Stroke is the leading cause of adult disability and costs U.S. taxpayers >$60 billion annually. Interventions designed to educate patients to seek treatment sooner when a stroke occurs may increase low rates of treatment with thrombolysis (current rates 3% national average). Thrombolysis can increase the odds of minimal to zero disability from stroke if emergency medical system response times and in-hospital response times are optimized (maximum time from symptom onset to intravenous thrombolysis is 4.5 hours). Black and Hispanic Americans have higher stroke incidence compared to Whites and are less likely to receive thrombolysis for acute stroke. The latency to hospital arrival is largely dependent on patients'recognition of stroke symptoms, and immediate presentation to the emergency department. Our group has found very low stroke literacy rates among Blacks and Hispanics compared to Whites, which may, in part, be responsible for disparities in acute stroke treatment. Building on our previous work, in which we have identified barriers to increasing stroke literacy and behavioral intent to call 911, we will develop and evaluate the effectiveness of a novel, culturally tailored intervention using storytelling (narrative persuasion) in the form of two professionally produced 12-min films (in English and Spanish), in minority populations in NYC. The film will (1) communicate knowledge of stroke symptoms;(2) communicate the range of severity with which the symptom may occur (a slight slurring of the speech, for example, should be enough to precipitate action);(3) communicate the therapeutic benefit of calling 911 and (4) overcome the natural reluctance to go to the ED, and barriers related to denial or embarrassment if symptoms turn out not to be serious. A transdisciplinary team comprising community members from local Black and Hispanic churches, a stroke expert, behavioral scientists including narrative communication experts, a specialist in theory of knowledge acquisition, and a professional filmmaker will guide the development and production of the intervention, which will be delivered in churches.

Public Health Relevance

If the current 3% rate of ischemic stroke patients receiving thrombolysis is increased to 10%, the annual cost savings to taxpayers would be more than $45m. It has been estimated that interventions designed to educate patients to seek treatment sooner when a stroke occurs may increase thrombolysis rates to 57%, if EMS and in-hospital response times are optimized which would result in enormous savings for taxpayers.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Specialized Center--Cooperative Agreements (U54)
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New York University
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