TY - JOUR
T1 - Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists?
T2 - Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban pakistani community
AU - Khan, Maria
AU - Kamal, Ayeesha Kamran
AU - Islam, Muhammad
AU - Azam, Iqbal
AU - Virk, Azam
AU - Nasir, Alia
AU - Rehman, Hasan
AU - Arif, Anita
AU - Jan, Muhammad
AU - Akhtar, Anjum
AU - Mawani, Minaz
AU - Razzak, Junaid Abdul
AU - Pasha, Omrana
N1 - Publisher Copyright:
© 2015 National Stroke Association.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by community health workers (CHWs) are required to identify stroke in the community in a resource-strapped region such as this. Methods The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire to Verify Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community-dwelling subjects using purposive sampling. Each CHW collected data independently, which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects were collected after a second training session for the CHWs. Sensitivity, specificity, and Cohen kappa were determined for the CHW-Administered questionnaire against neurovascular assessment. Results Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (confidence interval [CI], 64.1-86.9) and 85.8% (CI, 83.5-87.5), respectively. The chance-corrected agreement using the Cohen kappa statistic was.51 (CI,.38-.60). Kappa ranged from.37 to.58 for each of the 7 stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback. Conclusions We found a reasonable sensitivity and specificity and moderate agreement between CHW-Administered QVSFS and assessment by a vascular neurologist.
AB - Background Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by community health workers (CHWs) are required to identify stroke in the community in a resource-strapped region such as this. Methods The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire to Verify Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community-dwelling subjects using purposive sampling. Each CHW collected data independently, which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects were collected after a second training session for the CHWs. Sensitivity, specificity, and Cohen kappa were determined for the CHW-Administered questionnaire against neurovascular assessment. Results Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (confidence interval [CI], 64.1-86.9) and 85.8% (CI, 83.5-87.5), respectively. The chance-corrected agreement using the Cohen kappa statistic was.51 (CI,.38-.60). Kappa ranged from.37 to.58 for each of the 7 stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback. Conclusions We found a reasonable sensitivity and specificity and moderate agreement between CHW-Administered QVSFS and assessment by a vascular neurologist.
KW - Stroke
KW - detection
KW - developing countries
KW - epidemiology
KW - prevalence
UR - http://www.scopus.com/inward/record.url?scp=84920653904&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2014.07.030
DO - 10.1016/j.jstrokecerebrovasdis.2014.07.030
M3 - Article
C2 - 25440346
AN - SCOPUS:84920653904
SN - 1052-3057
VL - 24
SP - 91
EP - 99
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 1
ER -