Stroke Ready Intervention: Community Engagement to Decrease Prehospital Delay

Abstract

BackgroundTime‐limited acute stroke treatments are underused, primarily due to prehospital delay. One approach to decreasing prehospital delay is to increase stroke preparedness, the ability to recognize stroke, and the intention to immediately call emergency medical services, through community engagement with high‐risk communities.Methods and ResultsOur community–academic partnership developed and tested “Stroke Ready,” a peer‐led, workshop‐based, health behavior intervention to increase stroke preparedness among African American youth and adults in Flint, Michigan. Outcomes were measured with a series of 9 stroke and nonstroke 1‐minute video vignettes; after each video, participants selected their intended response (primary outcome) and symptom recognition (secondary outcome), receiving 1 point for each appropriate stroke response and recognition. We assessed differences between baseline and posttest appropriate stroke response, which was defined as intent to call 911 for stroke vignettes and not calling 911 for nonstroke, nonemergent vignettes and recognition of stroke. Outcomes assessments were performed before workshop 1 (baseline), at the conclusion of workshop 2 (immediate post‐test), and 1 month later (delayed post‐test). A total of 101 participants completed the baseline assessment (73 adults and 28 youths), 64 completed the immediate post‐test, and 68 the delayed post‐test. All participants were African American. The median age of adults was 56 (interquartile range 35–65) and of youth was 14 (interquartile range 11–16), 65% of adults were women, and 50% of youths were women. Compared to baseline, appropriate stroke response was improved in the immediate post‐test (4.4 versus 5.2, P<0.01) and was sustained in the delayed post‐test (4.4 versus 5.2, P<0.01). Stroke recognition did not change in the immediate post‐test (5.9 versus 6.0, P=0.34), but increased in the delayed post‐test (5.9 versus 6.2, P=0.04).ConclusionsStroke Ready increased stroke preparedness, a necessary step toward increasing acute stroke treatment rates.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01499173.

Reach Out Churches: A Community-Based Participatory Research Pilot Trial to Assess the Feasibility of a Mobile Health Technology Intervention to Reduce Blood Pressure Among African Americans

“…The partnership was established in 2009 as part of a CDC grant award, which facilitated community-academic development and partnership. In addition to stroke prevention, the partnership also works to increase stroke preparedness (Lesli E Skolarus et al, 2016; Lesli E. Skolarus et al, 2011). The academic partners, led by Dr. Skolarus, and the community partners, led by Elder Bailey, have weekly communication surrounding the projects and meet with the larger partnership as needed.…”

Community-Based Participatory Research

“…Examples include research on stroke preparedness, the ability to recognize a stroke and call 911; primary stroke prevention; secondary stroke prevention; and stroke recovery. Past projects using CBPR have examined barriers and facilitators to accessing medical care pre-and post-stroke 6 ; interventions to increase knowledge of stroke symptoms and control of stroke risk factors [6][7][8] ; and strategies to increase participation of diverse populations in stroke research 9 . Hypotheses for these research questions would not differ from non-CBPR research.…”

Development and Validation of a Bilingual Stroke Preparedness Assessment Instrument

“…16 Participants were recruited from three predominately African American churches. The intervention consisted of two peer-led workshops separated by one week.…”