Awareness of Stroke Risk Factors, Signs, and Symptoms Among Bahraini Adults Without Healthcare Training: A...

Background Stroke is a leading cause of death and long-term disability worldwide, with incidence in Bahrain nearly doubling over the past 16 years. Early recognition of stroke risk factors and symptoms is critical for prevention and timely treatment. However, public awareness, particularly among individuals without a medical background, remains insufficiently studied in the Bahraini population. Objective This cross-sectional survey aimed to assess item-level recognition of selected stroke risk factors, warning signs, and symptoms among a convenience and snowball sample of adult residents of Bahrain without healthcare training. A secondary objective was to explore associations between educational attainment and correct recognition of individual questionnaire items. Methods A cross-sectional survey was conducted using an online questionnaire distributed through convenience and snowball sampling across Bahrain, yielding 1,564 responses. The questionnaire included demographic data, degree of knowledge of stroke risk factors, recognition of signs and symptoms, and degree of knowledge of actions to take when witnessing a stroke. Descriptive statistics were calculated for overall awareness, while Pearson's chi-square and Cramér's V tests assessed associations between education level and awareness. Results Smoking was the most widely recognized risk factor (91.3%), while inflammatory conditions (29.9%) and newborn age (30.5%) were the least recognized. Awareness of hypertension (76.6%), diabetes (63.1%), and atrial fibrillation (46.0%) demonstrated strong associations with education level (Cramér's V = 0.350-0.549). Symptom recognition was highest for facial numbness (87.7%), whereas coordination issues (40.5%) and dizziness (45.7%) were poorly identified. Education significantly influenced awareness of most symptoms, with very strong associations for speaking difficulty (Cramér's V = 0.497) and sudden confusion (Cramér's V = 0.445). However, recognition of headache as a symptom of stroke decreased with higher education levels, suggesting misconceptions among more educated groups. Conclusion In this convenience and snowball sample of adults in Bahrain without healthcare training, awareness of stroke risk factors and symptoms varied substantially across educational levels, with notable gaps in recognition of several important risk factors and warning signs. Higher educational attainment was associated with greater awareness for most items; however, the cross-sectional design and unadjusted analyses preclude causal inference. These findings should be interpreted in light of potential recruitment bias and the use of a non-validated questionnaire, and they require confirmation in representative population-based surveys before informing national public health strategies.