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Skolarus LE, Bailey S, Corches CL, Sales AE, Lin CC, Bi R, Springer MV, Oliver A, Robles MC, Brooks T, Tupper M, Jaggi M, Al-Qasmi M, Trevithick BA, Barber K, Majjhoo A, Zimmerman MA, Meurer WJ, Brown DL, Morgenstern LB, Burke JF. Association of the Stroke Ready Community-Based Participatory Research Intervention With Incidence of Acute Stroke Thrombolysis in Flint, Michigan. JAMA Netw Open 2023; 6:e2321558. [PMID: 37399011 PMCID: PMC10318478 DOI: 10.1001/jamanetworkopen.2023.21558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
Importance Acute stroke treatment rates in the US lag behind those in other high-income nations. Objective To assess whether a hospital emergency department (ED) and community intervention was associated with an increased proportion of patients with stroke receiving thrombolysis. Design, Setting, and Participants This nonrandomized controlled trial of the Stroke Ready intervention took place in Flint, Michigan, from October 2017 to March 2020. Participants included adults living in the community. Data analysis was completed from July 2022 to May 2023. Intervention Stroke Ready combined implementation science and community-based participatory research approaches. Acute stroke care was optimized in a safety-net ED, and then a community-wide, theory-based health behavior intervention, including peer-led workshops, mailers, and social media, was conducted. Main Outcomes and Measures The prespecified primary outcome was the proportion of patients hospitalized with ischemic stroke or transient ischemic attack from Flint who received thrombolysis before and after the intervention. The association between thrombolysis and the Stroke Ready combined intervention, including the ED and community components, was estimated using logistic regression models, clustering at the hospital level and adjusting for time and stroke type. In prespecified secondary analyses, the ED and community intervention were explored separately, adjusting for hospital, time, and stroke type. Results In total, 5970 people received in-person stroke preparedness workshops, corresponding to 9.7% of the adult population in Flint. There were 3327 ischemic stroke and TIA visits (1848 women [55.6%]; 1747 Black individuals [52.5%]; mean [SD] age, 67.8 [14.5] years) among patients from Flint seen in the relevant EDs, including 2305 in the preintervention period from July 2010 to September 2017 and 1022 in the postintervention period from October 2017 to March 2020. The proportion of thrombolysis usage increased from 4% in 2010 to 14% in 2020. The combined Stroke Ready intervention was not associated with thrombolysis use (adjusted odds ratio [OR], 1.13; 95% CI, 0.74-1.70; P = .58). The ED component was associated with an increase in thrombolysis use (adjusted OR, 1.63; 95% CI, 1.04-2.56; P = .03), but the community component was not (adjusted OR, 0.99; 95% CI, 0.96-1.01; P = .30). Conclusions and Relevance This nonrandomized controlled trial found that a multilevel ED and community stroke preparedness intervention was not associated with increased thrombolysis treatments. The ED intervention was associated with increased thrombolysis usage, suggesting that implementation strategies in partnership with safety-net hospitals may increase thrombolysis usage. Trial Registration ClinicalTrials.gov Identifier: NCT036455900.
