Attitude of Nurses in Government Health Institutions Towards Sickle Cell Persons

UNIVERSITY OF GHANA, LEGON
DEPARTMENT OF PSYCHOLOGY
MAIN CAMPUS.
RESEARCH WORK
TITLE OF STUDY
ATTITUDE OF NURSES IN GOVERNMENT HEALTH INSTITUTIONS TOWARDS
SICKLE CELL PERSONS
PRESENTED BY : FRANCIS KOFI SOMUAH
INDEX NUMBER : 10227103
SUPERVISOR : MRS. ANGELA ANARFI GYASI-GYAMERAH
A DISSERTATION SUBMITTED TO THE DEPARTMENT OF PSYCHOLOGY,

UNIVERSITY OF GHANA, LEGON, IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE AWARD OF THE BACHELOR OF ART DEGREE IN
PSYCHOLOGY.
MAY, 2010
DECLARATION
1
I, Somuah Francis Kofi, hereby affirm that this work is my own unique work and has not
been submitted to any university in order to acquire an academic qualification.
Mrs. Angela Anarfi Gyasi-Gyamerah
(Supervisor)
Signature:……………………………………..
Date:………………………………………….
Somuah Francis Kofi
(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
steps I have already taken.
To the almighty God, I give you all.
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.
TABLE OF CONTENTS PAGES
Declaration………………………………………………………………..i
5
Dedication………………………………………………………………..ii
Acknowledgement……………………………………………………….iii
Abstract…………………………………………………………………..iv
Table of contents…………………………………………………………v-vi
CHAPTER ONE - INTRODUCTION...................................................1-5
Statement of the problem
Aims and objectives
Relevance of the study
CHAPTER TWO - LITERATURE REVIEW………………………6-10
Theoretical framework
Related studies
Hypotheses
Operational definition
CHAPTER THREE - METHODOLOGY………………………….11-13
Research setting
Population /sample
Sampling techniques
Instruments
Scoring
Research design
Procedure for data collection
Data analysis
CHAPTER FOUR……………………………………………….14-33
Results
CHAPTER FIVE - DISCUSSION……………………………...34-39
Attitude of nurses with relatives with Sickle Cell Disease

6
Academic qualification and level of knowledge about the Sickle Cell Disease
Gender and attitude towards Sickle cell persons
Age and level of knowledge about Sickle Cell Disease
Summary
Conclusion
Implication of the finding
Limitation of the study
Suggestions and recommendations for further studies
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
understanding of the molecular pathology, pathophysiology, control and management of the
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
one haemoglobin S and another abnormal haemoglobin such as C, causing SC disease, or a
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
inconsequential to severe; causing the variable presentation of painful vaso-occlusive crises;
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
extraordinary conditions (Harris, 2002).
'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
cause sickle cell disease of varying degrees of severity, namely Haemoglobins D, E, G, K, O,
Korle-Bu, Osu-Christiansborg, etc. Beta-Thalassaemia is not an abnormal haemoglobin gene
(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
disappear in adulthood). If Foetal Haemoglobin persists into adulthood it is known as
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-
Thalassaemia, SFhereditary, etc. (www.sicklecell.md/faq)
The sickled cells in a person with SCD have a hard time moving through the blood vessels in
the body (Druggin, 2006).
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.
(Milosavljevic, B., Kesola, S., Shain, T.M. 2007).
1.1 STATEMENT OF THE PROBLEM
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
the most common single gene-disorders (Abioye-Kuteyi et al., 2009).

