To elucidate Filipino American (FilAm) cultural and knowledge barriers in accessing acute stroke care

Los Angeles FilAms make up the largest Filipino community outside of the Philippines and 2^nd largest Asian subgroup in L.A. County.  FilAms also have higher rates of stroke not only compared to other Asian subgroups but also to African American and Latino communities.  Little is known about FilAm barriers in accessing acute stroke care.

Using qualitative descriptive design, we studied knowledge, attitudes, and health behaviors of the L.A. FilAm community regarding acute stroke care by conducting 5 focus groups and 6 semi-structured interviews with key community leaders.  Participants were recruited through L.A. FilAm community organizations.  Focus groups were organized as follows: 1st: elderly community members at high stroke risk; 2^nd: spouses of those at high stroke risk; 3^rd: paid caregivers of those with stroke risk; 4^th: unpaid caregivers of those with stroke risk; 5^th: young FilAms with family members with stroke risk.  Six individual interviews were with elderly FilAms identified as exceptionally healthy by community leaders.  We conducted thematic analysis, coding for themes on barriers to acute stroke care.

Two key themes emerged: 1) spiritualistic fatalism, the belief that God is in control of all outcomes despite individual will 2) fear of calling 911, linked to shame in being perceived as unhealthy by neighbors, fear of deportation among the undocumented, and fear of ambulance cost.  Elderly participants perceived social media as one of the most effective ways to engage FilAms on stroke.

Beliefs related to spiritualistic fatalism as well as fear are powerful barriers to acute stroke care among FilAms.  The results inform a culturally-relevant community intervention using social media and the Internet to encourage FilAms to obtain acute stroke care.  Lessons learned will be used to create stroke education for U.S. Asian Pacific Islander communities.