# The Stroke Alert Project: A Longitudinal Evaluation of a School-Based Stroke Knowledge Intervention

## TL;DR

A school-based stroke education program significantly improved students' knowledge and retention over a year.

## Contribution

Demonstrates the effectiveness of a school-based intervention in improving and retaining stroke knowledge among children.

## Key findings

- Students' stroke knowledge scores increased significantly after the intervention and remained elevated for one year.
- Improvements were observed in symptom recognition, emergency actions, and prevention measures.
- No gender differences were found in knowledge retention over time.

## Abstract

Introduction

Stroke is a leading cause of morbidity and mortality in Portugal, and early recognition of symptoms is crucial for timely treatment and improved outcomes. School-based educational programmes may play an important role in increasing stroke-related knowledge among children and, indirectly, their families. This study aimed to evaluate the effect of a school-based educational intervention on stroke-related knowledge among fifth-grade students and to assess knowledge retention immediately after the intervention, one month later, and one year later.

Methods

A quasi-experimental, longitudinal pre-post study was conducted with 149 fifth-grade elementary school students from a public school in Portugal. The educational intervention consisted of a 45-minute interactive session covering stroke definition, recognition of warning signs, appropriate actions in suspected stroke, and primary prevention measures. Stroke-related knowledge was assessed using a 10-item multiple-choice questionnaire administered at four time points: pre-intervention, immediately post-intervention, one month post-intervention, and one year post-intervention. Data analysis was performed using Microsoft Excel® (Microsoft Corp., Redmond, WA, USA). Descriptive statistics, one-way ANOVA with Bonferroni-adjusted post-hoc tests, and independent-samples t-tests were used.

Results

All 149 students completed the four assessments. Mean scores increased from 6.1 ± 1.9 at baseline to 8.7 ± 1.3 immediately after the intervention, 8.1 ± 1.3 at one month, and 7.6 ± 1.8 at one year, corresponding to relative improvements of 42.6%, 32.8%, and 24.5%, respectively, compared with baseline. One-way ANOVA revealed a significant effect of time on knowledge scores (p < 0.001), and all post-intervention scores remained significantly higher than baseline (p < 0.001). No significant differences were observed between male and female students at any time point.

Conclusion

A brief, school-based educational intervention significantly improved stroke-related knowledge among fifth-grade students, with sustained retention over one year, particularly in symptom recognition, appropriate emergency actions and primary prevention measures. Integrating structured, age-appropriate stroke education into school health programmes may be a valuable strategy to strengthen stroke awareness in younger populations.