Professional Documents
Culture Documents
DEPARTMENT OF PSYCHOLOGY
MAIN CAMPUS.
RESEARCH WORK
TITLE OF STUDY
MAY, 2010
DECLARATION
1
I, Somuah Francis Kofi, hereby affirm that this work is my own unique work and has not
(Supervisor)
Signature:……………………………………..
Date:………………………………………….
(Student)
Signature:……………………………………
Date:………………………………………...
DEDICATION
2
This work is dedicated to all Sickle Cell Persons
ACKNOWLEDGEMENT
3
It is amazing to me when I realize that I have made it to the point where I must thank all of
the individuals who have supported me to help me get to where I am. I would like to begin by
thanking the woman, who have truly believed that I chose the correct path for myself and
have encouraged me through it all, my project supervisor Mrs. Angela Anarfi Gyasi-
Gyamerah.
Thank you to Mrs. Doris Boadi of the Sickle cell unit at the Tema General Hospital, who
provided a superb example of enthusiasm even through the frustrating moments. Of course I
would like to also thank everyone who has helped to make this research a success through
their advising, participation and support; Roland Brown of Sickle Aid Ghana, the fabulous
management and staff of the Sickle Cell unit of the Tema General Hospital.
Without my family and friends behind me when I pushed myself too hard, this would have
been a very difficult journey. I would like to thank my parents Mr. Jacob Kofi Kissi Somuah
and Mrs. Dora Gyamfuah Somuah and my siblings Kesse, Osei and Kissiwaa. I would also
like to send my support and thanks to my coursemates who have made it all bearable as well
as my friends especially Anna, Comfort, Emelia, Esther, Fati, Bolaji who remind me that
there is more to life than work. This has been an exciting time and it is unreal that the time
has come for another journey. I will not step onto the next path without reminders of all the
ABSTRACT
4
This survey was conducted to determine the level of knowledge about Sickle cell Disease
(SCD) and the attitude towards sickle cell persons among nurses in local government health
institutions in Ghana. Thirty four nurses, comprising thirty-two females and two males were
randomly selected from the Tema General Hospital to fill a thirty-one item questionnaire to
measure their attitude toward Sickle cell persons and asses their level of knowledge about
the Sickle Cell Disease. The Chi square test was used to test for all four hypotheses. All four
hypotheses were rejected. Findings from the research showed that nurses have positive
attitude towards sickle cell persons as well as a good knowledge about the SCD.
Declaration………………………………………………………………..i
5
Dedication………………………………………………………………..ii
Acknowledgement……………………………………………………….iii
Abstract…………………………………………………………………..iv
Table of contents…………………………………………………………v-vi
Theoretical framework
Related studies
Hypotheses
Operational definition
Research setting
Population /sample
Sampling techniques
Instruments
Scoring
Research design
Data analysis
CHAPTER FOUR……………………………………………….14-33
Results
Summary
Conclusion
REFERENCES…………………………………………………40-41
Appendix………………………………………………………..42-58
7
CHAPTER ONE
INTRODUCTION
Of all genetic disorders to which man is known to be liable, there is probably no other that
presents a collection of problems and challenges quite comparable to Sickle Cell Disease
(SCD) and related disorders, because of its extensive distribution, problem created by its
chronicity, and its resistance to therapy. It is a genetic abnormality whose control and cure
still elude clinicians, research workers, and social scientists. Despite major advances in our
inherited disorders of the haemoglobin, thousands of infants and children with these diseases
are dying through lack of appropriate medical care (Feroze and Aravidan, 2001).
SCD is a term used for a group of conditions in which the pathology is due to the presence of
haemoglobin S. Sickle cell anemia, or homozygous SCD, results from the inheritance of a
sickle cell gene from both parents. Other genotypes of SCD result from the inheritance of
thalassemia gene causing Sß+ or Sß0 thalassemia. SCD is characterized by continuous red
blood cell hemolysis usually resulting in anemia. This varies from patient to patient from
the potential for serious infections in childhood; and acute complications involving any of the
major organ systems, with progressive, irreversible organ damage. In sickle cell trait (the
carrier state) there is always more normal (A) haemoglobin than S haemoglobin. Patients
with sickle cell trait do not have symptoms from their sickle haemoglobin except under
'Sickle Cell Anaemia' is also sickle cell disease ('SS Phenotype'). The reason why it is called
sickle cell anaemia is because anaemia (low haemoglobin level) is the most obvious feature
8
of the SS phenotype. Other haemoglobin genes can combine with sickle haemoglobin to
(it is a gene for producing an insufficient amount of Normal haemoglobin), nor is Foetal
Haemoglobin (which is Normal Haemoglobin for the baby in the womb, but which should
Hereditary Persistence of Fetal Haemoglobin (HPFH) which can combine with sickle
haemoglobin gene to cause disease. Similarly, a beta-thalassaemia gene can combine with
Haemoglobin S to cause illness. So the sickle cell diseases can include the phenotypes SS
(sickle cell anaemia), SC, SD, SE, SG, SK, SO, S Korle-Bu, S Osu-Christiansborg, SBeta-
The sickled cells in a person with SCD have a hard time moving through the blood vessels in
The scientific discovery of the disease was in 1910 when a Chicago Physician, Dr. James
Herrick, came into contact with a Grenadan dental student with severe anaemia and yellow
eyes (jaundice). He examined his blood under the microscope and saw sickle-shaped red cells
and immediately published his findings and called the disease sickle cell anaemia.
Non-communicable diseases, especially genetic diseases such as SCD are a major cause of
morbidity and mortality. The sickle cell gene is known to be widespread, reaching its highest
incidence in equatorial Africa, with the proportion of carriers in the global human population
increasing as a result of a relatively high birth rate in the affected population. SCD is one of
symptomatic therapy, its specialised care, the associated high morbidity, reduction in life
expectancy of the affected, poor school attendance, the potential risk of the development of
drug addiction, especially to opiates, and its burden on the affected families all indicate that
the condition is a major public health problem where ever its risk prevalence is high.
