Stroke Education Research Articles

Abstract WP92: Developing A Culturally Competent Stroke Education Curriculum For Marginalized Asian Americans To Improve Health Disparities In West Michigan

Introduction: The presence of health disparities and poor health outcomes in minority groups in the United States is well described. Compared to the white patients, Asian American minorities and subgroups have more severe ischemic strokes, are less likely to receive thrombolytics with more hemorrhagic complications after administration, and experience worse functional outcomes. With this in mind, our team developed an educational community outreach program to address stroke knowledge gaps and promote health equity in local Asian American marginalized subgroups. Methods: A culturally competent stroke curriculum was developed and modified (e.g., translated) to fit each population. A series of community-level interventions have been performed to date (two sessions; 35 participants). Pre- and post-test data were collected related to stroke knowledge to assess the effectiveness of the intervention. Feedback from each session was used to make improvements for the next. Results: Feedback from each session was positive. Post-test data showed significant (p<0.001) improvements in ability to identify symptoms of stroke including weakness (20% vs 54.3%), speech changes (2.9% vs 65.7%), vision changes (2.9% vs 60%), and facial droop (8.6% vs. 65.7%), as well as risk factors for stroke including hypertension (14.3% vs 80%), sedentary lifestyle (2.9% vs 65.7%), hyperlipidemia (2.9% vs 77.1%), and diabetes (2.9% vs 54.3%). Participants showed improvements in recognizing the need for urgent medical attention when a stroke is suspected (11.4% vs 88.6%). Conclusions: Immediate improvements in stroke knowledge and awareness were seen following our community-level educational interventions. Sessions were positively received. Future education sessions and assessment of long-term retention are planned.

Using qualitative data to inform the adaptation of a stroke preparedness health intervention.

Qualitative research methods are often used to develop health interventions, but few researchers report how their qualitative data informed intervention development. Improved completeness of reporting may facilitate the development of effective behavior change interventions. Our objective was to describe how we used qualitative data to develop our stroke education intervention consisting of a pamphlet and video. First, we created a questionnaire grounded in the theory of planned behavior to determine reasons people delay in activating emergency medical services and presenting to the hospital after stroke symptom onset. From our questionnaire data, we identified theoretical constructs that affect behavior which informed the active components of our intervention. We then conducted cognitive interviews to determine emergency department patients' understanding of the intervention pamphlet and video. Our cognitive interview data provided insight into how our intervention might produce behavior change. Our hope is that other researchers will similarly reflect upon and report on how they used their qualitative data to develop health interventions.

Efficacy, feasibility, and acceptability of in-home stroke education for stroke survivors.

Barriers to learning after a stroke may prevent stroke survivors from acquiring helpful information regarding stroke prevention and preparedness. The objective of this study was to evaluate the efficacy, feasibility, and acceptability of a novel in-home stroke education program for survivors in the acute phase following a stroke. Study participants completed four in-home education sessions about stroke prevention and preparedness following their discharge home from inpatient rehabilitation. Sessions were designed to be completed within an 8-week period. Sessions were presented with evidence-based teaching methods and could be tailored to individual needs. Participants completed short quizzes before and after each education session to measure knowledge attainment. Forty-nine participants were included in this study. On average, the program was completed in 10 weeks, or 69.5 days (SD 29.6), and visits lasted 66.26 minutes; 81.5% of participants completed Visit 1, 77.5% completed Visit 2, and 73.5% completed Visits 3 and 4. Statistically significant changes from pretest-to-posttest scores were found for all races and genders and for ages 50-79. There was no significant change in pretest-to-posttest scores for participants over age 80 (n = 3). Results show that delivering a stroke education program can be accomplished, on an expanded timeline. The program was effective in increasing stroke knowledge for participants recently discharged from inpatient rehabilitation following a stroke.

