Kathleen M. Conley

A Randomized, Controlled Trial to Teach Middle School Children to Recognize Stroke and Call 911 The Kids Identifying and Defeating Stroke Project

Background and Purpose— Underutilization of acute stroke therapy is driven by delay to hospital arrival. We present the primary results of a pilot, randomized, controlled trial to encourage calling 911 for witnessed stroke among middle school children and their parents. Methods— This project occurred in Corpus Christi, an urban Texas community of 325 000. Three intervention and 3 control schools were randomly selected. The intervention contained 12 hours of classroom instruction divided among sixth, seventh, and eighth grades. Parents were educated indirectly through homework assignments. Two-sample t tests were used to compare pretest and posttest responses. Results— Domain 1 test questions involved stroke pathophysiology. Intervention students improved from 29% to 34% correct; control students changed from 28% to 25%. Domain 2 test questions involved stroke symptom knowledge. Intervention school students changed from 28% correct to 43%; control school students answered 25% correctly on the pretest and 29% on the posttest. Domain 3 test questions involved what to do for witnessed stroke. Intervention school students answered 36% of questions correctly on the pretest and 54% correctly on the posttest, whereas control students changed from 32% correct to 34%. A comparison of change in the mean proportion correct over time between intervention and control students was P<0.001 for each of the 3 individual domains. A poor parental response rate impaired the ability to assess parental improvement. Conclusions— A scientific, theory-based, educational intervention can potentially improve intent to call 911 for stroke among middle school children. A different mechanism is needed to effectively diffuse the curriculum to parents.

Stroke Health and Risk Education (SHARE) Pilot Project Feasibility and Need for Church-Based Stroke Health Promotion in a Bi-Ethnic Community

Background and Purpose— We performed a pilot project to assess the need for and feasibility of a church-based stroke risk reduction intervention in a predominantly Mexican American community. Methods— Participants were recruited after each mass on a single weekend from 2 Catholic churches in Corpus Christi, Texas. Questionnaires about personal stroke risk factors and interest in program participation were completed, and blood pressure screening was performed. Results— A total of 150 individuals participated (63% Mexican American, median age 62). A substantial majority (84%) were interested in being part of a long-term church-based health education project. Blood pressure was >139/89 mm Hg in 50 of 78 (64%) of individuals with a self-reported history of hypertension, and in 17 of 69 (25%) of individuals without known hypertension, with no ethnic differences in blood pressure. Mexican Americans were younger, had a higher BMI, and were more likely to have diabetes than non-Hispanic whites. Conclusions— There is substantial burden of stroke risk factors in these predominantly Mexican American church communities. Church-based health interventions may be a way to reduce stroke in this at-risk population.

Stroke Health and Risk Education (SHARE): Design, methods, and theoretical basis

BACKGROUND Stroke is a disease with tremendous individual, family, and societal impact across all race/ethnic groups. Mexican Americans, the largest subgroup of Hispanic Americans, are at even higher risk of stroke than European Americans. AIM To test the effectiveness of a culturally sensitive, church-based, multi-component, motivational enhancement intervention for Mexican Americans and European Americans in reducing stroke risk factors. METHODS Participants enroll in family or friendship pairs, from the same Catholic church in the Corpus Christi Texas area, and are encouraged to change diet and physical activity behaviors and provide support for behavior change to their partners. Churches are randomized to either the intervention or control group. Goal enrollment for each of the 10 participating churches is 40 participant pairs. The intervention consists of self-help materials (including a motivational short film, cookbook/healthy eating guide, physical activity guide with pedometer, and photonovella), five motivational interviewing calls, two tailored newsletters, parish health promotion activities and environmental changes, and a peer support workshop where participants learn to provide autonomy supportive counseling to their partner. SHAREs three primary outcomes are self-reported sodium intake, fruit and vegetable intake, and level of physical activity. Participants complete questionnaires and have measurements at baseline, six months, and twelve months. Persistence testing is performed at 18 months in the intervention group. The trial is registered with clinicaltrials.gov (NCT01378780).

A Multicomponent Behavioral Intervention to Reduce Stroke Risk Factor Behaviors: The Stroke Health and Risk Education Cluster-Randomized Controlled Trial.

