used history of stroke or transient ischemic attack (TIA) of the respondent, while Rowe et al (2001) used both a previous history of stroke of the respondent and family history of stroke. Although Rowe and co-workers used both an individual’s past history of stroke and family history of stroke in the analysis, only the latter was a significant independent predictor of knowledge of stroke warning signs. In contrast to the findings of Pancioli and colleagues, Yoon et al (2001a, 2001b) found that history of stroke was not an independent predictor of increased knowledge of warning signs. The majority of evidence presented here indicates relatively low levels of knowledge of stroke warning signs among members of the general public. To improve this situation, it is necessary to determine the sources of information regarding stroke. Among the studies reviewed here, one of the more frequently cited sources of information was friends and family members who had suffered a stroke. Between 20% and 70% of respondents in five separate studies (Pancioli et al 1998; Hux et al 2000; Yoon et al 2001b; Parahoo et al 2003; Schneider et al 2003) cited these people as sources of stroke knowledge. Mass media also appears to be an effective source of information, with 20%–30% of respondents noting newspapers, magazines, and television as their source of information regarding stroke. Less frequently, doctors and hospital personnel were cited as sources of stroke information, being cited by only 13%–20% of respondents in four studies (Pancioli et al 1998; Hux et al 2000; Yoon et al 2001b; Schneider et al 2003). These findings are important for organizations and individuals interested in improving stroke knowledge among the general public, as it would appear that dissemination of information through health professionals is less effective than mass media and peer networks. Several authors have noted that many respondents appear to have some difficulty in making the distinction between stroke and heart attack. As mentioned previously, this distinction becomes acutely obvious when comparing open- and closed-ended studies of stroke knowledge. While Rowe et al (2001) found very high levels of recognition (between 76% and 95%) when respondents were read a list of potential stroke warning signs, there was also a strong tendency for signs of heart attack to be identified as stroke symptoms. In this study, 58% of respondents identified “chest pain” as a stroke warning sign. Reeves et al (2002) noted the confusion between stroke and heart attack in the pilot phase of their study and altered the survey procedure to ensure that respondents were made aware of the fact that stroke affects Vascular Health and Risk Management 2005:1(2) Knowledge of risk factors and warning signs of stroke the blood vessels supplying the brain rather than the heart. Despite these alterations to the survey instrument, they still reported that nearly 10% of respondents identified “pain in chest or arm” as a stroke warning sign. In contrast to these findings, Yoon et al (2001a) used a closed-ended survey and found less than 2% of respondents identified “chest pain, chest tightness or murmur” as a symptom of stroke. Surprisingly, in a second study by the same group, where open-ended questions were used, nearly 10% of respondents identified “chest pain or chest tightness” as a warning sign. Even though these levels are less than reported previously, this confusion between stroke and heart attack still remains. In addition to the warning signs of stroke, there have been several attempts to determine community knowledge of the mechanism of stroke. Hux et al (2000) simply asked respondents “What is a stroke?” and compiled the results. In this study, 36.9% of respondents correctly described stroke as a disruption of blood supply to the brain, while an additional 25.5% gave partially correct responses. Partially correct responses were those where respondents mentioned that stroke affects the brain, or a disruption of blood supply, but not both. When asked to describe a stroke, 60.3% of those surveyed by Parahoo et al (2003) correctly described stroke as a “blood clot in the brain”, while an additional 14.7% of respondents described stroke as paralysis. In a study of patients admitted to an emergency department with a diagnosis of stroke, Kothari et al (1997) asked patients what part of the body is injured during a stroke. They reported that 49% of subjects realized that stroke was “due to an injury to the brain”, which is similar to the findings of Weltermann et al (2000), using members of a stroke support group where 52.4% of respondents mentioned the brain or head. It is somewhat surprising that stroke knowledge among this group was relatively low, as the respondent group was 69.8% stroke patients and 27.8% family members. Better in-hospital and outpatient education could greatly improve the levels of knowledge among this at-risk population. Knowledge of risk factors for stroke Analysis of knowledge of risk factors for stroke has occurred in a number of different groups, including community groups, people at high risk of stroke or TIA, and those who have recently had a stroke or TIA (Table 1). In a community- based study, Pancioli et al (1998) reported that 68% of 1880 respondents to a telephone survey of people asked to 143