Impact of a theory-informed and user-centered stroke information campaign on the public\u2019s behaviors, attitudes, and knowledge when facing acute stroke: a controlled before-and-after study

Julie Haesebaert,Thomas Bony,Caroline Laude,Anne Termoz,Sylvie Porthault,Hélène Trehard,Anne-Marie Schott,Laurent Derex,Nathalie Perreton,Estelle Bravant,Norbert Nighoghossian

doi:10.1186/s12889-020-09795-y

Abstract

BackgroundPublic awareness of stroke symptoms is a key factor to ensure access to reperfusion strategies in due time. We designed and launched a regional theory-informed and user-centered information campaign and assessed its impact on emergency medical services (EMS) calls for stroke suspicion, time-to-call, and public attitudes and awareness concerning stroke.MethodsA controlled before-and-after study was conducted during 3 sequential time-periods in 2 separate counties. Key messages of the campaign were underpinned by stroke representations and the theory of planned behavior, and focused on recognition of stroke warning signs and the need to call EMS urgently. The campaign included posters, leaflets, adverts and films displayed in bus and subway stations, internet, social networks, and local radio. Outcome measures on behavior, attitudes, and knowledge were assessed before the launch of the campaign, at 3 months, and 12 months.ResultsThe number of EMS calls for stroke suspicion increased by 21% at 12 months in the intervention county and this change was significantly different to that observed in the control county (p = 0.02). No significant changes were observed regarding self-reported attitudes in case of stroke. An 8% significant increase in recognizing at least 2 stroke warning signs was observed in the intervention county (p = 0.04) at 3 months, while it did not change significantly in the control county (p = 0.6). However, there was no significant difference in warning sign recognition between both counties (p = 0.16).ConclusionThe campaign significantly improved public’s behavior of calling EMS, although stroke knowledge was not improved as much as expected. Repeating these campaigns over time might further help improve timeliness and access to reperfusion strategies.Trial registrationClinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02846363.

Highlights

Public awareness of stroke symptoms is a key factor to ensure access to reperfusion strategies in due time
Based on the results of this study and informed by the theory of planned behavior (TPB) [14], we developed the ReACT campaign which aimed to improve the skills of the general population in recognizing the first signs of acute stroke and to understand the need to promptly call emergency medical services (EMS)
Impact on behaviors: EMS calls During the 3 periods, 217,476 EMS calls were recorded in the Rhône county, of which 707 met the inclusion criteria and were included

Summary

Introduction

Public awareness of stroke symptoms is a key factor to ensure access to reperfusion strategies in due time. While it has been demonstrated that calling emergency medical services (EMS) immediately constitutes the best choice in case of stroke, the majority of patients delay their contact with medical services by going directly to emergency departments (ED) or general practitioners [4, 5]. These increased delays are incompatible with access to an effective stroke treatment and increase stroke morbidity and mortality [6]. Targeting the general population would help improve stroke management by decreasing time from symptom onset to first medical contact and increase EMS calls

Objectives

Methods

Results

Discussion

Conclusion