Thesis (Ph.D.) - Indiana University, Public Health, 2015
Background: Current guidelines recommend that African Americans (AA) know their sickle cell trait status to inform their reproductive decisions. Two studies based on the Reasoned Action Approach (RAA) and the Extended Parallel Process Model were conducted with AA between 18 and 35 to understand their intention to get screened to determine their status. The aim of the main study was to identify factors underlying intention to go to their doctor to ask for sickle cell screening in the next 12 months. The aim of the secondary study was to identify how exposure to a brochure with information about sickle cell trait screening might influence knowledge and beliefs. Methods: Data were collected during March through May 2015 from community sites and via referral to Qualtrics from 300 AA residing in three cities in Indiana. After participants answered eligibility and knowledge questions, they were randomly exposed to one of two brochures. The control brochure had two boxes of information on sickle cell trait susceptibility, severity, and screening; the intervention brochure was identical to the control brochure with the recommended response (e.g., “Go to your doctor to ask for sickle cell trait screening.”) inserted between the two boxes. Then the participants completed a 45-item questionnaire. Results: In the main study sequential regression was used to predict intention. Adding the three RAA constructs of perceived behavioral control (β = .579, p<.001), attitude (β = .354, p<.001), and perceived norm (β = .177, p<.001) significantly increased the adjusted R2 from .173 to .639 (F=34.136, df, 16, 283 p<.001) over the model with four demographic variables and three knowledge and belief variables. In the secondary study, the multivariate t-test comparing those exposed to the control brochure to those exposed to the intervention brochure with the recommended response revealed no significant multivariate effects. However, a paired sample t-test comparing knowledge and beliefs before and after the brochures revealed that exposure to the brochure improved knowledge and beliefs about sickle cell trait screening. Conclusion: RAA was demonstrated to be a useful behavioral theory to understand factors underlying this genetic screening decision. Implications for interventions and research were discussed.