Subgroup analysis showed improvement in low-education group
Stroke preparedness may not improve among black and Hispanic church attendees after watching culturally tailored stroke videos compared to those receiving conventional stroke education brochures, a cluster randomized clinical trial found.
Average proportion of Stroke Action Test (STAT) questions answered correctly was similar for the usual care and video intervention groups at baseline (58.35% vs 59.05%, P=0.83), at 6-month follow-up (61.12% vs 63.94%, P=0.40), and at 1-year follow-up (61.58% vs 64.38%, P=0.41).
However, subgroup analysis showed substantial benefit with the intervention among those who hadn't completed high school education, improving from 52.4% to 66.7% of the 21 questions answered correctly, reported Olajide Williams, MD, of Columbia University Medical Center in New York City, and colleagues in JAMA Neurology.
These findings reveal insufficiencies in culturally customized, short-length stroke videos and conventional stroke informational pamphlets for improving stroke preparedness of ethnic and racial minority cohorts, the researchers noted.
"More work is needed to address this important public health problem," the authors wrote, pointing to lower stroke recognition and 911 use among Hispanic and black people that leads to ethnic and racial disparities in thrombolytic use.
Previous studies have demonstrated that narrative communication improves stroke preparedness among Hispanic and black youth and lowers blood pressure among black participants with hypertension, they wrote.
The researchers randomized 13 Hispanic and black churches located in urban areas, resulting in 160 patients in the intervention arm and 151 in the usual care group who were at least age 34 who had stroke risk factors but no history of it. Study participants and the churches involved were compensated for participation. The cohort was 79.1% female, 48.9% Hispanic, and 51.1% non-Hispanic black. Mean age was 58.6 years.
For the intervention arm, the investigators created two 12-minute stroke films on stroke preparedness -- a telenovela-based one for Hispanics and a gospel music-based one for blacks -- using a professional director, professional actors, and a trans-disciplinary research team. The usual care group received informational pamphlets in Spanish and English.
Participants in the intervention group watched one screening of the stroke video at their church and took home a DVD they were asked to watch again and share with friends and family. The usual care group received three stroke brochures in their preferred language at a church health fair and were asked to share them with friends and family.
Limitations of the study included the size of the cohort, self-reported education status, and lack of a cost-effectiveness or cost analysis component.
"While these findings may have potential implications regarding the design of stroke preparedness interventions, confirmatory testing in future studies is required," the researchers concluded.
The study was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health.
Williams disclosed relationships with the National Institute of Neurological Disorders and Stroke of the National Institutes of Health.
Source Reference: Williams O, et al "Effect of stroke education pamphlets vs a 12-minute culturally tailored stroke film on stroke preparedness among black and hispanic churchgoers: A cluster randomized clinical trial" JAMA Neurol 2019; DOI: 10.1001/jamaneurol.2019.1741.
Read the original article on Medpage Today: Minority-Targeted Videos Flop for Stroke Readiness