Stroke Recovery and Prevention Barriers Among Young African-American Men: Potential Avenues to Reduce Health Disparities

Abstract

Background African-Americans (AA) who experience a first time stroke are younger, and have double the stroke rate and more post-stroke complications than other Americans. Objective To assess perceived post-stroke care barriers among younger AA men and their care partners (CPs) in order to inform development of acceptable and effective improvements in post-stroke care for this high-risk group. Methods Ten community-dwelling AA stroke survivors and 7 of their care partners (CPs) participated in focus groups and advisory board meetings. Survivors had stroke or transient ischemic attack within one year and a Barthel ADL Index >60. In focus groups, using a semi-structured interview guide, survivors and CPs identified self-perceived barriers and facilitators to post-stroke care. Thematic analysis of session transcripts and the constant comparative method were used to generate themes. Results Survivor age ranged from 34 to 64. Mean Barthel was 95.5. CPs, all AA women, ranged in age from 49–61. CPs were 5 wives, a fianceé and a niece. Participants cited multiple personal, social, and societal stroke recovery challenges. While hypertension and smoking risks were acknowledged, stress, depression, PTSD, anger/frustration, personal identity change, and difficulty communicating unique needs as AA men were much more frequently noted. Facilitators included family support, stress reduction and dietary changes. Conclusions Younger AA men and their CPs perceive multiple post-stroke care barriers. Biological risk reduction education may not capture all salient aspects of health management for AA stroke survivors. Leveraging family and community strengths, addressing psychological health, and directly engaging patients with healthcare teams may improve care management.

Informing Policy for Reducing Stroke Health Disparities from the Experience of African-American Male Stroke Survivors

“…Data on barriers that can point to potential policy strategies for reducing population risk factors and the concomitant burden of stroke were collected as part of the NINR-funded study, “Targeted Management Intervention for African-American Men with TIA or Stroke (TEAM Study; 1R21NR013001) [10]. In the TEAM study, we conducted a series of three advisory panel meetings, using focus group methods, with 10 African American male stroke survivors and their care partners (N=7) [10].…”

“…In the TEAM study, we conducted a series of three advisory panel meetings, using focus group methods, with 10 African American male stroke survivors and their care partners (N=7) [10]. The purpose of the focus groups was to learn from stroke survivors and their care partners about the most salient barriers and facilitators to stroke prevention and recovery for younger African American men.…”

“…There is an imminent need to address this persistent and increasing health disparity, yet little is known about the mechanisms by which these disparities persist and few efforts have been made to make policy linkages to the lived experience of stroke for African American men under the age of 65 [10, 11]. …”

“…African American men face social and psychological challenges that stand in the way of adherence to a regimen of risk factor reduction [10, 11]. These challenges exist in the context of broader social determinants of health.…”

Addressing Racial Disparities in Stroke: The Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels (WISSDOM )

“…Therefore, interventions designed to improve strokerelated outcomes in AAs must also consider family and community factors during the development and implementation of novel interventions. 15 The specific aims of this project will be achieved in three phases: …”