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Stroke education for the at-risk elderly: Do words really matter?

Tricia Olea Santos1* and Hanna K. Ulatowska1
  • 1 University of Texas at Dallas, United States

“You can do nothing to bring the dead to life; but you can do much to save the living”

Statement of the problem

According to the Center for Disease Control (2011), stroke is the fourth leading causes of death in the United States and the leading cause of long-term severe disability. Health disparities are indicated, with a higher incidence of stroke among ethnic minorities as compared to Caucasian Americans. The CDC (2011) further states that older individuals who survive a stroke are more likely to experience moderate-to-severe disability.

Health prevention and promotion campaigns have begun investigating the role of information structure in educating at-risk individuals (Kreuter & McClure, 2004). Information structure, commonly in the form of narrative and expository discourse, has been compared especially across ethnic groups. For example, nutritional information in the context of narratives are perceived by Hispanic Americans as more believable compared to expository text (Slater, Buller, Waters, Archibeque, and LeBlanc, 2003). With regard to cancer screenings, illness narratives are more likely to result in better comprehension and compliance among African Americans (Kreuter, Holmes, Alcaraz, et al., 2010; Dillard, Fagerlin, Cin, Zikmund-Fisher & Ubel, 2010).

Although stroke narratives in aphasia have been studied for decades, the role of this information structure in preventing stroke has yet to be investigated among the at-risk elderly. This study focuses on stroke prevention via two commonly used forms of information structure: narrative and expository discourse. It further investigates how elderly individuals recall medical categories essential to constructing an illness: symptoms, timeline, consequences, causes and treatment.

The study specifically addresses stroke education among Elderly Filipino Americans. Despite being a highly collectivistic and well-educated group (McBride, 2002), Filipino Americans tend to have a short lifespan and are highly vulnerable to stroke (Dalusong-Angosta, 2010) and diabetes (dela Cruz & Galang, 2008). Strengths and limitations of using narrative as opposed to expository discourse structure among the elderly from ethnic groups are discussed.


Procedures
Thirty-five elderly Filipino Americans, between the ages of 60-75 years, participated in the study. They were college-educated and literate in English. Participants were randomly provided with narrative or expository text pertaining to stroke and diabetes. Immediate recall of the information was recorded and analyzed in terms of the amount of relevant medical information.

Results obtained
In terms of the amount of language, more medical information was recalled when medical conditions were presented in narrative as opposed to expository form. As regards categories of medical information, participants provided a more comprehensive picture of the condition when given narrative stimuli, by indicating the symptoms, cause/risk factors, timeline, consequences and treatment.


Conclusion
Illness narratives are vivid and have an inherent temporal-causal structure (Longacre, 1974; Winterbottom, Bekker, Conner, & Mooney, 2008). As such, elderly adults may benefit from the redundant contextual cues which help facilitate recall of medical information (Hultsch, Hertzog, & Dixon, 1990; Salthouse, 1990). Furthermore, illness narratives may be a more familiar and comfortable means of exchanging medical information, especially among collectivistic cultures who rely heavily on peers and family for information.


Acknowledgements

Authors would like to acknowledge the following individuals who provided input concerning the study: Dr. James Bartlett, Dr. Deborah Wiebe, Dr. Robert Stillman and Dr. Belinda Reyes. Thanks are also given to the individuals who took part in the study.

References

References

Dalusung-Angosta, A. (2010). Coronary Heart Disease Knowledge among Filipino Americans connected to Primary Care Services. PhD diss., University of Hawaii at Manoa.

dela Cruz, F. & Galang, C. (2008). The illness beliefs, perceptions, and practices of Filipino Americans with hypertension. Journal of the American Academy of Nurse Practitioners 20, no. 3: 118-27.

Dillard, A., Fagerlin, A, Dal Cin, S., Zikmund-Fisher, B., & Ubel, P. (2010). Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening. Social Science & Medicine 71: 45-52.

Hultsch, D., Hertzog, C., & Dixon, R. (1990). Ability correlates of memory performance in adulthood and aging. Psychology and Aging 5: 356-68.

Kreuter, M., Holmes, K., Alcaraz, K., Kalesan, B., Rath, S., Richert, M., McQueen, A., Caito, N., Robinson, L., & Clark, E. (2010). Comparing narrative and informational videos to increase mammography in low-income African American women. Patient Education and Counseling 81: S6-S14.

Kreuter, M. & McClure, S. (2004). The role of culture in health communication. Annual Review of Public Health 25: 439-55.

Longacre, R. (1974). Narrative versus other discourse genre. In Advances in tagmemics, ed. Ruth Brend, 357-76. Amsterdam: North-Holland Publishing Company.

McBride, M. (2002). Health and Health Care of Filipino American Elders. Stanford Geriatric Education Center. Stanford University School of Medicine. http://www.stanford.edu/group/ethnoger/filipino.html (accessed August 11, 2010).

Salthouse, T. (1990). Working Memory as a Processing Resource in Cognitive Aging. Developmental Review 10, no. 1: 101-24.

Slater, M., Buller, D., Waters, E., Archibeque, M., & LeBlanc, M. (2003). A Test of Conversational and Testimonial Messages versus Didactic Presentations of Nutrition Information." Journal of Nutrition Education and Behavior 35, no. 5: 255-59.

U.S. Centers for Disease Control and Prevention. (2011). CDC health disparities and inequalities report—United States, 2011. Morbidity and Mortality Weekly Report, 60 (Suppl): 1–160.

Winterbottom, A., Bekker, H., Conner, M., & Mooney, A. (2008). Does narrative information bias individual's decision making? A systematic review." Social Science and Medicine 67, no. 12: 2079-88.

Keywords: stroke education, Elderly, information structure, narratives, expository discourse

Conference: Academy of Aphasia -- 52nd Annual Meeting, Miami, FL, United States, 5 Oct - 7 Oct, 2014.

Presentation Type: Platform or poster presentation

Topic: Aphasia

Citation: Olea Santos T and Ulatowska HK (2014). Stroke education for the at-risk elderly: Do words really matter?. Front. Psychol. Conference Abstract: Academy of Aphasia -- 52nd Annual Meeting. doi: 10.3389/conf.fpsyg.2014.64.00002

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Received: 09 Mar 2014; Published Online: 04 Aug 2014.

* Correspondence: Dr. Tricia Olea Santos, University of Texas at Dallas, Dallas, TX - Texas, 75235, United States, tcmosantos@yahoo.com