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

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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.