These findings show us that it is possible to use a relatively cheap, broadly disseminable and culturally tailored approach with potentially sustained effects to target stroke education in populations with higher risk. We know that previously, lots of high-cost mass media campaigns have really not been very effective, and more importantly, were not sustainable and certainly not culturally tailored to higher-risk populations. This advance is a relatively cheap intervention that can be implemented very broadly, probably very easily and has shown some modest sustainability at 3 months after the intervention was delivered. We haven’t had that before.
This has implications on how to educate people on stroke recognition. The people we’re targeting are the high-risk parents who will potentially have these symptoms.
It’s clear that there was some uptake in children and there was definitely uptake in the parents as well. It was sustained in both populations. It translated into improved awareness and sustained improved awareness.
The intervention seemed to work. Immediately after, 57% of children remembered what they were taught. They were stroke-prepared, so to speak. The first question I would ask is, while it is very impressive that half were able to remember, how can we get those numbers even higher to make sure that immediately after, more people remember? We saw that at 3 months, about 24% remembered. This is still impressive, as we haven’t had those kinds of numbers in the past. Having said that, the issue is how do we get more children to remember immediately after and of course for it to be sustained at a higher rate at 3 months?
When you look at the parents, about 20% were able to recognize one of the key symptoms of the FAST acronym immediately after. About 17% were able to remember after 3 months. With the parents, about the same proportion still remembered at 3 months, while you saw a drop-off in the kids from about one in two remembering immediately after to one in four remembering after 3 months. The issue again is how do we get those numbers up if only one out of five parents or grandparents immediately after intervention were able to recognize at least one of the key symptoms of the acronym? If we can somehow impart this knowledge in a way that more parents upfront are able to recollect the information, maybe that might translate to even more impressive recollection and action rates down the road. Still, it’s very impressive that even the proportion that remembered were able to remember.
More research is needed to see if we can increase the numbers of people who remember immediately, because I suspect that would help to increase the number of people who have a sustained recollection of this knowledge. I’d love to see how long this knowledge is sustained. Three months is very helpful, but stroke can obviously strike at any time, so could we see if this knowledge is retained at 6 months or even 1 year later? How long from the time that they were taught can both parents and children can retain this? When and how many ‘booster’ training sessions are needed? It’s very important.
Another aspect of this would be prevention. I always tell my patients the best stroke is the stroke you never had. We know that 80% of strokes are imminently preventable. That’s why I wonder if this same, very novel approach, ie, using children as transmission vectors for important health knowledge can be used to improve stroke risk factor control and prevent strokes from happening in the first place? Recognizing stroke symptoms promptly and getting treatment early is a high priority, but it may not get us to where we ideally want to be, which is substantially reducing the overall burden of stroke on society through prevention. Maybe the future focus could be to create hip-hop videos for preadolescents that confer knowledge about physical activity, diet, major risk factors for stroke like hypertension, hyperlipidemia, diabetes, obesity, etc. If these kids retained this knowledge and shared it with their parents, it could have an impact on lifestyle choices in the home/household. Besides, given challenges with rising preadolescent and adolescent obesity rates in the country, beyond possibly positively influencing their parents and grandparents to reduce their stroke risk, such knowledge may also be of benefit to these children now and in the future, so they are able to ward off metabolic syndrome, diabetes, strokes, MIs, etc.
This is very promising work. It has really moved the field forward in many ways. I’d love to see durability, more uptick immediately after the intervention and to see this also applied to stroke risk factor control.
Bruce I. Ovbiagele, MD, MSc, MAS, MBA
Professor, Chairman of Neurology
Medical University of South Carolina, Charleston
Disclosures: Ovbiagele reports no relevant financial disclosures.