Abstract
BackgroundStroke 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 MethodsIn 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.DiscussionThis 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 registrationNCT01909271; July 22, 2013
Highlights
Stroke is a leading cause of adult disability and mortality
Stroke education studies have shown that placing an emphasis on calling 911 for suspected stroke can lead to reduced prehospital delays [4] and increased thrombolysis for acute stroke [7]
In a review of 182 stroke education studies, we found that there is a discrepancy between knowledge concerning stroke symptoms and the reaction to an acute manifestation of one or more of these symptoms [9]
Summary
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 − 41⁄2 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. Introduction Stroke is the leading cause of adult disability, with an estimated 795,000 new and recurrent strokes occurring annually in the US [1,2]. Only 3-5% of diagnosed ischemic stroke events receive t-PA therapy This low rate of treatment is predominantly due to the public’s inability to identify and respond appropriately to stroke symptoms when they occur [6]. Stroke education studies have shown that placing an emphasis on calling 911 for suspected stroke can lead to reduced prehospital delays [4] and increased thrombolysis for acute stroke [7]
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