Tailored approaches to stroke health education (TASHE): study protocol for a randomized controlled trial.
BACKGROUND
Stroke is a leading cause of adult disability and mortality. Intravenous thrombolysis can minimize disability when patients present to the emergency department for treatment within the 3 - 4½ h of symptom onset. Blacks and Hispanics are more likely to die and suffer disability from stroke than whites, due in part to delayed hospital arrival and ineligibility for intravenous thrombolysis for acute stroke. Low stroke literacy (poor knowledge of stroke symptoms and when to call 911) among Blacks and Hispanics compared to whites may contribute to disparities in acute stroke treatment and outcomes. Improving stroke literacy may be a critical step along the pathway to reducing stroke disparities. The aim of the current study is to test a novel intervention to increase stroke literacy in minority populations in New York City.


METHODS
In a two-arm cluster randomized trial, we will evaluate the effectiveness of two culturally tailored stroke education films - one in English and one in Spanish - on changing behavioral intent to call 911 for suspected stroke, compared to usual care. These films will target knowledge of stroke symptoms, the range of severity of symptoms and the therapeutic benefit of calling 911, as well as address barriers to timely presentation to the hospital. Given the success of previous church-based programs targeting behavior change in minority populations, this trial will be conducted with 250 congregants across 14 churches (125 intervention; 125 control). Our proposed outcomes are (1) recognition of stroke symptoms and (2) behavioral intent to call 911 for suspected stroke, measured using the Stroke Action Test at the 6-month and 1-year follow-up.


CONCLUSIONS
This is the first randomized trial of a church-placed narrative intervention to improve stroke outcomes in urban Black and Hispanic populations. A film intervention has the potential to make a significant public health impact, as film is a highly scalable and disseminable medium. Since there is at least one church in almost every neighborhood in the USA, churches have the ability and reach to play an important role in the dissemination and translation of stroke prevention programs in minority communities.


BACKGROUND
NCT01909271 ; July 22, 2013.
Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA. Joseph.Ravenell@nyumc.org.
Joseph
J
Ravenell
Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. el2766@columbia.edu.
Ellyn
E
Leighton-Herrmann
Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. aca2134@columbia.edu.
Amparo
A
Abel-Bey
Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. ald2146@columbia.edu.
Alexandra
A
DeSorbo
Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA. teresimeas@aol.com.
Jeanne
J
Teresi
Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. lv2321@columbia.edu.
Lenfis
L
Valdez
Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. mcg2160@columbia.edu.
Madeleine
M
Gordillo
The Pennsylvania State University, 208 Biobehavioral Health Building University Park, Pennsylvania, PA, 16802, USA. wxg17@psu.edu.
William
W
Gerin
The Pennsylvania State University, 501 Keller Building University Park, Pennsylvania, PA, 16802, USA. mlh10@psu.edu.
Michael
M
Hecht
Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA. MilRamirez@aol.com.
Mildred
M
Ramirez
Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. jn2054@columbia.edu.
James
J
Noble
Center for Health Innovation, Adelphi University, P.O. Box 701, Garden City, NY, 11530, USA. cohn@adelphi.edu.
Elizabeth
E
Cohn
Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA. Girardin.Jean-Louis@nyumc.org.
Giardin
G
Jean-Louis
Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA. Tanya.Spruill@nyumc.org.
Tanya
T
Spruill
National Institute of Neurological Disorders and Stroke at the National Institutes of Health, 6001 Executive Boulevard, North Bethesda, MD, 20852, USA. waddysp@ninds.nih.gov.
Salina
S
Waddy
Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA. Ogedegbe@nyumc.org.
Gbenga
G
Ogedegbe
Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA. ow11@columbia.edu.
Olajide
O
Williams
D001741:Black or African American / Q000193:education* / Q000523:psychology; D003153:Community Health Services; D003466:Cultural Characteristics; D004632:Emergency Medical Services; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D057220:Health Literacy; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000193:education* / Q000523:psychology; D006801:Humans; D008913:Minority Groups / Q000193:education* / Q000523:psychology; D054525:Minority Health / Q000193:education*; D009040:Motion Pictures; D009519:New York City; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010565:Persuasive Communication; D021641:Recognition, Psychology; D012107:Research Design; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D013689:Telephone; D013997:Time Factors; D061665:Time-to-Treatment