Community Outreach for Stroke Education
2008; Lippincott Williams & Wilkins; Volume: 39; Issue: 8 Linguagem: Inglês
10.1161/strokeaha.108.515734
ISSN1524-4628
Autores Tópico(s)Stroke Rehabilitation and Recovery
ResumoHomeStrokeVol. 39, No. 8Community Outreach for Stroke Education Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBCommunity Outreach for Stroke Education Corinne Hodgson, MA, MSc Corinne HodgsonCorinne Hodgson From CSH Associates Inc, Burlington, Ontario, Canada. Originally published19 Jun 2008https://doi.org/10.1161/STROKEAHA.108.515734Stroke. 2008;39:2189–2190Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 19, 2008: Previous Version 1 See related article, pages 2331–2335.Educating the public on the warning signs of stroke is considered a critical part of the chain of survival and of better stroke care.1 Repeated studies have demonstrated that high-risk groups, such as the elderly, minority groups, or those of low socioeconomic status, often have the poorest knowledge of stroke warning signs.2–4 Although mass media can be a powerful tool in stroke public education,5 it is not without its limitations. To be effective, mass media needs adequate reach and frequency to break through the advertising "clutter"—which requires significant and sustained funding. Moreover, the ability of mass media to target specific high-risk subgroups, whether ethnic, socioeconomic, or linguistic, is unclear.In this issue of Stroke, Kleindorfer et al6 describe a community-based project in which beauticians were used to deliver stroke education to black women, a group at increased risk of stroke. Community settings, such as churches, barber shops, and beauty salons, have been used to deliver a variety of health promotion programs in the United States, particularly among black and Latino populations.7–11 Thus, although the Beauty Shop Stroke Education Project (BSSEP) may be unique to the field of stroke prevention, it is rooted in a growing discipline of community-based, participatory health promotion and research.Like many community-based projects, the BSSEP is rooted in the Health Belief Model (HBM), one of the most widely used conceptual frameworks in health promotion and health behavior research. The HBM focuses in large part on people's perceptions, such as their perceived susceptibility to diseases, the seriousness of the target condition and its sequelae, and the barriers to, and benefits of, taking action.12 Because these are perceptions and thus inherently subjective, they require an understanding of how individuals acquire and use beliefs about health and the dynamics of human behavior, approaches characteristic of medical anthropology.13Community-based health promotion requires flexibility and a willingness to listen on the part of investigators; an "ivory tower" approach does not work. For instance, Kleindorfer et al describe how investigators had to recode data when discussions with the beauty shop operators helped them to understand that a response of "sugar" was actually a reference to diabetes. Researchers and those delivering programs must spend time in the target setting, learning about the physical and social environments.14 And, perhaps most importantly, collaboration is needed to ensure that researchers and participants share a similar vision of the program goals and priorities, particularly in light of other pressing community concerns and challenges.15The anthropological or ethnographic nature of community-based, participatory research can pose a challenge to publication in mainstream clinical journals. Those trained in, or used to, the methodological rigors of clinical trials can view the convenience samples and self-selecting nature of community-based projects as weak or even flawed. Mechanisms such as strict randomization, control groups and blinding can be difficult, if not impossible, to implement. Furthermore, as noted by Kleindorfer et al, privacy regulations have in some respects added to the challenges of collecting and analyzing data in community settings.Despite the challenges, it is important that projects such as the BSSEP be implemented, evaluated, and communicated among people working in the area of stroke public education. Although the BSSEP is labor-intensive, it does not require the funding commitment of large-scale mass media campaigns (which can run in the millions of dollars). As such, it may offer a viable alternative for local-level programming, one that not only educates members of high-risk groups but actively engages them in the health promotion process.In planning such programs, health promoters and investigators must not only adapt a participatory mentality but think carefully