Date of Award


Document Type


Degree Name

Master of Science (MS)



First Advisor

Jean S. Coffey

Second Advisor

Mark J. Gorman


Transient Ischemic Attack (TIA) is a prominent risk factor for subsequent stroke, and its associated morbidity, mortality, and health care costs. Studies have demonstrated up to 80% reductions in subsequent stroke rate with prompt, optimized protocols for rapid TIA evaluation and treatment. National Stroke Association (NSA) and American Heart Association (AHA) guidelines have recommended institution of protocols assuring timely completion of the recommended testing, and evaluation by a stroke expert within 48 hours. However, limited literature exists on the implementation of guideline-based care in rural regions, and the few studies related to TIA suggest that barriers including difficulty accessing services and poorly updated TIA knowledge amongst rural, non-neurologist providers exist despite national guidelines.

Behavior change theories have suggested that evaluating factors hindering or motivating behavior change may aid in tailoring implementation of guideline-based practices. This descriptive study sought to understand ED health care providers' perceived barriers to implementation of NSA/AHA TIA guidelines in a rural state. All healthcare providers in each of the state's emergency departments were invited by email to complete an online anonymous survey assessing knowledge of present TIA guidelines and perceived barriers to implementation of these guidelines in their practice setting using a modified Barriers and Facilitators Assessment Instrument (BFAI). After completing the knowledge based questions, respondents were presented a brief educational overview of the guidelines to ensure adequate familiarity with the TIA guidelines to complete the BFAI.

Thirty-nine respondents completed the survey. Twenty-seven worked at regional or academic medical centers, and 12 worked at critical access hospitals representing the more rural regions of the state. Consistent with prior work, the most notable finding of this study was a low awareness of the present TIA guidelines amongst ED providers, with none of the survey respondents correctly identifying all items consistent with the evaluation guidelines for TIA. In addition to a low awareness of the guidelines, a number of perceived barriers to implementation were identified, which may inform efforts at implementation, and/or offer a model for similar barrier assessment elsewhere.



Number of Pages

46 p.