https://doi.org/10.4081/qrmh.2022.10639
Using qualitative data to inform the adaptation of a stroke preparedness health intervention
Submitted: 25 May 2022
Accepted: 6 December 2022
Published: 23 January 2023
Accepted: 6 December 2022
Abstract Views: 1179
PDF: 285
Supplementary Materials: 31
Supplementary Materials: 31
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Qualitative research methods are often used to develop health interventions, but few researchers report how their qualitative data informed intervention development. Improved completeness of reporting may facilitate the development of effective behavior change interventions. Our objective was to describe how we used qualitative data to develop our stroke education intervention consisting of a pamphlet and video. First, we created a questionnaire grounded in the theory of planned behavior to determine reasons people delay in activating emergency medical services and presenting to the hospital after stroke symptom onset. From our questionnaire data, we identified theoretical constructs that affect behavior which informed the active components of our intervention. We then conducted cognitive interviews to determine emergency department patients’ understanding of the intervention pamphlet and video. Our cognitive interview data provided insight into how our intervention might produce behavior change. Our hope is that other researchers will similarly reflect upon and report on how they used their qualitative data to develop health interventions.
Aparicio, H. J., Carr, B. G., & Kasner, S. E., Kallan, M. J., Albright, K. C., Kleindorfer, D. O., & Mullen, M. T. (2105). Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers. Journal of the American Heart Association, 4(10), e001877.
DOI: https://doi.org/10.1161/JAHA.115.001877
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211.
DOI: https://doi.org/10.1016/0749-5978(91)90020-T
Ballard, A. M,, Davis, A., Hoffner, & C. A. (2021). The impact of health narratives on persuasion in African American women: A systematic review and meta-analysis. Health Commununication, 36(5),560-71.
DOI: https://doi.org/10.1080/10410236.2020.1731936
Boehme, A. K., Siegler, J. E., Mullen, M. T., Albright, K. C., Lyerly, M. J., Monlezun, D.J., Jones, E.M., Tanner, R., Gonzales, N. R., Beasley, T. M., Grotta, J. C., Savitz, S. I., & Martin-Schild, S. (2014). Racial and gender differences in stroke severity, outcomes, and treatment in patients with acute ischemic stroke. Journal of Stroke and Cerebrovascular Disease, 23(4), e255-61.
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.003
Boutron., I, Altman, D. G., Moher, D., Schulz, K. F., & Ravaud, P. (2017) CONSORT statement for randomized trials of nonpharmacologic treatments: A 2017 update and a consort extension for nonpharmacologic trial abstracts. Annals of Internal Medicine, 167(1), 40-7.
DOI: https://doi.org/10.7326/M17-0046
Carey, R. N., Connell, L. E., Johnston, M., Rothman, A. J., de Bruin, M., Kely, M. P., & Michie, S. (2019). Behavior change techniques and their mechanisms of action: A synthesis of links described in published intervention literature. Annals of Behavioral Medicine, 53(8), 693-707.
DOI: https://doi.org/10.1093/abm/kay078
Colligan, E. M., Pines, J. M., Colantuoni, E., & Wolff, J. L. (2017). Factors associated with frequent emergency department use in the medicare population. Medical Care Research and Review, 74(3), 311-27.
DOI: https://doi.org/10.1177/1077558716641826
Craig, P., Dieppe, P., Macintyre, S., Michies, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new medical research council guidance. British Medical Journal, 337, a1655.
DOI: https://doi.org/10.1136/bmj.a1655
Duggleby, W., Peacock, S., Ploeg, J., Swindle, J., Kaewwilai, L., & HeunJung, L. (2020). Qualitative research and its importance in adapting interventions. Qualitative Health Resarch, 30(10), 1605-13.
DOI: https://doi.org/10.1177/1049732320920229
Faysel, M. A., Singer, J., Cummings, C., Stefanov, D. G., & Levine, S. R. (2019). Disparities in the use of intravenous t-Pa among ischemic stroke patients: Population-based recent temporal trends. Journal of Stroke and Cerebrovascular Diease, 28(5): 1243-51.
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.013
Fjeldsoe, B. S., Miller, Y. D., O'Brien, J. L., & Marshall, A. L.(2012). Iterative development of mobilemums: A physical activity intervention for women with young children. International Journal of Behavioral Nutrition and Physical Activity, 9:151.
