Abstract
Objective: Georgia has one of the highest prevalences of sickle cell disease (SCD). For Georgians living with SCD, inadequate medication adherence is associated with important clinical outcomes. One important area that is understudied in SCD is the impact of social determinants of health (SDoH) on medication adherence. A foundational understanding of SDoH is needed to introduce, inform and carry out programs and interventions designed to facilitate hydroxyurea adherence through the state of Georgia.
Method: We conducted a systematic literature review to synthesize the literature on SDoH addressed in studies to improve hydroxyurea adherence in persons with SCD. SDoH were based on the five categories defined in Healthy People 2030. SDoH were divided into two categories, barriers and facilitators, to identify factors that could improve adherence to hydroxyurea. An in-depth search was conducted using online databases. Each study was appraised for methodological soundness. Twelve studies were selected and assessed for this systematic literature review.
Results: Four out of five categories of social determinants were highlighted in studies addressing hydroxyurea adherence. We found that healthcare access and quality (i.e., access to care, health literacy) was the SDoH most reported as a barrier to hydroxyurea adherence. Social and Community Context (e.g., peer support, community health worker, and patient navigator) was the most commonly reported facilitator to hydroxyurea adherence.
Conclusion: Notably, our analysis highlights a gap in the literature related to education as a social determinant and its relationship to hydroxyurea adherence among persons with SCD. This is an important finding as SDoH are a challenge for clinicians to address, particularly rural areas of Georgia where specialty care is limited. Future studies should explore development of multilevel interventions that address SDoH to improve hydroxyurea adherence in persons with SCD.
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Recommended Citation
Ugwu, Doreen O.; Vick, Lori L.; Williams, Terika; Nikaj, Aurela; Omeh, Seyi; Becerra, Benjamin Dr.; and Mayo-Gamble, Tilicia
(2026)
"The role of social determinants of health in hydroxyurea adherence among persons with sickle cell disease: A systematic review,"
Journal of the Georgia Public Health Association: Vol. 11:
No.
1, Article 13.
Available at:
https://digitalcommons.georgiasouthern.edu/jgpha/vol11/iss1/13
Resubmission Cover Letter
Table_ReviewerComments_SDoH_HU.docx (141 kB)
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Table 1. Summary of Studies
Table 2_Social Determinants.docx (18 kB)
Table 2. Summary of Social Determinants Identified
Table 3_Barriers_Facilitators Table.docx (12 kB)
Table 3. Social Determinants of Health Barriers and Facilitators to Hydroxyurea in Sickle Cell Disease
PRISMA_Hydroxyurea Adherence.docx (47 kB)
Figure 1. Systematic Review Diagram
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