Background and Purpose— The Stroke Health and Risk Education Project was a cluster-randomized, faith-based, culturally sensitive, theory-based multicomponent behavioral intervention trial to reduce key stroke risk factor behaviors in Hispanics/Latinos and European Americans. Methods— Ten Catholic churches were randomized to intervention or control group. The intervention group received a 1-year multicomponent intervention (with poor adherence) that included self-help materials, tailored newsletters, and motivational interviewing counseling calls. Multilevel modeling, accounting for clustering within subject pairs and parishes, was used to test treatment differences in the average change since baseline (ascertained at 6 and 12 months) in dietary sodium, fruit and vegetable intake, and physical activity, measured using standardized questionnaires. A priori, the trial was considered successful if any one of the 3 outcomes was significant at the 0.05/3 level. Results— Of 801 subjects who consented, 760 completed baseline data assessments, and of these, 86% completed at least one outcome assessment. The median age was 53 years; 84% subjects were Hispanic/Latino; and 64% subjects were women. The intervention group had a greater increase in fruit and vegetable intake than the control group (0.25 cups per day [95% confidence interval: 0.08, 0.42], P=0.002), a greater decrease in sodium intake (−123.17 mg/d [−194.76, −51.59], P=0.04), but no difference in change in moderate- or greater-intensity physical activity (−27 metabolic equivalent–minutes per week [−526, 471], P=0.56). Conclusions— This multicomponent behavioral intervention targeting stroke risk factors in predominantly Hispanics/Latinos was effective in increasing fruit and vegetable intake, reaching its primary end point. The intervention also seemed to lower sodium intake. Church-based health promotions can be successful in primary stroke prevention efforts. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01378780.

Kids Identifying and Defeating Stroke (KIDS): Development and Implementation of a Multiethnic Health Education Intervention to Increase Stroke Awareness Among Middle School Students and Their Parents

The Kids Identifying and Defeating Stroke (KIDS) project is a 3-year prospective, randomized, controlled, multiethnic school-based intervention study. Project goals include increasing knowledge of stroke signs and treatment and intention to immediately call 911 among Mexican American (MA) and non-Hispanic White (NHW) middle school students and their parents. This article describes the design, implementation, and interim evaluation of this theory-based intervention. Intervention students received a culturally appropriate stroke education program divided into four 50-minute classes each year during the sixth, seventh, and eighth grades. Each class session also included a homework assignment that involved the students’ parents or other adult partners. Interim-test results indicate that this educational intervention was successful in improving students’ stroke symptom and treatment knowledge and intent to call 911 upon witnessing a stroke compared with controls. The authors conclude that this school-based educational intervention to reduce delay time to hospital arrival for stroke shows early promise.

Coping strategies used in residential hospice settings: Findings from a national study

The purpose of this study was to explore professional caregivers’ coping strategies for dealing with the deaths of patients in residential hospices in the United States. Using the Guide to the Nation’s Hospices, 1996-97, purely residential hospices were identified and invited to participate in the study. Employees at each residential hospice were asked to complete the Ways of Coping Questionnaire. Results indicated that positive reappraisal coping was the most frequently used coping strategy. Employees dissatisfied with the coping experience reported greater use of confrontive coping, escape-avoidance coping, and accepting responsibility strategies. The findings suggest that in-service training related to coping strategies and environmental interventions may help in strengthening the coping responses of residential hospice staff.

A Multicomponent Behavioral Intervention to Reduce Stroke Risk Factor Behaviors

Background and Purpose— The Stroke Health and Risk Education Project was a cluster-randomized, faith-based, culturally sensitive, theory-based multicomponent behavioral intervention trial to reduce key stroke risk factor behaviors in Hispanics/Latinos and European Americans. Methods— Ten Catholic churches were randomized to intervention or control group. The intervention group received a 1-year multicomponent intervention (with poor adherence) that included self-help materials, tailored newsletters, and motivational interviewing counseling calls. Multilevel modeling, accounting for clustering within subject pairs and parishes, was used to test treatment differences in the average change since baseline (ascertained at 6 and 12 months) in dietary sodium, fruit and vegetable intake, and physical activity, measured using standardized questionnaires. A priori, the trial was considered successful if any one of the 3 outcomes was significant at the 0.05/3 level. Results— Of 801 subjects who consented, 760 completed baseline data assessments, and of these, 86% completed at least one outcome assessment. The median age was 53 years; 84% subjects were Hispanic/Latino; and 64% subjects were women. The intervention group had a greater increase in fruit and vegetable intake than the control group (0.25 cups per day [95% confidence interval: 0.08, 0.42], P=0.002), a greater decrease in sodium intake (−123.17 mg/d [−194.76, −51.59], P=0.04), but no difference in change in moderate- or greater-intensity physical activity (−27 metabolic equivalent–minutes per week [−526, 471], P=0.56). Conclusions— This multicomponent behavioral intervention targeting stroke risk factors in predominantly Hispanics/Latinos was effective in increasing fruit and vegetable intake, reaching its primary end point. The intervention also seemed to lower sodium intake. Church-based health promotions can be successful in primary stroke prevention efforts. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01378780.

