Therapy competence in delivering a brief cognitive behavioural therapy intervention to reduce maternal anxiety associated with child food allergy

Online, group, low-intensity psychological intervention for adults, children, and parents with food allergy

BACKGROUND

Food allergy (FA) impairs psychological wellbeing because of constant vigilance, planning and preparation, dietary and social restrictions, and fear of accidental ingestion, though psychological interventions are sparse.

OBJECTIVE

To examine online, group, low-intensity psychological interventions for adults, children, young people (CYP), and parents with food allergies.

METHODS

The randomized controlled trials assessed the feasibility and signal of the efficacy of a psychological intervention for adults, CYP, and parents with FA. Participants were randomized to receive the psychological intervention or treatment as usual. The intervention consisted of two, 3-hour manualized online sessions spaced 1 week apart. All participants completed relevant Food Allergy Quality of Life Questionnaires (FAQLQ) and worry (Penn State Worry Questionnaires), in addition to exploratory outcomes, at baseline, 1 month, and 3 months.

RESULTS

A total of 129 participants (n = 44 adults, n = 52 CYP, and n = 33 parents) were recruited and randomized; 95 (74%) (n = 36 adults, n = 35 CYP, and n = 24 parents) were retained at 3 months. Owing to baseline differences, mean change was used for parent and CYP outcomes. The psychological intervention demonstrated large FAQLQ benefits across adults (g = -1.12, 95% CI -0.41 to -1.28), CYP (g = 1.23, 95% CI 0.51-1.95), and parents (g = 1.43, 95% CI 0.54-2.30) compared with controls at 3-months.

CONCLUSION

This study provides encouraging findings regarding the feasibility of online, group, low-intensity psychological interventions, in terms of recruitment and retention as well as a signal of efficacy on FAQLQ. A definitive trial including health economic analysis and FA-specific psychological measures with consideration of best routes to implementation, is warranted.

TRIAL REGISTRATION

Clinicaltrials.gov Identifiers: NCT04763889 (adults), NCT04770727 (CYP), and NCT04774796 (parents).

Parental anxiety in food allergy: using a cognitive behavioural therapy approach to guide early intervention

Food allergy is a common allergic disease and often coexists with other allergic diseases such as asthma, allergic rhinitis and eczema. Parents of children and young people with food allergy commonly experience stress and anxiety and this can significantly affect their child's mental health. Interventions that incorporate approaches from cognitive behavioural therapy (CBT) can reduce stress and anxiety in parents of children and young people with food allergy and support healthy adjustment and psychological well-being in their children. However, access to psychological services is limited. This article uses reflection on a case study to illustrate the value of taking a CBT-informed intervention approach and to outline the potential role for nurses in its delivery. Research suggests that talking therapies may improve mental health and parenting behaviours in the parents of children and young people with a range of long-term conditions, so this article is also relevant to their care.

Managing food allergies at school: A qualitative study

INTRODUCTION

The prevalence of childhood allergic diseases, including food allergies, has increased globally. Parents and children have experienced psychosocial and financial difficulties, decreased quality of life, anxiety, and depression in the management of food allergies in schools.

PURPOSE

The aim of the study was to determine the challenges experienced by mothers of children with food allergies during their children's school life.

DESIGN

A qualitative phenomenological study design was used.

METHODS

Online interviews were conducted with 9 mothers who have children with food allergies between June-August 2022. The data were analyzed using the content analysis method. The COREQ checklist was used in the study.

RESULTS

The ages of the mothers participating in the study ranged from 28 to 40. Four themes were generated from 75 codes: 1) Problems experienced in the process of utilizing health services, 2) Burden of care, 3) Coming out of the shell: The school process, and 4) Environmental and social perspective.

CONCLUSIONS

Mothers carried the burden of food allergy management during the school process, and the increased burden of care negatively impacted mothers emotionally, physically, and socially. Also, mothers were anxious about the safety of their school-age children with food allergies and their experiences with school administration, teachers, and other parents made it difficult for food allergy management in the school environment.

CLINICAL RELEVANCE

Children with chronic health problems such as food allergies need to be closely monitored by a health professional in school to ensure their safety. Nurses have a pivotal role in supporting families to address their child's food allergies competently, hence fostering positive health outcomes. This study showed that there was a need for the development of school health policies to ensure the safety of children with food allergies and to reduce anxiety and care burden among mothers.

Living with food allergy: What this means for children

Health-related knowledge, skills and attitudes that translate to behaviours are important foundations for healthy living. However, deficiencies in any one of these factors have the potential to impact quality of life. This study investigates how Australian children perceive and manage their food allergy as they transition through childhood onto adolescence. To measure this, children aged 12 years and under completed an online survey [under 8 years and 8-12 years] on knowledge, skills and attitudes. Although recruitment involved advertisements to over 700 Australian pre-schools, 44 allergy specialists and multiple representations to the patient support group, Allergy & Anaphylaxis Australia, completion relied on parental notification and/or guidance. Of the 139 participants recruited, 114 commenced the survey with 65 participants under 8 years (58%) and 49 between 8 and 12 years. Results showed participants recognised different ways to keep safe with children under 8 years (N = 65) 100% cognisant of the need to check with 'Mum/Dad' or teachers if they could safely eat food as well as the importance of not swapping lunches, while there was a slight change in compliance for those aged 8-12 years as three (6.1%, n = 3/49) children did not see the necessity of asking an adult/teacher if a food item was safe to eat. Older children were also less likely to tell friends about their food allergy even if they thought they were having an allergic reaction, despite children under 8 years more likely to feel different to friends (38%, n = 24/64) compared to those aged 8-12 years (31%, n = 14/45). Although both groups disliked parents' fussing, for children under 8 years, there was a strong association between this and 'feeling different to friends'. Results from this study highlight the importance of normalising food allergy at home and in the community, so children are confident in telling others about their food allergy.

Trick or treat? - when children with childhood food allergies lead parents into unhealthy food choices

BACKGROUND

This study examines the relationships between childhood food allergy and parental unhealthy food choices for their children across attitudes towards childhood obesity as mediators and parental gender, income and education as potential moderators.

METHODS

We surveyed parents with at least one child between the ages of 6 and 12 living in Canada and the United States. We received 483 valid responses that were analysed using structural equation modelling approach with bootstrapping to test the hypothetical path model and its invariance across the moderators.

RESULTS

The analysis revealed that pressure to eat fully mediated the effects of childhood food allergy and restriction on parental unhealthy food choices for their children. Finally, we found that parental gender moderated the relationship between childhood food allergy and the pressure to eat.

CONCLUSIONS

The paper contributes to the literature on food allergies among children and the marginalisation of families with allergies. Our explorative model is a first of its kind and offers a fresh perspective on complex relationships between variables under consideration. Although our data collection took place prior to Covid-19 outbreak, this paper bears yet particular significance as it casts light on how families with allergies should be part of the priority groups to have access to food supply during crisis periods.