Knowledge, Attitude And Practice Toward Stroke Prevention And Associated Factors Among Hypertensive Patients Attending At Debre Markos And Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022.

Knowledge, Attitude And Practice Toward Stroke Prevention And Associated Factors Among Hypertensive Patients Attending At Debre Markos And Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, Attitude And Practice Toward Stroke Prevention And Associated Factors Among Hypertensive Patients Attending At Debre Markos And Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022. Wuhabie Tsega, Abebe Dilie, Setarg Ayenew, Menberu Gete This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5629723/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hypertension causes narrowing, rupture, or leakage of blood vessels. This causes stroke by interrupting the blood flow to the brain. The prevalence, incidence, and disability of stroke have surged due to poor knowledge, poor practices, and unfavorable attitudes toward stroke prevention. Awareness of the problem, good prevention practices, and a favorable attitudes toward prevention mechanisms are the milestones to prevent stroke among hypertensive patients. Objective: This study was aimed to assess knowledge, attitudes, and practices related to stroke prevention and associated factors among hypertensive patients attending at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022. Method: A cross-sectional study design was conducted at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Chronic Illness Follow-up Clinic from June 01 to July 11, 2022. A systematic random sampling technique was used to select 423 study participants. The data were collected using pretested and structured questionnaires through face-to-face exit interviews and chart reviews. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25 software. The associations between explanatory variables and outcome variables were analyzed by using a multivariable logistic regression model. Results: The findings of this study showed that 48.9% (95% CI: 44.0-53.8), 45.3% (95% CI: 40.4-50.2), and 44.1% (95% CI: 39.3-49.0) of the participants had good knowledge, favorable attitudes, and good practices respectively. The factors associated with good stroke prevention knowledge included urban residence (AOR=1.96 (1.22-3.15)), primary education (AOR=3.67 (1.56-8.61)) or secondary education and above (AOR=2.42 (1.47-3.99)), having monthly income ≥ 5000 Ethiopian birr (AOR=2.59 (1.38-4.87)), prior information about stroke (AOR=2.29 (1.33-3.96)) and strong social support (AOR=3.09 (1.73-5.54)). Similarly, having monthly income ≥ 5000 Ethiopian birr (AOR=2.05 (1.26-3.35)), moderate (AOR=1.76 (1.03-3.03)) and strong social support (AOR=2.27 (1.3-3.96)) and diabetes mellitus comorbidity (AOR=5.8: 95% CI= 3.62-9.31)) were significantly associated with good stroke prevention practices. On the other hand, duration of treatment (AOR=1.68 (1.08-2.59)) was a statistically and positively associated factor with a favorable attitude toward stroke prevention. Conclusion and recommendation: Nearly half of the respondents had good knowledge of stroke prevention and four out of nine participants had favorable attitudes toward stroke prevention and good prevention practices. Health care workers should dessiminate information for hypertensive patients early in their appointment to enhance their knowledge, attitudes and practices toward stroke prevention. Families , friends, neighbors, and the communities at large should support and encourage hypertensive patients to engage in stroke prevention practices. Nursing knowledge attitude practice stroke prevention hypertension Figures Figure 1 Figure 2 1. INTRODUCTION The World Health Organization (WHO) defines a stroke as “rapidly developing clinical signs of localized or global disruption of brain function lasting more than 24 hours or resulting in death due to vascular origin.”[ 1 ]. Ischemic and hemorrhagic strokes are the two most common forms of stroke that disrupt cerebral blood flow[ 2 ]. Ischemic strokes account for approximately 85% of all strokes, with hemorrhagic strokes accounting for the remaining 15%[ 3 ]. Ischemic stroke occurs when blood flow to a portion of the brain is suddenly halted by a blood clot, foreign materials in the circulation, or constriction, whereas hemorrhagic stroke occurs when a blood vessel breaks apart, pouring blood into areas around neurons[ 4 , 5 ]. From 1990 to 2019, the annual number of strokes and deaths due to stroke climbed dramatically, especially among people over the age of 70[ 6 ]. Between 1990 and 2019, the global stroke burden increased significantly (70% increase in incident strokes, 43% deaths from stroke, 102% prevalent strokes, and 143% disability-adjusted life years lost (DALYs)), with the majority of deaths (86% of deaths and 89% of DALYs occurring in low- and middle-income countries (LMICs))[ 7 ]. Stroke is still the world’s second leading cause of death, and the third leading cause of death and disability combined, according to the 2019 Global Burden of Disease estimates[ 8 ]. In 2019, stroke accounted for approximately 1 out of 19 deaths and a person died of stroke every 3 minutes 30 seconds in the United States[ 9 ]. The multiple social and cognitive consequences of stroke include communication difficulties, memory loss, movement difficulties, depression, and paralysis[ 10 ]. It also has economic consequences for the sufferer, such as job loss, diminished business activity, and business failure[ 11 ]. Hypertension is the leading cause of stroke worldwide, accounting for 79.6 million DALYs or 55.5% of all stroke DALYs[ 6 , 7 ]. It is also the risk factor with the strongest link to stroke, accounting for more than half of all stroke episodes worldwide[ 12 ]. Up to 98% of stroke patients in Africa have hypertension[ 13 , 14 ], and it is the most powerful of the ten major modifiable risk factors[ 15 ]. In 2019, hypertension was responsible for 53.5% of all strokes[ 16 ]. Hypertensive people are four to six times more likely to suffer a stroke than those who do not have hypertension[ 17 ]. Hypertension can cause occlusive stroke, as well as intracerebral or subarachnoid hemorrhage, and is linked to the risk of both first-time and recurrent stroke[ 18 ]. According to the study conducted in Mekele, Ethiopia, hypertension is the cause of 66.2% of all stroke admissions and 38% of all stroke patients are taking antihypertensive medication[ 19 ]. In another study conducted in Gondar and Jimma, hypertension was identified as the most common risk factor in 53.2% and 74.9% of patients, respectively[ 20 , 21 ]. Prevention is the primary treatment strategy aimed at reducing the morbidity and mortality related to stroke. Up to 50% of strokes can be prevented with appropriate treatment, risk factor management, and dietary and lifestyle modifications[ 12 ]. There are 3 stroke prevention modalities namely primordial, primary and secondary. Primordial prevention strategies prevent the emergence of risk factors [ 22 ]. Primary prevention aims to reduce the risk of stroke among those who are at risk of stroke but are asymptomatic subjects[ 23 ], while secondary stroke prevention is focused on reducing the risk of another stroke[ 24 ]. Stroke prevention knowledge, attitudes, and practices among hypertensive patients are influenced by sociodemographic factors, prior information about stroke, knowing someone with a stroke, and clinical characteristics such as duration of hypertension, duration of treatment and comorbidities[ 25 – 29 ]. According to different studies, patients with hypertension have little understanding of stroke prevention[ 30 – 32 ] and lack prevention practices for stroke[ 26 , 27 , 33 ], while the majority have a neutral attitudes toward its prevention[ 31 ]. Despite the notion that public awareness, practice, and a favorable attitudes toward stroke prevention are critical for reducing stroke incidence and prevalence, there is a lack of knowledge and practice in Ethiopia, especially in the study area. Furthermore, there has not been any research into people’s perceptions or attitudes about stroke prevention. Therefore, this study was aimed to fill these gaps by analyzing the level of knowledge, practices, and attitudes toward stroke prevention methods among patients with hypertension at Debre Markos Comprehensive Specialized Hospital (DMCSH) and Felege Hiwot Comprehensive Specialized Hospital (FHCSH). 2. METHODOLOGY 2.1. Study area and period The study was conducted at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals from June 01 to July 11, 2022. Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals are found in the Amhara Regional State, Northwest Ethiopia. These hospitals provide both inpatient and outpatient services including chronic health care services. The chronic illness follow up clinic is an overcrowded department with regular and referral patients for chronic health care services. Approximately 448 and 440 hypertensive patients visited the department each month at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, respectively. 2.2. Study design A hospital-based cross-sectional study design was used. 2.3. Population 2.3.1. Source population All hypertensive patients who were admitted to the chronic illness follow-up clinic at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals 2.3.2. Study population All hypertensive patients who visited Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals Chronic Follow-up Clinic during the data collection period. 2.4. Eligibility criteria 2.4.1. Inclusion criteria All hypertensive patients who were ≥ 18 years old and came to Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals Chronic Follow-up Clinic during the data collection period. 2.4.2. Exclusion criteria All hypertensive patients who were seriously ill and unable to communicate. 2.5. Sample size determination and procedure 2.5.1. Sample size determination To determine the sample size, both single and double population proportion formulas were used. For the dependent variables, a single population proportion formula was used by considering the following assumptions: proportion of good knowledge, 40.7%[ 29 ]; favorable attitude, 50% (since no previous study); good practice, 51.7%[ 29 ]; 95% confidence interval; and 5% marginal error. The calculation results sample size for knowledge = 371, for attitude = 384 and for practice = 384. The following assumptions were used for significantly associated factors according to calculations of the cohort or cross-sectional sample size from StatCalc: percentage of patients who were unexposed and exposed, 82.5% and 97.1% for age,16.5% and 37.65% for duration of hypertension, 21.48% and 52.49% for residence, 19.1% and 55.69% for level of education, respectively, with a 95% confidence interval, 80% power, 1 ratio of unexposed to exposed patients. Accordingly, sample size by Fleiss w/cc formula from StatCalc software became 160 for age, 156 for duration of hypertension, 88 for residence and 64 hypertensive patients for level of education, respectively ( Table 1 ). Since the maximum sample size was obtained by using a single population proportion formula, the final sample size after adding a 10% nonresponse rate was 423 according to estimated proportion of good stroke prevention practices 51.7% from previous study conducted in Gondar[ 29 ]. i. e., n= \(\:\left(Z\frac{\alpha\:}{2}\right)\) 2 x P (1-p)/ \(\:{d}^{2}\) n= \(\:{\left(1.96\right)}^{2}\) x (0.517) (0.483)/ (0.05) 2 n = 384 + 10% = 422.4 ~ 423 where n = estimated sample size p = proportion of good practices for stroke prevention d = margin of error Table 1 Summary of sample size determination for each objective. Objectives Proportion/P value Confidence Interval(CI) Marginal error Sample Size Reference 1. knowledge 40.7% 95% 5% 371 Study at Gondar[ 29 ] 2. Attitude 50% 95% 5% 384 3. Practice 51.7% 95% 5% 384 Study at Gondar[ 29 ] Factors Power CI Un exposed: Exposed % outcome in unexposed % outcome in exposed Fleiss w/cc sample size 1. Age 80% 95% 1 82.5 97.1 160 Study at Nigeria[ 27 ] 2. duration of hypertension 80% 95% 1 16.5 37.65 156 Study at Debre Tabor[ 25 ] 3. Residence 80% 95% 1 21.48 52.49 88 Study at Gondar[ 26 ] 4. Level of education 80% 95% 1 19.1 55.69 64 Study at Gondar[ 26 ] 2.5.2. Sampling procedure A systematic sampling technique was used to select the study participants after proportionate allocation of a sample size to each hospital. The first case was selected within the interval by the lottery method, and it was 2. Then, the remaining eligible participants were recruited every 2nd interval untill the required sample was obtained ( Fig. 1 ). 2.6. Study variables 2.6.1. Dependent variables Knowledge of stroke prevention Attitude toward stroke prevention Stroke prevention practice 2.6.2. Independent variables Sociodemographic factors (age, sex, residence, religion, occupation, educational status, marital status, monthly income, prior information, knowing someone with a stroke, social support) Clinical factors(duration of hypertension, duration of treatment, previous history of stroke, family history of stroke, comorbidity) 2.7. Operational definitions Good knowledge The scores for each knowledge-related question were summarized, and the overall knowledge score of the participants was subsequently calculated. Respondents who scored more than or equal to the computed mean knowledge score were categorized as having good knowledge[ 27 ]. Favorable attitude The scores for each attitude-related item were summarized, and the responses were categorized into favorable and unfavorable attitudes. Respondents who scored more than or equal to the computed mean attitude score were considered to have a favorable attitude. Good practice The scores for each practice-related item were summarized, and the overall practice score of the respondents was calculated. Respondents who scored more than or equal to the computed mean practice score were considered to have good practices[ 26 ]. Social support Respondents who completed the 3- item Oslo Social Support Scale (OSSS) 3–8, 9–11, or 12–14 are classified as having poor social support, moderate social support, or strong social support, respectively[ 34 ]. Regular exercise Three times per week for 50 minutes of aerobic exercise, such as walking, jogging, and swimming[ 35 , 36 ]. Salt reduction The daily recommended salt intake is not more than 2.0 g per day (equivalent to ½ tea spoon). However, if home-prepared spices contain salt the addition of salt should be restricted[ 35 , 36 ]. 2.8. Data collection procedure Six BSc holder nurses for data collection and two BSc nurses for supervision who were not employees of the study hospitals were selected to reduce a possible sources of bias. The data collectors approached the participants politely and respectfully and explained the purpose of the study and its possible benefits. The supervisors monitored the data collection process of the data collectors and if any problems occurred, they attempted to solve them or contact the principal investigator. 