Knowledge, Attitudes, and Practices Among Middle-Aged and Elderly Population Towards Ultrasound Screening for Strokes

Figures & data

Table 1 Sociodemographic Characteristics and KAP Scores

	N	%	Knowledge		Attitudes		Practices
			Mean ± SD	P	Mean ± SD	P	Mean ± SD	P
Total	552		5.53 ± 2.558		40.22 ± 5.604		38.30 ± 7.377
Gender				0.575		0.291		0.422
Male	208	37.68	5.61 ± 2.405		40.54 ± 5.630		38.63 ± 7.077
Female	344	62.32	5.48 ± 2.648		40.02 ± 5.587		38.10 ± 7.556
Age (years)				0.286		0.239		0.893
45–59	401	72.64	5.60 ± 2.531		40.39 ± 5.480		38.33 ± 7.317
≥ 60	151	27.36	5.34 ± 2.628		39.76 ± 5.916		38.23 ± 7.559
Residency				0.177		0.511		0.302
Rural	306	55.43	5.40 ± 2.556		40.08 ± 5.663		38.59 ± 7.309
Urban	246	44.57	5.69 ± 2.556		40.39 ± 5.536		37.94 ± 7.460
Marital status				0.012		0.064		0.085
Married	497	90.04	5.62 ± 2.538		40.37 ± 5.519		38.48 ± 7.137
Unmarried	55	9.96	4.71 ± 2.615		38.89 ± 6.220		36.67 ± 9.185
Education				0.472		0.108		0.197
Middle school and lower	165	29.89	5.53 ± 2.441		40.05 ± 5.582		37.56 ± 7.628
High school or secondary school	148	26.81	5.32 ± 2.668		39.55 ± 5.626		38.18 ± 7.241
Junior college, college, and above	239	43.30	5.65 ± 2.570		40.75 ± 5.577		38.89 ± 7.264
Monthly income per capita, CNY				0.170		0.083		0.036
< 2000	74	13.41	4.99 ± 2.697		38.69 ± 6.088		36.12 ± 8.304
2000–5000	211	38.22	5.66 ± 2.522		40.43 ± 5.500		38.93 ± 6.932
5000–10000	169	30.62	5.45 ± 2.573		40.34 ± 5.279		38.17 ± 7.100
> 10,000	98	17.75	5.79 ± 2.476		40.71 ± 5.882		38.82 ± 7.817
Health insurance				0.005		0.131		0.375
No	8	1.45	3.00 ± 2.828		37.25 ± 7.440		36.00 ± 10.637
Yes	544	98.55	5.56 ± 2.538		40.26 ± 5.570		38.33 ± 7.327
Smoking or passive smoking				0.098		0.005		0.814
No	209	37.86	5.30 ± 2.853		39.37 ± 6.106		38.21 ± 7.750
Yes	343	62.14	5.67 ± 2.353		40.74 ± 5.216		38.36 ± 7.151
Alcohol consumption				0.268		0.648		0.515
No	367	66.49	5.44 ± 2.708		40.14 ± 5.802		38.16 ± 7.824
Yes	185	33.51	5.70 ± 2.228		40.37 ± 5.202		38.59 ± 6.409
Preference for salty foods				0.418		0.317		0.444
No	249	45.11	5.43 ± 2.802		39.96 ± 5.794		38.57 ± 7.503
Yes	303	54.89	5.61 ± 2.340		40.44 ± 5.443		38.08 ± 7.277
Preference for fried or fatty foods				0.582		0.406		0.684
No	295	53.44	5.47 ± 2.682		40.03 ± 6.106		38.42 ± 7.975
Yes	257	46.56	5.59 ± 2.411		40.43 ± 4.970		38.16 ± 6.638
Frequency of physical exercise				0.384		0.111		< 0.001
Once daily	110	19.93	5.27 ± 2.736		39.62 ± 6.582		40.12 ± 8.181
3–6 times per week	93	16.85	5.33 ± 2.651		39.56 ± 5.474		38.59 ± 6.878
1–2 times per week	164	29.71	5.76 ± 2.370		41.03 ± 5.198		39.09 ± 6.635
0 times per week	185	33.51	5.57 ± 2.562		40.19 ± 5.333		36.38 ± 7.374
Number of stroke-related comorbidities				0.385		0.800		0.750
0	259	46.92	5.38 ± 2.699		40.15 ± 5.498		38.55 ± 8.229
1 or 2	234	42.39	5.61 ± 2.513		40.18 ± 5.955		38.06 ± 6.612
≥ 3	59	10.69	5.83 ± 2.044		40.68 ± 4.603		38.17 ± 6.292

Table 2 Knowledge

	Correctness Rate
	n	%
K1: The symptoms of a stroke.	169	30.62
K2: The risk factors for stroke.	33	5.98
K3: The emergency measures in the event of a stroke.	69	12.50
K4: Strokes are commonly treated with thrombectomy or thrombolysis.	330	59.78
K5: The optimal timing for administering thrombolysis after a stroke.	428	77.54
K6: The rehabilitation programs for stroke victims include training in limb function, language skills, cognitive functions, and psychological recovery.	440	79.71
K7: It is safe and repeatable to use ultrasound for stroke screening.	398	72.10
K8: The ultrasound screening method uses echo reflection imaging of ultrasound in human tissues.	410	74.28
K9: Ultrasound screening helps prevent and treat stroke, reducing its morbidity and mortality.	395	71.56
K10: Carotid artery ultrasound and transcranial color Doppler ultrasound are commonly used ultrasound screening methods.	379	68.66

