Document Type



Doctor of Philosophy (PhD)



First Advisor's Name

Dr. Ora Strickland

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Dr. Michelle Kameka

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Dr. Maria Olenick

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Dr. Deborah Sherman

Fourth Advisor's Committee Title

Committee member


sickle cell disease, sequelae, behavioral health outcomes, adults

Date of Defense



The lifelong experience of acute and chronic pain associated with sickle cell disease (SCD) not only has damaging physiological sequelae, but it also can negatively impact affected persons psychologically and socioculturally. These triad of SCD sequelae have an inter-relational and interactional mind-body-social connection that impact the behaviors of adults with SCD. These physiological, psychological, and sociocultural domains comprise the triadic sequelae.

The purpose of this study was to investigate the inter-relational and interactional mind-body-social relationship of the triadic sequelae in SCD as predictors of behavioral health outcomes (i.e., sickle cell fatalism, perceived sickle cell prejudice, and SCD self-efficacy) based on propositions of the Chronic Disease Outcomes Triad (CDOT) Model, which was developed as the basis for this study.

A predictive correlational research design was utilized to study 93 males (n = 29) and females (n = 64) adults with SCD to test the Chronic Disease Outcomes Triad (CDOT) Model’s predictive value of the triadic sequelae related to behavioral health outcomes. Measures completed by participants included Brief Pain Inventory, SCD Symptomatology Scale, Beck’s Depression Inventory, Chronic Disease Attitude Scale, Sickle Cell Self-Efficacy Scale, and a Demographic tool. Participants were between the ages of 18 to 75 years old and diagnosed with any genotype of SCD. The majority of participants were diagnosed with genotype HbSS (n = 64).

Findings indicated that adults with SCD have pain, other physical and other psychological symptoms, e.g. depression while either working or attending school or not. Participants who reported more physical symptoms were more likely to report more psychological symptoms and depression which interfered with their work and/or school involvement. Participants with more physiological and psychological sequelae, were more likely to have less work and/or school (sociocultural) involvement. Physiological, psychological, and sociocultural (work and/or school involvement) sequelae predicted behavioral health outcomes (fatalism, perceived prejudice, and self-efficacy). Other disease-related and participant-related characteristics were significantly related and predicted triadic sequelae and behavioral health outcomes. All significant relationships were consistent with the hypothesized directions.

It was concluded that adults with SCD have a triad of SCD sequelae that are associated with each other and that predict behavioral health outcomes.





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