Understanding the social networks of parents of children with sickle cell disease

Health Supervision for Children and Adolescents With Sickle Cell Disease: Clinical Report

Sickle cell disease (SCD) is a group of complex genetic disorders of hemoglobin with multisystem manifestations. The scope of this clinical report is such that in-depth recommendations for management of all complications is not possible. Rather, the authors present an overview focused on the practical management of children and adolescents with SCD and the complications that are of particular relevance to pediatric primary care providers. References with detailed commentary provide further information. Timely and appropriate treatment of acute illness is critical, because life-threatening complications may develop rapidly. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a time-intensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, nursing support, psychosocial care, and genetic counseling. Ideally, this care includes comanagement by the pediatrician or other pediatric primary care provider and a team of specialist SCD experts: Hematologist, other pediatric specialists, advanced practice providers, nurse specialists, social workers, patient navigators, and educational liaisons.

Knowledge and attitude towards sickle cell anemia among care givers of paediatric sickle cell patients at a tertiary hospital in Eastern Uganda: a cross sectional study

OBJECTIVE

To explore the knowledge and attitude towards sickle cell disease (SCD) among care givers of paediatric sickle cell patients at Mbale regional referral hospital in Eastern Uganda.

METHODS

A cross sectional study was conducted at Mbale regional referral hospital. We used simple random sampling technique to recruit participants from among the care givers of pediatric sickle cell patients admitted at the hospital, administered questionnaires and conducted multivariable logistic regression to establish the association between the different factors.

RESULTS

372 respondents participated in the study, 82.26% of which were female. 57.80% of the respondents had ever heard of SCD/SCA. 36.02% were willing to stay in a relationship with their partner despite the risk of having a child with SCD/SCA. A multivariate analysis revealed that variables; "number of children", "children with sickle cell can cope with life" and "willing to stay in a relationship despite the risk of a having a child with sickle cell" were statistically significant.

CONCLUSION

There was a high level of general awareness about SCD/SCA but comprehensive knowledge about its cause and prevention was low and the majority did not find a reason as to why it should influence their marital decisions. Inclusion of SCD/SCA in existing health education programs is highly recommended.

Determinants of retention in care of newborns diagnosed with sickle cell disease in Liberia: Results from a mixed-methods study of caregivers

High-income nations have established that early diagnosis and preventive treatment reduces early deaths in sickle cell disease (SCD). However, in low-/middle-income countries where SCD is common, attrition from clinical care is common. Reasons for poor retention in care are multi-factorial and poorly understood. The objective of this study was to identify factors that influence caregiver decision-making around chronic health care needs of a child with SCD. We conducted an exploratory sequential mixed methods study of caregivers of children diagnosed with SCD during a newborn screening program in Liberia. Caregivers completed questionnaires and semi-structured interviews designed to identify drivers of health decision-making. Interviews were digitally recorded, transcribed, coded, and analyzed using semi-structured thematic analysis to identify themes. Data integration occurred by using quantitative results to expand and clarify the qualitative themes. Twenty-six caregivers participated in the study. The mean age of the child at the interview was 43.7 months. Five themes influencing health decisions were identified: grief, the importance of support networks, stigma, perceived benefits, and the burden of chronic disease. The five themes crossed multiple domains of a socioecological model and identified complex interactions between family, community, social and cultural norms, and organizational structures. This study highlights the importance of community awareness of SCD and appropriate health communication by healthcare workers. Healthcare decision-making is multifactorial and complex. These results provide a framework for improving retention in care. In a low-resource country such as Liberia, much can be done by leveraging existing resources and cultural practices.

Promoting self-management behaviors in adolescents with type 1 diabetes, using digital storytelling: a pilot randomized controlled trial

BACKGROUND

This study aimed to assess the effects of digital storytelling on the self-management behavior of adolescents with type 1 diabetes (TID).

METHODS

In this pilot randomized controlled clinical trial, 60 adolescents with TID were randomly allocated into two parallel groups: intervention (training with digital storytelling method, n = 33) or control (training with a conventional method, n = 33). The primary outcome was assessing the Self-Management behavior of adolescents with TID (SMOD-A) at baseline and three months after the intervention.

RESULTS

The results revealed that digital storytelling could significantly improve self-management behaviors amongst adolescents with TID (P = 0.005). In contrast, in the control group, no significant changes were observed (P > 0.05). Furthermore, the mean score of Collaboration with Parents subscale was significantly higher in the digital storytelling group than in the control group after the intervention (p = 0.022). The results also showed that the level of Collaboration With Parents' subscale scores had a meaningful reverse relationship with the adolescent age after digital storytelling (p = 0.048). Repeated measures ANOVAs showed that there were significant main effects of time and group on collaboration with parents(p = 0.002) and goal subscales (p = 0.035). With respect to HbA1c levels, significant changes were not observed in any of the groups (P > 0.05).

CONCLUSIONS

Digital storytelling is practicable and a potentially beneficial training modality for adolescents with TID.