Knowledge, attitude, and practice of stroke among Saudi population in Balqarn Governorate, Kingdom of Saudi Arabia, 2023

Background: Stroke is a global top cause of death and disability, with a rising impact in countries like Saudi Arabia. Awareness of stroke signs, treatment urgency, and disparities tied to factors such as age and education contribute to its severity. This study aimed at assessing stroke knowledge, attitude, and practice among adults in the Balqarn community in Saudi Arabia. Methods: A cross-sectional survey was conducted among 745 adults in a community in Balqarn Governorate, Saudi Arabia, during the year 2023. Data were collected using a structured questionnaire that assessed knowledge, attitude, and practice related to stroke, as well as sociodemographic factors. Results: The studied participants had a mean age of 42.1 ± 12.8 years old, with most being males (74.4%) and married (77%). The majority had a university level of education or above (63.4%). The most known causes and risk factors of stroke were identified as unhealthy lifestyle, stress, obesity, hypercholesterolemia, hypertension, and Diabetes Miletus (DM). Social media and open channel internet were the most reported sources of information. Positive preventive behaviors were reported among participants, and the majority reported they would go directly to the hospital if they experienced stroke symptoms. Female gender and university level of education were significantly associated with a good overall knowledge level regarding stroke. Conclusion: The present study conducted at Balqarn Governorate, Saudi Arabia, underscores the necessity for improved stroke awareness and education. Social media and the internet stand out as key information sources, suggesting the potential for focused educational efforts. Encouragingly, participants showed readiness for healthy lifestyles. Women and university-educated individuals exhibited better stroke knowledge, highlighting targeted education's importance. These insights can shape effective stroke prevention and management strategies.

Pilot RCT Examining Satisfaction and Disability Outcomes of a Technology-Supported Self-Management Intervention in Post-Stroke Individuals

<h3>Research Objectives</h3> To evaluate the participant satisfaction and the preliminary efficacy of a technology-supported self-management intervention to improve post-stroke disability outcomes. <h3>Design</h3> 12-week, two-arm randomized controlled trial. <h3>Setting</h3> Community. <h3>Participants</h3> Twenty-four participants (intervention = 11; control = 13) with mild to moderate stroke (mean age = 59.4 years [SD = 11.7], male = 58%, black = 38%). <h3>Interventions</h3> Intervention group received the interactive Self-Management Augmented Rehabilitation Technologies (iSMART). It is an adjunctive behavioral intervention technology composed of skills training, coaching, and text messaging for improved self-management of chronic conditions and participation strategies. Control group received stroke education materials and phone calls over the 12-week. <h3>Main Outcome Measures</h3> Satisfaction was measured by the Client Satisfaction Questionnaire (CSQ), and the Healing Encounters & Attitudes Lists – Health Care Environment (HEAL-HCE), Patient-Provider Connection (HEAL-PPC) and Treatment Expectancy (HEAL-TEX). Disability outcomes were measured by the Patient Health Questionnaire-9 (PHQ-9), Stroke Impact Scale (SIS), Activity Card Sort (ACS), and Reintegration to Normal Living Index (RNL). <h3>Results</h3> Two iSMART participants withdrew from the study. The iSMART group reported greater satisfaction than the control group (CSQ: d = 0.387; HEAL-HCE: d = 0.454; HEAL-PPC: d = 0.374; HEAL – TEX: d = 0.328). The iSMART group exhibited moderate but the control group exhibited small effects on SIS's mobility (iSMART: d = 0.521, control: d = 0.069), hand function (d = 0.699, d = 0.222), and recovery (d = 0.545, d = 0.171), and RNL (d = 0.652, d = 0.272) scores. Both groups exhibited small effects on other scores. <h3>Conclusions</h3> The iSMART participants reported higher participant satisfaction and greater treatment effects than the control participants, suggesting that the iSMART may hold promise for post-stroke self-management. <h3>Author(s) Disclosures</h3> None disclosed.

