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Background: Because early recognition of symptoms and timely treatment of stroke can reduce mortality and the longterm effects of such events, efforts to make many people both aware of these symptoms and knowledgeable about what to do when recognising them are critical for reducing impacts from stroke. Objectives: To assess the impact of a stroke preparedness film (intervention) and stroke preparedness pamphlets (usual care) on self-efficacy for stroke recognition and action. Design: Two-arm cluster randomised trial conducted between July 2013 and August 2018. Setting: A total of 13 church sites located in economically disadvantaged urban neighbourhoods in New York. Of the 883 churchgoers approached, 503 expressed interest, 375 completed eligibility screening and 312 were randomised. Participant inclusion criteria were Black or Hispanic churchgoers, aged 34years or older, without stroke history, but at a high risk for stroke. The intervention consisted of two 12-minute stroke films: "Gospel of Stroke," in English for Black participants, and "Derrame Cerebral," in Spanish for Hispanic participants. Method: Participants were pre-post-tested (at baseline, 6-month follow-up and 12-month follow-up) for self-efficacy. Descriptive analysis, a linear mixed model and "t" tests were used to assess the effects of a stroke preparedness film and stroke preparedness pamphlets on self-efficacy. Results: Findings are based on intention-to-treat analysis. A total of 310 participants completed the study (99% retention rate). About half (53.8%) of participants were Black and 46.2% Hispanic in the intervention group; 48.3% were Black and 51.7% were Hispanic in the usual care group. Overall, both groups evidenced higher self-efficacy (i.e. lower predicted means) over time (p < 0.0001), although a significant benefit was not observed for the intervention relative to usual care. Conclusion: Both stroke preparedness films and stroke preparedness pamphlets improved self-efficacy with respect to stroke recognition and action among minority churchgoers.

Objective: Community stroke education is a regulated, integral component of stroke systems of care. However, little is known about the types of activities conducted by hospitals. This study was designed to examine the annual requirement for community stroke education among New York State's 119 designated Primary Stroke Centres and identify areas for improvement that may have an implication on stroke outcomes. Design: Cross-sectional survey design Setting: All 119 New York State designated Primary Stroke Centres were invited to participate. Methods: Participating hospitals completed a 29-item online questionnaire assessing multiple domains related to community stroke education including hospital characteristics, allocated resources, implementation barriers, current community stroke education practices and willingness to adopt best practice guidelines. Data were analysed using univariate descriptive and chi-square statistics. Results: Eighty-eight percent of hospitals completed the survey (105/119). Respondents were mostly stroke coordinators and stroke directors. Stroke outreach education was conducted two to four times per year in 58% of the hospitals (n = 69). Community stroke education included behavioural risk factor modification, the detection of stroke risk through screening and stroke preparedness education at health fairs. Although 95% of hospitals (n = 98) reported using at least one best practice approach for these activities, evaluation was generally poor, with only about 23% (n = 24) implementing outcome-specific assessments. Major barriers to stroke outreach were inadequate staffing, time constraints and lack of funding. Conclusion: Hospital-driven community stroke education efforts occur infrequently and are poorly evaluated. This component of stroke systems of care would benefit from guidelines from regulatory agencies, which currently do not exist.

Despite the known benefits of social-emotional learning (SEL) for children, evidence-based, culturally sensitive, and multisensory SEL programs are limited. To address existing challenges in SEL for underprivileged youth, we developed the multicomponent B.E. M.Y. F.R.I.E.N.D. (BMF) framework that capitalizes on (1) cultural tailoring to foster acceptability, (2) tools and strategies to build healthy habits, (3) parental engagement using the Child-Mediated Health Communication Model, (4) social engagement of teachers via peer interaction during learning experiences, and (5) multisensory learning. Each letter (component) of the BMF stands for a unique SEL skill. To test the BMF framework, we developed a proof of concept (POC) focused on one component of the BMF—mindfulness and gratitude SEL (M-letter). The POC includes a description of immersive and interactive multimedia modules with tailor-made music, digital games, cartoons, and booster activities. The outcomes from the POC will inform the development of fully powered randomized studies of each component of BMF and, ultimately, the implementation and dissemination of the entire BMF program. The Multisensory Multilevel Health Education Model (MMHEM) guided the design of the program. In the POC, we used a learning management system (LMS) platform to facilitate program scalability. The modules encompassed culturally and age-relevant real-world examples and were digitized and integrated with traditional learning approaches. This article presents qualitative and quantitative data evaluating feasibility, preliminary acceptability, and preliminary outcomes from the mindfulness and gratitude modules (letter "M" of the BMF). The studies were conducted with 4th and 5th-grade students (Studies 2–4) attending a New York City public school-affiliated after-school program in the Bronx and Queens and their teachers (Study 1). Study #1 presents the focus group data on teachers and principals; Study #2 shows the focus group data on minoritized students; Study #3 presents data from the pilot testing of study-specific outcome measures; and Study #4 presents data on the preliminary efficacy of the BMF mindfulness and gratitude modules using a within-subjects repeated measures pre-posttest study design. Results suggest that the "M" component (mindfulness and gratitude) of the BMF framework is feasible and highly engaging among minoritized children, with high acceptability among teachers and students. We also found a positive impact of the intervention on measures of gratitude and life satisfaction (preliminary efficacy). [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) and stroke are major contributors to chronic disease burden in the United States. Despite the high prevalence of stroke, 90% of all stroke events are preventable and can be attributed to seven key modifiable risk factors (MRFs)—high blood pressure (BP), high cholesterol, diabetes mellitus (DM), smoking, obesity, unhealthy diet, and physical inactivity. In the United States, stroke prevention interventions led by community health workers (CHWs) have been proven to be highly effective in preventing the onset of MRFs. We conducted a scoping review of the competency assessment methods used in CVD and stroke-focused CHW training programs. We searched six online databases: PubMed, Cochrane, CINAHL, Embase, Web of Science, and HaPI, from all available years until January 2021. Of the 1,774 initial articles found, we identified 30 eligible articles to be included in the review. Nine of these studies used previously validated instruments, whereas the remaining 21 studies used tools from the training curriculum or independently developed instruments. Only five of these validated tools reported psychometric properties; none of them were designed for the CHW population. Our scoping review of literature revealed that CHW-specific competency assessment methods were limited, with few or no domain-referenced tools on CVD or stroke risk factors that complied with established measurement standards. We conclude that there is an urgent need for the development of a comprehensive and valid assessment instrument in CVD and stroke prevention to evaluate CHW performance and optimize their credibility, representing important first steps toward integrating CHWs into health care systems. [ABSTRACT FROM AUTHOR]

