Development of an education campaign to reduce delays in pre-hospital response to stroke

BMC Emergency Medicine

Research Article

Licia Denti¹  Donata Guidetti²  Maria Luisa Zedde³  Giovanni Malferrari³  Silvia Riva⁴  Mario Baratti⁵  Peter Schulz⁶  Enrico Montanari⁷  Caterina Caminiti⁸  Barbara Marcomini⁸  Elisa Iezzi⁸  Umberto Scoditti⁹  Andrea Zini^1,10 

[1] Clinical Geriatrics Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy;Department of Neurology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy;Department of Neuromotor Physiol, Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy;Department of Oncology and Hematology, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy;Division of Neurology, B Ramazzini Hospital, Via Guido Molinari 2, 41012, Carpi, Modena, Italy;Institute of Communication and Health, Università della Svizzera italiana, Via Buffi 6, CH 6900, Lugano, Switzerland;Neurology Unit, Vaio Fidenza Hospital, Via Don Tincati 5, 43036, Fidenza, Parma, Italy;Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy;Stroke Care Program, Neurology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy;Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, Via Pietro Giardini 1355, 41126, Baggiovara, Modena, Italy;

关键词: Stroke;    Public campaign;    Pre-hospital delay;    Media;    Cartoon;    Intervention mapping;   

DOI  :  10.1186/s12873-017-0130-9

 received in 2016-11-22, accepted in 2017-06-12,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundSystematic reviews call for well-designed trials with clearly described intervention components to support the effectiveness of educational campaigns to reduce patient delay in stroke presentation. We herein describe the systematic development process of a campaign aimed to increase stroke awareness and preparedness.MethodsCampaign development followed Intervention Mapping (IM), a theory- and evidence-based tool, and was articulated in two phases: needs assessment and intervention development. In phase 1, two cross-sectional surveys were performed, one aiming to measure stroke awareness in the target population and the other to analyze the behavioral determinants of prehospital delay. In phase 2, a matrix of proximal program objectives was developed, theory-based intervention methods and practical strategies were selected and program components and materials produced.ResultsIn phase 1, the survey on 202 citizens highlighted underestimation of symptom severity, as in only 44% of stroke situations respondents would choose to call the emergency service (EMS). In the survey on 393 consecutive patients, 55% presented over 2 hours after symptom onset; major determinants were deciding to call the general practitioner first and the reaction of the first person the patient called. In phase 2, adult individuals were identified as the target of the intervention, both as potential “patients” and witnesses of stroke. The low educational level found in the patient survey called for a narrative approach in cartoon form. The family setting was chosen for the message because 42% of patients who presented within 2 hours had been advised by a family member to call EMS. To act on people’s tendency to view stroke as an untreatable disease, it was decided to avoid fear-arousal appeals and use a positive message providing instructions and hope. Focus groups were used to test educational products and identify the most suitable sites for message dissemination.ConclusionsThe IM approach allowed to develop a stroke campaign integrating theories, scientific evidence and information collected from the target population, and enabled to provide clear explanations for the reasons behind key decisions during the intervention development process.Trial registrationNCT01881152. Retrospectively registered June 7 2013

【 授权许可】

CC BY   
© The Author(s). 2017