Original Article
Raising stroke awareness among rural dwellers with a Facts for Action to Stroke Treatment-based educational program

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Abstract

Stroke is the third leading cause of death in the United States with 780,000 new and/or recurrent strokes each year. Interventions aimed at the onset of stroke symptoms have been successful in decreasing long-term neurological deficits; however, providing the prompt medical interventions in rural areas involves unique challenges. To decrease time-to-treatment in rural areas, education about symptoms of stroke and the need for immediate medical attention are critical. The objective of this study was to measure the effectiveness of the Facts for Action to Stroke Treatment (FAST)-based educational intervention program focused on the improving knowledge about stroke of 402 rural-dwelling adults. Using a paired means t test, the participants had a significant increase in knowledge from pretest to posttest (p = .000). Of those, 215 subjects participated in 2-month follow-up testing with the paired t test showing that the increased score from pretest to 2-month follow-up remained significant (p = .000). The authors concluded that the FAST-based program was an effective tool to use when teaching recognition of stroke symptoms and the need for immediate medical intervention to rural adults.

Introduction

Every 40 seconds, someone in the United States is having a stroke or cerebrovascular accident. Stroke is the third leading cause of death in the United States and involves 780,000 new and/or recurrent strokes each year (Rosamund et al., 2008). Although the risk of a stroke increases with age, it is not a disease of old age alone with one quarter of all strokes occurring in persons younger than 65 years. More than half of persons who have had stroke regain functional independence; however, 15% to 30% of stroke victims are permanently disabled and 20% require institutionalization 3 months after the event. It is estimated that the direct and indirect costs for medical care for persons experiencing stroke in the United States will exceed $65.5 billion in 2008 (Rosamund et al., 2008).

Because of the devastating impact on health and quality of life as well as the enormous economic impact, early detection and prevention of stroke are of critical importance. A major initiative of Healthy People 2010 is focused on reducing stroke mortality to less than 48 per 100,000 (U.S. Department of Health & Human Services, 2000). Presently, New York State (NYS) is fortunate to surpass this goal with a mortality rate of 42 per 100,000 (Rosamund et al., 2008). However, further examination reveals that some upstate areas of NYS have rates much higher than the state average (NYS Department of Health, 2008), thus offsetting lower mortality rates seen in the downstate (New York City) area. Delaware County, a rural county in upstate New York where the Facts for Action to Stroke Treatment (FAST) program herein described has stroke mortality rates 30% higher than the NYS average (NYS Department of Health, 2008) and thus was the focus of this educational program to improve stroke awareness.

Section snippets

Stroke care in rural areas

Long-term neurological deficits may be prevented with prompt medical intervention when symptoms of stroke occur. The American Heart Association (AHA) and the American Stroke Association (ASA) have issued comprehensive evidence-based guidelines for stroke care that include the immediate assessment of victims of acute ischemic strokes and the subsequent administration of thrombolytic therapy with recombinant tissue plasminogen activator for those individuals meeting specific criteria (Adams et

Knowledge about stroke in special at-risk groups

Stroke is the third leading cause of death among women; however, many women are unaware of their risks of stroke or symptoms of stroke (Ferris, Robertson, Fabunmi, & Mosca, 2005). Mosca et al. (2000) found that only 36% of women could identify sudden weakness or numbness on one side of the body as a symptom of stroke, and only 10% of the sample correctly identified any other sign of a stroke such as sudden change in vision, headache, slurred speech, and unexplained dizziness. Similarly, using

Designing an educational program to increase stroke awareness

Education of the public about the critical need for immediate intervention if symptoms of stroke occur is one factor to the provision of timely and comprehensive treatment. Various programs have assessed educational needs of communities regarding stroke awareness (Gupta and Thomas, 2002, Mosca et al., 2000, Pancioli et al., 1998, Robinson and Merrill, 2003, Schneider et al., 2003, Stern et al., 1999, Willoughby et al., 2001). An early assessment by Pancioli et al. (1998) at the Cincinnati

Design

A prospective quasi-experimental design was used to test whether the knowledge of stroke symptoms among adult rural dwellers improved following a stroke educational program and if any improvement in knowledge about stroke was maintained on repeat testing at 2 months after the educational intervention. Participants were recruited during educational programs on stroke prevention that were presented to groups including the Rotary club, church organizations, and senior centers in Delaware County in

Demographics

More than 30 stroke education programs were presented in Delaware County, NY, between September 2003 and December 2004. The resultant sample consisted of 402 subjects (M = 65, range = 18–93 years), and 73% of these subjects were female. These individuals primarily identified themselves as rural dwellers (352 or 88%). Of those rural dwellers, 327 (80%) reported no public transportation within 2 miles of home, and 282 (69%) did not have access to municipal water. Twenty-one subjects (5%) reported

Discussion

Participation in this FAST-based educational program led to an increase in knowledge about stroke and the need for immediate action when symptoms of stroke occurred. The finding that stoke awareness remained significant at the 2-month follow-up indicates the positive influence that programs such as this may have on knowledge about stroke in localities that are challenged with access to care issues.

Shortening the time-to-treatment window remains of critical importance in areas such as Delaware

Limitations

Limitations of this study included the quasi-experimental nature of this study including the use of a convenience sample and the lack of random sampling. Although this was a convenience sample, the number of participants (N = 402) was large enough to protect against loss of power when interpreting the results. Control was maintained by using each person as their own control via means of a pretest, posttest methodology. The use of the 2-month follow-up questionnaire indicated that pretest

Conclusion

Although an increase in knowledge does not necessarily indicate that people would accurately recognize and respond appropriately to the occurrence of a stroke, recognition is the first step in getting the needed immediate medical intervention when stroke symptoms do occur. Rural dwellers are at a disadvantage in obtaining the most effective stroke interventions in part due to the short window of time open for stroke treatment intervention. Early recognition of a stroke when it occurs coupled

Acknowledgments

The authors wish to acknowledge the contributions of the undergraduate research class of the Decker School of Nursing as well as the nurses of the PHNS of Delaware County for their assistance with this program. The authors also wish to acknowledge the support of the funding agencies for this program including A. Lindsay & Olive B. O'Connor Foundation; Kenneth M. Axtell, Jr. Foundation; Assemblyman Clifford Crouch of NYS; Robert B. & Addie P. Thomson Trust; and the Crane Widows and Children Fund.

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