Abstract T P319: Reducing Health Disparities for African-American Men: Under-Recognized Factors in Stroke Recovery

Abstract

Introduction: African-Americans (AA) have double the stroke rate, are younger and have more post-stroke complications than other Americans. There is a need for approaches that improve outcomes for AA stroke survivors. Unfortunately, little is known about which approaches are acceptable and effective for this high risk group. Objectives: To identify salient and modifiable barriers to post-stroke care among young (<age 65) AA men and members of their immediate social support network. Results informed refinement of a stroke recovery intervention for AA men. Methods: Ten AA stroke survivors and their care partners (CPs) (n=7) participated in focus groups and advisory board meetings. Survivors had stroke or transient ischemic attack within the past year, were community-dwelling, and had a Barthel ADL Index >60. Focus groups conducted with a semi-structured interview guide identified self-perceived barriers and facilitators to care among AA men and their CPs. Group interviews were conducted until theoretical saturation occurred. Thematic analysis of audio-recorded and transcribed sessions and the constant comparative method were used to generate constructs (themes). Results: Survivor mean age was 53 (range=34-64 years). Mean Barthel was 95.5 (SD=7.6). CPs were all AA women, mean age of 54 (range=49-61). Five CPs were wives (n=5) while others were fiancée (n=1) and niece (n=1). Participants cited multiple personal, social, and societal challenges to stroke recovery. While hypertension and smoking risks were acknowledged, psychological factors (stress, depression, PTSD, anger/frustration, change in personal identity, and communicating their own unique needs as AA men), were the most frequently noted barriers. Facilitators included family support, stress reduction and moderation of dietary habits. Conclusions: Biological risk reduction education may not capture all salient aspects of health management for AA stroke survivors. Men in this study identified psychological self-management barriers as critical impediments to good health outcomes. Incorporation of these factors into stroke care may help reduce health disparities for minority men.