361 EXPLORING THE EXPERIENCES OF HEALTHCARE PROFESSIONALS (HCPS) WORKING IN ACUTE STROKE DURING THE COVID-19 PANDEMIC: A QUALITATIVE STUDY

Abstract Background The COVID-19 pandemic had a significant impact on the delivery of stroke care internationally. The INAS (Irish National Audit for Stroke) report 2020, found that there was no significant disruption to stroke services as a result of the COVID-19 pandemic. Little is known about the experiences of Health-Care Professionals (HCPs) who were working in stroke care during the COVID-19 pandemic. This study explored the experiences of HCPs working in acute stroke care in an Irish hospital group during the COVID-19 pandemic. Methods A qualitative descriptive study was conducted. Using a combination of purposive and snowball sampling, 16 semi-structured interviews of healthcare professionals from six specialities (Medicine, Nursing, Physiotherapy, Occupational therapy, Speech and Language Therapy and Medical Social Work) in two model three hospitals and one model four hospital were conducted. Interviews were virtual. Analysis was completed using the Braun and Clarke six-step method. This research was approved by the Royal College of Surgeons Research Ethics committee and permission was secured from the Stroke Clinical lead at each site to conduct interviews. Results Two main themes emerged: (i) Disruption of the end-to-end acute stroke pathway and (ii) Opportunities of the pandemic to develop a new model of care. Theme (i) suggests challenges were experienced in emergency care, access to Stroke Units (SU) beds and multidisciplinary teams (MDT). In theme (ii) participants described opportunities in telemedicine, the development of new rehabilitation and existing Early Supported Discharge (ESD) pathways. Conclusion This study highlights the lived experience of HCPs, the disruption to the stroke pathway and the opportunities as a result of the pandemic. It demonstrates the need for further exploration of, telemedicine, alternative rehabilitation pathways in stroke care and the need for a wider stroke education programme for HCPs working outside stroke. Finally, this study highlights the unwavering resilience and empathy of HCPs working in Stroke.

White matter microstructure and verbal fluency

Poor performance on verbal fluency tasks is associated with an increased risk of post-stroke cognitive impairment. Grey matter regions supporting verbal fluency have been identified via lesion–symptom mapping, but the links between verbal fluency and white matter structure remain less well described. We examined white matter correlates of semantic (Category Fluency Animals) and phonemic or lexical fluency (COWAT FAS) after stroke, accounting for stroke severity measured with the National Institutes of health Stroke Scale (NIHSS), age, sex, and level of education. White matter fibre density and cross-section measures were automatically extracted from 72 tracts, using MRtrix and TractSeg software in 72 ischaemic stroke survivors assessed 3 months after their event. We conducted regression analyses separately for phonemic and semantic fluency for each tract. Worse semantic fluency was associated with lower fibre density in several tracts, including the arcuate fasciculus, superior longitudinal fasciculus, inferior occipito-frontal fasciculus, inferior longitudinal fasciculus, optic radiation, striato-occipital, thalamo-occipital tracts, and inferior cerebellar peduncle. Our stroke sample was heterogenous with largely non-overlapping and predominantly right-lateralised lesions (lesion distribution: left N = 27, right N = 43, bilateral N = 2), dissimilar to previous studies of verbal fluency. Yet, the tracts we identified as correlates of semantic fluency were all left-lateralised. No associations between phonemic fluency performance and fibre density metrics in any of the white matter tracts we extracted survived correction for multiple comparisons, possibly due to the limitations in the selection of tracts and sample characteristics. We conclude that when accounting for the effects of stroke severity, sex, age, and education, semantic fluency is associated with white matter microstructure in the left arcuate fasciculus, superior longitudinal fasciculus, and several occipital tracts, possibly reflecting the disconnection in the sagittal stratum. Our results obtained with fixel-based analysis, complement previous findings obtained with lesions–symptom mapping and neurodegenerative approaches.

