Stroke Education Program Research Articles

Evaluating a community‐based stroke nursing education and rehabilitation programme for patients with mild stroke

This study evaluated whether mild stroke patients who received a community-based stroke nursing intervention had better stroke knowledge, behaviour and self-efficacy than those who were exposed to traditional education programmes. The intervention group consisted of sixty five stroke patients randomly selected from seven communities who received three 2-hour stroke interventions per week for 8 weeks. The normal care group consisted of sixty two stroke patients randomly selected from a medical centre who received a general stroke education programme. The stroke patients in two groups were assessed at baseline, after intervention and at the 6-month follow-up. At the 6-month follow-up, the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group. Three months after education, the intervention group exhibited changes in the knowledge of stroke, social participation and self-efficacy compared with those at baseline. Also, self-efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6-month follow-up; self-efficacy was correlated with social participation after the 6-month follow-up. A community-based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors, social participation and self-efficacy.

Effects of a web-based stroke education program on recurrence prevention behaviors among stroke patients: a pilot study

The effectiveness of methods to prevent stroke recurrence and of education focusing on learners' needs has not been fully explored. The aims of this study were to assess the effects of such interventions among stroke patients and their primary caregivers and to evaluate the feasibility of a web-based stroke education program. The participants were 36 patients with a clinical diagnosis of ischemic stroke within 12 months post-stroke and their primary caregivers. The participants were randomly assigned to either an experimental or a control group. The primary measures included blood chemistry, self-reported health behaviors, sense of control, and health motivation for stroke patients, and caregiver mastery for caregivers. To test the feasibility of the intervention program, the rates of participation and occurrence of technical problems were calculated. The experimental group tended to improve significantly more than the control group in terms of exercise, diet, sense of control and health motivation for the stroke patients and in terms of caregiver mastery for the primary caregivers. The rate of participation in the web-based program was 63.1%. This program, which focuses on recurrence prevention in stroke patients and caregivers, has the potential to improve health behaviors for stroke patients.

WSO Stroke Education Program in Vietnam 2008–2011: 8596 Hospital Doctors Attended in 58 Cities and Received a Certificate from the WSO and the Ministry of Health

In 2008, the start of the WSO ABC Education Program Stroke Management in Vietnam was reported in the International Journal of Stroke (1). Now the successful ending of this program is reported. Until the end of 2011 the trainings took place in 58 cities and provinces with 8.596 doctors participating. The attending doctors received a Certificate signed by the WSO and the Ministry of Health in Hanoi, Vietnam. In 2008 there was virtually no structures stroke care existing in Vietnam. Today, stroke is recognized as a separate disease by most doctors. Vietnam has now a National Stroke Society which holds annual meetings and a Vietnamese edition of the International Journal of Stroke. A program endorsing the setting up of stroke units has been endorsed by the government and the stroke society.

Abstract TP376: Effect of Organized Stroke Education Program of Stroke Unit for Acute Stroke Patients to Increase Medication Compliance after Discharge

Background and purpose: Interdicipinary education program of stroke unit might be important to improve secondary prevention by increase of medication compliance and maintenance of relationship with physician. The present study evaluated that our education program of stroke unit including education materials for stroke prevention and man-to-man education schedule of stroke unit is helpful to increase the medication compliance and future follow-up rate for first-ever stroke patients. Methods: We first developed education materials, which were consisted of mechanisms and clinical characteristics of stroke, and importance of medication maintenance for secondary stroke prevention. Then man-to-man education was provided for patients who admitted stroke unit (Education group) from January to June of 2012. Medication maintenance rate at 3 months and follow-up rates checked 1 and 3 months after discharge were evaluated. Then, to evaluate the education effects, the rates of Education group were compared ones of No-Education group who were treated in general ward with no organized stroke education from January to June of 2010. Results: Total 392 patients (178; No-Education, 214; Education group) were enrolled. Among patients who admitted to stroke unit, 96.7% were educated by 2 stroke coordinators during admission period. The follow-up rates after discharge were slightly higher in Education group within 1month (89% vs 82%, p <0.05). Maintenance of the follow-up was significantly higher in Education group after 3months (83% vs 61%, p <0.05) than No-Education group. Maintenance rates of antithrombotic medication was highly achieved in the Education group (98% vs 89%, p <0.05) during follow-up period of 3 months. Conclusions: We observed that the educational effect of stroke unit is well maintained till 3 months after discharge. The high follow-up rate and good medication compliance could be obvious benefits of interdisciplinary working stroke unit.

