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Jiang BY, Chan L, Chen HC, Tam KW, Liou TH, Escorpizo R, Lin LF. Effects of world stroke campaign on stroke literacy and knowledge in Taiwan. Neurol Res 2024:1-11. [PMID: 39087592 DOI: 10.1080/01616412.2024.2381159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES Stroke is a leading cause of death in Taiwan. Poor public knowledge of stroke may lead to delays in prehospital arrival, resulting in unfavorable prognoses. Studies have investigated public knowledge of stroke and highlighted the importance of stroke education, however, few such studies have been conducted in Taiwan. This study assessed the changes in public knowledge of stroke between 2012 and 2020 by conducting a survey during two World Stroke Day events. Furthermore, this study identified areas where educational efforts may have been insufficient. MATERIALS & METHODS Questionnaires were distributed to the participants of 2012 and 2020 World Stroke Day events in Taiwan. In total, 328 and 336 questionnaires were completed, respectively. Stroke literacy and knowledge were analyzed between 2012 and 2020. Data were analyzed using the chi-square test or independent t-test. p < 0.05 indicates statistical significance. RESULTS Hypertension was the most recognized risk factor for stroke in both years (p < 0.001), and recognition of most of the given risk factors significantly increased. In addition, recognition of more than half of the stroke warning signs significantly increased, awareness of the correct acute stroke response also increased (p < 0.001), and overall stroke literacy in Taiwan increased (p = 0.001). CONCLUSION Stroke literacy and knowledge in Taiwan have improved significantly between 2012 and 2020, but many people still lack adequate stroke knowledge and awareness. Government health department must take this sort of intervention continually (campaigns) and novel approaches (e.g. board game…) to improve stroke literacy and knowledge in public health. REGISTRATION ID N202109072, approved by the Joint Institutional Review Board of Taipei Medical University on 2021/11/02.
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Affiliation(s)
- Bing-Yan Jiang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Education and Research, Renai Branch, Taipei City Hospital, Taipei, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University, New Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Ka-Wai Tam
- Shared Decision-Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, USA
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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2
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Mallaiah J, Williams O, Allegrante JP. Development and Validation of a Stroke Literacy Assessment Test for Community Health Workers. HEALTH EDUCATION & BEHAVIOR 2024:10901981241245050. [PMID: 38646736 DOI: 10.1177/10901981241245050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Community health workers (CHWs) are increasingly being required to perform complex health care activities, especially in community cardiovascular disease and stroke prevention. However, currently, there are no psychometrically validated instruments for assessing CHW competencies in these roles. This article describes the development and validation of the stroke literacy assessment test (SLAT)-pertaining to the Life's Simple Seven (LS7) risk factors for stroke-for evaluating CHWs' competencies in the context of education and training programs. The SLAT was developed using an iterative instrument design protocol, followed by empirically testing the instrument in 68 CHWs from the Columbia University Institute for Training Outreach and Community Health (InTOuCH) in New York. Data collection began in March 2021 and continued through May 2021. The evaluation was based on four types of validity evidence: (a) content validation with expert reviews of items and overall domain, (b) validation on examinee response processes with cognitive interviews, (c) item validation and diagnostic analysis, and (d) validity evidence based on expected directional group differences. In addition, the internal consistency reliability of the total test scores, with the best functioning items, were evaluated. Two such iterative cycles yielded a 34-item, written structured response test that assesses the factual knowledge and application levels of cognition, and demonstrates sufficient validity and reliability (Cronbach's α = .69) for use with CHWs specializing in stroke prevention efforts. The SLAT is a novel, valid, and reliable instrument that contributes to filling a critical gap in rigorous competency assessments for CHWs deployed in chronic disease prevention.
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Affiliation(s)
| | | | - John P Allegrante
- Columbia University, New York, NY, USA
- Teachers College, Columbia University, New York, NY, USA
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3
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Denny MC, Rosendale N, Gonzales NR, Leslie‐Mazwi TM, Middleton S. Addressing Disparities in Acute Stroke Management and Prognosis. J Am Heart Assoc 2024; 13:e031313. [PMID: 38529656 PMCID: PMC11179759 DOI: 10.1161/jaha.123.031313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.
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Affiliation(s)
- M. Carter Denny
- Department of NeurologyGeorgetown University School of MedicineWashingtonDCUSA
- Department of Neurology, MedStar HealthWashingtonDCUSA
| | - Nicole Rosendale
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCAUSA
- Weill Institute for Neurosciences, University of California San FranciscoSan FranciscoCAUSA
| | - Nicole R. Gonzales
- Department of NeurologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic UniversityDarlinghurstAustralia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic UniversityDarlinghurstAustralia
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4
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Towfighi A, Ovbiagele B. Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving 2023 Update. J Am Heart Assoc 2024; 13:e031306. [PMID: 38529646 PMCID: PMC11179747 DOI: 10.1161/jaha.124.031306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Amytis Towfighi
- University of Southern CaliforniaLos AngelesCAUSA
- Los Angeles County Department of Health ServicesLos AngelesCAUSA
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5
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Mavragani A, Ancer Leal A, Montiel TC, Wynne KJ, Edquilang G, Vu KYT, Vahidy F, Savitz SI, Beauchamp JE, Sharrief A. An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study. JMIR Form Res 2023; 7:e31903. [PMID: 35972729 PMCID: PMC9850284 DOI: 10.2196/31903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy-an understanding of stroke symptoms, risk factors, and treatment-likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. OBJECTIVE We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. METHODS The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. RESULTS A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. CONCLUSIONS An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1371/journal.pone.0171952.
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Affiliation(s)
| | - Andrea Ancer Leal
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States
| | | | - Keona J Wynne
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | | | - Kim Yen Thi Vu
- Memorial Hermann - Texas Medical Center, Houston, TX, United States
| | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Population Health Sciences, Weill Cornell Medical School, New York, NY, United States.,Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
| | - Sean I Savitz
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Jennifer Es Beauchamp
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Anjail Sharrief
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
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6
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Farcas AM, Joiner AP, Rudman JS, Ramesh K, Torres G, Crowe RP, Curtis T, Tripp R, Bowers K, von Isenburg M, Logan R, Coaxum L, Salazar G, Lozano M, Page D, Haamid A. Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review. PREHOSP EMERG CARE 2022; 27:1058-1071. [PMID: 36369725 DOI: 10.1080/10903127.2022.2142344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.
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Affiliation(s)
- Andra M Farcas
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anjni P Joiner
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jordan S Rudman
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karthik Ramesh
- School of Medicine, University of California San Diego, San Diego, California
| | | | | | | | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Bowers
- Atlanta Fire Rescue Department; Department of Emergency Medicine, University of Tennessee-Chattanooga, Chattanooga, Tennessee
| | - Megan von Isenburg
- Duke University Medical Center Library, Duke University, Durham, North Carolina
| | - Robert Logan
- San Diego Fire - Rescue Department, San Diego, California
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Michael Lozano
- Division of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Page
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ameera Haamid
- Section of Emergency Medicine, University of Chicago School of Medicine, Chicago, Illinois
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7
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Mack WJ. Getting ahead of stroke. J Neurointerv Surg 2022; 14:743-744. [PMID: 35835470 DOI: 10.1136/jnis-2022-019306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- William J Mack
- Department of Neurosurgery, Keck School of Medicine of USC Los Angeles, Los Angeles, CA 90033, USA
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8
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Sheriff F, Xu H, Maud A, Gupta V, Vellipuram A, Fonarow GC, Matsouaka RA, Xian Y, Reeves M, Smith EE, Saver J, Rodriguez G, Cruz-Flores S, Schwamm LH. Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke. J Am Heart Assoc 2022; 11:e023212. [PMID: 35229659 PMCID: PMC9075329 DOI: 10.1161/jaha.121.023212] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Endovascular therapy (EVT) use increased following clinical trials publication in 2015, but limited data suggest there may be persistent race and ethnicity differences. Methods and Results We included all patients with acute ischemic stroke arriving within 6 hours of last known well and with National Institute of Health Stroke Scale (NIHSS) score ≥6 between April 2012 and June 2019 in the Get With The Guidelines‐Stroke database and evaluated the association between race and ethnicity and EVT use and outcomes, comparing the era before versus after 2015. Of 302 965 potentially eligible patients; 42 422 (14%) underwent EVT. Although EVT use increased over time in all racial and ethnic groups, Black patients had reduced odds of EVT use compared with non‐Hispanic White (NHW) patients (adjusted odds ratio [aOR] before 2015, 0.68 [0.58‒0.78]; aOR after 2015, 0.83 [0.76‒0.90]). In‐hospital mortality/discharge to hospice was less frequent in Black, Hispanic, and Asian patients compared with NHW. Conversely discharge home was more frequent in Hispanic (29.7%; aOR, 1.28 [1.16‒1.42]), Asian (28.2%; aOR, 1.23 [1.05‒1.44]), and Black (29.1%; aOR, 1.08 [1.00‒1.18]) patients compared with NHW (24%). However, at 3 months, functional independence (modified Rankin Scale, 0–2) occurred less frequently in Black (37.5%; aOR, 0.84 [0.75‒0.95]) and Asian (33%; aOR, 0.79 [0.65‒0.98]) patients compared with NHW patients (38.1%). Conclusions In a large cohort of patients treated with EVT, Black versus NHW patient disparities in EVT use have narrowed over time but still exist. Discharge related outcomes were slightly more favorable in racial and ethnic underrepresented groups; 3‐month functional outcomes were worse but improved across all groups with time.
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Affiliation(s)
| | - Haolin Xu
- Duke Clinical Res Inst Durham Durham NC
| | - Alberto Maud
- Texas Tech University Health Sciences Center El Paso TX
| | - Vikas Gupta
- Texas Tech University Health Sciences Center El Paso TX
| | | | - Gregg C Fonarow
- UCLA Division of CardiologyRonald Reagan-UCLA Medical Center Los Angeles CA
| | | | - Ying Xian
- University of Texas Southwestern Medical Center Dallas TX
| | - Mathew Reeves
- College of Human Medicine Michigan State University East Lansing MI
| | | | | | | | | | - Lee H Schwamm
- Mass General HospitalHarvard Medical School Boston MA
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9
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Wallace AN, Gibson DP, Asif KS, Sahlein DH, Warach SJ, Malisch T, Lamonte MP. Racial Disparity in Mechanical Thrombectomy Utilization: Multicenter Registry Results From 2016 to 2020. J Am Heart Assoc 2022; 11:e021865. [PMID: 35156390 PMCID: PMC9245822 DOI: 10.1161/jaha.121.021865] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Previous studies on racial disparity in mechanical thrombectomy (MT) treatment of acute large vessel occlusion stroke lack individual patient data that influence treatment decision‐making. We assessed patient‐level data in a large US health care system from 2016 to 2020 for racial disparities in MT utilization and eligibility. Methods and Results A retrospective study was performed of 34 596 patients admitted to 43 hospitals from January 2016 to September 2020. Data included patient age, sex, race, residential zip code median income and population density, presenting hospital stroke certification, baseline ambulation, and National Institutes of Health stroke scale. The cohort included 26 640 White, non‐Hispanic (77.0%), and 7956 African American/Black (23.0%) patients. In multivariable logistic regression, Black patients were less likely to undergo MT (adjusted odds ratio [OR], 0.65; 95% CI, 0.54–0.76), arrive within 5 hours of “last known well” (adjusted OR, 0.73; 95% CI, 0.69–0.78), and have documented anterior circulation large vessel occlusion (adjusted OR, 0.78; 95% CI, 0.64–0.96). Race was not associated with MT rate among patients arriving within 5 hours of last known well with documented acute large vessel occlusion. Conclusions Black patients with stroke underwent MT less frequently than White patients, likely in part because of longer times from last known well to hospital arrival and a lower rate of documented acute large vessel occlusion. Further studies are needed to assess whether extending the MT time window and more aggressive large vessel occlusion screening protocols mitigate this disparity.
