"Healthcare seems to vary a lot": A focus group study among parents of children with severe allergy

Parents of children with atopic diseases - experiences with care and the interaction with healthcare professionals over time

OBJECTIVE

To explore how the parents of children with atopic dermatitis and allergic diseases such as food allergy, allergic rhinoconjunctivitis, and asthma experience interactions with the Danish healthcare system over time.

DESIGN AND METHODS

A qualitative design with individual in-depth interviews. The analysis was inspired by Systematic Text Condensation.

SUBJECTS

Eleven parents of children with atopic dermatitis and allergic diseases who received treatment at hospitals in the Capital Region of Denmark. The families had experiences of cross-sectoral patient care.

RESULTS

Despite having the same diseases, the children's care pathways were very different. Mapping demonstrated the intricacy of care pathways for this group of children. We identified three aspects that impacted interaction with healthcare: responsibility, tasks, and roles. The families experienced care when the distribution of tasks and responsibilities associated with treatment and system navigation were consistent with both their expectations and their actual experiences. At the same time, families frequently experienced limited collaboration between healthcare professionals resulting in perceived fragmented care and an extended role for parents as care coordinators. Families felt cared for when healthcare professionals knew both their biomedical and biographical circumstances, and adjusted the level of support and care in accordance with the families' particular needs, expectations, and evolving competences.

CONCLUSION

We suggest that a possible pathway to improve care may be through a partnership approach as part of family-centered care, with general practitioners having a key role in helping to articulate the individual needs and expectations of each family.

The experiences of mothers of children with food allergy: A qualitative study

BACKGROUND

Food allergies adversely affect the quality of life of the child and family, as they require lifelong treatment and follow-up. This study aims to examine the experiences of mothers who have children with food allergies within the framework of the biopsychosocial-spiritual model.

METHODS

This study, using a qualitative research design, was carried out with mothers of children followed up with food allergy in the pediatric allergy outpatient clinic of a university hospital between December 15, 2022 and January 05, 2023. Purposive sampling method was used in the study and semi-structured interviews were conducted with 12 mothers. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist.

FINDINGS

Three themes, eight sub-themes, and 19 categories were identified: The effects of the disease on the physical health of the child and mother in the biological effects theme; psychosocial responses to disease, adaptation to treatment, future anxiety, coping strategies, and communication/interaction in the psychosocial effects theme; search for purpose-meaning in life and understanding belief/basic human values in the spiritual effects theme.

DISCUSSION

It has been concluded that food allergies affect maternal health extensively, especially in the psychosocial field, and that it affects family relationships, the time that mothers spare for themselves, and physical and spiritual health.

APPLICATION TO PRACTICE

The findings will be a guide for improving the quality of life of mothers followed up with food allergies and for the care and counseling support to be provided to mothers.

Self-Efficacy Among Caregivers of Children With Food Allergy: A Cohort Study

Objective

The prevalence of pediatric food allergy (FA) is increasing and, due to early disease onset, requires significant caregiver management that is associated with psychosocial burden. Caregiver perception of how they cope and handle FA-related events (self-efficacy) has been linked to psychosocial outcomes in racially/geographically homogenous samples. This study explores FA-related caregiver self-efficacy and associations with FA-related caregiver quality of life (QoL) in a diverse cohort.

Methods

Caregivers of children, diagnosed with IgE-mediated FA who identified as non-Hispanic Black or White, were recruited from U.S. academic allergy clinics. Caregivers completed demographic and medical questionnaires, the Food Allergy Self-Efficacy Scale for Parents (FASE-P), Food Allergy Independent Measure—Parent Form (FAIM), and the Food Allergy Quality of Life—Parental Burden (FAQL-PB). Bivariate and multivariate associations estimated relationships between study variables.

Results

Caregivers of 365 children (Mage = 5.8 years, 62.2% male, 31.1% Black) were enrolled. Caregivers reported high FA self-efficacy (M = 82.06/100), moderate perceptions of risk/FA severity (FAIM: M = 3.9/7), and some limitations on the FAQL-PB (M = 3.9/7). Self-efficacy was related to lower perceptions of risk/FA severity across all demographic groups (r = −.42, p < .001). Caregivers who reported higher self-efficacy reported better QoL, particularly Black caregivers (r = .67).