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Affiliation(s)
- Lesli E. Skolarus
- Davee Department of Neurology, Stroke and Vascular Neurology, Northwestern University, Chicago, Illinois
- Department of Neurology, University of Michigan, Ann Arbor
| | | | | | - Anne E. Sales
- Department of Family and Community Medicine, Sinclair School of Nursing, University of Missouri, Columbia
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Chun Chieh Lin
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, Ohio State University, Columbus
| | - Ran Bi
- Department of Neurology, University of Michigan, Ann Arbor
| | | | | | | | - Tia Brooks
- Department of Neurology, University of Michigan, Ann Arbor
| | - Michael Tupper
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
| | - Michael Jaggi
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
| | - Mohammed Al-Qasmi
- Department of Emergency Medicine, Hurley Medical Center, Flint, Michigan
| | | | - Kimberly Barber
- Department of Clinical & Academic Research, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Aniel Majjhoo
- Department of Neurology, McLaren Flint Hospital, Flint, Michigan
| | | | | | - Devin L. Brown
- Department of Neurology, University of Michigan, Ann Arbor
| | - Lewis B. Morgenstern
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
| | - James F. Burke
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, Ohio State University, Columbus
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Skolarus LE, Springer MV, Bailey S, Rossman N, Corches CL. Partnering With a Home Health Agency to Implement a Brief Stroke Preparedness Intervention: Stroke Ready-Home Health. J Am Heart Assoc 2022; 11:e027462. [PMID: 36172965 PMCID: PMC9673744 DOI: 10.1161/jaha.122.027462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tang D, Cai W, Yang W, Chen S, Li L. Effectiveness of Health-Related Behavior Interventions on Physical Activity-Related Injuries in Junior Middle School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4049. [PMID: 35409732 PMCID: PMC8997892 DOI: 10.3390/ijerph19074049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 02/05/2023]
Abstract
The objective of this study was to determine the effectiveness of an intervention program based on Health-Related Behavior Theory (HRBT) in reducing physical activity-related injuries (PARIs) occurrence and individual risk-taking behaviors, as well as improving PA-related behaviors. A total of 1044 students from six junior middle schools in Shantou city were included and divided randomly into an intervention group (n = 550) and a control group (n = 494), respectively. The intervention group followed a prescribed PARIs intervention program based on HRBT, and the control group performed a common health education program, consisting of seven sessions and lasting seven months from May to November 2018. After the intervention, both groups showed a significantly lower prevalence of PARIs (intervention group: from 25.45% to 10.91%, control group: from 29.76% to 11.74%, both p < 0.05), but no significant between-group differences could be observed in the post-intervention PARIs prevalence (p > 0.05). Compared with the control group, students in the intervention group had a higher improvement in PA-related behaviors and a lower score of risk-taking behaviors (both p < 0.05). Thus, it could be concluded that the HRBT intervention program had a positive effect on PA-related and risk-taking behaviors in junior middle school students, though its effectiveness in reducing the occurrence of PARIs was not significant.
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Affiliation(s)
- Dongchun Tang
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
- Department of Non-communicable Diseases Control, Futian District Institute for Prevention and Control of Chronic Diseases, Shenzhen 518048, China
| | - Weicong Cai
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
- Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
| | - Wenda Yang
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
| | - Shangmin Chen
- School of Public Health, Shantou University, Shantou 515041, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China
| | - Liping Li
- School of Public Health, Shantou University, Shantou 515041, China
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Robles MC, Newman MW, Doshi A, Bailey S, Huang L, Choi SJ, Kurien C, Merid B, Cowdery J, Golbus JR, Huang C, Dorsch MP, Nallamothu B, Skolarus LE. A Physical Activity Just-in-time Adaptive Intervention Designed in Partnership With a Predominantly Black Community: Virtual, Community-Based Participatory Design Approach. JMIR Form Res 2022; 6:e33087. [PMID: 35343906 PMCID: PMC9002607 DOI: 10.2196/33087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Black people are disproportionally impacted by hypertension. New approaches for encouraging healthy lifestyles are needed to reduce hypertension and promote health equity in Black communities. Objective In this report, we describe the early-stage, virtual design of a just-in-time adaptive intervention (JITAI) to increase physical activity in partnership with members of a low-income, predominantly Black community. Methods The hallmark of JITAIs is highly contextualized mobile app push notifications. Thus, understanding participants' context and determinants of physical activity are critical. During the height of the COVID-19 pandemic, we conducted virtual discovery interviews and analysis guided by the Behavior Change Wheel (which focuses on participants' capacity, opportunity, and motivation to engage in physical activity), as well as empathy mapping. We then formed a community-academic participatory design team that partnered in the design sprint, storyboarding, and paper prototyping. Results For this study, 5 community members participated in the discovery interviews, 12 stakeholders participated in the empathy mapping, 3 community members represented the community on the design team, and 10 community members provided storyboard or paper prototyping feedback. Only one community member had used videoconferencing prior to partnering with the academic team, and none had design experience. A set of 5 community-academic partner design principles were created: (1) keep users front and center, (2) tailor to the individual, (3) draw on existing motivation, (4) make physical activity feel approachable, and (5) make data collection transparent yet unobtrusive. To address community-specific barriers, the community-academic design team decided that mobile app push notifications will be tailored to participants’ baseline mobility level and community resources (eg, local parks and events). Push notifications will also be tailored based on the day (weekday versus weekend), time of day, and weather. Motivation will be enhanced via adaptive goal setting with supportive feedback and social support via community-generated notifications. Conclusions We completed early-stage virtual design of a JITAI in partnership with community participants and a community design team with limited design and videoconferencing experience. We found that designing JITAIs with the community enables these interventions to address community-specific needs, which may lead to a more meaningful impact on users' health.
