Abstract
Introduction: In a segregated city like Chicago with distinct neighborhood characteristics, a discrepancy between neighborhoods in stroke knowledge, self-efficacy, and trust in the medical system could impact stroke outcomes. Methods: As part of a study which implemented a culturally-tailored stroke preparedness intervention targeting South (S) Side Chicago communities, individuals attending community health events were recruited in S neighborhoods and North (N) Side neighborhoods pre- and one-year post-intervention to assess stroke knowledge, self-efficacy, and trust. Independent stand-alone pre- and post-sample cohorts were purposefully recruited to match demographics. Survey outcomes included knowledge (assessed via Stroke Action Test, STAT), self-efficacy (Likert scale), trust (Health Care Trust Survey), and stress (Likert). Zip codes divided subjects into S/N neighborhoods. Two-sample t-tests compared cohorts, and interactions between race/ethnicity-time and neighborhood-time were tested, with multivariable linear regression when statistically (p<0.05) significant. Results: We recruited 364 subjects pre-intervention (S=199, N=165) and 363 subjects post-intervention (S=198, N=165) who were well-matched in race/ethnicity, sex, and education, though the post-group was slightly younger (p=0.04). Unadjusted analysis revealed increases post-intervention in stroke knowledge (p=0.07), self-efficacy (p<0.0001), trust (p<0.0001), and stress scores (p<0.0001). After adjusting for race/ethnicity, gender, and age, the N post-group had greater gains in knowledge (N: 4.0, p=0.02 vs. S: 0.7, p=0.69), self-efficacy (N: 2.3, p<0.0001 vs. S: 0.7, p<0.0001), trust (N: 0.8, p<0.0001 vs. S: -0.1, p=0.20) and stress (N: -0.3, p<0.0001 vs. S: -0.1, p=0.04). Conclusions: The observed gains in stroke knowledge, self-efficacy, trust, and stress, greater in the North Side of Chicago, could signal overall improved public health messaging around stroke recognition and treatment, but could also point to socioeconomic factors that may have disproportionately benefited North Side residents. Further focused research to understand neighborhood factors which influence stroke awareness and action is necessary.
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