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

Caterina Caminiti, Peter Schulz, Barbara Marcomini, Elisa Iezzi, Silvia Riva, Umberto Scoditti, Andrea Zini, Giovanni Malferrari, Maria Luisa Zedde, Donata Guidetti, Enrico Montanari, Mario Baratti, Licia Denti, Paola Castellini, Carla Zanferrari, Annalisa Tanzi, Francesca Diodati, Silvia Olivato, Filippo Barbi, Guido BigliardiMaria Luisa Dell'Acqua, Laura Vandelli, Francesca Rosafio, Roberta Pentore, Livi Picchetto, Daniela Monaco, Eva Perticaroli, Ilaria Iafelice, Paolo Imovilli, Luca Vaghi, Angelica Guareschi, On behalf of the Educazione e Ritardo di Ospedalizzazione (E.R.O.I) study group

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Systematic 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. Methods: Campaign 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. Results: In 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. Conclusions: The 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.

Original languageEnglish
Article number20
JournalBMC Emergency Medicine
Volume17
Issue number1
DOIs
Publication statusPublished - Jun 24 2017

Keywords

  • Cartoon
  • Intervention mapping
  • Media
  • Pre-hospital delay
  • Public campaign
  • Stroke

ASJC Scopus subject areas

  • Emergency Medicine

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