9
The chronic nature of SCD requiring life-long medical attention, expensive supportive
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
good relationship with a healthcare professional.
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
properly to avoid infant morbidity and mortality.
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
trained to handle patients in other parts of the country.
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
as sickle cell education, awareness and counselling.
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
sickle cell patient (Sutton et al., 1999).
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
thus more effective management of the patient with SCD.
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).
1.2 AIMS AND OBJECTIVES OF THE STUDY
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
this case, the Tema General Hospital.
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
attitude towards SCD.
1.3 RELEVANCE OF THE STUDY
1) This study can be used as a baseline as well as enhancing steps in educating the
general public and the professionals about SCD.
2) It will assist nurses to adopt positive and good practices towards sickle cell persons.
3) It will also serve as an initial step for researchers to build on a comprehensive
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
of policies that will benefit sickle cell persons.
5) The study will serve as a reference material for all those who want to broaden their
knowledge base on the SCD.
CHAPTER TWO
LITERATURE REVIEW
2.1 THEORITICAL FRAMEWORK
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
event-- this is often referred to as the attitude object.
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).
The affective response is an emotional response that expresses an individual's degree of
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
direct experience or observational learning from the environment.
Unlike personality, attitudes are expected to change as a function of experience. Tesser
(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
affect one's attitude to certain styles of music.
2.2 RELATED LITERATURE
Previous studies conducted to examine the attitudes towards sickle persons have shown poor
knowledge, misconceptions and myths in the care of sickle cell persons.
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
attitude amongst the respondents.
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
behaviours towards the sickle cell disorder and genetic screening.
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
of the screening process.
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
informed about the disease through awareness creation.
Hayes (2006) conducted a survey on Physicians attitudes and practices in SCD pain
management to access demographic information; and physicians attitudes toward and
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
poor knowledge in pain management for sickle cell persons.
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
directive forms. The convenience sample comprised 30 hospitalized patients in North
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
toward persons with the disease.
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
frequently admitted to hospital for management of their pain.
Results showed that the current organisation of pain for sickle cell crisis discourage self-
reliance and encourage hospital dependence.
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
more time with them.
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.
2.4 OPERATIONAL DEFINITION OF TERMS

