Stroke Knowledge and Educational Needs in Malta: A Mixed Methods Study

Stroke remains a leading cause of morbidity and mortality worldwide. Recent medical advances in the treatment of stroke have been the key to changing a preventable catastrophe to a potentially treatable disease. However, treatment is restricted to a time-window, which has led to the aphorism “Time is Brain”. Prompt presentation to emergency services has been extensively linked to patients’ knowledge about their symptomatology and recommended actions in stroke, which is subsequently influenced by more complex psychological ‘barriers’.
The aim of this study was to explore and quantify stroke knowledge in Malta and to identify any potential educational lacunae in this respect. The data generated may in turn be used to adapt local practices and improve patients’ long-term outcomes. This required an in-depth investigation of the stroke experience as recalled by affected patients, followed by the development of a quantitative tool which was later used to generalise the findings. For these purposes, a mixed methods approach was utilised.
The findings showed that stroke and response knowledge in Malta are severely lacking and reflect what has been reported in the literature. Several variables were found to affect this knowledge, including demographic factors as well as broader social and cultural influences. The interactions between these factors were deemed crucial to understanding the underlying problem and were explored with respect to Bronfenbrenner’s ecological framework as well as by adapting several health-promotion theories and models. Various stroke educational strategies and campaigns were also reviewed to assess how stroke education attempts could become more effective. Finally, several recommendations regarding the local management, education, and improvement of stroke services have been presented.