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Wu JK, McVay K, Mahoney KM, Sayani FA, Roe AH, Cebert M. Experiences with healthcare navigation and bias among adult women with sickle cell disease: a qualitative study. Qual Life Res 2024:10.1007/s11136-024-03805-x. [PMID: 39400689 DOI: 10.1007/s11136-024-03805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2024] [Indexed: 10/15/2024]
Abstract
PURPOSE The purpose of this study was to use qualitative interviews to understand the experiences of adult women with sickle cell disease (SCD) through daily life and navigating the healthcare system. METHODS We conducted semi-structured interviews with reproductive-aged women with SCD and performed thematic analysis. RESULTS We analyzed interviews from 20 participants. Our data demonstrated three overarching themes: perceptions of disease, transitions of care, and stigma and bias. Participants identified feelings of both empowerment and powerlessness from SCD that evolved over time and globally impacted their lives. The transition from pediatric to adult care was a vulnerable period, both surrounding changes in disease character and challenges transitioning healthcare systems. Finally, participants faced discrimination and prejudice within SCD care, which manifested as disvaluing of their own disease expertise or perpetuation of a "drug-seeking" stereotype. In the context of this bias, some participants prioritized seeking same-race providers. CONCLUSION Experiences with SCD contribute significantly to daily quality of life in women with SCD, and ongoing care gaps exist in relation to their disease. Within our population, SCD as a physical and mental stressor requiring interdisciplinary support should not be underestimated. More robust systems to support the transition from pediatric to adult care are also necessary, both on a healthcare institution level and to support patients' engagement in their care. Finally, provider education and training on anti-racist practice and both recognizing and eliminating bias are essential to improving care of SCD patients. Possible interactions between sex, gender, and race in the experience of SCD warrant further exploration.
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Affiliation(s)
- Jessica K Wu
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Kyler McVay
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Katherine M Mahoney
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Farzana A Sayani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Medicine, Division of Hematology and Oncology, Penn Medicine, Philadelphia, PA, 19104, USA
| | - Andrea H Roe
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Morine Cebert
- Dr. Susan L. Davis, RN, & Richard J. Henley College of Nursing, Sacred Heart University, Fairfield, CT, USA
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Munung NS, Treadwell M, Kamga KK, Dennis-Antwi J, Anie K, Bukini D, Makani J, Wonkam A. Caught between pity, explicit bias, and discrimination: a qualitative study on the impact of stigma on the quality of life of persons living with sickle cell disease in three African countries. Qual Life Res 2024; 33:423-432. [PMID: 37889387 PMCID: PMC10850006 DOI: 10.1007/s11136-023-03533-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Sickle cell disease (SCD) is an inherited blood disorder characterized by unpredictable episodes of acute pain and numerous health complications. Individuals with SCD often face stigma from the public, including perceptions that they are lazy or weak tending to exaggerate their pain crisis, which can profoundly impact their quality of life (QoL). METHODS In a qualitative phenomenological study conducted in Cameroon, Ghana, and Tanzania, we explored stakeholders' perceptions of SCD-related stigma using three analytical frameworks: Bronfenbrenner's Ecological Systems Theory; The Health Stigma and Discriminatory Framework; and A Public Health Framework for Reducing Stigma. RESULTS The study reveals that SCD-related stigma is marked by prejudice, negative labelling and social discrimination, with derogatory terms such as sickler, ogbanje (one who comes and goes), sika besa (money will finish), ene mewu (I can die today, I can die tomorrow), vampire (one who consumes human blood), and Efiewura (landlord-of the hospital), commonly used to refer to individuals living with SCD. Drivers of stigma include frequent crises and hospitalizations, distinct physical features of individuals living with SCD, cultural misconceptions about SCD and its association with early mortality. Proposed strategies for mitigating stigma include public health education campaigns about SCD, integrating SCD into school curricula, healthcare worker training and community engagement. CONCLUSION The results highlight the importance of challenging stigmatizing narratives on SCD and recognizing that stigmatization represents a social injustice that significantly diminishes the QoL of individuals living with SCD.
