Stroke Center and Department of Neurology, UCLA Medical Center, Los Angeles, CA 90095, USA.
Stroke. 2010 Apr;41(4):771-7. doi: 10.1161/STROKEAHA.109.576702. Epub 2010 Feb 18.
Ethnic minorities are at higher stroke risk than non-Hispanic whites yet are less likely to have optimal vascular risk factor control. There is a need to develop culturally sensitive strategies for enhancing vascular risk reduction in minority patients with stroke. This study aimed to develop a postdischarge report card to boost treatment adherence among elderly Spanish-speaking patients with stroke within an urban health system.
This study included a total of 13 Spanish-only speaking participants aged > or = 60 years discharged from a local government hospital in Los Angeles within 18 months of an index ischemic stroke and 6 caregivers engaged in focus groups and interviews. Structured interviews were conducted with 11 care providers and 9 administrators at the hospital. Framework analysis examined the data and elicited themes to adapt a pre-existing patient report card tool.
Spontaneously using the same phrase, "Al pie de la letra," several participants expressed a need to follow medical instructions accurately to prevent recurrent stroke and identified barriers/facilitators for doing so. They made comments about the pre-existing report card, advising several changes, including the clarification of phrases, and written instructions to explain the need for the card and how to fill it out. The providers and administrators recommended avenues for successfully using the card at the hospital. A new report card was created that incorporated all major perspectives.
Crafting a culturally sensitive tool for promoting treatment adherence in elderly Spanish-only-speaking patients with stroke within an urban health system using a participatory methodology is feasible. The efficacy of this new report card should be tested in a randomized controlled trial.
少数民族人群发生中风的风险高于非西班牙裔白人，但他们更不可能实现最佳的血管风险因素控制。因此，我们需要制定针对少数民族中风患者的、具有文化敏感性的策略来增强其血管风险降低的意识。本研究旨在开发一种出院后报告卡，以提高城市卫生系统中西班牙语老年中风患者的治疗依从性。
本研究共纳入 13 名西班牙语母语者，年龄均≥60 岁，他们在洛杉矶当地政府医院出院后 18 个月内发生了索引性缺血性中风，有 6 名照顾者参与了焦点小组和访谈。对 11 名医护人员和 9 名医院管理人员进行了结构化访谈。采用框架分析法分析数据并引出主题，以调整现有的患者报告卡工具。
有几位参与者自发地使用了相同的短语“Al pie de la letra”，表示需要准确遵循医嘱以预防中风复发，并确定了遵循医嘱的障碍/促进因素。他们对现有的报告卡提出了一些建议，包括澄清短语和书面说明，以解释需要报告卡以及如何填写报告卡。医护人员和管理人员为在医院成功使用报告卡提出了一些建议。最后创建了一份新的报告卡，其中纳入了所有主要观点。
使用参与性方法为城市卫生系统中的西班牙语老年中风患者制定一种促进治疗依从性的文化敏感性工具是可行的。应在随机对照试验中检验这种新报告卡的效果。