Abstract TP358: Creation and Utilization of Stroke Teaching Tool Increases Compliance of Stroke Patient Education

INTRODUCTION: Providing patients with stroke education is vital in secondary stroke risk reduction. A database was utilized which included an education measure that reflected the Joint Commission’s (JC) 5 core components for stroke education. In order to increase consistency with providing stroke patient education, a plan was developed to improve the education process. This plan included development of a carbon print Patient Health Log . PURPOSE: The purpose of this project was to increase consistency in providing stroke patient education with an emphasis on modifiable stroke risk factors. METHODS: A tool titled the Patient Health Log was created to include the JC 5 core components of stroke education. Nurses on the stroke unit were educated on rationale for standardization of stroke patient education and the completion of the Patient Health Log . Educational processes included: case reviews, discussion and review at staff meetings and daily safety briefings, open forum for clarifying questions, and educational flyers. Auditing of stroke education documentation in the EMR identified a need for improving stroke patient education. Collaboration with the stroke clinical nurse leader allowed for one on one staff education on all shifts. The tool was incorporated into the stroke education packet. The neuroscience nursing staff implemented the Patient Health Log in January 2012 for all patients with diagnosis of stroke. RESULTS: Stroke patient education and documentation were reflected in a database at 80% compliance prior to implementation of the Patient Health Log and intense education processes. In June 2012, six months after implementation of the tool, data analysis supported increased compliance with stroke patient education at 93.9%. CONCLUSION: Creation and implementation of a stroke teaching tool, in conjunction with modified nursing stroke education programs, has a positive impact on stroke patient education. The tool’s carbon format provides the patient with an individualized stroke risk reduction action plan to take to all multidisciplinary follow up appointments potentially increasing communication between providers in the outpatient setting.

Poster 87 The Impact of a Stroke Education Program on Patient's Stroke Knowledge and Their Change of Stroke Risk Behaviors

To assess the immediate and long term effectiveness of an interdisciplinary Stroke Education and Wellness Program on increasing patient's knowledge about stroke and stroke risk behavior modification (secondary prevention). Half the patients received an additional session that incorporates motivational interviewing and stages of change to help with behavioral change.

Abstract 2629: The Effectiveness Of A Stroke Educational Activity Performed By A Schoolteacher For Junior High School Students

Background and Purpose: School-based programs of stroke enlightenment would be promising means to improve prevention of stroke as well as to spread the knowledge of stroke. Junior high school education is compulsory in Japan. We developed an educational system of stroke for junior high school students and teachers. Our purpose is to verify the effectiveness of this educational system to acquire knowledge of stroke for junior high school educations. Methods: Subjects were 100 students in the 3 rd grade of a public junior high school (40 girls, 14-15 years old). A stroke neurologist gave 45 minutes’ lesson in stroke to 25 students (S group) and 1 schoolteacher of health education by use of our educational system. A stroke neurologist also performed instructions to the schoolteacher how to use our stroke educational system to the students. The system includes stroke signs, symptoms, the FAST massage (Facial droop, Arm weakness, Speech disturbance, Time to call 119) and risk factors. After instructions by the stroke neurologist, the schoolteacher performed the lesson using the same educational system to the other 75 students (T group). Questionnaires on stroke knowledge (total 12 items for stroke signs and 10 items for risk factors) were examined for all students at the baseline and immediately after the lesson. Results: The total scores were not significantly different between the 2 groups either at the baseline or immediately after the lesson. In the S group, the items of correct answers on stroke signs[median 11(IQR 8-11) vs. 6(6-8.5) , P<0.001 ]and stroke risk factors [9(8-9) vs. 7(5-7.5), P<0.001] significantly increased after the lesson than at baseline. In the T group, the items of correct answers on stroke signs [10(8-11) vs. 7(6-9), P<0.001 ]and stroke risk factors [8(7-10) vs. 7(6-8); P<0.001]also significantly increased. On the FAST massage, there is no significant difference between 2 groups (73% vs. 92%; P=0.056). Conclusions: The stroke education program using our educational system would be promising means for junior high school educations.

