Development of a culturally-tailored intervention to address care-seeking disparities in acute stroke treatment: A community-engaged approach

Blacks are twice as likely as Whites to die from stroke and less likely to receive urgent time-dependent thrombolytic stroke treatment due to care seeking delays.

To address this, we developed a 12-minute, musical, culturally-tailored theatrical film, “The Gospel of Stroke”, targeting actionable stroke knowledge of urban, Black Churchgoers. We used a community-engaged approach to all components of film development, including cast selection. We were guided by a transdisciplinary Community Advisory Committee that included 3 stroke survivors, 3 faith leaders, 3 health professionals (a stroke expert and 2 MPH RAs), a nurse, a communication expert, and the film director. Separate focus groups with additional stroke survivors and caregivers identified themes that informed the initial story board, which was subsequently revised following the results of a Narrative Performance Scale (NPS) administered to survivors, caregivers, and faith leaders. The NPS enables testing of the narrative effects of an action-oriented health message on predicting behavioral intent.

We then evaluated the effect of the final film on behavioral intent to call 911 for stroke symptoms on 60 adult Black Churchgoers using the validated Stroke Action Test (STAT) in a pre-posttest format. STAT data were analyzed using repeated measures ANOVA and showed significant increase in intent to call 911 at immediate post-test (p<0.001), which remained significant at 3-months. Participant data also revealed positive findings in response to key constructs of the NPS (interest, realism, identification with characters).

Community-engaged development of a narrative communication intervention may provide an effective means to increase 911 calling for stroke.