Conclusions

In this sample of caregivers of children with FA, greater self-efficacy was related to improved QoL regardless of sociodemographic factors. Caregivers’ perception of risk was lower for those with greater self-efficacy. Future research into the impact of FA management on QoL among diverse caregivers is needed.

Maternal anxiety and previous anaphylaxis are associated with alexithymia in young patients with food allergy

BACKGROUND

Alexithymia is a multifaceted personality construct described as "a lack of words to express emotions" that includes difficulty identifying feelings, difficulty describing feelings and a concrete, externally oriented cognitive style. Among patients with food allergy (FA) alexithymia has been found higher than in general population and associated with dysfunctional coping strategies. Childhood traumatic experiences and/or dysfunctional parent-child relationship can contribute to alexithymia. The study aimed to explore possible associations between child alexithymia and mother alexithymia and anxiety, as well as previous anaphylaxis.

METHODS

Sixty-five mother-child pairs have been recruited. Children had a medical diagnosis of FA. The Toronto Alexithymia Scale-20 was used to assess alexithymia in participants. The State-Trait Anxiety Inventory was used to assess trait anxiety in mothers. Statistical analysis was performed to investigate the influence of variables sex, previous anaphylaxis, and adrenaline auto-injector prescription on child and mother's alexithymia and to explore possible association between maternal and child alexithymia.

RESULTS

A substantial percentage of children were alexithymic (21.5%) or borderline (33.8%), while mothers' frequencies were lower and in line with prevalence in general population. Child alexithymia was positively associated with previous anaphylaxis and mothers' trait anxiety (p < .05). Mother trait anxiety was also associated with maternal alexithymia. Furthermore, a positive association between child and mother alexithymia has been found.

CONCLUSIONS

Clinicians must be aware of the role of alexithymia and its association with maternal anxiety and previous anaphylaxis in children with FA, encouraging seeking psychological support when needed. A multidisciplinary patient-centered approach should be put in place for the effective care of FA.

Food-allergy-specific anxiety and distress in parents of children with food allergy: A systematic review

BACKGROUND

Parenting a child with food allergy (FA) can lead to impaired quality of life and family functioning. Anxiety is a critical component of FA-associated distress and a potential target for therapeutic intervention. This systematic review aimed to clarify the concept of FA-specific anxiety (FAA) and its antecedents, consequences, and correlates and to determine the extent to which existing FA-specific outcome measures capture symptoms of parental distress and FAA.

METHODS

MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for qualitative and quantitative studies examining distress or anxiety in parents of children with FA through August 2020. This review was registered with PROSPERO (CRD42020208316) and conducted in accordance with PRISMA guidelines.

RESULTS

Ninety-eight studies were included in the final narrative synthesis. Most participants were mothers, and reporting of demographic data was limited. Parents identified anxiety as the most burdensome form of FA-specific emotional distress. Several allergy-related factors as well as medical and psychosocial interventions were associated with reduced parental anxiety and distress. However, affective, cognitive, and behavioral dimensions of FAA were only partially addressed by existing measures for general anxiety symptoms and FA-specific parental factors.

CONCLUSIONS

FAA contributes to distress and functional impairment among parents of children with FA. Current FA-specific parent measures fail to adequately capture dimensions of FAA, suggesting that further work is needed to improve the assessment and monitoring of FAA and its impacts. Characterization of this construct represents an initial step in developing standardized methods for assessing and monitoring FAA in clinical populations.

