Reducing Stroke Risk Among Young Adult African Americans: A Feasibility Study

Abstract

African Americans are disproportionately affected by stroke and its modifiable risk factors, and strategies are needed to help African Americans adopt healthy lifestyles early in life. The purpose of this study was to assess the feasibility of the Stroke Counseling for Risk Reduction (SCORRE) intervention, a tailored, theory-based intervention consisting of a motivational video of young African American stroke survivors, the American Heart Association's Life's Simple 7® (LS7) risk assessment and education tool, and a 6-week behavioral risk reduction diary. Feasibility and changes in theoretical variables were evaluated over 6 weeks. In four months, 30 participants were enrolled and randomized and 29 (97%) completed the study. Participants averaged 23 years old, most were female university students, and they had an average of 2.1 out of 7 risk factors for stroke. Only 7% had missing items on questionnaires, and 17% had missing daily diary entries. Although statistical significance of differences was not assessed, both intervention and control groups had improvements in knowledge scores following the initial session, and larger improvements in accuracy of perceived stroke risk and in health behaviors (physical activity and diet quality) were observed among participants receiving SCORRE. An exit survey indicated the majority of participants receiving SCORRE were motivated to achieve better health; enjoyed the video, LS7 and diary; and felt the program length was appropriate. Results suggest that SCORRE is feasible and acceptable, and with additional refinement and further testing has potential for reducing stroke risk among African Americans. © 2016 Wiley Periodicals, Inc.

Essential considerations in developing attention control groups in behavioral research

“…Thus, the written information received by the attention control group did contain some brief information about risk reduction similar to what might be received in usual care, but the information did not equal the amount of content or time (e.g., dosage) received by the intervention group. Nevertheless, the researchers observed improvements in knowledge of stroke risk factors, accuracy of perceived stroke risk, and health behaviors in both groups, although improvements were greater among SCORRE participants (Aycock, Clark, & Hayat, ).…”

“…When planning attention control group activities, researchers need to consider possible ways that the attention control activities may be associated with the study outcome(s). For example, Aycock et al () conducted a study to test the feasibility of the Stroke Counseling for Risk Reduction (SCORRE) intervention, designed to increase accuracy of perceived stroke risk and lifestyle behaviors (i.e., healthy diet and physical activity) in young adults at risk of stroke. Participants receiving SCORRE (see Table ) reviewed a stroke education brochure and motivational video and received counseling about their stroke risk factors based on the American Heart Association's Life's Simple 7 (LS7)®.…”

“…The simple act of giving the brochure and list of stroke risk factors to the attention control group may have resulted in improved knowledge and initiated behavior change for some. For a subsequent test of the SCORRE intervention in an ongoing study (Aycock, , Table ), the attention control group reviewed a safe sex education brochure and video, to mimic the amount of time and content received by the intervention group and serve as a placebo. Thus, one active component of the intervention, stroke risk factor education, was removed from the attention control group.…”

“…In initial feasibility testing of the SCORRE intervention (Aycock et al, ), to minimize variability and enhance validity, one person, an adult health nurse practitioner, administered both the intervention and the control group activities. While having one research staff administer the intervention and control activities may be a feasibility issue and provides control in one way, the potential issue is that in delivering the content for both, aspects of the intervention content may inadvertently be used with the control group.…”

“…A different focus of activities for an attention control group than the intervention group affects advertising for recruitment of participants. In the feasibility study of SCORRE (Aycock et al, ), the attention control group received a brochure on stroke risk factors, and the recruitment flyers described the study as about reducing stroke risk. However, for the larger test of the SCORRE study (Aycock, ), with a safe sex attention placebo control group, the advertising had to reflect a more general topic, such as “improving your health,” so those randomized to attention control did not wonder why they were not hearing about stroke risk reduction.…”