International Collaboration: Use of a Student-Led Educational Intervention to Decrease Stroke Risk in Rural Thailand

Over the past three decades there has been a shift in mortality from communicable disease towards chronic non-communicable (NCD) diseases with NCDs now responsible for the majority of deaths in Thailand (Kaufman, Chasmobat, Tanomsingh, Rajataramya, & Potempa, 2011). In 2012, cardiovascular disease (CVD) was the leading cause of death in Thailand resulting in 68.8 thousand deaths (World Health Organization, 2015). The World Health Organization (WHO) (2014) estimates that 29% of total deaths in Thailand are attributable to cardiovascular diseases. Further, since the early 2000’s through 2012, the crude death rate for CVD has increased demonstrating a need for enhanced prevention efforts (WHO, 2015).

There are a large proportion of individuals that have hyperlipidemia and hypertension that is not diagnosed, treated or controlled in both Thailand and low and middle income countries (LMICs) (Fuster et al., 2010; Khonputsa et al., 2012). According to Howteerakul, Suqannapong, Sittilerd, & Rawdaree, (2006), lifestyle programs are needed in Thailand to prevent hypertension: one of the largest risk factors for stroke. Notably, Asian countries including Thailand have higher rates of mortality from stroke than from coronary heart disease (CHD) (Ueshima et al., 2008). Despite several calls to action, there has been a lack of implementation of CVD prevention programs in LMICs largely due to insufficient investment in CVD prevention efforts (Fuster et al., 2011). Thus, this project seeks to address the global need for CVD prevention programs in LMICs through a stroke educational intervention implemented in the rural province of Nakhon Ratchasima, Thailand. Nurse practitioners (NPs), along with public health personnel, are most often the point of first contact within the healthcare system and the most readily available health care providers in rural areas. Thus, NPs are particularly well situated to deliver this type of health promotion and risk reduction education within the community.

This study worked with students from the University of Michigan School of Nursing (UMSN) primary care nurse practitioner (NP) programs and students from Suranaree University of Technology (SUT) community health course, course faculty from both schools, and local health workers. Teams conducted a comprehensive community assessment and individualized home visits to identify specific risk factors for stroke within the community. After identification of aggregate risk factors, educational sessions on modifiable risk factors and prevention of stroke were offered via open community forums. In addition to comprehensive materials that highlight the link between lifestyle and chronic disease, students and faculty discussed community-specific risk factors and identified specific risk-reduction strategies. Pre-test and Post-test knowledge assessments of modifiable stroke risk factors were administered at community educational forums and home visits. Number of visits at scheduled chronic disease screening clinics will be monitored and compared to total number of patient visits prior to the intervention. Descriptive statistics will be used to describe participants and T-Test and ANOVA will be used to test an effectiveness of interventions.