Adherence to Hydroxyurea and Patients’ Perceptions of Sickle Cell Disease and Hydroxyurea: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Sociodemographic and Clinical Characteristics of the Study Participants
3.2. Hydroxyurea Use among the Participants and Its Association with the Sociodemographic and Clinical Characteristics of the Participants
3.3. Hydroxyurea Adherence among the Participants and Its Associated Factors
3.4. Perception of SCD/HU and Participants’ Characteristics, Healthcare Utilization, and Self-Reported Adherence
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- What is Sickle Cell Disease?|CDC. Available online: https://www.cdc.gov/ncbddd/sicklecell/facts.html (accessed on 26 April 2023).
- Epping, A.S.; Myrvik, M.P.; Newby, R.F.; Panepinto, J.A.; Brandow, A.M.; Scott, J.P. Academic attainment findings in children with sickle cell disease. J. Sch. Health 2013, 83, 548–553. [Google Scholar] [CrossRef] [PubMed]
- Data & Statistics on Sickle Cell Disease|CDC. Available online: https://www.cdc.gov/ncbddd/sicklecell/data.html (accessed on 26 April 2023).
- Al-Qurashi, M.M.; El-Mouzan, M.I.; Al-Herbish, A.S.; Al-Salloum, A.A.; Al-Omar, A.A. The prevalence of sickle cell disease in Saudi children and adolescents. A community-based survey. Saudi Med. J. 2008, 29, 1480–1483. [Google Scholar]
- Jastaniah, W. Epidemiology of sickle cell disease in Saudi Arabia. Ann. Saudi Med. 2011, 31, 289–293. [Google Scholar] [CrossRef] [PubMed]
- Hazzazi, A.A.; Ageeli, M.H.; Alfaqih, A.M.; Jaafari, A.A.; Malhan, H.M.; Bakkar, M.M. Epidemiology and characteristics of sickle cell patients admitted to hospitals in Jazan region, Saudi Arabia. J. Appl. Hematol. 2020, 11, 10. [Google Scholar] [CrossRef]
- Rees, D.C.; Williams, T.N.; Gladwin, M.T. Sickle-cell disease. Lancet 2010, 376, 2018–2031. [Google Scholar] [CrossRef]
- Panepinto, J.A.; Bonner, M. Health-related quality of life in sickle cell disease: Past, present, and future. Pediatr. Blood Cancer 2012, 59, 377–385. [Google Scholar] [CrossRef] [PubMed]
- Alhazmi, S.A.; Maashi, A.Q.; Shabaan, S.K.; Majrashi, A.A.; Thakir, M.A.; Almetahr, S.M.; Qadri, A.M.; Hakami, A.A.; Abdelwahab, S.I.; Alhazmi, A.H. The Health Belief Model Modifying Factors Associated with Missed Clinic Appointments among Individuals with Sickle Cell Disease in the Jazan Province, Saudi Arabia. Healthcare 2022, 10, 2376. [Google Scholar] [CrossRef]
- Piccin, A.; Fleming, P.; Eakins, E.; McGovern, E.; Smith, O.P.; McMahon, C. Sickle cell disease and dental treatment. J. Ir. Dent. Assoc. 2008, 54, 75–79. [Google Scholar]
