Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists? Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban pakistani community

Maria Khan, Ayeesha Kamran Kamal, Muhammad Islam, Iqbal Azam, Azam Virk, Alia Nasir, Hasan Rehman, Anita Arif, Muhammad Jan, Anjum Akhtar, Minaz Mawani, Junaid Abdul Razzak, Omrana Pasha

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)91-99
Number of pages9
JournalJournal of Stroke and Cerebrovascular Diseases
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Stroke
  • detection
  • developing countries
  • epidemiology
  • prevalence

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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