PloS one · 2026
Low self-esteem in adolescents with sickle cell disease: Determinants and coping mechanisms; A mixed methods study.
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Nakabuye Janipher, Muzeyi Wani, Nakirulu Annet, Kiguli Sarah, Ndeezi Grace, Munube Deogratias
Аннотация
BACKGROUND: Sickle Cell Disease (SCD) is a chronic genetic condition affecting approximately 112 per 100,000 live births globally, with adolescents being particularly vulnerable. Beyond its physical burden, SCD can significantly impact adolescents' mental health, particularly self-esteem. While positive coping strategies can mitigate these effects, data on self-esteem among adolescents with SCD in Uganda remain limited. The objective of this study was to determine the prevalence, associated factors, and coping mechanisms of low self-esteem among adolescents with SCD attending the Sickle Cell Clinic (SCC) at Mulago National Referral Hospital (MNRH).
METHODS: A sequential explanatory mixed-methods study was conducted at the SCC of MNRH from January to March 2024. Quantitative data were collected from 356 adolescents. Low self-esteem was defined as a total Rosenberg self-esteem score of less than 15. For analysis of factors associated with low self-esteem, modified Poisson regression with a log link and robust standard errors was used to estimate prevalence ratios (PRs) and their 95% CIs. Qualitative data on coping mechanisms were obtained through in-depth interviews with nine adolescents and three key informant interviews with health workers. Thematic analysis was done guided by the THRIVE framework.
RESULTS: The prevalence of low self-esteem was 21.6% (95% CI: 17.6-26.3%). Lower prevalence of low self-esteem was observed among adolescents not frequently absent from school (aPR = 0.94, 95% CI 0.90-0.99, P = 0.011) and those without limitations to physical activity (aPR = 0.94, 95% CI 0.90-0.98, P = 0.005), while limited social engagement was associated with higher prevalence (aPR = 1.16, 95% CI 1.03-1.31, P = 0.014)."Coping mechanisms reported by adolescents included adherence to medication, healthy eating and hydration, participation in social activities and hobbies, prayer, and peer awareness.
CONCLUSION: Adolescents with SCD are at considerable risk of low self-esteem, particularly those with limited physical activity, social involvement, and frequent school absenteeism. Interventions promoting healthy lifestyles, consistent medication use, peer support, and social engagement may help strengthen self-esteem in this population.
METHODS: A sequential explanatory mixed-methods study was conducted at the SCC of MNRH from January to March 2024. Quantitative data were collected from 356 adolescents. Low self-esteem was defined as a total Rosenberg self-esteem score of less than 15. For analysis of factors associated with low self-esteem, modified Poisson regression with a log link and robust standard errors was used to estimate prevalence ratios (PRs) and their 95% CIs. Qualitative data on coping mechanisms were obtained through in-depth interviews with nine adolescents and three key informant interviews with health workers. Thematic analysis was done guided by the THRIVE framework.
RESULTS: The prevalence of low self-esteem was 21.6% (95% CI: 17.6-26.3%). Lower prevalence of low self-esteem was observed among adolescents not frequently absent from school (aPR = 0.94, 95% CI 0.90-0.99, P = 0.011) and those without limitations to physical activity (aPR = 0.94, 95% CI 0.90-0.98, P = 0.005), while limited social engagement was associated with higher prevalence (aPR = 1.16, 95% CI 1.03-1.31, P = 0.014)."Coping mechanisms reported by adolescents included adherence to medication, healthy eating and hydration, participation in social activities and hobbies, prayer, and peer awareness.
CONCLUSION: Adolescents with SCD are at considerable risk of low self-esteem, particularly those with limited physical activity, social involvement, and frequent school absenteeism. Interventions promoting healthy lifestyles, consistent medication use, peer support, and social engagement may help strengthen self-esteem in this population.