Background: Consequences of stroke can be devastating and long-term, impacting physical and mental functioning, quality of life, and other activities of daily living. Based on fear appeal research, perceived harm from having a stroke can be used to motivate people to engage in self-protective behaviors.
Methods: REGARDS is a national, population-based, longitudinal study of 30,239 blacks and whites ≥ 45 years. The study used a centralized telephone interview and an in-home evaluation for baseline risk assessment with telephone follow-up every six months. Ten years after enrollment, participants underwent a 2nd risk factor assessment. As part of a Risk Behavior Diagnosis Scale, participants were asked their level of agreement with the statement “I believe that stroke is extremely harmful.” Data from the 10-year assessment were available on 15,312 participants. Logistic regression was used to examine the association of agreement with the statement by demographics, region, socioeconomic (SES) factors, previous stroke and hypertension.
Results: Almost 500 (3%; 446/15,312) participants did not agree with the statement that stroke is extremely harmful. In the multivariable model (see table), the odds of blacks agreeing that stroke was harmful was only one-third that of whites. Older participants, those with previous stroke, and those with lower income or education were also much less likely to agree stroke was harmful. There was no significant association by sex, region, or hypertension.
Conclusions: Despite public health campaigns and active participation in a long term observational study of stroke risk factors, the harmful repercussions from stroke are not perceived similarly for blacks and whites, across SES and age groups, and even in persons who have experienced a stroke compared to those who have not. Fear-based messaging intended to motivate stroke prevention behaviors may not be as effective in these subgroups.