RCT: Effect of Novel Intervention to Improve Stroke Symptom Recognition

描述(申请人提供)：在美国，中风是导致成人长期严重残疾的首要原因，也是导致死亡的第三大原因，黑人的发病率是大多数美国人的两倍。在症状出现后最多3小时内进行溶栓治疗可以降低发病率、死亡率和费用；然而，只有3%的患者在3小时内到达医院，主要是因为公众缺乏对中风症状的了解，以及当他们被识别时的适当反应，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，以提高高危、少数民族、经济困难人群的症状识别和反应。为此，昂贵的大众媒体中风教育活动是不可持续的，特别是在经济困难的人群中。相反，我们建议对9至11岁儿童的学校教室进行干预，教授中风的五大症状，当它们发生时正确的行动方案，并强调提前到达医院的潜在治疗益处，目的是让儿童随后教育他们的父母。为了帮助实现这一点，我们开发了一个名为Hip Hop Stroke(HHS)的程序，该程序由笔划说唱歌曲和两个融入笔画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这些信息，并至少保持两年的时间。最近的一项先导性研究显示，在先导性研究中(N=182)，74%的儿童与父母沟通材料，这种沟通显著提高了父母的中风识字能力。在小样本中证明了HHS干预的有效性后，我们现在提议进行一项随机对照试验，以测试儿童能够并将在高危、经济困难的少数群体中教育父母或成年照顾者中风的可能性，以及父母回忆所转移知识的能力。利用儿童作为针对其父母的干预措施的“传播媒介”，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--以及开发和改进更一般的干预模式。 与公共卫生相关：曾零星尝试以儿童为目标与其父母进行干预，但几乎没有取得成功的报告。我们的模型利用儿童作为“传播媒介”，对高危社区中的父母和祖父母进行干预，在这种情况下与中风有关。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--以及开发和改进更一般的干预模式。

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.