Stroke is the second leading cause of morbidity and mortality worldwide (1). The number of deaths due to stroke was 6.6 million in 2020, a figure projected to increase by at least 50% by 2050 (1). The burden of disability linked with disease complications is also on the rise, with an estimated increase from 144.8 million disability-adjusted life-years (DALYs) in 2020 to 189.3 million DALYs by 2050 (1). Previous data on the incidence and deaths due to stroke have been markedly and rapidly increasing since the 1990s, predominantly in low- and middle-income countries (LMICs) (1). The recent alarming findings are the higher incidence of stroke in young individuals (18–50 years) (2, 3). Stroke is also associated with high economic impact, with estimated costs of treatment, rehabilitation, and loss of productivity exceeding US$891 billion per year globally (1). Evidence-based solutions have been proposed to reduce the global incidence of stroke based on the following four pillars: surveillance, prevention, acute care, and rehabilitation (1). Primordial prevention of stroke meets the sustainable development goals (4), including (1) reducing poverty, (2) improving socioeconomic conditions, (3) universal health coverage, (4) health equity, (5) reducing air pollution, (6) healthy lifestyle, (7) building healthy cities and homes, (8) and public health campaigns to raise awareness about stroke and stroke risk factors (1).

The World Health Organization and the Lancet Neurology Commission surveyed 84 LMICs and high-income countries (HICs) to compare the status of stroke services. The results showed numerous deficiencies, including a lack of public education in many countries (5). The scope of this study is primordial community education as a preventive measure of stroke occurrence and recurrence (6). Primordial stroke prevention consists of activities to avoid stroke risk factors, whereas primary prevention aims to limit or manage exposure to risk factors for stroke (6). Research showed that the community knowledge of stroke symptoms, prevention measures, and the urgency of hospitalization in case of an event is poor or lacking in both LMICs and HICs (7–9).

Educational campaigns, including mass media (10), and digital platforms such as mobile applications [e.g., the PreventS-MD web app (PreventS-MD) (11) and stroke riskometer (12)], text messages to mobile health telemedicine (12), computer and web-based technologies, including artificial intelligence, are adapted tools to support stroke knowledge, awareness, and management (6). A systematic review and meta-analysis found that public stroke campaigns significantly influence the identification of stroke symptoms and the urgency for hospital transfer (13). The study stressed the accessibility and affordability of the digital technologies used by lay individuals for primary stroke prevention and considered that evidence-based content improves physician–patient communication and healthcare provision (13). Educating young adults about stroke was found beneficial in spreading awareness among families, raising the alarms about harmful health behaviors, and adapting preventive measures to reduce the burden of stroke in adult life (14). Numerous studies have demonstrated the effectiveness of educational campaigns and other digital tools in enhancing public knowledge of stroke to modify health behaviors and minimize delays in emergency transfer of a patient experiencing stroke (15–17). In this study, a 3-min educational video was built based on the American Stroke Association online awareness materials (18), the BE-FAST algorithm (19), and the Stroke Foundation New Zealand (20). The BE-FAST algorithm allows the identification of persons experiencing an ischemic stroke episode (18) to act fast and avoid delays in seeking emergency care. This study aims to test the impact of the budget-free short educational online video on public knowledge in Arab countries about stroke and factors influencing stroke knowledge scores.

In this study, the educational video successfully improved stroke knowledge among highly educated participants from different age groups and Arab countries. The predominant originality includes its brevity (which maintains audience focus), evidence-based content (18–20, 23), and availability online free of charge in English and Arabic. The educational tool effectively delivered relevant information about stroke occurrence sites, types, risk factors, warnings, signs, preventive measures, and appropriate behavior in emergencies, as evidenced by the significant improvement in all knowledge scores. The use of lay language and suggestive images made the content easily understood by the public and healthcare professionals. Improving knowledge, especially at a young age, is crucial to raising awareness of inappropriate health behaviors that may increase the risk of stroke. It could also help save lives by identifying alarming signs in case of an event and understanding the importance of seeking emergency care.

The pretest knowledge scores varied across countries, with Jordan exhibiting the highest scores, followed by Lebanon, while Egypt and UAE had comparable knowledge. Previous research in Jordan had categorized the level of knowledge and awareness regarding stroke as good, particularly among those with a higher level of education (25). Conversely, studies conducted in Lebanon have reported poor knowledge in the general population, but not among participants with a university degree (26), a trend also observed among older adults (24). Similarly, in the present study, 88.3% of the Lebanese participants had a university degree. Unfortunately, campaigns intended to educate the general population are limited and lacking in Lebanon. Public education about stroke currently relies on academia and the scientific communities’ efforts (27, 28). Since awareness campaigns need general budgeting and planning, the main barriers in Lebanon are the ongoing economic downturn, the health system collapse, and the political crisis (29). In Egypt, a low level of stroke knowledge was reported across four governorates (30), with participants from urban areas demonstrating better knowledge than their rural counterparts (31). Egypt and the UAE have established strategies to manage, prevent, and improve awareness of stroke (32–34) (35–39). In Egypt, accredited stroke centers, including tele-stroke units and training and education centers, have been established in collaboration with the Wings of Angels initiative (32, 40). While the UAE is engaged in multiple awareness campaigns about stroke and is invested in stroke management and prevention plans through partnerships (33) and the implementation of centers for excellence (34), stroke knowledge was better among educated individuals than the general public (41).

