w w w . r b h h . o r g
Hematology, Transfusion and Cell Therapy
Original article
Knowledge of professional healthcare providers about sickle cell disease: Impact of a distance education course
Katy Karoline Santos Diniz
∗, Adriana Silvina Pagano, Ana Paula Pinheiro Chagas Fernandes, Ilka Afonso Reis,
Leonardo Gonc¸alves Pinheiro Júnior, Heloísa de Carvalho Torres
UniversidadeFederaldeMinasGerais(UFMG),BeloHorizonte,MG,Brazil
a r t i c l e i n f o
Articlehistory:
Received9March2018 Accepted20June2018 Availableonline20July2018
Keywords:
Sicklecelldisease Healthcareprovider Knowledge Healtheducation
a bs t r a c t
Objective:Toassesstheimpactofthedistanceeducationcourse“SickleCellDisease:Primary HealthCareLine”onknowledgeacquisitionofprofessionalhealthcareproviders.
Methods:Across-sectionalstudywasconductedwithaquantitativeapproachattheEdu- cationalandSupportCenterforHemoglobinopathies(Cehmob-MG),stateofMinasGerais, Brazil,in2016.Onehundredandfifty-threeoutof300professionalhealthcareproviders wereinvitedtoparticipateintheproposeddistancecourse.Oftheparticipatingprofessional healthcareproviders,72(47%)successfullyconcludedthecourse(GroupA),whereas81(53%) didnotcompletetheircourseassignmentsanddidnotmeettheminimumrequirements forregularattendance(GroupB).KnowledgeacquisitionwasassessedwiththeKnowl- edgeofSickleCellDiseaseInstrument,DFConhecimento,appliedusingthewebtooleSurv.
UnivariateanalysisbyPoissonregressionwasemployedtoassesstheinfluenceofsociode- mographicvariablesontheDFConhecimentoscoreandtoselectvariablestocomposethe initialmultivariateregressionmodel(p-value<0.20).Theanalysiswasperformedinthe statisticalprogrammingenvironmentR.
Results:Theaveragescorewas9.76forGroupAand6.54forGroupB.Thetwogroupswere consideredstatisticallydifferent(p-value<0.05)forallitemswiththeproportionofcorrect itemsbeinggreaterinGroupA.Professionalhealthcareproviderswhoconcludedthecourse hadasignificantlyhigherDFConhecimentoscore(45%)whencomparedtothosewhodid notsuccessfullyconcludethecourse.
Conclusion:Participationinadistanceeducationcourseonsicklecelldiseasehadaposi- tiveimpactontheacquisitionofknowledgeaboutthediseasebyprofessionalhealthcare providers.
©2018Associac¸ ˜aoBrasileiradeHematologia,HemoterapiaeTerapiaCelular.Published byElsevierEditoraLtda.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).
∗ Correspondingauthor.
E-mailaddress:[email protected](K.K.Diniz).
https://doi.org/10.1016/j.htct.2018.06.004
2531-1379/©2018Associac¸ ˜aoBrasileiradeHematologia,HemoterapiaeTerapiaCelular.PublishedbyElsevierEditoraLtda.Thisisan openaccessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction
Consideredapublichealthproblem,sickle celldisease isa hereditaryconditionofgreatimportancegloballyandinBrazil.