16
i. Older nurses refers to nurses aged forty (41) years and above.
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.
iv. Lower academic qualifications refers to BECE and SSCE/WASSCE
CHAPTER THREE
METHODOLOGY
3.1 RESEARCH SETTING
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
the health centre closer to me.
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
were filled and returned.
3.3 SAMPLING TECHNIQUES
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
made up of questions on the Affective component of attitude.
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
about SCD or not.
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.
3.6 RESEARCH DESIGN
The design for the study was descriptive survey. It was used to describe the attitude of nurses
in government health institutions towards sickle cell persons.
3.7 PROCEDURE FOR DATA COLLECTION
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
assisted in administering the questionnaires. The questionnaires administered were not
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.
3.8 DATA ANALYSIS
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
of the dependence (relationship).This test involves the test of the hypothesis:
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
made in this study. Thus all p-values will be compared to 5%
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
dependent on each other and there exist no relationship between them.
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
likely to have a good knowledge about SCD than younger nurses.
Descriptive statistic on the demographic variables such as age, sex and religious affiliation
are discussed below.
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
the male nurses.
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
academic education and qualifications.
LEVEL OF ASSOCIATION AND RELATIONSHIP WITH THE SICKLE CELL
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.
FEELINGS AND EMOTIONS TOWARDS SICKLE CELL PERSONS (AFFECTION)
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
were asked. The results have been analysed below:
 Sickle Cell persons should be treated like any other person
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
remaining 10 and 3 respondents who respectively disagreed and strongly disagreed.
 Sickle Cell persons should be kept behind closed doors
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.
 Sickle Cell persons should be treated in a separate hospital
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
remaining 3 answered in the affirmative.
 Sickle Cell persons should be allowed to mingle with others
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
disagreed likewise undecided.
 Sickle Cell persons are cooperative
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.
 Sickle Cell persons are brilliant
Interestingly, 11 and 16 respondents answered strongly agree and agree respectively. 3 each
were undecided and disagreed. Only one nurse strongly disagreed.
This is a clear indication from the findings that Sickle Cell nurses are brilliant.
 Sickle Cell persons are dangerous
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
by the findings of this research.
 Sickle Cell persons are active
Exactly half (50%) of the nurses agreed. 13(38.2%) disagreed. 2 each of the nurses were
undecided and strongly agreed respectively.
Findings here shows that, Sickle Cell persons can sometimes be active and sometimes non
active.
 Sickle Cell persons are worthless
23
More than half (22 nurses) strongly disagreed. 9 of them disagreed. 5.9% and 2.9% agreed
and was undecided respectively.
The findings here reveal that, Sickle Cell persons are not worthless. This is because majority
of the nurses debunked the statement.
ACTIONS AND MANNERS TOWARDS SICKLE CELL PERSONS (BEHAVIOUR)
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
behave towards sickle cell persons have been presented below:
 I will willingly agree to have him/her as a friend
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.
 He or she can live a normal life
Interestingly, no nurse disagreed. Only one person was undecided. The remaining 33 nurses
strongly agreed (55.9%) and agreed (41.2%) respectively.
 I will willingly allow my brother/sister/daughter/son to marry him/her
12 of the respondents representing 35.3% were undecided. 13 of the remaining answered
agree while 5 and 4 answered strongly agree and disagree respectively.
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
allow any of their brothers/sisters/daughters/sons to marry a sickle cell patient.
 I will willingly recommend him/her for a job
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
one answered strongly disagree.
From the findings, it is obvious that, when it comes to job recommendation, Sickle Cell
persons will have the favour of nurses.
 I will willingly agree to have him/her as a visitor in my house for a week
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
and live in harmony with them.
 I will willingly share my utensils with him or her
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
47.1% answered strongly agree.
BELIEFS, LEVEL OF KNOWLEDGE AND MISCONCEPTIONS ABOUT SICKLE
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
torture (Umoh and Akinola, 1994)
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.
 Sickle cell is inherited from either father or mother, not both.
More than half (58.8%) of the nurses strongly disagreed and 8 (23.5%) disagreed. Only 2 and
4 of the respondents answered strongly agree and agree respectively.
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
which is the Sickle Cell gene.
30 nurses, representing 88.3% answered in the affirmative. Only 3 (8.8%) respondents
strongly disagreed while 1(2.9%) person disagreed.
This shows that the nurses are knowledgeable of the genetic causes of the SCD.
 Sickle cell confers immunity to malaria
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
immunity to malaria which has been a misconception amongst most people.
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
respondents answered in the affirmative.
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
respectively. 3 of the nurses were undecided.
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
mother, making “SS”.
 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
transfusion. 49.2% representing 15 nurses refuted.
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.
 Sickle cell does not occur in white people
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
respondents were undecided.
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
are in India and Saudi Arabia.
 Sickle Cell is so serious that, no patient has attained go years of age
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
remaining assented the claim.
 Sickle Cell is a Sexually Transmitted Disease
Findings indicate that 91.2% (31 nurses) of the respondents rejected the claim that Sickle Cell
is a Sexually Transmitted Disease. Only 1 respondent agreed. 2 nurses were undecided.
28
It is obvious that, the nurses who were interviewed are aware or know that Sickle Cell is not a
Sexually Transmitted Disease.
 Sickle Cell occurs only in black people
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
(8.8%) respondents were undecided while the remaining 13 (38.2%) agreed.
 Sickle Cell can be acquired through interaction with infected persons
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.
 Sickle Cell trait is interchangeable with Sickle Cell Disease
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
that Sickle Cell trait is not interchangeable with SCD.
 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
what Sickle Cell trait is.
 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
acid daily to strengthen the sickle shaped red blood cells.
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
SCD (no normal-haemoglobin gene inherited, i.e. SS or SC, or SD, or S beta-Thalassaemia)
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.
4.1 TEST OF HYPOTHESES
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
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
with SCD and their level of knowledge and beliefs about SCD
Beliefs and knowledge about