2.9. Data collection tool A structured closed-ended questionnaire was prepared according to the objectives of the study and adapted from different relevant works in the literature [ 25 , 27 , 33 , 37 – 39 ]. Then, the questionnaire was translated to Amharic by an expert and retranslated back to English by another individual for analysis and to check for any inconsistencies. The questionnaire has six parts: sociodemographic characteristics, which include eleven items; clinical-related factors which include five questions; and stroke prevention knowledge, which includes twelve items with yes, no or do not know responses, and scores of 1, 2, or 3, respectively. The scale for stroke prevention attitudes contains ten Likert-type items ranging from 1 = Strongly Disagree to 5 = Strongly Agree responses, and the scale for stroke prevention practices contains eight items with yes or no possible responses and scores of 1 or 2, respectively. The Oslo Social Support Scale (OSSS) contains 3-items ranging from 3–14. The internal consistency reliability of the outcome measures was examined through a pretest with 22 hypertensive patients from Injibara General Hospital using Cronbach’s α. The specific values are 0.82, 0.69, and 0.71 for the knowledge, attitude and practice items, respectively. The content validity of the questionnaire was judged by two experts (one is an assistant professor in adult health nursing and a PhD candidate while the other is a medical doctor). Before the interviews, the questionnaires were arranged based on the content validity index (CVI) format and sent to them via email for evaluation. Based on their responses, item- content validity index (I-CVI) scores were calculated by dividing the expert agreement by the number of experts, and finally, the average of the I-CVI scores across all items was computed. Accordingly, the content validity indices are 0.92, 0.85 and 0.94 for knowledge, attitude and practice respectively, which indicates that the tool is acceptable. The client's chart was reviewed to retrieve medical information (duration of hypertension, duration of treatment and comorbidity). 2.10. Data quality control Training on interview techniques was given to the data collectors one day before the data collection and supervision of the data collectors were performed by the supervisors. Each questionnaire was checked for completeness and missed values and those incomplete questionnaires were omitted from the analysis. Pretesting in 5% (22) of the sample was performed by the principal investigator at Injibara General Hospital to assess the content, and to correct unclear and vague issues on the questionnaire. Additional adjustments in the sequence and wording of the questionnaire were made based on the results of the pretest. The selected and trained supervisors supervised the data collectors on a daily basis for completeness and consistency of the completed questionnaires. In addition, the data were thoroughly cleaned and carefully entered into the computer before the beginning of the analysis. 2.11. Data processing and analysis The collected data were checked for completeness, and the responses were coded and entered into the computer using the Epi data version 4.4 statistical package. The data were cleaned for inconsistencies, and then analyzed using SPSS version 25 statistical software. Descriptive statistics such as frequencies, percentages, mean values, and standard deviations were calculated. Graphical presentations such as tables and bar graphs were used to present the findings of the study. Crude Odds ratios (CORs), 95% confidence intervals (CIs), and P-values < 0.25 were used to present the results of the bivariable analysis. All variables with a p-value < 0.25 were entered into a multivariable logistic regression to assess the association between the independent and dependent variables. A multivariable logistic regression model with a back ward likelihood ratio method was used to assess factors associated with stroke prevention knowledge, attitudes, and practices, and a p-value < 0.05 indicated statistical significance. Multicollinearity was checked with the variance inflation factor, and its values were less than 5. Hosmer and Lemeshow goodness of fit was tested to check model fitness, and a model had p-values of 0.167, 0.806, and 0.774 for knowledge, attitude, and practice, respectively which is > 0.05. 2.12. Ethical consideration Ethical approval was obtained from Debre Markos University, Health Science College Research and Ethical Review Committee. Before the beginning of the data collection, permission letter was provided to the two hospitals’ administrative bodies for data collection. At the time of data collection, both written and informed verbal consent were obtained from the participants to confirm whether they were willing to participate. Those not willing to participate were given the right to do so. Coding was used to eliminate names and other personal identification of respondents throughout the study process to ensure participant confidentiality. 3. RESULTS Sociodemographic characteristics of the study participants Of the 423 hypertensive patients who were planned to be included in the study, 415 were interviewed for a response rate of 98%. Among the respondents, half of them were males. The respondents’ mean age was 53.12 years, with a standard deviation(SD) of ± 16.166 years, and more than half (59.5%) of them were older than fifty years. The majority of respondents, 69.9% were urban dwellers. Three hundred fifty-five (85.5%) of participants were Orthodox Christianity followers (Table 2) . Table 2: Sociodemographic characteristics of hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415) Variables Category Frequency (%) Age <50 years 168 (40.5) ≥50 years 247 (59.5) Sex Male 209 (50.4) Female 206 (49.6) Residence Urban 290 (69.9) Rural 125 (30.1) Religion Orthodox 355 (85.5) Muslim 46 (11.1) Protestant 11 (2.7) Catholic 3 (0.7) Marital status Single 27 (6.5) Married 316 (76.1) Divorced 36 (8.7) Widowed 36 (8.7) Educational status Unable to read and write 166 (40.0) Able to read and write (have no formal education) 72 (17.3) Primary education 40 (9.7) Secondary education 54 (13.0) Diploma and above 83 (20.0) Occupational status Government employee 104 (25.1) Merchant 85 (20.5) Farmer 96 (23.1) House wife 65 (15.7) Retired 40 (9.6) Student 10 (2.4) Labor worker 15 (3.6) Monthly income <5000 ETB 284 (68.4) ≥5000 ETB 131 (31.6) Prior information about stroke Yes 211 (50.8) No 204 (49.2) Knowing someone with a stroke Yes 115 (27.7) No 300 (72.3) Social support Poor 162 (39.04) Moderate 147 (35.42) Strong 106 (25.54) Approximately half of the respondents (50.8%) had prior information about stroke. More than one-third of the participants had received information from health professionals during their visits (Figure 2) . Clinical characteristics More than half of the respondents (60.5%) were diagnosed, and nearly, three-fourths of the participants (72.3%) had followed up in the last five years respectively (Table 3) . Table 3: Clinical characteristics of hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415) Variables Category Frequency(%) Duration of illness <5 years ≥5 years 251 (60.5) 164 (39.5) Duration of treatment <5 years ≥5 years 300 (72.3) 115 (27.7) Previous history of stroke Yes No 57 (13.7) 358 (86.3) Family history of stroke Yes No 18 (4.3) 397 (95.7) DM comorbidity Yes No 133 (32.0) 282 (68.0) Level of knowledge of stroke prevention The computed mean knowledge score for stroke prevention was 7.04 ± 2.84 (mean ± SD). The percentage of respondents with good knowledge to prevent the occurrence of stroke among these at-risk populations was approximately 48.9% (95% CI: 44.0-53.8). Factors associated with stroke prevention knowledge among hypertensive patients Bivariable and multivariable logistic regression analyses were used to determine factors affecting knowledge on the prevention of stroke. To adjust for potential confounders, variables that were <0.25 in the bivariable analysis were entered into the multivariable logistic regression. The results revealed that urban residence, educational status, monthly income, prior information, and social support were significantly associated with knowledge of stroke prevention. The odds of having good knowledge of stroke prevention was two times greater among urban residents than among those living in rural areas (AOR = 1.96: 95% CI = 1.2-3.2). Educational status was positively related to stroke prevention knowledge in hypertensive patients. Compared with patients who were unable to read and write, hypertensive patients with primary education or secondary education and above had 3.7 and 2.4 times greater odds of having good stroke prevention knowledge, respectively (AOR=3.67: 95% CI=1.56-8.61) and (AOR= 2.42: 95% CI=1.5-3.99) compared to unable to read and write. Hypertensive patients who had a monthly income of ≥5000 ETB were 2.59 times more likely to have good knowledge than those whose monthly income was <5000 ETB (AOR= 2.59: 95% CI=1.38-4.87). Patients who had prior information about stroke were 2.29 times more likely to have good stroke prevention knowledge than were those who had no information (AOR=2.29: 95% CI=1.33-3.96). Similarly, the odds of having good stroke prevention knowledge was three times greater among patients with strong social support (AOR= 3.09: 95% CI= 1.73-5.54) than among their counterparts (Table 4) . Table 4: Factors associated with knowledge of stroke prevention among hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415) Variables Knowledge of stroke prevention Good Poor COR(95% CI) AOR(95% CI) Age <50 years ≥50 years 89 114 79 133 1.31(0.89-1.95) 1 Sex Male Female 111 92 98 114 1 1.4(0.95-2.07) Residence Urban Rural 162 41 128 84 2.59(1.67-4.02) 1 1.96(1.22-3.15)* 1 Marital status Single Married Divorced Widowed 21 147 21 14 6 169 15 22 5.5(1.78-16.99) 1.37(0.68-2.77) 2.2(0.86-5.65) 1 Educational status Unable to read and write Able to read and write Primary education Secondary education and above 41 26 22 114 85 40 10 77 1 1.35(0.73-2.50) 4.56(1.98-10.52) 3.07(1.92-4.92) 1 1.11(0.59-2.11) 3.67(1.56-8.61)* 2.42(1.47-3.99)* Occupational status Government employee Merchant Farmer House wife Other 66 57 29 18 33 38 28 67 47 32 1 1.17(0.64-2.14) 0.25(0.14-0.45) 0.22(0.11-0.43) 0.59(0.32-1.11) Monthly income <5000 ≥5000 107 96 177 35 1 4.54(2.88-7.15) 1 2.59(1.38-4.87)* Prior information about stroke Yes No 141 62 70 142 4.61(3.05-6.98) 1 2.29(1.33-3.96)* 1 Knowing someone with a stroke Yes No 83 120 32 180 3.89(2.44-6.22) 1 1.79(0.98-3.31) 1 Social support Poor Moderate Strong 47 66 89 100 67 46 1 2.16(1.33-3.51) 4.12(2.51-6.77) 1 1.53(0.87-2.67) 3.09(1.73-5.54)* Duration of illness <5 years ≥5 years 115 88 136 76 1 1.37(0.92-2.03) Duration of treatment <5 years ≥5 years 139 64 161 51 1 1.45(0.94-2.24) Family history of stroke Yes No 11 192 4 208 2.98(0.93-9.51) 1 DM comorbidity Yes No 66 137 69 143 0.99(0.69-1.58) 1 Key: 1= reference group; *= statistically significant at p < 0.05; abbreviations: COR= crude odds ratio, AOR= adjusted odds ratio, CI= confidence interval, DM= diabetes mellitus Level of attitude toward stroke prevention The computed mean attitude score for stroke prevention was 31.13 ± 2.94 (mean ± SD). Accordingly, 45.3% (95% CI:39.3-49.0) of patients had a favorable attitudes while 54.7% (95% CI: 49.8%-59.6%) of patients had an unfavorable attitudes toward stroke prevention. Factors associated with stroke prevention attitudes among hypertensive patients According to the bivariable logistic regression analysis, attitudes toward stroke prevention was significantly associated with nine variables. After adjustment for potential confounders, duration of treatment was found to be significantly and positively associated with attitudes toward stroke prevention among hypertensive patients. The odds of having a favorable attitude was 1.68 times greater among patients treated for hypertension five years and above than among those treated for hypertension less than five years (AOR=1.68: 95% CI= 1.08-2.59) (Table 5) . Table 5: Factors associated with attitudes toward stroke prevention among hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415) Variables Attitude toward stroke prevention Favorable Unfavorable COR(95% CI) AOR(95% CI) Age <50 years ≥50 years 70 118 98 129 0.78(0.53-1.16) 1 Educational status Unable to read and write Able to read and write Primary education Secondary education and above 55 32 19 82 71 34 13 109 1 1.22(0.67-2.21) 1.89(0.86-4.15) 0.97(0.62-1.53) Occupational status Government employee Merchant Farmer House wife Other 43 37 41 34 33 61 48 55 31 32 1 1.09(0.61-1.95) 1.06(0.60-1.86) 1.56(0.83-2.90) 1.46(0.78-2.73) Knowing someone with a stroke Yes No 99 89 112 115 1.14(0.99-2.37) 1 1.46(0.94-2.27) 1 Duration of illness <5 years ≥5 years 103 85 148 79 1 1.55 (1.04-2.29) Duration of treatment <5 years ≥5 years 125 63 175 52 1 1.69 (1.1-2.62) 1 1.68(1.08-2.59)* Previous history of stroke Yes No 16 172 9 218 2.25(0.97-5.22) 1 2.05(0.88-4.79) 1 Family history of stroke Yes No 10 178 5 222 2.49(0.84-7.43) 1 DM comorbidity Yes No 69 119 66 161 1.41 (0.89-2.04) 1 Key: 1= reference group; *= statistically significant at p < 0.05; abbreviations: COR=crude odds ratio, AOR= adjusted odds ratio, CI= confidence interval, DM= diabetes mellitus Levels of prevention practices for stroke The computed mean prevention practice for stroke patients was 5.31 ± 1.14 (mean ± SD). Accordingly, 44.1% (95% CI: 39.3-49.0) of the respondents had good practices while 55.9% (95% CI: 51%-60.7%) of the respondents had poor practices for stroke prevention. Factors associated with stroke prevention practices among hypertensive patients Like knowledge and attitude, numerous associations were found to be significant in the bivariable analysis at a p-value < 0.25. Therefore, a multivariable approach was applied to determine which factors best explained and predicted stroke prevention practices. Consequently, several independent factors such as monthly income, social support, and having DM comorbidity, were significantly associated with good stroke prevention practices according to the multivariable analysis. Hypertensive patients who had a monthly income of ≥5000 ETB were two times more likely to have good stroke prevention practices than those who had a monthly income less than 5000 ETB (AOR=2.05:95% CI= 1.26-3.35). Considering the respondents’ level of social support, participants who had moderate and strong social support were 1.76 and 2.27 times more likely to have good practices, respectively, than those who had poor social support (AOR=1.76: 95% CI= 1.03-3.03) and (AOR=2.27: 95% CI= 1.30-3.96). On the other hand, patients with DM comorbidities had 5.8 times greater odds of engaging in stroke prevention practices (AOR=5.8: 95% CI= 3.62-9.31) than those who did not have medical conditions other than hypertension (Table 6) . Table 6: Factors