Stroke awareness and knowledge of warning signs among the Saudi public: a systematic review and meta-analysis of prevalence and associated factors

Stroke is a leading cause of death and disability globally, and early recognition of warning signs is critical for timely treatment. In Saudi Arabia, stroke burden is rising, yet public awareness remains inadequately characterized. This systematic review and meta-analysis aimed to estimate the pooled prevalence of stroke awareness and knowledge of warning signs among the Saudi public and identify associated sociodemographic factors. PubMed, Web of Science, and Cochrane Library were searched systematically from inception to 2026 for cross-sectional studies reporting stroke awareness among the Saudi public. Random-effects meta-analyses using the Freeman-Tukey double-arcsine transformation were performed. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Twelve studies comprising 9,548 participants were included. The pooled prevalence of adequate stroke awareness was 44.1% (95% CI: 21.3% to 68.3%), with very high heterogeneity (I² ≤ 99.74%). Correct emergency action was reported by 76.0% (95% CI: 63.1% to 86.8%). Knowledge of the 4.5-hour thrombolysis window was consistently low (11.3% to 26.3%). Female gender (OR: 1.82â€"2.94), higher education, and family history of stroke (β: 0.46â€"0.96) were the most consistent predictors of better awareness. Most studies (11/12) were rated as moderate risk of bias, primarily due to online convenience sampling. Public stroke awareness in Saudi Arabia was suboptimal, particularly regarding symptom recognition and the time-critical nature of acute treatment. Targeted educational interventions leveraging digital platforms and community networks are urgently needed, alongside standardized awareness metrics for future research.