Ischemic stroke is a major source of illness and burden in the U.S. Stroke survivors are at high risk for recurrence, and therefore they are an important group for secondary prevention. However, there are three major gaps of knowledge in stroke survivors that are obstacles to effective intervention following stroke: inadequate knowledge of the early warning signs of stroke, inadequate understanding of the purpose and goals of rehabilitation, and lack of awareness of personal risk factors. These knowledge gaps in stroke education lead to suboptimal management of stroke and suboptimal prevention of stroke-related morbidity. This education is not adequately addressed in the various health care environments that treat stroke patients (such as medical rehabilitation). We propose that an effective program of education that addresses these gaps in stroke survivors' knowledge would improve stroke outcomes by promoting rehabilitation, reducing the risk of another stroke, and reducing morbidity of recurrent strokes. This Phase I SBIR application is to establish the feasibility of web-based education for stroke survivors and their families. The proposal will develop a prototype to provide knowledge about stroke, including presenting symptoms, risk factors, and management of one common risk factor (hypertension). Stroke survivors present with a wide range of cognitive deficits. To accommodate some of these patients with mild- moderate deficits, methods of """"""""adaptive learning"""""""" will be explored using various multi-media formats and self-assessment exercises. We will convene focus groups of stroke patients and their caregivers recruited from a large rehabilitation facility. Information from these groups regarding the desired attributes of a web-based education will be used to develop the content and format of the educational modules. We will then develop a prototype with two content modules: a general education about stroke, including risk factors, warning signs, and what to do if a stroke is suspected; and a module focused on hypertension, including an explanation of what hypertension is, why it is a risk factor for stroke, and how to best manage it (treatment compliance, life-style, etc.). These modules will be produced in two different presentation styles to adapt to the users' deficits, including features that will permit repetition and reinforcement according to the cognitive abilities of the users. The program will include self-assessment tools to identify users' learning needs. After the development of the prototype, another group of patients and families will provide satisfaction data and qualitative feedback. Based on the Phase I feedback, the Phase II will develop a web-based program that addresses all of the main manageable risk factors, general stroke knowledge, and an understanding of stroke rehabilitation. This will be a marketable product to providers of medical treatment for stroke, including rehabilitation hospitals which must meet specific patient education requirements. Additionally, insurance companies that wish to improve stroke prevention efforts could be a source of revenue. ? ? ?