associated with the practice of stroke prevention among hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415) Variables Practice of stroke prevention Good Poor COR(95% CI) AOR(95% CI) Marital status Single Married Divorced Widowed 8 150 10 15 19 166 26 21 0.59 (0.2-1.7) 1.27 (0.63-2.54) 0.54(0.2-1.4) 1 Occupational status Government employee Merchant Farmer House wife Other 50 40 47 26 20 54 45 49 39 45 1 0.96(0.54-1.70) 1.04(0.59-1.81) 0.72(0.38-1.35) 0.48(0.25-0.92) Monthly income <5000 ≥5000 113 70 171 61 1 1.74(1.14-2.64) 1 2.05 (1.26-3.35)* Social support Poor Moderate Strong 51 60 72 96 73 63 1 1.55(0.96-2.50) 2.15(1.33-3.47) 1 1.76(1.03-3.03)* 2.27(1.30-3.96)* DM comorbidity Yes No 96 87 39 193 5.46(3.33-8.19) 1 5.80(3.62-9.31)* 1 Key: 1= reference group; *= statistically significant at p < 0.05; abbreviations: COR= crude odds ratio, AOR= adjusted odds ratio, CI= confidence interval, DM= diabetes mellitus 4. DISCUSSION The present study was conducted to assess the level of knowledge, attitudes, and practices of hypertensive patients concerning the prevention of stroke among hypertensive patients. The findings of this study revealed that nearly half of the participants (48.9%, (44.0-53.8)) had adequate knowledge about stroke prevention, which is higher than that reported in the finding of previous studies in Ethiopia (Debre Tabor, 24.9% [ 25 ]; two studies in Gondar, 38.41%[ 26 ] and 40.7%[ 29 ]; and Southeast India, 11.43%[ 40 ]). The possible reason for this discrepancy may be the fact that patients may be exposed to chronic noncommunicable diseases, including stroke, which have comparable risk factors and prevention strategies. Furthermore, there was a difference in sample size and classification criteria for good and poor knowledge. Respondents who scored 75% or above on the stroke prevention knowledge-related items were judged to have good stroke prevention knowledge in India. However, this result is lower than those of studies conducted in southern India, (66.7%)[ 41 ], and Nigeria, (90.8%)[ 27 ]. This may be due to sociodemographic differences in the study population. In contrast, approximately 70% of the respondents were educated in India and Nigeria. Urban residents were two times more likely to have good knowledge of stroke prevention than were those living in rural areas. This finding is supported by research done in Debre Tabor[ 25 ] and Gondar[ 26 ]. The possible reason may be the greater accessibility of information in urban areas than in rural areas. Another factor affecting stroke prevention knowledge among hypertensive patients was educational status. Hypertensive patients with primary education or secondary education and above had 3.7 and 2.4 times greater odds of having good stroke prevention knowledge, respectively than did those who were unable to read and write. This was in line with the findings of many studies, according to which having a high level of education was the most significant factor for hypertensive patients in Ethiopia [ 33 , 42 ], Nigeria [ 27 ], Ghana [ 43 ], Turkey [ 44 ], India [ 40 ] and China [ 30 ]. The reason could be that patients who have at least completed their elementary education may have a greater probability of being exposed to various communication media, such as magazines, books, and the internet. Furthermore, a possible explanation could be that educated people have a better understanding of their health, pay attention to individual health problems, and then take healthy measures to ensure their health. The study showed that the odds of having good stroke prevention knowledge was 2.59 times greater among patients with a monthly income of ≥ 5000 ETB than among patients with a monthly income below 5000 ETB. This finding is inline with a study conducted in Gondar [ 26 ]. The possible reason may be the accessibility of information through media and the internet in relation to stroke as patients with high monthly income may be able to buy and access it. Prior information about stroke was another factor in stroke prevention among hypertensive patients. Patients who had prior information about stroke were 2.29 times more likely to have good stroke prevention knowledge than were those who had no information. Having strong social support from families, friends, and the community at large was found to be a factor for stroke prevention knowledge among hypertensive patients. Patients with strong social support were three times more likely to have good stroke prevention knowledge than their counterparts. This could be due to creating a chance for smooth interaction and area of discussion with others regarding their health problems. In this study, 44.1% (40.4–50.2) of respondents had good prevention practices for stroke, which is consistent with a study done in Gondar, (42.67%)[ 26 ]. However, this percentage is lower than that reported in other studies conducted in Gondar (51.7%)[ 29 ] and in two other studies in India (62.9%[ 41 ] and 64%[ 31 ]). This discrepancy may be due to differences in sample size and classification criteria. In a study conducted in North India, participants were considered to have good practices if they were practiced 50% of the items related to stroke prevention. Furthermore, stroke prevention practices were associated with high monthly income, moderate and strong social support, and having a concomitant disease. Those hypertensive patients with a monthly income of 5000 ETB and above were two times more likely to practice stroke prevention strategies than those who had a monthly income below 5000 ETB. This is because economical subjects have a better chance of finding information regarding the disease from various sources which is consistent with a study done in Gondar[ 26 ]. The level of social support was the other factor in stroke prevention strategies. Good stroke prevention practices were 1.76 and 2.27 times more likely among patients with moderate and strong social support, respectively, than among patients with poor social support. This could be because interpersonal relationships help patients to engage in desired practices by providing information about their disease and may serve as a role model for good habits. Moreover, patients with diabetes mellitus and hypertension were 5.8 times more likely to practice stroke prevention than patients with hypertension alone. This could be due to the fear of late complications of the two diseases. Approximately 45.3% (39.3–49.0) of the participants had a favorable attitude toward stroke prevention, which is lower than that reported in earlier studies in Southwest India, (64.3%)[ 32 ] and South India, (73.8%)[ 41 ]. A plausible reason for this discrepancy may be the small sample size. In the study conducted in South and Southwest India, 70 and 210 respondents participated respectively, which may increase the percentage of patients with a favorable attitude toward stroke prevention if the majority of them were positively intended to items related to stroke prevention attitudes, whereas 415 hypertensive patients participated in this study. Patients’ perceptions of stroke are crucial for better understanding and practicing preventive techniques. On the other hand, knowing the duration of treatment in hypertension management has great importance for the occurrence of hypertension-related complications. In this study, patients who received hypertension treatment for five years or more were 1.68 times more likely to have a favorable attitude toward stroke prevention than those who received hypertension treatment for less than five years. The possible reason could be a result of repeated follow-up contact with healthcare professionals, which can cause cognitive changes in stroke prevention strategies. 5. LIMITATIONS OF THE STUDY Since the practice of patients towards stroke prevention was assessed through self-reported practice, it may be exposed to social desirability bias and hence may increase the percentage of good practice. There may also recall-bias due to expressed practice. Hypertension medication adherence was not assessed. Clinical variables like BP, PR, ECG finding and cardiac enzymes were not included. 6. CONCLUSION AND RECOMMENDATION 6.1. Conclusion Nearly half of the hypertensive patients had good knowledge of stroke prevention. Urban residency, educational status, high monthly income, having prior information about stroke, and social support were all strongly associated with good stroke prevention knowledge. Approximately four out of nine participants had good practices for stroke prevention. Monthly income, social support and having diabetes as a comorbidity were significantly associated with stroke prevention practices among hypertensive patients. More than half of the hypertensive patients at Debre Markos and Felege Hiwot Comprehensive and Specialized Hospitals had unfavorable attitudes toward stroke prevention, and the length of treatment was found to be significantly associated with favorable attitudes toward stroke prevention. 6.2. Recommendations Health care workers should disseminate information for hypertensive patients early in their appointment to enhance their knowledge, attitudes and practices regarding stroke prevention. Families, friends, neighbors, and communities at large should support and encourage hypertensive patients to engage in stroke prevention practices. Other researchers should assess patient practices related to stroke prevention using observational checklists. Researchers should conduct research on other risky population segments. Abbreviations DALYs: Disability Adjusted Life Years Lost; DMCSH: Debre Markos Comprehensive Specialized Hospital; ETB: Ethiopian Birr; FHCSH: Felege Hiwote Comprehensive Specialized Hospital; I-CVI: Item- Content Validity Index; OSSS: Oslo Social Support Scale Declarations Ethical approval and consent to participate Ethical approval was obtained from Debre Markos University, Health Science College Research and Ethical Review Committee. Before the beginning of the data collection, permission letter was provided to the two hospitals’ administrative bodies for data collection. At the time of data collection, both written and informed verbal consent were obtained from the participants to confirm whether they were willing to participate. Those not willing to participate were given the right to do so. Coding was used to eliminate names and other personal identification of respondents throughout the study process to ensure participant confidentiality. Consent for publication : Not applicable Availability of data and materials All the data are available from the corresponding author upon reasonable request. Competing interests: The authors declare that there are no competing intersts. Funding: There was no funding support. Author Contributions WT conceptualized and drafted the proposal and data collection tools. WT, AD and SA were involved in formal analysis, validation and report writing. WT and MG were prepared the manuscript. All authors were critically reviewed and revised the manuscript. ACKNOWLEDGMENT The authors would like to thank Debre Markos University for material support for this research. The authors are also grateful to hospital administrators, content validity experts, study participants and data collectors. References R. L. Sacco, S. E. Kasner, J. P. Broderick, L. R. Caplan, J. Connors, A. Culebras , et al. , "An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association," Stroke, vol. 44, pp. 2064-2089, 2013. W. Walelgne, D. Yadeta, Y. Feleke, and T. Kebede, "Guidelines on Clinical and Programmatic Management of Major Non Communicable Diseases," Addis Ababa: Federal Democratic Republic of Ethiopia Ministry of Health, 2016. L. H. Pellico, C. Bautista, and C. Esposito, Focus on adult health medical-surgical nursing , 2012. J. L. Hinkle and K. H. Cheever, Brunner and Suddarth’s textbook of medical-surgical nursing : Wolters kluwer india Pvt Ltd, 2018. L. S. Williams and P. D. Hopper, Understanding medical surgical nursing : FA Davis, 2015. V. L. Feigin, B. A. Stark, C. O. Johnson, G. A. Roth, C. Bisignano, G. G. Abady , et al. , "Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019," The Lancet Neurology, vol. 20, pp. 795-820, 2021. V. L. Feigin, M. Brainin, B. Norrving, S. Martins, R. L. Sacco, W. Hacke , et al. , "World Stroke Organization (WSO): Global Stroke Fact Sheet 2022," International Journal of Stroke, vol. 17, pp. 18-29, 2022. M. O. Owolabi, A. G. Thrift, A. Mahal, M. Ishida, S. Martins, W. D. Johnson , et al. , "Primary stroke prevention worldwide: translating evidence into action," The Lancet Public Health, 2021. C. W. Tsao, A. W. Aday, Z. I. Almarzooq, A. Alonso, A. Z. Beaton, M. S. Bittencourt , et al. , "Heart disease and stroke statistics—2022 update: a report from the American Heart Association," Circulation, vol. 145, pp. e153-e639, 2022. A. G. Adams, D. Schweitzer, P. Molenberghs, and J. D. Henry, "A meta-analytic review of social cognitive function following stroke," Neuroscience & Biobehavioral Reviews, vol. 102, pp. 400-416, 2019. M. Mapulanga, S. Nzala, and C. Mweemba, "The Socio‑economic Impact of Stroke on Households in Livingstone District, Zambia: A Cross‑sectional Study," Annals of medical and health sciences research, vol. 4, pp. 123-127, 2014. D. Smajlović, "Strokes in young adults: epidemiology and prevention," Vascular health and risk management, vol. 11, p. 157, 2015. R. W. Walker, A. Jusabani, E. Aris, W. K. Gray, D. Whiting, G. Kabadi , et al. , "Post-stroke case fatality within an incident population in rural Tanzania," Journal of Neurology, Neurosurgery & Psychiatry, vol. 82, pp. 1001-1005, 2011. R. Walker, D. Whiting, N. Unwin, F. Mugusi, M. Swai, E. Aris , et al. , "Stroke incidence in rural and urban Tanzania: a prospective, community-based study," The Lancet Neurology, vol. 9, pp. 786-792, 2010. M. J. O'donnell, D. Xavier, L. Liu, H. Zhang, S. L. Chin, P. Rao-Melacini , et al. , "Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study," The Lancet, vol. 376, pp. 112-123, 2010. M. Jaberinezhad, M. Farhoudi, S. A. Nejadghaderi, M. Alizadeh, M. J. Sullman, K. Carson-Chahhoud , et al. , "The burden of stroke and its attributable risk factors in the Middle East and North Africa region, 1990–2019," Scientific reports, vol. 12, pp. 1-11, 2022. P. LeMone, K. Burke, T. Levett-Jones, T. Dwyer, L. Moxham, K. Reid-Searl , et al. , "Medical-surgical nursing: Critical thinking for person-centred care," 2014. Z. Gaciong, M. Siński, and J. Lewandowski, "Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses," Current hypertension reports, vol. 15, pp. 559-574, 2013. S. A. Gebremariam and H. S. Yang, "Types, risk profiles, and outcomes of stroke patients in a tertiary teaching hospital in northern Ethiopia," eNeurologicalSci, vol. 3, pp. 41-47, Jun 2016. E. S. Greffie, T. Mitiku, and S. Getahun, "Risk factors, clinical pattern and outcome of stroke in a referral hospital, Northwest Ethiopia," Clin Med Res, vol. 4, pp. 182-188, 2015. G. Fekadu, L. Chelkeba, and A. Kebede, "Risk factors, clinical presentations and predictors of stroke among adult patients admitted to stroke unit of Jimma university medical center, south west Ethiopia: prospective observational study," BMC neurology, vol. 19, pp. 1-11, 2019. J. D. Pandian, S. L. Gall, M. P. Kate, G. S. Silva, R. O. Akinyemi, B. I. Ovbiagele , et al. , "Prevention of stroke: a global perspective," The Lancet, vol. 392, pp. 1269-1278, 2018. J. Polívka, V. Rohan, and P. Ševčík, "Personalized approach to primary and secondary prevention of ischemic stroke," EPMA Journal, vol. 5, pp. 1-7, 2014. E. S. O. E. Committee and E. W. Committee, "Guidelines for management of ischaemic stroke and transient ischaemic attack 2008," Cerebrovascular diseases, vol. 25, pp. 457-507, 2008. N. S. Tibebu, T. D. Emiru, C. M. Tiruneh, A. B. Nigat, M. W. Abate, and A. T. Demelash, "Knowledge on prevention of stroke and its associated factors among hypertensive patients at Debre Tabor general hospital: an institution-based cross-sectional study," Risk Management and Healthcare Policy, vol. 14, p. 1681, 2021. A. B. Mekuria, Z. D. Kifle, and A. D. Melak, "Level of knowledge, prevention practice, and predictors towards stroke among diabetic and hypertensive patients having a follow up at University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia. A cross-sectional study," Clinical Epidemiology and Global Health, p. 100950, 2022. S. A. Arisegi, K. J. Awosan, M. O. Oche, A. A. Sabir, and M. T. Ibrahim, "Knowledge and practices related to stroke prevention among hypertensive and diabetic patients attending Specialist Hospital, Sokoto, Nigeria," Pan African Medical Journal, vol. 29, pp. 1-17, 2018. D. Girma, "Knowledge, attitude and practice of new stroke patients and their caregivers towards stroke: A HOSPITAL BASED INTERVIEW," 2017. G. Azeze, F. K. Woldetsadik, T. Kassa, W. Hailu, and Y. Girma, "Stroke Related Knowledge, Prevention Practices and Associated Factors Among Hypertensive Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021," Frontiers in Neurology, p. 699, 2022. L.