From Barriers to Breakthroughs: A Mixed-Methods Evaluation of Stroke Education in an Under-Resourced Urban Population

ABSTRACTBackground Stroke remains a leading cause of death and disability in the U.S., with persistent disparities in care tied to social drivers of health. In New Haven, CT, a diverse city with high poverty and linguistic barriers, socioeconomic deprivation has been shown to delay hospital arrival for patients with stroke. Educational interventions can improve stroke preparedness but often lack cultural tailoring. This project aims to create and deliver culturally relevant stroke education to help reduce these disparities. Methods A convergent, parallel, mixed-methods study was conducted from March 2022 to June 2025, combining community-based focus groups with a cross-sectional survey to evaluate stroke knowledge and perceptions in the Greater New Haven area. Focus groups guided by the Health Belief Model explored community health priorities, cultural perceptions of stroke, and barriers to emergency response. Sessions were transcribed and thematically analyzed. Concurrently, an eight-item stroke preparedness survey was distributed at community events across New Haven County to assess baseline knowledge. Survey data was analyzed using descriptive and inferential statistics. Results Analysis of 92 survey responses showed that participants from neighborhoods with higher socioeconomic deprivation had significantly lower stroke knowledge scores. Focus groups (n=20) identified key barriers, including food insecurity, medical mistrust, and fear of ambulance costs. Conclusion Community stroke education in under-resourced communities may be supported by using culturally tailored, community-informed interventions. Focus groups offer an exploratory framework to understand the specific needs of communities to create targeted interventions. With proper validation, this approach could be scaled to reduce stroke-related inequities nationwide.