Because SCD causes so many health problems, persons with the disease need to establish a
Despite major advances in SCD treatment that have occurred over the past three decades,
important gaps exist both in the equity of government and private philanthropic support for
research and in the uniform provision of high quality clinical care (Smith et al 2006).
About two per cent of babies born in Ghana every year have SCD which need to be managed
Without proper medical diagnosis and treatment, most of these children die by the age of five
years, with malaria, chest infections and anaemia being the major causes.
25 to 30 per cent of Ghanaians carry genes that can result in the SCD when passed on to
children, and most of the carriers do not know of carrying such genes.
Unfortunately, there are only a few clinics in the health system in Accra, Tema, Koforidua,
Kumasi and Sunyani, to manage patients hence the need for more health personnel to be
In Ghana, public health professionals constitute the tier of health care closest to the people. It
is responsible for primary health care, and houses the majority of all health records of the
people. Its workers have considerable impact on local community beliefs, values and
practices. Therefore, they constitute a key agent of change in their local communities and an
10
important group of people to target for the introduction of communitywide interventions such
SCD is an autosomal recessive disease that primarily affects persons of African ancestry. The
hallmark of the disease is haemolytic anaemia and vaso-occlusive crisis. Patients often have
recurrent and severely painful episodes that necessitate the use of opioids. The reluctance of
some healthcare providers to prescribe narcotics has resulted in adversarial relationships with
some patients. The socio-cultural disparity between patients and providers may play a role.
However, the lack of knowledge and understanding of the underlying pathophysiology of the
disease and pain are the key issues. Education, research and hands-on experience, resulting in
changes in attitudes and behaviours, will ultimately lead to a more empathic approach to the
SCD is an inherited chronic illness that carries the risk of significant morbidity and mortality.
Lack of knowledge about SCD and the difficult issues of pain management lead to negative
attitudes among providers toward persons with the disease. Through research and education,
changing attitudes and behaviors will lead to establishing a more reciprocal relationship, and
As health care professionals, our attitudes and beliefs influence the relationships that we form
with our patients. These beliefs affect the care and management we provide (Sutton et al.,
1999).
11
The general aim of this survey is to determine the level of knowledge about SCD and the
attitude towards sickle cell persons among nurses in local government health institutions, in
1. To investigate nurses attitude towards SCD and the sickle cell person.
2. To ascertain the existence of social stigma associated with the sickle cell person among
nurses.
3. To determine whether personal contact with the sickle cell person influence people’s
1) This study can be used as a baseline as well as enhancing steps in educating the
2) It will assist nurses to adopt positive and good practices towards sickle cell persons.
nationwide assessment, treatment and care of sickle cell persons as well as awareness
creation exercise.
4) The study will help policy makers in the hospitals on the management and formation
5) The study will serve as a reference material for all those who want to broaden their
CHAPTER TWO
LITERATURE REVIEW
12
An attitude is a hypothetical construct that represents an individual's degree of like or dislike
for an item. Attitudes are generally positive or negative views of a person, place, thing, or
People can also be conflicted or ambivalent toward an object, meaning that they
simultaneously possess both positive and negative attitudes toward the item in question.
Attitudes are judgments. They develop on the ABC model (affection, behaviour, and
cognition).
preference for an entity. The behavioural intention is a verbal indication or typical behavioral
tendency of an individual. The cognitive response is a cognitive evaluation of the entity that
constitutes an individual's beliefs about the object. Most attitudes are the result of either
(1993) has argued that hereditary variables may affect attitudes - but believes that they may
do so indirectly. For example, if one inherits the disposition to become an extrovert, this may
Previous studies conducted to examine the attitudes towards sickle persons have shown poor
13
A more recent study was conducted by Abioye-Kuteyi et al.(2009). The aim of their study
was to determine the level of knowledge about SCD and the factors associated with its
prevention among local government workers in Ile-Ife. Results showed a poor knowledge and
Milan et al. (2009) conducted a survey to determine the Knowledge and attitudes towards
SCD Screening of the UK Sickle Cell Society. Members of the Sickle Cell Society provided
an ideal population for this exploratory study looking at people’s knowledge, attitudes and
Two hundred (200) questionnaires were posted to the sickle cell community. A total of 61
questionnaires were returned to the university. In total 43 women and 16 men responded
whilst two did not write down their gender. Nearly 75% defined themselves as Christians,
another 20% stated they had no religion, two were of Muslim or Hindu faiths and three did
not answer the question. Of the 24 people who were married, the overwhelming majority
(77.2%) had married partners from within their own ethnic group. No significant difference
in knowledge was found between males and females. There was an overall lack of awareness
Milosavljevic et al. (2007) in their study on the topic; sickle cell disease: experiences of the
care givers in managing the disease in children living in the western region of Jamaica found
out that, care givers had little information about SCD. They therefore needed to be well
Hayes (2006) conducted a survey on Physicians attitudes and practices in SCD pain
knowledge of pain, pain treatment and drug addiction and abuse among sickle cell persons.
14
Questionnaires were administered to 286 physicians at seven National Institutes of Health-
funded university-based comprehensive sickle cell centers. Physicians reported varied pain
management strategies; however, many believed that attitudes toward addiction and to
patients in pain crisis may result in under treatment of pain. Generally, the results indicated
Douglas and Brown (2002) conducted a research to explore hospitalized patients’ attitudes
toward advance directives, their reasons for completing or not completing advance directive
forms, and demographic differences between patients who did and did not complete advance
Carolina. Participants were interviewed using an adapted advance directive attitude survey
(ADAS), and were asked five general questions about advance directives. Validity and
reliability were established on the adapted tool. The overwhelming majority of participants
had received information on advance directives and they were moderately positive about
them. The majority who had completed advance directives were Caucasian, female, over age
65, had less than a high school education, and perceived their health as poor.
Most believed that an advance directive would ensure they received the treatment they
desired at the end of life. Patients’ attitudes alone did not determine who will and will not
complete advance directives. Most participants who completed advance directives had
specific reasons for doing so. Nurses have responsibility for discussing advance directives
with patients, families, and physicians to ensure adequate education about the completion of
advance directives.