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Affiliation(s)
- Adam N. Wallace
- Neurointerventional Surgery Ascension Columbia St. Mary’s Hospital Milwaukee WI
| | - Daniel P. Gibson
- Neurointerventional Surgery Ascension Columbia St. Mary’s Hospital Milwaukee WI
| | - Kaiz S. Asif
- Neuroendovascular Surgery and Vascular Neurology Ascension Illinois and Alexian Brothers Medical Center Elk Grove Village IL
| | - Daniel H. Sahlein
- Interventional Neuroradiology Ascension St. Vincent Hospital Indianapolis IN
- Goodman Campbell Brain and Spine Indianapolis IN
| | - Steven J. Warach
- Department of Neurology Ascension Texas and Dell Medical School at The University of Texas at Austin Austin TX
| | - Timothy Malisch
- Interventional Neuroradiology Ascension Illinois and Alexian Brothers Medical Center Elk Grove Village IL
| | - Marian P. Lamonte
- Department of Neurology Ascension St. Agnes Hospital and University of Maryland School of Medicine Baltimore MD
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10
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Ikeme S, Kottenmeier E, Uzochukwu G, Brinjikji W. Evidence-Based Disparities in Stroke Care Metrics and Outcomes in the United States: A Systematic Review. Stroke 2022; 53:670-679. [PMID: 35105178 DOI: 10.1161/strokeaha.121.036263] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke disproportionately affects racial minorities, and the level to which stroke treatment practices differ across races is understudied. Here, we performed a systematic review of disparities in stroke treatment between racial minorities and White patients. A systematic literature search was performed on PubMed to identify studies published from January 1, 2010, to April 5, 2021 that investigated disparities in access to stroke treatment between racial minorities and White patients. A total of 30 studies were included in the systematic review. White patients were estimated to use emergency medical services at a greater rate (59.8%) than African American (55.6%), Asian (54.7%), and Hispanic patients (53.2%). A greater proportion of White patients (37.4%) were estimated to arrive within 3 hours from onset of stroke symptoms than African American (26.0%) and Hispanic (28.9%) patients. A greater proportion of White patients (2.8%) were estimated to receive tPA (tissue-type plasminogen activator) as compared with African American (2.3%), Hispanic (2.6%), and Asian (2.3%) patients. Rates of utilization of mechanical thrombectomy were also lower in minorities than in the White population. As shown in this review, racial disparities exist at key points along the continuum of stroke care from onset of stroke symptoms to treatment. Beyond patient level factors, these disparities may be attributed to other provider and system level factors within the health care ecosystem.
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Affiliation(s)
- Shelly Ikeme
- CERENOVUS, Johnson & Johnson, Irvine, CA (S.I., E.K.)
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11
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Burns SP, Lutz BJ, Magwood GS. 'Timing it Right': needs of African American adults with stroke and their caregivers across the care continuum. ETHNICITY & HEALTH 2022; 27:420-434. [PMID: 31752519 DOI: 10.1080/13557858.2019.1693512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 11/02/2019] [Indexed: 06/10/2023]
Abstract
Objective: African Americans are disproportionately affected by stroke in the United States (US). The purpose of this study is to explore experiences, wants, and needs of African Americans with stroke and their family caregivers residing in the stroke belt across the care continuum using the 'Timing It Right' (TIR) framework as a conceptual guide.Design: We conducted a series of focus groups among 20 African Americans living with stroke and 19 family caregivers. Focus groups were audio-recorded and transcribed verbatim. For this secondary analysis, we coded qualitative data using the TIR framework.Results: Participants in this sample identified pre-stroke needs in addition to the TIR phases that span across the care continuum and into community living. We identified four important contextual factors and real-world conditions that operate in the background and influence the post-stroke needs of this specific population across the TIR framework: (1) religion, faith, and church, (2) healthcare delivery, (3) community, and (4) sentinel events.Conclusions: We propose a TIR model that expands upon the original TIR framework which includes factors important for consideration when developing and delivering community-based interventions among African Americans with stroke and family caregivers in the southeastern US.
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Affiliation(s)
- Suzanne Perea Burns
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
| | - Barabara J Lutz
- College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Gayenell S Magwood
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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12
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Sirisha S, Jala S, Vooturi S, Yada PK, Kaul S. Awareness, Recognition, and Response to Stroke among the General Public-An Observational Study. J Neurosci Rural Pract 2021; 12:704-710. [PMID: 34737504 PMCID: PMC8559085 DOI: 10.1055/s-0041-1735822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective
To evaluate awareness and response to stroke among the general public.
Materials and Methods
In this prospective, observational study, self-reported stroke awareness questionnaire was administered in 2000 consecutive participants who visited outpatient clinic of a tertiary care hospital. For data analysis, comparison included for awareness of stroke and response in case of stroke.
Results
The average age of the study participants was 39.64 ± 15.55 (17–85), with 651(32.6%) women. Among the respondents, 786(39.3%) participants mentioned stroke as blood clot in the brain; 268(13.4%) stated it as brain hemorrhage. Awareness of stroke was higher in people in cities (71.0 vs. 8.5%;
p
< 0.001) and graduates (75.3 vs. 60.9%;
p
< 0.001) or knew a family member or friend who had stroke (42.7 vs. 30.4%;
p
< 0.001). Most commonly recognized risk factors included stress (1,152; 57.6%) and hypertension (1,148; 57.4%). Most identified warning sign was weakness of one side of body (807; 40.4%) and speech impairment (658; 32.9%). Participants who were aware of stroke knew a greater number of risk factors (3.75 ± 2.88 vs. 2.45 ± 2.66;
p
< 0.001) and warning signs (2.85 ± 2.25 vs. 1.49 ± 1.41;
p
<0.001). Among 1,138 participants who were aware of stroke, 166 (14.6%) participants knew one correct response in case of a stroke, either call a doctor (49.3 vs. 35.0%;
p
<0.001) or call an ambulance (41.1 vs. 34.9%;
p
= 0.055). Participants who knew one correct response to stroke had at least a family member/friend who had stroke (44.1 vs. 34.3%;
p
< 0.022).
Conclusion
We report that among 56.9% of the participants who were aware of stroke most could not name more than four risk factors or three warning signs of stroke. Only 14.6% of those aware of stroke knew appropriate response to stroke.
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Affiliation(s)
- Sai Sirisha
- School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sireesha Jala
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Praveen Kumar Yada
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Subhash Kaul
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Bhatt NR, Backster A, Ido MS, Nogueira RG, Bayakly R, Wright DW, Frankel MR. Impact of Intravenous Alteplase Door-to-Needle Times on 2-Year Mortality in Patients With Acute Ischemic Stroke. Front Neurol 2021; 12:747185. [PMID: 34721274 PMCID: PMC8548610 DOI: 10.3389/fneur.2021.747185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We sought to determine whether administration of Intravenous Thrombolysis (IVT) to patients with Acute Ischemic Stroke (AIS) within 60 min from hospital arrival is associated with lower 2-year mortality. Methods: This retrospective study was conducted among patients receiving IVT in hospitals participating in the Georgia Coverdell Acute Stroke Registry (GCASR) from January 1, 2008 through June 30, 2018. Two-year mortality data was obtained by linking the 2008–2018 Georgia Discharge Data System data and the 2008–2020 Georgia death records. We analyzed the study population in two groups based on the time from hospital arrival to initiation of IVT expressed as Door to Needle time (DTN) in a dichotomized (DTN ≤ 60 vs. > 60 min) fashion. Results: The median age of patients was 68 years, 49.4% were females, and the median NIHSS was 9. DTN ≤60 min was associated with lower 30-day [odds ratio (OR), 0.62; 95% CI, 0.52–0.73; P < 0.0001], 1-year (OR, 0.71; 95% CI, 0.61–0.83; P < 0.0001) and 2-year (OR, 0.76; 95% CI, 0.65–0.88; P = 0.001) mortality as well as lower rates of sICH at 36 h (OR, 0.57; 95% CI, 0.43–0.75; P = 0.0001), higher rates of ambulation at discharge (OR, 1.38; 95% CI, 1.25–1.53; P < 0.0001) and discharge to home (OR, 1.36; 95% CI, 1.23–1.52; P < 0.0001). Conclusion: Faster DTN in patients with AIS was associated with lower 2-year mortality across all age, gender and race subgroups. These findings reinforce the need for intensifying quality improvement measures to reduce DTN in AIS patients.
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Affiliation(s)
- Nirav R Bhatt
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Anika Backster
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Moges S Ido
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, United States.,Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Atlanta, GA, United States
| | - Raul G Nogueira
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Rana Bayakly
- Georgia Department of Public Health, Division of Health Protection, Epidemiology Program, Atlanta, GA, United States
| | - David W Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael R Frankel
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
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14
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Ehrlich ME, Han B, Lutz M, Ghorveh MG, Okeefe YA, Shah S, Kolls BJ, Graffagnino C. Socioeconomic Influence on Emergency Medical Services Utilization for Acute Stroke: Think Nationally, Act Locally. Neurohospitalist 2021; 11:317-325. [PMID: 34567392 DOI: 10.1177/19418744211010049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts. Methods We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle. Results EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times. Conclusion Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.
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Affiliation(s)
- Matthew E Ehrlich
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Bin Han
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Michael Lutz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Yasmin Ali Okeefe
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Brad J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Carmelo Graffagnino
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
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15
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Stroke Knowledge in the EstEPA Project, a Population-Based Study. J Stroke Cerebrovasc Dis 2020; 30:105471. [PMID: 33242783 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Stroke knowledge is poor in the general population worldwide. Yet, data from Spanish-Speaking populations, particularly in Latin America, are scant. We aim to evaluate stroke awareness using personal interviews in a population-based study. MATERIALS AND METHODS A questionnaire of stroke awareness was administered to a randomly selected sample of households. "Good stroke knowledge for action" was defined as recognition of impaired strength, sensation and language plus intention to seek urgent medical attention in a hypothetical stroke situation. Demographics, the term to name stroke, recognition of warning signs and attitude towards seeking medical attention were compared between individuals with and without "good stroke knowledge for action". RESULTS From 1986 respondents (87%, median age 59 years [IQR 23], 50.7% female), most recognized stroke as ACV (cerebrovascular accident, [63%]). Weakness/decreased sensation were recognized as stroke warning signs by 83.5% of respondents, followed by aphasia (77.9%), incoordination (71.6%) and headache (70.5%). Chest pain was misclassified as stroke warning sign by 25% of subjects. In a hypothetical stroke situation, most respondents would go to the hospital (52.3%), or activate the EMS (39%). Individuals with a good stroke knowledge for action (63.5%) recognized visual symptoms (60.4% vs 43.8, p<0.0001), incoordination (78.8% vs 34.4%, p<0.0001) and headache (70.5% vs. 57.8%, p<0.0001) more frequently, and were less likely to misrecognize chest pain as stroke warning sign (23.8% vs. 28.9%, p=0.015). Neither, age (OR 1 CI 0.99-1.00, p=0.94), gender (OR 0.95, CI 0.79-1.16, p=0.61) or race (OR 1.17, CI 0.97-1.42, p=0.097) predicted good stroke knowledge for action. CONCLUSIONS Most people recognize stroke as ACV. The recognition of stroke warning signs and the attitude towards seeking emergent medical attention appears acceptable. Yet, most respondents would go directly to the hospital avoiding the EMS.
