Gardois Paolo, Booth Andrew, Goyder Elizabeth, Ryan Tony
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
BMC Public Health. 2014 Apr 28;14:409. doi: 10.1186/1471-2458-14-409.
Stroke places a significant burden to all affected individuals, but it is perhaps more significant amongst members of black, minority and ethnic communities, who may experience poorer awareness of stroke symptoms than the general population. Recently, several initiatives tried to improve public awareness that symptoms of stroke need to be treated as a medical emergency. However, ethnic communities present cultural barriers, requiring tailored health promotion interventions, whose effectiveness remains uncertain. Our systematic review aimed to identify relevant published evidence, synthesize the main study components and identify evidence of the effectiveness of the interventions.
MEDLINE, EMBASE, CINAHL, and PsycInfo were searched for journal articles on health promotion interventions for increasing stroke awareness in ethnic minorities, published in English between 1995 and 2012. Search results were collaboratively assessed by the authors; included studies were analysed to identify their main characteristics, and a thematic analysis of their content was conducted. No meta-analysis was performed, due to the heterogeneity of results.
Eighteen studies were included, reporting 15 interventions conducted in the US, for African-Americans or Hispanics; populations sizes differed between interventions. Interventions were mostly carried out in community settings with different educational techniques, focussing on experiential methods. Health professionals usually organized the programs, delivered by nurses, other health professionals or volunteers.The few theory-based interventions focussed on individual-level behavioural change. Practical cultural adaptation strategies were not linked to specific theoretical frameworks. Interventions widely differed as for target populations, settings, delivery methods, contents and professional roles involved. All study designs were quantitative, and the emerging evidence of effectiveness was inconclusive.Such interventions operate in very complex scenarios, and several variables may influence their effectiveness. Therefore, qualitative or mixed-methods study designs may shed light on barriers and facilitators, experiential education strategies and community involvement.Network- and community-level theories may help improving design and evaluation of interventions.
Eleven case reports and four RCTs provide evidence about stroke awareness interventions organized in the US. The studies provide only partial and inconclusive evidence about the effectiveness of the interventions. Hence, further research is needed on different countries and ethnic minorities.
中风给所有受影响的个体带来了沉重负担，但在黑人、少数族裔和其他族裔社区成员中，负担可能更为严重，他们对中风症状的认知可能比普通人群更差。最近，一些举措试图提高公众对中风症状需作为医疗急症来对待的认识。然而，不同族裔社区存在文化障碍，需要量身定制的健康促进干预措施，但其效果仍不确定。我们的系统评价旨在识别相关的已发表证据，综合主要研究内容，并确定干预措施有效性的证据。
检索MEDLINE、EMBASE、CINAHL和PsycInfo数据库，查找1995年至2012年期间以英文发表的关于提高少数民族中风意识的健康促进干预措施的期刊文章。作者共同评估检索结果；对纳入的研究进行分析以确定其主要特征，并对其内容进行主题分析。由于结果的异质性，未进行荟萃分析。
纳入了18项研究，报告了在美国针对非裔美国人或西班牙裔开展的15项干预措施；不同干预措施的人群规模有所不同。干预措施大多在社区环境中采用不同的教育技术实施，侧重于体验式方法。健康专业人员通常组织这些项目，由护士、其他健康专业人员或志愿者实施。少数基于理论的干预措施侧重于个体层面的行为改变。实际的文化适应策略未与特定的理论框架相关联。干预措施在目标人群、环境、实施方式、内容和所涉及的专业角色方面差异很大。所有研究设计均为定量研究，关于有效性的新证据尚无定论。此类干预措施在非常复杂的情况下开展，几个变量可能会影响其有效性。因此，定性或混合方法的研究设计可能会揭示障碍和促进因素、体验式教育策略以及社区参与情况。网络和社区层面的理论可能有助于改进干预措施的设计和评估。
11份病例报告和4项随机对照试验提供了关于美国组织的中风意识干预措施的证据。这些研究仅提供了关于干预措施有效性的部分且不确定的证据。因此，需要对不同国家和少数民族进行进一步研究。
