Effects of Stroke Education of Junior High School Students on Stroke Knowledge of Their Parents
Background and purpose—Educating the youth about stroke is a promising approach for spreading stroke knowledge. The aim of this study was to verify communication of stroke knowledge to parents by educating junior high school students about stroke.
Methods—We enrolled 1127 junior high school students (age, 13–15 years) and their parents in the Tochigi prefecture, Japan. All students received a stroke lesson, watched an animated cartoon, and read the related Manga comic as educational aids. The students took back home the Manga and discussed what they learned with their parents. Questionnaires on stroke knowledge were given to all at baseline and immediately after the lesson.
Results—A total of 1125 students and 915 parents answered the questionnaires. In the students, the frequency of correct answers increased significantly for all questions on stroke symptoms except for headache, and for all questions on risk factors after the lesson. In the parents, the correct answer rates increased for stroke symptoms except for headache and numbness in one side of the body, and for all questions on risk factors except for hypertension. Ninety-one percent of students and 92.7% of parents correctly understood the Face, Arm, Speech, and Time (FAST) mnemonic after the lesson.
Conclusions—Improvement of stroke knowledge immediately after the stroke lesson was observed in parents as well as their children, which indicated that our teaching materials using the Manga was effective in delivering the stroke knowledge to parents through their children.
Stroke education is expected to reduce the time from onset of symptom to arrival at the hospital through increasing the knowledge of warning signs for stroke. We and others recently reported the results of studies of stroke educational campaigns for teenagers.1–5 These results suggest that educating the youth on stroke is effective in spreading stroke knowledge to their families indirectly by communication among their family members.
The Tochigi project was planned to be a campaign of public education of stroke knowledge in collaboration with the local government of Tochigi prefecture between September 2012 and July 2013. The Tochigi prefecture with around 2 million residents is one of the prefectures with the highest rate of mortality for stroke in Japan.
The aim of this study was to verify the effectiveness of stroke education, which is the part of the Tochigi project, in a large population of junior high school students by delivering stroke lessons using an animated cartoon or a Manga.
Supplemental methods including analysis of data are provided in the online-only Data Supplement.
We enrolled 1127 students of the first to third grades (age, 13–15 years) in 9 public junior high schools and their parents. For recognition of stroke signs and symptoms, we used the Face, Arm, Speech, and Time (FAST) mnemonic derived from the Cincinnati prehospital stroke scale.6,7 After receiving a stroke lesson by a stroke neurologist on how to educate students about stroke using our teaching materials, our collaborators who were Public Health employees gave lectures as teachers on stroke knowledge to the students. Educational posters of FAST3 were put on the walls of each classroom 1 week before the stroke lesson. The stroke lecture consisted of 3 parts, such as a 20-minute stroke lesson by teachers, watching an animated cartoon for 10 minutes, and reading a Manga comic for 10 minutes. At the close of the lesson, the teacher asked the students to take back home the Manga comic and questionnaire sheets and talk about stroke with their parents while showing the Manga.
Stroke knowledge of students and their parents was assessed at 2 time points: baseline and immediately after the instruction. Questionnaires of stroke knowledge were the same as those reported previously (Table in the online-only Data Supplement).3,4
Statistical analyses were performed using SPSS (version 13.0; SPSS Inc, Chicago, IL). Data before the lesson and immediately after the lesson were compared with the 2 sample test of proportions. A P<0.05 was considered to indicate statistical significance.
Test scores were evaluated from 1125 of 1127 students (98%) and from 915 parents/guardians (860 parents and 55 guardians) among whom there were 755 mothers and 137 medical professionals; median age was 43 years. In students, the frequency of correct answers increased significantly for all questions on stroke symptoms except for headache, for all questions on risk factors, and for calling an ambulance. Correct test scores were 60.7% before versus 94.3% after the lesson (P<0.001; Table 1). In parents/guardians, the correct answer rates for stroke symptoms except for headache and numbness in one side of the body, for all questions on risk factors except for hypertension, and for calling an ambulance increased after the lesson. Correct test scores were 83.0% before versus 92.7% after the lesson (P<0.001; Table 2). Ninety-one percent of students and 92.7% of parents/guardians correctly understood the FAST mnemonic after the lesson.
This study showed that for junior high school students, there was an improvement of stroke knowledge immediately after delivering the stroke lesson to the students and that stroke knowledge, especially the FAST mnemonic, could be delivered to the students’ parents by giving the students a stroke lesson using the Manga. Because ease of understanding is essential for spreading the stroke education, the Manga, a part of the Japanese culture, could be expected to play an important role in spreading stroke knowledge universally without the need of language just by visual presentation all over the world.
There were several limitations in this study. First, our study is not a randomized controlled study. However, we confirmed the feasibility of delivering stroke knowledge to the parents through their children with a large number of subjects. Second, it could not be determined which teaching materials were more useful in the improvement of stroke knowledge. Third, the stroke lesson was delivered by medical professionals. For spreading stroke knowledge widely through school-based instruction, school teachers rather than medical staff should be trained for delivering stroke knowledge as suggested previously.4 Fourth, stroke symptoms other than those in the FAST mnemonic were not communicated to the parents. Placing emphasis on the FAST mnemonic may be the reason behind low percentage of correct test scores regarding headache as a stroke symptom.
A lesson on stroke using teaching materials using the Manga in junior high school students improved the stroke knowledge of students immediately after the lesson, and the stroke knowledge was communicated to their parents through their children. Instruction on stroke for children in junior high school is a promising means to spread the stroke knowledge nationwide, and could lead to a reduction of onset to door times in the future.
Participating Investigators of Tochigi Junior High School Stroke Education Group
Kosuke Matsuzono, Satoshi Ohyama, Akiko Ishigami, Kosuke Okumura, Kunihiro Nishimura, Chiaki Yokota, Kazunori Toyoda, Yoshihiro Miyamoto, and Kazuo Minematsu in National Cerebral and Cardiovascular Center, Daisuke Sugiyama and Tomonori Okamura in Keio University School of Medicine, Masanori Nagao and Hidehiro Takekawa in Dokkyo Medical University, Hirofumi Nakayama in Japan Stroke Association, Akiko Morimoto, Aya Kadota, and Naomi Miyamatsu in Shiga University of Medical Science, Nobue Takizawa in Ibaraki Prefectural Office, Kayo Ieiri and Teruki Watanabe in Tochigi prefectural government.
Sources of Funding
This study was supported by the Intramural Research Fund of the National Cerebral and Cardiovascular Center (22-4-1).
* A list of all Participating Investigators of Tochigi Junior High School Stroke Education Group is given in the Appendix.
The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/doi:10.1161/STROKEAHA.114.007907/-/DC1.
- Received October 24, 2014.
- Revision received November 24, 2014.
- Accepted November 25, 2014.
- © 2014 American Heart Association, Inc.
- Morgenstern LB,
- Gonzales NR,
- Maddox KE,
- Brown DL,
- Karim AP,
- Espinosa N,
- et al
- Williams O,
- DeSorbo A,
- Noble J,
- Gerin W
- Miyashita F,
- Yokota C,
- Nishimura K,
- Amano T,
- Inoue Y,
- Shigehatake Y,
- et al