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16
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Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan SU, Cainzos-Achirica M, Vahidy FS, Krumholz HM, Nasir K. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke 2020; 51:3552-3561. [PMID: 33100188 DOI: 10.1161/strokeaha.120.031137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite declining stroke rates in the general population, stroke incidence and hospitalizations are rising among younger individuals. Awareness of and prompt response to stroke symptoms are crucial components of a timely diagnosis and disease management. We assessed awareness of stroke symptoms and response to a perceived stroke among young adults in the United States. METHODS Using data from the 2017 National Health Interview Survey, we assessed awareness of 5 common stroke symptoms and the knowledge of planned response (ie, calling emergency medical services) among young adults (<45 years) across diverse sociodemographic groups. Common stroke symptoms included: (1) numbness of face/arm/leg, (2) confusion/trouble speaking, (3) difficulty walking/dizziness/loss of balance, (4) trouble seeing in one/both eyes, and (5) severe headache. RESULTS Our study population included 24 769 adults, of which 9844 (39.7%) were young adults who were included in our primary analysis, and represented 107.2 million US young adults (mean age 31.3 [±7.5] years, 50.6% women, and 62.2% non-Hispanic White). Overall, 2718 young adults (28.9%) were not aware of all 5 stroke symptoms, whereas 242 individuals (2.7%; representing 2.9 million young adults in the United States) were not aware of a single symptom. After adjusting for confounders, Hispanic ethnicity (odds ratio, 1.96 [95% CI, 1.17-3.28]), non-US born immigration status (odds ratio, 2.02 [95% CI, 1.31-3.11]), and lower education level (odds ratio, 2.77 [95% CI, 1.76-4.35]), were significantly associated with lack of symptom awareness. Individuals with 5 high-risk characteristics (non-White, non-US born, low income, uninsured, and high school educated or lower) had nearly a 4-fold higher odds of not being aware of all symptoms (odds ratio, 3.70 [95% CI, 2.43-5.62]). CONCLUSIONS Based on data from the National Health Interview Survey, a large proportion of young adults may not be aware of stroke symptoms. Certain sociodemographic subgroups with decreased awareness may benefit from focused public health interventions.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Shiwani Mahajan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Javier Valero-Elizondo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Tamer Yahya
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Richa Sharma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Gowtham R Grandhi
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Rohan Khera
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Salim S Virani
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Judith Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Safi U Khan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Miguel Cainzos-Achirica
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Farhaan S Vahidy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Harlan M Krumholz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Khurram Nasir
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
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17
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Prabhakaran S, Richards CT, Kwon S, Wymore E, Song S, Eisenstein A, Brown J, Kandula NR, Mason M, Beckstrom H, Washington KV, Aggarwal NT. A Community-Engaged Stroke Preparedness Intervention in Chicago. J Am Heart Assoc 2020; 9:e016344. [PMID: 32893720 PMCID: PMC7726971 DOI: 10.1161/jaha.120.016344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background We evaluated a community‐engaged stroke preparedness intervention that aimed to increase early hospital arrival and emergency medical services (EMS) utilization among patients with stroke in the South Side of Chicago, Illinois. Methods and Results We compared change in early hospital arrival (<3 hours from symptom onset) and EMS utilization before and after our intervention among patients with confirmed ischemic stroke at an intervention hospital on the South Side of Chicago with concurrent data from 6 hospitals in nonintervention communities on the North Side of Chicago and 17 hospitals in St Louis, Missouri. We assessed EMS utilization for suspected stroke secondarily, using geospatial information systems analysis of Chicago ambulance transports before and after our intervention. Among 21 497 patients with confirmed ischemic stroke across all sites, early arrival rates at the intervention hospital increased by 0.5% per month (95% CI, −0.2% to 1.2%) after intervention compared with the preintervention period but were not different from North Side Chicago hospitals (difference of −0.3% per month [95% CI, −0.12% to 0.06%]) or St Louis hospitals (difference of 0.7% per month [95% CI, −0.1% to 1.4%]). EMS utilization at the intervention hospital decreased by 0.8% per month (95% CI, −1.7% to 0.2%) but was not different from North Side Chicago hospitals (difference of 0.004% per month [95% CI, −1.1% to 1.1%]) or St Louis hospitals (difference of −0.7% per month [95% CI, −1.7% to 0.3%]). EMS utilization for suspected stroke increased in the areas surrounding the intervention hospital (odds ratio [OR], 1.4; 95% CI, 1.2–1.6) and in the South Side (OR, 1.2; 95% CI, 1.1–1.3), but not in the North Side (OR, 1.0; 95% CI, 0.9–1.1). Conclusions Following a community stroke preparedness intervention, early hospital arrival and EMS utilization for confirmed ischemic stroke did not increase. However, ambulance transports for suspected stroke increased in the intervention community compared with other regions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02301299.
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Affiliation(s)
| | | | - Soyang Kwon
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | - Erin Wymore
- Northwestern University, Feinberg School of Medicine Chicago IL
| | - Sarah Song
- Rush University Medical Center Chicago IL
| | | | - Jen Brown
- Northwestern University, Feinberg School of Medicine Chicago IL
| | | | - Maryann Mason
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | | | | | - Neelum T Aggarwal
- The Retirement Research Foundation Chicago IL.,Rush Alzheimer's Disease Center Chicago IL
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18
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Stroke literacy in the population of the Eastern Province of Saudi Arabia; immediate steps are essential to bridge the gap. J Stroke Cerebrovasc Dis 2020; 29:105088. [PMID: 32912552 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Stroke is a medical emergency that demands early recognition for time sensitive acute management. Knowledge about stroke in public has not been found satisfactory in most of the studies worldwide. Studies describing the awareness of public about recognition of stroke and its treatment from Saudi Arabia (SA) are deficient. This study aimed to assess the knowledge of general population living in the Eastern Province of SA about stroke in relation to recognition of warning signs, risk factors and available acute treatment. METHODS A prospective, cross sectional study was conducted using a structured questionnaire distributed through an electronic web site over a period of six months. The data was analyzed with SPSS version 22.0. RESULTS Among a total of 1,213 respondents, 62.4% were women. Three fourth identified the affected organ correctly. Psychological stress was the most commonly identified risk factor (73.5%) followed by hypertension (63.8%). More than half of the respondents (58.5%) were not aware of diabetes mellitus as a risk factor for stroke. Speech difficulty was the most commonly identified stroke warning sign (64.4%) followed by focal weakness (62.4%). More than half (59.9%) did not recognize facial asymmetry as stroke warning sign. Nearly three fourth of the participants were unaware of t-PA (73.7%) and nearest available health care center for acute stroke management (74.9%). CONCLUSION Our survey found the stroke literacy in the population of the Eastern Province of SA as non- satisfactory and highlights the importance of taking immediate measure such as mass media campaign and hospital based activities to improve it.
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Krishnamurthi RV, Barker-Collo S, Barber PA, Tippett LJ, Dalrymple-Alford JC, Tunnage B, Mahon S, Parmar PG, Moylan M, Feigin VL. Community Knowledge and Awareness of Stroke in New Zealand. J Stroke Cerebrovasc Dis 2019; 29:104589. [PMID: 31879136 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104589] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Community knowledge and stroke awareness is crucial for primary prevention of stroke and timely access to stroke treatments including acute reperfusion therapies. We conducted a national telephone survey to quantify the level of community stroke awareness. METHODS A random sample of 400 adults in New Zealand (NZ), stratified by the 4 main ethnic groups, was surveyed. Eligible participants answered stroke awareness questions using both unprompted (open-ended) and prompted questions (using a list). Proportional odds logistic regression models were used to identify factors associated with stroke awareness. RESULTS Only 1.5% of participants named stroke as a major cause of death. The stroke signs and symptoms most frequently identified from a list were sudden speech difficulty (94%) and sudden 1-sided weakness (92%). Without prompting, 78% of participants correctly identified at least 1 risk factor, 62% identified at least 2, and 35% identified 3 or more. When prompted with the list, scores increased 10-fold compared with unprompted responses. Ethnic disparities were observed, with Pacific peoples having the lowest level of awareness among the 4 ethnic groups. Higher education level, higher income, and personal experience of stroke were predictive of greater awareness (P ≤ .05). CONCLUSIONS Stroke was not recognized as a major cause of death. Although identification of stroke risk factors was high with prompting, awareness was low without prompting, particularly among those with lower education and income. Nationwide, culturally tailored public awareness campaigns are necessary to improve knowledge of stroke risk factors, recognition of stroke in the community and appropriate actions to take in cases of suspected stroke.
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Affiliation(s)
- Rita V Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | | | - Peter Alan Barber
- Centre for Brain Research, University of Auckland, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lynette J Tippett
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - John C Dalrymple-Alford
- Department of Psychology, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Bronwyn Tunnage
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Susan Mahon
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Priyakumari G Parmar
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Melanie Moylan
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Boden-Albala B, Goldmann E, Parikh NS, Carman H, Roberts ET, Lord AS, Torrico V, Appleton N, Birkemeier J, Parides M, Quarles L. Efficacy of a Discharge Educational Strategy vs Standard Discharge Care on Reduction of Vascular Risk in Patients With Stroke and Transient Ischemic Attack: The DESERVE Randomized Clinical Trial. JAMA Neurol 2019; 76:20-27. [PMID: 30304326 DOI: 10.1001/jamaneurol.2018.2926] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Despite secondary prevention strategies with proven efficacy, recurrent stroke rates remain high, particularly in racial/ethnic minority populations who are disproportionately affected by stroke. Objective To determine the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack. Design, Setting, and Participants Randomized clinical trial with 1-year follow-up. Participants were white, black, and Hispanic patients with mild/moderate stroke/transient ischemic attack prospectively enrolled from 4 New York City, New York, medical centers during hospitalization or emergency department visit between August 2012 and May 2016. Through screening of stroke admissions and emergency department notifications, 1083 eligible patients were identified, of whom 256 declined to participate and 275 were excluded for other reasons. Analyses were intention to treat. Interventions The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention is a skills-based, culturally tailored discharge program with follow-up calls delivered by a community health coordinator. This intervention was developed using a community engagement approach. Main Outcomes and Measures The primary outcome was systolic blood pressure reduction at 12 months postdischarge. Results A total of 552 participants were randomized to receive intervention or usual care (281 women [51%]; mean [SD] age, 64.61 [2.9] years; 180 Hispanic [33%], 151 non-Hispanic white [27%], and 183 non-Hispanic black [33%]). At 1-year follow-up, no significant difference in systolic blood pressure reduction was observed between intervention and usual care groups (β = 2.5 mm Hg; 95% CI, -1.9 to 6.9). Although not powered for subgroup analysis, we found that among Hispanic individuals, the intervention arm had a clinically and statically significant 9.9 mm Hg-greater mean systolic blood pressure reduction compared with usual care (95% CI, 1.8-18.0). There were no significant differences between arms among non-Hispanic white (β = 3.3; 95% CI, -4.1 to 10.7) and non-Hispanic black participants (β = -1.6; 95% CI, -10.1 to 6.8). Conclusions and Relevance Few behavioral intervention studies in individuals who have had stroke have reported clinically meaningful reductions in blood pressure at 12 months, and fewer have focused on a skills-based approach. Results of secondary analyses suggest that culturally tailored, skills-based strategies may be an important alternative to knowledge-focused approaches in achieving sustained vascular risk reduction and addressing racial/ethnic stroke disparities; however, these findings should be tested in future studies. Trial Registration ClinicalTrials.gov identifier: NCT01836354.
