Stroke Essay for NURS 6050: Policy and Advocacy for Improving Population Health

Stroke Essay for NURS 6050: Policy and Advocacy for Improving Population Health

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Developing Health Advocacy

 Stroke

Surprisingly, stroke is a top five leading cause of death and disability in the United States.  “Stroke kills almost 130,000 of the 800,000 Americans who die of cardiovascular disease each year – that’s 1 in every 19 deaths from all causes” (Centers for Disease Control, 2016, p.1)   According to the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR), stroke was the “fourth leading cause of death in the United States, and stroke was a leading cause of long-term disabilities” (“Prevalence of Stroke,” 2012, p. 1)  MMWR also noted, that “care for stroke survivors cost an estimated $18.8 billion in the United States during 2008” (2012).  Although efforts have been made to increase awareness of the signs and symptoms of a stroke, there remains “limited public knowledge about stroke recognition and the importance of seeking immediate medical attention” (Payne et al. 2010).  The purpose of this paper is to identify the population most at risk, identify effective advocacy campaigns and discuss educating the public of all ages and geographical areas and explore the possible implementation of education as it relates to other risk factors for public awareness.

Population Health Issues

According to the Centers for Disease Control and Prevention (CDC), “every year, about 610,000 in the United States have a new stroke” (2016a).  Risk factors for stroke include: certain conditions, behavior, and family history and other characteristics.   Some risk factors can be modified to reduce the risk for stroke (Center for Disease Control and Prevention, 2016, p.1).

Conditions that increase risk for stroke include: previous stroke or transient ischemic attack (TIA), high blood pressure, high cholesterol, heart disease, diabetes and sickle cell disease (Centers for Disease Control and Prevention, 2016b).  Behaviors that increase risk for a stroke include: an unhealthy diet, physical inactivity, obesity, too much alcohol and tobacco use places one at higher risk (Centers for Disease Control and Prevention, 2016c).  Family History and other characteristics that increase the risk for stroke include: genetics and family history, age, sex and race or ethnicity (Centers for Disease Control and Prevention, 2016d). NURS 6050 Developing Health Advocacy – Stroke Essay. “The chances of having a stroke about doubles ever 10 years after age 55” (Centers for Disease Control and Prevention, 2016, p.1).  Research demonstrates that stroke is more common in women and women are more likely to die from a stroke than men.  Blacks, Hispanics, American Indians and Alaska Natives are at higher risk than Asians and non-Hispanic whites (Centers for Disease Control and Prevention, 2016d).  According to the National Stroke Association (NSA), stroke is the third leading cause of death for women with an estimated 55,000 more women having a stroke in comparison to men (2016).  NURS 6050 Developing Health Advocacy – Stroke Essay. The NSA, also reported that women may report symptoms that are very different from the most common symptoms such as: loss of consciousness or fainting, generalized weakness, shortness of breath, confusion, agitation, hallucinations, nausea or vomiting, pain, seizures and/or hiccups (2016).

Advocacy Campaigns

Advocacy programs supporting the understanding and education on stroke awareness have made little impact to date.  According to an article published in the Journal of Public Health Management and Practice, “only 38 percent of US adults in the states surveyed were aware that all five were symptoms of stroke and cause for calling 911 (Payne, Fang, Fogle, Oser, Wigand, Theisen & Farris, 2010). NURS 6050 Developing Health Advocacy – Stroke Essay.

“The Global Burden of Disease (GBD) study provides the most comprehensive state of health in the world since 1990.  The absolute number of people affected by stroke worldwide has significantly increased.  The increased global stroke burden strongly implies that the current high-risk and population-wide primary stroke prevention strategies are not sufficiently effective, and we need to develop strategies that have larger effect sizes” (Feigin et al. 2016 p.1).

Two popular campaigns are Suddens and FAST.  Suddens was created by Brain Attack Coalition and incorporates the five sudden stroke warning signs, which was adopted by the American Heart Association (Payne et al. 2010).

The Suddens warning signs include:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no cause
• NURS 6050 Developing Health Advocacy – Stroke Essay

The campaign FAST was created by researchers at the University of Cincinnati and is an acronym for: Face, Arm, Speech and Timely action (Payne et al, 2010).  A much shorter version and easily remembered.

Attributes of an Effective Advocacy Campaign

In regards to the attributes of the SUDDENS stroke campaign, it is more informative by identifying all five warning signs.  In order to be effective, the message must be easily remembered and understood for everyone from school age children to elderly adults who are highest risk.