-H. Wan, J. Zhao, X.-P. Zhang, S.-F. Deng, L. Li, S.-Z. He , et al. , "Stroke prevention knowledge and prestroke health behaviors among hypertensive stroke patients in mainland China," Journal of Cardiovascular Nursing, vol. 29, pp. E1-E9, 2014. R. Sinha, P. Verma, K. K. Rohilla, and C. V. Kalyani, "Hypertensive Patients Knowledge, Attitude and Practice for Stroke Prevention in Uttarakhand, India," Community Med, vol. 11, pp. 385-389, 2020. S. KP, K. Athira, and H. G. MJ, "Awareness and attitude towards stroke and its prevention among hypertensive and non-hypertensive people," Asian J Pharm Clin Res, vol. 11, pp. 39-42, 2018. A. D. Melak, D. Wondimsigegn, and Z. D. Kifle, "Knowledge, Prevention Practice and Associated Factors of Stroke Among Hypertensive and Diabetic Patients–A Systematic Review," Risk Management and Healthcare Policy, vol. 14, p. 3295, 2021. R.-D. Kocalevent, L. Berg, M. E. Beutel, A. Hinz, M. Zenger, M. Härter , et al. , "Social support in the general population: standardization of the Oslo social support scale (OSSS-3)," BMC psychology, vol. 6, pp. 1-8, 2018. W. H. Organization, "Technical package for cardiovascular disease management in primary health care: healthy-lifestyle counselling," World Health Organization2018. A. H. Lichtenstein, L. J. Appel, M. Vadiveloo, F. B. Hu, P. M. Kris-Etherton, C. M. Rebholz , et al. , "2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association," Circulation, vol. 144, pp. e472-e487, 2021. J. Babu, "Knowledge, Attitude and Practice towards Stroke among General Population," JKK Nattraja College of Pharmacy, Kumarapalayam, 2019. A. N. Madubuko, "Stroke Risk Factor Knowledge, Attitude, Prevention Practices, and Stroke," Walden University, 2018. R. R. Pradhan, A. Jha, S. Bhandari, S. Ojha, and R. Karn, "Knowledge, attitude, and practice of stroke and thrombolysis among students preparing for undergraduate medical entrance examination in Kathmandu, Nepal," Health Science Reports, vol. 4, p. e268, 2021. H. S. J. Cecily, "Knowledge on Prevention of Cerebro Vascular Accident among Patients with Diabetes and Hypertension in India," IJSR International Journal of Science and Research (IJSR), vol. 5, pp. 1401-1404, 2016. U. Venkatesh and D. Srivastava, "Knowledge, attitude and practice in relation to stroke: comparative study between hypertensive and non-hypertensive patients attending a tertiary care centre in Gorakhpur, Uttar Pradesh," India J Med Sci Clin Res, vol. 4, pp. 15014-15021, 2016. A. T. Abate, N. Bayu, and T. G. Mariam, "Hypertensive patients’ knowledge of risk factors and warning signs of stroke at Felege Hiwot referral hospital, Northwest Ethiopia: a cross-sectional study," Neurology Research International, vol. 2019, 2019. P. K. Ampiah, "Ampiah_et_al., 2018 Knowledge of Stroke among Hypertensive-Diabetic Patients at the National Diabetes Management and Research Centre of Korle-Bu Teaching Hospital in Ghana," Journal of Preventive and Rehabilitative Medicine, vol. 1, pp. 46-62, 2018. S. Ozkan and N. Ata, "Stroke awareness in people with hypertension," 2019. Additional Declarations The authors declare no competing interests. Supplementary Files Suppf.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5629723","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":389406050,"identity":"8f741f4e-8b6b-41b6-bc5b-17890f3b69b7","order_by":0,"name":"Wuhabie 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Hospitals, Northwest Ethiopia, 2022.\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eThe World Health Organization (WHO) defines a stroke as \u0026ldquo;rapidly developing clinical signs of localized or global disruption of brain function lasting more than 24 hours or resulting in death due to vascular origin.\u0026rdquo;[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Ischemic and hemorrhagic strokes are the two most common forms of stroke that disrupt cerebral blood flow[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Ischemic strokes account for approximately 85% of all strokes, with hemorrhagic strokes accounting for the remaining 15%[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Ischemic stroke occurs when blood flow to a portion of the brain is suddenly halted by a blood clot, foreign materials in the circulation, or constriction, whereas hemorrhagic stroke occurs when a blood vessel breaks apart, pouring blood into areas around neurons[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom 1990 to 2019, the annual number of strokes and deaths due to stroke climbed dramatically, especially among people over the age of 70[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Between 1990 and 2019, the global stroke burden increased significantly (70% increase in incident strokes, 43% deaths from stroke, 102% prevalent strokes, and 143% disability-adjusted life years lost (DALYs)), with the majority of deaths (86% of deaths and 89% of DALYs occurring in low- and middle-income countries (LMICs))[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Stroke is still the world\u0026rsquo;s second leading cause of death, and the third leading cause of death and disability combined, according to the 2019 Global Burden of Disease estimates[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In 2019, stroke accounted for approximately 1 out of 19 deaths and a person died of stroke every 3 minutes 30 seconds in the United States[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The multiple social and cognitive consequences of stroke include communication difficulties, memory loss, movement difficulties, depression, and paralysis[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It also has economic consequences for the sufferer, such as job loss, diminished business activity, and business failure[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHypertension is the leading cause of stroke worldwide, accounting for 79.6\u0026nbsp;million DALYs or 55.5% of all stroke DALYs[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is also the risk factor with the strongest link to stroke, accounting for more than half of all stroke episodes worldwide[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Up to 98% of stroke patients in Africa have hypertension[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and it is the most powerful of the ten major modifiable risk factors[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In 2019, hypertension was responsible for 53.5% of all strokes[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Hypertensive people are four to six times more likely to suffer a stroke than those who do not have hypertension[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Hypertension can cause occlusive stroke, as well as intracerebral or subarachnoid hemorrhage, and is linked to the risk of both first-time and recurrent stroke[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. According to the study conducted in Mekele, Ethiopia, hypertension is the cause of 66.2% of all stroke admissions and 38% of all stroke patients are taking antihypertensive medication[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In another study conducted in Gondar and Jimma, hypertension was identified as the most common risk factor in 53.2% and 74.9% of patients, respectively[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevention is the primary treatment strategy aimed at reducing the morbidity and mortality related to stroke. Up to 50% of strokes can be prevented with appropriate treatment, risk factor management, and dietary and lifestyle modifications[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. There are 3 stroke prevention modalities namely primordial, primary and secondary. Primordial prevention strategies prevent the emergence of risk factors [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Primary prevention aims to reduce the risk of stroke among those who are at risk of stroke but are asymptomatic subjects[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], while secondary stroke prevention is focused on reducing the risk of another stroke[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Stroke prevention knowledge, attitudes, and practices among hypertensive patients are influenced by sociodemographic factors, prior information about stroke, knowing someone with a stroke, and clinical characteristics such as duration of hypertension, duration of treatment and comorbidities[\u003cspan additionalcitationids=\"CR26 CR27 CR28\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to different studies, patients with hypertension have little understanding of stroke prevention[\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and lack prevention practices for stroke[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], while the majority have a neutral attitudes toward its prevention[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Despite the notion that public awareness, practice, and a favorable attitudes toward stroke prevention are critical for reducing stroke incidence and prevalence, there is a lack of knowledge and practice in Ethiopia, especially in the study area. Furthermore, there has not been any research into people\u0026rsquo;s perceptions or attitudes about stroke prevention. Therefore, this study was aimed to fill these gaps by analyzing the level of knowledge, practices, and attitudes toward stroke prevention methods among patients with hypertension at Debre Markos Comprehensive Specialized Hospital (DMCSH) and Felege Hiwot Comprehensive Specialized Hospital (FHCSH).\u003c/p\u003e"},{"header":"2. METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Study area and period\u003c/h2\u003e\n \u003cp\u003eThe study was conducted at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals from June 01 to July 11, 2022. Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals are found in the Amhara Regional State, Northwest Ethiopia. These hospitals provide both inpatient and outpatient services including chronic health care services. The chronic illness follow up clinic is an overcrowded department with regular and referral patients for chronic health care services. Approximately 448 and 440 hypertensive patients visited the department each month at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Study design\u003c/h2\u003e\n \u003cp\u003eA hospital-based cross-sectional study design was used.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3. Population\u003c/h2\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.1. Source population\u003c/h2\u003e\n \u003cp\u003eAll hypertensive patients who were admitted to the chronic illness follow-up clinic at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.2. Study population\u003c/h2\u003e\n \u003cp\u003eAll hypertensive patients who visited Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals Chronic Follow-up Clinic during the data collection period.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4. Eligibility criteria\u003c/h2\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.1. Inclusion criteria\u003c/h2\u003e\n \u003cp\u003eAll hypertensive patients who were \u0026ge;\u0026thinsp;18 years old and came to Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals Chronic Follow-up Clinic during the data collection period.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003e2.4.2. Exclusion criteria\u003c/h2\u003e\n \u003cp\u003eAll hypertensive patients who were seriously ill and unable to communicate.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5. Sample size determination and procedure\u003c/h2\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003e2.5.1. Sample size determination\u003c/h2\u003e\n \u003cp\u003eTo determine the sample size, both single and double population proportion formulas were used. For the dependent variables, a single population proportion formula was used by considering the following assumptions: proportion of good knowledge, 40.7%[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]; favorable attitude, 50% (since no previous study); good practice, 51.7%[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]; 95% confidence interval; and 5% marginal error. The calculation results sample size for knowledge\u0026thinsp;=\u0026thinsp;371, for attitude\u0026thinsp;=\u0026thinsp;384 and for practice\u0026thinsp;=\u0026thinsp;384.