Sutton et al. (1999) surveyed 220 persons with SCD (150 children and 70 adults) who
received their care at Mount Sinai Medical Center in USA to examine the misconceptions and
15
myths in the care of the patient with SCD and observed that, lack of knowledge about SCD
and the difficult issues of pain management lead to negative attitudes among providers
Maxwell et al. (1999) did a qualitative study to examine the experiences of hospital care and
treatment seeking for pain from SCD among 57 subjects with the SCD. The objective was to
investigate the sociocultural factors influence management of pain from SCD by comparing
the experiences of those who usually manage their pain at home with those who are more
Results showed that the current organisation of pain for sickle cell crisis discourage self-
Results of Olley et al. (1994) showed that, because of the low level of knowledge about SCD,
mothers experience the most stress in caring for their sickle cell children since they spend
2.3 HYPOTHESES
1. Nurses who have relatives with the SCD are more likely to have a good attitude towards
sickle cell persons than those who do not have relatives with the disease.
2. Nurses with higher levels of academic qualifications are more likely to have a good
knowledge about SCD than nurses with lower levels of academic qualifications.
3. Female nurses are more likely to have a good attitude towards sickle cell persons than
male nurses.
4. Older nurses are more likely to have a good knowledge about SCD than younger nurses.
ii. Younger nurses refer to nurses between the ages twenty (20) and forty (40).
iii. Higher academic qualifications are nurses with HND, Degree and above.
CHAPTER THREE
METHODOLOGY
The study was conducted at the Tema General Hospital. This area was chosen because it is
one of the few public health centres in the country with a special unit for the treatment of
SCD. The unit manages, train and educate sickle cell persons and the public at large. It is also
17
3.2 POPULATION/SAMPLE
Nurses working at the Tema General Hospital constituted the population size. The sample
size comprised 32 females and 2 males. Out of the 40 questionnaires administered, only 34
A random and purposive sampling was used to select respondents within the study area.
3.4 INSTRUMENT
Thirty-six (36) attitude questionnaire constructed on 5–point Likert scale ranging from
“strongly agree” to “strongly disagree” was used. The 36 item set questionnaires were
constructed into (4) major parts (sections A B C D). Section A was made up of respondents’
biodata: sex, age, educational level and whether they know someone with the SCD. Sections
B, C and D comprised questions based on the Tri-component view of attitude. Section B was
These questions measured the feelings and emotions nurses have towards Sickle Cell persons.
Questions in section C was based on the behaviour component of attitude. This measured the
actions and manners nurses portray towards Sickle Cell persons. Section D was based on the
cognitive component of attitude. Here the questions were aimed at assessing the beliefs and
knowledge of nurses about the SCD. It found out whether nurses had some misconceptions
3.5 SCORING
Five (5) points positive only Likert scale was used to score data ranging from strongly agree
to strongly disagree. Expressions of question included both negative and positive ones.
18
Positive questions were scored from 5-1 with reference to strongly agreed to strongly
disagree. Negative questions were scored from 1-5 with reference to strongly agree to
strongly disagree.
The design for the study was descriptive survey. It was used to describe the attitude of nurses
A letter was obtained from the Psychology department of University of Ghana, Legon to seek
permission from the Tema General Hospital to conduct the research. The letter was approved
by the director of the hospital before permission was granted me to conduct the survey.
Forty questionnaires were administered to the respondents to ascertain their attitude towards
Sickle Cell persons. The head nurse at the Sickle Cell Unit of the Tema General Hospital
collected the same day. They were given a period of one week to complete, after which they
were collected.
Thirty-four out of the forty questionnaires administered were filled and returned.
The CHI-SQUARE test was used to analyse the data and hypotheses.
This is a statistical technique that is used to check if two variables are dependent on each
other or not. If the test reveals a dependence of the variables in question, a correlation test is
then used to complete the test. The correlation test is used to check the nature and the strength
H0: The two variables in question are not dependent on each other (they are independent)
19
H1: The two variables in question are dependent on each other.
A 5percent (default) significant level will be used to make all decisions on all the tests to be
A p-value (probability value) approach will be used to make decision on the entire test. The
p-value shows the strength of the evidence in favour of the null hypothesis. The smaller it is,
the smaller the strength of the evidence in favour of the null hypothesis hence the null
hypothesis must be rejected. But if the p-value is large then there exist strong evidence in
favour of the null hypothesis and hence it must be accepted. If the p-value is less than 0.05
we reject the null hypothesis (accept the alternative hypothesis) and conclude that the two
variables in question are dependent. Hence, there will exist some kind of relationship
between the two variables. But if the p-value is greater than 0.05, we fail to reject the null
hypothesis (thus we accept the null hypothesis) and conclude that the two variables are not
CHAPTER FOUR
RESULTS
The general reason for conducting this study was to determine the level of knowledge about
SCD and the attitude towards Sickle Cell persons among nurses in local government health
institutions. It was therefore hypothesized that, nurses who have relatives with the SCD are
more likely to have a good attitude towards Sickle Cell persons than those who do not have
relatives with the disease. The second hypothesis tested was nurses with higher levels of
academic education and qualifications are more likely to have a good knowledge and attitude
towards Sickle Cell persons than nurses with lower levels of academic education and
20
qualifications. The next was female nurses are more likely to have a good attitude towards
Sickle Cell persons than male nurses. The fourth hypothesis tested was older nurses are more
Descriptive statistic on the demographic variables such as age, sex and religious affiliation
SEX
Thirty four nurses were interviewed for this research. 32(94.1%) constituting the majority
was females. Only 2(5.9%) were males. This clearly shows that, the female nurses outnumber
AGE
Information gathered from the ages of the nurses indicated that, majority of them are
younger. 11 (32.4%) nurses are aged between 20-30 years. The rest are 6 (17.6%), 8 (23.5%),
9 (26.5%) representing ages 31-40, 41-50, 51-60 respectively. No one was aged above 60
years.