- Yawn, B.P.; Buchanan, G.R.; Afenyi-Annan, A.N.; Ballas, S.K.; Hassell, K.L.; James, A.H.; Jordan, L.; Lanzkron, S.; Lottenberg, R.; Savage, W.J.; et al. Management of sickle cell disease: Summary of the 2014 evidence-based report by expert panel members. JAMA 2014, 312, 1033–1048. [Google Scholar] [CrossRef]
- Hurissi, E.; Hakami, A.; Homadi, J.; Kariri, F.; Abu-Jabir, E.; Alamer, R.; Mobarki, R.; Jaly, A.A.; َAlamer, E.; Alhazmi, A.H. Awareness and Acceptance of Hematopoietic Stem Cell Transplantation for Sickle Cell Disease in Jazan Province, Saudi Arabia. Cureus 2022, 14, e21013. [Google Scholar] [CrossRef]
- Wang, W.C.; Ware, R.E.; Miller, S.T.; Iyer, R.V.; Casella, J.F.; Minniti, C.P.; Rana, S.; Thornburg, C.D.; Rogers, Z.R.; Kalpatthi, R.V.; et al. Hydroxycarbamide in very young children with sickle-cell anaemia: A multicentre, randomised, controlled trial (BABY HUG). Lancet 2011, 377, 1663–1672. [Google Scholar] [CrossRef] [PubMed]
- Strouse, J.J.; Lanzkron, S.; Beach, M.C.; Haywood, C.; Park, H.; Witkop, C.; Wilson, R.F.; Bass, E.B.; Segal, J.B. Hydroxyurea for sickle cell disease: A systematic review for efficacy and toxicity in children. Pediatrics 2008, 122, 1332–1342. [Google Scholar] [CrossRef] [PubMed]
- Brawley, O.W.; Cornelius, L.J.; Edwards, L.R.; Gamble, V.N.; Green, B.L.; Inturrisi, C.; James, A.H.; Laraque, D.; Mendez, M.; Montoya, C.J.; et al. National Institutes of Health Consensus Development Conference statement: Hydroxyurea treatment for sickle cell disease. Ann. Intern. Med. 2008, 148, 932–938. [Google Scholar] [CrossRef] [PubMed]
- LaVista, J.M.; Treise, D.M.; Dunbar, L.N.; Ritho, J.; Hartzema, A.G.; Lottenberg, R. Development and evaluation of a patient empowerment video to promote hydroxyurea adoption in sickle cell disease. J. Natl. Med. Assoc. 2009, 101, 251–257. [Google Scholar] [CrossRef] [PubMed]
- Adewoyin, A.S.; Oghuvwu, O.S.; Awodu, O.A. Hydroxyurea therapy in adult Nigerian sickle cell disease: A monocentric survey on pattern of use, clinical effects and patient’s compliance. Afr. Health Sci. 2017, 17, 255–261. [Google Scholar] [CrossRef] [PubMed]
- Thornburg, C.D.; Calatroni, A.; Telen, M.; Kemper, A.R. Adherence to hydroxyurea therapy in children with sickle cell anemia. J. Pediatr. 2010, 156, 415–419. [Google Scholar] [CrossRef]
- Badawy, S.M.; Thompson, A.A.; Lai, J.-S.; Penedo, F.J.; Rychlik, K.; Liem, R.I. Adherence to hydroxyurea, health-related quality of life domains, and patients’ perceptions of sickle cell disease and hydroxyurea: A cross-sectional study in adolescents and young adults. Health Qual. Life Outcomes 2017, 15, 136. [Google Scholar] [CrossRef]
- Population in Jazan Region by Gender, Age Group, and Nationality (Saudi/Non-Saudi)|General Authority for Statistics. Available online: https://www.stats.gov.sa/en/6140 (accessed on 26 April 2023).
