Education strategies for stroke prevention.

troke is a major public health burden in the United States, with indications that stroke is emerging as a global epidemic. Furthermore, there exists an appreciation that focus on clinical treatment alone will not significantly reduce the burden of stroke, including morbidity and mortality. Emphasis needs to shift to acknowledging the importance of behavioral change science. The focus of this monograph is to provide insight into considerations for the development of theory-based interventions for reduction of stroke through behavioral change. The Science of Behavioral Change is a complex endeavor, and addressing the lifestyle changes during the life course needed to reduce the burden of stroke remains a significant challenge. Areas of exploration include an understanding of the acquisition of vascular risk behaviors; identifying and testing mechanisms for changing existing behaviors; identifying strategies that optimally support the maintenance of health behaviors ; and choosing the appropriate level for behavioral change (ie, individual change versus population level or structural change). Part of understanding behaviors includes making predictions about why people behave the way they do. Behavioral theory used in the design of interventions allows us to assess an individual's readiness to take action toward healthier behaviors. An accompanying theoretical platform, such as the transtheo-retical model, provides the framework for the type of strategy or process needed to guide individual or system interventions through the stages of change, including action and maintenance. An important epidemiological feature of cerebrovascular disease concerns the sharp gradients in morbidity and mortality by race-ethnicity. Indeed, some of the earliest educational materials for stroke prevention have been suboptimal because of the generic nature of information without reference to place or culture. For example, trust is a concern among many African American and Hispanic communities and low-income populations. Effective interventions in minority communities have established trust by building relationships with community members and organizations. Successful community engagement strategies include engaging in conversation with the community to inform about the issues; designing curricu-lums to focus a dialogue; establishing collaborative leadership models; and sharing use of resources. 1 Other important components of any intervention design include a focus on health-literate materials and cultural tailoring. Examples of health-literate and cultural tailored educational materials include American Heart/American Stroke Association Power to End Stroke Program and the Massachusetts Department of Health Video. 2 For decades, a sense of nihilism permeated stroke research stemming from a clinical frustration about the lack of realistic stroke treatments, poor …