ACADEMIC QUALIFICATION
9 (26.5%) nurses had the SSSCE/WASSCE certificate. 4(11.8%) had HND while 20 (58.8%)
nurses had Degree/Professional certificates respectively. Only one nurse had the BECE
qualification. This clearly indicates that, majority of the nurses had attained higher levels of
PERSON
When the nurses sampled for this research were asked whether they personally know
someone who is suffering from SCD, 10 of them constituting 29.4% of the total said no while
21
24 (70.6%) of them answered in the affirmative with most of them being their personal
friends.
By virtue of their job, nurses are supposed to have positive feelings and emotions towards
Sickle Cell persons during treatment in the hospitals. In an attempt to ascertain this, questions
When the respondents were asked to share their thoughts on the feeling that Sickle Cell
persons should be treated like children as a sign of extreme appreciation and care for them,
13 and 8 respondents respectively said they strongly agree or agree as opposed to the
Respondents responses to the idea that Sickle Cell persons should be kept behind closed
doors indicates that out of the 34 nurses interviewed, only 1 (2.9%)) of them strongly
disagreed, 6 (17.6%) of them disagreed and the remaining 27 (79.4%) of them strongly
disagreed.
This is a clear indication that, majority of the nurses opposes the idea that Sickle Cell persons
should be kept behind closed doors. Rather, they should be allowed to mingle with others.
14 and 16 respondents answered strongly disagree and disagree respectively. Only one person
was undecided as to whether Sickle Cell persons should be treated in a separate hospital. The
22
More than there-quarter of the respondents strongly agreed or agreed to for Sickle Cell
persons to mingle with others. 18 (52.9%) strongly agreed while 14 (41.2%) agreed. This
means 94.1% of the respondents answered in the affirmative. Only one person strongly
50% of the respondents agreed that Sickle Cell persons are corporative while 20.6% of them
strongly agreed. Besides, 17.6% of the respondents were undecided while 11.8% disagreed.
In view of the outcomes above, it can be concluded that Sickle Cell persons are cooperative.
Interestingly, 11 and 16 respondents answered strongly agree and agree respectively. 3 each
This is a clear indication from the findings that Sickle Cell nurses are brilliant.
More than two-third of the nurses objected to the statement. 24 of them, representing 70.6%
strongly disagreed. Only one person agreed. 2 of the nurses were undecided. The remaining 6
disagreed.
The notion or perception of nurses that Sickle Cell persons are dangerous has been debunked
Exactly half (50%) of the nurses agreed. 13(38.2%) disagreed. 2 each of the nurses were
Findings here shows that, Sickle Cell persons can sometimes be active and sometimes non
active.
23
More than half (22 nurses) strongly disagreed. 9 of them disagreed. 5.9% and 2.9% agreed
The findings here reveal that, Sickle Cell persons are not worthless. This is because majority
The negative actions, manners and to some extent stigma society exhibits towards Sickle Cell
persons need to identified and solved urgently. It then becomes necessary to unearth some of
these feelings, attitudes and behaviour of people towards such victims and also re-orientate
them against these perceptions based on empirical facts. Research findings on how people
Only one person disagreed. 18 (52.9%) and 15 (44.1%) respondents were willing to have
Sickle Cell persons as friends, hence they agreed and strongly agreed respectively.
This is a clear indication stigmatization towards sickle cell persons is very minimal.
Interestingly, no nurse disagreed. Only one person was undecided. The remaining 33 nurses
24
In view of these findings indicating that a large number of the respondents were undecided, it
can therefore be said that there is no enough evidence to conclude that nurses will willingly
94.2% of those interviewed answered in the affirmative. 11 and 21 answered strongly agree
and agree respectively. One nurse each answered undecided and disagrees respectively. No
From the findings, it is obvious that, when it comes to job recommendation, Sickle Cell
In trying to know whether nurses will agree to have a Sickle Cell person as a visitor in their
house, only three of the respondents answered undecided. The remaining 31 nurses answered
favourably.
From the results, we can say that, nurses will willingly open their doors to Sickle Cell persons
Assenting answers constituted 100%. In other words, all the nurses interviewed gave positive
answers. 18 nurses representing 52.9% answered agree while the remaining 16 representing
CELL DISEASE
Relatively high percentages of people are still not aware of some hereditary factors that
contribute to defective off-springs. When people marry; love, ethnicity, religion and common
interest, and social status are usually given prominence. Yet sickle cell anaemia, a major
25
blood disorder is affecting a great number of people, subjecting them to unspeakable bouts of
Lack of knowledge and misconceptions about SCD lead to negative attitudes among
providers toward persons with the disease. Through research and education, changing
attitudes and behaviors will lead to establishing a more reciprocal relationship, and thus more
effective management of the person with SCD. Research findings to assess the level of
knowledge and misconception nurses have toward sickle cell disease have been analysed
below.
More than half (58.8%) of the nurses strongly disagreed and 8 (23.5%) disagreed. Only 2 and
This shows majority of the nurses representing a number of 28 (82.3%) are aware of how
SCD is inherited. They know that SCD is acquired from both parents but not one parent.
Sickle Cell occurs when both parents pass on abnormal genes, at least one of
This shows that the nurses are knowledgeable of the genetic causes of the SCD.
21 of the nurses gave an opposing answer. That is they disagreed with the question. 4 of the
remaining were undecided. 4 and 5 answered strongly agree and agree respectively.
From the results, it is obvious that majority of the nurses are aware that SCD does not confer
26
People with SCD do suffer from malaria, and very badly too. Nurses who have been wrongly
taught have been known to advise their Sickle Cell persons travelling from Europe to the
Tropics not to bother taking anti-malarial tablets because the sickle cells make them immune
to the parasite. Dangerous advice, as malaria is the commonest cause of sickle cell crisis in
Africa.
Sickle Cell cannot occur when only one parent has the Sickle Cell gene
Research results for this question revealed that, there was a split as to whether SCD cannot
occur when only one parent has the Sickle Cell gene. 9 each of the respondents representing
26.5% answered strongly agree and agree respectively. This means 18 (53%) of the
A total of 15 (44.1%) disagreed to the question. Only one person was undecided. This clearly
shows that, there is a slight difference of those who agreed and those who disagreed. It
therefore be said that about half believe that, SCD cannot occur when one parent has the
Sickle Cell gene while the other half believe that SCD occurs when one parent has the Sickle
Cell gene.