- Alhazmi, A.; Hakami, K.; Abusageah, F.; Jaawna, E.; Khawaji, M.; Alhazmi, E.; Zogel, B.; Qahl, S.; Qumayri, G. The impact of sickle cell disease on academic performance among affected students. Children 2022, 9, 15. [Google Scholar] [CrossRef]
- Broadbent, E.; Petrie, K.J.; Main, J.; Weinman, J. The brief illness perception questionnaire. J. Psychosom. Res. 2006, 60, 631–637. [Google Scholar] [CrossRef]
- Ashur, S.T.; Shamsuddin, K.; Shah, S.A.; Bosseri, S. Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients. EMHJ 1995, 21, 22–728. [Google Scholar] [CrossRef]
- Alsalman, M.; Alkhalifa, H.; Alkhalifah, A.; Alsubie, M.; AlMurayhil, N.; Althafar, A.; Albarqi, M.; Alnaim, A.; Khan, A.S. Hydroxyurea usage awareness among patients with sickle-cell disease in Saudi Arabia. Health Sci. Rep. 2021, 4, e437. [Google Scholar] [CrossRef] [PubMed]
- Memish, Z.A.; Owaidah, T.M.; Saeedi, M.Y. Marked regional variations in the prevalence of sickle cell disease and β-thalassemia in Saudi Arabia: Findings from the premarital screening and genetic counseling program. J. Epidemiol. Glob. Health 2011, 1, 61–68. [Google Scholar] [CrossRef] [PubMed]
- Nevitt, S.J.; Jones, A.P.; Howard, J. Hydroxyurea (hydroxycarbamide) for sickle cell disease. Cochrane Database Syst. Rev. 2017, 4, CD002202. [Google Scholar] [CrossRef] [PubMed]
- Lê, P.Q.; Gulbis, B.; Dedeken, L.; Dupont, S.; Vanderfaeillie, A.; Heijmans, C.; Huybrechts, S.; Devalck, C.; Efira, A.; Dresse, M.; et al. Survival among children and adults with sickle cell disease in Belgium: Benefit from hydroxyurea treatment. Pediatr. Blood Cancer 2015, 62, 1956–1961. [Google Scholar] [CrossRef]
- Cela, E.; Bellón, J.M.; de la Cruz, M.; Beléndez, C.; Berrueco, R.; Ruiz, A.; Elorza, I.; de Heredia, C.D.; Cervera, A.; Vallés, G.; et al. National registry of hemoglobinopathies in Spain (REPHem). Pediatr. Blood Cancer 2017, 64, e26322. [Google Scholar] [CrossRef]
- Wang, W.C.; Ware, R.E.; Miller, S.T.; Iyer, R.V.; Casella, J.F.; Minniti, C.P.; Rana, S.; Thornburg, C.D.; Rogers, Z.R.; Kalpatthi, R.V.; et al. A multicenter randomised controlled trial of hydroxyurea (hydroxycarbamide) in very young children with sickle cell anaemia. Lancet 2011, 377, 1663. [Google Scholar] [CrossRef] [PubMed]
- Albohassan, H.; Ammen, M.; Alomran, A.A.; Shehab, H.B.; Al Sakkak, H.; Al Bohassan, A. Impact of Hydroxyurea Therapy in Reducing Pain Crises, Hospital Admissions, and Length of Stay Among Sickle Cell Patients in the Eastern Region of Saudi Arabia. Cureus 2022, 14, e31527. [Google Scholar] [CrossRef]
- Jose, J.; Elsadek, R.A.; Jimmy, B.; George, P. Hydroxyurea: Pattern of use, patient adherence, and safety profile in patients with sickle cell disease in Oman. Oman Med. J. 2019, 34, 327. [Google Scholar] [CrossRef]