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Affiliation(s)
- Bernadette Boden-Albala
- Department of Epidemiology, College of Global Public Health, New York University, New York.,Department of Global Health, College of Global Public Health, New York University, New York.,Department of Neurology, Langone School of Medicine, New York University, New York.,Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York
| | - Emily Goldmann
- Department of Epidemiology, College of Global Public Health, New York University, New York
| | - Nina S Parikh
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York
| | - Heather Carman
- Department of Epidemiology, College of Global Public Health, New York University, New York
| | - Eric T Roberts
- Department of Epidemiology, College of Global Public Health, New York University, New York.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Aaron S Lord
- Department of Neurology, Langone School of Medicine, New York University, New York
| | - Veronica Torrico
- Department of Epidemiology, College of Global Public Health, New York University, New York
| | - Noa Appleton
- Department of Epidemiology, College of Global Public Health, New York University, New York
| | - Joel Birkemeier
- Department of Epidemiology, College of Global Public Health, New York University, New York
| | - Michael Parides
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Leigh Quarles
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City
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Williams O, Teresi J, Eimicke JP, Abel-Bey A, Hassankhani M, Valdez L, Gomez Chan L, Kong J, Ramirez M, Ravenell J, Ogedegbe G, Noble JM. Effect of Stroke Education Pamphlets vs a 12-Minute Culturally Tailored Stroke Film on Stroke Preparedness Among Black and Hispanic Churchgoers: A Cluster Randomized Clinical Trial. JAMA Neurol 2019; 76:1211-1218. [PMID: 31260028 DOI: 10.1001/jamaneurol.2019.1741] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Black individuals and Hispanic individuals are less likely to recognize stroke and call 911 (stroke preparedness), contributing to racial/ethnic disparities in intravenous tissue plasminogen activator use. Objective To evaluate the effect of culturally tailored 12-minute stroke films on stroke preparedness vs the usual care practice of distributing stroke education pamphlets. Design, Setting, and Participants Cluster randomized clinical trial between July 26, 2013, and August 16, 2018, with randomization of 13 black and Hispanic churches located in urban neighborhoods to intervention or usual care. In total, 883 congregants were approached, 503 expressed interest, 375 completed eligibility screening, and 312 were randomized. Sixty-three individuals were ineligible (younger than 34 years and/or did not have at least 1 traditional stroke risk factor). Interventions Two 12-minute stroke films on stroke preparedness for black and Hispanic audiences. Main Outcomes and Measures The primary outcome was the Stroke Action Test (STAT), assessed at baseline, 6 months, and 12 months. Results In total, 261 of 312 individuals completed the study (83.7% retention rate). Most participants were female (79.1%). The mean (SD) age of participants was 58.57 (11.66) years; 51.1% (n = 159) were non-Hispanic black, 48.9% (n = 152) were Hispanic, and 31.7% (n = 99) had low levels of education. There were no significant end-point differences for the STAT at follow-up periods. The mean (SD) baseline STAT scores were 59.05% (29.12%) correct for intervention and 58.35% (28.83%) correct for usual care. At 12 months, the mean (SD) STAT scores were 64.38% (26.39%) correct for intervention and 61.58% (28.01%) correct for usual care. Adjusted by education, a post hoc subgroup analysis revealed a mean (SE) intervention effect of 1.03% (0.44%) (P = .02) increase per month in the low-education subgroup (about a 10% increase in 12 months). In the high-education subgroup, the mean (SE) intervention effect was -0.05% (0.30%) (P = .86). Regarding percentage correct, the low-education intervention subgroup improved from 52.4% (7 of 21) to 66.7% (14 of 21) compared with the other subgroups. Conclusions and Relevance No difference was observed in stroke preparedness at 12 months in response to culturally tailored 12-minute stroke films or conventional stroke education pamphlets. Additional studies are required to confirm findings from a post hoc subgroup analysis that suggested a significant education effect. Trial Registration ClinicalTrials.gov identifier: NCT01909271.
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Affiliation(s)
- Olajide Williams
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Jeanne Teresi
- Columbia University Stroud Center, New York State Psychiatric Institute, New York.,Research Division, Hebrew Home at Riverdale, Bronx, New York
| | | | - Amparo Abel-Bey
- Department of Neurology, Columbia University Medical Center, New York, New York
| | | | - Lenfis Valdez
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Luisa Gomez Chan
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Jian Kong
- Research Division, Hebrew Home at Riverdale, Bronx, New York
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale, Bronx, New York
| | - Joseph Ravenell
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Gbenga Ogedegbe
- Department of Population Health, NYU School of Medicine, New York, New York
| | - James M Noble
- Department of Neurology, Columbia University Medical Center, New York, New York
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Oh GJ, Lee K, Kim K, Lee YH. Differences in the awareness of stroke symptoms and emergency response by occupation in the Korean general population. PLoS One 2019; 14:e0218608. [PMID: 31211797 PMCID: PMC6581263 DOI: 10.1371/journal.pone.0218608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022] Open
Abstract
We evaluated the difference in awareness of stroke warning signs (SWS) and emergency response among occupational groups in the community-dwelling population. From the 2016 Korea Community Health Survey, a total of 10,445 individuals without stroke were included in the analysis. Multiple logistic regression analysis was used to explore the association of occupation with awareness of SWS and correct emergency response. SWS included the following: sudden numbness or weakness, sudden difficulty speaking or understanding speech, sudden dizziness, sudden visual impairment, and sudden severe headache. Respondents’ occupation was classified into six groups: managers and professionals (MP); clerks; service and sales workers (SSW); agricultural, forestry, and fishery workers (AFFW); mechanical and manual laborers (MML); or housewives and unemployed people (HUP). Awareness of each SWS was the same with the highest for MP and lowest for AFFW. After adjusting for socio-demographic factors, compared to MP (reference), AFFW (odds ratio 0.49; 95% confidence interval 0.36–0.67), HUP (0.55; 0.40–0.75), MML (0.57; 0.42–0.79), and SSW (0.62; 0.45–0.86) had significantly lower ORs for knowing at least one of the SWS. Additionally, AFFW (0.79; 0.66–0.96) and MML (0.76; 0.63–0.91) had significantly lower ORs for knowing all five SWS compared to MP. However, there was no significant occupational difference in correct emergency response when a stroke occurred. To improve stroke literacy and to reduce the disparity of awareness of SWS in community settings, public health efforts with an emphasis on AFFW and MML are needed.
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Affiliation(s)
- Gyung-Jae Oh
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Jeonbuk, Republic of Korea
| | - Kyungsuk Lee
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Jeonbuk, Republic of Korea
| | - Kyungsu Kim
- National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Jeonbuk, Republic of Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Jeonbuk, Republic of Korea
- * E-mail:
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Pitton Rissardo J, Fornari Caprara AL, Cervi Prado AL. Stroke Literacy in a South Brazilian City: A Community Based Survey. J Stroke Cerebrovasc Dis 2018; 27:2513-2518. [PMID: 29805082 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This community-based and cross-sectional study was performed in a Brazilian city and aimed to evaluate stroke literacy. METHODS A stroke knowledge survey was administered to passersby of a public square from December 2015 to October 2016, in Santa Maria, Rio Grande do Sul. Convenience sampling was performed. RESULTS A total of 633 respondents completed the survey. Of the respondents, 33% knew the meaning of "AVC"; 29.5% incorrectly localized stroke in the heart. Any warning sign of stroke (open-ended question) could not be remembered by 50.7% of the respondents; individuals with a higher level of schooling (>7 years of education) and those who localized stroke in the brain were more likely to call an emergency in the case of a stroke (adjusted odds ratio [OR] 1.040, 95% confidence interval [CI] 1.004-1.078 for years of schooling; adjusted OR 1.542, 95% CI 1.102-2.156 for replying "yes" to brain as the organ affected in stroke). CONCLUSIONS Brazilian public knowledge about stroke is still scarce, even in a population with levels of formal education above the national average or in a city where annual promotion of Stroke Awareness Campaigns have taken place for almost a decade. Thus, it might be necessary to design different informative strategies targeted to our study's population to improve stroke campaigns in Brazil. In Brazil, increasing awareness of stroke focused on stroke prevention and recognition of its warning signs should be a national priority in public health as the access to stroke treatment remains limited.
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Affiliation(s)
| | | | - Ana Lucia Cervi Prado
- Universidade Federal de Santa Maria Centro de Ciências da Saúde, Santa Maria, Brazil
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24
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Bushnell CD, Duncan PW, Lycan SL, Condon CN, Pastva AM, Lutz BJ, Halladay JR, Cummings DM, Arnan MK, Jones SB, Sissine ME, Coleman SW, Johnson AM, Gesell SB, Mettam LH, Freburger JK, Barton-Percival B, Taylor KM, Prvu-Bettger J, Lundy-Lamm G, Rosamond WD. A Person-Centered Approach to Poststroke Care: The COMprehensive Post-Acute Stroke Services Model. J Am Geriatr Soc 2018; 66:1025-1030. [PMID: 29572814 DOI: 10.1111/jgs.15322] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many individuals who have had a stroke leave the hospital without postacute care services in place. Despite high risks of complications and readmission, there is no standard in the United States for postacute stroke care after discharge home. We describe the rationale and methods for the development of the COMprehensive Post-Acute Stroke Services (COMPASS) care model and the structure and quality metrics used for implementation. COMPASS, an innovative, comprehensive extension of the TRAnsition Coaching for Stroke (TRACS) program, is a clinician-led quality improvement model providing early supported discharge and transitional care for individuals who have had a stroke and have been discharged home. The effectiveness of the COMPASS model is being assessed in a cluster-randomized pragmatic trial in 41 sites across North Carolina, with a recruitment goal of 6,000 participants. The COMPASS model is evidence based, person centered, and stakeholder driven. It involves identification and education of eligible individuals in the hospital; telephone follow-up 2, 30, and 60 days after discharge; and a clinic visit within 14 days conducted by a nurse and advanced practice provider. Patient and caregiver self-reported assessments of functional and social determinants of health are captured during the clinic visit using a web-based application. Embedded algorithms immediately construct an individualized care plan. The COMPASS model's pragmatic design and quality metrics may support measurable best practices for postacute stroke care.