about what messages are most appropriate. For example, Kleindorfer et al report that even though their program significantly increased knowledge of the warning signs of stroke (particularly for the mnemonic FAST) it had no effect on knowledge of stroke risk factors, suggesting that this approach may be more effective for some types of messages than for others. In short, community-based, participatory health promotion may not constitute a "silver bullet" for all types of stroke messaging. However, it is encouraging to have yet another option within our arsenal of stroke education programs.The opinions in this editorial are not necessarily those of the editors or of the American Heart Association.DisclosuresNone.FootnotesCorrespondence to Corinne Hodgson, MA, MSc, CSH Associates Inc, 378 Melores Drive, Burlington, ON, Canada L7L 4T8. E-mail [email protected] References 1 Suyama J, Crocco T. Prehospital care of the stroke patient. Emerg Med Clin North Am. 2002; 20: 537–552.CrossrefMedlineGoogle Scholar2 Nicol MB, Thrift AG. Knowledge of risk factors and warning signs of stroke. Vasc Health Risk Manag. 2005; 1: 137–147.CrossrefMedlineGoogle Scholar3 Pancioli AM, Borderick J, Kothari R, Brott T, Tuchfarber A, Miller R, Khoury J, Jauch E. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998; 279: 1288–1292.CrossrefMedlineGoogle Scholar4 Reeves MJ, Hogan JG, Rafferty AP. Knowledge of stroke risk factors and warning signs among Michigan adults. Neurology. 2002; 59: 1547–1552.CrossrefMedlineGoogle Scholar5 Hodgson C, Lindsay P, Rubini F. Can mass media influence emergency department visits for stroke? Stroke. 2007; 48: 2115–2122.Google Scholar6 Kleindorfer D, Miller R, Sailor-Smith S, Moomaw CJ, Khoury J, Frankel M. The challenges of community-based research: The Beauty Shop Stroke Education Project. Stroke. 2008; 39: 2331–2335.LinkGoogle Scholar7 Boltri JM, Davis-Smith M, Zayas LE, Shellenberger S, Seale JP, Blalock TW, Mbadinuju A. Developing a church-based diabetes prevention program with African Americans: focus group findings. The Diabetes Educator. 2006; 32: 901–909.CrossrefMedlineGoogle Scholar8 Sauaia A, Min S, Lack D, Apodaca C, Osuna D, Stoew A, McGinnis GF, Latts LM, Byers T. Church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans. Prev Chronic Dis. 2007; 4: A99.MedlineGoogle Scholar9 Hart A Jr, Bowen DJ. The feasibility of partnering with African-Am barbershops to provide prostate cancer education. Ethn Dis. 2004; 14: 269–273.MedlineGoogle Scholar10 Sadler GR, Ko CM, Cohn JA, White M, Weldon R, Wu P. Breast cancer knowledge, attitudes, and screening behaviors among African Am women: the Black cosmetologists promoting health program. BMC Public Health. 2007; 7: 57.CrossrefMedlineGoogle Scholar11 Linnan LA, Ferguson YO, Wasilewski Y, Lee AM, Yang J, Solomon F, Katz M. Using community-based participatory research methods to reach women with health messages: results from the North Carolina BEAUTY and Health pilot project. Health Promot Pract. 2005; 6: 164–173.CrossrefMedlineGoogle Scholar12 Janz NK, Champion VL, Strecher VJ. The Health Belief Model. In: Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education, Theory, Research and Practice. San Francisco, Calif: John Wiley & Sons; 2002.Google Scholar13 Dunn FL, Janes CR. Introduction: medical anthropology and epidemiology. In: Janes CR, Stall R, Gifford SM, eds. Anthropology and Epidemiology. Dordrecht, The Netherlands: D. Reidel Publishing Company; 1986.Google Scholar14 Solomon FM, Linnan LA, Wasilewski Y, Lee AM, Katz ML, Yang J. Observational study in ten beauty salons: results informing development of the North Carolina BEAUTY and Health Project. Health Education & Behavior. 2004; 6: 790–807.Google Scholar15 Merzel C, A'Affitti J. Reconsidering community-based health promotion: promise, performance, and potential. Am J Public Health. 2003; 93: 557–574.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Feigin V, Norrving B, George M, Foltz J, Roth G and Mensah G (2016) Prevention of stroke: a strategic global imperative, Nature Reviews Neurology, 10.1038/nrneurol.2016.107, 12:9, (501-512), Online publication date: 1-Sep-2016. O'Callaghan G, Murphy S, Loane D, Farrelly E and Horgan F (2012) Stroke Knowledge in an Irish Semi-Rural Community-Dwelling Cohort and Impact of a Brief Education Session, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2011.02.006, 21:8, (629-638), Online publication date: 1-Nov-2012. August 2008Vol 39, Issue 8 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.108.515734PMID: 18566301 Originally publishedJune 19, 2008 Keywordswarning signshealth promotionpublic educationPsych & BehaviorPDF download Advertisement
Referência(s)