SCD
Poor Good
Relatives with SCD knowledge knowledge Total
Do you personally know yes 20 4 24
someone who is suffering no 8 2 10
from sickle cell disease?
Total 28 6 34
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
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.
Cross tabulation showing the relationship between Educational

level and Beliefs and knowledge about SCD
Beliefs and knowledge about

SCD
Level of academic Poor Good
qualification knowledge knowledge Total
Lower academic
8 2 10
qualification
Higher academic
20 4 24
qualification
Total 28 6 34
Table 2b.
Chi-Square Tests
Asymp. Sig. (2-

Value df sided)
Pearson Chi-Square .054a 1 .816
Continuity
.000 1 1.000
Correctionb
Linear-by-Linear
.052 1 .819
Association
b. Computed only for a 2x2
table
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
knowledge about SCD are independent of each other.
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
Feelings and emotions towards

SCP
Bad feeling or Good feeling or
Sex emotions emotions Total
Male 1 1 2
Female 22 10 32
Total 23 11 34
Table 3b.
36
Chi-Square Tests
Asymp. Sig. (2-
Value df sided)
Pearson Chi-
.302a 1 .582
Square
Continuity
.000 1 1.000
Correctionb
b
N of Valid Cases 34
a. 2 cells (50.0%) have expected count less than
5. The minimum expected count is .65.
Table 3c.
Cross tabulation showing the relationship between Sex and
Actions and Manners towards Sickle Cell Persons
Actions and manners towards

Sickle Cell Persons
Negative
Sex behaviour Positive behaviour Total
male 0 2 2
female 2 30 32
Total 2 32 34
Table 3d.
Chi-Square Tests
Asymp. Sig.
Value df (2-sided)
Pearson Chi-Square .133a 1 .716
Continuity
.000 1 1.000
Correctionb
minimum expected count is .12.
37
Table 3e.
Cross tabulation showing the relationship between sex and the
beliefs and knowledge about SCD.
Beliefs and knowledge about SCD
Sex Poor knowledge Good knowledge Total

male 2 0 2
female 26 6 32
Total 28 6 34
Table 3f.
Chi-Square Tests
Asymp. Sig. (2-
Value df sided)
Pearson Chi-
.455a 1 .500
Square
Continuity
.000 1 1.000
Correctionb
N of Valid
34
Casesb
minimum expected count is .35.
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
Beliefs and knowledge about SCD

Age Poor knowledge Good knowledge Total
Younger Nurses 12 5 17
Older Nurses 16 1 17
Total 28 6 34
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
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
independent of each other.
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.
Attitude of nurses with relatives with SCD
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
dependent on whether one has a relative with the disease or not.
Academic qualification and level of knowledge about the SCD
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
qualifications one has.
Gender and attitude towards Sickle cell persons
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
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
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
have a good knowledge about SCD than younger nurses.
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.
5.3 Implication of the Finding
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
young men and women.
5.4 Limitation of the Study
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.
5.5 Suggestions and Recommendations for Further Studies
This study was based on the attitude of nurses towards Sickle Cell persons in government
health institutions; I therefore recommend a qualitative study on the experiences of hospital
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
assist of children with SCD
REFERENCES
Abioye-Kuteyi EA, Oyegbade O, Bello I, Osakwe C. (2009). Sickle cell knowledge,
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
cell disease in a Post racial America, 101(10), 1065-1066
Douglas, R., & Brown, H. N. (2002). Patient attitudes towards advance directives. Journal of
Nursing Scholarship, 34(1), 61-65.

46
Druggin, S.RN. (2006). Detecting stroke risk with transcortical Doppler ultrasound. Sickle
cell Today-newsletter, 2, 3.
Feroze, M. , & Aravidan, K. P. (2001). Sickle cell disease among Tribals of Attapady.
Calicut: Medical college
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
management. Sickle cell Today-newsletter, 2, 2.
Konotey-Ahulu, (2001, January). New African, The inheritance of sickle cell,40-43
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
Cell Disease Screening: A study of members of the UK Sickle Cell Society.
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
(2nd Ed.) Accra: Ghana University Press.
Opoku, J.Y. (2004). Tutorials in Inferential Social Statistics: A companion for
undergraduate
students. Accra: CSIR Printing Division.
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
world wide web:http://www.pediatrics.org/cgi/content/full/117/1763

