Comparison of knowledge, attitude and practice on stroke knowledge in Malaysia and other nations: A review of literature

Background: There is an increasing trend of stroke occurrence among Malaysian populations recently. Thus, there is a need for further early management and secondary prevention of stroke. Objectives: To provide an overview on knowledge, attitude and practice (KAP) had been carried out among stroke patients and general population. Data sources: Published survey studies on KAP had been carried out among stroke patients general population in Malaysia and globally. Review methods: Searches were conducted in two data-bases (ProQuest, EBSCOhost). Reviews were included, if these were based on a survey study that measures KAP between 2005 and 2015. The authors had focused the survey study design, population and sampling method highlighting the tools and interview strategy used in order to obtain the information on KAP. The scope of interest were perceptions towards stroke, knowledge on risk factors, signs and symptoms of stroke and its association with socio-demography background of the participants. Results: A total of 22 articles were reviewed included, but none of them from Malaysia studies. However, only 14 were reviewed systematically on the basis of its completeness for quantitative synthesis. In this article, we had reviewed the existing literatures on the scope mentioned earlier and compared it with those of developed countries. Findings highlighted the level of stroke knowledge on risk factors as well as signs and symptoms were range from moderate to poor. This knowledge level was found to be associated with age, gender, education level and income status. Conclusion: Study on KAP is crucial in order to increase the awareness about stroke disease on the risk factors management, administration of appropriate treatment as well as further secondary prevention. This findings may be adopted in Malaysia to improve awareness and knowledge specifically for the stroke patients and their family members and among the public generally

Translation and validation of the Malay version of the Stroke Knowledge Test

Background: To date, there is a lack of published studies on assessment tools to evaluate the effectiveness of stroke education programs. Methods: This study developed and validated the Malay language version of the Stroke Knowledge Test research instrument. This study involved translation, validity, and reliability phases. The instrument underwent backward and forward translation of the English version into the Malay language. Nine experts reviewed the content for consistency, clarity, difficulty, and suitability for inclusion. Perceived usefulness and utilization were obtained from experts’ opinions. Later, face validity assessment was conducted with 10 stroke patients to determine appropriateness of sentences and grammar used. A pilot study was conducted with 41 stroke patients to determine the item analysis and reliability of the translated instrument using the Kuder Richardson 20 or Cronbach’s alpha. Results: The final Malay version Stroke Knowledge Test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Psychometric investigations suggest that Malay version Stroke Knowledge Test had moderate reliability with Kuder Richardson 20 or Cronbach’s alpha of 0.58. Improvement is required for Stroke Knowledge Test items with unacceptable difficulty indices. Overall, the average rating of perceived usefulness and perceived utility of the instruments were both 72.7%, suggesting that reviewers were likely to use the instruments in their facilities. Conclusions: Malay version Stroke Knowledge Test was a valid and reliable tool to assess educational needs and to evaluate stroke knowledge among participants of group-based stroke education programs in Malaysi

Malay version Stroke Knowledge Test

Malay version Stroke Knowledge Test is originally developed by Sullivan and Dunton (2004) as reported in their article "Development and validation of the Stroke Knowledge Test. Topics in Stroke Rehabilitation, 11(3), 19-28." Permission was granted from the original author by Siti Noorkhairina et. al. (2019) during her Ph.D study in Universiti Sains Malaysia, Kubang Kerian to translate the original English version into Malay language version. The translated Malay version is named Ujian Pengetahuan Stroke and was utilized among the stroke patients to measure their knowledge level on stroke disease

Test-retest reliability of Malay version of stroke knowledge test

Objective: This study was aimed to evaluate the stability and reliability of the Malay version of the Stroke Knowledge Test among kidney disease patients at the Hemodialysis Unit and Nephrology Clinic of Hospital Tengku Ampuan Afzan, Kuantan. Methods: A cross-sectional study was conducted on 30 conveniently selected kidney disease patients between April and May 2017. The questionnaires consisted of three parts: sociodemographic background, clinical, and lifestyle-related risk factors; the Malay version of the Stroke Knowledge Test were administered on the patients in a pre-test/post-test manner with a gap of two weeks. Results: The Malay version of the Stroke Knowledge Test had a fair pre-test/post-test agreement (ICC=0.247) when administered on the kidney disease patients to measure their knowledge of stroke. The items were considered to have acceptable difficulty and discrimination indexes. They were also reliable as all aspects of stroke were covered. Conclusions: The Malay version of the Stroke Knowledge Test had a fair pre-test/ post-test agreement when conducted on the kidney disease patients to check its stability and reliability. The results reflected a mixture of easy and moderate content, as well as acceptable modifications of the items. Hence, as per previous researches, this instrument was considered to be a reliable tool for evaluating the knowledge of stroke outcomes in kidne

36-month clinical outcomes of patients with venous thromboembolism: GARFIELD-VTE

Background: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality worldwide.Methods: GARFIELD-VTE is a prospective, non-interventional observational study of real-world treatment practices. We aimed to capture the 36-month clinical outcomes of 10,679 patients with objectively confirmed VTE enrolled between May 2014 and January 2017 from 415 sites in 28 countries.Findings: A total of 6582 (61.6 %) patients had DVT alone, 4097 (38.4 %) had PE +/- DVT. At baseline, 98.1 % of patients received anticoagulation (AC) with or without other modalities of therapy. The proportion of patients on AC therapy decreased over time: 87.6 % at 3 months, 73.0 % at 6 months, 54.2 % at 12 months and 42.0 % at 36 months. At 12-months follow-up, the incidences (95 % confidence interval [CI]) of all-cause mortality, recurrent VTE and major bleeding were 6.5 (7.0-8.1), 5.4 (4.9-5.9) and 2.7 (2.4-3.0) per 100 person-years, respectively. At 36-months, these decreased to 4.4 (4.2-4.7), 3.5 (3.2-2.7) and 1.4 (1.3-1.6) per 100 person-years, respectively. Over 36-months, the rate of all-cause mortality and major bleeds were highest in patients treated with parenteral therapy (PAR) versus oral anti-coagulants (OAC) and no OAC, and the rate of recurrent VTE was highest in patients on no OAC versus those on PAR and OAC. The most frequent cause of death after 36-month follow-up was cancer (n = 565, 48.6 %), followed by cardiac (n = 94, 8.1 %), and VTE (n = 38, 3.2 %). Most recurrent VTE events were DVT alone (n = 564, 63.3 %), with the remainder PE, (n = 236, 27.3 %), or PE in combination with DVT (n = 63, 7.3 %).Interpretation: GARFIELD-VTE provides a global perspective of anticoagulation patterns and highlights the accumulation of events within the first 12 months after diagnosis. These findings may help identify treatment gaps for subsequent interventions to improve patient outcomes in this patient population