Abstract 3384: Effectiveness of the FAST Program Targeting African American Middle School Teachers

Significance and Purpose: During the school year, teachers interact with middle students almost half of their waking hours and have a unique opportunity to positively affect their own health as well as their students. The purpose of this pilot study performed in a predominantly African American middle school was to evaluate the effectiveness of the 3 month long FAST Stroke Education Program designed for teachers that used Social Cognitive Theory as the underlying framework. The program objectives were to: (1) increase the teachers’ knowledge of the major stroke risk factors, stroke warning signs, and treatment seeking behaviors (call 911); (2) improve the teachers self-efficacy related to improving one of their own modifiable stroke risk factors; and (3) achieve their self-identified goal to reduce a modifiable stroke risk factor. Methodology: After obtaining consent, the teachers received a pretest survey that assessed their stroke knowledge and self-efficacy related to stroke. Following this pretest, the teachers received a 45 minute educational intervention that included interaction with a stroke survivor and taking an immediate posttest. As part of this session, the teachers also identified one personal objective for the next 3 months (i.e., exercise 30 minutes 3 times/day) and listed 2-3 feasible actions to achieve this objective. Six weeks later, they were mailed their objective, action plan, and stroke related educational materials in a self-addressed envelope. At three months, teachers received a long-term posttest that also determined if they had achieved their self-identified modifiable stroke risk factor. Findings: The study’s convenience sample consisted of 29 full-time teachers who were mostly male (n = 18, 62%) and African American (n=19, 65.5%). Risk factor knowledge scores were significantly higher at immediate posttest than at pretest, t = 2.25, p = .03 and was maintained at 3 months. Regarding stroke warning signs, there was a significant difference between pretest and posttest with a t=2.52, p = .015,but this knowledge wasn’t maintained. Subjects improved and maintained their stroke self-efficacy from pretest to long-term posttest and 31% of the teachers achieved their health objective. Another 58.6% stated they made some progress in achieving their stroke reduction objective. Conclusions and Practice Implications: Pilot results reveal some positive stroke outcomes involving middle school teachers. Additional refinements in the FAST program and educational strategies will occur to further enhance information retention and achievement of personal health outcomes prior to testing with a larger sample.

Abstract 2426: A Stroke Campaign of Act FAST for Junior High School Students and Their Parents

