A Community-Engaged Assessment of Barriers and Facilitators to Rapid Stroke Treatment

Res Nurs Health. 2016 Dec;39(6):438-448. doi: 10.1002/nur.21749. Epub 2016 Aug 22.


Treatment for acute ischemic stroke must be initiated within hours of stroke symptom onset, and the sooner it is administered, the better. In South Carolina, 76% of the population can access expert stroke care, and rural hospitals may provide specialized treatment using telemedicine, but many stroke sufferers seek care too late to achieve full benefit. Using a community-engaged approach in a southern rural community, we explored barriers and facilitators to early stroke care and implications for improvement. The Community-Engaged Assessment to facilitate Stroke Elimination (CEASE) study was guided by a community advisory group to ensure community centeredness and local relevance. In a qualitative descriptive study, eight focus groups were conducted including 52 individuals: recent stroke survivors, family members, emergency medical personnel, hospital emergency department staff, primary care providers, and community leaders. From analysis of focus group transcripts came six themes: lack of trust in healthcare system and providers; weak relationships fueled by poor communication; low health literacy; financial limitations related to health care; community-based education; and faith as a message of hope. A hierarchy model for improving early community-based stroke care was developed through consensus dialogue by community representatives and the research team. This model can be used to inform a community-partnered, stakeholder-informed intervention to improve stroke care in a rural southern community with the goal of improving stroke education, care, and outcome. © 2016 Wiley Periodicals, Inc.

Keywords: stroke; community-engaged research; focus groups; health care access; qualitative research; rural communities.

MeSH terms

  • Community-Based Participatory Research / methods*
  • Early Medical Intervention*
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Health Literacy
  • Health Services Accessibility / economics*
  • Humans
  • Male
  • North Carolina
  • Patient Education as Topic
  • Qualitative Research
  • Rural Population
  • Stroke / diagnosis
  • Stroke / therapy*
  • Telemedicine