October 31, 2016 — Blog Post
Primary Stroke Centers in Chicago Provide Lessons on Health Literacy
As a very “hands on” physician and physician-researcher, I often conduct in-home visits and reach out to various social service organizations to find out if their services could help patients in our population based studies. It was through those home visits, that I would encounter health literacy issues. One of the biggest areas where I’ve seen a disconnect was stroke.
Stroke is time-sensitive
The phrase “time is brain” has been used to emphasize the importance of quickly getting to the hospital and emergency department for treatment. We often say that for each minute a typical stroke patient is untreated, 1.9 million neurons (brain cells) and 14 billion synapses – connections between neurons – are lost.
Also consider: stroke the 5th leading cause of death in the United States, and the leading cause of serious long term adult disability. In the U.S. 800,000 people will experience a stroke this year. And in Chicago, stroke affects approximately 9,000 people each year. Unfortunately:
- Less than half would call 911 if a stroke were occurring.
- Many people are unaware of the role of Primary Stroke Centers (PSC) located in community hospitals that can provide care for acute stroke.
I continued my home visits for studies and began to ask my participants what was their knowledge about stroke and what they would do if a stroke occurred.
It became painfully clear that many did not make the connection between stroke and disability and death. Many did not know where to receive care and more importantly, what type of care would be given for acute stroke.
The start of CEERIAS
Enter the Mini Internship Primary Stroke Center (PSC) program that later became the foundation for the CEERIAS (Community Engagement for Early Recognition and Immediate Action in Stroke). The goal was to educate high-risk minority communities and their leaders on the use of a PSC for acute stroke. 5 area community PSC hospitals were contacted and we conducted walking tours throughout the 1. Emergency Room 2. Intensive Care Unit 3. Stroke Unit and 4. Rehabilitation Unit.
On these tours questions from the participants (including clergy, community leaders, aldermen, and social services employees) they asked health professionals:
- How many strokes/year in the local community?
- Approximate number of patients treated yearly at (hospital PSC)?
- What are the major unmet needs for the community and the hospital and how could both groups work together to decrease the risk for stroke?
- How is stroke treated; what medicines are used and what tests are run and why?
Relevance of a walking tour to best practices for Health Literacy:
- These tours created a shame free environment to ask questions about stroke, its treatment and why it was important to act FAST.
- They improved interpersonal communication between the community/ patients and the health care teams.
- Ideas on how to message the importance of calling 911 became clearer and we focused on 1-3 key messages.
- Extensive “teach back” and ‘show me ” techniques about stroke and care occurred throughout the tour, in a natural setting.
- Healthcare providers learned to listen more and speak less to understand patient concerns throughout the tour.
Think about conducting a walking tour of your own.
Tours where people are brought together with healthcare providers in non “crisis” situation, create a level of understanding that you will not get simply based on paper education. Engaging and empowering people about their health in non-traditional ways is the answer to improve health literacy for everyone.