The investigators plan to develop and adapt a community-partnered intervention using community health promoters ("Stroke Promoters") to deliver messaging regarding stroke symptom awareness and the need for calling 911 after stroke onset. The study investigators will implement this intervention in 2 large south side Chicago communities and measure the impact on symptom onset to hospital arrival times and EMS utilization using an interrupted time-series analysis.
The CEERIAS community-partnered research project has the following specific aims:
1. To examine personal, community, and cultural barriers to calling 911 after stroke onset and adapt a culturally-tailored intervention for delivery in multi-ethnic communities (African American, Hispanic, non-Hispanic White) surrounding 2 hospitals on the south side of Chicago;
2. To implement a culturally-adapted stroke awareness and action program and monitor its penetration and adoption using the RE-AIM (Reach, Evaluate, Adoption, Implementation, Maintenance) framework in 2 multi-ethnic communities on the south side of Chicago; and
3. To assess change in early hospital arrival and EMS use at 2 intervention hospitals before and after the community intervention.
For aim 1, the investigators will explore and identify facilitators and barriers to calling 911 for stroke through focus groups conducted and involving key stakeholders including children and adults, stroke survivors, neighborhood alderman/legislators, spiritual and community leaders, school teachers, and stroke advocacy group members. The CEERIAS team will test and culturally refine our core community-partnered pilot intervention for implementation.
For aim 2, the investigators will identify and train Stroke Promoters from collaborating community organizations on the adapted intervention techniques and messages, provide materials for public dissemination, and evaluate and monitor adoption and implementation in the surrounding communities.
For aim 3, the investigators will perform an interrupted time-series analysis of EMS use and early hospital arrival among stroke patients before and after our intervention in 2 south side Chicago communities. The research team will also compare time trends in EMS use and early hospital arrival for stroke with control PSCs on the north and west sides of Chicago and PSCs in St. Louis.
If the intervention is successful, the effect will be an increase in EMS use for stroke which will translate into earlier treatment for stroke and reduced death and disability. The CEERIAS results will be generalizable to other urban communities in the US and should be salient to other health emergencies such as heart attack and cardiac arrest.
- Community-based Stroke Awareness Program Behavioral
Other Names: Community Stroke Promoter Program Intervention Desc: A culturally-adapted stroke awareness and action program will be delivered by trained Stroke Promoters in the targeted neighborhoods in the south side of Chicago. Community Stroke Promoters will be trained on 1) the benefits of early recognition and EMS utilization for stroke (i.e. stroke centers, tPA), 2) culturally-adapted solutions to current barriers (i.e. misperceptions about vulnerability, severity, mistrust, costs), and 3) cues to aid in stroke recognition and immediate action. The intervention will take place at community settings throughout a 1-year period. ARM 1: Kind: Experimental Label: Community-based Stroke Awareness Program Description: Neighborhoods in the south side of Chicago surrounding 2 primary stroke center hospitals will be targeted for a community-partnered stroke awareness and action educational campaign. To assess the effectiveness of this intervention, we will monitor early hospital arrival and EMS use for stroke over a 60-month period at the 2 primary stroke center hospitals using an interrupted time-series analysis.
- Masking: Open Label
- Purpose: Health Services Research
- Intervention: Single Group Assignment
|Type||Measure||Time Frame||Safety Issue|
|Primary||Early arrival after stroke onset||12 months||No|
|Primary||Emergency medical services (EMS) utilization for stroke||12 months||No|
|Secondary||Knowledge, self-efficacy, and perceptions||12 months||No|