{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:23:18Z","timestamp":1787289798231,"version":"build-2736575974"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Stroke"],"abstract":"<jats:sec>\n                    <jats:title>Background\/objectives<\/jats:title>\n                    <jats:p>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 (\u201cZhongfeng, shuo-xiao-dong\u201d meaning \u201cstroke, speech, smile, move\u201d), compare its learning efficiency, comprehension, and 1-h recall with Stroke-120, and validate its performance in a larger pragmatic cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Phase 1 involved a comparison of standardized community sessions using CFAST (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f192) or Stroke-120 (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f192). The primary outcome was 1-h recall ability post-training (0\u20133-point checklist). The secondary outcomes were learning efficiency (time taken to recite the mnemonic) and immediate comprehension (0\u20133 elements explained correctly). In Phase 2, CFAST was implemented alone among 3,688 participants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In Phase 1, all CFAST-trained participants (192\/192; 100%) mastered the mnemonic within 5\u202fmin, compared to 3.65% (7\/192) in the Stroke-120 group after a 30-min training (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). When tested for comprehension, 100% of the CFAST group accurately explained the terms \u201cspeaking,\u201d \u201csmiling\u201d and \u201cmoving,\u201d 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\u202fh, 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\u202f=\u202f3,688; 100% comprehension and recall,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fstro.2026.1845862","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T04:23:05Z","timestamp":1787286185000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["CFAST: a simplified and culturally adapted stroke education tool for Chinese communities"],"prefix":"10.3389","volume":"5","author":[{"given":"Haroon","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People\u2019s Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People\u2019s Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Zhongshan Hospital, Affiliated to Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Bing","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People\u2019s Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dongfang Hospital, Affiliated to Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People\u2019s Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Ling","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People\u2019s Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiannan","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People\u2019s Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan-Cheng","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People\u2019s Hospital of Shenzhen","place":["Shenzhen, Guangdong, China"]},{"name":"Department of Neurology, Dongfang Hospital, Affiliated to Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1161\/STROKEAHA.116.015169","article-title":"BE-FAST (balance, eyes, face, arm, speech, time): reducing the proportion of strokes missed using the FAST mnemonic","volume":"48","author":"Aroor","year":"2017","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3456144","DOI":"10.1155\/2022\/3456144","article-title":"Improving the prehospital identification and acute care of acute stroke patients: a quality improvement project","volume":"2022","author":"Bao","year":"2022","journal-title":"Emerg. Med. Int."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1038\/nrneurol.2009.116","article-title":"Reducing prehospital delay in acute stroke","volume":"5","author":"Bouckaert","year":"2009","journal-title":"Nat. Rev. Neurol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2154","DOI":"10.1161\/STROKEAHA.110.612036","article-title":"Stroke public awareness campaigns have increased ambulance dispatches for stroke in Melbourne, Australia","volume":"42","author":"Bray","year":"2011","journal-title":"Stroke"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"513","DOI":"10.46234\/ccdcw2022.113","article-title":"Trends in stroke mortality rate - China, 2004-2019","volume":"4","author":"Cheng","year":"2022","journal-title":"China CDC Wkly"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1038\/s41467-019-09073-5","article-title":"Social networks and risk of delayed hospital arrival after acute stroke","volume":"10","author":"Dhand","year":"2019","journal-title":"Nat. Commun."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1186\/1471-2458-13-915","article-title":"The impact of the UK 'act FAST' stroke awareness campaign: content analysis of patients, witness and primary care clinicians' perceptions","volume":"13","author":"Dombrowski","year":"2013","journal-title":"BMC Public Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/17474930211065917","article-title":"World stroke organization (WSO): global stroke fact sheet 2022","volume":"17","author":"Feigin","year":"2022","journal-title":"Int. J. Stroke"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"858926","DOI":"10.3389\/fpubh.2022.858926","article-title":"Identification of high-risk factors for prehospital delay for patients with stroke using the risk matrix methods","volume":"10","author":"Gao","year":"","journal-title":"Front. Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101156","DOI":"10.1016\/j.ienj.2022.101156","article-title":"Identification and analysis of key risk factors for prehospital delay in patients with stroke","volume":"62","author":"Gao","year":"","journal-title":"Int. Emerg. Nurs."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13167-024-00356-6","article-title":"The paradigm change from reactive medical services to 3PM in ischemic stroke: a holistic approach utilising tear fluid multi-omics, mitochondria as a vital biosensor and AI-based multi-professional data interpretation","volume":"15","author":"Golubnitschaja","year":"2024","journal-title":"EPMA J."