Itpredominantlyaffectsthe Blackpopulationand presents clinicalmanifestationswithinthefirstyearsoflifewithreper- cussionsonmorbidityandmortality.1,2Despitetechnological andscientificadvancestoimprovetheprognosisofsicklecell disease,its managementpersistsasachallengeforprofes- sionalhealthcareproviders,sinceitinvolvescomplexaspects ofdiagnosis,treatmentandpreventionofcomplications.3–5
Studies point to insufficient knowledge of professional healthcareprovidersaboutimportantaspectsofthequalityof lifeofpeoplewithsicklecelldisease,suchasgrowthanddevel- opmentalconsultations,immunization,schoolperformance, useoffolicacid,prophylacticantibiotictherapy,complications duetovaso-occlusion,transfusions,prevalenceofironover- load,strokes inchildrenandscreeningofstrokeriskusing transcranialDopplerultrasonography.2,6–9Inordertoimprove the quality ofcareprovidedto people withsickle cell dis- easeandtoreducemorbidityandmortalityrates,thereisa clearneedtodevelopeducationalinterventionstoincrease knowledgeofprofessionalhealthcareprovidersaboutsickle celldisease.3,10–12
Tothatend,adistanceeducation courseentitled“Sickle CellDisease:PrimaryHealthCareLine”hasbeenofferedby theEducationalandSupportCenterforHemoglobinopathies (CEHMOB-MG)ofthe stateofMinasGeraissince2010.The purposeofthecourseistobuildcompetenceofprofession- alsandtoimprovethequalityofcareforpeoplewithsickle celldisease.2,3
Distance education is considered an important tool in thedisseminationofup-to-dateknowledgeandinformation, especially inemerging countries. Itseducational resources allowinteraction,sharedexperience,improvementofknowl- edgeindifferenthealthareasandcanaffectalargenumberof professionalsindifferentregionsofthecountry.Inaddition, studieshavedemonstratedtheeffectivenessofthisapproach byeducational interventions targeting professional health- careproviders.13–16Despitetherelevanceofdistancecourses, nostudieswere foundintheliteraturethatinvestigatethe impactofdistanceeducation onthemanagement ofsickle celldisease.
Thisstudy aims toevaluate the impactof the distance education course“SickleCell Disease: Primary Health Care Line” on knowledge acquisition by professional healthcare providers.
Methods
Thisisacross-sectionalstudywithaquantitativeapproach carriedoutfromApriltoJune2016attheEducationalandSup- portCenterforHemoglobinopathies(Cehmob-MG)inthestate ofMinasGerais.
Thedistanceeducationcourse“SickleCellDisease:Primary HealthCareLine”aimsatpromotinganeducationalstrategy toimproveknowledgewithinavirtuallearningenvironment.
Thecourseworkloadis95hoverthreemonthswithfollow-up
sessionsmanagedbytutorswithexpertiseinsicklecelldis- ease.Thecoursecontentisdividedintomodulesdealingwith topicsrelatedtohealthsurveillanceactionstargetingchildren, adolescentsandadults,managementofacuteevents,sickle cell behaviorand otherhemoglobinopathies (Table1).Con- tentisdevelopedthroughstudentengagementincasestudy analysis,discussionforumsandgroupactivitieswithdebate andreflectionontheprovisionofprofessionalcare,leadingto knowledgeconstructionandproposalstoimprovethequality ofcareforpeoplewithsicklecelldisease.
To recruit participants, local and regional authorities are contacted and alerted as to the relevance of build- ing professionalcompetencetodealwiththe disease.Asa result,authoritiesdelegatehealthcareprovidersworkingwith sicklecelldisease(physicians,nurses,dentists,socialassis- tants,psychologists,physicaltherapists,physicaleducators, dieticiansandothers)totakepartinthecourse.Otherprofes- sionalswishingtoparticipateinthecoursearealsowelcome.
During theperiodfrom 2010to2016,2446professionals wereselectedtoparticipateintheCehmobdistanceeducation course.Ofthese,1171(48%)successfullyconcludedthecourse obtainingaminimumscoreof70%forcourseworkandatten- dance.Theremaining1275(52%)didnotobtaintheminimum scoreordroppedoutofthecourse.
The present study used a database of all professional healthcareprovidersfortheselectionofprospectivepartici- pants.InApril2016,aninvitationtoparticipateinthisstudy with a briefexplanation of the research, and aninformed consentformwassentbyemailto300randomlyselectedpro- fessionalsamongthoseenrolledinthecourse.Asthestudy aimedtoassessparticipantswhosuccessfullyconcludedthe courseaswellasthosewhodidnot,150professionalswere randomlyselectedfromeachgroup.
Oftheinvitees, 153(51%)acceptedtoparticipateinthis study;72(47%)hadsuccessfullyconcludedthecourse(hence- forthreferredtoasGroupA)and81(53%)hadnotmetthe minimumrequirementsforcoursecompletion(GroupB).
