Improving Parent Sign-Up for a Children's Stroke Awareness Program

August 4, 2026 updated by: University of Macedonia

Behavioral Insights for Public Health Engagement: A Four-Arm School-Level Comparative Study on Parental Registration in FAST Heroes

Many families do not sign up for a school-based stroke awareness program (FAST Heroes) that teaches children and parents to recognize stroke symptoms and act quickly. This study compared four different ways of encouraging parents to complete online registration for the program: a printed letter sent home, an email, an email combined with follow-up reminders from teachers, and an email combined with teacher reminders plus an automated chatbot. Thirty-seven schools that had not previously had any parents register were assigned to one of these four approaches, and the study measured how many parents in each group registered within eight weeks. The goal was to identify practical, low-cost communication strategies that schools and public health programs can use to increase parent engagement with health education initiatives.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

FAST Heroes is a school-based education programme that teaches kindergarten-aged children and their families to recognize stroke symptoms (using the FAST acronym: Face, Arms, Speech, Time) and to call emergency services promptly. A key component of the programme requires parents to complete online registration, but registration rates have historically been low. This study was conducted to identify communication strategies that could improve parental registration.

Eligible schools were those that had implemented the FAST Heroes programme during the prior school year (2023-2024) with zero parental registrations recorded. From the pool of eligible schools, participating schools were allocated at the school level to one of four conditions using a pre-specified, non-random balanced allocation procedure intended to achieve comparability across conditions in pupil numbers and school settlement category (urban versus non-urban, per the 2021 Greek Census classification): (1) a printed letter sent home with pupils; (2) an email sent directly to parents; (3) an email combined with weekly teacher-delivered reminders to parents for five weeks; and (4) an email combined with weekly teacher reminders plus an automated chatbot (delivered via a messaging app chatbot) sending parents reminders over the same five-week period.

The primary outcome was the proportion of parents who completed online registration within eight weeks of the initial prompt in their assigned condition. Because schools (not individual pupils) were the unit of allocation while registration was assessed at the level of individual pupils/families, the primary analysis used mixed-effects logistic regression with a random intercept for school to account for clustering within schools. Exploratory analyses examined whether the effect of condition varied by school settlement category (urban vs. non-urban) and by class size.

Study Type

Interventional

Enrollment (Actual)

37

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Greece
      • Thessaloniki, Greece, 54636
        • University of Macedonia

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion criteria:

  • School was implementing the FAST Heroes stroke awareness programme during the 2023-2024 school year
  • Zero parental registrations recorded for the school prior to the start of the study (2024-2025 school year)
  • School and/or parents provided informed consent to participate

Exclusion criteria:

  • Schools with one or more parental registrations already recorded prior to the study period
  • Schools that did not provide consent to participate
  • Schools not located in Greece

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Printed Letter
Schools in this condition received a printed letter sent home with pupils inviting parents to complete online registration for the FAST Heroes programme.
Behavioral: Printed Letter
A printed letter sent home with pupils, inviting parents to complete online registration for the FAST Heroes stroke awareness programme.
Experimental: E-mail
Schools in this condition received an email sent directly to parents inviting them to complete online registration for the FAST Heroes programme.
Behavioral: E-mail Invitation
An e-mail sent directly to parents inviting them to complete online registration for the FAST Heroes stroke awareness programme.
Experimental: E-mail Plus Teacher Feedback
Schools in this condition received an email invitation to register, followed by weekly teacher-delivered reminders to parents for five weeks.
Behavioral: E-mail Invitation Plus Teacher Feedback
An e-mail invitation to register, followed by weekly reminders delivered by teachers to parents over a five-week period.
Experimental: E-mail Plus Teacher Feedback Plus Chatbot
Schools in this condition received an email invitation to register, weekly teacher-delivered reminders, and an automated chatbot sending weekly reminders to parents over the same five-week period.
Behavioral: Email Invitation Plus Teacher Feedback Plus Automated Chatbot
An e-mail invitation to register, weekly teacher-delivered reminders, and an automated chatbot sending weekly reminders to parents, all over the same five-week period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Parental Registration Rate
Time Frame: Within 8 weeks of the initial registration prompt
Proportion of parents who completed online registration for the FAST Heroes stroke awareness programme, calculated per school condition.
Within 8 weeks of the initial registration prompt

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Macedonia

Investigators

  • Principal Investigator: Maria Baskini, PhD, Aristotle University Of Thessaloniki

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 11, 2024

Primary Completion (Actual)

June 15, 2025

Study Completion (Actual)

June 15, 2025

Study Registration Dates

First Submitted

July 29, 2026

First Submitted That Met QC Criteria

July 29, 2026

First Posted (Actual)

August 4, 2026

Study Record Updates

Last Update Posted (Actual)

August 5, 2026

Last Update Submitted That Met QC Criteria

August 4, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 14/15.06.2020

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Individual participant data that underlie the results reported in this study (after de-identification) will be available from the corresponding author upon reasonable request.

IPD Sharing Time Frame

Beginning 3 months and ending 3 years following article publication.

IPD Sharing Access Criteria

Requests should be directed to the corresponding author, who will evaluate each request individually.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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