Door-to-Door: A Community Stroke Awareness Project in South Texas Border Towns

Sunday, 17 November 2019

Nancy Nadeau, MSN
School of Nursing, University of Texas Rio Grande Valley, Edinburg, TX, USA

The Rio Grande Valley (RGV) where the UTRGV students, faculty and other professionals live, work, socialize and go to school is an area where one-third of the population lives in poverty. The RGV includes Cameron, Hidalgo, and Starr Counties. The population of this area is 1,305,782 (National Census Bureau, 2012) with the majority of the population identifying themselves as Hispanics. According to the U.S Census Bureau in 2008, 86% of Cameron County, 90% of Hidalgo County, 97% of Starr County, and 86 percent of Willacy county are Hispanic (US Census, 2012). The estimated diabetes prevalence rate in the Rio Grande Valley is 26% (UTPA Border Health Office, 2006). The rate of diabetes in the Rio Grande Valley is 20% higher than for Texas as a whole (South Texas Diabetes Initiative, 2018).

Between 2013-2017, the percentages of the persons living in poverty in the different counties of the RGV were as follows: Hidalgo county 25.2%, (without insurance 30.5%): Cameron county 27.79% (without insurance 29.5%), and Starr county 32% (without insurance 28.2) and Willacy county 35% (without insurance 22.8%). These numbers are twice as high as the state level of 14.7% (without insurance 19.4%) and almost triple compared to the national level with 12.3% (without insurance 10.2%). The average household income in Hidalgo is $45,057 in Cameron is $36,095, in Starr is $27,133 and in Willacy county is $29,104 which is way below the average household income $57,051 for the state of Texas and $57,652 at the national level. (http://quickfacts.census.gov/qfd/states/48/48215.html)

The average income of the families visited by the BSN students was determined to be around $14,500. Examples of homes selected were those needing repair with non-paved driveway, non-fenced yards, no central air conditioner with washer located outside the home. While some communities have actively and collectively engaged in health promotion, smaller unincorporated communities may be at a disadvantage since their residents may be struggling to meet their basic needs. Since 2015, our BSN Program has been regularly conducting community family home visits to better understand our community. During those visits, basic health assessment such as blood pressure screening was conducted and self-reported medical history such as diabetes.

Health disparities in the border towns are a reality due to poverty and no insurance or underinsured for the Hispanic community. The prevalence of diabetes combined with hypertension and obesity is higher than the rest of the nation. According to DSHS, as of 2012, 2.5 million Texans had diabetes, of which 457,819 were estimated to be undiagnosed. In Texas, the percentage of adults living with diabetes for that same year was 10.6 percent. Data from Texas Department of State Health Services and the federal Centers for Disease Control and Prevention indicate that the prevalence of diabetes in Texas increased almost 50 percent from 2002 to 2012. According to the Centers for Disease Control and Prevention, one in three adults has hypertension (or high blood pressure), which is a leading cause of stroke, heart attack and kidney failure. Approximately 30% of hypertension cases may be attributable to obesity, and the figure may be as high as 60% in men under age 45. People who are overweight also are more likely to have hypertension. The most recent Behavioral Risk Factor Surveillance System (BRFSS) finds that nine of the 10 states with the highest rates of hypertension are in the South (The Sate of Obesity, 2018). Jones & al, 2001 reported few prevalence studies have been completed reflecting Mexican-American populations. South Texas hypertension trends are comparable to national trends. However, the awareness of hypertension in South Texas is lower than that of the national population.

During the home visits, BSN students asked about the knowledge on how to identify major stroke symptoms and what to do about it with a pre-test. We quickly realized the need to increase public awareness of the warning signs of stroke or neurological emergencies and the need to call 911to get appropriate medical care in a timely matter for best treatment. The BSN students were able to provide free preventative care services: screening and bilingual education that empower, not only the residents of the colonia, but the BSN students. This venue provides students with understanding how the determinants of health affect our vulnerable RGV families.