Perception of recurrent risk versus objective measured risk of ischemic stroke in first-ever stroke patients from a rural area in China: A cross-sectional study

Risk perception is critical to the formation of individual health prevention behaviors. A long-term accurate perception of stroke recurrent risks is imperative for stroke secondary prevention. This study aims to explore the level of recurrence risk perceptions and the influential factors of inaccuracy between perceived and objective risk in first-ever ischemic stroke patients from a rural area. From May to November 2020, 284 first-ever ischemic stroke patients were conveniently recruited in a rural area of Henan Province, China. Perceived risk was measured based on self-reported using a numerical rating scale, whereas the objective risk was measured by the Essen Stroke Risk Score. Patients' perceived risk was compared with their objective risk and categorized as “Accurate,” “Underestimated,” and “Overestimated.” The influencing factors of inaccuracy were further evaluated using multivariate regression analyses. 46% of the participants underestimated their stroke risk, while 15.9% overestimated their risks. Patients who were younger (≤65 years), didn’t worry about recurrent stroke, and had a low actual recurrent risk were more likely to underestimate their recurrent risk. Patients who were employed, had lower independence, and had greater anxiety were more likely to overestimate their recurrent risk. The majority of participants were unable to accurately perceive their own risk of stroke recurrence. Patients' age, working status, worry about recurrent stroke, actual recurrent risk, level of dependence, and anxiety played a role in perception inaccuracy. The findings could help healthcare providers gain a better understanding of the level and accuracy of recurrence risk perceptions among first-ever stroke patients in the rural area. Future counseling on the perceived risk of stroke recurrence and individual objective risk assessment could be conducted to help patients better understand their risk of recurrence. Individualized risk communication and multidisciplinary teamwork can be developed to improve the accuracy of recurrence risk perceptions and health behaviors.