Tailored Approaches to Stroke Health Education

Stroke is the leading cause of adult disability and costs U.S. taxpayers >$60 billion
annually. Interventions designed to educate patients to seek treatment sooner when a stroke
occurs may increase low rates of treatment with thrombolysis (current rates 3% national
average). Thrombolysis can increase the odds of minimal to zero disability from stroke if
emergency medical system response times and in-hospital response times are optimized (maximum
time from symptom onset to intravenous thrombolysis is 4.5 hours). Black and Hispanic
Americans have higher stroke incidence compared to Whites and are less likely to receive
thrombolysis for acute stroke. The latency to hospital arrival is largely dependent on
patients' recognition of stroke symptoms, and immediate presentation to the emergency
department. Our group has found very low stroke literacy rates among Blacks and Hispanics
compared to Whites, which may, in part, be responsible for disparities in acute stroke
treatment.

Inclusion Criteria:

1. No prior history of stroke;

2. High risk (defined as a history of one or more stroke risk factor (HTN, diabetes,
tobacco, abdominal obesity, heart disease, high cholesterol);

3. Over age 34 years at onset of intervention (we have selected this age cut off due to
the large increase in stroke incidence among minority groups at age 34 );

4. Self-identified as Black or Hispanic; and

5. Member of a church congregation who lives in a household with a telephone.

Exclusion Criteria:

1. Participant is unable to give consent;

2. A modified Rankin score > 4 at baseline;

3. history of dementia; and

4. terminal illness, or other medical illness resulting in mortality < 1 year.