Participants were requested to answer a questionnaire applied using the web tool e-Surv. This questionnaire comprised three sections: (1) sociodemographic data: sex, education, city ofresidence, and professional category; (2) details of professional performance:type ofhealth service in which the participantworked and the number of years workinginhealthcareservices;and(3)theDFConhecimento instrument (Attachment 1). Thirteenmultiple-choice ques- tionswereincludedaboutthediseasecovering:1.Newborn screeningprogram;2.Sicklecelldisease;3.Sicklecellanemia genotype;4.Sicklecelltrait;5.Clinicalmanifestations;6.Acute events;7.Conditionsfavoringredbloodcellhemolysis;8.Signs ofsicklecelldisease;9.Medications;10.Prophylaxis;11.Ado- lescence;12.Pregnancy;and13.Preventionoflegulcers.
TheDFConhecimentoinstrumentwasconstructedandval- idatedbythestudy authorsfromMay2015toApril2016at theUniversidadeFederaldeMinasGerais(UFMG).Instrument contentvalidationwascarriedoutby11expertsininstrument validationandinsicklecelldiseasethatmadeupapanelof experts.Theinstrumentpresentedanaveragecontentvalidity indexof0.88.Regardingthereliabilityanalysis,theinstrument presentedsatisfactory indexes.Cronbach’salphapresented avalueof0.818,indicatingahighinternalconsistency.The
Table1–Modules,unitsandaimsofthedistancecourse“SickleCellDisease:PrimaryHealthCareLine”.
Module Unit Aim
Gettingfamiliar Courseintroduction Togetfamiliarwiththevirtuallearningenvironmentandtools 1.Monitoringchildrenwith
sicklecelldisease
Activesearch,prophylaxis, immunization
Understandingrisksofsicklecelldiseaseandtheneedto identifythediseaseinprimaryhealthcareforplanning monitoringbyallprofessionalhealthcareproviders 2.Managingacuteevents Acutesplenicsequestration,
infection,paincrisis,stroke, cholecystitis,acutechest syndrome
Learningaboutacuteeventsandestablishingprotocolsfor dealingwiththematbasichealthcareunitsandreferral
3.Monitoringadolescents andadultswithsicklecell disease
Pregnancy,puberty Understandingspecialneedsofadolescentsandadultswith sicklecelldisease.Identifyingrisksinpregnancy
4.Caringforpatientswith sicklecelldiseaseand other
hemoglobinopathies
HbAS—sicklecelltrait;Hb CC—hemoglobinC
Acquiringadvancedknowledgeaboutsicklecelldiseaseand otherhemoglobinopathiestoplanguidelinesforinstruction andfollowup
5.Discussinghealthcare promotionstrategies
Endofcourseassignment Exerciseonplanningeducationalactionsaboutsicklecell diseaseasajointtaskbyateamoffamilyhealthcareproviders intraclasscorrelationcoefficientbetweenthetestandretest
presentedavalueof0.67[95%confidenceinterval(95%CI):
0.55–0.76], indicating that the temporal reproducibility is acceptable.Theinstrumentpresents dimensionscomposed ofitemscompatible withthemesindicatedaspriorities for knowledgeon sicklecelldisease bythe healthprofessional (diagnosis,treatmentandpreventionofcomplications).17
TheDFConhecimentoinstrumentscoreswerecalculated with1beingassignedforcorrectanswersand0forincorrect answers(range:0–13).Thequalitativevariables—sex,educa- tion,trainingcategory,numberofyearsworkinginhealthcare services,typeofhealthserviceandpreviousexperienceassist- ingpatientswithsicklecelldisease—aresummarizedusing absoluteandrelativefrequencies.Thescoresobtainedwith theinstrumentaresummarizedasmean,median,standard deviation(SD) and interquartilerange. The Fisherexact or chi-square tests were used toanalyze the homogeneity of groups inrelation tosex, education, professional category, professional performanceand number ofyears working in healthcareservices.Alevelofsignificanceof5%ormore(p- value>0.05)indicatedevidenceofhomogeneity.18
The chi-square test with a level of significance of 5%
wasadoptedtocomparetheproportionsofcorrectanswers betweenGroupAandGroupB.Thequalitativevariablesare presentedusingabsoluteandrelativefrequencies.18
ThePoissonregressionmodelwasusedtostudytheinflu- enceoffactors—havingcompletedthecourse,sex,academic training,trainingcategory,numberofyearsworkinginhealth- care, type of healthcare service and previous experience assistingpatientswithsicklecelldisease.19Univariateanaly- sisallowedtheselectionoffactorsthatpotentiallyinfluenced theknowledgescorewithalevelofsignificanceequalto25%
beingconsideredatthis selectionstage.Using theselected variables,univariateanalysisemployingageneralizedlinear Poissonmodelwasemployedtoverifythedirectinfluenceof distanceeducationonthescoresoftheprofessionalsandcon- firmedwhether othercharacteristicvariablesofthesample hada significantinfluenceon theirknowledge.Thus,mul- tivariatePoisson regression modelswere fit withbackward elimination being used to select the variables of the final model.Asignificancelevelof5%wasadoptedforbackward
elimination.17Allanalyseswereperformedusingthestatisti- calsoftwareR(Rcoreteam).
