Measurement of Patients' Perceptions of the Quality of Acute Stroke Services: Development and Validation of the STROKE Perception Report

The Sky's the Limit: Expanding Nursing's Contribution to Acute Stroke Science

Stroke is the number one cause of preventable disability in adults in the United States. Significant advances have occurred in medications and technology supporting rapid stroke diagnosis and treatment during the past 30 years, along with blurring of the lines of what traditionally constituted nursing or medical research. Ischemic stroke is a disease of vascular insufficiency that mirrors myocardial infarction more than any other neurologic diagnosis. My primary program of research is focused on exploration of methods to improve intracranial blood flow in patients with hyperacute ischemic stroke who have viable, yet vulnerable, brain tissue to prevent worsening or enable improvement of stroke symptoms. I am also examining augmentation of recombinant tissue plasminogen activator treatment and stimulation of both arteriogenesis and angiogenesis with external counter-pulsation in patients with intracranial atherosclerosis. My secondary program of research focuses on methods to improve stroke systems of care, including improvement of advance practice providers' contributions to acute stroke care, use of innovative mobile stroke units, and improvement of quality core measure processes. Lessons learned along the way are highlighted, along with the value of interdisciplinary "team science" to build knowledge and enhance the care of highly vulnerable patients with acute stroke.

The Importance of Incorporating Stroke Survivors' Health Perceptions in Addressing Health Care Disparities

Patient-centered research in determining health care disparities among stroke patients is limited. Several studies have examined patient perceptions in stroke survivors and have utilized the Illness Perceptions Questionnaire-Revised (IPQ-R) and Brief Illness Perceptions Questionnaire (BIPQ), which are validated measures of illness beliefs. Yet, there are several domains these surveys could assess that warrant more investigation, including: perception of medication side effects; acceptance of the stroke diagnosis; consequence and long-term impact of symptoms; the importance of medications in long-term health maintenance; and perception of ease of access to equitable health care. Though these surveys are available, representation of diverse and under-represented groups within stroke surveys utilizing them is low. Also, only a limited number of studies of stroke patients' perceptions have focused on health disparities or specifically beliefs and attitudes of under-represented stroke survivors. Due to insufficient current research, future studies should focus on using these patient perception questionnaires with underrepresented populations. Improvements in this field may allow providers to offer patient-centered care among a diverse population, bridging gaps in health care equity.

Correlates of stigma for poststroke patients: A meta-analysis

AIMS

A meta-analysis was carried out to review and identify correlates of stigma in poststroke patients.

BACKGROUND

Patients suffer from impaired physical functions and sequelae of stroke. Stroke-related stigma hinders the recovery process and produces poorer clinical outcomes of stroke, leading to compromised quality of life.

DESIGN

A systematic review and meta-analysis was reported by following PRISMA 2020 guidelines.

REVIEW METHODS

Nine databases were searched from their inception to May 2021 to identify studies focused on the relationships among demographics, disease-related factors, psychosocial factors and poststroke stigma. Included studies were assessed by using the Agency for Healthcare Research and Quality (AHRQ) scale. The statistical software R studios were used to perform statistical analysis.

RESULTS

Nineteen studies were included in the meta-analysis. Four demographic factors (age, caregiver, residence, monthly income), seven stroke-related characteristics (type of stroke, mRS, ADLs, stroke duration, recurrence, sequelae, chronic disease comorbidity) and three psychosocial factors (depression, social support, quality of life) showed significant associations with stroke-related stigma.

CONCLUSIONS

The results of our study can serve as a foundation for designing interventions to reduce stigma and improve the overall quality of life of poststroke patients and may produce positive clinical outcomes. Healthcare professionals should be aware of stroke patients who are characterised by correlates of stigma. Relevance to clinical practice Poststroke patients showed a moderate-to-high level of stigma, and this issue warrants more attention. This review provides a preliminary foundation for healthcare professionals to develop interventions to address stroke-related stigma by focusing on demographic, disease-related and psychosocial factors. Additionally, stigma identification should be a part of clinical nursing evaluation. The involvement of clinical and community nursing is very important to screen stroke-related stigma and pay attention to this population.

Providing Stroke and Hypertension Education in Amharic for Ethiopian Persons Living in Dallas, Texas, United States

BACKGROUND

The purpose of this study was to compare knowledge of a stroke education module provided to bilingual members of the Ethiopian immigrant population in Dallas, Texas, presented in the Amharic language as compared to in English.

METHODS

A convenience sample of 84 participants were recruited using a snowball technique and randomly assigned to receive education in English or Amharic. The participants completed a pre- and posttest of their knowledge about strokes, a demographic survey, and a satisfaction survey. Data was analyzed using a general linear model and chi-square analysis.

RESULTS

There were no statistically significant differences between satisfaction scores comparing those educated in Amharic versus English (χ2 = 6.5108, p = .0107). Although mean pretest (10.8) and posttest (16.4) stroke knowledge scores were higher across all groups (p < .001), the mean posttest scores were lower for subjects who watched the Amharic versus the English video (14.9 vs. 18.1, p = .003).

CONCLUSION

This study did not show a statistically significant increase in knowledge about stroke when presented learning materials in subjects' native language compared to in English. The use of video to present stroke and stroke-risk educational content can be used in future research and global health initiatives to increase stroke knowledge in the Amharic-speaking community.