Sickle Cell is known as Sickle Cell anaemia when both parents pass on a sickling
gene i.e. S from the father, S from the mother, making “SS”.
Assenting answers for this question indicated that 14 and 6 respondents strongly agree and
agree respectively. On the other hand, 8 and 3 nurses answered disagree and strongly disagree
Findings for this question has indicated majority of the nurses (58.8%) believe that Sickle
Cell anaemia is when both parents pass on a sickling gene i.e. S from the father, S from the
Sickle cell persons seldom go through life without regular blood transfusion.
27
Results obtained reveal that 52.9% of the respondents interviewed constituting majority
assented the claim that Sickle cell persons seldom go through life without regular blood
The results indicates that nurses majority of the nurses interviewed still have the
misconception that Sickle cell persons seldom go through life without regular blood
transfusion. This shows low level of knowledge about SCD on the part of nurses.
20 nurses representing more than half (58.9%) disapproved the claim that SCD does not
occur in white people. However 10 (29.4%) of the remaining approved the claim. 4 of the
Research by Konotey-Ahulu shows that, SCD is not "only found in Black people". White
people in Greece, Sicily, Turkey, and their offspring around the world suffer from SCD. In
fact, the highest incidences of the sickle cell gene (S, for short) are not found in Africa; they
To ascertain whether this misconception pertains or not, answers from the respondents
indicate that, Sickle cell Persons can attain and even grow beyond 60 years.
Findings from the respondents reveal that a majority of 85.3% refute the claim; Sickle Cell is
so serious that, no patient has attained go years of age. 2 nurses answered undecided. The
Findings indicate that 91.2% (31 nurses) of the respondents rejected the claim that Sickle Cell
28
It is obvious that, the nurses who were interviewed are aware or know that Sickle Cell is not a
Previously, respondents were asked whether SCD does not occur in white people, and
majority of them disapproved the claim. In other to be certain whether the respondents really
know SCD occurs in white people they were also asked whether SCD occurs only in black
people. Answers for this question tallied with the answers of the previous question.
Results showed that, more than half of the respondents (52.9%) disagreed to the claim. 3
To ascertain whether the misconception that Sickle Cell can be acquired through interaction
with infected person, interesting results showed that, 30 (88.2%) respondents strongly
disagreed with an additional 2 (5.9%) answering disagree. The remaining 2 respondents were
undecided.
26 (76.5%) respondents disagreed to the claim that Sickle Cell trait is interchangeable with
SCD. 3 respondents agreed while 1 was undecided. 1 respondent did not answer the question.
With majority of the respondents disapproving the claim, it can be said that, from the findings
Sickle Cell Trait means the possession of one normal gene for haemoglobin
formation (A) and the abnormal sickle gene (S), with the proportion of A always
exceeding that of S.
23 (67.6%) of the respondents agreed to the fact that Sickle Cell Trait means the possession
of one normal gene for haemoglobin formation (A) and the abnormal sickle gene (S), with the
29
proportion of A always exceeding that of S. 8 and 3 respondents answered undecided and
disagree respectively.
Therefore, the findings indicate that, majority of nurses interviewed are knowledgeable about
Folic acid can help the body to replace damaged red blood cells
Because the red blood cells of a person with SCD are sickle shaped, they have to take Folic
To find out whether nurses are aware of this, they were asked whether Folic acid can help
replace damaged red blood cells. Remarkably, 32 (94.1%) answered in the affirmative. One
each answered undecided and disagree respectively. Clearly it is obvious from the findings
that, folic acid can help replace damaged red blood cells.
Lung, stroke, chest pains are major symptoms of the sickle cell crises
Sickle cell crisis occurs when a significant number of the red blood cells of a person with
alter their shape from the usual round-shape to sickle-shape. People often thought that all the
red cells flowing in the blood vessels of someone with sickle cell disease were distorted and
sickled. No, the red cells are usually round and malleable like those of a person without
Haemoglobin S. It is when circumstances make the body's internal environment lack oxygen,
or get too hot, or too 'acidic', or too sluggish, that red blood cells with Haemoglobin S change
shape into sickle-shape (or mini-cigar shape), clogging up the tiny vessels and causing severe
pains wherever the clogging up occurs - around joints, in the abdomen, in the head, in the
male organ (priapism), in the ribs, in the bones of the back, and limbs, etc.
30
Surprisingly, respondents interviewed to ascertain whether lung, stroke, chest pains are major
symptoms of the sickle cell crises indicates that, more than half (53%) answered disagree and
strongly disagree. 2 persons were undecided while the remaining 14 nurses agreed.
HYPOTHESIS 1
• Nurses who have relatives with the SCD are more likely to have a good attitude
towards sickle cell persons than those who do not have relatives with the disease.
Table 1a.
31
Cross tabulation showing the relationship between those have relatives
Table 1c.towards them.
with SCD and their affection
Cross tabulation showing the relationship between those have relatives
with SCD and their behaviour towards them.
Feelings and emotions Total
towards Sickle Cell Persons
Bad feeling or Actions and
Good feeling
Relative with SCD emotions manners towards
or emotions
Sickle Cell person
Do you personally know yes 14 10 24
someone who is no 9 1 10
Relatives with SCD Positive behaviour Total
suffering from sickle
cellDo you personally know
disease? Yes 24 24
someone
Total who is suffering from No
23 11 3410
10
sickle cell disease?
Total 34 34
Table 1b.
Chi-Square Tests
Asymp. Sig.
Value Df (2-sided)
Pearson Chi-Square 3.234a 1 .072
Continuity
1.949 1 .163
Correctionb
Likelihood Ratio 3.703 1 .054
b
N of Valid Cases 34
a. 1 cells (25.0%) have expected count less than 5. The
minimum expected count is 3.24.
b. Computed only for a 2x2 table
Table 1d.
32
Cross tabulation showing the relationship between those have relatives
with SCD and their level of knowledge and beliefs about SCD
Table 1e.
