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Stroke Education Campaigns Are Not Working

NEW ORLEANS, Feb 15 (Reuters Health) - A survey of people residing in the particular region of the US Stroke Belt with the highest incidence of stroke — the so-called Stroke Belt Buckle — shows that intensive educational campaigns in the area have had little effect. The level of awareness of signs and symptoms of stroke, risk factors and actions to take during stroke remain at a very low level.

The Stroke Belt Buckle is a term coined by Dr. George Howard who showed a few years ago that residents along the coastal plains of North Carolina, South Carolina and Georgia have a higher incidence of stroke than other residents of the Stroke Belt, which runs along the southeastern United States.

Dr. Mark Alberts of Duke University in Durham, North Carolina, reported here at the 25th international conference on Stroke of the American Stroke Association that a survey of 300 individuals in three North Carolina cities showed that only 29% knew that numbness, weakness or paralysis were symptoms of stroke. Only 42% would call 911 if these symptoms were present.

Dr. Alberts said that 24% identified hypertension as a risk factor for stroke but that only 3% knew that treatment of hypertension lowered stroke risk, 23% identified a poor diet as a stroke risk factor and only 16% knew that smoking is a risk factor for stroke. Dr. Alberts said that the findings were particularly notable in that 77% of those surveyed had a friend or family member who had had a stroke.

"About 60 to 70% indicated that they would go to their physician for information on stroke," Dr. Alberts said, but he noted that with the growing influence of managed care on the practice of medicine, a visit could last less than 10 minutes — not enough time to provide adequate education on stroke.

"Many of the subjects identified stress as a risk factor for stroke, although there are no epidemiological studies to show this," Dr. Alberts told Reuters Health. This area has been the focus of widespread stroke education campaigns.

Stroke education needs to be tailored to specific groups of people, Dr. Charlotte A. Pratt of the Michigan Public Health Institute in Okemos asserted. Her study consisted of 50 African Americans in the Henry Ford Health System, in Detroit, who participated in focus groups conducted to assess their knowledge of stroke awareness and stroke management. The average age of the group was 60 to 79. Maximum score possible on the stroke awareness survey was 26. Mean score in this group was 10.

"Most, while they show they know something about strokes, have a very low knowledge of risk factors," Dr. Pratt reported. She identified specific barriers to profiting from stroke education campaigns--low education and older age. Subjects in this study also identified lack of willpower in choosing a healthy diet and a stressful environment as barriers to reducing risk factors, Dr. Pratt told Reuters Health.

Most participants named their physician as their preferred provider of stroke education, which suggested to the Detroit team that a hospital-based program might be the most effective. Most respondents also indicated a preference for a group setting for education, rather than a one-on-one approach — except in the area of nutrition counseling.

Identification of barriers to education can aid the healthcare provider in tailoring the message to a specific audience, Dr. Pratt commented.

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