Effective and Elaborative Induction Program for Mitigating Myths and Misconceptions Linked to Hematopoietic Stem Cell Transplantation in a Resource Limited Setting

Study Objectives, Design, Settings and HypothesisPrimary Study Objective

Assessment of myths and misconceptions about HSCT and the effect of an educational intervention among final year medical and nursing students.

Secondary Study Objective

Explore the intention and willingness to donate stem cell, before and after an educational program, among final year medical and nursing students.

Design and Settings

An interventional Quasi Experimental study design (pre/posttest) was used for this work that was conducted at medical and nursing Faculties at our institution during the period from October to December 2021.

Research Hypothesis

There is a certain degree of myths and misconceptions about HSCT among medical and nursing students. Those could be corrected by a targeted educational program. Moreover, the intervention could potentiate willingness for stem cells donation among the study participants. In addition, the study assumed baseline differences in the knowledge about HSCT among 5th year medical students and 4th year nursing students. This assumption was based on differences in their study courses, the assumed main source of their knowledge.

Study Subjects

Two groups of students were included in the study, Group 1: 5th year undergraduate medical students and Group 2: 4th year undergraduate nursing students. Each group was randomly selected and both did not have prior exposure or training with regards to HSCT. Willingness to participate in the study was a prerequisite for subject's inclusion. History of chronic illness and / or blood-related diseases of the student or someone of his/her family members were exclusion criteria.

Both groups 1 and 2 assumed to have knowledge about HSCT from their study courses, also they represent a sector from the general population that could be involved in a HSCT team in their future career. Their course work, regarding HSCT, is mainly theoretical, but include rotations on hematology-oncology floors to a certain degree, with no rotations at HSCT units.

Calculation of Sample Size

According to Epi-info program version 6 with significance level of 95%, power of 80% and prevalence of respondents had a 76.4% average correct response rate regarding knowledge of donation process [8], the total required sample size was 277.

Study Tools and MethodsDevelopment of a Structured Questionnaire

An investigators' developed structured questionnaire was self-administered to the study participants, after taking their consent. The questions were adopted from the investigators' clinical practice and experience as most of them were frequently asked by their patients or their relatives. Other questions were developed by the researchers after national and international literature review. The tool was developed in English language as in appendix A then translated to Arabic language, participants' first language (appendix B). The later form was used in the study. The tool consisted of three parts:

Part I-Aimed to Collect Socio-Demographic Data of the Study Participants

Including age, sex, marital status, educational level, occupation, residence, and family wealth.

Family wealth was assessed with Family Affluence Scale (FAS). We used a three point ordinal scale, where FAS low (score = 0–2) indicates low affluence, FAS medium (score = 3–5) indicates middle affluence, and FAS high (score = 6–9) indicates high affluence [13].

Part II-Aimed to Assess Source of Participants' Information Regarding HSCT and Their Willingness for Donation of HSC

Including source of their knowledge, willingness for getting more knowledge, and willingness for donation.

Part III-Aimed to Explore Myths and Misconceptions About HSCT Among the Study Participants

This was consisted of three domains; A: Myths and misconceptions about HSCT (10 questions), B: Myths and Misconceptions about HSC donation (23 questions), and C: Myths and Misconceptions about umbilical cord blood stem cell preservation (13 questions).

Validation of the Study Tool

Content validity and reliability of the study tool was established by a panel of seven experts (3 from BMT staff, 2 from Public Health staff, and 2 from Medical Surgical Nursing staff) who reviewed the study tools for clarity, relevance, simplicity, comprehensiveness, and applicability. Minor modifications were required. Then, the final form of the tool was designed and tested for reliability by using Cronbach's alpha that was calculated to the total score 46 value = 0.898.

Pilot Study

A pilot study was conducted on 10% of the study sample, to ensure clarity, examine applicability, and identify difficulties of the tools, also to determine the needed time to answer the questions. This group of participants was asked to answer both the English and Arabic versions of the study tool. Results of the pilot study revealed that the average time needed to complete the questionnaire was approximately 20 min. Based on the pilot study minor changes and modifications were applied to the study tool, so the sample piloted was excluded from the actual study sample.

The Educational Intervention

An educational program was developed by the researchers based on review of the relevant literature and textbooks to provide the study sample with the needed knowledge about HSCT in a trial to correct their myths and misconceptions about this type of treatment. The educational leaflet included three theoretical parts: First part included knowledge about HSCT as description of HSCT, definition, types, indications, contraindications, and how HSCT is performed. Second part included knowledge about HSC donation as Peripheral Blood Stem Cell donation (PBSCD), Bone marrow collection, and contraindications of donation. Third part included knowledge about stem cell banking as description of umbilical cord blood, reasons to store umbilical cord blood, the process of its collection, and method of preservation. This was in addition to educational lectures and sessions developed and presented by the researchers.

Procedure

The study proceeded in three phases.

Assessment Phase (Pretest)

The researchers met the selected studied sample; each one of them was fully informed with the purpose and nature of the study and their agreement was obtained. Base line data of the myths and misconceptions about HSCT among the study participants were collected using the validated study tool (parts I, II, and III).

Implementation Phase (Intervention)

The educational program was delivered by the researchers; each participant received an educational leaflet and included in educational sessions (3-sessions) that included a group of students. Each session lasted about 50-mimutes.

During the session extensive literature review that included pictures and guidance about HSCT to correct participants' myths and misconceptions in clear Arabic language, to help them retain the learned material.

A brief review was elicited from the study sample to assess their understanding, then the researchers clarified any points that they did not understand.

Evaluation Phase (Posttest)

In this phase, the studied sample was reassessed at the end of the educational session using the validated study tool (parts II and part III), to evaluate the effectiveness of the educational program on correcting their myths and misconceptions about HSCT.

Data Collection and Scoring System

Participants' answers of the pre and post-tests were collected. A total misconception score for HSCT was calculated. The misconceptions score measured on 0–1 scale for each item, giving one point for each correct response, whereas incorrect or unknown responses received zero points (the total for all items was 46 (10 items for bone marrow transplantation, 23 items for bone marrow donation & 13 items for stem cell banking). The overall misconceptions score was dichotomized as High level of Myths if the correct answers < 50%, Moderate level of Myths 50%—< 70% and Low level of Myths ≥ 70%, by cutoff level of 23, which was the median score of the distribution.

Statistical Analyses

Data entry and analysis were carried out using Statistical Package for Social Sciences (SPSS) version16. Descriptive statistics were represented in the form of frequencies, mean and SD. The X2 test and independent sample T-test were used to compare between the study groups and the paired sample T-test to compare pre and post-test for each group. The Pearson's correlation coefficient and Chi-square test were used to assess association between sociodemographic characteristics and total score of corrected answers of medical /nursing faculty students/ and willingness to donate HSC. Values were considered significant when P values less than 0.05.

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