Responses of patients to the onset of stroke symptoms can determine whether the individuals live or die. Management of acute ischemic stroke is dependent on early referral for thrombolysis. Shah and coworkers explored motivational factors affecting stroke sufferers and bystanders and their cognitive and behavioral responses, especially those that would affect prompt management of stroke. They conducted a survey of patients admitted to a stroke unit in an area where thrombolysis for acute stroke had not yet been introduced. Outcome measures, such as knowledge of stroke, health beliefs, self-efficacy, and self-care responses, were recorded. Only 41% of the patients correctly assessed their symptoms to be stroke; 44% perceived their symptoms to be mild; and 59% would wait to see whether their symptoms would improve spontaneously. About 61% of the patients and 80% of the bystanders worried about troubling other people with their problem. The bystander was a relative in 68% of cases. Of the bystanders, 65% correctly assessed the symptoms as stroke; only 42% perceived the patient's symptoms as severe. About 25% of the bystanders took a passive approach and would wait and see whether symptoms improved spontaneously; 93% did not find it difficult to ask for assistance.

VALUE OF STUDY TO READER. The authors concluded that in order to promote early referral to a hospital, educational strategies must address the public's knowledge and information base, and seek to address the cognitive and behavioral processes involved so as to overcome barriers to action. These processes are the basic parts of the self-management of a stroke. As such, everyone need have some knowledge about the signs of a stroke and what actions to take. It is also important that patients not wait, but to be proactive in seeking treatment. The data also suggest that maybe the patient needs to be more proactive than those around him or her in seeking help.

M. Shah, K.A. Makinde, P. Thomas. Cognitive and behavioral aspects affecting early referral of acute stroke patients to hospital. Journal of Stroke & Cerebrovascular Diseases, 2007;16:71-76.