Transcript Public Health Project NUR 455

Public Health Project
NUR 455
Elizabeth Hotaling, RN
Helen McDonald, RN
Healthy People 2020 Topic:
Heart Disease & Stroke
Objective:
Reduce Stoke Deaths
Baseline Data
• According to Healthy People 2020, as of 2007
there were 42.2 stroke deaths per 100,000
Target
• The target for 2020 is 33.8 stroke deaths per
100,000
Population of Focus
• African-Americans are at a higher risk for
stroke
Stroke facts
• Stroke is the 4th leading cause of death in the
U.S.
• Up to 80% of strokes are preventable
• More than 2/3 of stroke survivors will have
some type of disability
• African Americans have almost twice the risk
for stroke compared to Caucasians.
• The estimated cost of stroke in the U.S in 2010
was 73.7 billion dollars.
African Americans and Stroke
• In 2009 there were 55.7 per 100,000 African
American stroke deaths compared to 37.8 per
100,000 Caucasian stroke deaths.
• African Americans have an increased
prevalence of risk factors for stroke including:
obesity, hypertension, high cholesterol, and
cigarette smoking.
African Americans and Stroke Risk
Factors
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per the National Stroke Association:
One in three suffer from high blood pressure
Have a higher rate of diabetes
Sickle Cell Anemia is the most common
genetic disorder. A sickle shaped cell can block
a blood vessel to the brain and stroke can
result.
Smoking doubles the risk of stroke.
Compared to Caucasians, African
Americans:
• Have twice the mortality from stroke
• Have more severe and disabling strokes
• Women have a lower one year survival rate
following an ischemic stroke
• Are significantly less likely to receive tPA which
is the only FDA approved treatment for stroke
African American Disparity
A 2011 study published in the American Journal of Health
Behavior reports the following possible factors for health
disparity of African Americans:
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Genetic disposition
Developmental and environmental exposures
Racial discrimination and perceived racism
Life experiences and stressful events
Psychosocial exposures
Socioeconomic position
Lifestyle behaviors
Public Health Programs for Stroke
Prevention
• States including New York began to receive
funding from the CDC in 1998 for a heart disease
and stroke prevention program
• NYS partners with other states to collaborate on
stroke prevention programs.
• Public health partnerships with African American
Churches.
• Development of a multi-media stroke prevention
program
• Designated Stroke Centers
Partnerships with African American
Churches
• Pastors have a strong influence on individuals
in the community and play an important role
in successful implementation of health
programs.
• Partnerships decrease health disparities in this
population by reaching individuals who lack
transportation and funds.
• Early interventions in the community setting
can help decrease incidence of stroke.
Multi-Media Campaign
(Per the Northeast Cerebrovascular Consortium)
• Television Ads “Reverse Hospital” and “Stroke
Heroes ACT FAST”
• Radio Ad – “Ticking Clock” developed by Utah
DOH
• Information through transit – at bus shelters,
inside and outside public buses
• Printed Materials – table tents, pharmacy cards,
and magnets
Television Ads
• The Act F.A.S.T. Campaign includes multiple TV
commercials including this one developed by the
Massachusetts Department of Public Health
• Stroke Heroes Act Fast – YouTube
• There are also television ads developed by the
American Heart Association and American Stroke
Association
• American Heart Association Stroke Awareness
Campaign Symptoms spot - YouTube
Radio Ads
• There are multiple radio ads that help educate
individuals on stroke signs and symptoms
• Stroke Awareness Campaign, VDH - Meeting Radio Announcement – YouTube
Educational elements of Multi-Media
Campaign
• Uses the F.A.S.T. mnemonic
• Emphasizes to call 9-1-1
• Uses a catchy jingle to help the audience
memorize important information
• Discusses five warnings signs in relation to
“Walk, Talk, Reach, See, Feel”
NYS Designated Stroke Centers
• The NYS DOH designates stroke centers statewide
to improve the standard and access to quality of
care for patients with a presumptive diagnosis of
stroke.
• The Bureau of Emergency Medical Services (EMS)
works with the DOH to maintain a list of
designated stroke centers, allowing any potential
stroke victims to be brought directly to a stroke
center, and have the NYS BLS Stroke Protocol
initiated immediately.
The Capital Region Stroke Network
• In the Capital Region Albany Medical Center,
St. Peter’s Health Partners (including Albany
Memorial, Samaritan, and St. Mary’s
hospitals), and Ellis Hospital are designated
stroke centers
Effectiveness
Per Healthy People 2020:
• Between 2007 and 2010 there was a decrease in
the number of stroke deaths per 100,000 for the
general population of 3.1 deaths per 100,000
• For African Americans, there was a decrease in
the number of stroke deaths per 100,000 of 7.3
• This demonstrates effectiveness of educating
African Americans on stroke prevention, signs,
symptoms, and actions to take.
Effectiveness
Total
Population
Stroke Deaths
per 100,000
African
American
Stroke Deaths
per 100,000
2007
2008
2009
2010
42.2
40.7
38.9
39.1
60.3
57.4
54.5
53.0
Effectiveness of Multi-Media
• A study conducted by the NYS DOH and University at
Albany School of Public Health examined four focus
groups regarding stroke prevention, and their reaction
to the multi-media campaign.
