Design of a school-based stroke preparedness intervention: challenges in acute diseases recognition

BACKGROUND: Timely activation of emergency medical services (EMS) by bystanders is important and it can improve outcomes of acute diseases such as stroke in Europe. Since there are no effective interventions addressing the complexity of help-seeking behaviour in the event of stroke, this study describes the development of the Czech “HOBIT” programme, which educates secondary school children to correctly activate the EMS. METHODS: Intervention Mapping was used to guide the development of the intervention using theory and evidence, as well as principles of co-creation. A needs assessment was completed by reviewing the evidence and interviewing stroke survivors. It identified sub-behaviours and their determinants. The information obtained was utilised to select the methods of behaviour change and their practical applications. In the last phase, the intervention tools were created. RESULTS: The needs assessment revealed stroke recognition and assessment as well as ambulance call as the main behaviours that must be done for EMS activation. Risk perception, outcome expectations, social influences, knowledge, and skills were revealed as important determinants of above behaviours. Modelling was selected as a method for the behaviour change. Based on discussions with 157 children aged 11-15, the format of an entertainment-education video was chosen. Incorporation of the modelling parameters (engagement, transplantation, identification) into the video was assessed during discussions with 15 children (scored >4 on the 5-point scale). As a result, a 5-minute entertainment video, modelling an acute stroke with a child as the main bystander was created. CONCLUSIONS: The innovative educational video teaches children to correctly activate the EMS in stroke by modelling a real-life situation. Our results enable future projects to build on our findings to create the intervention for supporting behaviours in acute events that cannot be trained by direct experience. KEY MESSAGES: • Using the systematic approach built on co-creation with stakeholders is a significant foundation for the development of an effective intervention to improve timely activation of the EMS in stroke. • The current paper provides a comprehensive roadmap to help health promoters approach structured planning for behaviour change in acute diseases response.