The attributes of the FAST campaign is that it is much more easily remembered and easily taught to all ages.  From school age children to adults with less than a high school education, the FAST campaign seems to be intended for all age groups.  The important thing is to raise awareness and call to emergency action for earlier treatment.  The most important thing is to recognize symptoms and call 911.

Development of Health Advocacy Campaign

In order to be effective, a campaign not only needs to provide the information and education, but make it easily accessible to all through various means.  This would include: mass media, social media, billboards, pamphlets, flyers, and face-to-face education.  Education needs to be provided and made appropriate to nearly every age group.  Face-to-face education campaign consideration may include grade schools, health department, clinics and emergency room visits.  Many do not necessarily associate their behaviors and conditions they may experience to the potential risk of stroke.  That is why stroke awareness and education needs to be tied to other risk factors that a person may already have.  For example, if you are diagnosed with high blood pressure, high cholesterol, or diabetes or if you are black, Hispanic, a woman or a smoker, then you should receive stroke education from a licensed health care provider.  According to a published study in the Journal of Stroke and Cardiovascular Disease, the elderly population is increasing and especially pronounced in rural populations.  Another interesting article in the Journal of Stroke and Cerebrovascular Disease, identified a population group which was difficult to educate due to geographical location (Inoue et al. 2015).  In an effort to reach the rural areas and the elderly, a stroke educational campaign at super markets and grocery stores was implemented.  The campaign was conducted in rural Japan and the idea was simple, “grocery shopping is a necessity at any age and the average shopper goes to the grocery store twice weekly” (Inoue et al. 2015).  The campaign was conducted in a rural mountainous region with 4000 flyers being distributed to shoppers.  The flyers included all five of the warning signs and findings suggested that educational flyers should be structured to keep stroke campaigns as simple as possible (Inoue et al. 2015).  The results showed that the more difficult signs and symptoms such as visual disturbances, dizziness, difficulty understanding others remained low throughout the campaign (Inoue et al.

2015).

Summary

A Stroke can affect anyone, at any age, and is one of the leading causes of death and disability in the United States alone.  The cost of stroke related disability is astounding and increasing as stroke related mortality decreases.  The recognition of signs and symptoms of a stroke and early intervention is critical.  The most effective advocacy campaigns keep it simple.  A consideration is to reach all demographics and geographical locations, including rural areas to decrease out of hospital delays in emergency treatment. One idea found effective is placing flyers in grocery bags at supermarkets (Inoue et al, 2015).  Education needs to also begin with the diagnosis of risk factors, conditions and behaviors such as high blood pressure, diabetes, gender, race and habits.  Therefore, a proposal to extend education in an appropriate manner to all ages, at various outlets, geographical areas and tie education to the diagnosis of risk factors should be incorporated.

References

Centers for Disease Control and Prevention. (2016c). Behaviors That Increase Risk for Stroke.  Retrieved from https://www.cdc.gov/stroke/behaviors.htm

Centers for Disease Control and Prevention. (2016b). Conditions That Increase Risk for Stroke.  Retrieved from https://www.cdc.gov/stroke/conditions.htm

Centers for Disease Control and Prevention. (2016d). Family History and Other Characteristics That Increase Risk for Stroke.  Retrieved from https://www.cdc.gov/stroke/family-history.htm

Centers for Disease Control and Prevention. (2016a).  Know the Facts About Stroke. Retrieved from https://www.cdc.gov/stroke/docs/sonsumered_stroke.pdf

Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR): Prevalence of Stroke – United States, 2006-2010. (2012). Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR), 61(20). 379-382. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6120a5.htm?s_cid=mm6120a5_w

Feigin, V. L., Norrving, B., George, M. G., Foltz, J. L., Roth, G. A., & Mensah, G. A. (2016, July 22). Prevention of stroke: a strategic global imperative. REVIEWS. http://dx.doi.org/10.1038/nrneurol.2016.107

Inoue, Y., Jonda, S., Wataabe, M., & Ando, Y. (2015, February). Education Campaigns at Point of Purchase in Rural Supermarkets Improve Stroke Knowledge. Journal of Stroke and Cerebrovascular Diseases, 24, 480-484. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.022

Payne, G. H., Fang, J., Fogal, C. C., Oser, C. S., Wigand, D. A., Theisen, V., & Farris, R. P. (2010, July/August). Stroke Awareness: Surveillance, Educational Campaigns, and Public Health. Journal of Public Health Management and Practice, 16(345-358). http://dx.doi.org/10.1097/PHH.0b013e3181c8cb79

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