- Alzahrani, F.; Albaz, G.F.; AlSinan, F.; Alzuhayri, J.; Barnawi, Z.M.; Melebari, N.; Al Twairgi, T.M. Hydroxyurea use among children with sickle cell disease at King Abdulaziz University Hospital in Jeddah City. Cureus 2021, 13, e13453. [Google Scholar] [CrossRef]
- Kang, H.A.; Barner, J.C. The association between hydroxyurea adherence and opioid utilization among Texas Medicaid enrollees with sickle cell disease. J. Manag. Care Spec. Pharm. 2020, 26, 1412–1422. [Google Scholar] [CrossRef]
- Loiselle, K.; Lee, J.L.; Szulczewski, L.; Drake, S.; Crosby, L.E.; Pai, A.L.H. Systematic and meta-analytic review: Medication adherence among pediatric patients with sickle cell disease. J. Pediatr. Psychol. 2016, 41, 406–418. [Google Scholar] [CrossRef]
- Patel, N.G.; Lindsey, T.; Strunk, R.C.; DeBaun, M.R. Prevalence of daily medication adherence among children with sickle cell disease: A 1-year retrospective cohort analysis. Pediatr. Blood Cancer 2010, 55, 554–556. [Google Scholar] [CrossRef] [PubMed]
- Strouse, J.J.; Heeney, M.M. Hydroxyurea for the treatment of sickle cell disease: Efficacy, barriers, toxicity, and management in children. Pediatr. Blood Cancer 2012, 59, 365–371. [Google Scholar] [CrossRef]
- Namazzi, R.; Conroy, A.L.; Bond, C.; Goings, M.J.; Datta, D.; Ware, R.E.; Jang, J.H.; John, C.C.; Opoka, R.O. Effect of Hydroxyurea Therapy on the Incidence of Infections in Ugandan Children with Sickle Cell Anaemia. Blood 2021, 138, 765. [Google Scholar] [CrossRef]
- Gordeuk, V.R.; Campbell, A.; Rana, S.; Nouraie, M.; Niu, X.; Minniti, C.P.; Sable, C.; Darbari, D.; Dham, N.; Onyekwere, O.; et al. Relationship of erythropoietin, fetal hemoglobin, and hydroxyurea treatment to tricuspid regurgitation velocity in children with sickle cell disease. Blood J. Am. Soc. Hematol. 2009, 114, 4639–4644. [Google Scholar] [CrossRef]
- Klok, T.; Kaptein, A.A.; Duiverman, E.J.; Brand, P.L. High inhaled corticosteroids adherence in childhood asthma: The role of medication beliefs. Eur. Respir. J. 2012, 40, 1149–1155. [Google Scholar] [CrossRef]
- Kung, M.; Koschwanez, H.E.; Painter, L.; Honeyman, V.; Broadbent, E. Immunosuppressant nonadherence in heart, liver, and lung transplant patients: Associations with medication beliefs and illness perceptions. Transplantation 2012, 93, 958–963. [Google Scholar] [CrossRef]
- Žugelj, U.; Zupančič, M.; Komidar, L.; Kenda, R.; Varda, N.M.; Gregorič, A. Self-reported adherence behavior in adolescent hypertensive patients: The role of illness representations and personality. J. Pediatr. Psychol. 2010, 35, 1049–1060. [Google Scholar] [CrossRef]
- Broadbent, E.; Donkin, L.; Stroh, J.C. Illness and treatment perceptions are associated with adherence to medications, diet, and exercise in diabetic patients. Diabetes Care 2011, 34, 338–340. [Google Scholar] [CrossRef]
