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309613
Results of Citywide Intervention Among African-Americans to Improve Stroke Preparedness and ED Arrival Time
Wednesday, November 19, 2014
Dorothy Farrar Edwards, Ph.D
,
Department of Kinesiology, Occupational Therapy Program, Neurology and Medicine, University of Wisconsin Madison, Madison, WI
Jeffrey J. Wing, MPH
,
Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor
M. Christopher Gibbons, MD, MPH
,
Urban Health Institute, Johns Hopkins University, Baltimore, MD
Amie Hsia, MD
,
Georgetown University, Hyattsville
Chelsea S. Kidwell, MD
,
The University of Arizona Medical School, Tucson, AZ
Health aging includes information and skills to tackle chronic disease. Lack of education about stroke preparedness action, particularly in underserved communities may prevent seeking timely care. The Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) is a citywide multi-level program using a community-engaged approach to stroke preparedness targeted to underserved black DC communities. The aim is to decrease acute stroke (AS) presentation times and increase use of IV-tPA) treatment. Phase 1 included: 1) AS preparedness; 2) Protocol enrichment; 3) Pre-intervention (PRE) AS patient data collection; 4) Focus group/survey identification of barriers to emergency stroke care to create a culturally tailored intervention. Phase 2 included implementing a culturally tailored community intervention while Phase 3 examined a post-intervention (POST) AS data collection. We compare PRE vs. POST AS parameters among ischemic stroke cases that arrived within 168 hours of stroke onset. Phase 1 identified 687 ischemic stroke cases, 85% black, 58% women; 56% > 65 yrs. Phase 2 conducted 531 community interventions for 10,256+ participants; performed 3,289 intervention evaluations; distributed over 35,000 preparedness bracelets and stroke warning magnets. In Phase 3, 684 ischemic stroke cases, 79% black, 58% women; 56% > 65 yrs; change in AS arrival time < 3 hours (14% to 27%; p<0.0001) and IV-tPA use (4% to 9%; p<0.001). ASPIRE demonstrates significant success increasing the proportion of AS arrivals to ED < 3 hours and increasing IV-tPA utilization. Culturally tailored community interventions can be effective in increasing stroke preparedness in underserved urban communities.
Learning Areas:
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research
Learning Objectives:
Evaluate and discuss a culturally tailored community intervention for stroke preparedness in underserved black DC communities.
Identify successful techniques for community engaged research/CBPR among urban American-American populations
Keyword(s): Community-Based Research (CBPR), Health Disparities/Inequities
Presenting author's disclosure statement:Qualified on the content I am responsible for because: Dr. Bernadette Boden-Albala who is an Associate Dean and Chief of the Division of Social Epidemiology at NYU’s Global Institute of Public Health. Dr. Boden-Albala is an expert in research related to health disparities with emphasis on the identification of novel modifiable stroke risk factors, and interventions promoting behavioral change for primary and secondary stroke prevention.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
