Methodology for a community-based stroke preparedness intervention: the Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities Study

Bernadette Boden-Albala; Dorothy F Edwards; Shauna St Clair; Jeffrey J Wing; Stephen Fernandez; M Chris Gibbons; Amie W Hsia; Lewis B Morgenstern; Chelsea S Kidwell

doi:10.1161/STROKEAHA.113.003502

Methodology for a community-based stroke preparedness intervention: the Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities Study

Stroke. 2014 Jul;45(7):2047-52. doi: 10.1161/STROKEAHA.113.003502. Epub 2014 May 15.

Authors

Bernadette Boden-Albala¹, Dorothy F Edwards¹, Shauna St Clair¹, Jeffrey J Wing¹, Stephen Fernandez¹, M Chris Gibbons¹, Amie W Hsia¹, Lewis B Morgenstern¹, Chelsea S Kidwell¹

Affiliation

¹ From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).

Abstract

Background and purpose: Acute stroke education has focused on stroke symptom recognition. Lack of education about stroke preparedness and appropriate actions may prevent people from seeking immediate care. Few interventions have rigorously evaluated preparedness strategies in multiethnic community settings.

Methods: The Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) project is a multilevel program using a community-engaged approach to stroke preparedness targeted to underserved black communities in the District of Columbia. This intervention aimed to decrease acute stroke presentation times and increase intravenous tissue-type plasminogen activator utilization for acute ischemic stroke.

Results: Phase 1 included (1) enhancement of focus of emergency medical services on acute stroke; (2) hospital collaborations to implement and enrich acute stroke protocols and transition District of Columbia hospitals toward primary stroke center certification; and (3) preintervention acute stroke patient data collection in all 7 acute care District of Columbia hospitals. A community advisory committee, focus groups, and surveys identified perceptions of barriers to emergency stroke care. Phase 2 included a pilot intervention and subsequent citywide intervention rollout. A total of 531 community interventions were conducted, reaching >10,256 participants; 3289 intervention evaluations were performed, and 19,000 preparedness bracelets and 14,000 stroke warning magnets were distributed. Phase 3 included an evaluation of emergency medical services and hospital processes for acute stroke care and a year-long postintervention acute stroke data collection period to assess changes in intravenous tissue-type plasminogen utilization.

Conclusions: We report the methods, feasibility, and preintervention data collection efforts of the ASPIRE intervention.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00724555.

Keywords: prevention & control; residence characteristics; stroke.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
Black or African American / statistics & numerical data
Brain Ischemia / therapy*
Clinical Trials as Topic / methods*
Community-Based Participatory Research / methods
District of Columbia
Emergency Medical Services* / organization & administration
Emergency Medical Services* / standards
Emergency Medical Services* / statistics & numerical data
Feasibility Studies
Female
Hospitals, Urban* / organization & administration
Hospitals, Urban* / standards
Hospitals, Urban* / statistics & numerical data
Humans
Male
Middle Aged
Patient Education as Topic / methods*
Pilot Projects
Program Development / methods*
Quality Assurance, Health Care* / statistics & numerical data
Stroke / therapy*

Associated data

ClinicalTrials.gov/NCT00724555

Grants and funding

U54 NS057405/NS/NINDS NIH HHS/United States