Infant Peanut Allergy Prevention: Understanding and Supporting Caregivers to Achieve Adherence

项目摘要 花生过敏（PA）是美国最常见的食物过敏，也是最不常见的过敏症之一 也是致命的食物过敏反应的主要原因这项具有里程碑意义的研究发现， 婴儿期摄入花生制品可使PA的发展减少81%以上。因此，在2017年， NIAID发布了花生过敏预防（PPA）指南。然而，这些措施的实施 这些准则的独特之处在于，它们与以前的准则相反，给所有人带来了额外的挑战。 持份者特别是对于幼儿的照顾者，遵守PPA指南要求他们 了解围绕食物过敏发展的科学变化，参与早期花生喂养， 短时间窗口（4-6个月大），并接受喂养婴儿的潜在风险 过敏性食物虽然已经进行了涉及儿科医生和过敏症专家的研究， 了解护理人员的意见PPA指南和我们的干预措施，以支持护理人员遵守 早期花生的引进是有限的。利用伊利诺伊州30多家儿科诊所的临床网络 （主要导师的父母补助iREACH），该提案将评估照顾者的障碍和促进者， PPA指南，并通过开展以下活动调查依从性和不依从性的关键驱动因素 与幼儿照顾者的定性访谈。这些数据将被纳入构建一个独特的 互动干预：iCARE（干预，以提高照顾者坚持有关早期花生 导言）。iCARE的目标是利用基于网络、移动的和/或视频的应用程序， 照顾者的障碍和未满足的需求，以促进早期花生引进。经过一个迭代 与利益相关者和专家一起开发iCARE的原型流程，将在护理人员中进行测试， 了解其有效性、可接受性和可行性。这将为R 01提案提供初步数据 在随机临床试验中研究iCARE的有效性。由于护理人员是PPA的最终驱动力 指南的实施，这个项目解决了我们目前的PA预防方法的差距。 该K23提案解决了Samady博士研究技能的多个缺口，提供了以下方面的额外培训： 1)定性数据分析，2）行为科学培训，3）开发和评估新的行为 干预措施。她的主要导师Gupta博士是食物过敏预防研究的全国领导者，她的合作伙伴 导师麦吉博士是定性研究和专业发展方面的领先专家，她的同事 导师范霍恩博士和庞格拉契奇博士在发展和评估行为方面有额外的专业知识， 干预措施。这些目标和培训目标的完成将支持萨马迪博士的长期目标， 成为一个独立的研究者和国家领导人研究婴儿特应性疾病，专注于 改善当前食物过敏预防工作的实施，并确定新的预防措施 战略布局

PROJECT SUMMARY Peanut allergy (PA) is the most common food allergy in the US; it is also one of the least frequently outgrown and the leading cause of fatal food-allergic reactions. The landmark Learning Early About Peanut study found that the ingestion of peanut products in infancy can decrease PA development by over 81%. Thus, in 2017 the NIAID published the Prevention of Peanut Allergy (PPA) Guidelines. However, implementation of these guidelines is unique in that they are a reversal of previous guidelines, posing additional challenges for all stakeholders. For caregivers of young infants specifically, compliance with the PPA guidelines requires them to understand the changing science around food allergy development, participate in early peanut feeding during short time window (4-6 months of age), and accept the risks involved with feeding their infant a potentially allergenic food. While studies involving pediatricians and allergists have been conducted, our current understanding of caregiver opinions PPA guidelines and our interventions to support caregivers to adhere to early peanut introduction are limited. Utilizing an established clinical network of over 30 pediatric clinics in Illinois (primary mentor’s parent grant iREACH), this proposal will evaluate caregiver barriers and facilitators to the PPA guidelines and investigate the key driving factors for adherence and nonadherence by conducting qualitative interviews with caregivers of young children. This data will be incorporated into building a distinct interactive intervention: iCARE (Intervention to Improve Caregiver Adherence Regarding Early Peanut Introduction). Using web-, mobile-, and/or video-based applications, the goal of iCARE will be to address caregiver barriers and unmet needs to facilitate early peanut introduction. After following an iterative prototyping process to develop iCARE with stakeholders and experts, it will be tested among caregivers to understand its efficacy, acceptability, and feasibility. This will provide preliminary data for an R01 proposal studying the effectiveness of iCARE in a randomized clinical trial. As caregivers are the ultimate drivers of PPA guideline implementation, this project addresses a gap in our current approach to PA prevention. This K23 proposal addresses multiple gaps in Dr. Samady’s research skillset, providing additional training in: 1) qualitative data analysis, 2) behavioral science training, 3) development and evaluation of novel behavioral interventions. Her primary mentor, Dr. Gupta is a national leader in food allergy prevention studies, her co- mentor Dr. McGee is a leading expert in qualitative research and professional development, and her co- mentors Drs. Van Horn, and Pongracic have additional expertise in developing and evaluating behavioral interventions. Completion of these aims and training goals will support Dr. Samady’s long-term goal of become an independent investigator and national leader studying infants with atopic disease, focused on improving the implementation of current food allergy prevention efforts and identifying new prevention strategies.