Identifying Factors Underlying the Decision for Sickle Cell Carrier Screening Among African Americans Within Middle Reproductive Age

Abstract

Guidelines recommend that African Americans know their sickle cell trait status to inform reproductive health decisions. Few studies have applied a behavioral theory to identify factors associated with sickle cell trait screening to inform intervention targets to increase this behavior. We applied a Sickle Cell Trait Screening Framework to identify factors associated with African Americans' intention to ask for sickle cell trait screening. Participants (N = 300), ages 18 to 35, completed a cross-sectional survey. A three-step sequential ordinary least squares regression analysis identified factors influencing intention. Results indicated socio-demographic factors (age, education), knowledge and fear beliefs (screening knowledge, perceived threat), and reasoned action approach (RAA) constructs were associated with intention. RAA constructs influenced intention over knowledge and fear beliefs with an increase in R of .468. Perceived behavioral control was more predictive of intention (β = .576, p < .001). Attitude and perceived norm also had significant weights (β = .325 and β = .192, both p < .001, respectively). Findings from this study can inform strategies (e.g., eliminating costs associated with screening, reducing fear of painful tests) to increase sickle cell trait screening among African Americans. Ultimately, more sickle cell carriers will become aware of their trait status and be able to make informed reproductive health decisions.

Sickle Cell Trait: What Every Nurse Practitioner Should Know

“…10 One of the barriers to information uptake maybe a lack of trust in health professionals, often because of previous unfair and unethical medical treatments. 23 Population screening programs of 1970s were often designed as targeted screening of African Americans, and several jurisdictions enacted laws requiring black individuals undergo screening for SCD. 23 Because of their insensitivity to race-related concerns, these programs resulted in discrimination against African Americans.…”

“…23 Population screening programs of 1970s were often designed as targeted screening of African Americans, and several jurisdictions enacted laws requiring black individuals undergo screening for SCD. 23 Because of their insensitivity to race-related concerns, these programs resulted in discrimination against African Americans. 23 In certain states, school attendance and marriage licenses were precluded as a result of unwillingness to undergo screening.…”

“…23 Because of their insensitivity to race-related concerns, these programs resulted in discrimination against African Americans. 23 In certain states, school attendance and marriage licenses were precluded as a result of unwillingness to undergo screening. 23 Meaningful changes have been made to improve screening practices; however, mistrust continues as an issue when it comes to SCT/SCD screening and education.…”

“…23 In certain states, school attendance and marriage licenses were precluded as a result of unwillingness to undergo screening. 23 Meaningful changes have been made to improve screening practices; however, mistrust continues as an issue when it comes to SCT/SCD screening and education. To overcome this barrier, NPs should collaborate with trusted community leaders and faithbased organizations for help in delivering information that is ethnically and culturally sensitive.…”

“…To overcome this barrier, NPs should collaborate with trusted community leaders and faithbased organizations for help in delivering information that is ethnically and culturally sensitive. 23 Such organizations can also encourage persons to be tested for SCT and to be more open to disclosing SCT status to their partners and families. By partnering with community groups, NPs can improve public awareness and knowledge, and thus, potentially decrease the incidence and the healthcare burden of SCD.…”