We conducted a survey of community doctors from nine communities (Chunxi, Yanshikou, Niushikou, Hongsha, Jinjiang, Lianxin, Wanke, Quan subtree, and Daci temple) in the Jinjiang district of Chengdu (China) from February 2017 to February 2019. According to the method for estimating the minimum sample size of quantitative data recommended by the Chinese Residents of Nutrition and Health Survey in 2002, 450 community doctors in Jinjiang district was considered an appropriate sample number and these doctors were randomly selected. A cluster sampling method was adopted, selecting 50 doctors in each community.
Ethical approval for this study was obtained from the Medical and Health Research Ethics Committee of the Second People’s Hospital of Chengdu, China. Written informed consent was obtained from all the participants. All methods were carried out in accordance with relevant guidelines and regulations.
Based on the Chinese guidelines for the diagnosis and treatment of AIS in 2010 and the Chinese guidelines for the secondary prevention of ischemic stroke and transient ischemic attack (TIA) in 2010, a questionnaire on the current status of stroke management ability of community doctors was designed to conduct a cluster sampling survey among residents from nine communities in the Jinjiang district . The questionnaire contained 23 questions, which were divided into three main sections:
(1) Basic information: sex, age, education, title, specialty before engaging in community health services, general practitioner training status, time spent performing clinical work, engagement in community health services, etc.
(2) Concepts related to early recognition and emergency treatment for stroke: pre-hospital stroke identification, assessment (including knowledge of stroke warning signs), and processing (awareness of thrombolytic therapy and its time window; airway management; assessment of circulation; monitoring of heart function, inhaled oxygen supply, and blood glucose; establishment of intravenous route; and transfer of patients to the nearest comprehensive stroke center as soon as possible).
(3) Knowledge about secondary stroke prevention: risk factors for stroke; definition and management of TIA; general and ideal goal for target blood pressure, HbA1c, and international normalized ratio levels; awareness of statin, warfarin, and antiplatelet therapies and their side effects. We conducted stroke health education activities with the theme “understanding stroke” and evaluated the outcome. We designed a series of intensive stroke management training courses for community doctors according to the relevant guidelines for cerebrovascular prevention and treatment in China [6-8], including the management of major modifiable risk factors for stroke (hypertension, smoking, diabetes, carotid stenosis, atrial fibrillation, dyslipidemia, lack of physical exercise, unhealthy dietary habits, alcohol consumption, drug abuse, and obesity). Intensive training was conducted through face-to-face lectures, online training, and distribution of handouts and information manuals by experts in the area. The doctors were reassessed after the intensive training, using the self-designed questionnaire, to determine whether the training could improve their stroke management ability.
All statistical analyses were performed using IBM SPSS software, V. 22.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistical analysis was performed to assess the general characteristics of respondents before and after the training. Continuous and normally distributed variables were expressed as the mean ± standard deviation, and variables not normally distributed were expressed as medians (interquartile ranges). Categorical data were described as frequencies and percentages. A non-parametric test was performed to compare the influence of different factors as well as the effect of intensive training on the community doctors’ stroke prevention ability. Spearman’s rank correlation analysis was performed on the total knowledge score and sociodemographic characteristics of the doctors, such as age, sex, and educational level. Statistical significance was set at p < 0.05.