\u003c/p\u003e\n \u003cp\u003eThe following assumptions were used for significantly associated factors according to calculations of the cohort or cross-sectional sample size from StatCalc: percentage of patients who were unexposed and exposed, 82.5% and 97.1% for age,16.5% and 37.65% for duration of hypertension, 21.48% and 52.49% for residence, 19.1% and 55.69% for level of education, respectively, with a 95% confidence interval, 80% power, 1 ratio of unexposed to exposed patients. Accordingly, sample size by Fleiss w/cc formula from StatCalc software became 160 for age, 156 for duration of hypertension, 88 for residence and 64 hypertensive patients for level of education, respectively\u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSince the maximum sample size was obtained by using a single population proportion formula, the final sample size after adding a 10% nonresponse rate was 423 according to estimated proportion of good stroke prevention practices 51.7% from previous study conducted in Gondar[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003ei. e., n= \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\left(Z\\frac{\\alpha\\:}{2}\\right)\\)\u003c/span\u003e\u003c/span\u003e\u003csup\u003e2\u003c/sup\u003e x P (1-p)/\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{d}^{2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003en=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\left(1.96\\right)}^{2}\\)\u003c/span\u003e\u003c/span\u003ex (0.517) (0.483)/ (0.05)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;384\u0026thinsp;+\u0026thinsp;10% = 422.4\u0026thinsp;~\u0026thinsp;423\u003c/p\u003e\n \u003cp\u003ewhere n\u0026thinsp;=\u0026thinsp;estimated sample size\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;proportion of good practices for stroke prevention\u003c/p\u003e\n \u003cp\u003ed\u0026thinsp;=\u0026thinsp;margin of error\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of sample size determination for each objective.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObjectives\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProportion/P value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConfidence Interval(CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMarginal error\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSample Size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy at Gondar[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. Attitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy at Gondar[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUn exposed: Exposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e% outcome\u003c/p\u003e\n \u003cp\u003ein unexposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e% outcome in exposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFleiss w/cc sample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy at Nigeria[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. duration of hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy at Debre Tabor[\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. Residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy at Gondar[\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4. Level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy at Gondar[\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n \u003ch2\u003e2.5.2. Sampling procedure\u003c/h2\u003e\n \u003cp\u003eA systematic sampling technique was used to select the study participants after proportionate allocation of a sample size to each hospital. The first case was selected within the interval by the lottery method, and it was 2. Then, the remaining eligible participants were recruited every 2nd interval untill the required sample was obtained\u003cstrong\u003e(\u003c/strong\u003eFig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e2.6. Study variables\u003c/h2\u003e\n \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\n \u003ch2\u003e2.6.1. Dependent variables\u003c/h2\u003e\n \u003cp\u003eKnowledge of stroke prevention\u003c/p\u003e\n \u003cp\u003eAttitude toward stroke prevention\u003c/p\u003e\n \u003cp\u003eStroke prevention practice\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003e2.6.2. Independent variables\u003c/h2\u003e\n \u003cp\u003eSociodemographic factors (age, sex, residence, religion, occupation, educational status, marital status, monthly income, prior information, knowing someone with a stroke, social support)\u003c/p\u003e\n \u003cp\u003eClinical factors(duration of hypertension, duration of treatment, previous history of stroke, family history of stroke, comorbidity)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e2.7. Operational definitions\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eGood knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe scores for each knowledge-related question were summarized, and the overall knowledge score of the participants was subsequently calculated. Respondents who scored more than or equal to the computed mean knowledge score were categorized as having good knowledge[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFavorable attitude\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe scores for each attitude-related item were summarized, and the responses were categorized into favorable and unfavorable attitudes. Respondents who scored more than or equal to the computed mean attitude score were considered to have a favorable attitude.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGood practice\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe scores for each practice-related item were summarized, and the overall practice score of the respondents was calculated. Respondents who scored more than or equal to the computed mean practice score were considered to have good practices[\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial support\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRespondents who completed the 3- item Oslo Social Support Scale (OSSS) 3\u0026ndash;8, 9\u0026ndash;11, or 12\u0026ndash;14 are classified as having poor social support, moderate social support, or strong social support, respectively[\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRegular exercise\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThree times per week for 50 minutes of aerobic exercise, such as walking, jogging, and swimming[\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSalt reduction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe daily recommended salt intake is not more than 2.0 g per day (equivalent to \u0026frac12; tea spoon). However, if home-prepared spices contain salt the addition of salt should be restricted[\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e2.8. Data collection procedure\u003c/h2\u003e\n \u003cp\u003eSix BSc holder nurses for data collection and two BSc nurses for supervision who were not employees of the study hospitals were selected to reduce a possible sources of bias. The data collectors approached the participants politely and respectfully and explained the purpose of the study and its possible benefits. The supervisors monitored the data collection process of the data collectors and if any problems occurred, they attempted to solve them or contact the principal investigator.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e2.9. Data collection tool\u003c/h2\u003e\n \u003cp\u003eA structured closed-ended questionnaire was prepared according to the objectives of the study and adapted from different relevant works in the literature [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e]. Then, the questionnaire was translated to Amharic by an expert and retranslated back to English by another individual for analysis and to check for any inconsistencies. The questionnaire has six parts: sociodemographic characteristics, which include eleven items; clinical-related factors which include five questions; and stroke prevention knowledge, which includes twelve items with yes, no or do not know responses, and scores of 1, 2, or 3, respectively. The scale for stroke prevention attitudes contains ten Likert-type items ranging from 1\u0026thinsp;=\u0026thinsp;Strongly Disagree to 5\u0026thinsp;=\u0026thinsp;Strongly Agree responses, and the scale for stroke prevention practices contains eight items with yes or no possible responses and scores of 1 or 2, respectively. The Oslo Social Support Scale (OSSS) contains 3-items ranging from 3\u0026ndash;14.\u003c/p\u003e\n \u003cp\u003eThe internal consistency reliability of the outcome measures was examined through a pretest with 22 hypertensive patients from Injibara General Hospital using Cronbach\u0026rsquo;s \u0026alpha;. The specific values are 0.82, 0.69, and 0.71 for the knowledge, attitude and practice items, respectively. The content validity of the questionnaire was judged by two experts (one is an assistant professor in adult health nursing and a PhD candidate while the other is a medical doctor). Before the interviews, the questionnaires were arranged based on the content validity index (CVI) format and sent to them via email for evaluation. Based on their responses, item- content validity index (I-CVI) scores were calculated by dividing the expert agreement by the number of experts, and finally, the average of the I-CVI scores across all items was computed. Accordingly, the content validity indices are 0.92, 0.85 and 0.94 for knowledge, attitude and practice respectively, which indicates that the tool is acceptable. The client\u0026apos;s chart was reviewed to retrieve medical information (duration of hypertension, duration of treatment and comorbidity).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e2.10. Data quality control\u003c/h2\u003e\n \u003cp\u003eTraining on interview techniques was given to the data collectors one day before the data collection and supervision of the data collectors were performed by the supervisors. Each questionnaire was checked for completeness and missed values and those incomplete questionnaires were omitted from the analysis. Pretesting in 5% (22) of the sample was performed by the principal investigator at Injibara General Hospital to assess the content, and to correct unclear and vague issues on the questionnaire. Additional adjustments in the sequence and wording of the questionnaire were made based on the results of the pretest. The selected and trained supervisors supervised the data collectors on a daily basis for completeness and consistency of the completed questionnaires. In addition, the data were thoroughly cleaned and carefully entered into the computer before the beginning of the analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e2.11. Data processing and analysis\u003c/h2\u003e\n \u003cp\u003eThe collected data were checked for completeness, and the responses were coded and entered into the computer using the Epi data version 4.4 statistical package. The data were cleaned for inconsistencies, and then analyzed using SPSS version 25 statistical software. Descriptive statistics such as frequencies, percentages, mean values, and standard deviations were calculated. Graphical presentations such as tables and bar graphs were used to present the findings of the study. Crude Odds ratios (CORs), 95% confidence intervals (CIs), and P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were used to present the results of the bivariable analysis. All variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were entered into a multivariable logistic regression to assess the association between the independent and dependent variables. A multivariable logistic regression model with a back ward likelihood ratio method was used to assess factors associated with stroke prevention knowledge, attitudes, and practices, and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance. Multicollinearity was checked with the variance inflation factor, and its values were less than 5. Hosmer and Lemeshow goodness of fit was tested to check model fitness, and a model had p-values of 0.167, 0.806, and 0.774 for knowledge, attitude, and practice, respectively which is \u0026gt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003e2.12. Ethical consideration\u003c/h2\u003e\n \u003cp\u003eEthical approval was obtained from Debre Markos University, Health Science College Research and Ethical Review Committee. Before the beginning of the data collection, permission letter was provided to the two hospitals\u0026rsquo; administrative bodies for data collection. At the time of data collection, both written and informed verbal consent were obtained from the participants to confirm whether they were willing to participate. Those not willing to participate were given the right to do so. Coding was used to eliminate names and other personal identification of respondents throughout the study process to ensure participant confidentiality.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic characteristics of the study participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 423 hypertensive patients who were planned to be included in the study, 415 were interviewed for a response rate of 98%. Among the respondents, half of them were males. \u0026nbsp;The respondents\u0026rsquo; mean age was 53.12 years, with a standard deviation(SD) of \u0026plusmn; 16.166 years, and more than half (59.5%) of them were older than fifty years. The majority of respondents, 69.9% were urban dwellers. Three hundred fifty-five (85.5%) of participants were Orthodox Christianity followers\u003cstrong\u003e(Table 2)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTable 2: Sociodemographic characteristics of hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003eFrequency (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003e\u0026lt;50 years \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e168 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003e\u0026ge;50 years \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e247 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e209 (50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e206 (49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eResidence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e290 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e125 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eReligion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e355 (85.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eMuslim \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e46 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eProtestant \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e11 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eCatholic \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e3 (0.7) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e27 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e316 (76.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e36 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e36 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eEducational status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eUnable \u0026nbsp;to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e166 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eAble \u0026nbsp;to read and write\u003c/p\u003e\n \u003cp\u003e(have no formal education)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e72 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003ePrimary \u0026nbsp;education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e40 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eSecondary \u0026nbsp;education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e54 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eDiploma \u0026nbsp;and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e83 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eOccupational status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e104 (25.