Published online before print July 17, 2003, doi: 10.1161/01.STR.0000085293.12506.2C
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(Stroke. 2003;34:1968.)
© 2003 American Heart Association, Inc.
Original Contributions |
Editorial Comment—Advertising Strategies to Increase the Public Knowledge of the Warning Signs of Stroke
Duke Center for Cerebrovascular Disease, Stroke Policy Program, Center for Clinical Health Policy Research, Duke University and Durham VA Medical Center, Durham, North Carolina
Several studies have clearly demonstrated the public’s general lack of knowledge of stroke risk factors and symptoms.1–6 This is particularly true among the elderly,3,4 the portion of the population at highest risk.7 The current study is consistent with these and other previous reports. At the baseline assessment carried out in 4 communities in Ontario, Canada, less than half (39% to 44%) of those surveyed were able to name at least 2 stroke warning signs; knowledge was poorest among those over age 65 years (only 35% were able to name 2 or more warning signs). How can this situation be changed?
The study by Silver and colleagues is unique in that it directly compares 3 different strategies aimed at improving the public’s stroke-related knowledge. Three months after the cessation of advertising, there was no significant change in public knowledge of stroke warning symptoms following a print media campaign and significant improvements after both low- and high-intensity television campaigns. These results suggest that as a single intervention, advertising dollars are more effectively spent on television-based campaigns. However, several important points need to be stressed. First, even the television-based advertisements resulted in no significant change in knowledge among the highest risk group (ie, those over age 65). Although knowledge improved after the television campaign in those with lesser degrees of education, this group’s knowledge still lagged behind that of more educated individuals. Even among the most educated, a substantial proportion (35%) still could not name 2 stroke symptoms after the advertising was completed. The overall impact of the television media programs was modest (the mean number of named warning signs increasing from 1.27 to 1.47 with low-level and from 1.32 to 1.66 with high-level advertising). Because the data were not collected, it is uncertain whether there might be differences in the effectiveness of the various strategies in different race-ethnic groups. Future studies may need to vary the content of the advertisements to target different high-risk populations.
Most importantly, it is uncertain whether improved knowledge will translate into larger proportions of patients seeking timely and appropriate acute and preventive stroke care. Unfortunately, improving general public knowledge in isolation is unlikely to be sufficient.2 As reflected in the strategies used by business, including the pharmaceutical industry, a sustained multilevel campaign incorporating a variety of techniques will be required. This will need to be coupled with changes in the stroke healthcare infrastructure and with provider education.8 Additional studies of the type reported by Silver and colleagues will be needed to help provide a rational basis for the development of the most effective and most cost-effective public educational strategies.
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