Peer education for secondary stroke prevention in inner-city minorities: design and methods of the prevent recurrence of all inner-city strokes through education randomized controlled trial.
BACKGROUND
The highest risk for stroke is among survivors of strokes or transient ischemic attacks (TIA). However, use of proven-effective cardiovascular medications to control stroke risk is suboptimal, particularly among the Black and Latino populations disproportionately impacted by stroke.


METHODS
A partnership of Harlem and Bronx community representatives, stroke survivors, researchers, clinicians, outreach workers and patient educators used community-based participatory research to conceive and develop the Prevent Recurrence of All Inner-city Strokes through Education (PRAISE) trial. Using data from focus groups with stroke survivors, they tailored a peer-led, community-based chronic disease self-management program to address stroke risk factors. PRAISE will test, in a randomized controlled trial, whether this stroke education intervention improves blood pressure control and a composite outcome of blood pressure control, lipid control, and use of antithrombotic medications.


RESULTS
Of the 582 survivors of stroke and TIA enrolled thus far, 81% are Black or Latino and 56% have an annual income less than $15,000. Many (33%) do not have blood pressures in the target range, and most (66%) do not have control of all three major stroke risk factors.


CONCLUSIONS
Rates of stroke recurrence risk factors remain suboptimal in the high risk, urban, predominantly minority communities studied. With a community-partnered approach, PRAISE has recruited a large number of stroke and TIA survivors to date, and may prove successful in engaging those at highest risk for stroke and reducing disparities in stroke outcomes in inner-city communities.
Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY, USA. Judith.Goldfinger@mountsinai.org
Judith Z
JZ
Goldfinger
Ian M
IM
Kronish
Kezhen
K
Fei
Albert
A
Graciani
Peri
P
Rosenfeld
Kate
K
Lorig
Carol R
CR
Horowitz
D001741:Black or African American; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001794:Blood Pressure; D055812:Community-Based Participatory Research; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006630:Hispanic or Latino; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D002546:Ischemic Attack, Transient / Q000150:complications; D008055:Lipids / Q000097:blood; D009519:New York City; D010353:Patient Education as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012648:Self Care; D020521:Stroke / Q000208:ethnology* / Q000517:prevention & control*; D014505:Urban Population
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents; D008055:Lipids