Preventing Peanut Allergy in Young Children: Identifying Barriers to Protocol Engagement and Adherence

项目摘要/摘要 这个F32国家研究服务奖将支持申请者成为一名 调查儿科慢性病疾病管理的有效方法的独立调查者。 与这一目标一致，拟议的研究将侧重于将申请人的研究扩展到 审查家庭发起和遵守NIAID指南以防止发展的障碍 花生过敏(PA)。PA是最常见的食物过敏(FA)，倾向于在儿童早期发展， 而且很少长得过大。PA构成严重的医疗风险，占致死过敏的大部分 回应。2015年，关于花生过敏的早期学习(LEAP)试验证明了其有效性和 预防有PA危险的婴儿发生PA的可行性；婴儿定期摄入花生 与那些不吃花生的人相比，蛋白质不太可能产生PA。婴儿对花生的持续消费 然而，已经被证明是具有挑战性的，因为早期的引入研究报告了25%-65%的不遵守。 关于哪些因素影响家庭对早期介绍指南的了解，所知信息有限 花生蛋白含量，愿意启动早期导入，以及启动花生早期导入的能力，这些都是 其中一些因素是成功预防PA的重要组成部分。这项研究的目的是(1a)制定一个 照顾者对早期引入的知识、意愿和方法的类型 花生给有PA风险的幼儿照料者；(1b)检验特征模式的预测因素 与花生早期引种的启动有关；(2a)确定与启动和坚持有关的因素 及早在家庭中推广花生建议的防腐剂预防；(2b)确定背景障碍和 促进者通过深入的定性访谈及早介绍、启动和遵守；以及(3) 将定量和定性结果结合起来，加深对阻碍和促进因素的理解 启动和坚持花生早引种。拟议研究的长期目标是 设计干预措施以提高家庭在FA内贯彻治疗建议的能力 并改善有患PA风险的儿童的长期结局。 高度结构化的培训计划将允许申请者进行拟议的研究并获得 个性化培训，以促进她作为独立研究人员的发展。通过培训 在此奖学金提供的活动中，申请者将(1)增强她对以下方面的医学方面的了解 FA，(2)培养定性和混合方法方面的专门知识，(3)熟练掌握 分类建模；(4)促进专业发展。申请人的兴趣和培训 Goals非常适合布朗大学阿尔伯特分校的精神病学和人类行为学系 医学院和罗德岛医院，鉴于研究环境的力量，口径 博士后培训，以及FA内研究和临床护理的可用性。

PROJECT SUMMARY/ABSTRACT This F32 National Research Service Award will support the applicant’s long-term career goal of becoming an independent investigator examining effective approaches to disease management in pediatric chronic illness. Consistent with this goal, the proposed study will focus on extending the applicant’s research to the examination of families’ barriers to initiating and adhering to NIAID guidelines to prevent the development of peanut allergy (PA). PA is the most commonly reported food allergy (FA), tends to develop early in childhood, and is rarely outgrown. PA poses serious medical risks, accounting for the majority of fatal anaphylactic responses. In 2015, the Learning Early about Peanut Allergy (LEAP) trial demonstrated the effectiveness and feasibility of preventing the onset of PA in infants at risk of developing PA; infants regularly ingesting peanut protein were less likely to develop a PA than those avoiding peanuts. Consistent infant consumption of peanuts has proven challenging, however, as early introduction studies report non-adherence ranging from 25-65%. Limited information is known about what factors impact families’ knowledge of guidelines for early introduction of peanut protein, willingness to initiate early introduction, and ability to initiate early introduction of peanuts, all of which are essential components of successful PA prevention. The aims of the study are to (1a) develop a typology of patterns of caregiver knowledge of, willingness to initiate, and means to initiate early introduction of peanuts for caregivers of young children at risk of PA; (1b) examine predictors of patterns of characteristics related to initiation of peanut early introduction; (2a) identify factors associated with initiation and adherence to early introduction of peanuts among families recommended PA prevention; (2b) identify contextual barriers and facilitators to early introduction initiation and adherence through in-depth qualitative interviews; and (3) integrate quantitative and qualitative outcomes to develop an understanding of factors impeding and facilitating initiation and adherence to early introduction of peanuts. The long-term goal of the proposed research is to design interventions to increase families’ abilities to follow through on treatment recommendations within FA protocols and improve long-term outcomes of children at risk of developing PA. A highly structured training plan will allow the applicant to conduct the proposed research and receive individualized training to facilitate her development as an independent researcher. Through the training activities provided by this fellowship, the applicant will (1) enhance her knowledge of the medical aspects of FA, (2) develop expertise in qualitative and mixed-methods approaches, (3) establish proficiency in classification modeling, and (4) advance her professional development. The applicant’s interests and training goals are an excellent fit for the Department of Psychiatry and Human Behavior at Brown University’s Alpert Medical School and Rhode Island Hospital, given the strength of the research environment, caliber of postdoctoral training, and availability of research and clinical care within FA.