Health Literacy Regarding Stroke Recognition and Emergency Medical Services Utilization Among Patients with Acute Stroke in Thailand: A Multicenter Cross-Sectional Study

Introduction/Objective Early stroke recognition and EMS activation reduce prehospital delay. This study assessed stroke-related health literacy and EMS utilization among patients with acute stroke in Thailand, as well as factors associated with timely hospital arrival (≤4.5 hours). Methods A multicenter cross-sectional study included 1,292 patients with acute stroke from four tertiary hospitals in Thailand. Structured interviews and medical-record review assessed stroke knowledge, perceived severity, EMS awareness, attitudes toward EMS utilization, and healthcare access. A generalized linear mixed model with hospital as a random effect was used to examine factors associated with timely arrival. Results Moderate stroke knowledge was observed among 600 participants (46.4%), moderate perceived severity among 500 (38.7%), and moderate EMS attitudes among 560 (43.3%). Awareness of the national EMS number (1669) was reported by 640 (49.5%), and 625 (48.4%) had previous EMS experience. Timely arrival occurred in 650 (50.3%). Significant factors were sudden symptom onset (aOR 2.50, 95% CI 1.85-3.35), moderate NIHSS severity (aOR 2.00, 95% CI 1.40-2.85), severe NIHSS severity (aOR 4.50, 95% CI 2.80-7.20), awareness of 1669 (aOR 1.70, 95% CI 1.30-2.20), caregiver assistance (aOR 3.75, 95% CI 2.79-5.05), and distance ≥35 km (aOR 4.10, 95% CI 3.00-5.60) (all p <0.001). Discussion Stroke-related health literacy was generally moderate, but gaps in EMS awareness remained. Timely arrival was associated with symptom characteristics, stroke severity, EMS awareness, caregiver support, and access factors. Conclusion Strengthening stroke-symptom recognition, EMS number awareness, caregiver preparedness, and access to emergency care may support earlier hospital arrival.