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e85 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e96 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e65 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e40 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e10 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eLabor worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e15 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eMonthly income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003e\u0026lt;5000 ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e284 (68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003e\u0026ge;5000 ETB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e131 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003ePrior information about stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e211 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e204 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eKnowing someone with a stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e115 (27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e300 (72.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 42.9856%;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e162 (39.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e147 (35.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.4317%;\"\u003e\n \u003cp\u003eStrong\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.5827%;\"\u003e\n \u003cp\u003e106 (25.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eApproximately half of the respondents (50.8%) had prior information about stroke. More than one-third of the participants had received information from health professionals during their visits \u003cstrong\u003e(Figure 2)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMore than half of the respondents (60.5%) were diagnosed, and nearly, three-fourths of the participants (72.3%) had followed up in the last five years respectively\u003cstrong\u003e(Table 3)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Clinical characteristics of hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eDuration of illness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e251 (60.5)\u003c/p\u003e\n \u003cp\u003e164 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eDuration of treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt;5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e300 (72.3)\u003c/p\u003e\n \u003cp\u003e115 (27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003ePrevious history of stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e57 (13.7)\u003c/p\u003e\n \u003cp\u003e358 (86.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eFamily \u0026nbsp;history of stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e18 (4.3)\u003c/p\u003e\n \u003cp\u003e397 (95.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003eDM comorbidity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e133 (32.0)\u003c/p\u003e\n \u003cp\u003e282 (68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLevel of knowledge of \u0026nbsp;stroke prevention\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe computed mean knowledge score for stroke prevention was 7.04 \u0026plusmn; 2.84 (mean \u0026plusmn; SD). The \u0026nbsp;percentage of respondents with good knowledge to prevent the occurrence of stroke among these at-risk populations was approximately 48.9% (95% CI: 44.0-53.8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with stroke prevention knowledge among hypertensive patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBivariable and multivariable logistic regression analyses were used to determine factors affecting knowledge on the prevention of stroke. To adjust for potential confounders, variables that were \u0026lt;0.25 in the bivariable analysis were entered into the multivariable logistic regression. The results revealed that urban residence, educational status, monthly income, prior information, and social support were significantly associated with knowledge of stroke prevention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe odds of having good knowledge of stroke prevention was two times greater among urban residents than among those living in rural areas (AOR = 1.96: 95% CI = 1.2-3.2). Educational status was positively related to stroke prevention knowledge in hypertensive patients. Compared with patients who were unable to read and write, hypertensive patients with primary education or secondary education and above had 3.7 and 2.4 times greater odds of having good stroke prevention knowledge, respectively (AOR=3.67: 95% CI=1.56-8.61) and (AOR= 2.42: 95% CI=1.5-3.99) compared to unable to read and write. Hypertensive patients who had a monthly income of \u0026ge;5000 ETB were 2.59 times more likely to have good knowledge than those whose monthly income was \u0026nbsp; \u0026lt;5000 ETB (AOR= 2.59: 95% CI=1.38-4.87). Patients who had prior information about stroke were 2.29 times more likely to have good stroke prevention knowledge than were those who had no information (AOR=2.29: 95% CI=1.33-3.96). Similarly, the odds of having good stroke prevention knowledge was three times greater among patients with strong social support (AOR= 3.09: 95% CI= 1.73-5.54) than among their counterparts \u003cstrong\u003e(Table 4)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTable 4: Factors associated with knowledge of stroke prevention among hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of stroke prevention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;50 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.31(0.89-1.95)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.4(0.95-2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003cp\u003e41 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.59(1.67-4.02)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.96(1.22-3.15)*\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.5(1.78-16.99)\u003c/p\u003e\n \u003cp\u003e1.37(0.68-2.77)\u003c/p\u003e\n \u003cp\u003e2.2(0.86-5.65)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnable \u0026nbsp;to read and write\u003c/p\u003e\n \u003cp\u003eAble \u0026nbsp;to read and write\u003c/p\u003e\n \u003cp\u003ePrimary \u0026nbsp;education\u003c/p\u003e\n \u003cp\u003eSecondary \u0026nbsp;education and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.35(0.73-2.50)\u003c/p\u003e\n \u003cp\u003e4.56(1.98-10.52)\u003c/p\u003e\n \u003cp\u003e3.07(1.92-4.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.11(0.59-2.11)\u003c/p\u003e\n \u003cp\u003e3.67(1.56-8.61)*\u003c/p\u003e\n \u003cp\u003e2.42(1.47-3.99)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.17(0.64-2.14)\u003c/p\u003e\n \u003cp\u003e0.25(0.14-0.45)\u003c/p\u003e\n \u003cp\u003e0.22(0.11-0.43)\u003c/p\u003e\n \u003cp\u003e0.59(0.32-1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly income\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5000\u003c/p\u003e\n \u003cp\u003e\u0026ge;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e4.54(2.88-7.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e2.59(1.38-4.87)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrior information about stroke\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.61(3.05-6.98)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.29(1.33-3.96)*\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowing someone with a stroke\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.89(2.44-6.22)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.79(0.98-3.31)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial support\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003eStrong\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e2.16(1.33-3.51)\u003c/p\u003e\n \u003cp\u003e4.12(2.51-6.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.53(0.87-2.67)\u003c/p\u003e\n \u003cp\u003e3.09(1.73-5.54)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of illness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.37(0.92-2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.45(0.94-2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of \u0026nbsp;stroke\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.98(0.93-9.51)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 247px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM comorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.99(0.69-1.58)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKey:\u003c/strong\u003e 1= reference group;\u0026nbsp;*= statistically significant at p \u0026lt; 0.05; abbreviations: COR= crude odds ratio, AOR= adjusted odds ratio, CI= confidence interval, DM= diabetes mellitus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLevel of attitude toward stroke prevention\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe computed mean attitude score for stroke prevention was 31.13 \u0026plusmn; 2.94 (mean \u0026plusmn; SD). Accordingly, 45.3% (95% CI:39.3-49.0) of patients had a favorable attitudes while 54.7% (95% CI: 49.8%-59.6%) of patients had an unfavorable attitudes toward stroke prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with stroke prevention attitudes among hypertensive patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the bivariable logistic regression analysis, attitudes toward stroke prevention was significantly associated with nine variables. After adjustment for potential confounders, duration of treatment was found to be significantly and positively associated with attitudes toward stroke prevention among hypertensive patients. The odds of having a favorable attitude was 1.68 times greater among patients treated for hypertension five years and above than among \u0026nbsp;those treated for hypertension less than five years (AOR=1.68: 95% CI= 1.08-2.59) \u003cstrong\u003e(Table 5)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5: Factors associated with attitudes toward stroke prevention among hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"637\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttitude toward stroke prevention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFavorable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnfavorable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;50 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.78(0.53-1.16)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnable \u0026nbsp;to read and write\u003c/p\u003e\n \u003cp\u003eAble \u0026nbsp;to read and write\u003c/p\u003e\n \u003cp\u003ePrimary \u0026nbsp;education\u003c/p\u003e\n \u003cp\u003eSecondary \u0026nbsp;education and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.22(0.67-2.21)\u003c/p\u003e\n \u003cp\u003e1.89(0.86-4.15)\u003c/p\u003e\n \u003cp\u003e0.97(0.62-1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.09(0.61-1.95)\u003c/p\u003e\n \u003cp\u003e1.06(0.60-1.86)\u003c/p\u003e\n \u003cp\u003e1.56(0.83-2.90)\u003c/p\u003e\n \u003cp\u003e1.46(0.78-2.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowing someone with a stroke\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.14(0.99-2.37)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.46(0.94-2.27)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of illness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.55 (1.04-2.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.69 (1.1-2.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.68(1.08-2.59)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious history of stroke\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.25(0.97-5.22)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.05(0.88-4.79)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of \u0026nbsp; stroke\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.49(0.84-7.43)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM comorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.41 (0.89-2.04)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKey: 1= reference group;\u0026nbsp;*= statistically significant at p \u0026lt; 0.05;\u0026nbsp;abbreviations: COR=crude odds ratio, AOR= adjusted odds ratio, CI= confidence interval, DM= diabetes mellitus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLevels of prevention practices for stroke\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe computed mean prevention practice for stroke patients was 5.31 \u0026plusmn; 1.14 (mean \u0026plusmn; SD). Accordingly, 44.1% (95% CI: 39.3-49.0) of the respondents had good practices while 55.9% (95% CI: 51%-60.7%) of the respondents had poor practices for stroke prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with stroke prevention practices among hypertensive patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLike knowledge and attitude, numerous associations were found to be significant in the bivariable analysis at a p-value \u0026lt; 0.25. Therefore, a multivariable approach was applied to determine which factors best explained and predicted stroke prevention practices. Consequently, several independent factors such as monthly income, social support, and having DM comorbidity, were significantly associated with good stroke prevention practices according to the multivariable analysis.\u003c/p\u003e\n\u003cp\u003eHypertensive patients who had a monthly income of \u0026nbsp;\u0026ge;5000 ETB were two times more likely to have good stroke prevention practices than those who had a monthly income less than 5000 ETB (AOR=2.05:95% CI= 1.26-3.35). Considering the respondents\u0026rsquo; level of social support, participants who had moderate and strong social support were 1.76 and 2.27 times more likely to have good practices, respectively, than those who had poor social support (AOR=1.76: 95% CI= 1.03-3.03) and (AOR=2.27: 95% CI= 1.30-3.96). On the other hand, patients with DM comorbidities had 5.8 times greater odds of engaging in stroke prevention practices (AOR=5.8: 95% CI= 3.62-9.31) than\u0026nbsp;those who did not have medical conditions other than hypertension \u003cstrong\u003e(Table 6)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTable 6: Factors associated with the practice of stroke prevention among hypertensive patients at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022 (n=415)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"637\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 408px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractice \u0026nbsp;of stroke prevention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.59 (0.2-1.7)\u003c/p\u003e\n \u003cp\u003e1.27 (0.63-2.54)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0.54(0.2-1.4)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.96(0.54-1.70)\u003c/p\u003e\n \u003cp\u003e1.04(0.59-1.81)\u003c/p\u003e\n \u003cp\u003e0.72(0.38-1.35)\u003c/p\u003e\n \u003cp\u003e0.48(0.25-0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly income\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;5000\u003c/p\u003e\n \u003cp\u003e\u0026ge;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;1.74(1.14-2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e2.05 (1.26-3.35)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial support\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003eStrong\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;1.55(0.96-2.50)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2.15(1.33-3.