title: Enhancing the effectiveness of community stroke risk screening: a randomized controlled trial.
abstract: Stroke risk factors are routinely assessed in community screening programs; however, the rate of patient follow-up for health care once risk factors are identified is known to be low. This study was conducted to test the effectiveness of a brief behavioral telephonic intervention in an ongoing community stroke prevention screening program on health care seeking for stroke risk. A total of 227 participants with 2 or more stroke risk factors were randomly allocated to either an attention control arm or a behavioral intervention arm. The control group received standard information on risk and advice, whereas the intervention group received a brief Health Belief Model telephonic intervention designed to motivate care-seeking. The effect of treatment on the participants who completed a health care visit for stroke risk concerns was assessed using logistic regression. Cox survival analysis was used to compare time to physician visit between the 2 groups. Participants in the intervention arm were 1.85 times more likely to visit a primary care physician than controls. At 3 months, 69.2% of subjects in the intervention arm and 52.9% of those in the controls arm reported a new primary care visit after screening (P = .02), with 56.0% in the intervention arm and 38.4% in the control arm reporting a primary care visit specifically to discuss the stroke screening results (P < .01). Our data indicate that the brief, low-cost, motivational intervention effectively promoted adherence to screening advice and merits further testing.
authors.affiliation: Department of Public Health Sciences and Penn State Hershey Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Anderson
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: Ala I
authors.initials: AI
authors.lastname: Iaconi
authors.forename: Charles H
authors.initials: CH
authors.lastname: Tegeler
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003153:Community Health Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D011939:Mental Recall; D008875:Middle Aged; D009042:Motivation; D009657:North Carolina; D009819:Office Visits; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D011320:Primary Health Care; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D013689:Telephone; D013997:Time Factors