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Affiliation(s)
- Cheryl D Bushnell
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Pamela W Duncan
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Sarah L Lycan
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Christina N Condon
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Amy M Pastva
- Division of Physical Therapy, School of Medicine, Duke University, Durham, North Carolina
| | - Barbara J Lutz
- School of Nursing, University of North Carolina at Wilmington, Wilmington, North Carolina
| | - Jacqueline R Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Doyle M Cummings
- Family Medicine Center, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Martinson K Arnan
- Bronson Neuroscience Center, Bronson Methodist Hospital, Kalamazoo, Michigan
| | - Sara B Jones
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mysha E Sissine
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Sylvia W Coleman
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sabina B Gesell
- Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Laurie H Mettam
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Karen M Taylor
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Janet Prvu-Bettger
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina
| | | | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Denny MC, Vahidy F, Vu KYT, Sharrief AZ, Savitz SI. Video-based educational intervention associated with improved stroke literacy, self-efficacy, and patient satisfaction. PLoS One 2017; 12:e0171952. [PMID: 28333925 PMCID: PMC5364024 DOI: 10.1371/journal.pone.0171952] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Interventions are needed to improve stroke literacy among recent stroke survivors. We developed an educational video for patients hospitalized with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). Methods A 5-minute stroke education video was shown to our AIS and ICH patients admitted from March to June 2015. Demographics and a 5-minute protocol Montreal Cognitive Assessment were also collected. Questions related to stroke knowledge, self-efficacy, and patient satisfaction were answered before, immediately after, and 30 days after the video. Results Among 250 screened, 102 patients consented, and 93 completed the video intervention. There was a significant difference between pre-video median knowledge score of 6 (IQR 4–7) and the post-video score of 7 (IQR 6–8; p<0.001) and between pre-video and the 30 day score of 7 (IQR 5–8; p = 0.04). There was a significant difference between the proportion of patients who were very certain in recognizing symptoms of a stroke pre- and post-video, which was maintained at 30-days (35.5% vs. 53.5%, p = 0.01; 35.5% vs. 54.4%, p = 0.02). The proportion who were “very satisfied” with their education post-video (74.2%) was significantly higher than pre-video (49.5%, p<0.01), and this was maintained at 30 days (75.4%, p<0.01). There was no association between MoCA scores and stroke knowledge acquisition or retention. There was no association between stroke knowledge acquisition and rates of home blood pressure monitoring or primary care provider follow-up. Conclusions An educational video was associated with improved stroke knowledge, self-efficacy in recognizing stroke symptoms, and satisfaction with education in hospitalized stroke patients, which was maintained at 30 days after discharge.
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Affiliation(s)
- Mary Carter Denny
- Department of Neurology, Stroke Program, UTHealth, Houston, Texas, United States of America
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, United States of America
- * E-mail:
| | - Farhaan Vahidy
- Department of Neurology, Stroke Program, UTHealth, Houston, Texas, United States of America
| | - Kim Y. T. Vu
- Memorial Hermann Hospital—Texas Medical Center, Houston, Texas, United States of America
| | - Anjail Z. Sharrief
- Department of Neurology, Stroke Program, UTHealth, Houston, Texas, United States of America
| | - Sean I. Savitz
- Department of Neurology, Stroke Program, UTHealth, Houston, Texas, United States of America
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6094] [Impact Index Per Article: 870.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Metias MM, Eisenberg N, Clemente MD, Wooster EM, Dueck AD, Wooster DL, Roche-Nagle G. Public health campaigns and their effect on stroke knowledge in a high-risk urban population: A five-year study. Vascular 2017; 25:497-503. [PMID: 28264181 DOI: 10.1177/1708538117691879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The level of knowledge of stroke risk factors and stroke symptoms within a population may determine their ability to recognize and ultimately react to a stroke. Independent agencies have addressed this through extensive awareness campaigns. The aim of this study was to determine the change in baseline knowledge of stroke risk factors, symptoms, and source of stroke knowledge in a high-risk Toronto population between 2010 and 2015. Methods Questionnaires were distributed to adults presenting to cardiovascular clinics at the University of Toronto in Toronto, Canada. In 2010 and 2015, a total of 207 and 818 individuals, respectively, participated in the study. Participants were identified as stroke literate if they identified (1) at least one stroke risk factor and (2) at least one stroke symptom. Results A total of 198 (95.6%) and 791 (96.7%) participants, respectively, completed the questionnaire in 2010 and 2015. The most frequently identified risk factors for stroke in 2010 and 2015 were, respectively, smoking (58.1%) and hypertension (49.0%). The most common stroke symptom identified was trouble speaking (56.6%) in 2010 and weakness, numbness or paralysis (67.1%) in 2015. Approximately equal percentages of respondents were able to identify ≥1 risk factor (80.3% vs. 83.1%, p = 0.34) and ≥1 symptom (90.9% vs. 88.7%, p = 0.38). Overall, the proportion of respondents who were able to correctly list ≥1 stroke risk factors and stroke symptoms was similar in both groups.(76.8% vs. 75.5%, p = 0.70). The most commonly reported stroke information resource was television (61.1% vs. 67.6%, p = 0.09). Conclusion Stroke literacy has remained stable in this selected high-risk population despite large investments in public campaigns over recent years. However, the baseline remains high over the study period. Evaluation of previous campaigns and development of targeted advertisements using more commonly used media sources offer opportunities to enhance education.
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Affiliation(s)
| | - Naomi Eisenberg
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
| | | | | | - Andrew D Dueck
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
| | - Douglas L Wooster
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
| | - Graham Roche-Nagle
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
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Ramirez M, Teresi JA, Ogedegbe G, Williams O. Using Qualitative Methods to Assess the Conceptual Equivalence of the Spanish and English Stroke Action Test (STAT). QUALITATIVE HEALTH RESEARCH 2016; 26:1812-1822. [PMID: 27055498 DOI: 10.1177/1049732316636362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Members of racial/ethnic minorities, in contrast to majority groups, experience disparities in stroke risk factors, recognition, evaluation, and treatment. This article describes the use of qualitative methods to examine the cultural and lifestyle appropriateness, clarity of item-wording, comprehension of item intent, and conceptual equivalence of the developed Spanish and the revised English Stroke Action Test (which includes three additional atypical stroke symptoms more common in women). Thirty in-depth cognitive interviews were conducted (10 in Spanish) using concurrent structured probes. The desired ultimate outcome was to obtain conceptually equivalent measures in both languages. Four sources of variability in comprehension were identified: unfamiliar and/or idiosyncratic Spanish words used in translation; phrases in the original (English) and in the literal (Spanish) translation that were not understood; and unclear intended meaning of the original (English) items. Cognitive interviews helped identify problematic items, highlighted potential response errors, and provided insight regarding putative causes for inconsistent interpretation.
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Affiliation(s)
- Mildred Ramirez
- 1 Hebrew Home at Riverdale, Research Division, Riverdale, New York, USA
- 2 Weill Cornell Medical College, New York City, New York, USA
| | - Jeanne A Teresi
- 1 Hebrew Home at Riverdale, Research Division, Riverdale, New York, USA
- 2 Weill Cornell Medical College, New York City, New York, USA
- 3 Columbia University Stroud Center, New York City, New York, USA
| | - Gbenga Ogedegbe
- 4 New York University School of Medicine, New York City, New York, USA
| | - Olajide Williams
- 5 Columbia University Medical Center, New York City, New York, USA
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Community-Level Measures of Stroke Knowledge among Children: Findings from Hip Hop Stroke. J Stroke Cerebrovasc Dis 2016; 26:139-142. [PMID: 27751629 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/17/2016] [Accepted: 08/30/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Community-level determinants of stroke knowledge among children are unknown but could meaningfully impact public stroke education campaigns. We explored for associations between community- and school-level quality measures relative to baseline stroke knowledge among children participating in the Hip Hop Stroke program. METHODS Baseline stroke knowledge assessments were performed in 2839 fourth-, fifth-, and sixth-grade students (ages 9-11 years) from November 2005 to April 2014. Knowledge was assessed relative to school performance grade (SPG, graded A-F; a school-level measure determined by the New York City [NYC] Department of Education) and economic need index (ENI, range: 0-2; a community-level, within-school measure of subsidized housing and meals with higher scores indicating more socioeconomic distress). RESULTS Schools studied included those with SPG = B (n = 196), SPG = C (n = 1590), and SPG = D (n = 1053) and mean ENI = .85 (standard deviation: .23). A composite assessment of knowledge, including 4 stroke symptoms (blurred vision, facial droop, sudden headache, and slurred speech), was conducted consistently since 2006. Overall, students correctly identified a mean of 1.74 stroke symptoms (95% confidence interval: 1.70-1.79; possible range: 0-4, expected value of chance response alone or no knowledge = 2). For quartiles of ENI, mean knowledge scores are as follows: ENIQ1 = 2.00, ENIQ2 = 2.09, ENIQ3 = 1.46, and ENIQ4 = 1.56 (ENIQ3 and ENIQ4 versus ENIQ1, P < .001). For SPG, SPG = B schools: 2.09, SPG = C: 1.83, and SPG = D: 1.56 (SPG = C and SPG = D versus SPG = B schools, P ≤ .05). CONCLUSIONS Children's stroke knowledge was lowest in NYC communities with greater economic need and lower school performance. These findings could guide stroke education campaign implementation strategies.
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Chan L, Lin YD, Liu CH. World Stroke Day in Taiwan: Raising Public Awareness of Stroke. INT J GERONTOL 2016. [DOI: 10.1016/j.ijge.2016.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Williams O, Leighton-Herrmann E, DeSorbo A, Eimicke J, Abel-Bey A, Valdez L, Noble J, Gordillo M, Ravenell J, Ramirez M, Teresi JA, Jean-Louis G, Ogedegbe G. Effect of two 12-minute culturally targeted films on intent to call 911 for stroke. Neurology 2016; 86:1992-5. [PMID: 27164682 DOI: 10.1212/wnl.0000000000002703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/22/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed the behavioral effect of two 12-minute culturally targeted stroke films on immediately calling 911 for suspected stroke among black and Hispanic participants using a quasi-experimental pretest-posttest design. METHODS We enrolled 102 adult churchgoers (60 black and 42 Hispanic) into a single viewing of one of the 2 stroke films-a Gospel musical (English) or Telenovela (Spanish). We measured intent to immediately call 911 using the validated 28-item Stroke Action Test in English and Spanish, along with related variables, before and immediately after the intervention. Data were analyzed using repeated-measures analysis of variance. RESULTS An increase in intent to call 911 was seen immediately following the single viewing. Higher self-efficacy for calling 911 was associated with intent to call 911 among Hispanic but not black participants. A composite measure of barriers to calling 911 was not associated with intent to call 911 in either group. A significant association was found between higher stroke symptom knowledge and intent to call 911 at baseline, but not immediately following the intervention. No sex associations were found; however, being older was associated with greater intent to call 911. The majority of participants would strongly recommend the films to others. One participant appropriately called 911 for a real-life stroke event. CONCLUSIONS Narrative communication in the form of tailored short films may improve intent to call 911 for stroke among the black and Hispanic population.
