Development and validation of stroke literacy and action measures for pre-adolescent children

Stroke is the fifth leading cause of death and the leading cause of disability in the United States. Only 7% of ischemic stroke patients receive tissue plasminogen activator, a life-saving medication that can significantly improve stroke outcomes if administered to an eligible patient within four-and-a-half hours of stroke onset. The greatest barrier to timely treatment is pre-hospital arrival delays, often caused by a lack of stroke education among the public. Stroke education directed at children has been recommended to improve stroke education among the public. Despite numerous studies reporting stroke knowledge in a pediatric population (grades K-8), there is currently no existing valid and reliable instrument to assess stroke literacy and action among children as young as eight years old.;The purpose of this dissertation project was to develop valid and reliable stroke literacy and action measures for pre-adolescent children. This dissertation comprises three separate, but related, papers that report on each of three phases of the project. These phases include: a) a systematic review of the stroke literacy instrumentation literature; b) the development of a valid and reliable stroke literacy instrument, the Stroke Literacy and Action Measures (S.L.A.M.); and c) an evaluation of stroke literacy among children living in a low-income urban community of Chicago that was conducted with the S.L.A.M.;In phase one of the study, a systematic review demonstrated that there is a need for a valid and reliable stroke literacy and action measures for use among pre-adolescent children. In phase two, the S.L.A.M. was demonstrated to be consistent and reliable within its sub-constructs of stroke knowledge, behavioral intent to act (call "911") and self-efficacy to take action. All 39 items from the draft measures were determined to be of clinical significance and were retained in the final instrument. In phase three, baseline data from pre-adolescent children using the S.L.A.M. indicated that, overall, understanding of stroke symptoms is low. Students who indicated that they know a family member or friend who has had a stroke performed significantly better on the stroke knowledge items than those without such experience.;The results of this study demonstrate the S.L.A.M. to be a valid and reliable instrument with which investigators can measure and assess stroke literacy and action among pre-adolescent children and low-literacy adult populations.