Introduction: Differences in self-efficacy, stroke knowledge, and symptom recognition during acute stroke may affect calling 9-1-1, time to hospital arrival, and stroke outcomes. In a segregated city like Chicago, with significant disparities in stroke outcomes, comparing differences between geographic neighborhoods could reveal important areas for focused interventions.
Methods: The ongoing Community Engagement in Early Recognition and Immediate Action in Stroke (CEEERIAS) study is a community- and patient-partnered intervention to improve early hospital arrival for stroke patients in Chicago. As part of study analysis, we conducted surveys of a sample of Chicago residents to assess stroke knowledge, self-efficacy, and barriers to calling 9-1-1. Subjects, recruited at community events, were separated into North Side (N) and South Side (S) groups by subject zip code. Surveys included the validated Stroke Action Test (STAT) for knowledge, self-efficacy scales for willingness to call 9-1-1 for stroke, and the Health Care Trust Survey for trust.
Results: A total of 364 subjects participated (199 in N group and 165 in S group; 55% female [S: 63.6% vs. N: 48.3%]). The N group was more educated while the S group had greater interest in participating in the CEERIAS study, more health problems, and more recent hospital visits. Though stroke knowledge using the STAT was similar, the N group felt more confident recognizing a stroke (p<0.0001). The S group was less likely to believe that immediate hospital care improved post-stroke survival and more likely to believe doctors treated that black patients differently than whites, that hospitals covered up mistakes, and that hospitals experimented on people without consent. The S group was more likely to not call 9-1-1 for fear of financial costs, compared to the N group (23.5% vs. 4.5%, p<0.001).
Conclusion: Though both neighborhoods had similar levels of stroke knowledge, the subjects living on the South Side had higher mistrust of hospitals and were less likely to call 9-1-1 due to financial costs. Understanding neighborhood-level perceptions of healthcare and barriers allows for development and implementation of targeted, nuanced community-partnered interventions to reduce disparities in stroke outcomes.