TheprojectwasapprovedbytheResearchEthicsCommit- teeInvolvingHumanBeingsoftheUniversidadeFederalde MinasGerais(decisionNo.1.717.975).Theagreementofthe subjectstoparticipateinthestudywasrecordedbymeansof theinformedconsentformavailableintheinitialmenuofthe electronicquestionnaireonthewebsitee-Surv.
Results
Ofthe participantsofthe study,127(83%)were female, 82 (54%)onlystudiedtodegreelevel,88(58%)werenurses,52 (34%)hadworkedinhealthcareservicesformorethannine years,118 (77%)had previouslyprovidedcaretosickle cell diseasepatientsand134(90%)workinmunicipalitiesinthe StateofMinasGerais(Table2).Thegroupsunderstudywere consideredhomogeneousinallanalyzedvariables.
Table3showsthedescriptivestatisticsoftheknowledge scoresaccordingtothesituationoftheprofessionalsinrela- tiontoconcludingthecourse.ItcanbeobservedthatGroup AhadhighermeanandmedianscoresthanGroupB.Scores rangedfromaminimumof0toamaximumof13points.The meanscorewas9.76(SD:2.62)forGroupAand6.54(SD:3.22) forGroupB.
Table 4presents acomparisonofproportionsofcorrect answersbetweenGroupAandGroupB.Therewasasignificant difference(p-value<0.05)forallthequestionswiththepropor- tionofcorrectanswersbeingsignificantlyhigheramongthose whocompletedthecourse.
The mean percentage ofcorrect answers ofsubjects in GroupA(75.0±2.6%)washigherthantheresultsofGroupB (50.6±3.2%).
Intheunivariateanalysis(Table5),thefollowingvariables were selected: Group (A and B), academic training, health servicetypeandpreviousexperienceassistingsicklecelldis- easepatients;variableswereconsideredpossiblesignificant influenceswhenp-valueswere<0.25.Asignificantdifference regardingtheknowledgescore(p-value<0.001)wasobserved betweenGroupA(averagescorewas49%higher)andGroup
Table2–SociodemographiccharacterizationoftheprofessionalswhoansweredtheDFConhecimentoinstrument stratifieddependingoncoursecompletion.
Sociodemographiccharacteristic n(%) p
GroupA GroupB Total
Sex
Female 59(82) 68(84) 127(83) 0.909a
Male 13(18) 13(16) 23(17)
Education
Degree 13(18) 29(36) 42(27) 0.141b
Specialization 40(56) 42(52) 82(54)
Master’sdegree 10(14) 8(10) 18(12)
Doctoratedegree 6(8) 2(2) 8(5)
Professionalcategory
Nursing 40(56) 48(59) 88(58) 0.765a
Others* 32(44) 33(41) 65(42)
Numberofyearsworkinginhealthcareservices
Upto4years 14(19) 30(37) 44(29) 0.110a
From5to8 20(28) 19(23) 39(25)
9yearsormore 29(40) 23(28) 52(34)
None 9(13) 9(11) 18(12)
Typeofhealthservice
Primaryhealthcare 32(44) 41(53) 74(48) 0.706a
Others** 40(56) 40(57) 79(52)
Previousexperienceassistingpatientswithsicklecelldisease
No 13(18) 22(27) 35(23) 0.252a
Yes 59(82) 59(73) 118(77)
a Chi-squaretest.
b Fisher’sexacttest.
∗ Others:biomedicine(2);physicaleducation(1);pharmacy(7);physiotherapy(2);healthmanagement(3);manager(1);medicine(12);nutrition (8);odontology(4);pedagogy(1);psychology(5);socialwork(18);occupationaltherapy(1).
