CFAST: a simplified and culturally adapted stroke education tool for Chinese communities

Rapid recognition of stroke symptoms in Chinese populations is poor, and improving the timely and reliable identification of patients could significantly expedite the administration of stroke therapy. This study aimed to develop and evaluate CFAST ("Zhongfeng, shuo-xiao-dong" meaning "stroke, speech, smile, move"), compare its learning efficiency, comprehension, and 1-h recall with Stroke-120, and validate its performance in a larger pragmatic cohort.

Phase 1 involved a comparison of standardized community sessions using CFAST (n = 192) or Stroke-120 (n = 192). The primary outcome was 1-h recall ability post-training (0-3-point checklist). The secondary outcomes were learning efficiency (time taken to recite the mnemonic) and immediate comprehension (0-3 elements explained correctly). In Phase 2, CFAST was implemented alone among 3,688 participants.

In Phase 1, all CFAST-trained participants (192/192; 100%) mastered the mnemonic within 5 min, compared to 3.65% (7/192) in the Stroke-120 group after a 30-min training (p < 0.001). When tested for comprehension, 100% of the CFAST group accurately explained the terms "speaking," "smiling" and "moving," whereas only 3.65% of the Stroke-120 group correctly identified the meaning of numbers associated with stroke symptoms. Short-term retention tests showed that 100% of CFAST-trained participants could accurately recall all mnemonic elements after 1 h, compared to none in the Stroke-120 group, where only 20.31% (39/192) could recall one or two items. These results were consistently replicated in a larger CFAST cohort (n = 3,688; 100% comprehension and recall, p < 0.001).

The newly developed CFAST mnemonic achieved superior short-term comprehension and recall compared with Stroke-120 and demonstrated scalability across communities. Our findings support its feasibility for public stroke education in Chinese populations.