RCT: Effect of Novel Intervention to Improve Stroke Symptom Recognition

描述（由申请人提供）：中风是美国严重长期成人残疾的主要原因，也是第三大死亡原因，黑人的发病率是大多数美国人的2倍。在症状发作后最多3小时内进行溶栓血运重建治疗可降低发病率、死亡率和费用;然而，只有3%的患者在3小时内到达医院，主要是由于公众缺乏有关中风症状的知识，以及在发现症状时的适当反应，即拨打911。我们建议使用一种新的行为干预来减少这些延迟，以改善高风险，少数民族，经济弱势群体的症状识别和反应。为此目的，昂贵的大众媒体中风教育运动是不可持续的，特别是在经济困难的人群中。相反，我们建议对9至11岁的儿童进行学校课堂干预，教授五种主要的中风症状，发生时的正确行动方案，并强调早期到达医院的潜在治疗益处，目的是让孩子们教育他们的父母。为了帮助实现这一目标，我们开发了一个名为Hip Hop Stroke（HHS）的程序，该程序由中风说唱歌曲和两个包含中风知识的动画音乐卡通组成。我们发现，9-11岁的儿童可以快速学习信息，并将信息保持至少2年。最近的一项试点研究表明，试点中74%的儿童（N=182）将材料传达给父母，这种沟通显着提高了父母的中风素养。在小样本中证明了HHS干预的有效性后，我们现在提出了一项随机对照试验，以测试儿童能够并愿意在高风险、经济弱势、少数群体中教育父母或成年照顾者有关中风的可能性，以及父母回忆传授知识的能力。利用儿童作为“传播媒介”，对他们的父母采取干预措施，有可能成为在健康饮食和减肥等许多其他领域采取干预措施的基础。因此，拟议的试验的意义在于解决研究中的公共卫生问题-中风症状识别和反应-以及开发和完善更通用的干预模型。 公共卫生相关性：针对儿童对其父母进行干预的尝试是零星的，很少有成功的报道。我们的模型利用儿童作为“传播媒介”进行干预，在这种情况下，中风相关的，针对他们的父母和祖父母在高风险社区。因此，拟议的试验的意义在于解决研究中的公共卫生问题-中风症状识别和反应-以及开发和完善更通用的干预模型。

DESCRIPTION (provided by applicant): Stroke is the leading cause of serious long-term adult disability in the U.S. and third leading cause of death, and has a 2-fold greater incidence in Blacks compared to the majority Americans. Thrombolytic revascularization treatment administered within a maximum of 3 hours from symptom onset reduces morbidity, mortality and cost; however, only 3% of patients arrive at the hospital within 3 hours, mostly due to the public's lack of knowledge concerning stroke symptoms, and the appropriate response when they are recognized, which is to call 911. We propose to reduce these delays using a novel behavioral intervention to improve symptom recognition and response in a high-risk, minority, economically disadvantaged population. Expensive mass media stroke education campaigns are not sustainable for this purpose, particularly in economically disadvantaged populations. Instead, we propose to intervene in school classrooms with children aged 9 to 11 years, to teach the five cardinal stroke symptoms, the correct course of action when they occur, and to highlight the potential therapeutic benefit of early hospital arrival, with the intent that the children will then educate their parents. To help accomplish this, we have developed a program called Hip Hop Stroke (HHS), which is comprised of stroke rap songs and two animated musical cartoons that incorporate stroke knowledge. We have found that children aged 9-11 years can rapidly learn the information, and retain the information well for at least 2 years. One recent pilot study showed that 74% of children in the pilot (N=182) communicated the material to a parent, and that this communication significantly improved the parent's stroke literacy. Having demonstrated the efficacy of the HHS intervention in a small sample, we now propose a randomized controlled trial to test the likelihood that children can and will educate parents or adult caregivers about stroke in a high-risk, economically- disadvantaged, minority population, and parents' ability to recall knowledge transferred. Utilizing children as a "transmission vector" for carrying out interventions aimed at their parents has the potential to serve as the basis for intervention in any number of other areas such as healthy eating and weight loss. Thus, the significance of the proposed trial addresses the public health problem under study - stroke symptom identification and response - as well as development and refinement of a more general model of intervention. PUBLIC HEALTH RELEVANCE: Targeting children to intervene with their parents has been sporadically attempted and little success reported. Our model utilizes children as a "transmission vector" for carrying out interventions, in this case stroke related, aimed at their parents and grandparents in high-risk communities. Thus, the significance of the proposed trial addresses the public health problem under study - stroke symptom identification and response - as well as development and refinement of a more general model of intervention.