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. 2021 Aug 10;2(1):87.
doi: 10.1186/s43058-021-00192-z.

Identified barriers and facilitators to stroke risk screening in children with sickle cell anemia: results from the DISPLACE consortium

Shannon M Phillips  1 , Alyssa M Schlenz  2   3 , Martina Mueller  4   5 , Cathy L Melvin  5 , Robert J Adams  6 , Julie Kanter  7
Affiliations

Identified barriers and facilitators to stroke risk screening in children with sickle cell anemia: results from the DISPLACE consortium

Shannon M Phillips et al. Implement Sci Commun. .

Abstract

Background: Children with sickle cell anemia are at risk for stroke. Ischemic stroke risk can be identified among children ages 2-16 years with sickle cell anemia using transcranial Doppler ultrasound. Despite strong recommendations for transcranial Doppler screening in guidelines released by the National Heart, Lung, and Blood Institute, implementation of transcranial Doppler screening in sickle cell anemia remains suboptimal. The purpose of this study was to identify barriers and facilitators to transcranial Doppler screening in a large national consortium to inform subsequent implementation interventions.

Methods: A qualitative descriptive approach was used to conduct 52 semi-structured interviews with a sample of patients with sickle cell anemia, their parents or primary caregivers, and healthcare providers dispersed across the United States. Interviews took place from September 2018 through March 2019. Directed content analysis was conducted with an adapted version of the Multilevel Ecological Model of Health as an initial coding framework, completed July 2019. Frequency analysis was conducted to determine predominant barrier and facilitator themes.

Results: Fourteen barrier themes and 12 facilitator themes emerged representing all levels of the ecological framework. Two barrier themes (Logistical Difficulties and Competing Life Demands and Gaps in Scheduling and Coordination), and 5 facilitator themes (Coordination, Scheduling and Reminders; Education and Information; Provider and Staff Investment and Assistance; Positive Patient Experience; and Convenient Location) were predominant.

Conclusions: Barriers and facilitators to transcranial Doppler screening in children with sickle cell anemia are complex and occur across multiple ecological levels. One barrier theme and 3 facilitator themes were found to be optimal to address in subsequent implementation interventions.

Keywords: Caregivers; Children; Healthcare providers; Qualitative; Sickle cell anemia; Social ecological model; Transcranial Doppler screening.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Themes by ecological level. Legend: predominant themes (text in bold), patient/caregiver report (text in blue), provider report (text in red), patient/caregiver and provider report (text in green)
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