Chi-Square Tests
Asymp. Sig. (2-
Value Df sided)
a
Pearson Chi-Square .054 1 .816
b
Continuity Correction .000 1 1.000
Likelihood Ratio .053 1 .818
N of Valid Casesb 34
a. 2 cells (50.0%) have expected count less than 5. The
minimum expected count is 1.76.
b. Computed only for a 2x2 table
Since hypothesis 1 is measuring the relationship between nurses with relatives with the SCD
and attitude; and attitude is in three components, it was measured on three levels. Hence the
three Chi-Square test tables. From Tables 1b and 1e, the p-values are 0.072 and 0.816
respectively. It implies that the p-values are greater than the significant level of 0.05 (p-
values > 0.05). Since the p-values are greater than the significant level of 0.05, we reject the
hypothesis that nurses who have relatives with the SCD are more likely to have a good
attitude towards sickle cell persons than those who do not have relatives with the disease.
33
Hence the hypothesis that nurses who have relatives with the SCD are more likely to have a
good attitude towards sickle cell persons than those who do not have relatives with the
disease is false.
HYPOTHESIS 2
• Nurses with higher levels of academic qualifications are more likely to have a good
knowledge about SCD than nurses with lower levels of academic qualifications.
34
Table 2a.
Table 2b.
Chi-Square Tests
From Table 2b, it can be seen that the p-value is 0.816. This implies that the p-value is
greater than the significant level of 0.05 (p-value > 0.05). As a result of this, we reject the
hypothesis that nurses with higher levels of academic qualifications are more likely to have a
good knowledge about SCD than nurses with lower levels of academic qualifications.
35
Hence the hypothesis that nurses with higher levels of academic qualifications are more
likely to have a good knowledge about SCD than nurses with lower levels of academic
qualifications is false. In other words, the relationship between educational level and
HYPOTHESIS 3
• Female nurses are more likely to have a good attitude towards sickle cell persons than
male nurses.
Table 3a.
Cross tabulation showing the relationship between sex
and feelings and emotions towards Sickle Cell persons
Table 3b.
36
Chi-Square Tests
Asymp. Sig. (2-
Value df sided)
Pearson Chi-
.302a 1 .582
Square
Continuity
.000 1 1.000
Correctionb
Likelihood Ratio .284 1 .594
b
N of Valid Cases 34
a. 2 cells (50.0%) have expected count less than
5. The minimum expected count is .65.
b. Computed only for a 2x2 table
Table 3c.
Cross tabulation showing the relationship between Sex and
Actions and Manners towards Sickle Cell Persons
Table 3d.
Chi-Square Tests
Asymp. Sig.
Value df (2-sided)
Pearson Chi-Square .133a 1 .716
Continuity
.000 1 1.000
Correctionb
Likelihood Ratio .250 1 .617
N of Valid Casesb 34
a. 3 cells (75.0%) have expected count less than 5. The
minimum expected count is .12.
b. Computed only for a 2x2 table
37
Table 3e.
Cross tabulation showing the relationship between sex and the
beliefs and knowledge about SCD.
Table 3f.
Chi-Square Tests
Asymp. Sig. (2-
Value df sided)
Pearson Chi-
.455a 1 .500
Square
Continuity
.000 1 1.000
Correctionb
Likelihood Ratio .803 1 .370
N of Valid
34
Casesb
a. 2 cells (50.0%) have expected count less than 5. The
minimum expected count is .35.
b. Computed only for a 2x2 table
Since hypothesis 3 is measuring the relationship between sex/gender and attitude, and attitude
is in three components, it was measured on three levels. Hence the three Chi-Square test
tables. From all the three Chi-Square test tables (Tables 3b, 3d and 3f), it can be seen that all
the p-values are greater than the significant level of 0.05. They are 0.582, 0.716 and 0.500
respectively. On the whole the p-values are greater than 0.05. As a result, we fail to accept
the hypothesis that female nurses are more likely to have good attitude towards sickle cell
persons than male nurses. Hence the hypothesis that female nurses are more likely to have a
38
good attitude towards sickle cell persons than male nurses is false. In other words no
relationship exists between gender/sex and attitude towards sickle cell persons. Sex/gender
and attitude towards Sickle Cell persons are independent of each other.
HYPOTHESIS 4
• Older nurses are more likely to have a good knowledge about SCD than younger
nurses.
Table 4a.
Cross tabulation showing the relationship between Age and Beliefs and
knowledge about SCD
Table 4b.
Chi-Square Tests
Value df Asymp. Sig. (2-sided)
Pearson Chi-Square 3.238a 1 .072
Continuity
1.821 1 .177
Correctionb
Likelihood Ratio 3.484 1 .062
Linear-by-Linear
3.143 1 .076
Association
N of Valid Casesb 34
a. 2 cells (50.0%) have expected count less than 5. The minimum
expected count is 3.00.
b. Computed only for a 2x2
table
39
With a p-value of 0.072 as shown in Table 4b, it can be concluded that, since the p-value is
greater than the significant level of 0.05 (p-value > 0.05), we fail to accept the hypothesis that
older nurses are more likely to have a good knowledge about SCD than younger nurses.
Hence the hypothesis that older nurses are more likely to have a good knowledge about SCD
than younger nurses is false. In other words there is no relationship between age and
knowledge about SCD. That is the relationship between age and knowledge about SCD is
CHAPTER FIVE
DISCUSSION
40
Sickle cell disease is an inherited chronic illness that carries the risk of significant morbidity
and mortality. Lack of knowledge about sickle cell disease and the difficult issues of pain
management lead to negative attitudes among providers toward patients with the disease.
Through research and education, changing attitudes and behaviours will lead to establishing a
more reciprocal relationship, and thus more effective management of the patient with sickle
cell disease. This study was therefore conducted to determine the level of knowledge about
SCD and the attitude towards Sickle Cell persons among nurses in government health
institutions.
It was therefore hypothesized that, nurses who have relatives with the SCD are more likely
to have a good attitude towards Sickle Cell persons than those who do not have relatives with
the disease. The second hypothesis tested was nurses with higher levels of academic
education and qualifications are more likely to have a good knowledge and attitude towards
Sickle Cell persons than nurses with lower levels of academic education and qualifications.