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Affiliation(s)
| | - Mark W Newman
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Aalap Doshi
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Bailey
- Bridges into the Future, Flint, MI, United States
| | - Linde Huang
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI, United States
| | - Soo Ji Choi
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Chris Kurien
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Beza Merid
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Joan Cowdery
- School of Health Promotion and Human Performance, Eastern Michigan University, Ypsilanti, MI, United States
| | - Jessica R Golbus
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Christopher Huang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Brahmajee Nallamothu
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lesli E Skolarus
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
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ALSHARIF HZH, SHU T. Research on food safety information training system based on component algorithm. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.52221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Tong SHU
- Business School of Hunan University, China
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ZHAO Y, TALHA M. Evaluation of food safety problems based on the fuzzy comprehensive analysis method. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.47321] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Yingwen ZHAO
- Guizhou Rural Economy and Culture Institute, China
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Skolarus LE, Brown DL, Corches CL, Reynolds E, Bailey S, Mansour M, Robles MC, Rice T, Springer MV, Burke JF, Sudore RL. Extending Advance Care Planning to Black Americans in the Community: A Pilot Study of the PREPARE Program. J Pain Symptom Manage 2021; 62:e4-e9. [PMID: 33647422 PMCID: PMC8435356 DOI: 10.1016/j.jpainsymman.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Advance care planning (ACP) is underutilized, especially among Black Americans. Yet, no ACP interventions have been tested at the community level. OBJECTIVES Within an established academic and community partnership, we sought to determine whether ACP is a community-identified need and if so, to conduct a pilot study of an evidence-based ACP program, PREPARE (PrepareForYourCare.org). METHODS We conducted open discussions and in-depth interviews to determine the relevance of ACP to the community. We then conducted a pre- to 3-week postpilot study of a virtual peer facilitated brief session to introduce ACP and encourage participants to engage with PREPARE. We conducted thematic content analysis for qualitative data and used paired t-tests to assess within-participant changes in the validated ACP Engagement Survey measured on a 1-5 scale (5 = greatest engagement). RESULT We conducted two discussion groups with community leaders (n = 12) and key informant interviews (n = 6), including leaders in aging, public health, health care and faith. We concluded that ACP is a community priority. In the pilot study, we enrolled 13 Black Americans; 85% were women and the mean age was 59.7 years (SD 15.1). There was a trend toward increased ACP engagement after the peer facilitated PREPARE (mean 3.2 (SD 0.6) pre vs. 3.5 (SD 0.6) post, paired t-test P = 0.06). All participants found the intervention to be acceptable and were satisfied with it. CONCLUSION Community members identified ACP as important for their community. Peer facilitated PREPARE program is a promising community-based strategy to increase engagement in ACP and may promote health equity.
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Affiliation(s)
- Lesli E Skolarus
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Devin L Brown
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Casey L Corches
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Evan Reynolds
- Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Maria Mansour
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Tia Rice
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mellanie V Springer
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan
| | - James F Burke
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan; Neurology Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health Care System, Ann Arbor, Michigan
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California; San Francisco Veterans Affairs Health Care System, San Francisco, California
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