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1.76(1.03-3.03)*\u003c/p\u003e\n \u003cp\u003e2.27(1.30-3.96)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM comorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.46(3.33-8.19)\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.80(3.62-9.31)*\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKey: 1= reference group; *= statistically significant at p \u0026lt; 0.05; abbreviations: COR= crude odds ratio, AOR= adjusted odds ratio, CI= confidence interval, DM= diabetes mellitus\u0026nbsp;\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe present study was conducted to assess the level of knowledge, attitudes, and practices of hypertensive patients concerning the prevention of stroke among hypertensive patients. The findings of this study revealed that nearly half of the participants (48.9%, (44.0-53.8)) had adequate knowledge about stroke prevention, which is higher than that reported in the finding of previous studies in Ethiopia (Debre Tabor, 24.9% [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]; two studies in Gondar, 38.41%[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and 40.7%[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]; and Southeast India, 11.43%[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]). The possible reason for this discrepancy may be the fact that patients may be exposed to chronic noncommunicable diseases, including stroke, which have comparable risk factors and prevention strategies. Furthermore, there was a difference in sample size and classification criteria for good and poor knowledge. Respondents who scored 75% or above on the stroke prevention knowledge-related items were judged to have good stroke prevention knowledge in India. However, this result is lower than those of studies conducted in southern India, (66.7%)[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and Nigeria, (90.8%)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This may be due to sociodemographic differences in the study population. In contrast, approximately 70% of the respondents were educated in India and Nigeria.\u003c/p\u003e \u003cp\u003eUrban residents were two times more likely to have good knowledge of stroke prevention than were those living in rural areas. This finding is supported by research done in Debre Tabor[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and Gondar[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The possible reason may be the greater accessibility of information in urban areas than in rural areas.\u003c/p\u003e \u003cp\u003eAnother factor affecting stroke prevention knowledge among hypertensive patients was educational status. Hypertensive patients with primary education or secondary education and above had 3.7 and 2.4 times greater odds of having good stroke prevention knowledge, respectively than did those who were unable to read and write. This was in line with the findings of many studies, according to which having a high level of education was the most significant factor for hypertensive patients in Ethiopia [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], Nigeria [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], Ghana [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], Turkey [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], India [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and China [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The reason could be that patients who have at least completed their elementary education may have a greater probability of being exposed to various communication media, such as magazines, books, and the internet. Furthermore, a possible explanation could be that educated people have a better understanding of their health, pay attention to individual health problems, and then take healthy measures to ensure their health.\u003c/p\u003e \u003cp\u003eThe study showed that the odds of having good stroke prevention knowledge was 2.59 times greater among patients with a monthly income of \u0026ge;\u0026thinsp;5000 ETB than among patients with a monthly income below 5000 ETB. This finding is inline with a study conducted in Gondar [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The possible reason may be the accessibility of information through media and the internet in relation to stroke as patients with high monthly income may be able to buy and access it.\u003c/p\u003e \u003cp\u003ePrior information about stroke was another factor in stroke prevention among hypertensive patients. Patients who had prior information about stroke were 2.29 times more likely to have good stroke prevention knowledge than were those who had no information. Having strong social support from families, friends, and the community at large was found to be a factor for stroke prevention knowledge among hypertensive patients. Patients with strong social support were three times more likely to have good stroke prevention knowledge than their counterparts. This could be due to creating a chance for smooth interaction and area of discussion with others regarding their health problems.\u003c/p\u003e \u003cp\u003eIn this study, 44.1% (40.4\u0026ndash;50.2) of respondents had good prevention practices for stroke, which is consistent with a study done in Gondar, (42.67%)[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, this percentage is lower than that reported in other studies conducted in Gondar (51.7%)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and in two other studies in India (62.9%[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and 64%[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]). This discrepancy may be due to differences in sample size and classification criteria. In a study conducted in North India, participants were considered to have good practices if they were practiced 50% of the items related to stroke prevention.\u003c/p\u003e \u003cp\u003eFurthermore, stroke prevention practices were associated with high monthly income, moderate and strong social support, and having a concomitant disease. Those hypertensive patients with a monthly income of 5000 ETB and above were two times more likely to practice stroke prevention strategies than those who had a monthly income below 5000 ETB. This is because economical subjects have a better chance of finding information regarding the disease from various sources which is consistent with a study done in Gondar[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe level of social support was the other factor in stroke prevention strategies. Good stroke prevention practices were 1.76 and 2.27 times more likely among patients with moderate and strong social support, respectively, than among patients with poor social support. This could be because interpersonal relationships help patients to engage in desired practices by providing information about their disease and may serve as a role model for good habits. Moreover, patients with diabetes mellitus and hypertension were 5.8 times more likely to practice stroke prevention than patients with hypertension alone. This could be due to the fear of late complications of the two diseases.\u003c/p\u003e \u003cp\u003eApproximately 45.3% (39.3\u0026ndash;49.0) of the participants had a favorable attitude toward stroke prevention, which is lower than that reported in earlier studies in Southwest India, (64.3%)[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and South India, (73.8%)[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. A plausible reason for this discrepancy may be the small sample size. In the study conducted in South and Southwest India, 70 and 210 respondents participated respectively, which may increase the percentage of patients with a favorable attitude toward stroke prevention if the majority of them were positively intended to items related to stroke prevention attitudes, whereas 415 hypertensive patients participated in this study.\u003c/p\u003e \u003cp\u003ePatients\u0026rsquo; perceptions of stroke are crucial for better understanding and practicing preventive techniques. On the other hand, knowing the duration of treatment in hypertension management has great importance for the occurrence of hypertension-related complications. In this study, patients who received hypertension treatment for five years or more were 1.68 times more likely to have a favorable attitude toward stroke prevention than those who received hypertension treatment for less than five years. The possible reason could be a result of repeated follow-up contact with healthcare professionals, which can cause cognitive changes in stroke prevention strategies.\u003c/p\u003e"},{"header":"5. LIMITATIONS OF THE STUDY","content":"\u003cp\u003eSince the practice of patients towards stroke prevention was assessed through self-reported practice, it may be exposed to social desirability bias and hence may increase the percentage of good practice. There may also recall-bias due to expressed practice. Hypertension medication adherence was not assessed. Clinical variables like BP, PR, ECG finding and cardiac enzymes were not included.\u003c/p\u003e"},{"header":"6. CONCLUSION AND RECOMMENDATION","content":"\u003ch2\u003e6.1.\u0026nbsp;Conclusion\u003c/h2\u003e\n\u003cp\u003eNearly half of the hypertensive patients had good knowledge of stroke prevention. Urban residency, educational status, high monthly income, having prior information about stroke, and social support were all strongly associated with good stroke prevention knowledge. Approximately four out of nine participants had good practices for stroke prevention. Monthly income, social support and having diabetes as a comorbidity were significantly associated with stroke prevention practices among hypertensive patients. More than half of the hypertensive patients at Debre Markos and Felege Hiwot Comprehensive and Specialized Hospitals had unfavorable attitudes toward stroke prevention, and the length of treatment was found to be significantly \u0026nbsp;associated with favorable attitudes toward stroke prevention.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e6.2. Recommendations\u003c/h2\u003e\n\u003col style=\"list-style-type: lower-roman;\"\u003e\n \u003cli\u003eHealth care workers should disseminate information for hypertensive patients early in their appointment to enhance their knowledge, attitudes and practices regarding stroke prevention.\u003c/li\u003e\n \u003cli\u003eFamilies, friends, neighbors, and communities at large should support and encourage hypertensive patients to engage in stroke prevention practices.\u003c/li\u003e\n \u003cli\u003eOther researchers should assess patient practices related to stroke prevention using observational checklists.\u003c/li\u003e\n \u003cli\u003eResearchers should conduct research on other risky population segments.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDALYs: Disability Adjusted Life Years Lost; DMCSH: Debre Markos Comprehensive Specialized Hospital; ETB: Ethiopian Birr; FHCSH: Felege Hiwote Comprehensive Specialized Hospital; I-CVI: Item- Content Validity Index; OSSS: Oslo Social Support Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from Debre Markos University, Health Science College Research and Ethical Review Committee. Before the beginning of the data collection, \u0026nbsp;permission letter was provided to the two hospitals’ administrative bodies for data collection. At the time of data collection, both written and informed verbal consent were obtained from the participants to confirm whether they were willing to participate. Those not willing to participate were given the right to do so. Coding was used to eliminate names and other personal identification of respondents throughout the study process to ensure participant confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that there are no competing intersts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e There was no funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWT conceptualized and drafted the proposal and data collection tools. WT, AD and SA were involved in formal analysis, validation and report writing. \u0026nbsp; WT and MG were prepared the manuscript. \u0026nbsp; All authors were \u0026nbsp;critically \u0026nbsp;reviewed \u0026nbsp; and revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Debre Markos University for material support for this research. The authors are also grateful to hospital administrators, content validity experts, study participants and data collectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eR. L. Sacco, S. E. Kasner, J. P. Broderick, L. R. Caplan, J. Connors, A. Culebras\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association,\u0026quot; \u003cem\u003eStroke, \u003c/em\u003evol. 44, pp. 2064-2089, 2013.\u003c/li\u003e\n\u003cli\u003eW. Walelgne, D. Yadeta, Y. Feleke, and T. Kebede, \u0026quot;Guidelines on Clinical and Programmatic Management of Major Non Communicable Diseases,\u0026quot; \u003cem\u003eAddis Ababa: Federal Democratic Republic of Ethiopia Ministry of Health, \u003c/em\u003e2016.\u003c/li\u003e\n\u003cli\u003eL. H. Pellico, C. Bautista, and C. Esposito, \u003cem\u003eFocus on adult health medical-surgical nursing\u003c/em\u003e, 2012.\u003c/li\u003e\n\u003cli\u003eJ. L. Hinkle and K. H. Cheever, \u003cem\u003eBrunner and Suddarth\u0026rsquo;s textbook of medical-surgical nursing\u003c/em\u003e: Wolters kluwer india Pvt Ltd, 2018.\u003c/li\u003e\n\u003cli\u003eL. S. Williams and P. D. Hopper, \u003cem\u003eUnderstanding medical surgical nursing\u003c/em\u003e: FA Davis, 2015.\u003c/li\u003e\n\u003cli\u003eV. L. Feigin, B. A. Stark, C. O. Johnson, G. A. Roth, C. Bisignano, G. G. Abady\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Global, regional, and national burden of stroke and its risk factors, 1990\u0026ndash;2019: A systematic analysis for the Global Burden of Disease Study 2019,\u0026quot; \u003cem\u003eThe Lancet Neurology, \u003c/em\u003evol. 20, pp. 795-820, 2021.\u003c/li\u003e\n\u003cli\u003eV. L. Feigin, M. Brainin, B. Norrving, S. Martins, R. L. Sacco, W. Hacke\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;World Stroke Organization (WSO): Global Stroke Fact Sheet 2022,\u0026quot; \u003cem\u003eInternational Journal of Stroke, \u003c/em\u003evol. 17, pp. 18-29, 2022.