Dorien Brouwer

98 Chapter 2.1 PART 2 in public knowledge and behavior is possible [60] but difficult. [37, 60, 61] A study performed in the United States found that public knowledge of stroke risk factors did not substantially improve between 2000 and 2005 despite numerous national stroke public awareness campaigns. [62] An explanation for the failure of some public campaigns could be that they have neither been targeted to the proper audience nor tested for efficacy before widespread implementation. However, the mass-media campaign in the Netherlands, consisting of television and radio advertisements, combined with flyers distributed personally by volunteers at every household door, which started in 2005 with repeated advertisements till 2008, has improved knowledge about warning signs, i.e. the Face– Arm–Speech–Time test and care-seeking intention. [63] The number of respondents who could name at least one correct warning sign of stroke increased from 70% at baseline to 89% in 2008. Attitude and skills Studies indicated that recognition of stroke is not sufficient to prompt stroke victims in the general population to call the national emergency number. [51, 64] One study found [65] that people who knew that stroke was a serious and treatable disease, were about twice as likely to call the emergency number. Calling the national emergency number was not driven by knowledge of risk factors and warning signs. Previous studies found that delay in seeking medical attention after stroke onset is the most frequent reason for low rates of thrombolysis for acute ischemic stroke. [66] Health behavior and risk factor modification There are no studies available on the effect of HE on the public and the effect of risk factor modification concerning stroke. Health education in patients with CAD Coronary artery disease is a significant public health problem in the developed world with high case fatality. The CAD caused about one of every five deaths in the United States in 2005. [59, 67] The CAD and stroke share many aspects such as the need of risk factor management and lifestyle change, of acute treatment and of treatment with antiplatelets or other preventive treatment. Given these similarities, the state of the art of HE for cardiovascular patients is of great interest. Knowledge In contrast to studies in stroke, only a few studies assessed knowledge of disease, symptoms and risk factors in patients with an acute coronary syndrome. [68–70] All studies indicated low levels of knowledge of the participants. Short individual teaching by a nurse