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Stroke. 2013 Oct;44(10):2829-34. doi: 10.1161/STROKEAHA.113.001537. Epub 2013 Jul 25.

Effects of intensive and moderate public education on knowledge of early stroke symptoms among a Japanese population: the Acquisition of Stroke Knowledge study.

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From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital, Hiroshima, Japan (A.T.); Department of Neurology, Shizuoka City Shimizu Hospital, Shizuoka, Japan (T.H.); and National Cerebral and Cardiovascular Center, Osaka, Japan (T.Y.).



To assess the effects of intensive and moderate public education on knowledge of early stroke symptoms among a general Japanese population.


Information on early stroke symptoms was distributed by leaflet 12× and by booklet twice in an intensive intervention area >22 months, and by leaflet and booklet once each in a moderate intervention area. No distribution occurred in the control area. Before and after the intervention, a mailed survey was conducted in the 3 areas. A total of 2734 individuals, aged 40 to 74 years, who did not select all 5 correct symptoms of stroke in the preintervention survey were eligible for our analysis.


The numbers of correct answers selected about stroke symptoms did not differ significantly among the 3 areas in the preintervention survey (P=0.156). In the postintervention survey, the proportions of participants who selected sudden 1-sided numbness or weakness (94.2% in the intensive intervention area, 88.3% in the moderate intervention area, and 89.2% in the control area; P<0.001) and sudden severe headache (76.8%, 70.1%, and 70.4%, respectively; P<0.001) differed significantly among the 3 areas. After adjustment for confounding factors, the multivariable-adjusted odds ratios (95% confidence intervals) for correctly choosing all 5 symptoms were 1.35 (1.07-1.71) in the intensive intervention area and 0.96 (0.74-1.24) in the moderate intervention area compared with the control area.


Our findings suggest that frequent distribution of leaflets and booklets significantly improved the short-term knowledge of community residents about early symptoms of stroke.


early stroke symptoms; knowledge; leaflet/booklet distribution; public education

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