Multicultural Recommendations to Guide Stroke Care: A Document Review of International Stroke Guidelines

Abstract

Stroke disproportionately affects individuals from culturally and linguistically diverse backgrounds, often leading to poorer outcomes. Although stroke guidelines are essential for ensuring evidence-based care, the extent to which they incorporate cultural considerations remains unclear. This document review aims to systematically review international stroke guidelines for the inclusion of culture-related recommendations that support equitable stroke care. We conducted a document review of English-language international stroke guidelines published between June 2019 and May 2024, using a structured search strategy. Paired reviewers independently screened and extracted cultural recommendations, with a third reviewer resolving discrepancies. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II instrument. Among 24 included guidelines, only 3 (12%) contained culture-related recommendations. Of 2991 total recommendations, 6 (0.2%) addressed cultural considerations, spanning prehospital care, acute care, rehabilitation, and palliative care. Most were supported by low-to-moderate quality evidence. The majority (88%) of international stroke guidelines lack cultural recommendations. Incorporating cultural considerations is critical for promoting culturally safe and equitable stroke care. Future research should explore barriers and facilitators to integrating cultural recommendations into stroke guidelines.