In this issue of JNN, a nurse researcher reports the findings of a pilot study conducted to evaluate the effect of an Internet-based stroke preparedness recognition intervention conducted among African American women. This article is an excellent example of not only a timely intervention study but also a novel and culturally sensitive approach used to educate women about stroke symptoms and appropriate response.
Study Purpose
The purpose of this study was to investigate the effect of Sisters Against Stroke, an Internet-based stroke preparedness intervention for African American women, for self-efficacy to recognize a stroke and to know what to do in the event of stroke, awareness of stroke symptoms, and identification of appropriate action in response to stroke symptoms.
Significance
Patient treatment delay, which is of particular concern among African Americans, is one of the major reasons for thrombolytic therapy underuse among patients with ischemic stroke. The magnitude of benefits of thrombolytic therapy diminishes with treatment delays. With a reported one-fifth of African American women who are unable to name a single stroke symptom and their perception of stroke symptoms as similar to other health problems or everyday bodily sensations, stroke preparedness intervention is especially critical in this population.
Methods
African American women recruited from 4 churches participated in this quasi-experimental study. Participants randomly chosen from 2 churches were assigned to the intervention group (n = 32), and those from 2 churches were assigned to the wait-list comparison group (n = 21). Sisters Against Stroke was developed by a 6-member community advisory board, features American Heart Association and American Stroke Association's Stop a Stroke FAST (face drooping, arm weakness, speech difficulty, time to call 911) symptoms through videos and lay language description, captures 88.9% of symptoms, and conforms to national guidelines for online consumer health information. The community advisory board evaluated findings from a formative qualitative study to ensure the intervention addressed identified stroke onset education needs in a culturally sensitive way. Demographic characteristics, perception of stroke preparedness, and sources of stroke information were collected during pretest. The instrument used to measure outcomes had vignettes, a 4-pont Likert-type scale, and open-ended questions. Awareness of stroke signs and symptoms, self-efficacy to recognize stroke symptoms and take correct and appropriate action in response to stroke symptoms were measured at pretest, immediately after intervention during posttest, and 1 month later. The intervention group had access to the Sisters Against Stroke for 2 weeks after the pretest. The comparison group participants had access to the intervention for 2 weeks after completing the 1-month posttest. Data were analyzed using Friedman and Wilcoxon signed rank tests and Cochran-Mantel-Haenszel statistics. Effect size estimates were calculated by converting z scores to r.
Results
The mean age of the participants was 52.98 years. At pretest, 47.7% indicated that they would not be able to tell whether someone was having stroke, and 56.8% indicated that they would not know whether someone was having stroke. At posttest, the intervention group showed improvement in self-efficacy to know what to do in the event of stroke (P = .0002) and ability to identify symptoms in vignette measure (P = .003), increase in number of women indicating timely 911 call for suspected stroke in themselves (P = .01), and increase in number of women indicating timely 911 call for suspected stroke in someone else (P = .01). Furthermore, during the 1-month posttest, the intervention group showed improvement in ability to identify stroke symptoms (P = .001) and increase in number of women indicating timely 911 call (P = .01).
Implications
Intervention programs developed to improve stroke preparedness should be culturally appropriate and easy to use for the target population. This pilot study is an excellent example of successful use of Internet-based intervention in improving stroke preparedness for African American women. Results of this study could inform Internet-based preparedness interventions in other at-risk populations.