Stroke Stroke Ready Intervention : Community Engagement to Decrease Pre - Hospital Delay Running title :

Background: Time limited acute stroke treatments are underused primarily due to pre-hospital delay. One approach to decreasing pre-hospital delay is to increase stroke preparedness, the ability to recognize stroke and the intention to immediately call emergency medical services, through community engagement with high risk communities. Methods and Results: Our community-academic partnership developed and tested ‘Stroke Ready’, a peer-led, workshop-based, health behavior intervention to increase stroke preparedness among African American youth and adults in Flint, Michigan. Outcomes were measured with a series of nine stroke and non-stroke one minute video vignettes; after each video, participants selected their intended response (primary outcome) and symptom recognition (secondary outcome) receiving one point for each appropriate stroke response and recognition. We assessed differences between baseline and post-test appropriate stroke response which was defined as intent to call 911 for stroke vignettes and not calling 911 for non-stroke, non-emergent vignettes and recognition of stroke. Outcomes assessments were performed before workshop one (baseline), at the conclusion of workshop two (immediate posttest) and one month later (delayed post-test). A total of 101 participants completed the baseline assessment (73 adults and 28 youth), 64 completed the immediate post-test and 68 the delayed post-test. All participants were African American. The median age of adults was 56 (IQR 35-65) and youth was 14 (IQR 11-16), 65% of adults were female and 50% of youth were female. Compared to baseline, appropriate stroke response was improved in the immediate post-test (4.4 vs. 5.2, p<0.01) and was sustained in the delayed post-test (4.4 vs. 5.2, p<0.01). Stroke recognition did not change in the immediate post-test (5.9 vs. 6.0, p=0.34), but increased in the delayed post-test (5.9 vs. 6.2, p=0.04). Conclusion: Stroke Ready increased stroke preparedness a necessary step toward increasing acute stroke treatment rates. Clinical Trial Registration Information: www.clinicaltrials.gov. Identifier: NCT01499173.