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Affiliation(s)
- Olajide Williams
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Ellyn Leighton-Herrmann
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York.
| | - Alexandra DeSorbo
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Joseph Eimicke
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Amparo Abel-Bey
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Lenfis Valdez
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - James Noble
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Madeleine Gordillo
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Joseph Ravenell
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Mildred Ramirez
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Jeanne A Teresi
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Girardin Jean-Louis
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
| | - Gbenga Ogedegbe
- From the Department of Neurology (O.W., E.L.-H., A.D., A.A.-B., L.V., J.N., M.G.), Columbia University Medical Center, New York; Research Division (J.P.E., M.R., J.A.T.), The Hebrew Home at Riverdale, Bronx; and Department of Population Health (J.R., G.J.-L., G.O.), NYU School of Medicine, New York
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Sharrief AZ, Johnson B, Abada S, Urrutia VC. Stroke Knowledge in African Americans: A Narrative Review. Ethn Dis 2016; 26:255-62. [PMID: 27103777 DOI: 10.18865/ed.26.2.255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of this review is to evaluate the state of knowledge in regard to stroke literacy in African Americans. This topic is important for assessing the specific gaps in stroke knowledge for this population, as well as to evaluate the methodology that has been used to assess stroke literacy. METHODS This narrative review includes studies that evaluated and reported stroke knowledge in African Americans and were published between January 2000 and October 2015. RESULTS Our review revealed that disparities may exist in recognition of headache and visual symptoms, knowledge of the organ in which stroke occurs, and identification of tobacco use as a risk factor. Stress may be perceived as a more important risk factor among African Americans than among White Americans. The literature does not suggest disparities in knowledge of the appropriate action to take for stroke. CONCLUSIONS Racial disparities may exist for specific domains of stroke knowledge. Future studies should explore specific gaps in knowledge to be addressed in stroke prevention interventions for African Americans. Standardization of methods is needed to aid comparisons across populations. The relationship between stroke knowledge and clinical outcomes also needs to be evaluated.
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Affiliation(s)
- Anjail Z Sharrief
- Department of Neurology; University of Texas Health Science Center at Houston, Medical School
| | | | - Sharon Abada
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health
| | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine
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Ojike N, Ravenell J, Seixas A, Masters-Israilov A, Rogers A, Jean-Louis G, Ogedegbe G, McFarlane SI. Racial Disparity in Stroke Awareness in the US: An Analysis of the 2014 National Health Interview Survey. JOURNAL OF NEUROLOGY & NEUROPHYSIOLOGY 2016; 7:365. [PMID: 27478680 PMCID: PMC4966617 DOI: 10.4172/2155-9562.1000365] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/AIMS Stroke is a leading cause of premature death and disability, and increasing the proportion of individuals who are aware of stroke symptoms is a target objective of the Healthy people 2020 project. METHODS We used data from the 2014 Supplement of the National Health Interview Survey (NHIS) to assess the prevalence of stroke symptom knowledge and awareness. We also tested, using a logistic regression model, the hypothesis that individuals who have knowledge of all 5 stroke symptoms will be have a greater likelihood to activate Emergency Medical Services (EMS) if a stroke is suspected. RESULTS From the 36,697 participants completing the survey 51% were female. In the entire sample, the age-adjusted awareness rate of stroke symptoms/calling 911 was 66.1%. Knowledge of the 5 stroke symptoms plus importance of calling 911 when a stroke is suspected was higher for females, Whites, and individuals with health insurance. Stroke awareness was lowest for Hispanics, Blacks, and survey participants from Western US region. CONCLUSION The findings allude to continuing differences in the knowledge of stroke symptoms across race/ethnic and other demographic groups. Further research will confirm the importance of increased health literacy for Stroke management and prevention in minority communities.
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Affiliation(s)
- Nwakile Ojike
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Joe Ravenell
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Azizi Seixas
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Alina Masters-Israilov
- The Saul R. Korey, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - April Rogers
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health, New York University Medical Center, New York, USA
| | - Samy I McFarlane
- Division of Endocrinology, department of Medicine, SUNY-Downstate, Brooklyn, NY, 11203, USA
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Martinez M, Prabhakar N, Drake K, Coull B, Chong J, Ritter L, Kidwell C. Identification of Barriers to Stroke Awareness and Risk Factor Management Unique to Hispanics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010023. [PMID: 26703690 PMCID: PMC4730414 DOI: 10.3390/ijerph13010023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/26/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022]
Abstract
Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs). We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI), the Multidimensional Health Locus of Control (MHLC) Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW), Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029). Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all). Hispanics scored higher on the "powerful others" sub-scale (11.3 vs. 10, p < 0.05) of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control.
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Affiliation(s)
- Marina Martinez
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Nitin Prabhakar
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Kendra Drake
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Bruce Coull
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Jenny Chong
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Leslie Ritter
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
| | - Chelsea Kidwell
- Department of Neurology, University of Arizona College of Medicine, 1501 N. Campbell Avenue Tucson, AZ 85724, USA.
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HRS/NSA 2014 survey of atrial fibrillation and stroke: Gaps in knowledge and perspective, opportunities for improvement. Heart Rhythm 2015; 12:e105-13. [DOI: 10.1016/j.hrthm.2015.04.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 12/22/2022]
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Frankel DS, Parker SE, Rosenfeld LE, Gorelick PB. HRS/NSA 2014 Survey of Atrial Fibrillation and Stroke: Gaps in Knowledge and Perspective, Opportunities for Improvement. J Stroke Cerebrovasc Dis 2015; 24:1691-700. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sharrief AZ, Johnson B, Urrutia VC. Stroke Outreach in an Inner City Market: A Platform for Identifying African American Males for Stroke Prevention Interventions. Front Neurol 2015; 6:133. [PMID: 26124744 PMCID: PMC4467175 DOI: 10.3389/fneur.2015.00133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/23/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There are significant racial disparities in stroke incidence and mortality. Health fairs and outreach programs can be used to increase stroke literacy, but they often fail to reach those at highest risk, including African American males. METHODS We conducted a stroke outreach and screening program at an inner city market in order to attract a high-risk group for a stroke education intervention. A modified Framingham risk tool was used to estimate stroke risk and a 10-item quiz was developed to assess stroke literacy among 80 participants. We report results of the demographic and stroke risk analyses and stroke knowledge assessment. RESULTS The program attracted a majority male (70%) and African American (95%) group of participants. Self-reported hypertension (57.5%), tobacco use (40%), and diabetes (23.8%) were prevalent. Knowledge of stroke warning signs, risk factors, and appropriate action to take for stroke symptoms was not poor when compared to the literature. CONCLUSION Stroke outreach and screening in an inner city public market may be an effective way to target a high-risk population for stroke prevention interventions. Stroke risk among participants was high despite adequate stroke knowledge.
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Affiliation(s)
| | - Brenda Johnson
- Department of Neurology, Comprehensive Stroke Center, The Johns Hopkins Hospital , Baltimore, MD , USA
| | - Victor Cruz Urrutia
- Department of Neurology, Comprehensive Stroke Center, The Johns Hopkins Hospital , Baltimore, MD , USA ; Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
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Ravenell J, Leighton-Herrmann E, Abel-Bey A, DeSorbo A, Teresi J, Valdez L, Gordillo M, Gerin W, Hecht M, Ramirez M, Noble J, Cohn E, Jean-Louis G, Spruill T, Waddy S, Ogedegbe G, Williams O. Tailored approaches to stroke health education (TASHE): study protocol for a randomized controlled trial. Trials 2015; 16:176. [PMID: 25927452 PMCID: PMC4417303 DOI: 10.1186/s13063-015-0703-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Stroke is a leading cause of adult disability and mortality. Intravenous thrombolysis can minimize disability when patients present to the emergency department for treatment within the 3 − 4½ h of symptom onset. Blacks and Hispanics are more likely to die and suffer disability from stroke than whites, due in part to delayed hospital arrival and ineligibility for intravenous thrombolysis for acute stroke. Low stroke literacy (poor knowledge of stroke symptoms and when to call 911) among Blacks and Hispanics compared to whites may contribute to disparities in acute stroke treatment and outcomes. Improving stroke literacy may be a critical step along the pathway to reducing stroke disparities. The aim of the current study is to test a novel intervention to increase stroke literacy in minority populations in New York City. Design and Methods In a two-arm cluster randomized trial, we will evaluate the effectiveness of two culturally tailored stroke education films – one in English and one in Spanish – on changing behavioral intent to call 911 for suspected stroke, compared to usual care. These films will target knowledge of stroke symptoms, the range of severity of symptoms and the therapeutic benefit of calling 911, as well as address barriers to timely presentation to the hospital. Given the success of previous church-based programs targeting behavior change in minority populations, this trial will be conducted with 250 congregants across 14 churches (125 intervention; 125 control). Our proposed outcomes are (1) recognition of stroke symptoms and (2) behavioral intent to call 911 for suspected stroke, measured using the Stroke Action Test at the 6-month and 1-year follow-up. Discussion This is the first randomized trial of a church-placed narrative intervention to improve stroke outcomes in urban Black and Hispanic populations. A film intervention has the potential to make a significant public health impact, as film is a highly scalable and disseminable medium. Since there is at least one church in almost every neighborhood in the USA, churches have the ability and reach to play an important role in the dissemination and translation of stroke prevention programs in minority communities. Trial registration NCT01909271; July 22, 2013
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Affiliation(s)
- Joseph Ravenell
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Ellyn Leighton-Herrmann
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Amparo Abel-Bey
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Alexandra DeSorbo
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Jeanne Teresi
- Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA.
| | - Lenfis Valdez
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Madeleine Gordillo
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - William Gerin
- The Pennsylvania State University, 208 Biobehavioral Health Building University Park, Pennsylvania, PA, 16802, USA.
| | - Michael Hecht
- The Pennsylvania State University, 501 Keller Building University Park, Pennsylvania, PA, 16802, USA.
| | - Mildred Ramirez
- Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA.
| | - James Noble
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Elizabeth Cohn
- Center for Health Innovation, Adelphi University, P.O. Box 701, Garden City, NY, 11530, USA.
| | - Giardin Jean-Louis
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Tanya Spruill
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Salina Waddy
- National Institute of Neurological Disorders and Stroke at the National Institutes of Health, 6001 Executive Boulevard, North Bethesda, MD, 20852, USA.
| | - Gbenga Ogedegbe
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Olajide Williams
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
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Hawkes MA, Ameriso SF, Willey JZ. Stroke knowledge in Spanish-speaking populations. Neuroepidemiology 2015; 44:121-9. [PMID: 25871697 DOI: 10.1159/000381100] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/19/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spanish is the second most-spoken language in the world. Spanish-speaking populations (SSP) have heterogeneous cultural backgrounds, racial and ethnical origins, economic status, and access to health care systems. There are no published reviews about stroke knowledge in SSP. We reviewed the existing literature addressing stroke knowledge among SSP and propose here some future directions for research. SUMMARY We identified 18 suitable studies by searching PubMed, Lilacs, Scopus, Embase, Cochrane and Scielo databases, and by looking at reference lists of eligible articles. We also included 2 conference abstracts. Data related to stroke knowledge from studies of Spanish-speakers were analyzed. Key Messages: Little is known about stroke knowledge in SSP, especially in Latin America. Information is lacking even among subjects at risk, stroke patients, stroke survivors, and health care providers. 'Ictus', the word used for stroke in Spanish, is largely unrecognized among subjects at risk. Furthermore, access to medical care and the availability of neurologists are suboptimal in many regions. There are several potential issues to solve regarding stroke knowledge and stroke care in SSP. Programs to educate the general population and non-neurologists medical providers in stroke and telemedicine may be better ways of improving the present situation.