\u003c/li\u003e\n\u003cli\u003eM. O. Owolabi, A. G. Thrift, A. Mahal, M. Ishida, S. Martins, W. D. Johnson\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Primary stroke prevention worldwide: translating evidence into action,\u0026quot; \u003cem\u003eThe Lancet Public Health, \u003c/em\u003e2021.\u003c/li\u003e\n\u003cli\u003eC. W. Tsao, A. W. Aday, Z. I. Almarzooq, A. Alonso, A. Z. Beaton, M. S. Bittencourt\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Heart disease and stroke statistics\u0026mdash;2022 update: a report from the American Heart Association,\u0026quot; \u003cem\u003eCirculation, \u003c/em\u003evol. 145, pp. e153-e639, 2022.\u003c/li\u003e\n\u003cli\u003eA. G. Adams, D. Schweitzer, P. Molenberghs, and J. D. Henry, \u0026quot;A meta-analytic review of social cognitive function following stroke,\u0026quot; \u003cem\u003eNeuroscience \u0026amp; Biobehavioral Reviews, \u003c/em\u003evol. 102, pp. 400-416, 2019.\u003c/li\u003e\n\u003cli\u003eM. Mapulanga, S. Nzala, and C. Mweemba, \u0026quot;The Socio‑economic Impact of Stroke on Households in Livingstone District, Zambia: A Cross‑sectional Study,\u0026quot; \u003cem\u003eAnnals of medical and health sciences research, \u003c/em\u003evol. 4, pp. 123-127, 2014.\u003c/li\u003e\n\u003cli\u003eD. Smajlović, \u0026quot;Strokes in young adults: epidemiology and prevention,\u0026quot; \u003cem\u003eVascular health and risk management, \u003c/em\u003evol. 11, p. 157, 2015.\u003c/li\u003e\n\u003cli\u003eR. W. Walker, A. Jusabani, E. Aris, W. K. Gray, D. Whiting, G. Kabadi\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Post-stroke case fatality within an incident population in rural Tanzania,\u0026quot; \u003cem\u003eJournal of Neurology, Neurosurgery \u0026amp; Psychiatry, \u003c/em\u003evol. 82, pp. 1001-1005, 2011.\u003c/li\u003e\n\u003cli\u003eR. Walker, D. Whiting, N. Unwin, F. Mugusi, M. Swai, E. Aris\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Stroke incidence in rural and urban Tanzania: a prospective, community-based study,\u0026quot; \u003cem\u003eThe Lancet Neurology, \u003c/em\u003evol. 9, pp. 786-792, 2010.\u003c/li\u003e\n\u003cli\u003eM. J. O\u0026apos;donnell, D. Xavier, L. Liu, H. Zhang, S. L. Chin, P. Rao-Melacini\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study,\u0026quot; \u003cem\u003eThe Lancet, \u003c/em\u003evol. 376, pp. 112-123, 2010.\u003c/li\u003e\n\u003cli\u003eM. Jaberinezhad, M. Farhoudi, S. A. Nejadghaderi, M. Alizadeh, M. J. Sullman, K. Carson-Chahhoud\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;The burden of stroke and its attributable risk factors in the Middle East and North Africa region, 1990\u0026ndash;2019,\u0026quot; \u003cem\u003eScientific reports, \u003c/em\u003evol. 12, pp. 1-11, 2022.\u003c/li\u003e\n\u003cli\u003eP. LeMone, K. Burke, T. Levett-Jones, T. Dwyer, L. Moxham, K. Reid-Searl\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Medical-surgical nursing: Critical thinking for person-centred care,\u0026quot; 2014.\u003c/li\u003e\n\u003cli\u003eZ. Gaciong, M. Siński, and J. Lewandowski, \u0026quot;Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses,\u0026quot; \u003cem\u003eCurrent hypertension reports, \u003c/em\u003evol. 15, pp. 559-574, 2013.\u003c/li\u003e\n\u003cli\u003eS. A. Gebremariam and H. S. Yang, \u0026quot;Types, risk profiles, and outcomes of stroke patients in a tertiary teaching hospital in northern Ethiopia,\u0026quot; \u003cem\u003eeNeurologicalSci, \u003c/em\u003evol. 3, pp. 41-47, Jun 2016.\u003c/li\u003e\n\u003cli\u003eE. S. Greffie, T. Mitiku, and S. Getahun, \u0026quot;Risk factors, clinical pattern and outcome of stroke in a referral hospital, Northwest Ethiopia,\u0026quot; \u003cem\u003eClin Med Res, \u003c/em\u003evol. 4, pp. 182-188, 2015.\u003c/li\u003e\n\u003cli\u003eG. Fekadu, L. Chelkeba, and A. Kebede, \u0026quot;Risk factors, clinical presentations and predictors of stroke among adult patients admitted to stroke unit of Jimma university medical center, south west Ethiopia: prospective observational study,\u0026quot; \u003cem\u003eBMC neurology, \u003c/em\u003evol. 19, pp. 1-11, 2019.\u003c/li\u003e\n\u003cli\u003eJ. D. Pandian, S. L. Gall, M. P. Kate, G. S. Silva, R. O. Akinyemi, B. I. Ovbiagele\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Prevention of stroke: a global perspective,\u0026quot; \u003cem\u003eThe Lancet, \u003c/em\u003evol. 392, pp. 1269-1278, 2018.\u003c/li\u003e\n\u003cli\u003eJ. Pol\u0026iacute;vka, V. Rohan, and P. \u0026Scaron;evč\u0026iacute;k, \u0026quot;Personalized approach to primary and secondary prevention of ischemic stroke,\u0026quot; \u003cem\u003eEPMA Journal, \u003c/em\u003evol. 5, pp. 1-7, 2014.\u003c/li\u003e\n\u003cli\u003eE. S. O. E. Committee and E. W. Committee, \u0026quot;Guidelines for management of ischaemic stroke and transient ischaemic attack 2008,\u0026quot; \u003cem\u003eCerebrovascular diseases, \u003c/em\u003evol. 25, pp. 457-507, 2008.\u003c/li\u003e\n\u003cli\u003eN. S. Tibebu, T. D. Emiru, C. M. Tiruneh, A. B. Nigat, M. W. Abate, and A. T. Demelash, \u0026quot;Knowledge on prevention of stroke and its associated factors among hypertensive patients at Debre Tabor general hospital: an institution-based cross-sectional study,\u0026quot; \u003cem\u003eRisk Management and Healthcare Policy, \u003c/em\u003evol. 14, p. 1681, 2021.\u003c/li\u003e\n\u003cli\u003eA. B. Mekuria, Z. D. Kifle, and A. D. Melak, \u0026quot;Level of knowledge, prevention practice, and predictors towards stroke among diabetic and hypertensive patients having a follow up at University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia. A cross-sectional study,\u0026quot; \u003cem\u003eClinical Epidemiology and Global Health, \u003c/em\u003ep. 100950, 2022.\u003c/li\u003e\n\u003cli\u003eS. A. Arisegi, K. J. Awosan, M. O. Oche, A. A. Sabir, and M. T. Ibrahim, \u0026quot;Knowledge and practices related to stroke prevention among hypertensive and diabetic patients attending Specialist Hospital, Sokoto, Nigeria,\u0026quot; \u003cem\u003ePan African Medical Journal, \u003c/em\u003evol. 29, pp. 1-17, 2018.\u003c/li\u003e\n\u003cli\u003eD. Girma, \u0026quot;Knowledge, attitude and practice of new stroke patients and their caregivers towards stroke: A HOSPITAL BASED INTERVIEW,\u0026quot; 2017.\u003c/li\u003e\n\u003cli\u003eG. Azeze, F. K. Woldetsadik, T. Kassa, W. Hailu, and Y. Girma, \u0026quot;Stroke Related Knowledge, Prevention Practices and Associated Factors Among Hypertensive Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021,\u0026quot; \u003cem\u003eFrontiers in Neurology, \u003c/em\u003ep. 699, 2022.\u003c/li\u003e\n\u003cli\u003eL.-H. Wan, J. Zhao, X.-P. Zhang, S.-F. Deng, L. Li, S.-Z. He\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Stroke prevention knowledge and prestroke health behaviors among hypertensive stroke patients in mainland China,\u0026quot; \u003cem\u003eJournal of Cardiovascular Nursing, \u003c/em\u003evol. 29, pp. E1-E9, 2014.\u003c/li\u003e\n\u003cli\u003eR. Sinha, P. Verma, K. K. Rohilla, and C. V. Kalyani, \u0026quot;Hypertensive Patients Knowledge, Attitude and Practice for Stroke Prevention in Uttarakhand, India,\u0026quot; \u003cem\u003eCommunity Med, \u003c/em\u003evol. 11, pp. 385-389, 2020.\u003c/li\u003e\n\u003cli\u003eS. KP, K. Athira, and H. G. MJ, \u0026quot;Awareness and attitude towards stroke and its prevention among hypertensive and non-hypertensive people,\u0026quot; \u003cem\u003eAsian J Pharm Clin Res, \u003c/em\u003evol. 11, pp. 39-42, 2018.\u003c/li\u003e\n\u003cli\u003eA. D. Melak, D. Wondimsigegn, and Z. D. Kifle, \u0026quot;Knowledge, Prevention Practice and Associated Factors of Stroke Among Hypertensive and Diabetic Patients\u0026ndash;A Systematic Review,\u0026quot; \u003cem\u003eRisk Management and Healthcare Policy, \u003c/em\u003evol. 14, p. 3295, 2021.\u003c/li\u003e\n\u003cli\u003eR.-D. Kocalevent, L. Berg, M. E. Beutel, A. Hinz, M. Zenger, M. H\u0026auml;rter\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;Social support in the general population: standardization of the Oslo social support scale (OSSS-3),\u0026quot; \u003cem\u003eBMC psychology, \u003c/em\u003evol. 6, pp. 1-8, 2018.\u003c/li\u003e\n\u003cli\u003eW. H. Organization, \u0026quot;Technical package for cardiovascular disease management in primary health care: healthy-lifestyle counselling,\u0026quot; World Health Organization2018.\u003c/li\u003e\n\u003cli\u003eA. H. Lichtenstein, L. J. Appel, M. Vadiveloo, F. B. Hu, P. M. Kris-Etherton, C. M. Rebholz\u003cem\u003e, et al.\u003c/em\u003e, \u0026quot;2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association,\u0026quot; \u003cem\u003eCirculation, \u003c/em\u003evol. 144, pp. e472-e487, 2021.\u003c/li\u003e\n\u003cli\u003eJ. Babu, \u0026quot;Knowledge, Attitude and Practice towards Stroke among General Population,\u0026quot; JKK Nattraja College of Pharmacy, Kumarapalayam, 2019.\u003c/li\u003e\n\u003cli\u003eA. N. Madubuko, \u0026quot;Stroke Risk Factor Knowledge, Attitude, Prevention Practices, and Stroke,\u0026quot; Walden University, 2018.\u003c/li\u003e\n\u003cli\u003eR. R. Pradhan, A. Jha, S. Bhandari, S. Ojha, and R. Karn, \u0026quot;Knowledge, attitude, and practice of stroke and thrombolysis among students preparing for undergraduate medical entrance examination in Kathmandu, Nepal,\u0026quot; \u003cem\u003eHealth Science Reports, \u003c/em\u003evol. 4, p. e268, 2021.\u003c/li\u003e\n\u003cli\u003eH. S. J. Cecily, \u0026quot;Knowledge on Prevention of Cerebro Vascular Accident among Patients with Diabetes and Hypertension in India,\u0026quot; \u003cem\u003eIJSR International Journal of Science and Research (IJSR), \u003c/em\u003evol. 5, pp. 1401-1404, 2016.\u003c/li\u003e\n\u003cli\u003eU. Venkatesh and D. Srivastava, \u0026quot;Knowledge, attitude and practice in relation to stroke: comparative study between hypertensive and non-hypertensive patients attending a tertiary care centre in Gorakhpur, Uttar Pradesh,\u0026quot; \u003cem\u003eIndia J Med Sci Clin Res, \u003c/em\u003evol. 4, pp. 15014-15021, 2016.\u003c/li\u003e\n\u003cli\u003eA. T. Abate, N. Bayu, and T. G. Mariam, \u0026quot;Hypertensive patients\u0026rsquo; knowledge of risk factors and warning signs of stroke at Felege Hiwot referral hospital, Northwest Ethiopia: a cross-sectional study,\u0026quot; \u003cem\u003eNeurology Research International, \u003c/em\u003evol. 2019, 2019.\u003c/li\u003e\n\u003cli\u003eP. K. Ampiah, \u0026quot;Ampiah_et_al., 2018 Knowledge of Stroke among Hypertensive-Diabetic Patients at the National Diabetes Management and Research Centre of Korle-Bu Teaching Hospital in Ghana,\u0026quot; \u003cem\u003eJournal of Preventive and Rehabilitative Medicine, \u003c/em\u003evol. 1, pp. 46-62, 2018.\u003c/li\u003e\n\u003cli\u003eS. Ozkan and N. Ata, \u0026quot;Stroke awareness in people with hypertension,\u0026quot; 2019.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Debre Markos University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"knowledge, attitude, practice, stroke, prevention, hypertension","lastPublishedDoi":"10.21203/rs.3.rs-5629723/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5629723/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eHypertension causes narrowing, rupture, or leakage of blood vessels. This causes stroke by interrupting the blood flow to the brain. The prevalence, incidence, and disability of stroke have surged due to poor knowledge, poor practices, and unfavorable attitudes toward stroke prevention. Awareness of the problem, good prevention practices, and a favorable attitudes toward prevention mechanisms are the milestones to prevent stroke among hypertensive patients. \u003cstrong\u003eObjective: \u003c/strong\u003eThis study was aimed to assess knowledge, attitudes, and practices related to stroke prevention and associated factors among hypertensive patients attending at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA cross-sectional study design was conducted at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals, Chronic Illness Follow-up Clinic from June 01 to July 11, 2022. A systematic random sampling technique was used to select 423 study participants. The data were collected using pretested and structured questionnaires through face-to-face exit interviews and chart reviews. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25 software. The associations between explanatory variables and outcome variables were \u0026nbsp;analyzed by using a multivariable logistic regression model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe findings of this study showed that 48.9% (95% CI: 44.0-53.8), 45.3% (95% CI: 40.4-50.2), and 44.1% (95% CI: 39.3-49.0) of the participants had good knowledge, favorable attitudes, and good practices respectively. The factors associated with good stroke prevention knowledge included urban residence (AOR=1.96 (1.22-3.15)), primary education (AOR=3.67 (1.56-8.61)) or secondary education and above (AOR=2.42 (1.47-3.99)), having monthly income ≥ 5000 Ethiopian birr (AOR=2.59 (1.38-4.87)), prior information about stroke (AOR=2.29 (1.33-3.96)) and strong social support (AOR=3.09 (1.73-5.54)). Similarly, having monthly income ≥ 5000 Ethiopian birr (AOR=2.05 (1.26-3.35)), moderate (AOR=1.76 (1.03-3.03)) and strong social support (AOR=2.27 (1.3-3.96)) and diabetes mellitus comorbidity (AOR=5.8: 95% CI= 3.62-9.31)) were significantly associated with good stroke prevention practices. On the other hand, duration of treatment (AOR=1.68 (1.08-2.59)) was a statistically and positively associated factor with a favorable attitude toward stroke prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation: \u003c/strong\u003eNearly half of the respondents had good knowledge of stroke prevention and four out of nine participants had favorable attitudes toward stroke prevention and good prevention practices. Health care workers should dessiminate information for hypertensive patients early in their appointment to enhance their knowledge, attitudes and practices toward stroke prevention. Families , friends, neighbors, and the communities at large should support and encourage hypertensive patients to engage in stroke prevention practices.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitude And Practice Toward Stroke Prevention And Associated Factors Among Hypertensive Patients Attending At Debre Markos And Felege Hiwot Comprehensive Specialized Hospitals, Northwest Ethiopia, 2022.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-13 15:04:01","doi":"10.21203/rs.3.rs-5629723/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d6b456e-448b-44ca-9339-80e55bea1e2f","owner":[],"postedDate":"December 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":41517041,"name":"Nursing"}],"tags":[],"updatedAt":"2024-12-13T15:04:01+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-13 15:04:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5629723","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5629723","identity":"rs-5629723","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}