Hip Hop Stroke: Statewide Dissemination of a School-based Public Stroke Education Intervention

Despite effective Acute Stroke Treatment, fewer than 10% of patients in the United States
receive them. The largest barrier to this treatment are pre-hospital delays which include
limited to no, knowledge of stroke signs and symptoms and the intent seek care. While there
is abundance of stroke education materials available, studies continue to reveal severe
deficiencies in stroke literacy (knowledge of symptoms, urgent action, and prevention
measures).

A mere 7% of ischemic stroke events in the US receive thrombolysis (t-PA) therapy1 due to
delayed hospital arrival, most often related to the failure to recognize stroke symptoms and
to call 911 immediately. Efforts to improve the public's stroke literacy have been driven by
mass media stroke education campaigns that include public service announcements and print
advertising. However, these efforts have failed to have an effect on 911 use (the major
determinant of early hospital arrival) beyond the funding period for the specific media
campaign. Stroke Centers may represent more sustainable channels for public stroke education
initiatives promoting the use of ambulance services.

State Departments of Health and the Joint Commission regulate Stroke Center hospitals through
an accreditation process that requires the fulfillment of certain stroke care measures.
Notably, one of these regulatory requirements is community stroke education by the hospital;
however, these are underdeveloped, and lack guidelines and evaluation metrics. Consequently,
stroke education efforts by Stroke Centers are often poorly delivered and do not use
evidence-based approaches.

The program helps schools fulfill NYS health education requirements through its primordial
prevention modules. Children are also taught to teach stroke information to their
parents/caregivers. HHS2.0 has shown to be effective in the real world setting through
several studies, including an Randomized Clinical Trial (RCT) involving more than 3,000
predominantly Black and Hispanic urban school children aged 9-11 years. These studies found
that children can and will: (1) learn how to recognize stroke, including self-efficacy for
calling 911 when they witness stroke, and retain this knowledge for at least 15 months, (2)
communicate stroke literacy successfully to their parents and grandparents who retain this
knowledge for at least 3 months, and (3) actually call 911 when they witness stroke symptoms
occurring in their homes or community.

This project is an outgrowth of our previously funded RCT (R01NS067443), in which we
developed and established the effectiveness of a novel intervention to teach economically
challenged minority residents of New York City to recognize stroke symptoms and know the
correct response - call 911 (stroke literacy).

Inclusion Criteria:

- Schools located in the 47 hospital (stroke center) geographic catchment areas

- Schools with 4th and/or 5th grade classes and have ascertained the following: student
bodies have at least 50 students in each of these grades, diverse socio-demographic
NYS communities, and computer resources / internet access required for the
implementation of the HHS program.

Exclusion Criteria:

- Special education school with a student body comprised of those with learning
disabilities.