title: Methodology for a community-based stroke preparedness intervention: the Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities Study.
abstract: OBJECTIVE
  Acute stroke education has focused on stroke symptom recognition. Lack of education about stroke preparedness and appropriate actions may prevent people from seeking immediate care. Few interventions have rigorously evaluated preparedness strategies in multiethnic community settings.
  
  
  METHODS
  The Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) project is a multilevel program using a community-engaged approach to stroke preparedness targeted to underserved black communities in the District of Columbia. This intervention aimed to decrease acute stroke presentation times and increase intravenous tissue-type plasminogen activator utilization for acute ischemic stroke.
  
  
  RESULTS
  Phase 1 included (1) enhancement of focus of emergency medical services on acute stroke; (2) hospital collaborations to implement and enrich acute stroke protocols and transition District of Columbia hospitals toward primary stroke center certification; and (3) preintervention acute stroke patient data collection in all 7 acute care District of Columbia hospitals. A community advisory committee, focus groups, and surveys identified perceptions of barriers to emergency stroke care. Phase 2 included a pilot intervention and subsequent citywide intervention rollout. A total of 531 community interventions were conducted, reaching >10,256 participants; 3289 intervention evaluations were performed, and 19,000 preparedness bracelets and 14,000 stroke warning magnets were distributed. Phase 3 included an evaluation of emergency medical services and hospital processes for acute stroke care and a year-long postintervention acute stroke data collection period to assess changes in intravenous tissue-type plasminogen utilization.
  
  
  CONCLUSIONS
  We report the methods, feasibility, and preintervention data collection efforts of the ASPIRE intervention.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00724555.
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Dorothy F
authors.initials: DF
authors.lastname: Edwards
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Shauna
authors.initials: S
authors.lastname: St Clair
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Wing
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Fernandez
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: M Chris
authors.initials: MC
authors.lastname: Gibbons
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Amie W
authors.initials: AW
authors.lastname: Hsia
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.affiliation: From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.).
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Kidwell
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002545:Brain Ischemia / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000379:methods*; D055812:Community-Based Participatory Research / Q000379:methods; D004219:District of Columbia; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006786:Hospitals, Urban / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D016730:Program Development / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D020521:Stroke / Q000628:therapy*
keywords: prevention & control; residence characteristics; stroke