In a novel study, hairdressers increased their African-American female clients’ recognition of stroke symptoms by telling them about the disease in the salon setting, according to research reported at the American Stroke Association’s International Stroke Conference 2007.

Such unique approaches could improve knowledge of stroke warning signs and risk factors, researchers said.  That knowledge is low, especially among African Americans.

“We know that African Americans have higher rates of stroke than Caucasians and that women tend to be more affected by stroke as they age,” said Dawn Kleindorfer, M.D., lead author of the study.   “We conducted a community research study, reaching out to African-American women and educating them about stroke risk factors, symptoms and the importance of quickly calling 9-1-1.”

Prompt recognition of a stroke is critical.  The only U.S. Food and Drug Administration treatment for acute ischemic stroke – tissue plasminogen activator (tPA) – must be given within three hours of symptom onset.

Kleindorfer, a stroke neurologist and associate professor at the University of Cincinnati College of Medicine in Ohio, noted that community-based research studies aimed at increasing African Americans’ awareness of health issues is often conducted through churches.   But churches in predominately African-American communities have become overwhelmed with multiple requests about various health topics, prompting researchers to seek alternative environments for health education, she said.

Kleindorfer and colleagues educated beauticians in African-American-run beauty shops in Cincinnati and Atlanta about stroke warning signs and risk factors.  A stroke survivor also spoke to the beauticians about the project. The beauticians then educated their African-American clientele during appointments. 

Beginning May 2005 (May is American Stroke Awareness Month), researchers armed beauticians with education materials and asked them to give a baseline survey testing clients’ knowledge of stroke warning signs and risk factors during appointments.   The beauticians would then talk to their clients about stroke, as they were doing the women’s hair.

“Once that was done, the beauticians gave their clients a packet, including cookbooks, wallet cards with warning signs and materials donated by the American Heart Association and its division the American Stroke Association,” Kleindorfer said. “We then repeated the open-ended-question survey, giving it to the clients at roughly the five-week and five-month marks, to see if the knowledge was sustained.”

Nearly 400 women completed baseline surveys and 318 surveys were completed by the five-month mark. More than three-fourths of the women were younger than 60-years-old and most had some college education.   Forty-one percent had hypertension and 12 percent had diabetes.

The researchers used the “FAST” method for teaching stroke warning signs and plan of action, by emphasizing the recognition of sudden onset weakness on one side of the face or arm, slurred speech and trouble talking, and time to call 9-1-1.

They found that the women’s recognition of stroke warning signs improved significantly.   At the start of the study, 40.7 percent of the women surveyed knew three stroke warning signs; by five months, 50.6 percent of women identified three warning signs. There were similar improvements in knowledge in both study regions.

“We also had a significant decrease in the number of women who didn’t know any stroke signs at the start of the study by the end of the study,” Kleindorfer said.

Awareness of stroke as an emergency situation also increased.  Researchers noted an 8 percent increase (to a total of 93 percent) in the women who knew to call 9-1-1 immediately and a 7 percent increase (to a total 92 percent) in those who recognized stroke when given a clinical scenario.

However, the women’s knowledge of risk factors for stroke did not improve at either location from the baseline.   Risk factor categories considered correct were hypertension, diabetes, smoking, high cholesterol, heart disease, increasing age, African-American race, and male gender, all of which were taught to beauticians and were included in the educational materials distributed.

Education on risk factors remains a challenge and warrants further study, Kleindorfer said.

The message, she said, is that similar programs can effectively educate minorities and researchers need to find different venues for this type of community-based research.

“In addition to doing this, we are working with the local beauty academy to incorporate stroke education into their classes for future beauticians,” she said.

“We know that this program works. We had two women have a stroke during the study in the beauty salon and the beauticians called 9-1-1 and got them to the hospital within 45 minutes.   Those beauticians said they would not have known what to do before our project.”

Co-authors are Sharion Sailor-Smith, R.N.; Charles Moowmaw, Ph.D.; Jane Khoury, Ph.D.; Michael Frankel, M.D. and Joseph Broderick, M.D.

The work was funded by the Hazel K. Goddess Fund for Stroke Research in Women

Editor’s note: The American Stroke Association’s Power To End Stroke is an awareness campaign to reach African Americans.  For information on stroke or the campaign, call 1-888-4STROKE, or visit