Advancing Community Connections and Calculating Risk to Optimize Stroke Survivorship (ACROSS)

The risk and burden of stroke are disparately experienced by racially and ethnically minoritized populations and socioeconomically disadvantaged groups; these disparities are substantial and persistent despite prior intervention attempts.

Minoritized and disadvantaged people experience greater adverse social determinants of health, leading to greater health-related social needs (HRSN; i.e., food, transportation, housing).

Routine post-stroke care adds more medications, medical appointments, and rehabilitation to patients’ and caregivers' already busy lives.

The unexpected burden of HRSN imposed by stroke and recommendations for more medical care are major contributors to medication non-adherence among stroke survivors. New ideas are needed.

In the words of a community advisory board member and a stroke caregiver, our new idea is to 'help you [stroke survivors and caregivers] do the best you can with what you got----what you can do right now.

And if you get more, what can you do then?' The Advancing Community Connections and Calculating Risk to Optimize Stroke Survivorship (ACROSS) proposal seeks to meet stroke survivors where they are by 1) increasing stroke survivor capacity by providing linkages to personalized resources to address HRSN; 2) decreasing stroke survivor workload by reducing the burden of treatment by aligning medication regimens to stroke survivors' priorities.

Our long-term goal is to decrease stroke disparities through community-engaged health equity research and interventions bridging the community and health system.

ACROSS will be conducted in partnership with Flint, Michigan, and the South Side of Chicago, Illinois communities and will focus on Black, Latino/a/x, and socioeconomically disadvantaged stroke survivors with HRSN.

The main objectives are to understand the lived experience of stroke survivors with HRSN (Aim 1); enhance existing HRSN community maps to include community stroke services (Aim 2); adapt a risk reduction calculator to provide personal estimates of the effects of various secondary stroke prevention medication regimens (Aim 3); and determine the acceptability and feasibility of the simple, personalized ACROSS intervention among stroke survivors from populations that experience health disparities (Aim 4).

The Health Equity Research Partnership, our 13-year, highly productive academic-community partnership committed to stroke equity, is the cornerstone of ACROSS.

Additionally, we partnered with the Flint Public Health Youth Academy and the Chicago- MAPSCorps program, a national model for training students from disinvested communities to work as community data scientists and advocates.

Through meaningful community engagement, we will achieve clinical trial readiness, enhance community partnerships, invest in local public health capacity, and contribute to thriving communities to promote health equity.