Introduction: Racial/ethnic minority and lower income communities are disproportionately affected by stroke. Earlier recognition and treatment after stroke onset improves outcomes. The goal of this study was to understand the barriers to and facilitators of stroke recognition and subsequent action in multi-ethnic, high-risk communities in Chicago to inform a culturally relevant intervention for increasing early hospital arrival after stroke.
Methods: This qualitative research study, funded by PCORI, engaged community members and stakeholders in development of a focus group guide about stroke recognition and action, participant recruitment, and analysis and interpretation of results. Six (4 in English, 2 in Spanish) focus groups (51 participants) were conducted with African-American (n=26), Caucasian (n=12), and Hispanic adults (n=13) in two communities. Analysis of focus group transcripts was done by 4 team members using constant comparative methods in which initial thematic codes were derived from the focus group guide. Initial codes were applied, results compared, and codes revised until agreement was reached among coders.
Results: Themes relating to risk factors, symptoms, knowledge of stroke mechanisms, experience of acute stroke, help seeking, stroke education, recovery, and treatment were identified. Though there was a general understanding of stroke treatments such as “tPA” among all participants, Hispanics frequently discussed folk treatments including "smoothies" and "linseed oil." Specific barriers to calling 9-1-1 included fears about immigration status and fatalism among Hispanics and financial costs and fear/embarrassment of being wrong among African-Americans. Suggestions for stroke education and dissemination included offering resources for low-cost care and treatment among Hispanics and emphasizing neighborhood-level prevalence of stroke among African-Americans.
Conclusions: This study identified differences in knowledge of treatments and attitudes and specific barriers to acute stroke care in minority and lower income communities in Chicago. These findings underscore the importance of engaging communities to tailor interventions and messages to racial/ethnic barriers and needs.