Stroke knowledge and intended care-seeking behavior among adults with hypertension and type 2 diabetes: A cross-sectional study
7 affiliations
- 1Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, United States of America
- 2Grupo de Investigación de Neuroepidemiología, Subred Integrada de Servicios de Salud del Norte E.S.E., Bogotá, Colombia
- 3Department of Neurology, Hospital Simón Bolívar, Subred Integrada de Servicios de Salud del Norte E.S.E, Bogotá, Colombia
- 4Department of Neurology, McGovern Medical School, UTHealth Houston, McGovern Medical School, Houston, Texas, United States of America
- 5Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
- 6Departamento de Neurología, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- 7School of Medicine, Universidad de los Andes Bogotá, Bogotá, Colombia
Abstract
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.
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BibTeX
@article{alviz2026stroke,
title = {{Stroke knowledge and intended care-seeking behavior among adults with hypertension and type 2 diabetes: A cross-sectional study}},
author = {Luisa Fernanda Alviz and Juan Diego Oyola and Juan Diego Martinez-Lemus and Javier Alexander Perez-Lopez and Mariana Medina-Soler and Jaime Eduardo Rodriguez and John Benavides and Carlos Martinez and Claudio Jimenez},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0335001},
url = {https://doi.org/10.1371/journal.pone.0335001},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stroke knowledge and intended care-seeking behavior among adults with hypertension and type 2 diabetes: A cross-sectional study
AU - Luisa Fernanda Alviz
AU - Juan Diego Oyola
AU - Juan Diego Martinez-Lemus
AU - Javier Alexander Perez-Lopez
AU - Mariana Medina-Soler
AU - Jaime Eduardo Rodriguez
AU - John Benavides
AU - Carlos Martinez
AU - Claudio Jimenez
PY - 2026
DA - 2026/10/27
JO - PLOS One
DO - 10.1371/journal.pone.0335001
UR - https://doi.org/10.1371/journal.pone.0335001
AB - 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.
SN - 1932-6203
ER -