Health Literacy Regarding Stroke Recognition and Emergency Medical Services Utilization Among Patients with Acute Stroke in Thailand: A Multicenter Cross-Sectional Study

Early stroke recognition and EMS activation reduce prehospital delay. This study assessed stroke-related health literacy and EMS utilization among patients with acute stroke in Thailand, as well as factors associated with timely hospital arrival (≤4.5 hours).

A multicenter cross-sectional study included 1,292 patients with acute stroke from four tertiary hospitals in Thailand. Structured interviews and medical-record review assessed stroke knowledge, perceived severity, EMS awareness, attitudes toward EMS utilization, and healthcare access. A generalized linear mixed model with hospital as a random effect was used to examine factors associated with timely arrival.

Moderate stroke knowledge was observed among 600 participants (46.4%), moderate perceived severity among 500 (38.7%), and moderate EMS attitudes among 560 (43.3%). Awareness of the national EMS number (1669) was reported by 640 (49.5%), and 625 (48.4%) had previous EMS experience. Timely arrival occurred in 650 (50.3%). Significant factors were sudden symptom onset (aOR 2.50, 95% CI 1.85-3.35), moderate NIHSS severity (aOR 2.00, 95% CI 1.40-2.85), severe NIHSS severity (aOR 4.50, 95% CI 2.80-7.20), awareness of 1669 (aOR 1.70, 95% CI 1.30-2.20), caregiver assistance (aOR 3.75, 95% CI 2.79-5.05), and distance ≥35 km (aOR 4.10, 95% CI 3.00-5.60) (all p<0.001).

Stroke-related health literacy was generally moderate, but gaps in EMS awareness remained. Timely arrival was associated with symptom characteristics, stroke severity, EMS awareness, caregiver support, and access factors.

Strengthening stroke-symptom recognition, EMS number awareness, caregiver preparedness, and access to emergency care may support earlier hospital arrival.