Background: Despite delivery of hospital-required stroke education, retention by patients/families is poor. We examined knowledge retention using a test-enhanced learning strategy for provision of stroke education.
Methods: An experimental study was conducted, enrolling consecutive consenting English-speaking, literate patients/family members from a comprehensive stroke center to two groups: Control group (routine individual teaching, time for questions, and provision of written materials); or, a Test-Enhanced Stroke education Target (TEST) group (informed on enrollment about a discharge written test requirement, along with provision of the same routine education). Prior to discharge both groups completed a written stroke knowledge test to gauge content retention. Demographic data and correct test items were analyzed using descriptive statistics, Fisher’s Exact test, and Mann-Whitney U.
Results: We enrolled and prospectively randomized 30 patients to either the control or TEST group. Patient characteristics were similar between groups: 80% and 93% ischemic strokes, 53% and 47% females, 67% and 53% African Americans, with a median LOS of 3 days in the control and TEST groups respectively. However, patients in the TEST group were significantly older at 64 (range 35-84; p=0.03) vs. 52 (range 24-70) years in controls. Overall median scores for all test items were significantly higher in the TEST group compared to controls (p=0.02), with TEST patients understanding their personal risk factors for stroke (p=0.02) and medication for secondary prevention (p=0.04) significantly better than controls patients (Table).
Conclusions: Stroke knowledge retention is improved when patients are alerted to a formal testing requirement. Test-enhanced learning may play an important role in preparing stroke patients and family members for assumption of self-care post-hospitalization.