47
Sutton M, Atweh G.F, M.D., Cashman T.D., R.N., M.S., & Davis W.T., R.N. (1999).
Resolving conflicts: Misconceptions and myths in the care of the patient with sickle
cell disease. The mount Sinai journal of medicine. 66.282-285.
Tesser, A. (1993). On the importance of heritability in psychological research: The case of
attitudes. Psychological Review, 100, 129-142.
Umoh, S.H., & Akinola, T.O. (1994). Nigerian University students awareness of Sickle Cell
Anaemia. Ilorin Journal of Education, 14(1), 43-50.
48
APPENDIX A
QUESTIONNAIRE
SECTION A – (BIODATA)
Circle the number that corresponds to your answer.
1. Sex (1) Male (2) Female
2. Age (1) 20-30yrs (2) 31-40 yrs (3) 41-50 yrs (4) 51-60 yrs (5) 61 yrs and above
3. Academic qualification (1) SSSCE/WASSCE (3) DIPLOMA (4)DEGREE

(5) OTHER (please specify) ………………………………..
4. Do you personally know someone who is suffering from Sickle cell disease?
(1) Yes (2) No
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
Sickle cell persons should be treated

like any other person
Sickle cell persons should be kept

behind closed doors
Sickle cell persons should be treated in

a separate hospital
Sickle cell persons should be allowed

to mingle with others
I will feel bad if a sickle cell person

dies in my hand
I will feel reluctant to administer

treatment to sickle cell persons
I will prioritise treatment to sickle cell
49
persons than other patients
I will manage sickle cell pain with

dedication
Sickle cell persons are worthless
SECTION C – (BEHAVIOUR)
(YOUR ACTIONS AND MANNERS TOWARDS SICKLE CELL PERSONS)
I will willingly agree to have
him/her as a friend.
He or she can live normal life.
I will willingly allow my

brother/sister/daughter/son to marry
him/her.
I will willingly agree to be on duty

with him/her.
I will willingly recommend him/her

for a job.
I will willingly agree to him/her as a

visitor in my house for a week.
I will willingly share my utensils

with him/her
SECTION D
(BELIEFS AND KNOWLEDGE ABOUT SICKLE CELL DISEASE)
Sickle cell is inherited from either father
or mother, not both.
Sickle cell occurs when both parents pass

on abnormal haemoglobin genes, at least
one of which is the sickle gene.
Sickle cell confers immunity against

malaria
Sickle cell cannot occur when only one

parent has the sickle gene
Sickle cell is known as sickle cell anaemia

only when both parents pass on a sickling
gene i.e. S from father, S from mother,
making "SS".
50
Sickle cell persons seldom go through life
without regular blood transfusion
Sickle cell does not occur in white people
Sickle cell is so serious that no patient has

attained 60 years of age
Sickle cell is a sexually transmitted

disease
Sickle cell occurs only in black people
Sickle cell can be acquired through

interaction with infected persons
Sickle Cell Trait is interchangeable with

Sickle Cell Disease.
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
Folic acid can help the body to replace