Stroke symptoms, risk factors awareness and personal decision making in Chile. A national survey

BackgroundKnowledge about stroke symptoms, correct decision in front of a stroke case and recognition of stroke risk factors are crucial to fight against stroke burden. We aimed to assess the stroke awareness among a sample of the Chilean population. MethodsA closed-ended questions structured survey was applied in November 2019 using a computer-assisted telephone interviewing system. Probabilistic sample, random selection and stratification for region was used. Multivariate logistic regression model was used to estimate the association between participants’ characteristics and responses. ResultsOf 706 participants, only 74.4% (95% CI 70.9-77.5) recognized at least one typical stroke symptom. Most (586, 82.4% 95% CI 75.2-89.7) chose to contact the emergency ambulance or directly go to the emergency department in case of a stroke symptom and recognized at least one risk factor (692, 97.9% CI 96.7-98.8). In multivariable analysis, sociodemographic characteristics associated to a worse recognition of at least one stroke symptom were being men (OR 0.67, 95% CI 0.47-0.96), being 55 years old or older (OR 0.59 95% CI 0.37-0.93) and from the lowest socioeconomic level (SES) (OR 0.33 95% CI 0.16-0.67). Female sex was associated with lower stroke risk factor knowledge (OR 0.64 95% IC 0.47-0.87). Participants who recognized at least one typical stroke symptom and would promptly seek care at an emergency department differed significantly between SES (p=0.001) and age groups (p=0.035). ConclusionsWe found insufficient knowledge about stroke symptoms and best decisions making in the Chilean population. We describe gaps that can be targeted in future stroke awareness campaigns. There is a need to strengthen tailored stroke education particularly for underserved populations.

Determinants of Exclusion from Treatment with Alteplase in Acute Ischemic Stroke at the Largest Tertiary Center in Lebanon

Objectives: Thrombolysis remains underutilized for Acute Ischemic Stroke (AIS) in healthcare systems in low- and middle-income countries. We aimed to investigate the factors associated with utilization of intravenous thrombolysis in an academic medical center in Lebanon. Materials and Methods: This is a retrospective, cross-sectional, singlecentered, chart review-based study of AIS patients presenting to the American University of Beirut Medical Center (AUBMC) between January 2015 and October 2019. Included patients were older than 18 years and presented to the Emergency Department (ED) within 48 hours from symptom onset. Patient, disease, and health system response characteristics were collected and those eligible for and those who received thrombolysis within 4.5 hours onset by guidelines criteria were identified by chart review. Descriptive statistics, bivariate and multivariate analyses were performed for association with thrombolysis administration. Results: Out of the 373 AIS patients, 17.4% were candidate for rTPA and of those, 38.5% did not receive treatment. Patients who were candidate for IV alteplase had a higher NIHSS (OR 1.22 [1.14-1.31], p&lt;0.0001), total or partial anterior circulation stroke (OR 3.58 [1.49-8.6, p=0.004) as compared to posterior or lacunar strokes and a shorter duration since symptom onset (OR 0.14 [0.07- 0.27, p&lt;0.0001). The multivariate analysis showed that thrombolysis among eligible patients associated with younger age (OR 1.05 [1.01-1.10], p=0.029), a higher NIHSS (OR 1.12 [1.01-1.25], p=0.041), and stroke code activation (OR 2.81 [1.16-6.81], P=0.022). Conclusion: A good proportion of eligible AIS patients did not receive thrombolysis. To increase thrombolysis use in low- and middle-income countries, more consistent stroke code activation and education on age and stroke severity in eligibility are needed.

Impact of Nurse-Led Stroke Education Program (NSEP) on ADL and SS-QOL among Patients with Stroke and Burden among Caregivers

Impact of Nurse-Led Stroke Education Program (NSEP) on ADL and SS-QOL among Patients with Stroke and Burden among Caregivers

The role of social resources and trajectories of functional health following stroke