Background and purpose: Early recognition of stroke signs and symptoms is essential for emergent treatment and improvement of clinical outcomes. We examined efficacy of a stroke education program for junior high school students and their parents. Methods: From February 2010 to May 2011, 349 students in 11 classes of the 1 st grade of 3 junior high schools (12 - 13 years old) and their parents were enrolled. The subjects were divided into 2 groups; an intervention group (6 classes, 190 students) and a control group (5 classes, 159 students). Students in the intervention group received a 45-minutes lesson on stroke signs and symptoms, the FAST message (Facial droop, Arm weakness, Speech disturbance, Time to call 119), and stroke risk factors. School items consisting of a pen, file, magnet, sticky note with the FAST message, and stroke pamphlets were also distributed to students in the intervention group. Parents of the intervention group were educated indirectly through the stroke pamphlets and items. For all subjects, questionnaires on stroke knowledge were examined at the baseline, immediate post-lesson time and 3-month after the stroke lesson. Results: Percentages of correct answers were not significantly different between the 2 students groups at the baseline. Three-months after the stroke lesson, students in the intervention group answered more correctly than the control group in the questions of facial palsy (97% in the intervention group vs. 54% in the control group; P<0.001), speech disturbance (98% vs. 67%; P<0.001), hemiplegia (80% vs. 63%; P<0.001), calling 119 for stroke (88% vs. 57%; P<0.001), alcohol drinking (85% vs. 65%; P<0.001), smoking (70% vs. 51%; P<0.001), hypertension (81% vs. 68%; P=0.004) and the FAST message (96% vs. 10%; P<0.001). Parents of the intervention group also answered more correctly in the question of facial palsy (93% vs. 80%; P=0.001), speech disturbance (95% vs. 86%; P=0.008), hemiplegia (87% vs. 78%; P=0.032), calling 119 for stroke (95% vs. 85%; P=0.004), arrhythmia (31% vs. 19%; P=0.016), and the FAST message (78% vs. 26%; P<0.001) than those of the control group 3 month after the stroke lesson. Conclusions: The stroke education program for junior high school students and their parents improved their stroke knowledge, especially of the FAST message.

中学生に対する脳卒中啓発活動：Ａｃｔ ＦＡＳＴ

Early recognition of stroke signs and symptoms is essential for early treatment and improvement of clinical outcomes. We performed a stroke education program for junior high school students and their parents. In February 2010, 79 students in 2 classes of the 1st grade of a junior high school and their parents were enrolled. Subjects were divided into 2 groups: an intervention class (39 students) and a control class (40 students). Students in the intervention class received a 45-minute lesson about stroke signs and symptoms. This group was taught the FAST message (Facial droop, Arm weakness, Speech disturbance, Time to call 119), and stroke risk factors. School items consisting of a pen, file, magnet, sticky note with the FAST message, and stroke pamphlets were also distributed to students in the intervention class. Parents of the intervention class were educated indirectly through the stroke pamphlets and items. For all subjects, questionnaires on stroke knowledge were examined at the baseline and immediate post-lesson time-points and 3 months after the stroke lesson. In students, the percentages of correct answers did not differ significantly between the 2 classes at the baseline. Three months after the stroke lesson, students in the intervention class answered more correctly than in the control class to the questions of facial palsy (97% in the intervention class vs. 55% in the control class; P<0.0001), speech disturbance (100% vs. 83%; P=0.006), calling 119 for stroke (90% vs. 55%; P=0.001), smoking (87% vs. 63%; P=0.012), hypertension (92% vs. 73%; P=0.021) and the FAST message (97% vs. 13%; P<0.0001). Parents of the intervention group also answered more correctly the question of the FAST message (82% vs. 19%; P<0.0001) than did the control group 3 months after the stroke lesson. We demonstrated that the stroke education program for junior high school students and their parents improved their stroke knowledge, especially of the FAST message.

Primary Stroke Center Education for Nurses

Primary Stroke Center designation by the Joint Commission distinguishes those healthcare organizations with exemplary stroke prevention and management. However, meeting the Joint Commission's high-level excellence standards is challenging. This article provides nurse leaders with a stroke education template, based on Donabedian's quality model, which meets Primary Stroke Center nurse education requirements. The authors describe the structure, process, and outcomes of a stroke education program for nurses, recognized as Best-in-Practice in Connecticut, successfully implemented in a community hospital.

Predictors of intention to reduce stroke risk among people at risk of stroke: An application of an extended health belief model.

