Stroke is a leading cause of morbidity and mortality in the Philippines. Telestroke systems have been introduced to improve timely recognition and referral; however, their effectiveness depends on utilization at the community level.

To assess stroke and telestroke knowledge, attitudes, practices, and barriers among barangay health workers (BHWs), and to determine factors associated with telestroke utilization.

A cross-sectional study was conducted among 202 BHWs. Data were collected using a structured questionnaire assessing knowledge, attitudes, practices, and perceived barriers. Descriptive statistics were used to summarize responses. Associations between variables were analyzed using appropriate statistical tests, with significance set at p < 0.05.

Respondents had high stroke knowledge (75.5%, SD = 17.45) and telestroke knowledge (85.5%, SD = 18.82), as well as favorable attitudes (mean = 4.37). However, only 31.1% reported telestroke utilization. The most commonly reported barriers were lack of training (61.4%) and poor internet connectivity (15.8%). Telestroke familiarity was significantly associated with higher knowledge (p = 0.005) and more favorable attitudes (p = 0.001). Stroke-related training (p = 0.001) and years of experience (p = 0.001) were significantly associated with higher utilization.

Despite high knowledge and favorable attitudes, telestroke utilization among BHWs remains low. Training, familiarity, and infrastructure appear to play key roles in bridging the gap between knowledge and practice. Strengthening these factors may improve the effectiveness of community-based telestroke systems.