Background & Aims
Non-pharmacological interventions (NPIs) are widely used to manage a wide range of pain conditions including sickle cell disease (SCD)(1,2). Nigeria is the epicentre of SCD globally with an estimated 150,000 annual births. Adolescents use NPIs as they battle recurrent painful sickle cell crises (SCC) and navigate the complex biopsychosocial demands of adolescence (3,4). The effects of NPIs on SCC pain and outcomes have been sparsely explored in literature, particularly in low-resource settings (2). Hence, it is critical to learn more about the NPIs used by this population. This information can guide health promotion initiatives or interventions in Nigeria and other low-resource settings. This study aimed to examine the use, prevalence, types, and perceived value of NPIs used to manage SCC pain in Nigerian adolescents, and users’ preferred medium for NPI educational resources.
Methods
A population-based survey targeting adolescents aged 12 to 18 living with SCD in Nigeria was used. Participants (N=140) were asked to complete a 27-item questionnaire, delivered online (Qualtrics) or on paper, disseminated through SCD foundations across Nigeria and support groups on Facebook. The survey was developed based on past studies and in conjunction with language experts in Nigeria to ensure the survey is age-appropriate. It was reviewed by a team of nursing researchers to assess its face validity. The survey was pre-tested with 5 adolescents, and the readability score was 85%. The survey was distributed between March 15th – July 31st, 2024. The eligibility criteria were any adolescent with SCD aged 12-18 years, has any SCD genotype, has had at least one episode of SCC in the past year and speaks/reads English. Data were descriptively analysed.
Results
Out of 140 surveys returned, 111 surveys were included in the final analysis. Among the respondents, 51% were males with a mean age of 14.78 (SD±2.11) and a mean number of SCC in the past year was 4.4 (SD±4.1; range 1-15). Most respondents (75%) had used at least one NPI to manage pain during SCC, and 35 different NPIs were reported. The most commonly used NPIs were massage (50%), herbal products (37%) and prayer (26%). Most respondents had used just one NPI (37%); while 8% had used up to 14 different NPIs. Respondents described, through open-ended questions, various factors that influenced NPI use, including healthcare providers’ disapproval, severe pain, lack of knowledge and access to certain NPIs. The most common NPIs that the adolescents plan to use in the future were: herbal products (47%), massage (31%) and prayer (24%). Lastly, 1/3 of respondents indicated a preference to receive NPI education via videos (34%), followed by video animation (20%) and web-based resources (17%).
Conclusions
The study shows that Nigerian adolescents use various NPIs to manage their pain during SCC including traditional remedies, physical, and spiritual interventions. Many participants already used (or planned to use) herbal products and other NPIs with limited scientific evidence of their safety or effects on SCD outcomes. This warrants the attention of clinicians and researchers as there is an urgent need to further investigate the specific NPIs being used and their safety and impact on SCD outcomes. It is understandable for clinicians to scrutinize questionable NPIs, but surprisingly, the survey results suggest many clinicians in low-resource settings hold negative attitudes towards NPIs in general, including evidence-based ones such as distraction. Also, respondents preferred video educational resources, highlighting the need to consider patient preferences, particularly in low-resource settings where they may differ from high-income countries where most SCD research is conducted.
References
1.Castellano-Tejedor, C. (2022). Non-Pharmacological Interventions for the Management of Chronic Health Conditions and Non-Communicable Diseases. International Journal of Environmental Research and Public Health, 19(14), 8536.
2.Ibitoye, B. M., Garrett, B., Ranger, M., & Stinson, J. (2023). Non-pharmacological pain interventions for sickle cell crisis in pediatrics: A scoping review. Journal of Pediatric Nursing, 71, 42-54.
3.Oshikoya KA, Edun B, Oreagba IA. Acute pain management in children with sickle cell anaemia during emergency admission to a teaching hospital in Lagos, Nigeria. SAJCH South African Journal of Child Health 2015;9(4):119–123.
4.Poku, B. A., Caress, A. L., & Kirk, S. (2018). Adolescents’ experiences of living with sickle cell disease: An integrative narrative review of the literature. In International Journal of Nursing Studies (Vol. 80, pp. 20–28). Elsevier Ltd.https://doi.org/10.1016/j.ijnurstu.2017.12.008
Presenting Author
Bukola Mary Ibitoye
Poster Authors
Topics
- Pain in Special Populations: Adolescents