Stroke is a major cause of disability in old age. Research has revealed that social resources available after the onset of stroke can mitigate functional prognosis. However, most studies have conceptualized resources as static rather than dynamic and have not measured changes in social resources from the pre-to post-stroke periods. To better understand the recovery process following stroke, we examined how social resources available before its onset and changes from pre-to post-stroke were associated with trajectories of functional health following stroke. Data were derived from an up to 19-year longitudinal study of a nationally representative sample of Japanese adults aged 60 years and older. We identified 389 people who experienced self- or proxy-reported first stroke during follow-up (age at stroke onset: M = 75.9, SD = 6.8; 49.1% women). The average number of observations was 4.6 (SD = 1.6, range 2–7). Functional health was measured with self- or proxy-reported basic and instrumental activities of daily living. Social resources were indexed as residential status, contact with own non-coresident children, social participation, and perceived support. Analyses were adjusted for age at stroke onset, sex, education, health condition, and cognitive function. A multiphase growth model indicated that individuals who participated more frequently in social groups prior to stroke exhibited less functional deterioration post-stroke than those who participated less frequently. Whereas contact frequency with non-coresident children typically declined following stroke, the analysis further revealed that individuals who maintained contact frequency from pre-to post-stroke showed less steep functional decline over time in the post-stroke period despite minor individual differences. We found that social resources before stroke onset and changes in the resources following stroke may play a protective role against adverse prognoses. Inclusive communities may help older adults remain independent even after serious health events.

Access to acute stroke care: A retrospective descriptive analysis of stroke patients' journey to a district hospital.

The burden of stroke in Africa has increased in the last two decades, with the population undergoing a rapid epidemiological transition, with a rise in the incidence of stroke risk factors together with the gradual aging of the population. Evidence-based guidelines for acute stroke care are often not feasible in resource challenged settings but even when resources are available, considerable delays to definitive care exists. This study aims to describe the factors that influence time from symptom onset to hospital arrival in patients that present to a district level hospital Emergency Centre with confirmed ischaemic strokes. A descriptive analysis was performed using a retrospective folder and database review. All adult patients with a confirmed ischaemic stroke, on Computed Tomography (CT) scan, presenting to Mitchells Plain Hospital Emergency Centre during the study period of 12 months (1st of January 2019 to 31st of December 2019), were eligible for inclusion. Data were collected from existing electronic patient databases and the time from onset of symptoms to hospital arrival was extracted from the clinical notes. A total of 730 (2%) patients presented with a diagnosis of stroke, of which 381 (52%) were included (CT confirmed ischaemic strokes). Only 48 (13%) presented within 4.5h of symptom onset and the median time from onset of symptoms to presentation to the hospital was 24h (IQR 12-72h). The majority of patients (31%) arrived via a primary public emergency medical service (EMS) call, while 29% presented directly to the hospital as self-referrals with private transport. Primary public EMS calls had the shortest call-to-hospital-arrival time (1 hour and 31 minutes), even though the median time from symptom onset to hospital arrival was still 16h. The median time from symptom onset to hospital arrival for patients with stroke symptoms is much longer than what evidence-based guidelines suggest. The chain of survival for emergency stroke care is only as strong as its weakest link and the data from this study suggest that improvement campaigns should target stroke education and access to care.

Role of Proxy Respondents in International Stroke Research: Experience of the INTERSTROKE Study

Introduction: Measuring patient-reported information in stroke research is challenging. To overcome this, use of proxy respondents is often a necessary strategy. In this study, we report on use and effect of proxy respondents on patient case-mix in a large international epidemiologic stroke study (INTERSTROKE). Methods: This was a cross-sectional study of 13,458 cases of acute first stroke in 32 countries. A standardized study questionnaire recording behavioural cardiovascular risk factors was administered to the patient, and if unable to communicate adequately, a valid proxy, or both. We used logistic regression to evaluate the association of age, sex, education, occupation, stroke severity, and region with need for proxy respondent, and report odds ratio (OR) with 95% confidence interval (CI). Results: Among 13,458 participants with acute stroke, questionnaires were completed by patients alone in 41.4% (n = 5,573), combination of patient and proxy together in 21.7% (n = 2,918), and proxy alone in 36.9% (n = 4,967). Use of proxy alone was greater in participants with severe stroke (4.7% with modified-Rankin score of 0 vs. 80.5% in those with score 5; OR 187.13; 95% CI: 119.61–308.22), older persons (43.8% of those aged 80 years and over vs. 33.2% of those aged less than 40 years; age per decade OR 1.09; 95% CI: 1.06–1.12), women (40.7% vs. 34.3% of men; OR 1.32 95% CI: 1.22–1.43), and those less educated (58.9% of those never educated vs. 25.7% of those who attended third level education; OR 7.84; 95% CI: 6.78–9.08). Conclusion: Use of proxy respondents enhances the generalizability of international research studies of stroke, by increasing representation of women, patients with severe stroke, older age, and lower education.

