Our scholars’ stories: Andrabi seeks to fill a gap in care for stroke survivors in Alabama’s Black Belt
African American communities have a higher prevalence of both hypertension and stroke than any other ethnicity. Alabama is among one of 11 states makes up part of the region known as the Stroke Belt where death from stroke is from 2 to 4 times greater than other states.
“Stroke is especially prominent among African American adults living in the Black Belt of rural Alabama,” says Mudasir Andrabi, Ph.D., Forge AHEAD Center scholar.
Andrabi, who is researching the needs and preferences of individuals living in rural Alabama on their post-stroke life management and blood pressure management.
A gap in post-stroke care
Data shows that seventy percent of stroke survivors are discharged from health care facilities, out of which, 40% are released without any community-based services.
“These rates worsen in rural areas due to the socio-demographics of persons living in these areas, including unavailability of services, unaffordable care, lack of transportation, and low socioeconomic status,” says Andrabi, who is an assistant professor at the University of Alabama’s Capstone College of Nursing.
“Lack of health services makes post-stroke self-management for these individuals more challenging, leading to hypertension and recurrence of stroke.”
Mudasir Andrabi, Ph.D.
Assistant Professor, Capstone College of Nursing, University of Alabama
“Stroke is especially prominent among African American adults living in the Black Belt of rural Alabama.”
Andrabi’s research study aims to address the critical gaps in managing stroke-related challenges among African American individuals aged 50 and above who have a documented diagnosis of chronic stroke and high blood pressure condition with mild to moderate disability. Approximately 15% to 20% of individuals will experience a stroke recurrence. According to a recent study, risk of stroke recurrence at 3 years is higher for Black individuals (17.4%) compared with non-Black individuals (14.7%) in the U.S.
With the right tools, self-management interventions can prevent 80% of stroke recurrences.
Andrabi’s why
During her previous work with African American individuals living in rural counties of Alabama, Andrabi says the community key leaders and participants “anecdotally mentioned a lack of services for individuals who have stroke and high blood pressure.”
Did you know?
African American communities have a higher prevalence of both hypertension and stroke than any other ethnicity.
They were reported to have poor management for high blood pressure and engaged in limited preventive behaviors like physical activity and adherence to the treatment.
“Moreover, there is minimal to no rehabilitation services available to these individuals’ post-stroke due to unaffordable co-pays and lack of insurance.”
Due to scarce resources, these individuals have poorer outcomes, including poor body balance, avoidance of physical activity due to fear of falling, and lack of knowledge and skills for alternate other suitable physical activities. Andrabi shared that they typically become dependent on family for their activities of daily living. They also seem to have poor control over their blood pressure in general.
“Since high blood pressure is a major risk factor for stroke, these individuals often end up having a recurrence of stroke. Therefore, it was found to be a priority to help them manage their high blood pressure and post-stroke life as much as possible.”
Andrabi says she wants to empower individuals post-stroke to engage in health behaviors to reduce likelihood of stroke recurrence including reducing sedentary activities, appropriate exercise and medication adherence.
Interventions that prevent stroke recurrence and save lives
Interventions help stroke patients manage and improve their high blood pressure symptoms, physical and emotional stress, taking medication consistently, activities of daily living, and quality of life.
However, intervention strategies are not widely tested among older African American stroke survivors for the management of their post-stroke life and their high blood pressure management.
“We aim to develop a need-based intervention that will be tailored to the social determinants of health and culture of the African American aging populations of rural Alabama,” explains Andrabi.
The group plans to utilize basic technology and other resources available in Alabama’s rural counties. The intervention will be minimally expensive and can be delivered using a minimum health workforce.
Creating a program unique to the community
“Our study involves the community’s key members throughout the entire study including the needs assessment, intervention development, and delivery of intervention.”
To Andrabi’s knowledge, this study is a unique and innovative culturally tailored intervention that would be accessible and affordable for these underserved populations in Alabama at high risk for stroke recurrence.
Developing a cost-effective and accessible self-management program will aim to overcome barriers to health care accessibility and increase equity in the distribution of health care services within these geographically disadvantaged areas.
The overall study focuses on improving stroke survivors to manage their high blood pressure and challenges related to their post-stroke life to improve their health outcomes and quality of life.
Andrabi’s post-stroke self-management program
The post-stroke self-management program includes teaching important information via teleconferences, creating a unique exercise plan based on the severity of the stroke survivor’s disability, sending reminders through texts or calls depending on participant preference, and problem solve to address barriers that may prevent them from engaging in preventive health behaviors.
Andrabi says the main research question is to assess the needs of stroke survivors and develop the best intervention to address those needs. Components will be tailored to the specific needs and preferences of participants, such as:
- Delivery of education to build learning related to management of high blood pressure and post-stroke life
- Accessibility of the program in participants’ homes to overcome their lack of transportation and long distance from the health care facilities
- Simplicity and the social relevance of the educational content
- Reminders for educational sessions for their ease of understanding, especially among elderly individuals
Did you know?
Alabama is part of the Stroke Belt, where death is 2-4 times higher than other states.
- Use of existing resources in counties, such as existing social groups, existing teleconference system, local produce, community halls, or church halls for indoor physical activity during unfavorable weather
All these components focus on overcoming the barriers of lack of insurance and unaffordability of care.
Testing a post-stroke self-management program
Ultimately, the goal of this project is to assess the feasibility, acceptability, and effectiveness of a newly developed intervention for African American stroke survivors in rural Alabama.
In addition, the study involves the community members in every phase, building their capacity to run the program independently and enabling them to control their health.