damaged red blood cells
Lung, stroke, chest pains are major

symptoms of the sickle cell crises
APPENDIX B
BUDGET
ITEM AMOUNT
GH¢
PAYMENT TO RESEARCH ASSISTANTS 60.00
TRAVEL EXPENSES 55.00
51
TYPING & BINDING COST 35.00
PHOTOCOPYING 15.00
STATIONERY 45.00
MISCELLANEOUS 20.00
TOTAL 230.00
APPENDIX C
TIME-TABLE
FIRST SEMESTER
( 2nd –4th ) week Reading around the research area.
( 5th ) week Present topic for supervisor’s approval.
( 6th -
8th ) week First draft of proposal.
52
( 9th ) week Proposal presentation.
(10th ) week Revise draft after supervisor’s comment.
( 11th —12th ) week Proof reading by researcher and others.
( 12th ) week Submission of proposal
Inter –Semester Break - Data collection
SECOND SEMESTER
( 2nd _ 5th ) Week Data Analyses.
( 6th _ 8th ) Week First draft of report.
( 9th _ 10th ) Week Submission of draft for supervisor’s comment.
( 11th _12th ) Week Revise draft after supervisor’s comment.
( 13th) Week Proof reading by researcher and competent others.
( 14th ) Week Submission of report for examination.
APPENDIX D
FREQUENCY TABLES
Sex
Cumulative
Frequency Percent Valid Percent Percent
Valid male 2 5.9 5.9 5.9
female 32 94.1 94.1 100.0
Total 34 100.0 100.0
53
Age
Cumulative
Valid 20-30 11 32.4 32.4 32.4
31-40 6 17.6 17.6 50.0
41-50 8 23.5 23.5 73.5
51-60 9 26.5 26.5 100.0
Total 34 100.0 100.0
academic qualification
Cumulative
Valid BECE 1 2.9 2.9 2.9
SSSCE/WASSCE 9 26.5 26.5 29.4
HND 4 11.8 11.8 41.2
DEGREE AND ABOVE 6 17.6 17.6 58.8
OTHER 14 41.2 41.2 100.0
Total 34 100.0 100.0
do you personally know someone who is suffering from sickle cell

disease?
Cumulative
Valid yes 24 70.6 70.6 70.6
no 10 29.4 29.4 100.0
Total 34 100.0 100.0
54
If yes, then indicate by ticking in the boxes below, the exact relationship that exist
between you and the sickle cell patient
Cumulative
Valid 10 29.4 29.4 29.4
brother 1 2.9 2.9 32.4
sister 1 2.9 2.9 35.3
son/daughter 1 2.9 2.9 38.2
friend 16 47.1 47.1 85.3
other 5 14.7 14.7 100.0
Total 34 100.0 100.0
sickle cell person should be treated like any other person
Cumulative
Valid strongly agree 13 38.2 38.2 38.2
agree 8 23.5 23.5 61.8
disagree 10 29.4 29.4 91.2
strongly disagree 3 8.8 8.8 100.0
Total 34 100.0 100.0
Sickle cell persons should be kept behind closed doors
Cumulative
disagree 6 17.6 17.6 20.6
Total 34 100.0 100.0
55
Sickle cell persons should be treated in a separate hospital
Cumulative
undecided 1 2.9 2.9 11.8
disagree 16 47.1 47.1 58.8
Total 34 100.0 100.0
Sickle cell persons should be allowed to mingle with others
Cumulative
agree 14 41.2 41.2 94.1
undecided 1 2.9 2.9 97.1
Total 34 100.0 100.0
Sickle cell persons are cooperative
Cumulative
agree 17 50.0 50.0 70.6
undecided 6 17.6 17.6 88.2
disagree 4 11.8 11.8 100.0
Total 34 100.0 100.0
Sickle cell persons are brilliant
Cumulative
agree 16 47.1 47.1 79.4
undecided 3 8.8 8.8 88.2
disagree 3 8.8 8.8 97.1
Total 34 100.0 100.0

