Culturally tailored stroke education films were not more effective than conventional education pamphlets for improving stroke preparedness at one year among black and Hispanic churchgoers, a study found. Stroke films were somewhat effective, however, for improving stroke preparedness in low-education individuals, according to findings published in JAMA Neurology.

A transdisciplinary research team developed two culturally relevant 12-minute stroke films on stroke preparedness for black (n=159) and Hispanic (n=152) churchgoers with no history of stroke but at high risk for stroke (mean age, 58.57 years). The first film was a telenovela that targeted the Hispanic audience and the second was a musical Gospel film directed toward the black audience. A total of three stroke education pamphlets that described 5 cardinal stroke symptoms were also provided to each population in either Spanish or English. Films were considered the intervention condition, whereas the pamphlets were designated usual care.

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Patients were randomly assigned to either intervention (n=160) or usual care (n=151). The primary outcome included changes in the Stroke Action Test (STAT), which was the self-reported behavioral intent to call 911 at the onset of stroke symptoms from baseline to 6 and 12 months.

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At baseline, the mean STAT scores for intervention and usual care were 59.05% correct and 58.35% correct, respectively (P =.83). No differences were observed between the intervention and control groups with regard to changes in the STAT score at 12 months (mean score, 13.52 vs 12.93, respectively; P =.41). There was an increase in the mean intervention effect among a subgroup of low-education individuals (mean intervention effect, 1.03% increase; P =.02). Conversely, the mean intervention effect in the high-education subgroup was −0.05% (P =.86).

Factors associated with answering a higher number or greater percentage of STAT questions correctly included being non-Hispanic black (correlation coefficient, 0.266; P <.001), having higher education (correlation coefficient, 0.149; P =.009), and having a higher family income (correlation coefficient, 0.150; P <.01).

Study limitations include the small subgroup of low-education black participants, self-reported nature of education status, small sample size, and no analysis pertaining to cost-effectiveness of the intervention compared with usual care.

“While these findings may have potential implications regarding the design of stroke preparedness interventions,” the researchers wrote, “confirmatory testing in future studies is required.”

Disclosures: The authors disclosed no pharmaceutical conflicts of interests but did report grant funding from the National Institute of Neurological Disorders and Stroke and the National Institutes of Health.


Williams O, Teresi J, Eimicke JP, et al. Effect of stroke education pamphlets vs a 12-minute culturally tailored stroke film on stroke preparedness among black and Hispanic churchgoers: a cluster randomized clinical trial [published online July 1, 2019]. JAMA Neurol. doi:10.1001/jamaneurol.2019.1741