Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial

Stroke. 2018 Apr;49(4):972-979. doi: 10.1161/STROKEAHA.117.019861.


Background and purpose: Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents.

Methods: We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates.

Results: Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; P=0.09) of the intervention group demonstrated optimal stroke preparedness (perfect scores on the knowledge/preparedness test) at baseline, increasing to 57% (95% CI, 44%-69%) immediately after the program in the intervention group compared with 1% (95% CI, 0%-1%; P<0.001) among controls. At 3-month follow-up, 24% (95% CI, 15%-33%) of the intervention group retained optimal preparedness, compared with 2% (95% CI, 0%-3%; P<0.001) of controls. Only 3% (95% CI, 2%-4%) of parents in the intervention group could identify all 4 letters of the stroke FAST (Facial droop, Arm weakness, Speech disturbance, Time to call 911) acronym at baseline, increasing to 20% at immediate post-test (95% CI, 16%-24%) and 17% at 3-month delayed post-test (95% CI, 13%-21%; P=0.0062), with no significant changes (3% identification) among controls. Four children, all in the intervention group, called 911 for real-life stroke symptoms, in 1 case overruling a parent's wait-and-see approach.

Conclusions: HHS is an effective, intergenerational model for increasing stroke preparedness among economically disadvantaged minorities.

Clinical trial registration: URL: Unique identifier: NCT01497886.

Keywords: child; multimedia; parents; school; speech.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Child
  • Communication
  • Female
  • Health Education / methods*
  • Health Knowledge, Attitudes, Practice*
  • Health Literacy*
  • Humans
  • Intergenerational Relations
  • Male
  • Parents*
  • Schools
  • Stroke / diagnosis*
  • Stroke / drug therapy
  • Thrombolytic Therapy
  • Time-to-Treatment*
  • Urban Population

Associated data