Evaluating general public awareness can help to improve public information programs about stroke, but our estimates indicate that stroke awareness among Koreans is generally poor. Only 44.8% of the subjects in this study answered correctly that stroke is a vascular disease in the brain. The inability of many Koreans to define stroke correctly may be attributable to the strong influence of traditional Oriental medicine, which defines stroke as 'paralysis by lack of harmony of negativity and positivity' and considers stroke a disease of both the peripheral nervous and cerebrovascular systems . Traditional Oriental and Western medicine have equal social and cultural status in the treatment of stroke in Korea; indeed, the Chinese character 'Poong' (meaning wind) has spread to the Western medical terminology for stroke [7, 8]. However, we found that preference for Oriental versus Western medicine for stroke treatment did not significantly affect awareness of stroke warning signs and risk factors. The lack of difference may be attributable to Korea's modernization and industrialization, which have led to the dissipation of traditional concepts and the emergence of Western medicine campaigns by groups such as the Korean Stroke Society .
Public knowledge of stroke warning signs is important for ensuring timely access to emergency medical care [14, 16, 17]. Our results show numbness and weakness to be the most frequently (and correctly) identified signs and symptoms of stroke (60.2%). A higher proportion of respondents recognized numbness and weakness as a stroke warning sign. In four previous studies, the most common stroke warning signs listed by respondents were dizziness (24%) and numbness (19%) , weakness (26%) , blurred vision (24%) , and numbness (45%) and speech difficulties (38%) . Differences in the medical systems and location of the sample populations make it difficult to compare the present study with other population studies. However, it is possible that the variation in stroke warning signs identified by the study participants reflects differences in their perceptions of the importance or severity of symptoms. It was encouraging that more than 60% of respondents in this study reported the correct signs of stroke.
Stroke prevention is dependent on the ability to recognize and control stroke risk factors [5, 6, 21]. Increased public awareness of potential risk factors will help to reduce the prevalence of stroke and increase treatment compliance. The proportion of respondents considering hypertension to be a risk factor of stroke was higher in our study (66.7%) than in a previous study in Korea (28.3%) . The better understanding of potential hypertension risks in our study may be attributable to the special campaigns conducted by the National Hypertension Center of the Korean government over the past few years [22, 23]. As in previous studies, diabetes mellitus and cardiovascular disease were underestimated as risk factors, while mental stress and overexertion were considered important [5, 8, 18]. Given the lack of evidence that mental stress and overexertion are stroke risk factors, it is important to emphasize the contributions of diabetes mellitus, cardiovascular disease, obesity and smoking to stroke . In this study, answers to the questionnaire differed significantly depending on whether or not the respondent was able to define stroke correctly. This suggests that understanding of the basic concepts of stroke may play a crucial role in public health.
In the multivariate logistic regression model, a lower level of education and incorrect definition of stroke were independent predictors of poorer knowledge of stroke warning signs. These finding are consistent with those of a previous study  reporting that younger age, female gender, higher level of education and high cholesterol were all associated with the correct identification of stroke warning signs. We also found that older age, lower level of education, family history of stroke and incorrect definition of stroke were independent predictors of poorer knowledge of stroke risk factors. Blades and colleagues  also showed that younger respondents and women were more likely to identify stroke risk factors correctly. The overall implication of the present study's findings is that these populations should be specifically targeted with public health education about stroke.
Despite the tendency among Koreans to respect and follow the decisions of the oldest member of their families (who tend to prefer traditional Oriental medicine ), Western medicine was preferred over traditional Oriental medicine for medical treatment of stroke. The customary idea in Korea that stroke should be treated by traditional Oriental medicine may lead to the expectation that traditional Oriental medicine produces better results. However, the actual effectiveness of traditional Oriental medicine for stroke is controversial . One of the main reasons that patients are not admitted to a hospital early enough in Korea is that they seek treatment with traditional Oriental medicine beforehand .
The mass media (television, radio, newspapers and magazines) were the most popular sources of information for stroke knowledge; this should be considered when promoting public knowledge of stroke and the associated risk factors . In contrast, our findings suggest that hospitals and medical schools do not provide effective public education. Public education promoting awareness of the seriousness of stroke and provision of access to emergency care during the narrow therapeutic time window may lead to changes in behavior . A previous study evaluating the effectiveness of different media in increasing public awareness of stroke found that television advertising is often promoted owing to its ability to reach across demographic groups based on gender, age and education . The second most popular source of information about stroke was a family member or other relative, suggesting that acquisition of information from personal contacts could become an effective method for dispersing accurate medical information. Ensuring that patients and their families retain simple and accurate information on stroke as they progress through stroke rehabilitation may be an effective means of disseminating this information to the general public .
This study has a number of limitations. The study was conducted on a Korean population, and there may be significant differences with respect to the awareness of stroke warning signs and risk factors in other geographic and racial and ethnic communities. Moreover, because the sample was drawn from a limited geographic area within Korea, the results may not generalize to the national population. However, many rural districts in Korea are quickly urbanizing, and Ansan is a good example of the nation's many urbanized areas. The relatively low sample size may also affect the study's generalizability, although the sampling design does represent a random age- and gender-stratification. There is also the possibility of non-coverage and non-response bias because those not sampled in this study may have a different level of stroke awareness than those who participated. Aside from generalizability, another limitation of the study is that it does not address whether there is a causal relationship between stroke knowledge and behavior such as risk factor modification and rapid seeking of medical attention in the event of stroke symptoms.