∗∗ Others:Technicalreferencesandprojectsofthestateandmunicipalhealthdepartments(27);hospital(15);educationalinstitution(10);
emergencycareunit(7);bloodcenter(7);laboratory(3);socialworkdepartment(5);socialcontrol(1);doesnotworkinthehealtharea(4).
Table3–Descriptiveanalysisofscores.
Scores Mean SD Min. 1stquartile Median 3rdquartile Max.
Total 8.1 3.1 0 6 8 11 13
GroupA 9.8 2.6 0 8 10 12 13
GroupB 6.5 3.2 0 4 6 9 13
SD,standarddeviation;Min.,minimum;Max.,maximum.
Table4–Proportionsofcorrectanswersofprofessionalswhoansweredthequestionnaireandcompletedthecourse (GroupA)andthosethatdidnot(GroupB).
Questions Total(n=153) GroupA(n=72) GroupB(n=81) pa
n(%) n(%) n(%)
Q1 118(77.1) 62(86.1) 56(69.1) 0.013
Q2 131(85.6) 67(93.1) 64(79) 0.013
Q3 123(80.4) 65(90.3) 58(71.6) 0.004
Q4 115(75.2) 65(90.3) 50(61.7) 0.000
Q5 59(38.6) 38(52.8) 21(25.9) 0.001
Q6 105(68.6) 64(88.9) 41(50.6) 0.000
Q7 73(47.7) 47(65.3) 26(32.1) 0.000
Q8 61(39.9) 35(48.6) 26(32.1) 0.037
Q9 59(38.6) 37(51.4) 22(27.2) 0.002
Q10 82(53.6) 46(63.9) 36(44.4) 0.016
Q11 104(68) 63(87.5) 41(50.6) 0.000
Q12 92(60.1) 54(75) 38(46.9) 0.000
Q13 111(72.5) 60(83.3) 51(63) 0.005
Mean 95(62.1) 54(75) 41(50.6) 0.000
a Chi-squaretest.
Table5–UnivariateanalysisusingthePoissonregressionmodel.
Variable ˇ EP(ˇ) Exp(ˇ) 95%CI p
Group A 0.40 0.06 1.49 1.32–1.69 <0.001
B – – –
Sex Female – – –
Male 0.10 0.09 0.91 0.76–1.09 0.291
Education Degree – –
Specialization 0.16 0.08 1.17 1.00–1.37 0.047
Master’sdegree 0.28 0.11 1.32 1.06–1.64 0.015
Doctoratedegree 0.44 0.14 1.55 1.17–2.04 0.003
Trainingcategory Nursing – –
Other 0.02 0.07 1.02 0.89–1.17 0.764
Numberofyearsworkingin healthcare
None – –
Upto4years 0.07 0.12 1.07 0.84–1.36 0.593
From5to8years 0.12 0.12 1.13 0.89–1.44 0.321
9yearsormore 0.25 0.12 1.29 1.02–1.62 0.033
Typeofhealthservice Primaryhealthcare – –
Other 0.08 0.07 1.09 0.95–1.24 0.227
Previousexperienceassisting patientswithsicklecelldisease
No – –
Yes 0.15 0.08 1.16 0.99–1.37 0.075
95%CI:95%confidenceinterval.
B.Therewasasignificantdifference(p-value<0.005)between traininglevels.Onaverage,comparedtoparticipantswithjust adegree,those withaspecialization presented17%higher scores; witha master’sdegree or taking amaster’s degree hadscores32%higher;whilethosewithadoctoratedegree hadscores55%higher.Therewasasignificantdifference(p- value=0.033)inthenumberofyearsworkinginhealthcare, sincetheknowledgescoreforprofessionalswhohadworked nineyearsormorewasonaverage29%higherthanthescore ofthosewhohadneverworkedinhealthcare.Therewasno significant difference between mean scoreswhen compar- ing variablessuchas gender,professional category,typeof healthcareserviceandwhethertheyhaddealtwithsicklecell diseasepatientspreviously.
