Jamie Cage

Stroke Recovery and Prevention Barriers Among Young African- American Men: Potential Avenues to Reduce Health Disparities

Abstract Background: African Americans (AAs) who experience a first time stroke are younger and have double the stroke rate and more poststroke complications than other Americans. Objective: To assess perceived poststroke care barriers among younger AA men and their care partners (CPs) in order to inform the development of acceptable and effective improvements in poststroke care for this high-risk group. Methods: Ten community-dwelling AA stroke survivors and 7 of their CPs participated in focus groups and advisory board meetings. Survivors had stroke or transient ischemic attack within 1 year and a Barthel Index score >60. In focus groups, using a semi-structured interview guide, survivors and CPs identified self-perceived barriers and facilitators to poststroke care. Thematic analysis of session transcripts and the constant comparative method were used to generate themes. Results: Survivor age ranged from 34 to 64 years. Mean Barthel score was 95.5. CPs, all AA women, ranged in age from 49 to 61 years. Five CPs were wives, 1 was a fiancée, and 1 was a niece. Participants cited multiple personal, social, and societal stroke recovery challenges. Although hypertension and smoking risks were acknowledged, stress, depression, posttraumatic stress disorder, anger/frustration, personal identity change, and difficulty communicating unique needs as AA men were more frequently noted. Facilitators included family support, stress reduction, and dietary changes. Conclusions: Younger AA men and their CPs perceive multiple poststroke care barriers. Biological risk reduction education may not capture all salient aspects of health management for AA stroke survivors. Leveraging family and community strengths, addressing psychological health, and directly engaging patients with health care teams may improve care management.

A Targeted Self-Management Approach for Reducing Stroke Risk Factors in African American Men Who Have Had a Stroke or Transient Ischemic Attack:

Purpose: This study compared a novel self-management (TargetEd MAnageMent Intervention [TEAM]) versus treatment as usual (TAU) to reduce stroke risk in African American (AA) men. Design: Six-month prospective randomized controlled trial with outcomes evaluated at baseline, 3 months, and 6 months. Setting: Academic health center. Participants: Thirty-eight (age < 65) AA men who had a stroke or transient ischemic attack and a Barthel index score of >60 were randomly assigned to TEAM (n = 19) or TAU (n = 19). Intervention: Self-management training, delivered in 1 individual and 4 group sessions (over 3 months). Measures: Blood pressure, glycosylated hemoglobin (HbA1c), lipids, medication adherence, weight, and standardized measures of health behaviors (diet, exercise, smoking, substances), depression, and quality of life. Qualitative assessments evaluated the perspectives of TEAM participants. Analysis: T tests for paired differences and nonparametric tests. Thematic content qualitative analysis. Results: Mean age was 52.1 (standard deviation [SD] = 7.4) and mean body mass index was 31.4 (SD = 7.4). Compared to TAU, TEAM participants had significantly lower mean systolic blood pressure by 24 weeks, and there was also improvement in HbA1c and high-density lipoprotein cholesterol (P = .03). Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.

Barriers and facilitators to epilepsy self-management for patients with physical and psychological co-morbidity

Objectives This exploratory study identifies barriers and facilitators to self-management to inform future epilepsy self-management interventions for persons who have epilepsy complicated by co-morbid mental health conditions and serious medical events. Methods Focus group methods were used in a series of community advisory board meetings. Analysis was conducted using a thematic, constant comparative approach aiming to describe the range of barriers and facilitators salient to participants. There were a total of 22 participants, including 8 health professionals, 9 patients with epilepsy, and 5 care partners. Mean age was 49.1 (SD = 11.0, range 32–69), 11 (50%) were female, and 11 (50%) were male. For those with epilepsy, mean years having epilepsy was 24.7 (SD = 19.9, range 1–58 years). Results Individual psychological barriers (mental illness, fatigue, and psychological distress) prominently interfered with health behaviors. Community and family barriers included stigma, lack of epilepsy knowledge, and poor social support. Facilitators included planning for seizures, learning about medications, stress management, socializing with others, and talking with other epilepsy patients. Discussion Qualitative evidence in this study suggests a linkage between social integration and positive health behaviors. Future efforts to embed patients with epilepsy and their caregivers into clinical care processes could offset barriers and enhance facilitators.

Using focus groups to inform the development of stroke recovery and prevention programs for younger African-American (AA) men

Abstract Objective: To assess perceived facilitators and recommendations for stroke recovery and prevention among younger African-American (AA) men (age < 65 years) in order to inform the development and pilot testing of an intervention for this high-risk group. Methods: Focus group methodology was used to collect data from 10 community-dwelling AA stroke survivors and seven of their care partners (CPs) (N = 17). Thematic analysis of session transcripts and the constant comparative method were used to generate themes. Results: Participants cited facilitators to post-stroke care and recovery as Family Support, Stress Reduction, and Dietary Changes. Specific person-level recommendations for AA men included following established stroke guidelines, use of complementary and alternative medicine, and never give up recovery efforts. Community-level recommendations included making a list of community resources available, providing support and education to care partners, using videos that feature AA men to deliver information and use AA men stroke survivors to help disseminate the information. Provider and health system recommendations included consolidation of medical bills, improving provider communication skills, and making providers aware of needs specific to AA men and their families. Conclusions: While AA men and their CPs acknowledged and welcomed learning more about the American Health Association Stroke Prevention Guidelines, it is clear that they desired approaches that addressed their specific needs and preferences as young AA men who sometimes felt de-valued by their community and care providers. Specific person, community and care-system level approaches that are of perceived value to AA men offer potential to improve health outcomes and reduce health disparities.

Barriers Experienced by Kinship and Non-Relative Caregivers During the Foster and Adoptive Parent Licensure and Home Study Process

The shortage of foster/adoptive parents being licensed to care for children in the public welfare system prompted an evaluation of the Licensure and Home Study Process (LHSP). Ecological systems theory framed the barriers-to-resources interplay among kinship and non-relative caregivers who withdrew or completed the LHSP. This mixed-methods study examined differences in applicant characteristics and types of barriers experienced. Results indicated that applicants responsible for other children in the home paired with welfare system barriers served as a tipping point for withdrawal. Relatives encountered the most barriers and all grandparents withdrew from the LHSP prior to licensure.

Health Literacy (HL) & Health-Related Quality of Life (HRQL) Among Minority Men

Health literacy remains a key factor in the continuance of health disparities in our society as health related quality of life can be negatively affected by limited health literacy. This study explores how limited health literacy among minority men, attending a community health fair, correlates with their health related quality of life. Findings reflect that minority men who possess lower levels of health literacy experience lower self-reported quality of life. Directions for healthcare providers, community health educators and future research approaches are provided.