Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Dr. Nickola W. Nelson

Second Advisor

Dr. Mary Lagerwey

Third Advisor

Dr. Evvy Hay Campbell


Stroke, treatment delays, qualitative, stroke education, stroke knowledge, Latino health


This dissertation is comprised of three studies centered on addressing factors that influence stroke knowledge and decision-making during the acute stroke emergency in both general and Hispanic populations. The first study provided data on patterns of explicit stroke knowledge in a sample of 94 Hispanic subjects. This study assessed relationships between stroke knowledge (Stroke Action Test; STAT; Billings-Gagliardi & Mazor, 2005) and subjects’ typical language use (Short Acculturation Scale for Hispanics; Marín, Sabogal, VanOss Marín, Otero-Sabogal, Pérez-Stable, 1987). No relationship was found between language use (Spanish/English) and stroke symptom knowledge. Contrastingly, STAT scores were found to vary in association with the linguistic register in which symptoms were phrased, with higher scores associated everyday rather than medical register.

The second study was a mixed methods textual analysis designed to explore linguistic register variation in a purposeful sample of stroke education brochures through analysis of linguistic and extra-linguistic features. Analysis of register across texts revealed features associated with biomedical and advertising registers. Relationships among identified lexical and syntactic features were found to vary independent of Flesch- Kincaid readability measures. Qualitative and quantitative results led to an integrative framework informed by register and overarching communicative purposes designed to support decision-making in stroke education planning.

The third study explored the stroke emergency experiences Mexican-American survivors and bystander assistants through personal interviews. Interviews focused on aspects of stroke knowledge and emergency decision-making from the patient perspective. Findings included observation of pain as defining the boundary between illness and health and informing decisions to seek care. Emergency activation (911) was not taken by any interviewees and reflected numerous competing influences in the decision to seek help. Forces that competed with the decision to seek emergency care included social, psychological, economic and legal elements. These competing influences reflected the potential for disparate priorities between health educators and patients.

Access Setting

Dissertation-Campus Only

Restricted to Campus until