RCT: Effect of Novel Intervention to Improve Stroke Symptom Recognition

Columbia University Health Sciences, New York NY

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): Stroke is the leading cause of serious long-term adult disability in the U.S. and third leading cause of death, and has a 2-fold greater incidence in Blacks compared to the majority Americans. Thrombolytic revascularization treatment administered within a maximum of 3 hours from symptom onset reduces morbidity, mortality and cost; however, only 3% of patients arrive at the hospital within 3 hours, mostly due to the public's lack of knowledge concerning stroke symptoms, and the appropriate response when they are recognized, which is to call 911. We propose to reduce these delays using a novel behavioral intervention to improve symptom recognition and response in a high-risk, minority, economically disadvantaged population. Expensive mass media stroke education campaigns are not sustainable for this purpose, particularly in economically disadvantaged populations. Instead, we propose to intervene in school classrooms with children aged 9 to 11 years, to teach the five cardinal stroke symptoms, the correct course of action when they occur, and to highlight the potential therapeutic benefit of early hospital arrival, with the intent that the children will then educate their parents. To help accomplish this, we have developed a program called Hip Hop Stroke (HHS), which is comprised of stroke rap songs and two animated musical cartoons that incorporate stroke knowledge. We have found that children aged 9-11 years can rapidly learn the information, and retain the information well for at least 2 years. One recent pilot study showed that 74% of children in the pilot (N=182) communicated the material to a parent, and that this communication significantly improved the parent's stroke literacy. Having demonstrated the efficacy of the HHS intervention in a small sample, we now propose a randomized controlled trial to test the likelihood that children can and will educate parents or adult caregivers about stroke in a high-risk, economically- disadvantaged, minority population, and parents' ability to recall knowledge transferred. Utilizing children as a transmission vector for carrying out interventions aimed at their parents has the potential to serve as the basis for intervention in any number of other areas such as healthy eating and weight loss. Thus, the significance of the proposed trial addresses the public health problem under study - stroke symptom identification and response - as well as development and refinement of a more general model of intervention. PUBLIC HEALTH RELEVANCE: Targeting children to intervene with their parents has been sporadically attempted and little success reported. Our model utilizes children as a transmission vector for carrying out interventions, in this case stroke related, aimed at their parents and grandparents in high-risk communities. Thus, the significance of the proposed trial addresses the public health problem under study - stroke symptom identification and response - as well as development and refinement of a more general model of intervention.