Stroke-related knowledge and attitudes among university students in Northeast Nigeria

Stroke education programs at schools and colleges help to promote public knowledge of stroke, but the impact in Nigeria is not well known. This study assessed stroke-related knowledge and attitudes among university students in Nigeria, where health studies are parts of college curricula. This was a cross-sectional study of students at three universities in Northeast Nigeria. Using questionnaire survey, we assessed biographical data and participant knowledge of the primary site, warning signs and risk factors of stroke. Responses were graded on a knowledge score, where ≥2.5 points indicated adequate knowledge. Data were analyzed with the SPSS version 21 program. We studied 824 participants, 67.1% males. Males were older than females (mean age ± SD: 27.42±5.58 years versus 26.27±5.31 years; P = 0.009; 95% CI: 0.29 – 1.99) and 14.5% participants had stroke lectures during general studies. Major sources of stroke knowledge were personal discussions (44.6%) and internet websites (24.5%). Only 15.7% participants correctly identified the brain as the primary site of stroke, while knowledge of one or more stroke warning signs and risk factors were noted in 42.2% and 49.6%, respectively. Mean knowledge score was 1.08 ± 0.99. Adequate knowledge of stroke was noted in 13.2% participants, and was higher in females (17.7% versus 10.7%; P = 0.01). Logistic regression analysis showed significant associations between adequate knowledge of stroke with female sex (OR 1.8; 95% CI: 1.2 – 2.8; P = 0.008) and a history of stroke in close relatives (OR 1.7; 95% CI: 1.1 – 2.6; P = 0.025) but not with age, academic discipline or stroke lectures. University students in Northeast Nigeria have low knowledge of stroke, which is worse in males. Although health issues are taught at universities, little is taught on stroke, suggesting a need to prioritize stroke knowledge in the university curriculum.

What do stroke survivors want in stroke education and information provision in Australia?

Despite evidence that stroke education is important and effective, low rates of stroke education are reported worldwide. Many stroke survivors and carers report that current stroke information does not meet their needs. The aim of the current study was to explore the perceptions of stroke survivors and carers towards stroke education in an Australian health context. A qualitative descriptive approach using focus groups was used to explore education received and preferred content, format and timing of education. Data were analysed inductively using qualitative content analysis to identify key categories, sub-categories and an overarching theme. Fifteen stroke survivors and four carers participated. Four categories emerged: the timing of stroke education, the content of stroke education, the format of stroke education, and reactions to stroke education. Each category contained a number of sub-categories. One overarching theme was woven through the transcripts: everyone is different and has different needs. Overall, participants generally expressed positive attitudes towards stroke education. Participants reported that education should occur at multiple timepoints and in a mixed format. All participants reported receiving stroke education in hospital, but not in the community. Stroke survivors preferred group education, while carers did not share this preference. Both stroke survivors and carers desired information about post-stroke physical changes and computer use; however, stroke survivors desired additional information spanning a variety of areas such as motivation and driving. Tailoring of stroke education for each individual is critical to ensure that education meets the needs of stroke survivors and carers from the hospital to the community.

Primary Prevention of Stroke in Children With Sickle Cell Anemia in Nigeria: Protocol for a Mixed Methods Implementation Study in a Community Hospital.

