Behavioural Insights for Public Health Engagement: A Four-Arm School-Level Comparative Study on Parental Registration in FAST Heroes
Abstract
Abstract Background FAST Heroes is an international school-based stroke education programme that uses child-mediated learning to improve stroke preparedness. Despite its public health impact, parental registration on the programme’s digital platform remains low, potentially limiting family engagement and reinforcement. This study evaluated four prompting conditions to increase parental registration and explored variation by settlement category and class size. Methods We conducted a prospective, four-arm, school-level comparative intervention study in 37 Greek kindergartens that had implemented FAST Heroes but recorded no parental registrations in the preceding school year ( N = 872 pupils). Eligible schools were allocated using a balanced procedure aimed at comparability in pupil numbers and settlement category; the final sample comprised consenting schools, without post-consent reallocation. Conditions comprised a printed letter, an e-mail letter, e-mail plus weekly feedback to teachers, and e-mail plus feedback to teachers and automated chatbot reminders to parents. The primary outcome was parental registration within eight weeks. The primary analysis used mixed-effects logistic regression with a random intercept for school, including prompting condition and settlement category as fixed effects. The condition-by-settlement interaction and class size were explored. Results Registration rates were 11.6% with the printed letter, 20.0% with the e-mail letter, 24.1% with e-mail…
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