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Methodology for a community-based stroke preparedness intervention: the Acute Stroke Program of Interventions
Bernadette Boden-Albala1, Dorothy F Edwards1, Shauna St Clair1
1From 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.).
This study evaluated the Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) to improve stroke preparedness in underserved Black communities. The program aimed to reduce stroke presentation times and increase treatment utilization.
Area of Science:
- Public Health
- Community Health Interventions
- Stroke Preparedness
Background:
- Acute stroke education traditionally focuses on symptom recognition, neglecting preparedness and timely care seeking.
- Interventions for stroke preparedness in multiethnic communities are scarce and require rigorous evaluation.
- Underserved Black communities in Washington D.C. face unique barriers to accessing acute stroke care.
Purpose of the Study:
- To implement and evaluate a community-engaged stroke preparedness program (ASPIRE) in underserved Black communities.
- To decrease acute stroke presentation times and increase intravenous tissue-type plasminogen activator (tPA) utilization.
- To address racial and ethnic disparities in acute stroke care.
Main Methods:
- The ASPIRE project utilized a multilevel, community-engaged approach in Washington D.C.
- Phase 1 involved enhancing EMS focus, hospital collaborations, and preintervention data collection.
- Community input guided intervention design, followed by pilot and citywide rollouts with extensive participant reach and material distribution.
Main Results:
- Over 10,256 participants were reached through 531 community interventions.
- 19,000 preparedness bracelets and 14,000 stroke warning magnets were distributed.
- Data collection assessed emergency medical services and hospital processes, with a year-long postintervention evaluation planned for tPA utilization.
Conclusions:
- The ASPIRE intervention demonstrated feasibility in a community-engaged approach.
- Preintervention data collection provided baseline insights into stroke care processes.
- Further evaluation will assess the impact on tPA utilization and overall acute stroke care outcomes.
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