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Affiliation(s)
- Nchangwi Syntia Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Marsha Treadwell
- Department of Pediatrics/Division of Hematology, University of California San Francisco, Oakland, CA, USA
| | - Karen Kengne Kamga
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Kofi Anie
- London Northwest University Healthcare (NHS) Trust, Harrow, UK
- Imperial College London, London, UK
| | - Daima Bukini
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
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Bhat D, Babu BV, Surti SB, Ranjit M, Sarmah J, Sridevi P, Sharma Y. Stigma of sickle cell disease among Indian tribal population: A multi-centric qualitative study. J Natl Med Assoc 2023; 115:556-565. [PMID: 37845145 DOI: 10.1016/j.jnma.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Sickle Cell Disease (SCD) is the most prevalent hemoglobinopathy, impacting around 5% of the global population. The Indian tribal population, which has been a key focus of the Indian SCD program, can experience health-related stigma due to the multidimensional impact of the disease. This preliminary qualitative inquiry delves into the lived experiences of individuals and synthesizes domains to identify the sources of stigma. METHODOLOGY The study's framework for developing the stigma tool was rooted in Bronfenbrenner's Ecology of Human Development. The study was implemented in five tribal-dominated districts of India and involved in-depth interviews with sickle cell disease (SCD) patients and their caregivers to explore their stigmatizing experiences. RESULTS The analysis revealed four overarching themes and several subthemes explaining the type of stigma, its source, and factors contributing to stigmatization. First, the study focused on elements associated with perceived stigma, such as disclosure, self-isolation/refusal to participate, and self-judgment. The second theme pertained to the internalization of stigma. The third theme addressed experienced stigma concerning the disease's impact on day-to-day events, and the fourth theme explored the support system patients needed. The framework highlighted the varying degrees of stigmatizing components within different aspects of patients' ecology. CONCLUSION Our study highlights the importance of addressing stigma at various levels. Policies, programs, and healthcare interventions must target stigma across these levels. Culturally adaptive tools for identifying stigma, implementing appropriate interventions, and improving healthcare participation are essential for enhancing the quality of life and reducing the disease burden.
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Affiliation(s)
- Deepa Bhat
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Bontha V Babu
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India.
| | - Shaily B Surti
- Department of Community Medicine, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India
| | - Manoranjan Ranjit
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Jatin Sarmah
- Department of Biotechnology, Bodoland University, Kokrajhar, India
| | - Parikipandla Sridevi
- Department of Biotechnology, Central Tribal University of Andhra Pradesh, Vizianagaram, India
| | - Yogita Sharma
- Division of Socio-Behavioural, Health Systems & Implementation Research, Indian Council of Medical Research, New Delhi, India
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de Araújo PO, Soares IMSC, do Vale PRLF, de Sousa AR, Aparicio EC, Carvalho ESDS. Ageism directed to older adults in health services: A scoping review. Rev Lat Am Enfermagem 2023; 31:e4019. [PMID: 37820219 PMCID: PMC10557401 DOI: 10.1590/1518-8345.6727.4020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/20/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE to map the expressions of ageism directed to older adults in health services and the respective coping measures. METHOD a scoping review of primary studies in English, Spanish and Portuguese, without time delimitation and collected from 14 databases. Selection of the titles, abstracts and full text was in charge of two independent and blinded reviewers, totaling a corpus comprised by 41 articles. Data extraction was performed by pairs. The data were presented in narrative summaries and charts. RESULTS the ageism expressions are understood at the interpersonal level through images and attitudes that depreciate, devalue life and delegitimize older adults' needs, as well as at the institutional level, which confers barriers to accessing health services, generating non-assistance and neglect. The coping measures consist of educational interventions and expansion of communication channels between aged people, health professionals and managers. CONCLUSION the results may make health professionals vigilant for care/neglect guided by age bias and sensitive for coping with ageism by obtaining diverse scientific knowledge. The analysis of the phenomenon in the Unified Health System context constitutes a knowledge gap, as well as the implicit ageism expressions. (1) Ageism expressions involve interpersonal and institutional relationships. (2) Ageism directed to older adults permeates from diagnosis to treatment. (3) The coping measures comprise educational actions and also scientific research studies. (4) It is necessary to recognize the presence of ageism in health services. (5) It is necessary to recognize care/neglect practices guided by age bias.
