Abstract NS1: Mobile Health Technology Is Feasible And Effective For Self-management Support Among Underserved Stroke Survivors

Background and Purpose: Self-management Support (SMS) helps stroke survivors control risk factors to prevent second stroke. Little is known about feasibility and effectiveness of using mobile health technology (MHT) for SMS among underserved stroke survivors. The investigators studied feasibility and effectiveness of using a video teleconference mobile application to deliver a SMS program to underserved, hard to reach stroke survivors. Methods: The Video teleconference Self-management TO Prevent stroke (V-STOP) program was evaluated using longitudinal design with measurements at baseline, immediately post intervention (6 weeks), intermediate (12 weeks), and at study end (18 weeks). Medically underserved stroke survivors with uncontrolled stroke risk factors were included. Feasibility was assessed as time in intervention, telehealth satisfaction, stroke knowledge and SMS effectiveness were measured as psychological (depression, PHQ-8; anxiety, GAD-7), social (community integration questionnaire), and stroke self-management (goal attainment) outcomes. Generalized estimating equations were used with site and time in intervention as covariates. Results: V-STOP was successfully delivered to 106 participants using MHT over 2 years. Mean age was 59.3 (±10.9), majority were white (82.1%), males (54.3%), not living alone (85.9%), married (52.8%), with low annual income (<$25,000) ( 58.5%), and health insurance (59.4%). Program feasibility indicated mean number of V-STOP sessions were 4.6 (±1.8), with 4.4 (±2.0) hours of total time for the intervention. Overall satisfaction at 6 weeks with V-STOP (4.8(±0.5)) and telehealth (4.7(±0.5)) was high. Stroke knowledge was high at 12 weeks (9.6(±0.7)). SMS effectiveness indicated improvement in psychological outcomes at 6, 12, and 18 weeks from baseline; depression (18 weeks - β = 0.64 (CI 0.49-0.84)) and anxiety (18 weeks - β = 0.66 (CI 0.51-0.85)). Community integration improved by 18 weeks - β = 1.08 (CI 1.01-1.16) and stroke self-management also improved long term at 12 and 18 weeks (β = 0.92 (CI 0.84-0.99). Conclusion: MHT is feasible to deliver SMS to underserved stroke survivors. It improves psycho-social and self-management goal setting and goal attainment outcomes.

Music to My Ears: Developing Kanji Stroke Knowledge through an Educational Music Game

Millions of people worldwide are taking up foreign languages with logographic writing systems, such as Japanese or Chinese. Learning thousands of characters necessary for literacy in those languages is a unique challenge to those coming from alphabetic backgrounds, and sustaining motivation in the face of such a momentous task is a struggle for many students. Many games exist for this purpose, but few offer production memory practice such as writing, and the vast majority are thinly veiled flashcards. To address this gap, we created Radical Tunes—a musical kanji-writing game—which combines production practice with musical mnemonic by assigning a melody to each element of a character. We chose to utilize music as it is a powerful tool that can be employed to enhance learning and memory. In this article, we explore whether incorporating melodies into a kanji learning game can positively affect the memorization of the stroke order/direction and overall shape of several Japanese characters, similar to the mnemonic effect of adding music to text. Specifically, we conducted two experimental studies, finding that (1) music improved immersion—an important factor related to learning; and (2) there was a positive correlation between melody presence and character production, particularly for more complex characters.

