CHAPTER ONE INTRODUCTION

        Background of the study

Health communication, as defined by Bernhardt (2004), “is the scientific development, strategic dissemination, and critical evaluation of relevant, accurate, accessible, and understandable health information communicated to and from intended audiences to advance the health of the public.” It is also defined as “the study and use of communication strategies to inform and influence individual and community decisions that enhance health” (CDC, 2001; U.S. Department of Health and Human Services, 2005).

However, in order to develop strategies, and to ensure that accurate information on stroke is communicated to the public, it is important to assess the baseline knowledge, attitudes and practices of citizens. That, is the thesis of this study. The study examined the awareness and behaviour dispositions of the public towards stroke, and the role of communication in those outcomes. Specifically, it sought to find out the knowledge, attitude and practices of respondents in Accra on stroke prevention. The information gained from assessing the level of knowledge, attitudes and practices will inform health communication strategies geared towards stroke prevention.

        Stroke as a Global Health Concern

Stroke, medically termed as Cerebrovascular Accident, is a non-communicable disease that affects the blood vessels in the brain. It occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures. This usually results in paralysis or weakness of one side of the body (WHO, 2014).

In recent years, stroke has become a condition of growing global concern; not only on account of its demonstrated interface with infectious disease burdens (Elkind & Mitchell 2010; Manousakis, Jensen,  Chacon, Sattin, & Levine 2009), but also because its incidence and consequence have far reaching, economic and social implications on households and communities (Mapulanga, Nzala, & Mweemba 2014). Stroke is the major cause of death worldwide, and lack of knowledge contributes to its rise in incidence (Sallar, Williams, Omishakin, & Lloyd, 2010). It is one of the reasons for disability and reduced quality of life (Agyemang, Attah-Adjepong, Owusu-Dabo et al, 2012).

The World Stroke Organization (2019) estimates that 1 in 6 people worldwide will have a stroke in their lifetime. Also, 15 million people worldwide suffer a stroke each year and 5.8 million people die from it. Stroke is the third most common cause of death in the United States, claiming a life every three minutes (World Stroke Organization, 2019). Until recently, stroke was a condition of the developed world, but the risk of stroke has been significantly reduced in many developed countries by introducing evidence-based control measures (Donkor, Owolabi, Bampoh et al, 2014).

A systematic review of the empirical research to investigate the burden of stroke in the African region of the WHO reported an annual incidence rate of up to 316 per 100,000, a prevalence rate of 315 per 100,000 and a three-year death rate of up to 84 percent in Africa. (Nakibuuka, 2011). The impact of the disease is felt in sub-Saharan Africa yet, only little information needed to help reduce the burden is available (Owolabi, Sarfo, Akinyemi et al, 2018).

        Stroke in Ghana

Stroke in Ghana is becoming an increasing cause of disease and death due to lifestyle changes and a growing ageing population (Agyemang & Sanuade, 2013). In Accra, cardiovascular diseases, stroke being the most common, emerged the seventh root of death in 1991 to be the number one cause of death in 2007 (Agyemang et al, 2012). The World Health Organization (2017) ranked stroke as the number one cause of death in Ghana.

This is notwithstanding that, as indicated already above, stroke is the neurological disease that can most be prevented. This is largely as a result of its modifiable risk factors such as hypertension, high cholesterol, diabetes and smoking, which can be prevented by choosing a healthier lifestyle (Donkor, Owolabi, Bampoh et al, 2014). Disease risk factors are said to be modifiable when the conditions that increase a person’s susceptibility can be changed or prevented, as in the case of stroke.

        Stroke and Bankers in Accra

Regular exercise is an important in the prevention of the increasing global epidemic of chronic diseases such as stroke. The WHO (2011) recommends a moderate-intensity exercise of at least 150 minutes per week for adults aged 18–64. And yet, research shows that globally, no fewer than

As a result of this predisposing factor (sedentary lifestyle), bankers are prone to stroke. Also, in Ghana, Accra has the highest prevalence of stroke (Agyeman et al, 2012). It is for these reasons that bankers in Accra are the subject of interest for this study.