56
Sickle cell persons are dangerous
Cumulative
undecided 2 5.9 5.9 8.8
disagree 6 17.6 17.6 26.5
7 1 2.9 2.9 100.0
Total 34 100.0 100.0
Sickle cell persons are active
Cumulative
agree 17 50.0 50.0 55.9
undecided 2 5.9 5.9 61.8
disagree 13 38.2 38.2 100.0
Total 34 100.0 100.0
Sickle cell persons are worthless
Cumulative
Valid agree 2 5.9 5.9 5.9
undecided 1 2.9 2.9 8.8
disagree 9 26.5 26.5 35.3
Total 34 100.0 100.0
57
I will willingly agree to have him/her as a friend.
Cumulative
agree 18 52.9 52.9 97.1
disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
He or she can live normal life.
Cumulative
agree 14 41.2 41.2 97.1
undecided 1 2.9 2.9 100.0
Total 34 100.0 100.0
I will willingly allow my brother/sister/daughter/son to marry him/her.
Cumulative
agree 13 38.2 38.2 52.9
undecided 12 35.3 35.3 88.2
disagree 4 11.8 11.8 100.0
Total 34 100.0 100.0
I will willingly agree to be on duty with him/her.
Cumulative
agree 21 61.8 61.8 94.1
undecided 1 2.9 2.9 97.1
disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
58
I will willingly recommend him/her for a job.
Cumulative
agree 19 55.9 55.9 85.3
undecided 5 14.7 14.7 100.0
Total 34 100.0 100.0
I will willingly agree to him/her as a visitor in my house for a week.
Cumulative
agree 21 61.8 61.8 91.2
undecided 3 8.8 8.8 100.0
Total 34 100.0 100.0
I will willingly share my utensils with him/her
Cumulative
agree 18 52.9 52.9 100.0
Total 34 100.0 100.0
Sickle cell is inherited from either father or mother, not both.
Cumulative
agree 4 11.8 11.8 17.6
disagree 8 23.5 23.5 41.2
Total 34 100.0 100.0
59
Sickle cell occurs when both parents pass on abnormal hemoglobin genes, at least
one of which is the sickle gene.
Cumulative
agree 14 41.2 41.2 88.2
disagree 1 2.9 2.9 91.2
Total 34 100.0 100.0
Sickle cell confers immunity against malaria
Cumulative
agree 5 14.7 14.7 26.5
undecided 4 11.8 11.8 38.2
disagree 14 41.2 41.2 79.4
Total 34 100.0 100.0
Sickle cell cannot occur when only one parent has the sickle gene
Cumulative
agree 9 26.5 26.5 52.9
undecided 1 2.9 2.9 55.9
disagree 8 23.5 23.5 79.4
Total 34 100.0 100.0
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
agree 6 17.6 17.6 58.8
undecided 3 8.8 8.8 67.6
disagree 8 23.5 23.5 91.2
Total 34 100.0 100.0
Sickle cell persons seldom go through life without regular blood transfusion
Cumulative
agree 17 50.0 50.0 52.9
undecided 1 2.9 2.9 55.9
disagree 11 32.4 32.4 88.2
Total 34 100.0 100.0
Sickle cell does not occur in white people
Cumulative
agree 5 14.7 14.7 29.4
undecided 4 11.8 11.8 41.2
disagree 11 32.4 32.4 73.5
Total 34 100.0 100.0
61
Sickle cell is so serious that no patient has attained 60 years of age
Cumulative
agree 1 2.9 2.9 11.8
undecided 1 2.9 2.9 14.7
disagree 12 35.3 35.3 50.0
Total 34 100.0 100.0
Sickle cell is a sexually transmitted disease
Cumulative
Valid agree 1 2.9 2.9 2.9
undecided 2 5.9 5.9 8.8
disagree 2 5.9 5.9 14.7
Total 34 100.0 100.0
Sickle cell occurs only in black people
Cumulative
agree 8 23.5 23.5 38.2
undecided 3 8.8 8.8 47.1
disagree 8 23.5 23.5 70.6
Total 34 100.0 100.0
62
Sickle cell can be acquired through interaction with infected persons
Cumulative
Valid undecided 2 5.9 5.9 5.9
disagree 2 5.9 5.9 11.8
Total 34 100.0 100.0
Sickle Cell Trait is interchangeable with Sickle Cell Disease.
Cumulative
Valid 1 2.9 2.9 2.9
agree 2 5.9 5.9 11.8
undecided 4 11.8 11.8 23.5
disagree 14 41.2 41.2 64.7
Total 34 100.0 100.0
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
Cumulative
agree 10 29.4 29.4 67.6
undecided 8 23.5 23.5 91.2
disagree 3 8.8 8.8 100.0
Total 34 100.0 100.0
63
Folic acid can help the body to replace damaged red blood cells
Cumulative
agree 6 17.6 17.6 94.1
undecided 1 2.9 2.9 97.1
disagree 1 2.9 2.9 100.0
Total 34 100.0 100.0
Lung, stroke, chest pains are major symptoms of the sickle cell crises
Cumulative
agree 9 26.5 26.5 41.2
undecided 2 5.9 5.9 47.1
disagree 14 41.2 41.2 88.2
Total 34 100.0 100.0
64