The next was female nurses are more likely to have a good attitude towards Sickle Cell
persons than male nurses. The fourth hypothesis tested was older nurses are more likely to
have a good knowledge about SCD than younger nurses. All four hypotheses were rejected.
The Chi-Square test was used to test for all four hypotheses.
The attitude of nurses towards their relatives, friends and parents has greater influence on the
attitude they form towards Sickle cell persons. The first hypothesis tested was Nurses who
have relatives with the SCD are more likely to have a good attitude towards sickle cell
persons than those who do not have relatives with the disease. Since attitude is in three
components (affective, behaviour and cognitive), gender or sex was measured on all three
components. From the research the p-values are 0.072, 0.000 and 0.816 for affective,
behaviour and cognitive respectively (p-values > 0.05). Since the p-values are greater than
41
the significant level of 0.05, we reject the hypothesis that nurses who have relatives with the
SCD are more likely to have a good attitude towards sickle cell persons than those who do
not have relatives with the disease. It means that attitude towards Sickle Cell persons is not
Lack of knowledge and misconceptions about SCD lead to negative attitudes among
providers toward persons with the disease. The second hypothesis tested was nurses with
higher levels of academic qualifications are more likely to have a good knowledge about
SCD than nurses with lower levels of academic qualifications. From the study, the p-value is
0.816. This implies that the p-value is greater than the significant level of 0.05 (p-value >
0.05). As a result of this, we reject the hypothesis that nurses with higher levels of academic
qualifications are more likely to have a good knowledge about SCD than nurses with lower
levels of academic qualifications. This implies that the relationship between educational level
and knowledge level about SCD are independent of each other. In other words, the beliefs
and causes one has about SCD is not dependent on the level of academic education and
Females are perceived to portray good attitude towards others than males. The third
hypothesis tested was; female nurses are more likely to have a good attitude towards sickle
cell persons than male nurses. Since attitude is in three components (affective, behaviour and
cognitive), gender or sex was measured on all three components. From the research, all the p-
values for the three components of attitude gender was measured with are greater than the
significant level of 0.05. They are 0.582, 0.716 and 0.500 respectively. As a result, we fail to
accept the hypothesis that female nurses are more likely to have good attitude towards sickle
cell persons than male nurses. This means that the gender of a person has no relationship to
do with the attitude he or she will put up towards Sickle Cell persons.
42
Age and level of knowledge about Sickle Cell Disease
In every society, old age is a sign of wisdom. It is therefore perceived that, older persons
know more than younger persons. The fourth hypothesis therefore tested the level of
knowledge about the causes of the SCD among older nurses and younger nurses. It was
hypothesised that older nurses are more likely to have a good knowledge about SCD than
younger nurses. From the research, since the p-value (0.072) is greater than the significant
level of 0.05 (p-value > 0.05), we fail to accept the hypothesis that older nurses are more
likely to have a good knowledge about SCD than younger nurses. This implies that, the level
of knowledge about the causes of SCD is independent of age. In other words, your age does
not determine whether you know more about the causes, beliefs and misconceptions about the
SCD.
5.1 Summary
for an item. Attitudes are generally positive or negative views of a person, place, thing, or
event. This is often referred to as the attitude object. Most attitudes are the result of either
direct experience or observational learning from the environment.The general reason for
conducting this study was to determine the level of knowledge about SCD and the attitude
towards Sickle Cell persons among nurses in local government health institutions.
It was therefore hypothesized that, nurses who have relatives with the SCD are more likely to
have a good attitude towards Sickle Cell persons than those who do not have relatives with
the disease. The second hypothesis tested was nurses with higher levels of academic
education and qualifications are more likely to have a good knowledge and attitude towards
Sickle Cell persons than nurses with lower levels of academic education and qualifications.
The next was female nurses are more likely to have a good attitude towards Sickle Cell
43
persons than male nurses. The fourth hypothesis tested was older nurses are more likely to
Findings from the research showed that, nurses had positive attitudes towards Sickle Cell
persons irrespective of whether they have relatives with SCD or not. There was positive
attitude towards Sickle Cell persons among nurses irrespective of their gender. Level of
knowledge about the SCD had no relationship with age. Also the level of knowledge about
SCD was good among nurses irrespective of their academic qualifications and education.
The researcher hope that the findings from this study and the suggestions will be given the
need consideration in policy formulation translated into programmes that would benefit the
mentally ill and other stakeholders for the prevention and control of mental illness in Ghana.
5.2 Conclusion
Findings from the research showed that, nurses had positive attitudes towards Sickle Cell
persons irrespective of whether they have relatives with SCD or not. There was positive
attitude towards Sickle Cell persons among nurses irrespective of their gender. Level of
knowledge about the SCD had no relationship with age. Also the level of knowledge about
SCD was good among nurses irrespective of their academic qualifications and education.
The outcome from the research revealed that nurses at the Tema General Hospital have a
good level of knowledge about the causes of the SCD. They do not have any misconceptions
about the causes of the disease. They believe SCD is an inherited disease from both parents
and not a Sexually transmitted disease. It was also revealed that, male and female nurses have
positive attitude towards sickle cell persons. They are willing to work, share belongings and
live in harmony with sickle cell persons. This means that, Sickle cell persons are not
44
stigmatised when receiving treatment. Public education to foster community acceptance of
people who are mentally ill is recommended for all sections of the community especially the
The most common limitation placed on this study was the small sample size of the target
population, hence generalisation becomes a problem. The small number of males compared
to females does not give a fair representation of gender among nurses used in the study. This
made it difficult to make comparisons between male and female nurses. The target population
unwillingness to answer the questionnaire was also a limitation for this study. Another
limitation placed on this study is time factor. Also, the concept is very difficult to be
objectively measured so this implies that the validity and reliability of this study cannot be
absolutely assured. Finally, the period used for data collection and analysis placed a lot of
pressure on the researcher as he had to combine the research work with other academic work.
