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. 2024 Nov 28;24:3322. doi: 10.1186/s12889-024-20809-x

Table 2.

Pairing the relevant determinant with Behavior Change methods to target in intervention

Determinants and their change objectives Method Parameter Practical application

Knowledge

- recall stroke symptoms

- recall mimicking symptoms

- recall risk factors

- recall the FAST method

- recall calling EMS as the only right reaction

- recall what to say to the operator

-Information

-Elaboration

-Providing cues

Attention, reinforcement, identification, self-efficacy, coping,

personal relevance, surprising, repeated, easily understandable, direct instruction,

tailored selection

-Knowledge about stroke is incorporated into a film script and repeated at the end of the film

-Knowledge about stroke is given in personally relevant, surprising and repeated way by embedding it into entertainment storytelling with a child as a main character

-Real-life situations are used as cues in the film script

Risk-perception

-recognize younger people are at risk of stroke

-recognize healthy people are at risk of stroke

-Scenario-based risk information

-Belief selection

Attention, reinforcement, identification, self-efficacy, coping

Scenario with a cause and an outcome

Investigation of the current beliefs

-The model in the film presents a scenario that demonstrated that stroke can also happen in the absence of diseases that may cause stroke

- The belief that stroke only happens to old people with pre-existing conditions such as obesity, hypertension, or diabetes, needed to be changed. The belief that stroke could happen to all categories of people is introduced in the film

Outcome expectations

- expect that symptoms recognition can save life

- expect that even weak symptoms have severe consequences

- expect that acting assertively can save life

- expect that an immediate EMS call can save life

-Modeling

-Elaboration

-Cultural similarity

Attention, reinforcement, identification, self-efficacy, coping,

personal relevance, surprising, repeated, easily understandable, direct instruction,

use socio-cultural characteristics of the target group

-The main character decides to help a woman with a stroke because he knows about the consequences of stroke and the role of time in stroke treatment

- The message about stroke outcomes is given in a personally relevant surprising way by embedding it into entertainment storytelling with a child as a main character

-The film is tailored for the target group (children) by giving a message in a social-cultural relevant context

Social influence

-recognize that the witness can intervene even if significant others do not allow it / it is not allowed by social status

- recognize that calling EMS is the right action even in the presence of social pressure from others

-Modeling

- Belief selection

Attention, reinforcement, identification, self-efficacy, coping

-The main character (a child) resists the social influence exerted by significant others (i.e., the father and the police) and takes appropriate action despite their disagreement

-The belief that children lack the ability to act independently in urgent situations and that their knowledge is not valid, is changed in the film. The capacity and empowerment of children to act in urgent situations are promoted by peer modeling

Self-efficacy

- express confidence in distinguishing stroke symptoms from mimicking symptoms

- express confidence in applying the FAST method,

- express confidence in communication that an ambulance call is required

- express confidence in the need to call EMS

- express confidence in describing symptoms

-Modeling Attention, reinforcement, identification, self-efficacy, coping

-The primary model is portrayed as a peer who successfully overcomes the barriers to seeking emergency medical care for stroke.

-To enhance identification with the character, the film highlights the common peer characteristics of the protagonist.

Skills

-demonstrate the skills to apply the FAST method

-demonstrate the skills to explain to victim/bystanders that an ambulance call is needed

- demonstrate the skills to explain the situation to the EMS operator correctly

-Modeling Attention, reinforcement, identification, self-efficacy, coping

-The film demonstrates the application of the FAST method in a high-stress situation, providing children with real-life examples of how the method must be used.

- The film demonstrates communication between the principal character (child) and other characters who are actively discouraging him from EMS activation. In doing so, the film effectively highlights the essential skills of crisis communication in the context of stroke help-seeking behavior.