A Randomized, Controlled Trial to Teach Middle School Children to Recognize Stroke and Call 911

Abstract

Background and Purpose-Underutilization of acute stroke therapy is driven by delay to hospital arrival. We present the primary results of a pilot, randomized, controlled trial to encourage calling 911 for witnessed stroke among middle school children and their parents. Methods-This project occurred in Corpus Christi, an urban Texas community of 325 000. Three intervention and 3 control schools were randomly selected. The intervention contained 12 hours of classroom instruction divided among sixth, seventh, and eighth grades. Parents were educated indirectly through homework assignments. Two-sample t tests were used to compare pretest and posttest responses. Results-Domain 1 test questions involved stroke pathophysiology. Intervention students improved from 29% to 34% correct; control students changed from 28% to 25%. Domain 2 test questions involved stroke symptom knowledge. Intervention school students changed from 28% correct to 43%; control school students answered 25% correctly on the pretest and 29% on the posttest. Domain 3 test questions involved what to do for witnessed stroke. Intervention school students answered 36% of questions correctly on the pretest and 54% correctly on the posttest, whereas control students changed from 32% correct to 34%. A comparison of change in the mean proportion correct over time between intervention and control students was PϽ0.001 for each of the 3 individual domains. A poor parental response rate impaired the ability to assess parental improvement. Conclusions-A scientific, theory-based, educational intervention can potentially improve intent to call 911 for stroke among middle school children. A different mechanism is needed to effectively diffuse the curriculum to parents. (Stroke.

Strengthening the Link

“…14,15 A review of the literature reveals 3 successful stroke education programs with children to date: the FAST Stroke Prevention Educational Program for Middle School Students 14 ; the Brain Child Project 15 ; and, the Kids Identifying and Defeating Stroke (KIDS) Project. 16 These programs coupled with the current "Hip-Hop" Stroke Program by Williams and Noble elucidate 3 primary factors that are potentially associated with successful stroke education among children: culturally appropriate contexts, live, recognizable persons, and recurring exposure to the message.…”

“…One child even called 911 when a grandparent experienced stroke symptoms after exposure to the program. Similarly, the KIDS Project 16 conducted within an urban Texas community with a large Mexican-American population used a Tejano (Texas-Mexican) dance scenario as part of the curriculum and also had successful posteducation results.…”

“…Furthermore, the Brain Child Project 15 used a local TV personality to describe his experience with stroke as well as live performances by actors well known to the children acting out stroke symptoms. Although the KIDS Project 16 did not directly use a live person, it did use a video of a local teacher who had experienced a stroke. Of note is the fact that one classroom in the study by Williams and Noble only viewed a video of the live performance by the hip-hop artist but appear to have had similar positive knowledge gains.…”

“…14 In particular, the KIDS Project, which was the only program that included parents (although indirectly) in the curriculum, had a parental participation rate of 18% in the intervention group and 16% in the control group. 16 Therefore, it is currently unknown whether these programs affect parental knowledge of stroke as well. The KIDS Project results suggest that actively including parents in the process, as opposed to having children take home material to teach the parents, may be a more effective approach.…”

“…The KIDS Project results suggest that actively including parents in the process, as opposed to having children take home material to teach the parents, may be a more effective approach. 16 The impact of these programs on knowledge of stroke risk factors has also been somewhat disappointing. There was better retention of stroke warning signs versus risk factors in the FAST program 14 and better test performance on symptom recognition items as opposed to stroke prevention measure items in the current "Hip-Hop" Stroke Program.…”