A major barrier to timely care for ischemic stroke is delayed hospital arrival, often due to failure to identify symptoms as those of a stroke or serious enough to seek immediate care. We developed a facilitator-driven multimedia stroke literacy intervention - Hip Hop Stroke (HHS) - to improve knowledge of risk factors, symptoms, urgent action, treatment and prevention. HHS uses Hip Hop music and child-centric media (e.g., cartoons) to engage 4th-6th graders and their parents in high-risk minority communities. We have previously published on the efficacy of our 3-day program to improve short and long-term knowledge of children and transmission of key principles to adults. In an effort to widely disseminate HHS in an effective, cost-efficient way, we developed a pilot study to test a self-guided digital adaptation of the program.
We conducted focus groups with fifth graders to inform the modification of the existing HHS curriculum into six 20-minute, self-guided computer modules. We pilot tested the digital program with 4th and 5th graders (N=55) and assessed the effect on stroke knowledge through pre/post surveys embedded into the first and last modules. Data were analyzed using Pearson χ2 and Fisher exact tests.
Stroke knowledge improved after the program to a degree consistent with data from our facilitator-driven program. The proportion of students able to correctly identify symptoms of stroke significantly increased from pre to post-test on all symptoms. At post-test, 96% identified that a stroke occurs in the brain, compared to 44% at baseline (p<.001). Every student (100%) correctly identified slurred speech at post-test, compared to 43% at baseline (p<.001). Identification of an appropriate urgent plan for a hypothetical stroke scenario - calling 911 - also increased significantly. Importantly, students found the program enjoyable and engaging, and 84% said they shared stroke information with a family member at home.
These results show promise for computer-based stroke literacy programming for elementary school children and may serve as a conduit for health messages into the home when child mediation techniques are incorporated. This method may represent a novel strategy for broad dissemination of stroke information or other chronic diseases.