Table6presentstheresultsofthePoissonregressionmodel adjustedusingthevariables:group,academictraining,health servicetypeandprevious assistancetopatientswithsickle celldisease(initialmultivariatemodel).Thefinalmultivariate model was reached after step-by-step elimination of non- significant variables (p-value>0.05) from the initial model (Table6).TheanalysisofthefinalmodelshowsthatGroupA maintainedasignificantdifference,presentingonaverage45%
(95%CI:28–64%)higherscoresthanGroupB,evenwhenthis comparisonisadjustedbytheleveloftraining.Therewasalso asignificant difference(p-value=0.029)inthemeansofthe knowledgescoreofprofessionalswithdifferentlevelsofaca- demictraining;thosewithadoctoraldegreehad,onaverage, 34%(95%CI:3–73%)higherscoreswhencomparedtoprofes- sionalsjustwithgraduation.Forthelevelsofspecialization and master’s degree, no statisticallysignificant differences wereobservedinthescoreinrelationtothelevelofgradu- ation.
Discussion
Thecharacteristicsofthesamplestudiedrelatedtothevari- ablesofgender,professionalcategoryandspecializationwere
similartothoseobservedinotherstudieswithprofessional healthcare providers. In those, most of the professionals were female, withanursing backgroundandsomelevelof specialization.16,20Afavorableaspectofthisstudy,observed inthecharacterizationofthesample,isrelatedtothegraduate andhighereducationgroups,whichwereconsideredhomo- geneousinallthevariablesanalyzed.
In the individual evaluationofthe itemsofthe DFCon- hecimentoinstrument,theproportionofcorrectanswersfor thewholeinstrumentwereonaverage75%higheramongthe participantsinGroupA.Thisaveragewashigherthan that observedinastudycarriedoutintheUnitedStates(65%)that investigatedknowledgeaboutsicklecelldiseaseamongphysi- ciansandnursesofemergencyserviceswhoparticipatedina workshop thatincludedten lecturesgivenbyspecialistsin thearea.Theparticipantsansweredanelectronicquestion- naireofmultiple-choicequestionspreparedbytheauthorsof thestudybeforethebeginningofthelecturesandafterthe event.7
TheresultsofDFConhecimento, verifiedbythedescrip- tive analysis of the scores and by the generalized linear Poissonmodel,showedthatmembersofGroupAhadsignif- icantly moreknowledgeaboutthe disease afterthecourse compared to Group B. A similar result was obtained in a randomized study carried out in the northern part of the State of Minas Gerais, aimed at assessing an educational program about sickle cell disease that targeted commu- nity healthcare agents and nursing assistants working in primaryhealthcare.Participantsinthestudyshowedknowl- edge acquisition by improvements in their performance during the assessment (p-value<0.001).21 Studies verified a significant positive impact on knowledge ofprofessional healthcare providers afterbeing submitted toan interven- tion inother healthdomainsusingthemethodofdistance education.14–16
The positive impact of the distance education course aboutsicklecelldiseaseontheprofessionalswhocompleted the study suggests that this educational strategy can be
Table6–Resultsofmultivariateanalysis(adjustmentofthegeneralizedlinearPoissonmodel).
Variables Initialmodel Finalmodel
ˇ EP(ˇ) Exp(ˇ) 95%CI p ˇ EP(ˇ) Exp(ˇ) 95%CI p
Group A 0.37 0.06 1.44 1.27–1.64 <0.001 0.37 0.06 1.45 1.28–1.64 <0.001
B – – – – – – – – – –
Education Degree – – – – – – – – – –
Specialization 0.08 0.08 1.09 0.94–1.26 0.280 0.11 0.07 1.12 0.96–1.29 0.143 Master’sdegree 0.15 0.11 1.16 0.94–1.44 0.179 0.20 0.10 1.22 1.00–1.50 0.056 Doctoratedegree 0.20 0.14 1.22 0.92–1.61 0.161 0.29 0.13 1.34 1.03–1.74 0.029 Numberofyearsworkingin
healthcare
None – – – – – – – – – –
Upto4years 0.16 0.12 1.17 0.93–1.48 0.173 – – – – –
From5to8years 0.13 0.12 1.14 0.90–1.45 0.280 – – – – –
9yearsormore 0.21 0.12 1.24 0.99–1.56 0.068 – – – – –
Typeofhealthservice Primaryhealthcare – – – – – – – – – –
Other 0.08 0.07 1.08 0.94–1.24 0.259 – – – – –
Previousexperienceassisting patientswithsicklecelldisease
No – – – – –
Yes 0.07 0.08 1.07 0.92–1.25 0.390 – – – – –
95%CI:95%confidenceinterval.