Objectives: We explored the effect of a culturally targeted calorie label intervention on food purchasing behavior of elementary school students. Method: We used a quasi-experimental design with two intervention schools and one control school to assess food purchases of third through fifth graders at standardized school food sales before and after the intervention (immediate and delayed) in schools. The intervention comprised three 1-hour assembly-style hip-hop--themed multimedia classes. Results: A mean total of 225 children participated in two baseline preintervention sales with and without calorie labels; 149 children participated in immediate postintervention food sales, while 133 children participated in the delayed sales. No significant change in purchased calories was observed in response to labels alone before the intervention. However, a mean decline in purchased calories of 20% (p < 0.01) and unhealthy foods (p < 0.01) was seen in immediately following the intervention compared to baseline purchases, and this persisted without significant decay after 7 days and 12 days. Conclusion: A 3-hour culturally targeted calorie label intervention may improve food-purchasing behavior of children.

Background: Dementia health literacy is low among the public and likely poses a significant barrier to Alzheimer's disease (AD) symptom recognition and treatment, particularly among minority populations already facing higher AD burden. We evaluated the pilot phase of a novel AD health education program, Old SCHOOL (Seniors Can Have Optimal Aging and Ongoing Longevity) Hip-Hop (OSHH), which is designed to enable children to be AD health educational conduits in the home ("child-mediated health communication"). Method: OSHH applied our stroke-validated model of engaging, dynamic, and age- and culturally appropriate curriculum delivered to elementary school-age children (fourth/fifth grades, ages 9-11 years). We assessed AD knowledge among the children at baseline, immediately following the intervention (1-hour program delivered daily over 3 consecutive days), and 3 months later. For key AD symptoms, we developed the FLOW mnemonic (forget, lose, overlook, write/wander); students were additionally taught action plans for recognized symptoms. Results: Seventy-five students completed baseline assessments, and 68 completed posttesting. AD symptoms in FLOW were not well known at baseline (individually ranging from 16% to 71% correct) but were highly learned after 3 days (89% to 98% correct) and retained well after 3 months (80% to 95% correct, p = 0.01 for all comparisons vs. baseline). AD localization, including its effect on memory and the hippocampus, was also highly learned and retained (p < 0.001). Eighteen students (24%) reported having a close friend/family member with AD. Conclusions: This study suggests our hip-hop health education model may be an effective method to improve AD health literacy.

Background: The audience response system (ARS) allows students to respond and interact anonymously with teachers via small handheld wireless keypads. Despite increasing popularity in classroom settings, the application of these devices to health education programming has not been studied. We assessed feasibility, engagement, and learning among children using an ARS compared with traditional pencil-paper formats, (ARS) for a stroke health education program. Method: We compared outcome data generated via an ARS-based intervention to pencil-paper controls, including test scores and missing data rates among 265 schoolchildren 9 to 11 years old participating in stroke education. Among 119 children, we evaluated the feasibility of ARS use and explored student motivation with a 10-item questionnaire. We assessed facilitator experience with both methods. Results: ARS use is feasible. Students reported having more fun ("p" < 0.001), increased attention ("p" < 0.001), participation ("p" < 0.001), and perceived learning outcomes ("p" < 0.001) compared with pencil-paper controls. Test scores showed highly positive improvement for both ARS and paper without additional benefits of ARS on learning. There was no difference in missing data rates ("p" < 0.001). Educators preferred the ARS. Conclusion: The use of an ARS among children is feasible and improves student and facilitator engagement without additional benefits on stroke learning.