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Affiliation(s)
- Maximiliano A Hawkes
- Neurology Department, Institute for Neurological Research FLENI, Buenos Aires, Argentina
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Aycock DM, Kirkendoll KD, Coleman KC, Clark PC, Albright KC, Alexandrov AW. Family history of stroke among African Americans and its association with risk factors, knowledge, perceptions, and exercise. J Cardiovasc Nurs 2015; 30:E1-6. [PMID: 24598552 PMCID: PMC5806121 DOI: 10.1097/jcn.0000000000000125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African Americans are at greater risk for stroke than whites are; however, it is unclear what role family history of stroke (FHS) plays in the adoption of healthier lifestyles among African Americans. OBJECTIVE The aim of this study was to compare modifiable risk factors, knowledge of stroke risk factors, perceived threat of stroke, perceived control of stroke, and exercise behaviors and intentions in African Americans with a FHS and those without a FHS. METHODS A cross-sectional study was conducted with rural African Americans aged 19 to 54 years participating in a mobile health clinic. Participants' stroke knowledge, perceptions of risk, exercise history and intent, physiologic data, and health history were collected. RESULTS Participants (N = 66) had a mean (SD) age of 43.3 (9.4) years and were mostly women, high school graduates, and unemployed. Participants with a FHS (n = 33) did not differ on average number of risk factors from those without a FHS. However, participants with a FHS were more likely to report a history of hypertension than were those without. There were no significant differences between groups in stroke knowledge, perceived threat and perceived control, or recent exercise performance, although participants with a FHS had significantly lower future intentions to exercise than did those without a FHS. CONCLUSIONS Family history of stroke was common in this sample; however, it did not translate into better understanding of stroke or better exercise behaviors and intentions. More can be done to identify African Americans with a FHS, especially those with multiple risk factors, to educate them about the significance of FHS while promoting lifestyle change and self-management.
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Affiliation(s)
- Dawn M Aycock
- Dawn M. Aycock, PhD, RN, ANP-BC Assistant Professor, Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta. Kenya D. Kirkendoll, MSN, MPH, RN PhD Student, School of Nursing, The University of Alabama at Birmingham. Kisha C. Coleman, MSN, RN, CPHM DNP Student, School of Nursing, The University of Alabama at Birmingham. Patricia C. Clark, PhD, RN, FAHA, FAAN Professor, Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta. Karen C. Albright, DO, MPH Postdoctoral Fellow, Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education, The University of Alabama at Birmingham. Anne W. Alexandrov, PhD, RN, CCRN, ANVP-BC, FAAN Assistant Dean for Program Evaluation and Professor, School of Nursing, The University of Alabama at Birmingham
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Feldman PH, McDonald MV, Trachtenberg MA, Schoenthaler A, Coyne N, Teresi J. Center for stroke disparities solutions community- based care transition interventions: study protocol of a randomized controlled trial. Trials 2015; 16:32. [PMID: 25622823 PMCID: PMC4322449 DOI: 10.1186/s13063-015-0550-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/05/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities persist in stroke occurrence, recurrence, morbidity and mortality. Uncontrolled hypertension (HTN) is the most important modifiable risk factor for stroke risk. Home health care organizations care for many patients with uncontrolled HTN and history of stroke; however, recurrent stroke prevention has not been a home care priority. We are conducting a randomized controlled trial (RCT) to compare the effectiveness, relative to usual home care (UHC), of two Community Transitions Interventions (CTIs). The CTIs aim to reduce recurrent stroke risk among post-stroke patients via home-based transitional care focused on better HTN management. METHODS/DESIGN This 3-arm trial will randomly assign 495 black and Hispanic post-stroke home care patients with uncontrolled systolic blood pressure (SBP) to one of three arms: UHC, UHC complemented by nurse practitioner-delivered transitional care (UHC + NP) or UHC complemented by an NP plus health coach (UHC + NP + HC). Both intervention arms emphasize: 1) linking patients to continuous, responsive preventive and primary care, 2) increasing patients'/caregivers' ability to manage a culturally and individually tailored BP reduction plan, and 3) facilitating the patient's reintegration into the community after home health care discharge. The primary hypothesis is that both NP-only and NP + HC transitional care will be more effective than UHC alone in achieving a SBP reduction. The primary outcome is change in SPB at 3 and 12 months. The study also will examine cost-effectiveness, quality of life and moderators (for example, race/ethnicity) and mediators (for example, changes in health behaviors) that may affect treatment outcomes. All outcome data are collected by staff blinded to group assignment. DISCUSSION This study targets care gaps affecting a particularly vulnerable black/Hispanic population characterized by persistent stroke disparities. It focuses on care transitions, a juncture when patients are particularly susceptible to adverse events. The CTI is innovative in adapting for stroke patients an established transitional care model shown to be effective for HF patients, pairing the professional NP with a HC, implementing a culturally tailored intervention, and placing primary emphasis on longer-term risk factor reduction and community reintegration rather than shorter-term transitional care outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01918891 ; Registered 5 August 2013.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 107 East 70th Street, 10021, New York, NY, USA.
| | - Margaret V McDonald
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, 10001, New York, NY, USA.
| | - Melissa A Trachtenberg
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, 10001, New York, NY, USA.
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, 227 East 30th Street, 634, 10016, New York, NY, USA.
| | - Noreen Coyne
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, 10001, New York, NY, USA.
| | - Jeanne Teresi
- Columbia University Stroud Center and New York State Psychiatric Institute, Research Division, Hebrew Home at Riverdale, 5901 Palisade Avenue, 10471, Bronx, NY, USA.
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Ivanov LL, Wallace DC, Hernández C, Hyde Y. Diabetes risks and health literacy in southern African American and Latino women. J Community Health Nurs 2015; 32:12-23. [PMID: 25674971 PMCID: PMC4666304 DOI: 10.1080/07370016.2015.991664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Minority women experience health disparities, especially related to diabetes. The purpose of this article is to examine diabetes risk in minority women. A survey design was used to recruit 52 African Americans (AA) and 48 Latina women. Participants described their health, health behaviors, and health literacy. Blood pressure and body mass index were measured. AA women had more diabetes risks than Latinas, and older women had more risks than younger women. All of the women had low health literacy. Women with higher numbers of diabetes risks had lower health literacy. Findings can be used to develop diabetes prevention and education programs.
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Affiliation(s)
- L Louise Ivanov
- a University of North Carolina at Greensboro , School of Nursing , Greensboro , North Carolina
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Tataris K, Kivlehan S, Govindarajan P. National trends in the utilization of emergency medical services for acute myocardial infarction and stroke. West J Emerg Med 2014; 15:744-8. [PMID: 25493113 PMCID: PMC4251214 DOI: 10.5811/westjem.2014.9.22851] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/26/2014] [Accepted: 09/06/2014] [Indexed: 01/01/2023] Open
Abstract
Introduction The emergency medical services (EMS) system plays a crucial role in the chain of survival for acute myocardial infarction (AMI) and stroke. While regional studies have shown underutilization of the 911 system for these time-sensitive conditions, national trends have not been studied. Our objective was to describe the national prevalence of EMS use for AMI and stroke, examine trends over a six-year period, and identify patient factors that may contribute to utilization. Methods Using the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS) dataset from 2003–2009, we looked at patients with a discharge diagnosis of AMI or stroke who arrived to the emergency department (ED) by ambulance. We used a survey-weighted χ2 test for trend and logistic regression analysis. Results In the study, there were 442 actual AMI patients and 220 (49.8%) presented via EMS. There were 1,324 actual stroke patients and 666 (50.3%) presented via EMS. There was no significant change in EMS usage for AMI or stroke over the six-year period. Factors independently associated with EMS use for AMI and stroke included age (OR 1.21; 95% CI 1.12–1.31), Non-Hispanic black race (OR 1.72; 95% CI 1.16–2.29), and nursing home residence (OR 11.50; 95% CI 6.19–21.36). Conclusion In a nationally representative sample of ED visits from 20003–2009, there were no trends of increasing EMS use for AMI and stroke. Efforts to improve access to care could focus on patient groups that underutilize the EMS system for such conditions.
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Affiliation(s)
- Katie Tataris
- University of California at San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Sean Kivlehan
- University of California at San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Prasanthi Govindarajan
- University of California at San Francisco, Department of Emergency Medicine, San Francisco, California
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Abstract
OBJECTIVES The purpose of this study was to explore the perceptions of African American women about stroke and examine their health information seeking practices outside of medical encounters. DESIGN AND SAMPLE An exploratory-descriptive qualitative study was conducted with 48 women of age 35 years and older recruited from four Black churches. MEASURES Data were collected during focus groups and analyzed with qualitative content analysis. RESULTS Most of what participants knew about stroke came from interaction with family members or acquaintances that had strokes rather than stroke campaigns or health providers. There was confusion about the multiple symptoms of stroke, and information about stroke symptoms may not provide meaningful symptom representations. Information about breast cancer was more readily available than information about stroke. The internet, other women, and television programs were main source of health information outside of medical encounters. There was uncertainty how to assess the trustworthiness of internet health sites. CONCLUSIONS The results suggest that culturally sensitive stroke education for African American women should include stories of women with stroke and provide experiential and visual depictions of stroke warning signs. Group forums, television, and web-based education may be acceptable ways to communicate stroke information to African American women.
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Affiliation(s)
- Claudia C Beal
- Baylor University Louise Herrington School of Nursing, Dallas, Texas
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Malek AM, Adams RJ, Debenham E, Boan AD, Kazley AS, Hyacinth HI, Voeks JH, Lackland DT. Patient awareness and perception of stroke symptoms and the use of 911. J Stroke Cerebrovasc Dis 2014; 23:2362-71. [PMID: 25213451 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/29/2014] [Accepted: 05/09/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Response to stroke symptoms and the use of 911 can vary by race/ethnicity. The quickness with which a patient responds to such symptoms has implications for the outcome and treatment. We sought to examine a sample of patients receiving a Remote Evaluation of Acute isCHemic stroke (REACH) telestroke consult in South Carolina regarding their awareness and perception of stroke symptoms related to the use of 911 and to assess possible racial/ethnic disparities. METHODS As of September 2013, 2325 REACH telestroke consults were conducted in 13 centers throughout South Carolina. Telephone surveys assessing use of 911 were administered from March 2012-January 2013 among 197 patients receiving REACH consults. Univariate and multivariate logistic regression was performed to assess factors associated with use of 911. RESULTS Most participants (73%) were Caucasian (27% were African-American) and male (54%). The mean age was 66 ± 14.3 years. Factors associated with use of 911 included National Institutes of Health Stroke Scale scores >4 (odds ratio [OR], 5.4; 95% confidence interval [CI], 2.63-11.25), unknown insurance which includes self-pay or not charged (OR, 2.90; 95% CI, 1.15-7.28), and perception of stroke-like symptoms as an emergency (OR, 4.58; 95% CI, 1.65-12.67). African-Americans were significantly more likely than Caucasians to call 911 (62% vs. 43%, P = .02). CONCLUSIONS African-Americans used 911 at a significantly higher rate. Use of 911 may be related to access to transportation, lack of insurance, or proximity to the hospital although this information was not available. Interventions are needed to improve patient arrival times to telemedicine equipped emergency departments after stroke.
