Development Strategies in Medical Education

Introduction
Stroke is the most important and common neurological disease. It is the third cause of death in older adults after heart diseases and cancers [1]. The highest mortality occurs shortly after a stroke; in the first 30 days, it is about 8-20% in ischemic stroke and reaches 30-80% in cerebral hemorrhages [2]. The quick referral of patients to medical centers after the onset of symptoms depends on public awareness of the risk factors and warning signs of stroke [6]. The incidence of stroke is estimated at about 5 per 100,000 population [7, 10]. In different countries, studies have been conducted to measure the awareness of people about stroke [5, 11]. In the United States and many other developed countries, increasing people’s awareness of stroke had been determined as a health priority by 2010 [12, 13]. Considering that there are very few studies in Iran on measuring the level of awareness of people in people, the present study aims to evaluate the effect of two educational interventions (using educational poster and pamphlets) about cerebrovascular accidents (CVA) or stroke on the knowledge and practice of non-medical students in Iran.

Methods
This is a quasi-experimental study with a pretest/posttest design, which was conducted on non-medical students in three faculties from September to December 2019.A stratified random sampling method was used to select participants. In this regard, 120 people participated in this study. They were randomly divided into three groups of educational posters, educational pamphlets, and control (40 in each group). The educational content included educational materials about CVA. A questionnaire was used measure the knowledge of participants before and three weeks after educational intervention. Data analysis was done in SPSS v.21 software using descriptive statistics and inferential statistics

Results
The results of the chi-square test showed no significant difference between the studied groups in terms of gender (P=0.526) or age (P=0.635).The results of one-way ANOVA showed no significant difference between the groups in terms of knowledge and practice scores at baseline. 
In the pamphlet group, the mean pretest score of knowledge was 8.95±1.41. After education, it increased to 10.57±0.59. Paired t-test results showed that the improvements in knowledge (P=0.001) and practice (P=0.002) of the pamphlet group were statistically significant.
In the poster group, the mean pretest score of knowledge was 9±1.2. After education, it increased to 10.3±0.51. The mean pretest score of practice was 0.8±0.40. After education, it increased to 0.975±0.40. Paired t-test results showed that the improvements in knowledge (P= 0.001) and practice (P=0.006) of the poster group were statistically significant.
Participants in the control group showed significant changes in knowledge (P=0.003) scores after the end of intervention, but the change in the practice score was not significant (P=0.453).
There was a significant difference in the scores of the control group and two pamphlet and poster groups after intervention, but there was no significant difference between the pamphlet and poster groups.

Conclusion
The results of the present study showed that participants in all intervention groups experienced a significant improvement in their knowledge and practice regarding the CVAs after receiving the educational interventions by posters and pamphlets. These findings show the effectiveness of the education by posters and pamphlets in increasing the knowledge and performance of the non-medical students regarding the CVAs. There is no significant difference between the pamphlet and poster groups.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (Code: IR.MUMS.MEDICAL.REC.1398.454)

Funding
This study was funded by Mashhad University of Medical Sciences.

Authors' contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declare no conflict of interest

Acknowledgments
The authors would like to thank the deputy for research of Mashhad University of Medical Sciences for financial support and all the students who participated in this study for their cooperation.


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