A Community Based Participatory Trial to Increase Stroke Treatment
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Post stroke disability represents a significant public health problem as there are over 7 million stroke survivors in the US, most of whom have persistent disability. Despite the fact that acute stroke treatments dramatically reduce post-stroke disability and are cost saving, they are markedly underutilized. There is no region in the US where acute stroke treatments are more underutilized than in Flint, Michigan. Flint is an urban, underserved city of about 100,000 residents of whom about 60% are African American.
The Peoples Health partnership was formed in 2009, consisting of stroke neurologists, experts in health behavior and health education, nurses, and Bridges into the Future, a faith based organization dedicated to improving the health of the community. The goal of the partnership was to reduce the burden of cardiovascular disease in Flint. The Peoples Health partnership completed a community needs assessment, designed and tested a peer-led, health behavior theory-based stroke preparedness (recognizing stroke warning signs and the importance of calling 911) intervention in African American churches. This community intervention, Stroke Ready, successfully increased stroke preparedness. This application represents the larger scale adaption and testing of the Stroke Ready intervention to increase the Flint community?s acute stroke treatment rates.
Stroke Ready expands to a multi-level intervention aims to increase acute stroke treatment through both community stroke preparedness and Emergency Department readiness. The cornerstone of the pilot Stroke Ready intervention was a stroke music video which will now be adapted into a stand-alone intervention. For community stroke preparedness, the music video, mass multimedia circulation, interactive workshops, and print workbooks will all be delivered throughout the Flint community. We will also intervene in a Flint area safety net Emergency Department in great need of improved acute stroke care to optimize treatment pathways. The primary outcome of the project will be change in acute stroke treatments which will directly benefit the community by reducing post-stroke disability.
This project will benefit the Flint community and other urban communities with low acute stroke treatment rates. Sustainability will be achieved in Flint by training of peer leaders, wide dissemination of Stroke Ready materials, ease of re-administering the intervention, hospital improvements and continued commitment and engagement of the community advisory board. To assist other safety net-hospitals outside of Flint, we will create a protocol to assess barriers to optimal acute stroke care. More broadly, this project will address a central unanswered scientific question of the relative importance of interventions in the community and/or hospital to increase acute stroke treatments. Thus other communities with limited resources who are interested in increasing their acute stroke rates will have a better understanding of whether to invest in community stroke preparedness or hospital readiness.