Health promotion interventions for increasing stroke awareness in ethnic minorities: a systematic review of the literature

Abstract

BackgroundStroke places a significant burden to all affected individuals, but it is perhaps more significant amongst members of black, minority and ethnic communities, who may experience poorer awareness of stroke symptoms than the general population. Recently, several initiatives tried to improve public awareness that symptoms of stroke need to be treated as a medical emergency. However, ethnic communities present cultural barriers, requiring tailored health promotion interventions, whose effectiveness remains uncertain. Our systematic review aimed to identify relevant published evidence, synthesize the main study components and identify evidence of the effectiveness of the interventions.MethodsMEDLINE, EMBASE, CINAHL, and PsycInfo were searched for journal articles on health promotion interventions for increasing stroke awareness in ethnic minorities, published in English between 1995 and 2012. Search results were collaboratively assessed by the authors; included studies were analysed to identify their main characteristics, and a thematic analysis of their content was conducted. No meta-analysis was performed, due to the heterogeneity of results.ResultsEighteen studies were included, reporting 15 interventions conducted in the US, for African-Americans or Hispanics; populations sizes differed between interventions. Interventions were mostly carried out in community settings with different educational techniques, focussing on experiential methods. Health professionals usually organized the programs, delivered by nurses, other health professionals or volunteers.The few theory-based interventions focussed on individual-level behavioural change. Practical cultural adaptation strategies were not linked to specific theoretical frameworks. Interventions widely differed as for target populations, settings, delivery methods, contents and professional roles involved. All study designs were quantitative, and the emerging evidence of effectiveness was inconclusive.Such interventions operate in very complex scenarios, and several variables may influence their effectiveness. Therefore, qualitative or mixed-methods study designs may shed light on barriers and facilitators, experiential education strategies and community involvement.Network- and community-level theories may help improving design and evaluation of interventions.ConclusionsEleven case reports and four RCTs provide evidence about stroke awareness interventions organized in the US. The studies provide only partial and inconclusive evidence about the effectiveness of the interventions. Hence, further research is needed on different countries and ethnic minorities.

Stroke Disparities

“…Indeed a recent systematic review of stroke preparedness for minority populations found 15 studies, all done in the U.S. 10 . This may, in part, be due to the expense associated with both intravenous thrombolysis and acute stroke intervention.…”

“…There have been some large studies aimed at improving stroke preparedness in minority populations. While a systematic review found that the effectiveness of interventions designed to promote stroke awareness in race/ethnic minority groups was considered inconclusive due to mixed results and design limitations, there have been some successes including four randomized clinical trials 10 . In one study, predominantly Mexican American middle school children received an intensive educational intervention aimed at stroke recognition and motivation to call 911.…”

Impact of the Swedish National Stroke Campaign on stroke awareness

“…The survey was confined to those answering the telephone being able to speak Swedish, excluding a number of potential respondents. Results therefore cannot be generalized to non‐Swedish speaking groups, which is important because these have consistently been reported to have poor stroke knowledge …”

Stroke Ready Intervention: Community Engagement to Decrease Prehospital Delay

“…Forty-nine percent of adult respondents had hypertension and 4% have had a stroke. The median age of the youth participants was 14 (interquartile range [11][12][13][14][15][16] and 50% were women. Of the 9 participants in the 16-to 20-yearold age group, 8 were men.…”