Purpose: To examine predictors of intention to reduce stroke risk in a sample of at risk individuals through the application of an expanded Health Belief Model (HBM). Research Method: Predictors included stroke knowledge, demographic variables, beliefs about stroke derived from the HBM, and measures of subjective norm and self-efficacy. The dependent variable was intention to reduce stroke risk. Two hundred and seventy six surveys were distributed to participants at three site types: bowling clubs, senior citizens clubs and retirement villages. One hundred and one surveys were returned yielding a response rate of 37%, and data from 76 of these respondents was used for further analysis. Results: With regard to exercise intention, a pattern of significant correlations between HBM variables, subjective norm and self-efficacy was observed. Results of multiple hierarchical regression analyses showed that perceived benefits of undertaking exercise, and self-efficacy in relation exercise were the two most important determinants of exercise intentions. Conclusions: Findings suggest that health beliefs may play an important role in stroke prevention. Practice Implications: Stroke education and prevention programs that selectively target beliefs about the perceived benefits of, and self-efficacy related to, exercise to reduce stroke risk may prove most efficacious.

Do clinical rehabilitation education programs really improve stroke-related knowledge?

We evaluated the effectiveness of a clinical stroke education program for improving stroke-related health knowledge after inpatient rehabilitation in a "real world" setting. Thirty-four patients participated in an inpatient rehabilitation clinical stroke education program. Their stroke-related health knowledge in three key domains-risk factors, warning signs, and appropriate actions to take if a stroke is suspected-was evaluated at admission and 12 wks later using a single-group, pretest-posttest design. Pretest and posttest comparisons were conducted using the Marginal Homogeneity test and the McNemar test. Small, nonsignificant improvements in stroke-related health knowledge were detected at posttest. Twelve weeks after the education program, 29% of participants were unable to name a single risk factor, 32% were unable to name a single warning sign, and 29% were unable to name appropriate emergency action in the event they suspected a stroke. A substantial proportion of patients who completed our clinical stroke education program continued to have poor stroke-related health knowledge. We noted several limitations in our program that may have contributed to this outcome. Changes may be useful for improving the success of clinical stroke education programs, thereby reducing knowledge deficits.

Kids Identifying and Defeating Stroke (KIDS): Development and Implementation of a Multiethnic Health Education Intervention to Increase Stroke Awareness Among Middle School Students and Their Parents

The Kids Identifying and Defeating Stroke (KIDS) project is a 3-year prospective, randomized, controlled, multiethnic school-based intervention study. Project goals include increasing knowledge of stroke signs and treatment and intention to immediately call 911 among Mexican American (MA) and non-Hispanic White (NHW) middle school students and their parents. This article describes the design, implementation, and interim evaluation of this theory-based intervention. Intervention students received a culturally appropriate stroke education program divided into four 50-minute classes each year during the sixth, seventh, and eighth grades. Each class session also included a homework assignment that involved the students' parents or other adult partners. Interim-test results indicate that this educational intervention was successful in improving students' stroke symptom and treatment knowledge and intent to call 911 upon witnessing a stroke compared with controls. The authors conclude that this school-based educational intervention to reduce delay time to hospital arrival for stroke shows early promise.

Stroke-Related Knowledge and Health Behaviors Among Poststroke Patients in Inpatient Rehabilitation

Koenig KL, Whyte EM, Munin MC, O’Donnell L, Skidmore ER, Penrod LE, Lenze EJ. Stroke-related knowledge and health behaviors among poststroke patients in inpatient rehabilitation. Objective To measure stroke knowledge and prestroke personal health behaviors of stroke patients undergoing inpatient rehabilitation and their caregivers. Design Prospective cohort. Setting Academic rehabilitation hospital. Participants A total of 130 stroke patients and 85 caregivers interviewed after ischemic stroke. Interventions Not applicable. Main Outcome Measure The Stroke Education Assessment measured stroke knowledge and prestroke personal health behaviors. Results Large deficiencies in patient and caregiver stroke knowledge were found. Fifty-two percent of patients could not name any stroke risk factors, 52% were unable to name a stroke warning sign, and 35% were unable to identify appropriate actions to take in a stroke emergency. Older patients were less knowledgeable than younger patients. Caregivers were more knowledgeable than patients. Regarding prestroke personal health behaviors, 28% of patients reported medication nonadherence, 26% did not see their primary care physician in the preceding year, and less than 40% of patients with diabetes or hypertension reported diets consistent with these diagnoses. Conclusions Stroke patients participating in inpatient rehabilitation and their caregivers have large gaps in stroke knowledge and have suboptimal personal health behaviors, thereby putting patients at high risk for recurrent stroke. Our finding highlights the need to develop stroke-education programs for rehabilitating patients that are effective in closing these gaps in knowledge and personal health behaviors.

