RCT: Effect of Novel Intervention to Improve Stroke Symptom Recognition

描述（由申请人提供）：在美国，中风是导致成人长期严重残疾的主要原因，也是导致死亡的第三大原因，与大多数美国人相比，黑人的发病率高出2倍。在症状出现后最多3小时内进行溶栓血运重建术治疗可降低发病率、死亡率和费用；然而，只有3%的患者在3小时内到达医院，这主要是由于公众对中风症状的认识不足，以及在认识到中风症状后的适当反应，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，以提高高风险，少数民族，经济上处于不利地位的人群的症状识别和反应。为此目的，特别是在经济上处于不利地位的人群中，昂贵的大众媒体中风教育活动是不可持续的。相反，我们建议在9至11岁儿童的学校教室中进行干预，教授五种主要中风症状，当它们出现时的正确行动方案，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“嘻哈中风”（HHS）的项目，该项目由中风说唱歌曲和两个包含中风知识的音乐动画组成。我们发现，9-11岁的孩子可以快速学习这些信息，并能很好地记住这些信息至少2年。最近的一项试点研究表明，74%的试点儿童（N=182）与父母交流了这些材料，这种交流显著提高了父母对中风的认识。在小样本中证明了卫生与公众服务部干预的有效性后，我们现在提议进行一项随机对照试验，以测试儿童能够并且愿意在高风险、经济弱势、少数民族人群中教育父母或成年照顾者有关中风的可能性，以及父母回忆转移知识的能力。利用儿童作为“传播媒介”开展针对其父母的干预措施，有可能成为健康饮食和减肥等任何其他领域干预措施的基础。因此，拟议试验的意义在于解决正在研究的公共卫生问题——中风症状的识别和反应——以及发展和完善更一般的干预模式。

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.