Attitude of Nurses in Government Health Institutions Towards Sickle Cell Persons

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Attitude of Nurses in Government Health Institutions Towards Sickle Cell Persons

Uploaded by

Copyright:

Available Formats

UNIVERSITY OF GHANA, LEGON

ATTITUDE OF NURSES IN GOVERNMENT HEALTH INSTITUTIONS TOWARDS

SICKLE CELL PERSONS

PRESENTED BY : FRANCIS KOFI SOMUAH

INDEX NUMBER : 10227103

SUPERVISOR : MRS. ANGELA ANARFI GYASI-GYAMERAH

A DISSERTATION SUBMITTED TO THE DEPARTMENT OF PSYCHOLOGY,

been submitted to any university in order to acquire an academic qualification.

Mrs. Angela Anarfi Gyasi-Gyamerah

Somuah Francis Kofi

steps I have already taken.

To the almighty God, I give you all.

TABLE OF CONTENTS PAGES

CHAPTER ONE - INTRODUCTION...................................................1-5

Statement of the problem

Aims and objectives

Relevance of the study

CHAPTER TWO - LITERATURE REVIEW………………………6-10

CHAPTER THREE - METHODOLOGY………………………….11-13

Procedure for data collection

CHAPTER FIVE - DISCUSSION……………………………...34-39

Attitude of nurses with relatives with Sickle Cell Disease

Gender and attitude towards Sickle cell persons

Age and level of knowledge about Sickle Cell Disease

Implication of the finding

Limitation of the study

Suggestions and recommendations for further studies

understanding of the molecular pathology, pathophysiology, control and management of the

one haemoglobin S and another abnormal haemoglobin such as C, causing SC disease, or a

inconsequential to severe; causing the variable presentation of painful vaso-occlusive crises;

extraordinary conditions (Harris, 2002).

cause sickle cell disease of varying degrees of severity, namely Haemoglobins D, E, G, K, O,

Korle-Bu, Osu-Christiansborg, etc. Beta-Thalassaemia is not an abnormal haemoglobin gene

disappear in adulthood). If Foetal Haemoglobin persists into adulthood it is known as

Thalassaemia, SFhereditary, etc. (www.sicklecell.md/faq)

the body (Druggin, 2006).

(Milosavljevic, B., Kesola, S., Shain, T.M. 2007).

1.1 STATEMENT OF THE PROBLEM

the most common single gene-disorders (Abioye-Kuteyi et al., 2009).

good relationship with a healthcare professional.

properly to avoid infant morbidity and mortality.

trained to handle patients in other parts of the country.

as sickle cell education, awareness and counselling.

sickle cell patient (Sutton et al., 1999).

thus more effective management of the patient with SCD.

1.2 AIMS AND OBJECTIVES OF THE STUDY

this case, the Tema General Hospital.

attitude towards SCD.

1.3 RELEVANCE OF THE STUDY

general public and the professionals about SCD.

3) It will also serve as an initial step for researchers to build on a comprehensive

of policies that will benefit sickle cell persons.

knowledge base on the SCD.

2.1 THEORITICAL FRAMEWORK

event-- this is often referred to as the attitude object.

The affective response is an emotional response that expresses an individual's degree of

direct experience or observational learning from the environment.

Unlike personality, attitudes are expected to change as a function of experience. Tesser

affect one's attitude to certain styles of music.

2.2 RELATED LITERATURE

knowledge, misconceptions and myths in the care of sickle cell persons.

attitude amongst the respondents.

behaviours towards the sickle cell disorder and genetic screening.