To assess the impact of FAST (Face-Arm-Speech-Time) public awareness campaigns on stroke signs recognition in Quebec, Canada, using data from repeated cross-sectional surveys.

Rapid community recognition of stroke signs is crucial to the timely activation of pre-hospital care, but the impact of public awareness campaigns is not fully understood.

The Heart & Stroke Foundation of Canada conducted four cross-sectional surveys in Quebec between July 2016 and January 2019 (wave 1: n=450; 2: n=450; 3: n=451; 4: n=1,100), asking participants to name stroke signs. A public awareness campaign preceded waves 1-3, and two campaigns preceded wave 4. We used weighted ordinal regression models to assess FAST stroke signs identification in the general population (ordinal scale: 0 to 3 signs) after the cumulative impact of four stroke public awareness campaigns, using 2016 responses as a baseline. We explored the effect of sociodemographic factors on stroke signs knowledge in the most recent survey (wave 4).

The identification of FAST stroke signs improved by 25% overall between waves 1 and 4 after adjustments (OR=1.25; 95% CI: 1.01, 1.54; p-value=0.039). However, the proportion of survey respondents unable to identify any FAST stroke signs remained high in each wave (wave 1=37.7%, 2=26.9%, 3=30.4%, and 4=30.5%). Factors associated with worse FAST stroke signs identification were male sex (OR=0.67; 95% CI: 0.53, 0.85; p-value=0.001), age 25-34 years (OR=0.46; 95% CI: 0.29, 0.72; p-value<0.001), and being retired (OR=0.54; 95% CI: 0.35, 0.84; p-value=0.006). Household income <40,000$ was associated with a tendency towards worse recognition (OR=0.71; 95% CI: 0.51, 1.00; p-value=0.052).