Prehospital
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Neurology

Stroke literacy in a sample of Italian adults: an iceberg model revealing domain-specific gaps beyond apparent emergency awareness.

Maria Rosaria Bagnato, Martina Gaia Di Donna, Francesca Bernocchi, Laura Borrello, Martina Bracaglia, Giovanni Di Mauro, Maria Rita Di Ruzza, Claudia Dionisi, Martina Fanella, Mario Ferrante and 4 more

Neurological Sciences · 2026-06-05 · Observational study

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Abstract

BACKGROUND AND AIMS: Despite public campaigns, pre-hospital delays in acute ischemic stroke remain substantial, with only modest improvement in onset-to-door times. METHODS: We ran a nationwide cross-sectional survey on ischemic stroke knowledge across four domains: conceptual knowledge, symptom recognition, awareness of time-dependent treatment, and intended emergency action (immediate EMS/112 call). A composite score (≥ 3 correct) was analysed using contingency tests and multivariable logistic regression. RESULTS: Among 1,769 participants, 71% were female, 60% university-educated, 35% were > 40 years, 9% worked in healthcare, and 47% reported a family history of stroke. Only 25% identified "cerebral stroke" and "cerebral ischemia" as synonyms, and 52% rated stroke as severe but ischemia as milder; accuracy was higher in healthcare workers (45% vs 23%, p < 0.001) and higher education (29% vs 22%, p = 0.002). One quarter failed to identify unilateral paralysis as the cardinal symptom, with lower recognition in those aged ≥ 41 years (70-73% vs ~ 77-79%, p = 0.019). Treatment awareness was high (84%) and associated with higher education/healthcare-related exposure (p = 0.007). Intended EMS/112 call was reported by 85% and associated with younger age (p = 0.004) and indirect stroke-care exposure (p = 0.001). Overall, 65% achieved a high composite score; healthcare employment independently predicted a high score (OR 2.02, 95% CI 1.28-3.19), whereas age and educational level were not independently associated. CONCLUSIONS: Findings support an iceberg model of stroke literacy, with surface awareness masking deeper, phase-specific gaps; education should target stroke severity misconceptions and symptom recognition, particularly in older adults.

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Bystanders · Equity & disparities

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