- Logan, D.E.; Radcliffe, J.; Smith-Whitley, K. Parent factors and adolescent sickle cell disease: Associations with patterns of health service use. J. Pediatr. Psychol. 2002, 27, 475–484. [Google Scholar] [CrossRef]
- Mitchell, M.J.; Lemanek, K.; Palermo, T.M.; Crosby, L.E.; Nichols, A.; Powers, S.W. Parent perspectives on pain management, coping, and family functioning in pediatric sickle cell disease. Clin. Pediatr. 2007, 46, 311–319. [Google Scholar] [CrossRef]
- Connelly, M.; Wagner, J.L.; Brown, R.T.; Rittle, C.; Cloues, B.; Taylor, L.C. Informant discrepancy in perceptions of sickle cell disease severity. J. Pediatr. Psychol. 2005, 30, 443–448. [Google Scholar] [CrossRef]
Sociodemographic Characteristics | Frequency (Percentage) | Hydroxyurea Status (Currently Use) | p-Value | |
---|---|---|---|---|
n = 217 | Yes 125 (57.6%) | No 92 (42.4%) | ||
Age (mean; SD) | 28.09; 8.40 | 28.52; 8.14 | 27.50; 8.75 | 0.37 |
Gender | ||||
Male | 118 (54.4%) | 63 (50.4%) | 55 (59.8%) | 0.17 |
Female | 99 (45.6%) | 62 (49.6%) | 37 (40.2%) | |
Family Monthly Income (in Riyals) | ||||
Less than 5 k | 57 (26.3%) | 33 (26.4%) | 24 (26.1%) | 0.008 * |
From 5 to 10 k | 77 (35.5%) | 53 (42.4%) | 24 (26.1%) | |
From 10 to 20 k | 53 (24.4%) | 20 (16%) | 33 (35.9%) | |
From 20 to 30 k | 22 (10.1%) | 15 (12%) | 7 (7.6%) | |
More than 30 k | 8 (3.7%) | 4 (3.2%) | 4 (4.3%) | |
Educational Level | ||||
Uneducated | 1 (0.5%) | 1 (0.8%) | 0 (0%) | 0.93 |
Primary | 6 (2.8%) | 4 (3.2%) | 2 (2.2%) | |
Medium | 6 (2.8%) | 4 (3.2%) | 2 (2.2%) | |
Secondary | 55 (25.3%) | 31 (24.8%) | 24 (26.1%) | |
University | 143(65.9%) | 82 (65.6%) | 61 (66.3%) | |
Post-Graduate | 6 (2.8%) | 3 (2.4%) | 3 (3.3%) | |
How many times a year are you hospitalized for sickle cell anaemia episodes? | ||||
0 | 28 (12.9%) | 13 (10.4%) | 15 (16.3%) | 0.26 |
1 | 33 (15.2%) | 20 (16%) | 13 (14.1%) | |
2 | 43 (19.8%) | 23 (18.4%) | 20 (21.7%) | |
3 | 31 (14.3%) | 20 (16%) | 11 (12%) | |
4 | 27 (12.4%) | 12 (9.6%) | 15 (16.3%) | |
5 | 55 (25.3%) | 37 (29.6%) | 18 (19.6%) | |
Number of episodes of pain crisis in the last three years | ||||
0 | 24 (11.1%) | 12 (9.6%) | 12 (13%) | 0.24 |
1 | 28 (12.9%) | 16 (12.8%) | 12 (13%) | |
2 | 23 (10.6%) | 10 (8%) | 13 (14.1%) | |
3 | 25 (11.5%) | 11 (8.8%) | 14 (15.2%) | |
4 | 18 (8.3%) | 12 (9.6%) | 6 (6.5%) | |
5 | 99 (45.6%) | 64 (51.2%) | 35 (38%) | |
Number of episodes of acute chest syndrome in the last three years | ||||
0 | 84 (38.7%) | 47 (37.6%) | 37 (40.2%) | 0.32 |
1 | 35 (16.1%) | 23 (18.4%) | 12 (13%) | |
2 | 37 (17.1%) | 21 (16.8%) | 16 (17%) | |
3 | 19 (8.8%) | 8 (6.4%) | 11 (12%) | |
4 | 17 (7.8%) | 8 (6.4%) | 9 (9.8%) | |
5 | 25 (11.5%) | 18 (14.4%) | 7 (7.6%) | |