introduced in the context of all professional healthcare providers working in the healthcare network. Thus, it is important that this strategy includes content related to knowledge deficits ofprofessional healthcare providers as described in the literature: content that addresses patho- physiologicalcomplications,transfusion,prevalenceofiron overload,strokeinchildren, clinicalmanifestationsaswell asthemanagementofsicklecelldisease.2,7,9,10,12
Theresultsobtainedfromtheprofessionalsinthisstudy andreportedintheliteratureshowthatadeficitofknowl- edgeaboutsicklecelldiseaseexistsandpersistsdespitethe technical-scientificadvancesandtheavailabilityofguidelines withrecommendationsforprofessionalpractice.However,the positiveimpact onthe knowledgeabout sicklecell disease ofprofessionals afterparticipating ineducationalinterven- tionswasconfirmedinrecentstudieswithNorthAmerican, Brazilian and Mexican professionals with different educa- tionallevels using qualitativeand quantitativemethods of knowledgeassessment.2,10,22–24
Thisstudyfillsagaphighlightedinapreviousstudy,which recommendedincludingphysiciansandnursesineducational programsonsickle cell disease.21 Because thiseducational interventionseekstoimprovetheknowledgeofprofession- alsinrespecttosicklecelldiseaseusingtechnology,itsstrong point is the viability of reproducing this study with more participantsandwithgeographicalexpansiontorepresenta greaterproportionofprofessionals.15,16,25
Conclusion
Distance learning courses have a positive impact on the knowledgeacquiredbyprofessionalhealth providersabout sickle cell disease. It is essential to include professionals whoassistsicklecelldiseasepatientsinsimilareducational actions.
Conflicts of interest
Theauthorsdeclarenoconflictsofinterest.
Appendix A. Supplementary data
Supplementarydataassociatedwiththisarticlecanbefound, intheonlineversion,atdoi:10.1016/j.htct.2018.06.004.
references
1.CordeiroRC,FerreiraSL.Experiencesofillnessamong individualswithsicklecellanemiaandself-carestrategies.
ActaPaulEnferm.2014;27(6):499–504.
2.GomesLM,VieiraMM,ReisTC,Andrade-BrabosaTL,de CaldeiraAP.Understandingoftechnicaleducationlevel professionalsregardingsicklecelldisease:adescriptive study.OnlineBrazJNurs.2013;12(2):482–90.
3.GomesLM,PereiraIA,TorresHC,CaldeiraAP,VianaMB.
Accessandcareofindividualswithsicklecellanemiaina primarycareservice.ACTAPaulEnferm.2014;27(4):348–55.
4.daFonsecaSF,AmorimT,Purificac¸ãoA,Gonc¸alvesM, Boa-SorteN.HemoglobinA2valuesinsicklecelldisease patientsquantifiedbyhighperformanceliquid
chromatographyandtheinfluenceofalphathalassemia.Rev BrasHematolHemoter.2015;7(5):296–301.
5.SilvaFilhoIL,RibeiroGS,Pimenta-BuenoLM,SerpaMJ.The frequencyof-globingenehaplotypes,␣-thalassemiaand geneticpolymorphismsofmethylenetetrahydrofolate reductase,factorVLeidenandprothrombingenesinchildren withsicklecelldiseaseinRiodeJaneiro,Brazil.RevBras HematolHemoter.2010;32(1):76–8.
6.GomesLM,deAndradeBarbosaTL,VieiraED,VieiraLJ,Castro KP,etal.Communityhealthcareworkers’perceptionofan educationalinterventioninthecareofpatientswithsickle celldiseaseinBrazil.MediterrJHematolInfectDis.
2015;7(1):e2015031.
7.TanabeP,StevensonA,DeCastroL,DrawhornL,LanzkronS, MolokieRE,etal.Evaluationofatrain-the-trainerworkshop onsicklecelldiseaseforEDproviders.J.Emerg.Nurs.
2013;39(6):539–46.
8.ReevesSL,FullertonHJ,DombkowskiKJ,BoultonML,Braun TM,LisabethLD.Physicianattitude,awareness,and knowledgeregardingguidelinesfortranscranialDoppler screeninginsicklecelldisease.Clin.Pediatr.(Phila.).
2015;54(4):336–45.