BackgroundIn Nigeria, approximately 150,000 children with sickle cell anemia (SCA) are born annually, accounting for more than half of all SCA births worldwide. Without intervention, about 11% of children with SCA will develop a stroke before their 20th birthday. Evidence-based practices for primary stroke prevention include screening for abnormal transcranial Doppler (TCD) measurements coupled with regular blood transfusion therapy for at least one year, followed by hydroxyurea (HU) therapy indefinitely. In high-resource countries, this strategy contributes to a 92% decrease in stroke incidence rates. In 2016, as part of a capacity building objective of the Stroke Prevention Trial in Nigeria (1R01NS094041: SPRING), TCD screening was adopted as standard care at Barau Dikko Teaching Hospital in Kaduna. However, with just 70 radiologists and only 3 certified in TCD screening in the state, just 5.49% (1101/20,040) of eligible children with SCA were screened. Thus, there is a need to explore alternate implementation strategies to ensure children with SCA receive standard care TCD screening to decrease stroke incidence.ObjectiveThis protocol describes a study to create a stroke prevention program in a community hospital in Kaduna through task shifting TCD screening to nurses and training medical officers to initiate and monitor HU utilization for stroke prevention.MethodsThis study will be conducted at 2 sites (teaching hospital and community hospital) over a period of 3 years (November 2020 to November 2023), in 3 phases using both quasi-experimental and effectiveness-implementation study designs. In the needs assessment phase, focus groups and structured interviews will be conducted with health care providers and hospital administrators to identify barriers and facilitators to evidence-based stroke prevention practices. Results from the needs assessment will inform intervention strategies and a process plan to fit the needs of the community hospital. In the capacity building phase, nurses and medical officers at the community hospital will be trained on TCD screening and HU initiation and monitoring. In the implementation phase, children with SCA aged 2-16 years will be recruited into a nonrandomized single-arm prospective trial to determine the feasibility of initiating a task-shifted stroke prevention program by recording recruitment, retention, and adherence rates. The Reach and Effectiveness components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework will be used to evaluate implementation outcomes between the community and teaching hospitals.ResultsThe needs assessment phase of the study was completed in February 2021. Manuscript on findings is currently in preparation. Capacity building is ongoing with TCD training and sickle cell disease and stroke education sessions for nurses and doctors in the community hospital. Recruitment for the implementation trial is expected to commence in July 2022.ConclusionsThis study proposes a structured, theory-driven approach to create a stroke prevention program in a community hospital in Kaduna, Nigeria, to decrease stroke incidence among children with SCA. Results will provide preliminary data for a definitive randomized clinical trial in implementation science.International Registered Report Identifier (IRRID)PRR1-10.2196/37927

The use of augmented reality for patient and significant other stroke education: a feasibility study.

Stroke education is a key factor in minimising secondary stroke risk, yet worldwide stroke education rates are low. Technology has the potential to increase stroke education accessibility. One technology that could be beneficial is augmented reality (AR). We developed and trialled a stroke education lesson using an AR application with stroke patients and significant others. A feasibility study design was used. Following development of the AR stroke education lesson, 19 people with stroke and three significant others trialled the lesson then completed a customised mixed method questionnaire. The lesson involved narrated audio while participants interacted with a model brain via a tablet. Information about participant recruitment and retention, usage, and perceptions were collected. Fifty-eight percent (n = 22) of eligible individuals consented to participate. Once recruited, 100% of participants (n = 22) were retained. Ninety percent of participants used the lesson once. Most participants used the application independently (81.82%, n = 18), had positive views about the lesson (over 80% across items including enjoyment, usefulness and perception of the application as a good learning tool) and reported improved confidence in stroke knowledge (72.73%, n = 16). Confidence in stroke knowledge post-lesson was associated with comfort using the application (p = 0.046, Fisher's exact test) and perception of the application as a good learning tool (p = 0.009, Fisher's exact test). Technology-enhanced instruction in the form of AR is feasible for educating patients and significant others about stroke. Further research following refinement of the lesson is required.

