Leveraging Multimedia Patient Engagement to Address Minority Cerebrovascular Health Needs: Prospective Observational Study (Preprint)
Authors: Noser Elizabeth Anne , Zhang Jing , Rahbar Mohammad Hossein , Sharrief Anjail Zarinah , Barreto Andrew David , Shaw Sandi , Grotta James Charles , Savitz Sean Isaac , Ifejika Nneka Lotea 
Published: March 2021

BACKGROUND

Social inequities affecting minority populations after Hurricane Katrina led to an expansion of environmental justice literature. In August 2017, Hurricane Harvey rainfall was estimated as a 3000- to 20,000-year flood event, further affecting minority populations with disproportionate stroke prevalence. The Stomp Out Stroke initiative leveraged multimedia engagement, creating a patient-centered cerebrovascular health intervention.

OBJECTIVE

This study aims to address social inequities in cerebrovascular health through the identification of race- or ethnicity-specific health needs and the provision of in-person stroke prevention screening during two community events (May 2018 and May 2019).

METHODS

Stomp Out Stroke recruitment took place through internet-based channels (websites and social networking). Exclusively through web registration, Stomp Out Stroke participants (aged &gt;18 years) detailed sociodemographic characteristics, family history of stroke, and stroke survivorship. Participant health interests were compared by race or ethnicity using Kruskal-Wallis or chi-square test at an α=.05. A Bonferroni-corrected <i>P</i> value of .0083 was used for multiple comparisons.

RESULTS

Stomp Out Stroke registrants (N=1401) were 70% (973/1390) female (median age 45 years) and largely self-identified as members of minority groups: 32.05% (449/1401) Hispanic, 25.62% (359/1401) African American, 13.63% (191/1401) Asian compared with 23.63% (331/1401) non-Hispanic White. Stroke survivors comprised 11.55% (155/1401) of our population. A total of 124 stroke caregivers participated. Approximately 36.81% (493/1339) of participants had a family history of stroke. African American participants were most likely to have Medicare or Medicaid insurance (84/341, 24.6%), whereas Hispanic participants were most likely to be uninsured (127/435, 29.2%). Hispanic participants were more likely than non-Hispanic White participants to obtain <i>health screenings</i> (282/449, 62.8% vs 175/331, 52.9%; <i>P</i>=.03). Asian (105/191, 54.9%) and African American (201/359, 55.9%) participants were more likely to request <i>stroke education</i> than non-Hispanic White (138/331, 41.6%) or Hispanic participants (193/449, 42.9%). African American participants were more likely to seek <i>overall health education</i> than non-Hispanic White participants (166/359, 46.2% vs 108/331, 32.6%; <i>P</i>=.002). Non-Hispanic White participants (48/331, 14.5%) <i>were less likely to speak to health care providers</i> than African American (91/359, 25.3%) or Asian participants (54/191, 28.3%). During the 2018 and 2019 events, 2774 health screenings were completed across 12 hours, averaging four health screenings per minute. These included blood pressure (1031/2774, 37.16%), stroke risk assessment (496/2774, 17.88%), bone density (426/2774, 15.35%), carotid ultrasound (380/2774, 13.69%), BMI (182/2774, 6.56%), serum lipids (157/2774, 5.65%), and hemoglobin A<sub>1c</sub> (102/2774, 3.67%). Twenty multimedia placements using the Stomp Out Stroke webpage, social media, <i>#stompoutstroke</i>, television, iQ radio, and web-based news reached approximately 849,731 people in the Houston area.

CONCLUSIONS

Using a combination of internet-based recruitment, registration, and in-person assessments, Stomp Out Stroke identified race- or ethnicity-specific health care needs and provided appropriate screenings to minority populations at increased risk of urban flooding and stroke. This protocol can be replicated in Southern US <i>Stroke Belt</i> cities with similar flood risks.

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