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Affiliation(s)
- Angela M Malek
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Robert J Adams
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Ellen Debenham
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Andrea D Boan
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Abby S Kazley
- Department of Healthcare Leadership & Management, Medical University of South Carolina, Charleston, South Carolina
| | - Hyacinth I Hyacinth
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jenifer H Voeks
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel T Lackland
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
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Gardois P, Booth A, Goyder E, Ryan T. Health promotion interventions for increasing stroke awareness in ethnic minorities: a systematic review of the literature. BMC Public Health 2014; 14:409. [PMID: 24775404 PMCID: PMC4019964 DOI: 10.1186/1471-2458-14-409] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 04/14/2014] [Indexed: 11/28/2022] Open
Abstract
Background Stroke places a significant burden to all affected individuals, but it is perhaps more significant amongst members of black, minority and ethnic communities, who may experience poorer awareness of stroke symptoms than the general population. Recently, several initiatives tried to improve public awareness that symptoms of stroke need to be treated as a medical emergency. However, ethnic communities present cultural barriers, requiring tailored health promotion interventions, whose effectiveness remains uncertain. Our systematic review aimed to identify relevant published evidence, synthesize the main study components and identify evidence of the effectiveness of the interventions. Methods MEDLINE, EMBASE, CINAHL, and PsycInfo were searched for journal articles on health promotion interventions for increasing stroke awareness in ethnic minorities, published in English between 1995 and 2012. Search results were collaboratively assessed by the authors; included studies were analysed to identify their main characteristics, and a thematic analysis of their content was conducted. No meta-analysis was performed, due to the heterogeneity of results. Results Eighteen studies were included, reporting 15 interventions conducted in the US, for African-Americans or Hispanics; populations sizes differed between interventions. Interventions were mostly carried out in community settings with different educational techniques, focussing on experiential methods. Health professionals usually organized the programs, delivered by nurses, other health professionals or volunteers. The few theory-based interventions focussed on individual-level behavioural change. Practical cultural adaptation strategies were not linked to specific theoretical frameworks. Interventions widely differed as for target populations, settings, delivery methods, contents and professional roles involved. All study designs were quantitative, and the emerging evidence of effectiveness was inconclusive. Such interventions operate in very complex scenarios, and several variables may influence their effectiveness. Therefore, qualitative or mixed-methods study designs may shed light on barriers and facilitators, experiential education strategies and community involvement. Network- and community-level theories may help improving design and evaluation of interventions. Conclusions Eleven case reports and four RCTs provide evidence about stroke awareness interventions organized in the US. The studies provide only partial and inconclusive evidence about the effectiveness of the interventions. Hence, further research is needed on different countries and ethnic minorities.
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Affiliation(s)
- Paolo Gardois
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Sanders K, Schnepel L, Smotherman C, Livingood W, Dodani S, Antonios N, Lukens-Bull K, Balls-Berry J, Johnson Y, Miller T, Hodges W, Falk D, Wood D, Silliman S. Assessing the impact of health literacy on education retention of stroke patients. Prev Chronic Dis 2014; 11:E55. [PMID: 24721215 PMCID: PMC3984940 DOI: 10.5888/pcd11.130259] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Inadequate health literacy is a pervasive problem with major implications for reduced health status and health disparities. Despite the role of focused education in both primary and secondary prevention of stroke, the effect of health literacy on stroke education retention has not been reported. We examined the relationship of health literacy to the retention of knowledge after recommended stroke education. METHODS This prospective cross-sectional study was conducted at an urban safety-net hospital. Study subjects were patients older than 18 admitted to the hospital stroke unit with a diagnosis of acute ischemic stroke who were able to provide informed consent to participate (N = 100). Health literacy levels were measured by using the short form of Test of Functional Health Literacy in Adults. Patient education was provided to patients at an inpatient stroke unit by using standardized protocols, in compliance with Joint Commission specifications. The education outcomes for poststroke care education, knowledge retention, was assessed for each subject. The effect of health literacy on the Stroke Patient Education Retention scores was assessed by using univariate and multivariate analyses. RESULTS Of the 100 participating patients, 59% had inadequate to marginal health literacy. Stroke patients who had marginal health literacy (mean score, 7.45; standard deviation [SD], 1.9) or adequate health literacy (mean score, 7.31; SD, 1.76) had statistically higher education outcome scores than those identified as having inadequate health literacy (mean score, 5.58; SD, 2.06). Results from multivariate analysis indicated that adequate health literacy was most predictive of education outcome retention. CONCLUSIONS This study demonstrated a clear relationship between health literacy and stroke education outcomes. Studies are needed to better understand the relationship of health literacy to key educational outcomes for primary or secondary prevention of stroke and to refine stroke education for literacy levels of high-risk populations.
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Affiliation(s)
- Kalina Sanders
- 580 W. 8th St, Tower 1, 9th Floor, Jacksonville, FL 32209. E-mail:
| | - Loretta Schnepel
- University of Florida, College of Medicine, Gainesville, Florida
| | - Carmen Smotherman
- the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - William Livingood
- University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Sunita Dodani
- University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Nader Antonios
- University of Florida, College of Medicine, Gainesville, Florida
| | | | - Joyce Balls-Berry
- the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Yvonne Johnson
- University of Florida Health Jacksonville, Jacksonville, Florida
| | - Terri Miller
- University of Florida Health Jacksonville, Jacksonville, Florida
| | - Wayne Hodges
- University of Florida, College of Medicine, Gainesville, Florida
| | - Diane Falk
- University of Florida, College of Medicine, Gainesville, Florida
| | - David Wood
- University of Florida, College of Medicine, Gainesville, Florida, and the Center for Health Equity and Quality Research, Jacksonville, Florida
| | - Scott Silliman
- University of Florida, College of Medicine, Gainesville, Florida
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Boehme AK, Siegler JE, Mullen MT, Albright KC, Lyerly MJ, Monlezun DJ, Jones EM, Tanner R, Gonzales NR, Beasley TM, Grotta JC, Savitz SI, Martin-Schild S. Racial and gender differences in stroke severity, outcomes, and treatment in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23:e255-61. [PMID: 24468069 PMCID: PMC3989836 DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/03/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Previous research has indicated that women and blacks have worse outcomes after acute ischemic stroke (AIS). Little research has been done to investigate the combined influence of race and gender in the presentation, treatment, and outcome of patients with AIS. We sought to determine the association of race and gender on initial stroke severity, thrombolysis, and functional outcome after AIS. METHODS AIS patients who presented to 2 academic medical centers in the United States (2004-2011) were identified through prospective registries. In-hospital strokes were excluded. Stroke severity, measured by admission National Institutes of Health Stroke Scale (NIHSS) scores, treatment with tissue plasminogen activator (tPA), neurologic deterioration (defined by a ≥2-point increase in NIHSS score), and functional outcome at discharge, measured by the modified Rankin Scale, were investigated. These outcomes were compared across race/gender groups. A subanalysis was conducted to assess race/gender differences in exclusion criteria for tPA. RESULTS Of the 4925 patients included in this study, 2346 (47.6%) were women and 2310 (46.9%) were black. White women had the highest median NIHSS score on admission (8), whereas white men had the lowest median NIHSS score on admission (6). There were no differences in outcomes between black men and white men. A smaller percentage of black women than white women were treated with tPA (27.6% versus 36.6%, P < .0001), partially because of a greater proportion of white women presenting within 3 hours (51% versus 45.5%, P = .0005). Black women had decreased odds of poor functional outcome relative to white women (odds ratio [OR] = .85, 95% confidence interval [CI] .72-1.00), but after adjustment for baseline differences in age, NIHSS, and tPA use, this association was no longer significant (OR = 1.2, 95% CI .92-1.46, P = .22). Black women with an NIHSS score less than 7 on admission were at lower odds of receiving tPA than the other race/gender groups, even after adjusting for arriving within 3 hours and admission glucose (OR = .66, 95% CI .44-.99, P = .0433). CONCLUSION Race and gender were not significantly associated with short-term outcome, although black women were significantly less likely to be treated with tPA. Black women had more tPA exclusions than any other group. The primary reason for tPA exclusion in this study was not arriving within 3 hours of stroke symptom onset. Given the growth in incident strokes projected in minority groups in the next 4 decades, identifying factors that contribute to black women not arriving to the emergency department in time are of great importance.
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Affiliation(s)
- Amelia K Boehme
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - James E Siegler
- Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, Louisiana
| | - Michael T Mullen
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennysylvania
| | - Karen C Albright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education, Birmingham, Alabama; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities Minority Health and Health Disparities Research Center, Birmingham, Alabama
| | - Michael J Lyerly
- Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dominique J Monlezun
- Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, Louisiana
| | - Erica M Jones
- Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, Louisiana
| | - Rikki Tanner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicole R Gonzales
- Department of Neurology, University of Texas Medical School-Houston, Houston, Texas
| | - T Mark Beasley
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - James C Grotta
- Department of Neurology, University of Texas Medical School-Houston, Houston, Texas
| | - Sean I Savitz
- Department of Neurology, University of Texas Medical School-Houston, Houston, Texas
| | - Sheryl Martin-Schild
- Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, Louisiana.
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Williams O, Hecht MF, DeSorbo AL, Huq S, Noble JM. Effect of a novel video game on stroke knowledge of 9- to 10-year-old, low-income children. Stroke 2014; 45:889-92. [PMID: 24481976 DOI: 10.1161/strokeaha.113.002906] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Improving actionable stroke knowledge of a witness or bystander, which in some cases are children, may improve response to an acute stroke event. METHODS We used a quasiexperimental pre-test post-test design to evaluate actionable stroke knowledge of 210 children aged 9 to 10 years in response to a single, 15-minute exposure to a stroke education video game conducted in the school computer laboratory. After immediate post-test, we provided remote password-protected online video game access and encouraged children to play at their leisure from home. An unannounced delayed post-test occurred 7 weeks later. RESULTS Two hundred ten children completed pretest, 205 completed immediate post-test, whereas 198 completed delayed post-test. One hundred fifty-six (74%) children had Internet access at home, and 41 (26%), mostly girls, played the video game remotely. There was significant improvement in stroke symptom composite scores, calling 911, and all individual stroke knowledge items, including a distractor across the testing sequence (P<0.05). Children who played the video game remotely demonstrated significant improvement in knowledge of 1 symptom (sudden imbalance) compared with children who did not (P<0.05), although overall composite scores showed no difference. CONCLUSIONS Stroke education video games may represent novel means for improving and sustaining actionable stroke knowledge of children.
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Affiliation(s)
- Olajide Williams
- From the Department of Neurology, The Neurological Institute of New York, Columbia University Medical Center, New York, NY
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Skolarus LE, Murphy JB, Zimmerman MA, Bailey S, Fowlkes S, Brown DL, Lisabeth LD, Greenberg E, Morgenstern LB. Individual and community determinants of calling 911 for stroke among African Americans in an urban community. Circ Cardiovasc Qual Outcomes 2013; 6:278-83. [PMID: 23674311 PMCID: PMC3779662 DOI: 10.1161/circoutcomes.111.000017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND African Americans receive acute stroke treatment less often than non-Hispanic whites. Interventions to increase stroke preparedness (recognizing stroke warning signs and calling 911) may decrease the devastating effects of stroke by allowing more patients to be candidates for acute stroke therapy. In preparation for such an intervention, we used a community-based participatory research approach to conduct a qualitative study exploring perceptions of emergency medical care and stroke among urban African American youth and adults. METHODS AND RESULTS Community partners, church health teams, and church leaders identified and recruited focus group participants from 3 black churches in Flint, MI. We conducted 5 youth (11-16 years) and 4 adult focus groups from November 2011 to March 2012. A content analysis approach was taken for analysis. Thirty-nine youth and 38 adults participated. Women comprised 64% of youth and 90% of adult focus group participants. All participants were black. Three themes emerged from the adult and youth data: (1) recognition that stroke is a medical emergency; (2) perceptions of difficulties within the medical system in an under-resourced community, and; (3) need for greater stroke education in the community. CONCLUSIONS Black adults and youth have a strong interest in stroke preparedness. Designs of behavioral interventions to increase stroke preparedness should be sensitive to both individual and community factors contributing to the likelihood of seeking emergency care for stroke.
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Affiliation(s)
- Lesli E Skolarus
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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