Stroke literacy in a sample of Italian adults: an iceberg model revealing domain-specific gaps beyond apparent emergency awareness.
Neurological sciences · 2026-06-05 · Observational study
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.