Lee LY, Ting SY, Tan HJ. Factors related to prehospital delay and decision delay among acute stroke patients in a district hospital, Malaysia. Med J Malaysia. 2023;78(2):241-249.
Sheng Z, Kuang J, Yang L, et al. Predictive models for delay in medical decision-making among older patients with acute ischemic stroke: a comparative study using logistic regression analysis and LightGBM algorithm. BMC Public Health. 2024;24(1):1413. doi:10.1186/s12889-024-18855-6
Zhang B, Sun Q, Lv Y, Sun T, Zhao W, Yan R, et al. Influencing factors for decision-making delay in seeking medical care among acute ischemic stroke patients in rural areas. Patient Educ Couns. 2023;108:107614. doi:10.1016/j.pec.2022.107614
Potisopha W, Vuckovic KM, DeVon HA, Park CG, Phutthikhamin N, Hershberger PE. Decision delay is a significant contributor to prehospital delay for stroke symptoms. West J Nurs Res. 2023;45(1):55-66. doi:10.1177/01939459221105827
García Ruiz R, Silva Fernández J, García Ruiz RM, et al. Response to symptoms and prehospital delay in stroke patients: is it time to reconsider stroke awareness campaigns? J Stroke Cerebrovasc Dis. 2018;27(3):625-632. doi:10.1016/j.jstrokecerebrovasdis.2017.09.036
Živanović S. Pre-hospital delay in patients with signs of acute stroke. Opšta Medicina. 2021;27:53-60. doi:10.5937/opmed27-33882
Liu D, Fang Y, Yin Z, Zhu Q, Li C. Status and influencing factors of pre-hospital delay in young and middle-aged Chinese patients with acute ischemic stroke. Front Public Health. 2025;13:1539219. doi:10.3389/fpubh.2025.1539219
Sasahara Y, Gon Y, Hida E. Association between acute care accessibility and in-hospital mortality among patients with acute ischemic stroke. JMA J. 2025;8(2):417-429. doi:10.31662/jmaj.2024-0249
Hov MS. Treatment for acute stroke—still best in urban areas. Tidsskr Nor Laegeforen. 2024. doi:10.4045/tidsskr.24.0624
Tarantini L, Merzou F, Luley M, et al. Perceived performance of activities of daily living by stroke patients: key in decision to call EMS and outcomes. Front Neurol. 2023;14:1241391. doi:10.3389/fneur.2023.1241391
He C, Zhang Y, Tang M, et al. Analysis of barriers associated with emergency medical service activation in patients with acute stroke and acute myocardial infarction from Zhongjiang County of Sichuan Province in China. BMC Emerg Med. 2024;24(1):113. doi:10.1186/s12873-024-01035-5
Wang R, Wang Z, Yang D, et al. Early hospital arrival after acute ischemic stroke is associated with family members' knowledge about stroke. Front Neurol. 2021;12:652321. doi:10.3389/fneur.2021.652321
Chunli H, Xu L, Q H, et al. Qualitative study on emergency rescue ability for acute onset of stroke patients' family members. Occup Health Emerg Rescue. 2022;40(1). doi:10.16369/j.oher.issn.1007-1326.2022.01.021
Aycock DM, Clark PC, Araya S. Measurement and outcomes of the perceived risk of stroke: a review. West J Nurs Res. 2019;41(1):134-154.
Chen C, Liu Y, Sun W, Xu J. Analysis of influencing factors of delay in seeking medical attention before hospital in middle-aged and elderly patients with acute ischemic stroke. J Bengbu Med Univ. 2024;49(12):1665-1669. doi:10.13898/j.cnki.issn.1000-2200.2024.12.025
National Science Foundation. Failure to understand risks may lead to dangerous delay in seeking medical care. Published 2017. Accessed June 22, 2026. https://new.demo.nsf.gov/news/failure-understand-risks-may-lead-dangerous-delay
Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies. Psychol Bull. 2014;140(2):511-543. doi:10.1037/a0033065
Köther AK, Alpers GW, Büdenbender B, Lenhart M, Michel MS, Kriegmair MC. Predicting decisional conflict: anxiety and depression in shared decision making. Patient Educ Couns. 2021;104(5):1229-1236. doi:10.1016/j.pec.2020.10.037
Cameron JI, O'Connell C, Foley N, et al. Canadian Stroke Best Practice Recommendations: managing transitions of care following stroke, guidelines update 2016. Int J Stroke. 2016;11(7):807-822. doi:10.1177/1747493016660102
McCurley JL, Funes CJ, Zale EL, et al. Preventing chronic emotional distress in stroke survivors and their informal caregivers. Neurocrit Care. 2019;30(3):581-589. doi:10.1007/s12028-018-0641-6
Guo Y, Cao X, Fan W, et al. Decisional conflict of proxies in the thrombolysis decision-making process for acute ischaemic stroke patients. Int J Nurs Pract. 2025;31(5):e70054. doi:10.1111/ijn.70054
Yang C, Ma K, Guo L, et al. The relationship between state anxiety of surrogate decision-makers and decision-making duration in acute ischemic stroke thrombolysis. Sci Rep. 2025;15(1):13363. doi:10.1038/s41598-025-95937-4
Morgenstern LB, Becker CJ, Lank R, et al. Long-term psychological distress among surrogate decision makers for Mexican American and non-Hispanic White patients with severe stroke. Neurology. 2024;102(2):e207960. doi:10.1212/WNL.0000000000207960
Downloads
Published
Issue
Section
License
ลิขสิทธิ์ (Copyright)
ต้นฉบับที่ได้รับการตีพิมพ์ในวารสารนี้ถือเป็นสิทธิ์ของไทยเภสัชศาสตร์และวิทยาการสุขภาพ การนำข้อความใด ๆ ซึ่งเป็นส่วนหนึ่งหรือทั้งหมดของต้นฉบับไปตีพิมพ์ใหม่จะต้องได้รับอนุญาตจากเจ้าของต้นฉบับและวารสารก่อน
ความรับผิดชอบ (Responsibility)
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความเป็นความรับผิดชอบของผู้นิพนธ์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากเทคนิคการพิมพ์