The Crisis of Sickle Cell Disease in Africa from Insights into Primary Prevention in Ghana and Nigeria: Notes from the Field.

Sickle cell disease (SCD), an inherited blood disorder, impacts 2% of newborns in Nigeria and Ghana. Despite devastating health consequences, SCD prevention is not a priority in either country. This article describes our U.S. research team's feasibility assessment for adapting CHOICES, a computer-based SCD education program, for use in Ghana and Nigeria. We identified indigenous collaborators by reviewing published research and investigating advocacy organizations online. This led to a fact-finding trip to Africa to discuss SCD prevention with local boards of advisors. Three major recommendations emerged from the group discussions: design a culturally appropriate intervention; enlist community healthcare workers to deliver the CHOICES program; and collaborate with religious and community leaders and elders in public awareness campaigns. Based on extensive advisor input, we will modify the content and delivery of the CHOICES intervention to meet the needs of those impacted by SCD in Ghana and Nigeria.

Skills and Strategies of African American Parents in the Management of ADHD: A Qualitative Study.

Objective: The purpose of this study is to use a strengths-based approach to determine African American parents' skills and strategies for management of children with ADHD. Method: Four focus groups were conducted to identify African American parent beliefs about appropriate ADHD management. Sixteen parents participated and reported having a total of 21 children diagnosed with ADHD. Results: Participants discussed several parenting challenges but advocated for the child by working closely with the child's school and physician. They also managed relationships with family members to protect the child from possible physical or emotional harm. However, parents desired more social support for management of ADHD. Conclusion: African American parents possess key skills and strategies in their management of children with ADHD. Further research is needed to determine the roles and responsibilities of extended family members for children with this disorder, and to identify the social supports parents access to aid with ADHD management.

Toward understanding family-related characteristics of young adults with sickle-cell disease or sickle-cell trait in the USA.

AIMS AND OBJECTIVES: To describe the family-related characteristics of young adults with sickle-cell disease or sickle-cell trait prior to taking part in a randomised controlled trial on sickle-cell reproductive health education. BACKGROUND: There is a critical need for educational programmes that target the reproductive needs of young adults with sickle-cell disease or trait. However, little is known about the family-related characteristics (i.e., demographic attributes and reproductive health behaviours) in which these young adults live. DESIGN: A descriptive cross-sectional analysis. METHOD: At study enrolment, 234 young adults (mean age = 25·9 years, 65% female) completed the SCKnowIQ questionnaire. Descriptive statistics depict the demographic attributes and reproductive health behaviours of young adults with sickle-cell disease (n = 138) or trait (n = 96). For group comparisons, independent t tests or Fisher's tests were used, as appropriate. RESULTS: Young adults with sickle-cell trait had significantly higher education, income and health insurance than those with sickle-cell disease. Both groups believed that sickle-cell disease was a severe condition. A majority of young adults with sickle-cell disease (65%) had no children compared to 42% of those with sickle-cell trait. Most young adults (85% sickle-cell disease, 82% sickle-cell trait) were not planning a pregnancy in the next six months, and many used condoms, withdrawal or oral contraceptives. CONCLUSIONS: Socioeconomic disparities exist between young adults with sickle-cell disease and sickle-cell trait. Future research that advances education about how and when to communicate appropriate genetic risk information to partners and children especially for young adults with sickle-cell trait would be beneficial. RELEVANCE TO CLINICAL PRACTICE: Awareness of the similarities and differences in the family-related characteristics among young adults with sickle-cell disease or trait can allow for more tailored reproductive education.

Interactions between adolescent fathers and health care professionals during pregnancy, labor, and early postpartum.

OBJECTIVE: To examine interactions between adolescent fathers and health care professionals from the perspectives of the families of the adolescent fathers during pregnancy and early postpartum. DESIGN: Content analysis methods were used to analyze data from the prenatal and 1 month data points of a larger longitudinal qualitative case study design examining paternal involvement. A purposive sample of 25 sets of unmarried, low-income Black adolescent fathers, adolescent mothers, and at least one of each of their parents were individually interviewed at 1, 6, 12, 18, and 24 months after birth using a semistructured interview guide. SETTING: Approximately 90% of participants were interviewed in their homes. PARTICIPANTS: Annual household incomes were between 0 dollars to 28K dollars (M=14,661 dollars). The 111 participants included 25 sets of adolescent parents, 50 grandmothers, and 11 grandfathers. Approximately 75% of the adolescent fathers were 17 to 19 years of age. RESULTS: Supportive (information, emotional, and material support), distancing, and neutralizing interactions between health care professionals and adolescent fathers were identified. CONCLUSIONS: Although most interactions were perceived as supportive, distancing, and neutralizing interactions could potentially have negative long-term effects for these vulnerable families and contribute to disparities in health care. Nurses may be important resources for these new fathers.