Developing a Pilot Program to Increase Stroke Education Among Internal Medicine Residents (P17-10.002)

Developing a Pilot Program to Increase Stroke Education Among Internal Medicine Residents (P17-10.002)

A community-based participatory approach to increase public knowledge of stroke among ethnic minorities in the northern mountains of Thailand

This study examines a stroke education program about knowledge of stroke among community partners that aims to increase the public knowledge of stroke in ethnic minorities. A one-group pre-test/post-test experimental design based on a community-based participatory approach was used in four steps following established community collaboration, planned intervention, community partner recruitment and training, implementation, and evaluation. The study was conducted between September 1, 2019 and February 28, 2020 in Chiang Rai province of Thailand. Purposive sampling was used to select 50 community partners, and cluster random sampling was used to select 419 participants from ethnic minorities. The 50 community partners already trained by researchers in the stroke education program proffered their knowledge of stroke to the ethnic minorities over a period of 1 month. A stroke knowledge questionnaire was used to test stroke knowledge among ethnic minorities before intervention (baseline) and 1 month later (post-intervention). At post-intervention, 60.6% of ethnic minorities could correctly recall more than 3 warning signs of stroke, while 51.3% correctly identified more than 3 risk factors for stroke. The score differed among 159 participants who could not speak Thai pre-intervention (mean=0.03, SD=0.39) and post-intervention (mean=7.52, SD=1.33). There were significant differences in pre-intervention and post-intervention overall stroke knowledge scores of 4 major ethnic groups (mean 0.57, SD=1.63 versus mean 7.62, SD=1.39; t=−67.38, p&lt;.001). The stroke educational program based on community-based participatory research can increase public stroke knowledge and help to overcome cultural and language barriers in ethnic minorities.

Stroke 120 or FAST (Face, Arm, Speech, Time): Which is Better in Stroke Awareness Promotion for Older Residents Living in Shanghai?

BackgroundTo make a parallel comparison regarding the effectiveness of Stroke 120 and FAST (Face, Arm, Speech, Time) in stroke knowledge promotion among community-living older residents in Shanghai. MethodsThis is a prospective community-based study. Between 1 February 2021 and 31 July 2021, we conducted a community-based stroke education program among older residents living in two communities in Minhang district, Shanghai. Residents aged over 60 years were educated with FAST and Stroke 120 separately. We defined the community educated with FAST as FAST-Community, the other one educated with Stroke 120 as Stroke 120-Community. Pre- and post-education survey were collected. The ability to recall the meanings of FAST and Stroke 120 in pre- and post-education survey was compared. The awareness of stroke risk factors and symptoms was also compared. ResultsThere were 466 responders in pre-education survey (231 from FAST-community, 235 from Stroke 120-community) and 456 responders in post-education survey (230 from FAST-community, 226 from Stroke 120-community). The mean age of responders in Stroke 120-community was 76 years (40% male) and in FAST-community was 71 years (52% male). Of the common stroke symptoms, we only found significant improvement in the awareness of Face drop (61.7% versus 34.6%, P<0.001) and Dizziness (45.7% versus 27.7%, P<0.001) in post-education survey for responders living in FAST-community. However, for responders living in Stroke 120-community, significant improvement was observed in all stroke symptoms (all P<0.05). As for the ability to recall the meanings of stroke awareness tools, the number of responders who can recall all the meanings of Stroke 120 increased from 0 in pre-education survey to 44 (21.5%) in post-education survey (P<0.001) for responders living in Stroke 120-community. However, among responders living in FAST-community, only 4 (5%) can recall all the meanings of FAST in post-education survey (5% versus 0%, P = 0.47). In the meantime, the proportion of responders who can recall part or all the meanings of them was also higher in Stroke 120-community in post-education survey. ConclusionAmong community-living older residents in Shanghai, Stroke 120 seems to be more suitable than FAST in stroke knowledge promotion.