Understanding Reasons for Delay in Seeking Acute Stroke Care in an Underserved Urban Population

Abstract

Background and Purpose Few patients arrive early enough at hospitals to be eligible for emergent stroke treatment. There may be barriers specific to underserved, urban populations that need to be identified before effective educational interventions to reduce delay times can be developed. Methods A survey of respondents’ likely action in a hypothetical stroke situation was given to 253 community volunteers in the catchment areas of a large urban community hospital. Concurrently, 100 structured interviews were conducted in the same hospital with acute stroke patients or proxy. Results In this predominantly urban, black population, if faced with a hypothetical stroke, 89% of community volunteers surveyed said they would call 911 first, and few felt any of the suggested potential barriers applied to them. However, only 12% of stroke patients interviewed actually called 911 first (OR 63.9; 95% CI 29.5 to 138.2). Instead, 75% called a relative/friend. Eighty-nine percent of stroke patients reported significant delay in seeking medical attention, and almost half said the reason for delay was thinking the symptoms were not serious and/or they would self-resolve. For those arriving by ambulance, only 25% did so because they thought it would be faster, while 35% cited having no other transportation options. Conclusions In this predominantly black urban population, while 89% of community volunteers report the intent of calling 911 during a stroke only 12% of actual stroke patients did so. Further research is needed to determine and conquer the barriers between behavioral intent and actual behavior to call 911 for witnessed stroke.

Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort

“…SWIFT data support evidence for brain attack coalition, Get with the Guidelines, and state-level certification programs that emphasize the critical role of continued education of by guest on May 12, 2018 http://stroke.ahajournals.org/ Downloaded from community. 5,15,16,[18][19][20] None, however, specify what the educational efforts must be or when those efforts may be used most effectively. SWIFT demonstrates that although the II group has significantly greater SK one-month post intervention, the EE group caught up at 1 year.…”

Life begins at 60: Identifying the social support needs of African American women aging with HIV

“…While individuals with chronic health conditions often find informal sources of support to be more helpful than formal sources 38, 39 the exact opposite situation was described by our participants. Our findings also reveal that because of the simultaneity of HIV stigma and societal ageism, 40 older HIV-positive women may find it more difficult to seek support from informal sources to aid them with their HIV management in comparison with other chronic illnesses.…”

Utilization of emergency medical service increases chance of thrombolytic therapy in patients with acute ischemic stroke

“…These percentages are lower as compared with other studies in Canada, Ireland, Italy and Japan 7,20,32,33 . More effective education programs on stroke awareness and on EMS utilization for high risk patients and their close families or friends should be developed, because most patients suffering from stroke at home and the first response in the majority of stroke patients was calling their families or friends for help instead of calling EMS 34 .…”