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1161\/01.STR.0000044170.46643.5E","article-title":"Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test","volume":"34","author":"Harbison","year":"2003","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2372","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.05.010","article-title":"Stroke education for multidisciplinary medical personnel in a rural area of Japan for promotion of hospital visit of acute stroke patients","volume":"23","author":"Kawano","year":"2014","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"123123","DOI":"10.1016\/j.jns.2024.123123","article-title":"Mobile stroke units: beyond thrombolysis","volume":"463","author":"Krothapalli","year":"2024","journal-title":"J. Neurol. Sci."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e897","DOI":"10.1016\/S2468-2667(21)00228-0","article-title":"Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the global burden of disease study 2019","volume":"6","author":"Ma","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e080634","DOI":"10.1136\/bmjopen-2023-080634","article-title":"Estimating the economic burden of stroke in China: a cost-of-illness study","volume":"14","author":"Ma","year":"2024","journal-title":"BMJ Open"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3389\/fneur.2019.00159","article-title":"Improving prehospital stroke services in rural and underserved settings with mobile stroke units","volume":"10","author":"Mathur","year":"2019","journal-title":"Front. Neurol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/cns.14005","article-title":"Prehospital stroke care in Africa: the reality and potential solutions","volume":"29","author":"Melifonwu","year":"2023","journal-title":"CNS Neurosci. Ther."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1572925","DOI":"10.3389\/fnins.2025.1572925","article-title":"Recanalization and reperfusion in clinically-relevant porcine model of stroke","volume":"19","author":"Nowak","year":"2025","journal-title":"Front. Neurosci."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e74","DOI":"10.1016\/s2468-2667(21)00230-9","article-title":"Primary stroke prevention worldwide: translating evidence into action","volume":"7","author":"Owolabi","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/str.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1161\/STR.0000000000000513","article-title":"2026 Guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association\/American Stroke Association","volume":"57","author":"Prabhakaran","year":"2026","journal-title":"Stroke"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1136\/emermed-2015-205197","article-title":"A systematic review of stroke recognition instruments in hospital and prehospital settings","volume":"33","author":"Rudd","year":"2016","journal-title":"Emerg. Med. J."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1186\/s12883-025-04202-8","article-title":"Knowledge of alarm signs of stroke among caretakers of stroke patients and first contact healthcare providers at two tertiary referral hospitals in Uganda","volume":"25","author":"Ssemmanda","year":"2025","journal-title":"BMC Neurol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1136\/svn-2020-000332","article-title":"Implementation of regional acute stroke care map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months","volume":"6","author":"Sui","year":"2021","journal-title":"Stroke Vasc. Neurol."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"107565","DOI":"10.1016\/j.clineuro.2022.107565","article-title":"Investigation of an alternative education module in raising middle school student's awareness of acute stroke","volume":"225","author":"Tekyol","year":"2023","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1016\/j.japh.2017.02.026","article-title":"Impact of the act FAST stroke campaign delivered by student pharmacists on the primary prevention of stroke","volume":"57","author":"Vo","year":"2017","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s00415-024-12842-y","article-title":"Long-term outcome of endovascular thrombectomy in patients with acute ischemic stroke: a systematic review and meta-analysis","volume":"272","author":"Wu","year":"2025","journal-title":"J. Neurol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1054823","DOI":"10.3389\/fnins.2022.1054823","article-title":"Ischemic post-conditioning in acute ischemic stroke thrombectomy: a phase-I duration escalation study","volume":"16","author":"Wu","year":"2022","journal-title":"Front. Neurosci."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s41983-024-00838-4","article-title":"Characteristics and reasons for delayed presentation in acute ischemic stroke: single-centered study in Indonesia","volume":"60","author":"Yang","year":"2024","journal-title":"Egypt. J. Neurol. Psychiatry Neurosurg."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1766","DOI":"10.1161\/STROKEAHA.118.021729","article-title":"Stroke 112: a universal stroke awareness program to reduce language and response barriers","volume":"49","author":"Zhao","year":"2018","journal-title":"Stroke"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1136\/svn-2019-000324","article-title":"Changing the strategy and culture of stroke awareness education in China: implementing stroke 1-2-0","volume":"5","author":"Zhao","year":"2020","journal-title":"Stroke Vasc. Neurol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/S1474-4422(16)30283-6","article-title":"Stroke 1-2-0: a rapid response programme for stroke in China","volume":"16","author":"Zhao","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1186\/s12883-019-1418-z","article-title":"Intravenous thrombolytic therapy for acute ischemic stroke in Hubei, China: a survey of thrombolysis rate and barriers","volume":"19","author":"Zhou","year":"2019","journal-title":"BMC Neurol."}],"container-title":["Frontiers in Stroke"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2026.1845862\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T04:23:06Z","timestamp":1787286186000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fstro.2026.1845862\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":34,"alternative-id":["10.3389\/fstro.2026.1845862"],"URL":"https:\/\/doi.org\/10.3389\/fstro.2026.1845862","relation":{},"ISSN":["2813-3056"],"issn-type":[{"value":"2813-3056","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"1845862"}}