Disparities in Awareness of Myocardial Infarction and Stroke Symptoms and Response Among United States– and Foreign‐Born Adults in the National Health Interview Survey

Background Atherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States. MI and stroke symptom awareness and response reduce delays in hospitalization and mortality. Methods and Results We analyzed cross‐sectional data from the 2014 and 2017 National Health Interview Surveys on US‐ and foreign‐born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). The outcomes were recommended MI and stroke knowledge, defined as knowing all 5 symptoms of MI or stroke, respectively, and choosing “call 9‐1‐1” as the best response. We included 63 059 participants, with a mean age 49.4 years; 54.1% were women, and 38.5% had a high school education or less. Recommended MI and stroke knowledge were highest in US‐born people. In both 2014 and 2017, MI knowledge was lowest in individuals born in Asia (23.9%±2.5% and 32.1%±3.3%, respectively), and stroke knowledge lowest for the Indian subcontinent (44.4%±2.4% and 46.0%±3.2%, respectively). Among foreign‐born adults, people from Russia and Europe had the highest prevalence of recommended MI knowledge in 2014 (37.4%±5.4%) and 2017 (43.5%±2.5%), respectively, and recommended stroke knowledge was highest in people from Europe (61.0%±2.6% and 67.2%±2.5%). Improvement in knowledge was not significant in all groups between 2014 and 2017. Conclusions These findings suggest a disparity in MI and stroke symptom awareness and response among immigrants in the United States. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.

The Stroke Knowledge Assessment Tool (SKAT): Development, Reliability and Validity

The purpose of the study was to develop and test the psychometric properties of a stroke knowledge assessment tool based on a mixed-methods approach and a synthesis of the relevant literature on stroke. The content of the tool was predominantly developed by the findings from a qualitative study involving ten stroke patients who had been admitted to a state hospital due to a stroke during the previous 2 years. The other source for tool construction was the information that emerged from an extensive literature review. The resulting online questionnaire was divided into three main sections namely i) demographics ii) stroke knowledge and iii) stroke response. A 5-point Likert scale was chosen to answer each question in Sections B and C, which facilitates the analysis process using descriptive and inference statistics. The tool was subjected to psychometric testing with promising results. The use of a standard tool, such as SKAT, which is the one presented in this paper, presents health professionals, who are in a prime position to gauge healthcare educational needs, with the means to assess stroke knowledge and carry out interesting uniform comparisons between different geographical and ethnical populations. The targeted audience for the use of this tool is a). The general population and/or b). A population where stroke knowledge enhancement is being planned. SKAT can then inform educational and awareness needs.

Age-Related Disparities in Stroke Knowledge Among Community Older Adults

Background: This study aimed to investigate the disparities in stroke knowledge between older adults and the oldest old.Methods: Family physicians conducted a cross-sectional survey through face-to-face interviews with the older and oldest old adults of two suburban communities in the Minhang district, Shanghai between October 1, 2020, and November 30, 2020. All participants were classified as oldest old (age ≥80 years) and older adults (age 60–79 years). Between-group differences in stroke knowledge were investigated by multivariate logistic regression analysis.Results: Overall, 466 older adults including 101 (21.67%) oldest old persons were qualified. Older adults were more familiar with the risk factors and symptoms of stroke than the oldest old. By multivariable logistic regression analysis, older adults were more familiar with the following risk factors: smoking [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.16–0.61], alcohol abuse (OR 0.45, 95% CI 0.23–0.87), dyslipidemia (OR 0.51, 95% CI 0.31–0.85), and obesity (OR 0.30, 95% CI 0.17–0.53) than the oldest old. Regarding stroke symptoms, older adults were more aware regarding vision alteration (OR 0.42, 95% CI 0.25–0.69) and face-drop (OR 0.57, 95% CI 0.35–0.95) than the oldest old. The oldest old were less aware of acute stroke therapy (OR 0.11, 95% CI 0.02–0.48) and calling the emergency medical service (OR 0.30, 95% CI 0.12–0.70) than older adults. Finally, the older adults used television (OR 0.53, 95% CI 0.28–1.0), WeChat (OR 0.21, 95% CI 0.05–0.89), and the community bulletin board (OR 0.43, 95% CI 0.23–0.80) as knowledge sources more than the oldest old.Conclusion: The older adults and the oldest old had significantly high disparities in stroke knowledge. Given the aging population across China, the life expectancy is expected to be longer in future decades. These differences should be addressed in stroke educational campaigns targeting the oldest old.