Have you been admitted to the ICU? | ||||
Yes | 60 (27.6%) | 43 (34.4%) | 17 (18.5%) | 0.01 * |
No | 157 (72.4%) | 82 (65.6%) | 75 (81.5%) | |
Did you have an operation for spleen removal? | ||||
Yes | 15 (6.9%) | 10 (8%) | 5 (5.4%) | 0.46 |
No | 202 (93.1%) | 115 (92%) | 87 (94.6%) | |
Did you receive blood transfusion due to SCD consequences? | ||||
Yes | 166 (76.5%) | 104 (83.2%) | 62 (67.4%) | 0.007 * |
No | 51 (23.5%) | 21 (16.8%) | 30 (32.6%) | |
Do you have other chronic diseases? | ||||
Yes | 175 (80.6%) | 104 (83.2%) | 71 (77.2%) | 0.26 |
No | 42 (19.4%) | 21 (16.8%) | 21 (22.8%) | |
Gallstones | ||||
Yes | 98 (45.2%) | 69 (55.2%) | 29 (31.5%) | 0.001 * |
No | 119 (54.8%) | 56 (44.8%) | 63 (68.5%) | |
Pulmonary hypertension | ||||
Yes | 12 (5.5%) | 7 (5.6%) | 5 (5.4%) | 0.95 |
No | 205 (94.5%) | 118 (94.4%) | 87 (94.6%) | |
Joint necrosis | ||||
Yes | 71 (32.7%) | 48 (38.4%) | 23 (25%) | 0.038 * |
No | 146 (67.3%) | 77 (61.6%) | 69 (75%) | |
Stroke | ||||
Yes | 17 (7.8%) | 12 (9.6%) | 5 (5.4%) | 0.25 |
No | 200 (92.2%) | 113 (90.4%) | 87 (94.6%) | |
Kidney dysfunction | ||||
Yes | 14 (6.5%) | 9 (7.2%) | 5 (5.4%) | 0.60 |
No | 203 (93.5%) | 116 (92.8%) | 87 (94.6%) | |
Recurrent infections or infections | ||||
Yes | 73 (33.6%) | 46 (36.8%) | 27 (29.3%) | 0.25 |
No | 144 (66.4%) | 79 (63.2%) | 65 (70.7%) |
Sociodemographic Characteristics | Hydroxyurea Adherence | p-Value | |
---|---|---|---|
Low | Moderate/High | ||
Frequency (n = 125) | 102 (81.6%) | 23 (18.4%) | |
Age (mean; SD) | 29.15; 8.43 | 25.74; 6.13 | 0.89 |
Did you do the blood transfusion because of the severe shortage of it? | |||
Yes | 89 (87.3%) | 15 (56.2%) | 0.01 * |
No | 13 (12.7%) | 8 (34.8%) | |
Recurrent infections or infections | |||
Yes | 42 (41.2%) | 4 (17.4%) | 0.03 * |
No | 60 (58.8%) | 19 (82.6%) |
(a) | |||||||||||
B-IPQ Domains | All (n = 217) | Hydroxyurea Adherence | Gender | ||||||||
Low | Moderate/High | p-Value | Male | Female | p-Value | ||||||
Consequences | 6.30; 3.08 | 6.46; 2.96 | 7.61; 2.5 | 0.08 | 6.86; 2.98 | 5.62; 3.07 | 0.003 * | ||||
Personal Control | 5.13; 3.05 | 5.32; 3.19 | 4.57; 2.67 | 0.29 | 4.82; 3.164 | 5.51; 2.88 | 0.10 | ||||
Treatment Control | 5.77; 2.99 | 6.38; 2.89 | 4.78; 3.5 | 0.02 * | 5.43; 3.04 | 6.18; 2.89 | 0.06 | ||||
Identity | 6.26; 2.79 | 6.39; 2.66 | 6.65; 2.42 | 0.66 | 6.70; 2.79 | 5.74; 2.70 | 0.01 * | ||||
Concerns | 6.51; 3.04 | 6.42; 2.92 | 6.61; 3.05 | 0.78 | 7.10; 2.79 | 5.81; 3.18 | 0.002 * | ||||
Understanding | 7.92; 2.57 | 8.13; 2.38 | 8.09; 2.62 | 0.94 | 7.74; 2.66 | 8.14; 2.46 | 0.25 | ||||
Emotional Response | 6.15; c2.26 | 5.99; 3.15 | 6.87; 2.98 | 0.22 | 6.40; 3.15 | 5.86; 3.75 | 0.25 | ||||
(b) | |||||||||||
B-IPQ Domains | All (n = 217) | Blood Transfusion | ICU Admission | ||||||||