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Jean-Baptiste DM, Wassef M, Bolyai SS, Jenerette C. Individuals with Sickle Cell Disease Using SBAR as a Communication Tool: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13817. [PMID: 36360702 PMCID: PMC9655268 DOI: 10.3390/ijerph192113817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a hemoglobinopathy that causes debilitating pain. Patients often report dissatisfaction during care seeking for pain or a sickle cell crisis (SCC). The Theory of Self-Care Management for SCD conceptualizes assertive communication as a self-care management resource that improves healthcare outcomes. OBJECTIVES This pilot study aimed to determine whether adults with SCD could learn to use the Situation, Background, Assessment, Recommendation (SBAR) communication method using a web-based trainer, and it aimed to determine their perceptions of the training. METHODS The participants included n = 18 adults with SCD. Inter-rater reliability (IRR) among three reviewers was used to evaluate the participants' ability to respond as expected to prompts using SBAR communication within the web-based platform. Content analysis was used to describe the participants' perspectives of the acceptability of using the SBAR patient-HCP communication simulation. RESULTS The SBAR IRR ranged from 64 to 94%, with 72% to 94% of the responses being evaluated as the using of the SBAR component as expected. The predominant themes identified were (1) Patient-Provider Communication and Interaction; (2) Patients want to be Heard and Believed; (3) Accuracy of the ED Experience and Incorporating the Uniqueness of each Patient; and (4) the Overall Usefulness of the Video Trainer emerging. CONCLUSIONS This pilot study supported the usefulness and acceptability of a web-based intervention in training adults with SCD to use SBAR to enhance patient-HCP communication. Enhancing communication may mitigate the barriers that individuals with SCD encounter during care seeking and improve the outcomes. Additional studies with larger samples need to be conducted.
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Affiliation(s)
| | - Maureen Wassef
- Tan Chingfen Graduate School of Nursing, Umass Chan Medical School, Worcester, MA 01655, USA
| | - Susan Sullivan Bolyai
- Tan Chingfen Graduate School of Nursing, Umass Chan Medical School, Worcester, MA 01655, USA
| | - Coretta Jenerette
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208, USA
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Araujo POD, Freitas RAD, Duarte ED, Cares LJ, Rodríguez KA, Guerra V, Carvalho ESDS. ‘The other’ of the COVID-19 pandemic: ageism toward the elderly people in newspapers in Brazil and Chile. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213402i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The emergence of the new coronavirus and the indication of the elderly population as a risk group led to the emergence of speeches, jokes, memes and facts indicative of ageism in social media and mass media. This article aims to analyze the expressions and implications of ageism toward the elderly reported in newspapers in Brazil and Chile in the first year of the COVID-19 pandemic. Documentary study of news from newspapers with the greatest access in Brazil and Chile. Data collection occurred in May 2021. The selection of titles, abstracts and full text was performed by two independently and blinded researchers. The final corpus of 89 news was submitted to thematic analysis supported by the MAXQDA software, whose codification, thematization and interpretation process was based on sociological theories that explain ageism. The expressions of ageism were evidenced through images and attitudes that devalue and depreciate the life of the elderly people, positioning them as ‘the other’ of the pandemic, which has implications for the life, health and work of this population.
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Araujo POD, Freitas RAD, Duarte ED, Cares LJ, Rodríguez KA, Guerra V, Carvalho ESDS. ‘O outro’ da pandemia da Covid-19: ageísmo contra pessoas idosas em jornais do Brasil e do Chile. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O surgimento do novo coronavírus e a indicação da população idosa como grupo de risco fez emergirem discursos, piadas, memes e fatos indicativos de ageísmo nas mídias sociais e nos veículos de comunicação. Este artigo objetiva analisar as expressões e as implicações do ageísmo contra a pessoa idosa reportadas em jornais do Brasil e do Chile no primeiro ano da pandemia da Covid-19. Estudo documental de notícias de jornais de maior acesso no Brasil e no Chile. A coleta de dados ocorreu em maio de 2021. A seleção de títulos, resumos e texto completo foi realizada por duas pesquisadoras de forma independente e cegada. O corpus final de 89 notícias foi submetido a análise temática apoiado pelo software MAXQDA, cujo processo de codificação, tematização e interpretação foi fundamentado nas teorias sociológicas que explicam o ageísmo. As expressões do ageísmo foram evidenciadas por meio de imagens e atitudes que desvalorizam e depreciam a vida da pessoa idosa, posicionando-a como sendo ‘o outro’ da pandemia, o que ocasiona implicações para vida, saúde e trabalho dessa população.
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