Kearsley A Stewart1, Monika Parshad-Asnani2, Ambroise Wonkam3, John Bollinger4, Valentina Ngo Bitoungui5, Edmond Wonkam-Tingang6, Jill Powell7, Kathia Desronvil4, Kathryn R K Benson4, Abby Clark4, Madelaine Katz4, Bianca Martin4, Carolyn Peterseim4, Christina Williams4, Nana Young4, Nirmish Shah8, Paula Tanabe9, Michael Babyak10, Charmaine D M Royal11. 1. Duke Global Health Institute, Duke University, Durham, North Carolina, USA. Electronic address: k.stewart@duke.edu. 2. Caribbean Institute for Health Research - Sickle Cell Unit, University of the West Indies, Mona Campus, Kingston, Jamaica. 3. Faculty of Health Sciences, Division of Human Genetics, University of Cape Town, Cape Town, South Africa; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon. 4. Duke Global Health Institute, Duke University, Durham, North Carolina, USA. 5. Department of Microbiology, Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon. 6. Faculty of Health Sciences, Division of Human Genetics, University of Cape Town, Cape Town, South Africa. 7. Duke Center on Genomics, Race, Identity, Difference, Durham, North Carolina, USA. 8. Divisions of Hematology and Pediatric Hematology/Oncology, Duke University School of Medicine, Durham, North Carolina, USA. 9. Duke University Schools of Nursing and Medicine, Durham, North Carolina, USA. 10. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, North Carolina, USA. 11. Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Duke Center on Genomics, Race, Identity, Difference, Durham, North Carolina, USA; Department of African & African American Studies, Duke University, Durham, North Carolina, USA.
Abstract
CONTEXT: Sickle cell disease (SCD), an autosomal recessive blood disorder, affects millions of people worldwide. Approximately 80% of all cases are located in Africa. OBJECTIVES: This cross-national, interdisciplinary, collaborative study investigated provider attitudes about, and practices for, managing (assessing and treating) SCD pain. METHODS: We conducted 111 quantitative surveys and 52 semistructured interviews with health-care providers caring for adults and/or children with SCD in Cameroon, Jamaica, and the U.S. RESULTS: Applying Haywood's scale for assessing SCD provider attitudes, the Jamaica site scored lower on "Negative Attitudes" than the Cameroonian and U.S. sites (P = 0.03 and <0.001, respectively). Providers at the U.S. site scored lower on "Positive Attitudes" than other sites (P < 0.001). "Red Flag" scores at the Cameroon sites were lower than at other sites (P < 0.001). Qualitative results across all three sites describe the current practices for SCD pain management, as well as the challenges surrounding management for health providers, including pain subjectivity, patient-provider and parent-provider relationships, resource availability, perceptions of drug-seeking behavior, and adherence. Providers also spontaneously offered solutions to reported challenges. CONCLUSION: Overall, findings reveal that SCD provider attitudes toward their patients differed across sites, yet at all three sites, treating SCD pain is multidimensional.
CONTEXT: Sickle cell disease (SCD), an autosomal recessive blood disorder, affects millions of people worldwide. Approximately 80% of all cases are located in Africa. OBJECTIVES: This cross-national, interdisciplinary, collaborative study investigated provider attitudes about, and practices for, managing (assessing and treating) SCD pain. METHODS: We conducted 111 quantitative surveys and 52 semistructured interviews with health-care providers caring for adults and/or children with SCD in Cameroon, Jamaica, and the U.S. RESULTS: Applying Haywood's scale for assessing SCD provider attitudes, the Jamaica site scored lower on "Negative Attitudes" than the Cameroonian and U.S. sites (P = 0.03 and <0.001, respectively). Providers at the U.S. site scored lower on "Positive Attitudes" than other sites (P < 0.001). "Red Flag" scores at the Cameroon sites were lower than at other sites (P < 0.001). Qualitative results across all three sites describe the current practices for SCD pain management, as well as the challenges surrounding management for health providers, including pain subjectivity, patient-provider and parent-provider relationships, resource availability, perceptions of drug-seeking behavior, and adherence. Providers also spontaneously offered solutions to reported challenges. CONCLUSION: Overall, findings reveal that SCD provider attitudes toward their patients differed across sites, yet at all three sites, treating SCD pain is multidimensional.