Stroke Prevention Education in the Hispanic Community

The Hispanic population is the fastest growing minority population in the United States. Little research has been done to assess the stroke risk in the Hispanic population, which has a higher prevalence of hypertension, diabetes, alcohol use, and physical inactivity. Healthcare professionals therefore are faced with the management and education of a cultural group with unfamiliar health beliefs. To decrease the risk of stroke, a culturally sensitive program that combines education and risk identification is needed. This article identifies the development of a stroke education and screening program for Hispanics.

The impact of a multidisciplinary stroke education programme on Chinese family carers

(2005). The impact of a multidisciplinary stroke education programme on Chinese family carers. Journal of Interprofessional Care: Vol. 19, No. 4, pp. 406-407.

Development and Validation of the Stroke Knowledge Test

Purpose: The purpose of this study was to develop a measure of stroke knowledge (the Stroke Knowledge Test [SKT]) using a systematic test construction process and to investigate the psychometric properties of this test. There are relatively few published measures of stroke knowledge, and, of those that exist, relatively little is documented about test construction or psychometric properties. Such tests are important for evaluation of stroke education programs. Method: Test construction involved systematic generation of pilot test items, expert review of pilot items, and calculation of pilot item properties. After final item selection, two experiments were conducted to determine if the SKT was sensitive to varying levels of stroke knowledge and to estimate the reliability of the test. Results: The final version of the test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Results from psychometric investigations suggest that SKT has relatively good reliability (internal consistency and test-retest reliability) and construct validity (i.e., SKT scores significantly increased after stroke education [cf. nonstroke education], and community-dwelling older adults who had a relative with stroke [and more prior exposure to stroke information] scored higher on the SKT than those without a stroke relative). Conclusion: Findings provide preliminary support for the SKT as a valid and reliable tool for assessing stroke knowledge. The SKT may be used to identify individual information needs of stroke survivors and their caregivers or as a tool to evaluate group- or community-based stroke education programs.

Rural case management for stroke: the development of a community-based screening and education program.

This article describes the evolution of a Community-Based Stroke Risk Screening and Education Program at a 400-bed regional medical center located in southeastern Alabama. The author outlines the implementation of a case management-oriented program developed to target the specific high-risk populations residing in this rural area. Retrospective chart reviews were used to identify a large discrepancy between patient-recognized onset of stroke symptoms and the actual time it took for the patient to present to the Emergency Department (ED). A performance improvement goal was initiated to increase community awareness of stroke warning signs, stroke risk, and prevention. Summaries of the research process, design, and outcome data overwhelmingly indicated a positive correlation between stroke education and ED presentation time.

Meeting the Needs of the Community: A Project to Prevent Stroke in Hispanics

The Hispanic population is the fastest growing minority population in the United States. Little research has been done to address the stroke risk in the Hispanic population that has a higher prevalence of diabetes, alcohol use, and physical inactivity. To change behavior and decrease the risk of stroke, a comprehensive program that combines education, risk identification, and follow-up is needed. The purpose of this article is to identify the increased risk factors of stroke in the Hispanic population, identify the barriers to health care, and outline the development of a stroke education and screening program for Hispanics.