No | Yes | p-Value | No | Yes | p-Value | ||||||
Consequences | 6.30; 3.08 | 5.63; 3.17 | 6.51; 3.03 | 0.075 | 5.99; 2.98 | 7.12; 3.22 | 0.016 * | ||||
Personal Control | 5.13; 3.05 | 4.82; 3.04 | 5.23; 3.056 | 0.40 | 5.29; 2.885 | 4.73; 3.44 | 0.23 | ||||
Treatment Control | 5.77; 2.99 | 5.51; 3.01 | 5.86; 2.98 | 0.47 | 5.85; 2.98 | 5.85; 3.01 | 0.56 | ||||
Identity | 6.26; 2.79 | 5.67; 3.10 | 6.45; 2.67 | 0.08 | 5.86; 2.72 | 7.32; 2.71 | 0.001 * | ||||
Concerns | 6.51; 3.04 | 6.29; 3.28 | 6.58; 2.97 | 0.56 | 6.29; 2.99 | 7.08; 3.13 | 0.087 | ||||
Understanding | 7.92; 2.57 | 7.43; 3.04 | 8.07; 2.40 | 0.12 | 7.83; 2.54 | 8.15; 2.65 | 0.42 | ||||
Emotional Response | 6.15; 2.26 | 5.43; 3.34 | 6.37; 3.21 | 0.07 | 5.99; 3.31 | 6.58; 3.11 | 0.22 | ||||
(c) | |||||||||||
B-IPQ Domains | All (n = 217) | Hospital Admission(s) per Year | |||||||||
0 | 1 | 2 | 3 | 4 | 5 or More | p-Value | |||||
Consequences | 6.30; 3.08 | 4.54; 3.66 | 5.52; 3.04 | 5.98; 2.69 | 6.19; 2.57 | 6.78; 2.75 | 7.75; 2.93 | <0.001 * | |||
Personal Control | 5.13; 3.05 | 5.79; 3.33 | 5.64; 2.21 | 5.53; 2.27 | 5.39; 2.66 | 4.67; 3.48 | 4.27; 3.21 | 0.14 | |||
Treatment Control | 5.77; 2.99 | 5.68; 3.66 | 6.27; 2.30 | 5.63; 2.64 | 6.16; 3.43 | 5.93; 3.19 | 5.35; 2.97 | 0.74 | |||
Identity | 6.26; 2.79 | 3.68; 3.019 | 5.42; 2.77 | 6.00; 2.04 | 6.74; 2.23 | 7.07; 2.36 | 7.62; 2.66 | <0.001 * | |||
Concerns | 6.51; 3.04 | 4.54; 3.51 | 5.82; 2.68 | 6.65; 2.79 | 6.65; 2.81 | 7.15; 2.59 | 7.44; 3.08 | 0.001 * | |||
Understanding | 7.92; 2.57 | 7.36; 3.29 | 7.82; 2.40 | 7.91; 2.75 | 8.52; 2.42 | 8.15; 1.75 | 7.84; 2.91 | 0.65 | |||
Emotional Response | 6.15; 2.26 | 5.11; 3.45 | 6.18; 3.08 | 5.67; 3.16 | 5.42; 3.48 | 7.00; 3.00 | 7.04; 3.13 | 0.04 * |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Madkhali, M.A.; Abusageah, F.; Hakami, F.; Zogel, B.; Hakami, K.M.; Alfaifi, S.; Alhazmi, E.; Zaalah, S.; Trabi, S.; Alhazmi, A.H.; et al. Adherence to Hydroxyurea and Patients’ Perceptions of Sickle Cell Disease and Hydroxyurea: A Cross-Sectional Study. Medicina 2024, 60, 124. https://doi.org/10.3390/medicina60010124
Madkhali MA, Abusageah F, Hakami F, Zogel B, Hakami KM, Alfaifi S, Alhazmi E, Zaalah S, Trabi S, Alhazmi AH, et al. Adherence to Hydroxyurea and Patients’ Perceptions of Sickle Cell Disease and Hydroxyurea: A Cross-Sectional Study. Medicina. 2024; 60(1):124. https://doi.org/10.3390/medicina60010124
Chicago/Turabian StyleMadkhali, Mohammed Ali, Faisal Abusageah, Faisal Hakami, Basem Zogel, Khalid M. Hakami, Samar Alfaifi, Essam Alhazmi, Shaden Zaalah, Shadi Trabi, Abdulaziz H. Alhazmi, and et al. 2024. "Adherence to Hydroxyurea and Patients’ Perceptions of Sickle Cell Disease and Hydroxyurea: A Cross-Sectional Study" Medicina 60, no. 1: 124. https://doi.org/10.3390/medicina60010124