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randomized controlled trial, reproductive behavior, sickle cell disease, sickle cell trait, young adult



  1. Wilkie, Diana J.
  2. Gallo, Agatha M.
  3. Yao, Yingwei
  4. Molokie, Robert E.
  5. Stahl, Christine
  6. Hershberger, Patricia E.
  7. Zhao, Zhongsheng
  8. Suarez, Marie L.
  9. Labotka, Robert J.
  10. Johnson, Bonnye
  11. Angulo, Rigo
  12. Angulo, Veronica
  13. Carrasco, Jesus
  14. Shuey, David
  15. Pelligra, Stephanie
  16. Wang, Edward
  17. Rogers, Dennie T.
  18. Thompson, Alexis A.


Background: People with sickle cell disease (SCD) or sickle cell trait (SCT) may not have information about genetic inheritance needed for making informed reproductive health decisions. CHOICES is a Web-based, multimedia educational intervention that provides information about reproductive options and consequences to help those with SCD or SCT identify and implement an informed parenting plan. Efficacy of CHOICES compared with usual care must be evaluated.


Objective: The purpose was to compare immediate posttest effects of CHOICES versus an attention-control usual care intervention (e-Book) on SCD-/SCT-related reproductive health knowledge, intention, and behavior.


Methods: In a randomized controlled study, we recruited subjects with SCD/SCT from clinics, community settings, and online networks with data collected at sites convenient to the 234 subjects with SCD (n = 136) or SCT (n = 98). Their ages ranged from 18 to 35 years; 65% were women, and 94% were African American. Subjects completed a measure of sickle cell reproductive knowledge, intention, and behavior before and immediately after the intervention.


Results: Compared with the e-Book group, the CHOICES group had significantly higher average knowledge scores and probability of reporting a parenting plan to avoid SCD or SCD and SCT when pretest scores were controlled. Effects on intention and planned behavior were not significant. The CHOICES group showed significant change in their intention and planned behavior, whereas the e-Book group did not show significant change in their intention, but their planned behavior differed significantly.


Discussion: Initial efficacy findings are encouraging but warrant planned booster sessions and outcome follow-ups to determine sustained intervention efficacy on reproductive health knowledge, intention, and actual behavior of persons with SCD/SCT.