TRIAL REGISTRATION

This trial was respectively registered.

CLINICALTRIALS

gov Identifier: IRCT20191220045828N1 . Date of registration: Oct 29. 2020.

Social support networks of adults with sickle cell disease

Sickle cell disease (SCD) can cause both physical and psychological complications, such as severe pain and depression. These effects often necessitate social and caregiving support. Few studies have assessed support networks within the adult SCD population. Here, we describe the support networks of adults with SCD and identify who in these networks (1) provides emotional support, (2) is dependable during crisis situations, including social and financial adversities, and (3) provides assistance in health crises. Forty-nine adults with SCD completed surveys and social network assessments through interview. Generalized mixed-effects linear regression models were fitted to investigate the composition of support provision within these personal networks. Our findings indicate that parents and 'other important people' (e.g., friends, spouses) play key roles in the support provided to those with SCD. Siblings with SCD appeared to be more emotionally supportive than unaffected siblings. With much research centered around the pediatric and adolescent SCD populations, focus needs to extend to adults and the individuals involved in their care and disease management. Understanding the flow of support within these networks can help genetic counselors and healthcare providers to better identify both social ties that serve as support resources and less supportive relationships for individuals living with SCD and other chronic genetic conditions that might be targeted for intervention.

Family Resilience From the Perspective of Caregivers of Youth With Sickle Cell Disease

Families coping with sickle cell disease (SCD) often face heightened psychosocial risk factors, and research in pediatric SCD has often focused more on this area than resiliency factors. The aim of this study was to gain a better understanding of family resiliency in SCD based on caregiver perspectives. A secondary qualitative analysis was conducted with data from a mixed-methods study of caregivers of youth with SCD (n=22). Qualitative analyses involved coding based on 2 resiliency frameworks, organizing coding categories into themes, and systematically reintegrating these themes into a conceptualization that reflected family resiliency. Themes aligned well with the resiliency frameworks and related to family belief systems and meaning-making around SCD (acceptance of SCD, positive attitude, religious faith), family organization and adaptation (flexibility, stability, social supports), and the importance of communication and problem-solving. Study findings emphasize the importance of assessing resilience in families of youth with SCD and suggest the potential clinical benefits of developing psychosocial interventions based on family strengths.

Determining parents' patterns of behaviour when searching for online information on their child's health

AIM

The internet has enabled parents to become informed medical consumers and take an active role in their child's treatment. We aimed to determine parents' online medical information-seeking behaviour about their child's health. This included sources of information, reasons for searching, use and assessment of information and whether parents wanted assistance with searching and assessing information.

METHODS

A questionnaire was distributed to 331 parents and carers of inpatients and outpatients at Children's Hospital at Westmead in 2015. Most questions involved tick-box responses and a few free-text responses. Responses were tabulated and described by frequencies and percentages. Associations between participant demographics and responses were examined using chi-square tests.

RESULTS

In all, 308 (93%) questionnaires were returned. Most participants (90%) reported searching for medical information about their child's health. Of these, 96% searched the internet, and of these, 63% used a smartphone. The most common reason for searching before seeing the doctor was to prepare questions. The most common reasons for searching after seeing the doctor were to know more and because participants had more questions. Only half (57%) ascertained whether an information source was reliable. Most wanted guidance on searching (69%) and assessing reliability (77%).

CONCLUSIONS

Almost all parents search for online information about their child's health, but most are unsure whether the information they find is trustworthy and are hesitant to act on or present it to their child's doctor. Health professionals could discuss this with parents during consultations to dispel potential misunderstandings and provide guidance on searching and assessing.

Experiences and Problems Encountered by Families of Children with Sickle Cell Anemia

Introduction: Sickle Cell Anemia is a disease that has a high level of morbidity and early mortality for patients that are not followed and controlled properly. Study was conducted the aim of determining experiences and problems of families whose children with sickle cell anemia. Methods: Descriptive study was conducted the aim of determining experiences and problems of families (n= 206) whose children with sickle cell anemia. Before conducting this study, a written permission from the related institution and research ethics committee approval from Gaziantep University were obtained. Questionnaire is made up of two sections (10 questions), socio-demographic of families and data about their problems (15 questions and 11 statements). Data were evaluated SPSS (21.0), number and percentage calculations. Results: It was determined that 96.1% of participants knew nothing about disease before their children were diagnosed, 92.7% of them are aware the disease was genetically inherited, all participants were a disease carrier themselves, and 93.7% of them had no blood tests before marriage. 97.1% of participants have no support from their spouses, It was determined that 98.5% of children suffer from pain, 60.7% suffer from weakness 51.5% of the participants apply to hospitals to decrease the problems and 48.5% use medications at home. Conclusion: A great number of families have problems regarding fear of losing their children, lack of social aid and support. Majority of children suffer from pain, weakness, exhaustion, they stay at hospital between at least 1 and 5 times a year, they need blood transfusion.