The baseline knowledge of stroke varied across different age groups, with participants aged 55 years and above scoring the highest (M = 22.46; SD = 6.00) compared to those aged 25–34 years (M = 20.74; SD = 8.18). According to the World Health Organization (WHO), stroke is the second leading cause of death in individuals aged >60 years and the fifth in people aged 15–59 years (42). The youngest age group (25–34 years) may not be aware of the high incidence of stroke reported at this age, which can explain the lower scores compared with older adults. In the last decade, stroke has been increasingly documented in young adults (1, 2, 42), potentially due to higher incidences of preventable risk factors, such as smoking, obesity, hypertension, and dyslipidemia (2, 4). Therefore, there is a critical need for educating young adults about the risks associated with stroke and the importance of preventive measures.

The baseline knowledge scores were lower among non-healthcare professionals, participants who did not have a family history of stroke, and those who consumed alcohol or did not maintain a healthy lifestyle. Interestingly, the difference between the pretest and posttest scores was significantly higher. These results indicate that the 3-min educational video succeeded in capturing the attention of susceptible individuals and those who may not have prior knowledge of this topic.

Educational campaigns have consistently demonstrated a significant improvement in stroke knowledge, awareness, and appropriate emergency response behaviors (14, 15, 43). In addition to educational lectures (44), these campaigns have used various tools, including mass media (18–20, 44–46), social media platforms (44, 47), mobile applications (14, 15), pharmacy flyers (47), readings in schools and high schools (44), and advertisement in public transportation spots (48). Notably, mobile applications were well-received by healthcare professionals and individuals at risk of stroke (14, 15). In Western Norway, mass media intervention effectively enhanced awareness about acute stroke onset, as indicated by the increase in the number of admissions to the emergency room (35). However, sustaining this improvement necessitated repeated campaigns beyond the initial 6 months allocated (35). Similarly, regular mass media coverage was recommended in Hungary to educate the public about stroke instead of a 1-day campaign (36). The Stroke Foundation in Australia conducted annual paid advertisements from 2004 to 2014 using the FAST campaign to promote the need for emergency medical services, resulting in improved public awareness and behaviors (37). Similar positive effects were observed in New Zealand with the implementation of these campaigns (38). Worldwide national campaigns among the general public significantly improved knowledge of stroke (39, 43, 45, 46) and emergency response behaviors (10, 43). These campaigns varied in duration, from 1-week campaigns per year for 4 years to 50-month initiatives (31).

The design and implementation of educational campaigns for stroke vary based on the sustainability of financial support and the intended audience’s demographics, including age, sex, cultural background, level of education, and stroke risks (43, 48–51). Reading was the preferred way to acquire information in schools (44). In some cultures, social networking may be a way of communicating and enhancing awareness about the topic (49). Television remains a widely accepted and efficient means of education and communication, reaching a vast audience. Nevertheless, it is time-limited and requires repetition to convey the message and a dedicated budget for sustained campaigns (44, 45, 50, 51). Social media platforms offer enhanced communication and interaction among healthcare professionals and the community (47). Blogs, infographics, and videos shared on social media can reach a vast audience (47). However, the proliferation of infodemics and misinformation on social media can have adverse effects on individuals’ health-related behaviors (52, 53).

Finally, the main challenges in stroke education campaigns include the need for short-term non-repetitive campaigns, sustainable financial support, and an adequate educational approach tailored to the cultural background, age, sex, and level of education of the target audience. Educating children in schools and colleges is crucial to preparing a knowledgeable society for the future and influencing the parents’ behaviors. Engaging students in academic activities allows them to undertake periodic educational campaigns within their community as part of extra-curricular public health initiatives. This bundle of initiatives may be effective even without a budget or financial support.

Educating the public about stroke has proven effective in enhancing knowledge and adapting appropriate behavior in case of an emergency. The main goal of this educational video in the short term is to improve community knowledge about stroke and the impact of inappropriate health behaviors, the identification of stroke signs, and action taken in case of an event. The mainstays are predominantly the sustainability and long-term effectiveness of this improvement in modifying inappropriate health behaviors and decreasing the risk of stroke morbidity and mortality. There is a need to capitalize on the strengths of this video and tailor its content to different cultural and educational backgrounds to reach all age groups. This tool can be part of a bundle of evidence-based interventions planned and implemented in collaboration with healthcare providers, the academic sector, governments, non-healthcare providers, and community engagement.

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found at: https://doi.org/10.6084/m9.figshare.24551878.v2.

The studies involving humans were approved by the institutional Review Board at Abu Dhabi University approved this study under the code number CoHS – 22-05-00018. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

KI: Conceptualization, Investigation, Methodology, Project administration, Supervision, Validation, Writing – original draft, Writing – review & editing. DR: Validation, Writing – original draft. PS: Data curation, Formal analysis, Software, Validation, Writing – review & editing. CH: Data curation, Formal analysis, Software, Visualization, Writing – review & editing. HS: Writing – review & editing. MB: Investigation, Writing – review & editing. RD: Investigation, Writing – review & editing. SE: Investigation, Writing – review & editing. JS: Investigation, Writing – review & editing. FS: Investigation, Writing – review & editing. MR: Conceptualization, Validation, Writing – review & editing. HH: Conceptualization, Validation, Writing – review & editing. MC: Conceptualization, Funding acquisition, Methodology, Project administration, Supervision, Validation, Writing – original draft.