Affiliation:
1. Department of Psychological and Brain Sciences Boston University Boston Massachusetts USA
2. Department of Pediatrics Boston Medical Center Boston Massachusetts USA
3. Child Health Equity Center Department of Pediatrics UMass Memorial Children's Medical Center University of Massachusetts Chan Medical School Worcester Massachusetts USA
4. Section of Infectious Diseases Department of Medicine Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center Boston Massachusetts USA
5. Department of Health Law Policy & Management Boston University School of Public Health Boston Massachusetts USA
6. Department of Pediatrics Yale University School of Medicine New Haven Connecticut USA
7. Department of Pediatrics Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
8. Department of Pediatrics Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA
Abstract
AbstractBackgroundChildren with sickle cell anemia (SCA) have substantial medical needs and more unmet basic needs than children with other medical conditions. Despite a recent focus on social determinants of health (SDoH), there remains an incomplete understanding of the processes linking SDoH and disease management, particularly for youth with SCA. This study elucidated these processes and identified ways to mitigate deleterious effects of adverse SDoH on SCA management.MethodsParents/primary caregivers (N = 27) of children with SCA (≤12 years old) participated in semi‐structured interviews regarding SCA management and SDoH and completed quantitative measures of basic needs. Qualitative data were systematically coded and analyzed using applied thematic analysis. Quantitative data were presented descriptively.ResultsThree qualitative themes were identified. First, SCA management is bidirectionally linked with the social environment, whereby challenges of SCA management can hinder basic needs from being met, and unmet basic needs and financial hardship hinder SCA management. Second, due to limited resources, parents/caregivers are faced with difficult choices between prioritizing basic needs versus SCA management. Third, addressing material, emotional, and informational needs may improve SCA management. Quantitatively, 73% of families endorsed ≥1 basic need, including food insecurity (42%), housing instability (62%), and/or energy insecurity 19% (vs. 20%).ConclusionDespite documented associations, there remains a poor understanding of the processes linking SDoH and health. Findings underscore how day‐to‐day conditions undermine the management of SCA treatments, symptoms, and complications, limiting treatment effectiveness. Understanding these processes may inform family‐centered, health equity interventions and policies to improve living conditions, disease management, and health outcomes.
Funder
National Heart, Lung, and Blood Institute
Subject
Oncology,Hematology,Pediatrics, Perinatology and Child Health