Patient-Centered eHealth Interventions for Children, Adolescents, and Adults With Sickle Cell Disease: Systematic Review

BACKGROUND

Sickle cell disease is an inherited blood disorder that affects over 100,000 Americans. Sickle cell disease-related complications lead to significant morbidity and early death. Evidence supporting the feasibility, acceptability, and efficacy of self-management electronic health (eHealth) interventions in chronic diseases is growing; however, the evidence is unclear in sickle cell disease.

OBJECTIVE

We systematically evaluated the most recent evidence in the literature to (1) review the different types of technological tools used for self-management of sickle cell disease, (2) discover and describe what self-management activities these tools were used for, and (3) assess the efficacy of these technologies in self-management.

METHODS

We reviewed literature published between 1995 and 2016 with no language limits. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and other sources. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included texting, mobile phone-based apps, or other eHealth interventions designed to improve self-management in pediatric and adult patients with sickle cell disease.

RESULTS

Of 1680 citations, 16 articles met all predefined criteria with a total of 747 study participants. Interventions were text messaging (4/16, 25%), native mobile apps (3/16, 19%), Web-based apps (5/16, 31%), mobile directly observed therapy (2/16, 13%), internet-delivered cognitive behavioral therapy (2/16, 13%), electronic pill bottle (1/16, 6%), or interactive gamification (2/16, 13%). Interventions targeted monitoring or improvement of medication adherence (5/16, 31%); self-management, pain reporting, and symptom reporting (7/16, 44%); stress, coping, sleep, and daily activities reporting (4/16, 25%); cognitive training for memory (1/16, 6%); sickle cell disease and reproductive health knowledge (5/16, 31%); cognitive behavioral therapy (2/16, 13%); and guided relaxation interventions (1/16, 6%). Most studies (11/16, 69%) included older children or adolescents (mean or median age 10-17 years; 11/16, 69%) and 5 included young adults (≥18 years old) (5/16, 31%). Sample size ranged from 11 to 236, with a median of 21 per study: <20 in 6 (38%), ≥20 to <50 in 6 (38%), and >50 participants in 4 studies (25%). Most reported improvement in self-management-related outcomes (15/16, 94%), as well as high satisfaction and acceptability of different study interventions (10/16, 63%).

CONCLUSIONS

Our systematic review identified eHealth interventions measuring a variety of outcomes, which showed improvement in multiple components of self-management of sickle cell disease. Despite the promising feasibility and acceptability of eHealth interventions in improving self-management of sickle cell disease, the evidence overall is modest. Future eHealth intervention studies are needed to evaluate their efficacy, effectiveness, and cost effectiveness in promoting self-management in patients with sickle cell disease using rigorous methods and theoretical frameworks with clearly defined clinical outcomes.

Health information seeking behaviors of ethnically diverse adolescents

Research on health information has primarily focused on the needs of adults or parents of children with chronic illnesses or consumers. There is limited research on the health information needs of adolescents and in particular those from underserved communities. The primary objective of this qualitative study was to understand the health information needs of healthy, urban adolescents, and how they met those needs. Focus group methodology was used to gather information from a sample of ethnically diverse urban adolescents. Data was analyzed using Kriekelas' information seeking behavior framework to, examine the participants'' report of their immediate and deferred health information needs. Our sample of adolescents used several different sources to satisfy their health information needs depending on acuity and severity, which was congruent with Kriekelas' framework. Understanding how adolescents use technology to meet their health information needs, and in what order of preference, will be critical for the development of technology that adolescents find useful and has the potential to decrease health disparities.

Parental information, motivation, and adherence behaviors among children with sickle cell disease

BACKGROUND

Identification of psychosocial correlates of health care utilization has become an important strategy in improving clinical care. The objective of the study was to examine the fit of the Information-Motivation-Behavioral Skills (IMB) model, applied to health care utilization among children with sickle cell disease (SCD).

PROCEDURE

Participants were parents of 150 children, ages 1-17 years, receiving care in a sickle cell center. Parents completed questionnaires assessing information, motivation, adherence behaviors, and other factors with respect to SCD management. Data regarding health care utilization in the previous 12 months were obtained from parent report and electronic medical records. Stepwise multiple regression analysis was conducted to determine associations between IMB factors and health care use.

RESULTS

Parents rated highly in the domains of information, motivation, and adherence behaviors for managing their child's SCD. Children of parents reporting higher satisfaction with social supports had higher odds (OR 1.49, 95% CI 1.03-2.15) of two or more routine hematology visits in the previous 12 months. Neither information nor adherence behavior was associated with urgent or routine care use. Among other variables measured, high parental illness-related stress and child health status reported as fair/poor were the strongest predictors of urgent care use while private insurance type was the strongest predictor of routine care use.

CONCLUSIONS

Among IMB factors, social support was associated with routine health care utilization. Social support and parental illness-related stress may serve as important, modifiable targets in interventions to allocate needed resources to families and reduce unnecessary medical care.