9. JeneretteCM,BrewerCA,SilvaS,TanabeP.Doesattendance atasicklecelleducationalconferenceimproveclinician knowledgeandattitudetowardpatientswithsicklecell disease?PainManageNurs.2016;17(3):226–34.
10.FernandesAP,JanuárioJN,CangussuCB,MacedoDL,DeViana MB.Mortalityofchildrenwithsicklecelldisease:a
populationstudy.J.Pediatr.(Rio.J).2010;86(4):279–84.
11.BarrosoLM,AraújoTM,AlvesBE,MartinsMC.Professional knowledgeofthefamilyhealthstrategyonsickle-cell disease.RPesqCuidFundamOnline.2013;5(6):9–19.
12.SabarenseAP,LimaGO,SilvaLM,VianaMB.Characterization ofmortalityinchildrenwithsicklecelldiseasediagnosed throughtheNewbornScreeningProgram.J.Pediatr.(Rio.J).
2015;91(3):242–7.
13.MokwenaK,Mokgatle-NthabuM,MadibaS,LewisaH, Ntuli-NgcoboaB.Trainingofpublichealthworkforceatthe NationalSchoolofPublicHealth:meetingAfrica’sneeds.Bull.
WorldHealthOrgan.2007;85(12):949–54.
14.GuerraCM,RamosMP,PennaVZ,GotoJM,SantiLQ,de AndradeStempliukV,etal.Howtoeducatehealthcare professionalsindevelopingcountries?ABrazilian experience.Am.J.Infect.Control.2010;38(6):491–3.
15.ConroyEJ,KirkhamJJ,BellisJR,PeakM,SmythRL,Williamson PR,etal.Apilotrandomisedcontrolledtrialtoassessthe utilityofane-learningpackagethattrainsusersinadverse drugreactioncausality.IntJPharmPract.2015;23(6):
447–55.
16.DetroyerE,DobbelsF,DebonnaireD,IrvingK,TeodorczukA, FickDM,etal.Theeffectofaninteractivedeliriume-learning toolonhealthcareworkers’deliriumrecognition,knowledge andstrainincaringfordeliriouspatients:apilot
pre-test/post-teststudy.BMCMedEduc.2016;16:17.
17.ColuciMZ,AlexandreNM,MilaniD.Constructionof measurementinstrumentsintheareaofhealth.CienSaude Colet.2015;20(3):925–36.
18.AgrestiA.CategoricalDataAnalysis.2ndedFlorida:
UniversityofFloridaGainesville;2002.
19.McCullaghP,NelderJA.GeneralizedLinearModels.2nded BeloHorizonte:Chapman&Hall;1989.p.511.
20.GomesLM,VieiraMM,ReisTC,BarbosaTL,CaldeiraAP.
KnowledgeoffamilyhealthprogrampractitionersinBrazil aboutsicklecelldisease:adescriptive,cross-sectionalstudy.
BMCFamPract.2011;12:89.
21.GomesLM,AndradeBarbosaTL,VieiraLJ,CastroKP,Caldeira AP,TorresHC,etal.Effectivenessofaneducational
programmeaboutsicklecelldiseaseintheformofactive methodologiesamongcommunityhealthagentsandnursing techniciansofprimarycareinMinasGeraisBrazil.Paediatr IntChildHealth.2017;37(1):56–62.
22.KavanaghPL,SprinzPG,WolfgangTL,KilliusK,Champigny M,SobotaA,etal.Improvingthemanagementof
vaso-occlusiveepisodesinthepediatricemergency department.Pediatrics.2015;136(4):1016–25.
23.ShookLM,FarrellCB,KalinyakKA,NelsonSC,HardestyBM, RampersadAG,etal.Translatingsicklecellguidelinesinto practiceforprimarycareproviderswithProjectECHO.Med EducOnline.2016;21:33616.
24.HaywoodCJr,Williams-Reade,RushtonC,BeachMC,GellerG.
Improvingclinicianattitudesofrespectandtrustforpersons withsicklecelldisease.HospPediatr.2015;5(7):377–84.
25.MokwenaK,Mokgatle-NthabuM,MadibaS,LewisH, Ntuli-NgcoboB.Trainingofpublichealthworkforceatthe NationalSchoolofPublicHealth:meetingAfrica’sneeds.Bull.
WorldHealthOrgan.2007;85(12):949–54.
