Abstract
INTRODUCTION: Racial disparities in stroke preparedness and prevention persist. Emerging research emphasizes the importance of stroke knowledge; however significant gaps remain. The aim of this work was to explore factors related to stroke knowledge/preparedness attainment in a stroke-free community setting. Methods: The Stroke Warning Information and Faster Treatment Community (SWIFT) study was a randomized stroke preparedness educational intervention, which prospectively enrolled stroke-free community members from 30 Northern Manhattan community-based organizations. This culturally tailored health literate intervention utilized visuals, and interactive sessions to overcome educational and language barriers. Baseline demographics and a validated stroke knowledge score (SKS) were assessed by interviewer administered questionnaires at each of the community sites. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults. At the end of the intervention, we assessed competency of stroke knowledge and preparedness using an open-ended teach back methodology. Results: The cohort included 423 stroke free community residents; mean age 64.1 years; 77% female; 30% white, 27% black, 40% Hispanic. Mean baseline stroke knowledge score was 72.4%. In a multivariate model adjusted for age, SKS was significantly associated with education (p <.0001) gender (p=.0046) and Latino race (p <.0001) with Latino males having less than high school education scoring 5 points less than white females with HS or more. While 46% demonstrated competency on the multiple choice section, only 26% demonstrated competency on open ended behavioral intent questions. Health literacy level was significantly correlated (r=.324, p=.0001) with total stroke knowledge score, but was not correlated with post-intervention competency assessment (r=.116, p=.116). Of the 76% that had a competency score, 77% demonstrated full competency post intervention. Discussion: Mismatch between multiple choice knowledge score and competency indicate that not all evaluation methods correspond to true learning. Appropriate intervention can overcome disparities in health literacy to improve stroke education for all.
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