Family Intervention in the Spirit of Motivational Interviewing (FITSMI)
The prevalence of stroke is higher in American Indians and Alaska Natives than in any other U.S. racial or ethnic group. Native people tend to be younger at stroke onset than non-Hispanic Whites, and they have poor post-stroke survival. In addition, Native people bear a disproportionate burden of stroke risk factors, including high blood pressure, smoking, obesity, and diabetes. However, no rigorous, population-based studies of stroke prevention have included Native participants. With our partners, we designed the Family Intervention in the Spirit of Motivational Interviewing (FITSMI), which is delivered at the household level. This intervention encourages lifestyle changes that will transform the home environment and reduce stroke risk for all household members. FITSMI uses a “talking circle” format in which facilitators guide participants to identify goals for change and then create a tailored plan to reach them. Goals typically address smoking, exercise, diet, and medication adherence. FITSMI requires just two household sessions scheduled one month apart. After the first session, text messages are sent to participants to boost their adherence to household goals. In a group-randomized trial design, we are recruiting 360 households. Half of them are randomly assigned to the FITSMI intervention, and the other half are assigned to the control condition, in which they simply receive educational brochures. All household residents aged 11 years and older are eligible for participation.