26 AHORA: A Spanish Language Stroke Symptom Identification Tool

Studies have shown that Spanish-speaking patients are twice as likely as their English-speaking counterparts to have low health literacy and Hispanics are three times as likely to be unable to understand medical instructions compared to non-Hispanic whites. Additionally, Hispanics with low English proficiency are less likely to correctly identify the symptoms of a stroke and to acknowledge the need to dial 911 in a timely manner, thus increasing their delay times for treatment and worsening their clinical outcomes. The authors sought to design a Spanish language stroke acronym education tool. A core group of stroke stakeholders including patients, paramedics, nurse educators, physicians, and students were assembled and developed AHORA. The letters A, H, O, R, and A stand for andar, hablar, ojos, rostro y cabeza, and ambos brazos o piernas (Figure 1). This is a translation of the English BEFAST. The poster asks bystanders to assess the patient for trouble with walking or balance, difficulty speaking or understanding, changes in vision or double vision, facial drooping, headache, and weakness in the arms or legs. They are then advised to call 911 immediately if the victim has exhibited any of these symptoms, even if they have gone away. Once developed, the tool was deployed amongst a focus group consisting of different patients, paramedics, nurse educators, physicians, and students to ensure that it performed well, and to fine tune any ambiguities. Following this, the tool was piloted in 100 patients with two different paramedics administering the scale to the same patient. The correlation coefficient r was 1, demonstrating a perfect correlation between the AHORA and the BEFAST. Based on these results, the AHORA has been adopted by several large hospital systems in central Florida. In preliminary field testing of the AHORA scale, its performance mirrors the validated BEFAST, making it a promising tool for evaluation of stroke symptoms amongst Hispanic populations. It is hoped that distribution and use of the “AHORA” poster will increase public education of strokes in Spanish-speaking populations the same way the “BEFAST” campaign did for English-speaking populations, effectively decreasing the burden of stroke for this ethnic group.