Efficacy of five strategies to improve stroke action awareness in Spanish-speaking adults: A randomized comparison

Journal article

Background and Aims: Improving stroke action awareness is challenging in non-English-speaking populations. In this study, we evaluated the effectiveness of five Spanish-language educational tools in improving recognition and making an emergency response to stroke symptoms among Spanish-speaking adults in Mexico. Methods: Spanish-speaking participants were recruited from public spaces. Individuals with a history of stroke were excluded. Participants were randomly assigned to receive an educational session tailored to one of five stroke awareness tools (RAPIDO, DALE, CAMALEON, CORRE, and ICTUS 911). Stroke knowledge was assessed using the Stroke Awareness Questionnaire before the educational intervention and after 6–9 days of follow-up. The primary outcome was the change in the proportions of correctly identified stroke symptoms. Secondary outcomes included changes in participants’ achievement of adequate stroke knowledge in individual FAST domains and their understanding of the appropriate actions to take after identifying stroke symptoms. Results: In data from 435 participants, all strategies improved stroke symptom recognition and risk factor awareness, although no statistically significant differences were observed in the primary outcomes. Changes ranged from 0.35 (DALE) to 0.49 (CAMALEON) for Facial Weakness, the symptom with the largest improvement, and from 0.00 (CAMALEON, CORRE, RAPIDO) to 0.15 (DALE) for Problems with Vision, the symptom with the smallest improvement. For the secondary outcomes, increases in adequate stroke knowledge ranged from 0.18 (CORRE, DALE) to 0.31 (ICTUS 911); between-group comparisons were statistically significant (p = 0.027). Improvements in appropriate action after symptom recognition ranged from 0.09 (RAPIDO) to 0.29 (ICTUS 911), with significant differences across groups (p = 0.034). Conclusions: This study shows that brief educational interventions can improve stroke symptom recognition and intended response in Spanish-speaking adults. Among five strategies, ICTUS 911 yielded the largest short-term gains, supporting its potential utility. Further research is needed to assess long-term effectiveness and broader applicability.

Authors: Marquez-Romero, JM; Sánchez-Ramírez, KI; Pérez-Malagón, CD; Padilla-López, J; Ford, GA

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: SAGE Publications
• Journal: International Journal of Stroke
• Volume: 21
• Issue: 3
• Pages: 419-429
• Publication date: 2025-08-30
• Acceptance date: 2025-08-13
• DOI: 10.1177/17474930251378229
• EISSN: 1747-4949
• ISSN: 1747-4930
• Language: English
• Keywords: Spanish-speaking populations; prehospital delays; Stroke awareness; emergency response; public health education