Table 3 Attitudes

	Strongly Disagree N(%)		Somewhat Disagree N(%)		Neutral N(%)		Somewhat Agree N(%)		Strongly Agree N(%)
A1. You bear the responsibility of self-initiated stroke prevention.	9	1.63	6	1.09	54	9.78	182	32.97	301	54.53
A2. You have the willingness to acquire knowledge about stroke ultrasound screening through online resources, television, and literature.	10	1.81	13	2.36	77	13.95	254	46.01	198	35.87
A3. You are interested in engaging in the hospital’s ultrasound education program.	5	0.91	17	3.08	83	15.04	244	44.20	203	36.78
A4. You intend to discuss ultrasound screening for stroke with your medical practitioner.	4	0.72	9	1.63	82	14.86	249	45.11	208	37.68
A5. Disseminating information about stroke and ultrasound screening through public media and the community holds significance.	3	0.54	8	1.45	72	13.04	233	42.21	236	42.75
A6. Ultrasound screening plays a crucial role in stroke prevention and treatment.	4	0.72	11	1.99	79	14.31	241	43.66	217	39.31
A7. Ultrasound screening is harmful.	117	21.20	103	18.66	189	34.24	119	21.56	24	4.35
A8. Regular performance of ultrasound screenings is recommended.	4	0.72	10	1.81	98	17.75	239	43.30	201	36.41
A9. You aim to promote the adoption of routine ultrasound screenings among others for the purpose of stroke prevention.	0	0.00	14	2.54	125	22.64	234	42.39	179	32.43
A10. You aspire to contribute to establishing health records within the ultrasound department, maintain timely communication with experts, and proactively engage in stroke prevention and control.	2	0.36	8	1.45	100	18.12	257	46.56	185	33.51

Table 4 Practices

	Very Unlikely N(%)		Unlikely N(%)		Neutral N(%)		Likely N(%)		Very Likely N(%)
P1. You take proactive steps to acquire knowledge towards stroke prevention and treatment from diverse sources, encompassing literature, online resources, and print media.	6	1.09	6	6.88	144	26.09	202	36.59	162	29.35
P2. You shall initiate communication with your physician to arrange an appointment for stroke ultrasound screening.	11	1.99	11	8.15	159	28.80	180	32.61	157	28.44
P3. Your engagement is envisioned in educational initiatives pertaining to stroke ultrasound screening, organized by entities like community health centers or the hospital’s ultrasound department.	8	1.45	8	6.52	149	26.99	199	36.05	160	28.99
P4. You purposefully undertake stroke prevention measures, which encompass dietary control, regular exercise, and lifestyle enhancement.	5	0.91	5	3.80	131	23.73	225	40.76	170	30.80
P5. You consciously familiarize yourself with the local stroke thrombolysis geographical distribution or utilize the stroke thrombolysis area application to identify the nearest medical facility providing thrombolysis intervention.	0	0.00	0	10.87	157	28.44	227	41.12	108	19.57
P6. It is advised to contemplate the possibility of a stroke when encountering symptoms such as numbness, muscle weakness, and speech impediments.	11	1.99	11	6.16	146	26.45	226	40.94	135	24.46
P7. You actively engage in the initiation of stroke-related health records at the hospital and subsequent follow-up activities.	11	1.99	11	4.17	134	24.28	226	40.94	158	28.62
P8. You devote attention to indicators present in the ultrasound screening report, including features such as plaque presence and blood flow velocity.	10	1.81	10	3.26	147	26.63	217	39.31	160	28.99
P9. You consciously seek understanding of emerging ultrasound screening technologies for stroke, such as ultra-microvascular imaging.	16	2.90	16	9.78	165	29.89	176	31.88	141	25.54
P10. You express the desire to actively contribute to the establishment of health records within the ultrasound department, maintain timely communication with experts, and engage proactively in stroke prevention and management.	12	2.17	12	5.25	135	24.46	212	38.41	164	29.71

Table 5 Pearson’s Analysis

	Knowledge	Attitudes	Practices
Knowledge	1
Attitudes	0.544(P<0.001)	1
Practices	0.404(P<0.001)	0.566(P<0.001)	1

Figure 1 Structural equation modeling.

Table 6 Test Results of the Hypothesis

			Estimate	S.E.	C.R.	P
Knowledge	<---	Marital_status	−0.909	0.361	−2.514	0.012
Attitude	<---	Knowledge	1.193	0.078	15.234	<0.001
Practice	<---	Attitude	0.656	0.053	12.415	<0.001
Practice	<---	Knowledge	0.410	0.116	3.541	<0.001
Practice	<---	Physical_exercise_frequency	−1.368	0.222	−6.160	<0.001
Practice	<---	Monthly_income_per_capita	0.163	0.266	0.612	0.540

Table 7 Model Fitness Indices for the KAP Structural Equation Model

Goodness-of-Fit Indices	Ideal Standards	Measurement Value
CMIN/DF	1–3 excellent, 3–5 good	0.949
RMSEA	<0.08 good	<0.001
IFI	>0.8 good	1.001
TLI	>0.8 good	1.002
CFI	>0.8 good	1.000

Abbreviations: CMIN/DF, Chi-square fit statistics/degree of freedom; RMSEA, root mean square error of approximation; IFI, incremental fix index; TLI, Tucker-Lewis index; CFI, comparative fix index.