Marketing Health Educators to Employers: Survey Findings, Interpretations, and Considerations for the Profession

In July 2007, a market research report was produced by Hezel Associates on behalf of five sponsoring health education profession member organizations and the National Commission for Health Education Credentialing. The purpose of the survey was to learn about current or potential employers’ knowledge, attitudes, and behaviors toward health educators and the health education profession and their future hiring practices. This article presents the background leading up to the production of this report, the major findings of the survey of employers, recommendations from the market research group regarding core messages, and implications for the profession having discovered for the first time information about employers’ understanding of professionally prepared health educators. The article discusses the umbrella and key messages that may be incorporated into a marketing plan and other recommendations by the firm that should assist health educators in marketing the profession. Furthermore, this article presents reactions by leaders in this field to these messages and recommendations and concludes with next steps in this project and a call for the overall need to market the profession of health education.

The Association between Changes in Behavioral Risk Factors for Stroke and Changes in Blood Pressure

BACKGROUND High blood pressure (BP) is the leading risk factor for stroke. Data on the association of physical activity (PA), fruit and vegetable (F&V) consumption, and dietary sodium with hypertension are lacking in Hispanic communities. In the current report, we provide data on the association between changes in these stroke behavioral risk factors and BP change. METHODS Participants were recruited from participating Catholic churches in Nueces County, Texas. BP was measured, and self-reported validated scales of F&V consumption, dietary sodium, and PA were collected at baseline and at 12 months. Linear mixed models were used to examine the associations between tertiles of improvement in the 3 behavior outcomes and BP change, adjusted for demographic characteristics. The association between the binary measure of at least 5 mmHg diastolic blood pressure (DBP) or 10 mmHg systolic blood pressure (SBP) reduction and behavior change was estimated with multilevel logistic regression models. RESULTS Of 586 participants, 66% were female and 82% were Mexican American (MA), and the mean age was 54 years. High compared with low change in PA was significantly associated with DBP change (P = .022), and high compared with low change in F&V intake was significantly associated with SBP change (P = .032). For the binary changes in DBP or SBP, there was a borderline association of PA (P = .054); all other variables were not associated (P > .10). CONCLUSIONS PA and F&V consumption are potential stroke prevention targets in predominantly MA populations.

A multicomponent behavioral intervention to reduce stroke risk factor behaviors: The SHARE Cluster-Randomized Controlled Trial

Background and Purpose— The Stroke Health and Risk Education Project was a cluster-randomized, faith-based, culturally sensitive, theory-based multicomponent behavioral intervention trial to reduce key stroke risk factor behaviors in Hispanics/Latinos and European Americans. Methods— Ten Catholic churches were randomized to intervention or control group. The intervention group received a 1-year multicomponent intervention (with poor adherence) that included self-help materials, tailored newsletters, and motivational interviewing counseling calls. Multilevel modeling, accounting for clustering within subject pairs and parishes, was used to test treatment differences in the average change since baseline (ascertained at 6 and 12 months) in dietary sodium, fruit and vegetable intake, and physical activity, measured using standardized questionnaires. A priori, the trial was considered successful if any one of the 3 outcomes was significant at the 0.05/3 level. Results— Of 801 subjects who consented, 760 completed baseline data assessments, and of these, 86% completed at least one outcome assessment. The median age was 53 years; 84% subjects were Hispanic/Latino; and 64% subjects were women. The intervention group had a greater increase in fruit and vegetable intake than the control group (0.25 cups per day [95% confidence interval: 0.08, 0.42], P=0.002), a greater decrease in sodium intake (−123.17 mg/d [−194.76, −51.59], P=0.04), but no difference in change in moderate- or greater-intensity physical activity (−27 metabolic equivalent–minutes per week [−526, 471], P=0.56). Conclusions— This multicomponent behavioral intervention targeting stroke risk factors in predominantly Hispanics/Latinos was effective in increasing fruit and vegetable intake, reaching its primary end point. The intervention also seemed to lower sodium intake. Church-based health promotions can be successful in primary stroke prevention efforts. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01378780.