Stroke Recognition Tools for Spanish-Speaking Consumers: A Nationwide Study

Stroke burden and structural inequities in stroke education among US Spanish-speaking Hispanic and Latino (SSHL) adults suggest a need for culturally appropriate education. Existing Spanish stroke recognition acronyms need to be evaluated among SSHL adults.

A 3-phase exploratory sequential design was used. To inform design of AHORA (Andar [Walk] or Alzar [Raise], Hablar [Talk], Ojos [Eyes], Rostro [Face], Ambos Brazos [Both Arms] or Activar [Activate]), PARA Stroke (Palabras [Words], Alzar [Raise], Rostro [Face], Avisar [Warn]), and RÁPIDO (Rostro Caído [Face Drooping], Alteración Del Equilibrio [Loss of Balance], Pérdida de Fuerza en el Brazo o Una Pierna [Loss of Strength in an Arm or Leg], Impedimento Visual [Visual Impairment], Dificultad PARA Stroke Hablar [Difficulty Speaking], Obtén Ayuda [Get Help]) before a randomized, parallel, 4-group prepost efficacy study involving 1105 SSHL participants (phase 3), interviews with health care professionals (n=15; phase 1) in May-June 2022 and focus groups with SSHL individuals (n=24; phase 2) were conducted in June-July 2022. Participants viewed a 1-minute video that included AHORA, PARA Stroke, RÁPIDO, or usual care (education without an acronym). Stroke knowledge and intent to contact 9-1-1 were examined pre- and 30 days post-video exposure via online questionnaires. Ordinal regression analyses were completed to determine acronym performances in improving stroke recognition, and binomial regression analyses were completed to determine increasing intention to call 9-1-1. Post hoc repeated measures ANOVA was used to determine if any acronym led to the greatest increase in intention to call 9-1-1.

At 30 days post-video (n=367), odds of recognizing more stroke signs compared with usual care were given as follows: odds ratio, 0.87 (95% CI, 0.45-1.69; P=0.69), odds ratio, 0.54 (95% CI, 0.28-1.00; P=0.05), and odds ratio, 1.47 (95% CI, 0.73-2.99; P=0.28), and odds of increased intent to call 9-1-1 were given as follows: 1.18 (95% CI, 0.59-2.37; P=0.64), 0.95 (95% CI, 0.49-1.80; P=0.76), and 1.06 (95% CI, 0.54-2.06; P=0.84) for AHORA, PARA Stroke, and RÁPIDO, respectively. The acronyms had significant long-term positive effects on the intent to call 9-1-1 (F[1101]=251.457; P<0.001; MSE=41.321) although no significant differences were observed between the acronyms.

AHORA, PARA Stroke, and RÁPIDO performed comparably to usual care. Healthcare professionals and SSHL consumers preferred a Spanish-language acronym, specifically RÁPIDO and PARA Stroke, compared with an acronym translated verbatim from English to Spanish.