This study was based on the attitude of nurses towards Sickle Cell persons in government
care and treatment seeking for pain from sickle cell disease to investigate how sociocultural
factors influence management of pain from sickle cell disease by comparing the experiences
of those who usually manage their pain at home with those who are more frequently admitted
to hospital for management of their pain. Also, a study on the guidelines for the treatment of
people with sickle cell disease will further throw more light on the quality of treatment sickle
cell persons receive when they attend health centers education on SCD that replaces
misconceptions with facts can help reduce stigmatisation. Finally, a study on perceived stress
factors and coping mechanisms among mothers of children with sickle cell disease can offer
45
potentials guidelines for designing counselling, education and social support interventions to
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premarital screening and marital decisions among local government workers in Ile-Ife,
Nigeria.
Bediako, S.M. & Haywood, C. (2009). Journal of the National Medical Association. Sickle
Douglas, R., & Brown, H. N. (2002). Patient attitudes towards advance directives. Journal of
cell Today-newsletter, 2, 3.
Feroze, M. , & Aravidan, K. P. (2001). Sickle cell disease among Tribals of Attapady.
Harris, K. B. , et al. (2002). Guidelines for the treatment of people with sickle cell disease.
New York, Pueto Rico & Virgin islands: sickle cell advisory committee.
Haynes, J.Jr. (2006). Physicians attitudes and practices in sickle cell disease pain
Maxwel, K. , Streetly, A. , & Bevan, D. (1999). Experiences of hospital care and treatment
seeking for pain from sickle cell disease: qualitative study, 318, 1585.
Millan, J. , Teijlingen van, E. , Eboh, W. (2009). Knowledge and attitudes towards Sickle
Milosavljevic, B., Kesola, S., Shain, T.M. (2007).Sickle cell disease : experiences of the
caregivers in managing the disease in children living in the western region of Jamaica
Olley, L. B. , Brieger, W. R. , & Olley B. O. (1997). Perceived stress factors and coping
mechanisms among mothers of children with sickle cell disease in Western Nigeria,
12(2), 161-170
Opoku, J.Y. (2005). A short Guide to Research writing in the social sciences and Education
undergraduate
Smith, L.A, Oyeku, S.O, Homer, C. & Zuckerman B. (2006). Pediatrics:office journal of the
American Academy of Pediatrics. 117, 1763-1778. Retrieved October 4, 2009 from the
Resolving conflicts: Misconceptions and myths in the care of the patient with sickle
Umoh, S.H., & Akinola, T.O. (1994). Nigerian University students awareness of Sickle Cell
48
APPENDIX A
QUESTIONNAIRE
SECTION A – (BIODATA)
Circle the number that corresponds to your answer.
2. Age (1) 20-30yrs (2) 31-40 yrs (3) 41-50 yrs (4) 51-60 yrs (5) 61 yrs and above
5. If Yes, then indicate by circling in any of the boxes below, the exact relationship that exist between
you and the sickle cell patient.
(1) Brother (2) Sister (3) Mother (4) Father (5) Son/ daughter (6) Friend (7) other
(please specify)…………………………………
Corresponding to each statement below is a numerical session that denotes the word/phrase that
range from “strongly agree” to “strongly disagree”. Tick appropriately the number that most
reflect the extent to which you agree or disagree with each statement in sections B, C and D.
SECTION B – (AFFECTION)
(FEELINGS AND EMOTIONS TOWARDS SICKLE CELL PERSONS)
Statement Strongly Agree Undecided Disagree Strongly
Agree Disagree
1 2 3 4 5
49
persons than other patients
SECTION C – (BEHAVIOUR)
(YOUR ACTIONS AND MANNERS TOWARDS SICKLE CELL PERSONS)
I will willingly agree to have
him/her as a friend.
SECTION D
(BELIEFS AND KNOWLEDGE ABOUT SICKLE CELL DISEASE)
Sickle cell is inherited from either father
or mother, not both.
50
Sickle cell persons seldom go through life
without regular blood transfusion
APPENDIX B
BUDGET
ITEM AMOUNT
GH¢
PAYMENT TO RESEARCH ASSISTANTS 60.00
51
TYPING & BINDING COST 35.00
PHOTOCOPYING 15.00
STATIONERY 45.00
MISCELLANEOUS 20.00
TOTAL 230.00
APPENDIX C
TIME-TABLE
FIRST SEMESTER
( 6th -
8th ) week First draft of proposal.
52
( 9th ) week Proposal presentation.
SECOND SEMESTER
APPENDIX D
FREQUENCY TABLES
Sex
Cumulative
Frequency Percent Valid Percent Percent
53
Age
Cumulative
Frequency Percent Valid Percent Percent
academic qualification
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
54
If yes, then indicate by ticking in the boxes below, the exact relationship that exist
between you and the sickle cell patient
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
55
Sickle cell persons should be treated in a separate hospital
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
57
I will willingly agree to have him/her as a friend.
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
58
I will willingly recommend him/her for a job.
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
59
Sickle cell occurs when both parents pass on abnormal hemoglobin genes, at least
one of which is the sickle gene.
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Sickle cell cannot occur when only one parent has the sickle gene
Cumulative
Frequency Percent Valid Percent Percent
60
Sickle cell is known as sickle cell anemia only when both parents pass on a sickling
gene i.e. S from father, S from mother, making "SS".
Cumulative
Frequency Percent Valid Percent Percent
Sickle cell persons seldom go through life without regular blood transfusion
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
61
Sickle cell is so serious that no patient has attained 60 years of age
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
62
Sickle cell can be acquired through interaction with infected persons
Cumulative
Frequency Percent Valid Percent Percent
Cumulative
Frequency Percent Valid Percent Percent
Sickle Cell Trait means the possession of one normal gene for hemoglobin
formation (A) and the abnormal sickle gene (S), with the proportion of A always
exceeding that of S.
Cumulative
Frequency Percent Valid Percent Percent
63
Folic acid can help the body to replace damaged red blood cells
Cumulative
Frequency Percent Valid Percent Percent
Lung, stroke, chest pains are major symptoms of the sickle cell crises
Cumulative
Frequency Percent Valid Percent Percent
64