title: A Community-Engaged Assessment of Barriers and Facilitators to Rapid Stroke Treatment.
abstract: Treatment for acute ischemic stroke must be initiated within hours of stroke symptom onset, and the sooner it is administered, the better. In South Carolina, 76% of the population can access expert stroke care, and rural hospitals may provide specialized treatment using telemedicine, but many stroke sufferers seek care too late to achieve full benefit. Using a community-engaged approach in a southern rural community, we explored barriers and facilitators to early stroke care and implications for improvement. The Community-Engaged Assessment to facilitate Stroke Elimination (CEASE) study was guided by a community advisory group to ensure community centeredness and local relevance. In a qualitative descriptive study, eight focus groups were conducted including 52 individuals: recent stroke survivors, family members, emergency medical personnel, hospital emergency department staff, primary care providers, and community leaders. From analysis of focus group transcripts came six themes: lack of trust in healthcare system and providers; weak relationships fueled by poor communication; low health literacy; financial limitations related to health care; community-based education; and faith as a message of hope. A hierarchy model for improving early community-based stroke care was developed through consensus dialogue by community representatives and the research team. This model can be used to inform a community-partnered, stakeholder-informed intervention to improve stroke care in a rural southern community with the goal of improving stroke education, care, and outcome. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Professor, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas, MSC 160, Charleston, SC 29425.
authors.forename: Lynne S
authors.initials: LS
authors.lastname: Nemeth
authors.affiliation: Professor and Ann Darlington Edwards Endowed Chair, College of Nursing, Medical University of South Carolina, Charleston, SC.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Jenkins
authors.affiliation: Professor, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.affiliation: Research Associate and Health Research Board Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland.
authors.forename: Sharon
authors.initials: S
authors.lastname: Conway
authors.affiliation: Medical Student (Former), Medical University of South Carolina, Charleston, SC.
authors.forename: Adam
authors.initials: A
authors.lastname: Pearlman
authors.affiliation: Associate Professor, College of Nursing, Medical University of South Carolina, Charleston, SC.
authors.forename: Ida J
authors.initials: IJ
authors.lastname: Spruill
authors.affiliation: Neurosciences Program Coordinator, Medical University of South Carolina, Charleston, SC.
authors.forename: Lynette J
authors.initials: LJ
authors.lastname: Brown
authors.affiliation: Community Outreach Coordinator, Georgetown Diabetes Community Outreach Resources and Education (CORE) Group, Georgetown, SC.
authors.forename: Joyce
authors.initials: J
authors.lastname: Linnen
authors.affiliation: Community Member, Georgetown Diabetes Community Outreach Resources and Education (CORE) Group, Georgetown, SC.
authors.forename: Florene
authors.initials: F
authors.lastname: Linnen
authors.affiliation: Dean and Professor, College of Nursing, University of South Carolina, Columbia, SC.
authors.forename: Jeannette O
authors.initials: JO
authors.lastname: Andrews
mesh_terms: D055812:Community-Based Participatory Research / Q000379:methods*; D061345:Early Medical Intervention; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D009657:North Carolina; D010353:Patient Education as Topic; D036301:Qualitative Research; D012424:Rural Population; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017216:Telemedicine
keywords:  stroke; community-engaged research; focus groups; health care access; qualitative research; rural communities