Targeted management intervention for African-American men with TIA or stroke

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DESCRIPTION (provided by applicant): Stroke is the leading cause of disability, third leading cause of death, and one of the most resource-intensive diseases among Americans. African-Americans (AA) have a stroke rate nearly double that of Euro-Americans (EA), and AA who experience a first-ever stroke are younger, have greater stroke disability, more post-stroke complications, and slower recovery compared to EA. Given the disproportionate burden and tremendous humanitarian and financial impact related to stroke, there is a critical need for healthcare approaches that that will improve health outcomes in AA men who have had a stroke, and reduce recurrent/future risk for stroke. Unfortunately, there is only a limited literatre that has specifically focused on improving engagement in post- stroke care for AA men stroke survivors. The proposed project is in response to NIH PA-10-237: Health Promotion among Racial and Ethnic Minority Males (R21). Interventions targeted to those AA men who have had transient ischemic attack (TIA) or a milder first-time stroke (FTS) may be particularly well-timed as some individuals experience the TIA/FTS as a "wake up call" or "first-brush" with a stroke-related event. This 2-phase project will use an iterative, collaborative process to refine an existing behavioral intervention developed by these investigators in ethnically diverse multiply morbid individuals, and then preliminarily test the refined intervention. Phase I will first use qualitative methods to evaluate barriers and facilitators to post- stroke care in AA men, and will then refine a TargetEd MAnageMent Intervention (TEAM) for AA men with TIA/FTS informed by input from a representative advisory board. Phase II will be a prospective pilot comparative study of TEAM vs. treatment as usual (TAU) in AA men with TIA/FTS. Participants will be randomized to receive either TEAM (N=19) or TAU (N=19) and followed for 6 months. We hypothesize that TEAM will be acceptable to AA men with TIA/FTS, and will be associated with greater improvement in medication adherence with prescribed stroke risk reduction pharmacotherapies compared to TAU. Exploratory assessments will evaluate effects on self-management (diet, exercise, smoking/substance use reduction) and biological risk markers for stroke (blood pressure, HbA1c, Body Mass Index/BMI, cholesterol, and triglycerides). A unique feature of TEAM is the use of Peer Dyads (AA men and their care partners) to provide support and model behaviors that will improve post-stroke care. Consistent with the focus on restoration of personal and social roles, the term "care partner" will be used rather than "caregiver". The proposed research features a person-centered, holistic intervention that takes advantage of existing strengths in AA families and communities. The intervention represents a practical and generalizable approach suitable for implementation in specialty, primary care, or community settings, and has the potential to reverse the unacceptably high morbidity seen in AA men due to stroke and stroke-related disorders. PUBLIC HEALTH RELEVANCE: African-American (AA) men are disproportionably burdened by stokes and generally has sub-optimal post- stroke care. Few studies have focused on improving post-stroke care involvement for AA men stroke survivors. This 2-phase project will refine an existing psychosocial intervention developed by these investigators, and then test the refined intervention in AA men with first time stroke or transient ischemic attack (TIA) vs. treatment as usual. The project has the potential to reverse the unacceptably high morbidity seen in AA men due to stroke.