From Awareness to Action: A Knowledge-Intended Practice Gap in Stroke Decision-Making Among Egyptian Medical Students and House Officers: A Cross-Sectional Study.

INTRODUCTION

Stroke remains a leading cause of mortality and long-term disability worldwide, and early recognition is critical for effective management. Despite growing awareness, the extent to which knowledge is translated into appropriate clinical practice among medical trainees remains uncertain. This study aims to assess stroke-related knowledge, attitude, and intended practice (KAP) among Egyptian medical students and house officers, and to identify gaps between knowledge and clinical decision-making.

METHODS

A cross-sectional study was conducted from August 2025 to March 2026 utilizing a structured, self-administered questionnaire derived from previously validated instruments. Participants were recruited through convenience and snowball sampling using a Google Forms questionnaire disseminated via online platforms and university networks. The survey assessed knowledge of stroke risk factors and warning signs, attitudes toward stroke severity and outcomes, and intended responses to suspected stroke scenarios. Knowledge and attitude scores were calculated, and associations among variables were examined using multivariate regression models.

RESULTS

Among the 1,065 participants, awareness of stroke was notably high, with nearly all recognizing it as a medical emergency (99.4%) and the majority reporting prior awareness (96.9%). Although classic stroke symptoms were widely recognized, atypical presentations were less well identified. Positive attitudes were present in 68.6% of participants, and adequate knowledge of warning signs and risk factors was observed in 86.9% and 81.4%, respectively. Nevertheless, inappropriate intended practices remained prevalent in simulated scenarios, with 23.4% indicating they would administer aspirin and 32.6% opting for self-transport. Multivariate analysis showed that prior training significantly predicted knowledge, while demographic factors influenced attitudes. Importantly, the observed inverse association between knowledge and intended practice highlights a concerning disconnect, emphasizing the need for interventions that bridge this knowledge-action gap.

CONCLUSION

Although participants generally demonstrated favorable stroke knowledge, this did not consistently translate into appropriate intended practice. These findings suggest that knowledge alone may not be sufficient to ensure appropriate emergency decision-making and support consideration of competency-based educational approaches. Future interventional studies are warranted to evaluate their effectiveness.