• Two of these focus groups were African American
• In regards to knowledge of stroke symptoms and
response to symptoms, the study found that African
Americans were more influenced by culture and family
history, more likely to wait and watch the symptoms
and then decide, and they were less likely to use 911
prior to seeing any of the multi-media campaign.
Effectiveness of Multi-Media (cont.)
• After exposure to the TV, radio, and bus ads,
the study demonstrated an overall increase in
the number of people who would NOT wait,
and WOULD dial 911.
• The study concluded that a multi-media stroke
prevention campaign can increase the number
of individuals who dial 9-1-1, and
recommends consistent, sustained media
messages.
Effectiveness of Designated Stroke
Centers
• A 2011 meta-analysis study published in the
American College on Emergency Physicians,
reports that stroke unit care is associated with a
21% reduction in death from stroke.
• Stroke Centers:
– Improve clinical outcomes
– Increase the use of TPA
– Provide more efficient care and are more effective at
initiating secondary medications
– Reduce death
Beth’s Analysis
(Per Sullivan, White, Young, & Scott):
• Stroke prevention programs should utilize
four factors regarding health beliefs:
– Benefits of preventative care
– Barriers to preventative care
– Perceived Illness
– Severity
Beth’s Analysis
• The multi media campaign provides stroke information
in a manner that may be extremely effective for the
population of African Americans. By using TV, radio,
and bus advertisements the campaign is able to reach
millions of people including African Americas.
• The media campaign appears to take into account the
factors regarding health beliefs.
• Appealing to all educational levels and reading levels
• Could be more effective if campaigns were nationally
consistent instead of varying from state to state.
Beth’s Analysis
• Designated Stroke Centers are effective for
decreasing stroke deaths in African Americans by
ensuring best practices of care, as long as they
are utilized. This reinforces the need for all
populations to know when to dial 9-1-1, and
arrive at a stroke center via ambulance. No time
to waste going to a non-designated facility
• Partnerships with community churches can help
to reinforce the media messages and spread the
word regarding the designated stroke centers.
Helen’s Analysis
• The multi-media campaign will be effective to
educate mass populations of individuals,
regardless of race, ethnicity and income.
• Campaign ad placement will be integral to
reaching focus populations.
• Ads need to be high quality, interesting and
culturally sensitive to catch the attention of
focus populations.
Helen’s Analysis
• People in general may not perceive stroke as an
immediate problem needing to be addressed. They
may dismiss campaign ads. They may be reluctant to
change behaviors to decrease risk factors.
• People need to feel empowered to have an active role
in their healthcare decisions.
• People need to have
– Access and control over needed resources
– Decision-making and problem solving ability
– The ability to communicate and obtain needed resources
Helen’s Analysis
• Collaborating with African American Churches
will help target the high risk population
identified. Early interventions to decrease risk
factors can be implemented. Ex: Blood pressure
and diabetes checks, health fairs.
• Pastors of the community need to be a part of
early program planning to assist with cultural
sensitivity and strategies to reach the targeted
group.
Helen’s Analysis
• Increasing awareness of designated stroke
centers as well as increasing the amount and
availability of these centers will help to
decrease time intervals for transportation to
treatment.
The End
Any Questions????
References
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Butler-Ajibade, P., Booth, W., & Burwell, C. (2012). Partnering with the Black Church: Recipe for Promoting Heart Health in the Stroke
Belt. ABNF Journal, 23(2), 34-37.
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Deuster, P. A., Su Jong, K., Remaley, A. T., & Poth, M. (2011). Allostatic Load and Health Status of African Americans and Whites.
American Journal Of Health Behavior, 35(6), 641-653. Retrieved from:
http://search.ebscohost.com.ezproxy.sunyit.edu/login.aspx?direct=true&db=rzh&AN=2011471715&site=ehost-live
•
Johnston, C. (2011). Does Stroke Center Designation Improve Patient Outcomes? The American College of Emergency Physicians.
Retrieved from: http://www.acep.org/MobileArticle.aspx?id=82874&coll
•
National Stroke Association. (2013). African Americans and Stroke. Retrieved from:
http://www.stroke.org/site/PageServer?pagename=AAMER
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New York State Department of Health. (2012) Stroke Centers. Retrieved from:
http://hospitals.nyhealth.gov/learn.php?t=SC&PHPSESSID=728a3d329e1d6b4b6130acce22a33a99
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Spicer, D., Howland, T., Brissette, I., Dennison, B., Maniccia, D., Jurkowski, J. (n.d.) Stroke Awareness – Impact of a Multi-Media
Campaign. The Northeast Cerebrovascular Consortium. Retrieved from: http://www.thenecc.org/images/Howland.pdf
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Sullivan, K., White, K., Young, R., & Scott, C. (2010). The Cerebrovascular Attitudes and Beliefs Scale (CABS-R): the factor structure and
psychometric properties of a tool for assessing stroke-related health beliefs. International Journal Of Behavioral Medicine, 17(1), 67-73.
doi:10.1007/s12529-009-9047-3 Retrieved from:
http://search.ebscohost.com.ezproxy.sunyit.edu/login.aspx?direct=true&db=rzh&AN=2010551377&site=ehost-live
•
Stanhope, M. & Lancaster, J. (2012). Public Health Nursing Population-Centered Health Care in the Community. Missouri: Mosby.