DOI: https://doi.org/10.1186/1479-5868-9-151
Hsia, A. W., Edwards, D. F., Morgenstern, L.B., Wing, J. J., Brown, N. C., Coles, R., Loftin, S., Wein, A., Koslosky, S. S., Fatima, S., Sánchez, B. N., Fokar, A., Gibbons, M. C., Shara, N., Jayam-Trouth, A., & Kidwell, C.S. (2011). Racial disparities in tissue plasminogen activator treatment rate for stroke: A population-based study. Stroke, 42(8): 2217-21.
DOI: https://doi.org/10.1161/STROKEAHA.111.613828
Hsia, A. W., Castle, A., Wing, J, J., Edwards, D.F., Brown, N,C,, Higgins, T.M., Wallace, J. L., Koslosky, S. S., Gibbons, M. C., Sánchez, B. N., Fokar, A., Shara, N., Morgenstern, L. B., & Kidwell, C.S. (2011). Understanding reasons for delay in seeking acute stroke care in an underserved urban population. Stroke, 42(6), 1697-701.
DOI: https://doi.org/10.1161/STROKEAHA.110.604736
Houston, T. K., Allison, J. J., Sussman, M., Horn, W., Holt, C. L., Trobaugh, J., Salas, M., Pisu, M., Cuffee, Y. L., Larkin, D., Person, S. D., Barton, B., Kiefe, C. I., & Hullett, S. (2011). Culturally appropriate storytelling to improve blood pressure: A randomized trial. Annals of Internal Medicine, 154(2), 77-84.
DOI: https://doi.org/10.7326/0003-4819-154-2-201101180-00004
Hystad, P., & Carpiano, R. M. (2012). Sense of community-belonging and health-behaviour change in Canada. Journal of Epidemiology and Community Health, 66(3), 277-83.
DOI: https://doi.org/10.1136/jech.2009.103556
Johnston, S. C., Fung, L. H., & Gillum, L. A. (2001). Utilization of intravenous tissue-type plasminogen activator for ischemic stroke at academic medical centers: The influence of ethnicity. Stroke, 32(5), 1061-8.
DOI: https://doi.org/10.1161/01.STR.32.5.1061
Katan, M., & Luft, A. (2018). Global burden of stroke. Seminars in Neurolology, 38(2), 208-1.
DOI: https://doi.org/10.1055/s-0038-1649503
Lacy, C. R., Suh, D. C., Bueno, M., & Kostis, J. B. (2001) Delay in presentation and evaluation for acute stroke: Stroke time registry for outcomes knowledge and epidemiology (S.T.R.O.K.E.). Stroke, 32(1), 63-9.
DOI: https://doi.org/10.1161/01.STR.32.1.63
Lewin, S., Gelenton, C., & Oxman, A. D. (2009). Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: Methodological study. British Medical Journal, 339, b3496.
DOI: https://doi.org/10.1136/bmj.b3496
Lichtman, J. H., Watanabe, E., Allen, N. B., Jones, S. B., Dostal, J., & Goldstein, L. B. (2009). Hospital arrival time and intravenous t-pa use in us academic medical centers, 2001-2004. Stroke, 40, 3845-50.
DOI: https://doi.org/10.1161/STROKEAHA.109.562660
Michie, S., Carey, R. N., Johnston, M., Rothman, A. J. de Bruin, M., Kelly, M. P., & Connell, L. E. (2018). From theory-inspired to theory-based interventions: A protocol for developing and testing a methodology for linking behaviour change techniques to theoretical mechanisms of action. Annals of Behavioral Medicine, 52(6), 501-12.
DOI: https://doi.org/10.1007/s12160-016-9816-6
Nasr, D. M., Brinjikji, W., Cloft, H. J., & Rabinstein, A. A. (2013). Racial and ethnic disparities in the use of intravenous recombinant tissue plasminogen activator and outcomes for acute ischemic stroke. Journal of Stroke and Cerebrovascular Disease, 22(2), 154-60.
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.07.003
National Institute of Neurological Disorders and Stroke, rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. (1995). The New England Journal of Medicine, 333(24), 1581-7.
