NHS Sheffield - Stroke interventions

Introduction

The cost of strokes to the United Kingdom is great, both NHS resources and lives lost. NHS Sheffield is committed to tackling this ongoing health concern and as part of their efforts commissioned The Campaign Company to investigate the inequalities of stroke knowledge and behaviour existing between BME, deprived, Gypsy Traveller and affluent communities.

The Campaign Company built relationships with these communities and used 7 focus groups, 16 formal interviews and other informal interaction to develop a understanding of the knowledge, values and behaviours at work.

We found the many of the barriers arose from a lack of knowledge or a lack of confidence of one’s own knowledge. White British audiences recalled and understood the national stroke awareness campaign, FAST, but with other communities, the campaign has not been as successful.

As the other communities saw the content of FAST as an effective way of raising the awareness of stroke symptoms, one of the underlying concepts for intervention delivery was to deliver this content in a manner suitable for each community.

The next stage of this project is to pilot the interventions: co-production of materials with BME communities, awareness in young people, health training for Gypsy communities and health events.

Our approach

The rising number of strokes, to some extent, is linked to increasing levels of obesity, sedentary occupation, unhealthy lifestyles and an ageing population.

The Department of Health launched the National Stroke Strategy to modernise service provision to meet the demands of our changing society.

In Sheffield, the national target - to reduce by mortality from stroke for people under 75 years by 40% - has already been achieved. However, the ageing of Sheffield’s population has brought new challenges. We anticipate an increased demand for acute investigation and treatment of patients with stroke, and for long term support. As people live longer following a stroke, the need for support is projected to increase even more (about 300 extra patients each year).

The global figure for Sheffield hides inequalities in stroke that are both geographical and ethnic. Reducing inequalities is paramount, which means differential interventions are needed in neighbourhoods, segmented by communities of interest. Our pilot for social marketing insights and behaviour change was one element of a three-pronged approach to raise awareness of strokes:

 

  1. Awareness raising among frontline staff of the symptoms of stroke and what to do (FAST – Facial weakness, Arm and leg weakness, Speech problems, Time to call 999).
  2. Universal awareness raising among the general public. The national campaign launched on 9 Feb 09, and a local Sheffield campaign took place on 26 March 2009.
  3. Targeted social marketing among selected communities of interest; which is the focus of this pilot.

 

These three approaches are designed to meet the first of twenty Quality Markers set out by the Department of Health in The National Stroke Strategy. This Quality Marker states:

“Members of the public and health and care staff are able to recognise and identify the main symptoms of stroke and know it needs to be treated as an emergency.”

NHS Sheffield asked us to examine four different communities in Sheffield: White working classes, BME, Gypsy and Traveller and a comparator affluent group.

Poverty and social exclusion are more prevalent in the three priority communities, particularly the BME community. At least two of the major stroke risk factors have higher rates among many of the marginalised communities: smoking and diabetes.

Due to the exploratory nature of the topic our focus was qualitative research. Our literature review - conducted by CLAHRC found no study of this topic or scale published in the United Kingdom. Our reflexive topic guides were flexible and probing, digging deeper to investigate current knowledge and behaviours relating to stroke, the barriers to knowledge and to behaviour and how these barriers might be overcome. As part of this research we evaluated each communities understanding of the national stroke awareness campaign FAST.

Access to the groups was brokered through stakeholders who held levels of trust in the communities. These included health visitors, ESOL teachers, regeneration officers and leaders of community groups. We also interviewed a broad range of stakeholders to provide a more comprehensive view of the topic.

A combination of focus groups and interviews were held until data saturation was reached, where we were not uncovering any new information relating to the topic. Following each group the data was coded into NVivo 8, a qualitative analysis tool that allows us to handle rich information so themes, trends and theories can be explored. Each time we collected new data, it was discussed then coded into a variety of themes in NVivo.

There were many key insights drawn from the research, which have a fall-out of being useful for other health topics and other services working with these communities. However, some are more pertinent to strokes:

Gypsy and Traveller Group
  • Low levels of literacy are endemic within the gypsy community, making a traditional paper based marketing campaign very ineffective
  • Despite claiming to know little or nothing about stroke, most of members of the community can name the symptoms of a stroke but are not confident in their knowledge
  • The majority of the community are unaware of the FAST campaign, but those who are agree that it was useful in creating a memorable message
BME Group
  • The BME settled community are aware of the basics of the FAST campaign but cannot always quickly decode the acronym
  • Language is a major barrier to understanding messages
  • Abstract concepts are more difficult for those with a weaker grasp of English.  It was asked if the woman’s head was really on fire during the FAST advertisement
White Working Class Group
  • The WWC group can name most of the symptoms and the risk factors of strokes
  • They are aware of the FAST campaign and could recall and decode the anagram without prompt
Affluent Group
  • The community are often knowledgeable about the medical technicalities of stroke or try to draw educated assumptions
  • They can understand abstract concepts easily
Our recommendations, which at the time of writing are under discussion, include:
  • Co-production
Empower BME communities with their own co-produced materials, which are distributed throughout pre-existing networks.  These activities are supported by community members and professionals providing ‘mini-courses’ on strokes.  This generates conversations, raises awareness and directly engages high risk communities.  Clinical leads and community members have already offered their support in such endeavours. Co-production is a manner of working with a target audience to co-design, co-decide, co-deliver and co-assess services.
  • Raising awareness in young people of the target communities
Equip the next generation with the ability to recognise the symptoms of strokes, in each other and in the rest of the population.  Working alongside current school programmes, lessons and activities are used to raise awareness of the symptoms and risk factors.  These young people then act as conduits, for the stroke messages, to their family.  Also, this provides an extra layer of people, who cross cultural and community groups, able to spot and react to strokes.
  • Health training
The Gypsy community faces a unique set of circumstances, so needs unique solutions.  As it is such a small community it can also be engaged in a more personal manner.  Empowering the community to begin supporting some of its own health needs is in tune with Gypsy values and culture.  To provide value, the health training should be more expansive than just stroke symptoms; it should arm the participants with the ability to manage their own health and their communities.  Accrediting the training as a first-aid course would provide a tangible exchange of their time for new skills.  Illustrative visually dependant materials produced with the community can be used to reinforce the messages.
  • Community health events
Getting out into the community and engaging with people face to face reinforces the message of materials and other interventions.  These events are used as platforms to showcase other elements of the campaign but still have their own distinctive offerings.  On the spot health check-ups, materials and advice provide the attendees with a tangible exchange, which educates and raises awareness. Collaborating with pre-existing networks brings more of an offering to the events and builds strong links with the communities.  Personal stories are intertwined with the event to bring the facts and figures to life.
For more information, speak to Rachel Ward on 0208 6880650 or rachel@thecampaigncompany.co.uk
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Last Updated on Thursday, 17 February 2011 11:46