DOI: https://doi.org/10.1056/NEJM199512143332401
O'Cathain, A., Croot, L., Duncan, E., Rousseau, N., Sworn, K., Turner, K. M., Yardley, L., & Hoddinott, P. (2019). Guidance on how to develop complex interventions to improve health and healthcare. British Medical Journal, 9, e029954.
DOI: https://doi.org/10.1136/bmjopen-2019-029954
Robles, M. C., Springer, M. V., Corches, C.L., Burke, J. F., Lin, C. C., Oliver, A., & Skolarus, L.E. (2020). Stroke ready very brief intervention improves immediate postintervention stroke preparedness. Circulation: Cardiovascular Quality and Outcomes, 13(12), e006643.
DOI: https://doi.org/10.1161/CIRCOUTCOMES.120.006643
Sandelowski, M., & Leeman, J. (2012). Writing usable qualitative health research findings. Qualitative Health Research, 22(10), 1404-13.
DOI: https://doi.org/10.1177/1049732312450368
Siegler, J.E., Boehme, A. K., Albright, K. C., & Martin-Schild, S. (2013). Ethnic disparities trump other risk factors in determining delay to emergency department arrival in acute ischemic stroke. Ethnicity & Disease, 23(1), 29-34.
Skolarus, L. E., Murphy, J. B., Zimmerman M. A,, Bailey, S., Fowlkes, S., Brown, D. L, Lisabeth, L.D., Greenberg, E., & Morgenstern, L. B. (2013). Individual and community determinants of calling 911 for stroke among african americans in an urban community. Circulation: Cardiovascular Quality and Outcomes, 6(3), 278-83.
DOI: https://doi.org/10.1161/CIRCOUTCOMES.111.000017
Springer, M. V., Labovitz, D. L., & Hochheiser, E. C. (2017). Race-ethnic disparities in hospital arrival time after ischemic stroke. Ethnicity & Disease, 27(2), 125-32.
DOI: https://doi.org/10.18865/ed.27.2.125
U.S. Census Bureau. (2021). U.S. Census bureau quickfacts. Available from: https://www.census.gov/quickfacts/flintcitymichigan.
Wei, H. G., & Camargo, C. A., Jr. (2000) Patient education in the emergency department. Academic Emergency Medicine, 7(6), 710-7.
DOI: https://doi.org/10.1111/j.1553-2712.2000.tb02052.x
Wigginton, B., Thomson, Z. O., Sandler, C. X., & Reeves, M. M. (2020). Reflexive intervention development: Using qualitative research to inform the development of an intervention for women with metastatic breast cancer. Qualitative Health Research, 30(5), 666-78.
DOI: https://doi.org/10.1177/1049732319884901
Williams, O., Teresi, J., Eimicke, J. P., Abel-Bey, A., Hassankhani, M., Valdez, L., Gomez Chan, L., Kong, J., Ramirez, M., Ravenell, J., Ogedegbe, G., & Noble, J. M. (2019). Effect of stroke education pamphlets vs a 12-minute culturally tailored stroke film on stroke preparedness among black and hispanic churchgoers: A cluster randomized clinical trial. JAMA Neurolology, 76(10), 1211-8.
DOI: https://doi.org/10.1001/jamaneurol.2019.1741
Williams, O., & Noble, J. M. (2008). “Hip-hop” stroke: A stroke educational program for elementary school children living in a high-risk community. Stroke, 39(10), 2809-16.
DOI: https://doi.org/10.1161/STROKEAHA.107.513143
Willis, G. B. (2005). Cognitive interviewing. SAGE Publications, Inc.
DOI: https://doi.org/10.4135/9781412983655
Yardley, L., Morrison, L., Bradbury, K., & Muller, I. (2015). The person-based approach to intervention development: Application to digital health-related behavior change interventions. Journal of Medical Internet Research, 17(1): e30.
DOI: https://doi.org/10.2196/jmir.4055
How to Cite
Springer, Mellanie V., Tiffany Hodges, Cristi Lanning, Michael Tupper, and Lesli E. Skolarus. 2023. “Using Qualitative Data to Inform the Adaptation of a Stroke Preparedness Health Intervention”. Qualitative Research in Medicine and Healthcare 6 (3). https://doi.org/10.4081/qrmh.2022.10639.
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.