Living with Food Hypersensitivity as an Adolescent Impairs Health Related Quality of Life Irrespective of Disease Severity: Results from a Population-Based Birth Cohort

Food hypersensitivity (FHS) refers to food-related symptoms, with or without concurrent Immunoglobulin E (IgE) antibodies related to food(s). It remains unclear how different FHS phenotypes affect health-related quality of life (HRQoL). We examined self-reported HRQoL (with the generic instrument EQ-5D (dimensions and a Visual Analogue Scale (VAS), range 0–100) in association with phenotypes of FHS, and food-specific symptoms among adolescents (n = 2990) from a population-based birth cohort. Overall, 22% of the adolescents had FHS. Compared to adolescents without FHS, those with FHS reported more problems in the dimensions of pain/discomfort (p < 0.001), and anxiety/depression (p = 0.007). Females with FHS reported more problems than males in these dimensions (p < 0.001). Different FHS phenotypes (IgE-sensitization, allergic co-morbidity, and severity of symptoms) were not associated with differences in HRQoL. EQ-VAS scores were lowest for adolescents with symptoms for wheat vs. no wheat, median 80 vs. 89, p = 0.04) and milk vs. no milk (median 85 vs. 90, p = 0.03). Physician-diagnosed lactose intolerance median EQ-VAS was 80 vs. 90, p = 0.03 and also associated with more problems in the dimension of anxious/depression. In conclusion, FHS is associated with lower HRQoL in adolescence, irrespective of phenotypes, but differentially affects females vs. males, and those with vs. without symptoms for milk or wheat.

A scoping review of the caregiver burden of pediatric food allergy

OBJECTIVE

Although a number of articles have described the psychosocial impact of raising a child with a food allergy, recent attempts at synthesizing this literature have been narrow in focus or methodologically limited. Consequently, this study aimed to synthesize both the quantitative and qualitative literature to achieve a better understanding of the psychosocial and financial burdens faced by families who raise children with food allergy.

DATA SOURCES

Searches were performed on PubMed, Scopus, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases for articles related to the psychosocial and financial burden experienced by individuals who care for a child with food allergy.

STUDY SELECTIONS

English language, original research articles were included in this review.

RESULTS

A total of 54 articles were deemed eligible for review. Results from the quantitative literature revealed that parents of children with food allergy (ie, food allergy and food protein-induced enterocolitis, proctocolitis, and enteropathy) consistently reported lower quality of life than their comparison groups. Within-group analyses suggest that this burden is increased for parents who manage multiple food allergies, severe food allergy, and comorbid allergic conditions. Thematic synthesis of the qualitative literature suggests that the psychosocial burden shouldered by parents of children with food allergy stems, in part, from the unpredictable threat of exposure and the practical and social burdens of managing a food allergy. In addition to psychosocial burdens, a small but growing body of literature suggests that families with food allergy also incur greater financial costs.

CONCLUSION

Findings suggest that pediatric food allergy imposes considerable burdens on parents both quantitatively and qualitatively.

The Unmet Needs of Patients with Food Allergies

This article reviews the unmet needs of patients with food allergies. Anxiety is common among patients with food allergies and their caregivers, which naturally stems from the avoidance, exposure, and uncertainty involved in care. Anxiety associated with allergen avoidance can have both adaptive and detrimental effects on overall health. Anxiety has implications for transitioning the responsibility of health and well-being from caregivers to the patients. As more children with food allergies become adults with food allergies, this will be an urgent topic. Moreover, as more exposure-based therapies become available, understanding patients' psychological expectations and experiences of exposure is vital.

High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019

Background

Food allergy has a known effect on quality of life (QoL), but this has not been extensively studied during the coronavirus disease 2019 pandemic.

Objective

To characterize the levels of anxiety of mothers of children aged 0 to 8 years with food allergy compared with families of children without a food allergy and the health-related QoL among children with food allergy during the coronavirus disease 2019 pandemic.

Methods

In a mixed-methods study, Canadian mothers of children aged 0 to 8 years with (cases) and without (controls) food allergy provided demographic data and completed age-appropriate anxiety questionnaires between April 14, 2020, and April 28, 2020. The cases also provided food allergy-related data and completed the Food Allergy Quality of Life Questionnaire. In-depth interviews were subsequently conducted with purposefully selected cases.

Results

In a total of 580 participants, 5.5% were cases and 94.5% were controls. For mothers of children aged 0 to 1.5 years, anxiety levels did not differ between cases and controls. For mothers of children aged 1.5 to 8 years, anxiety levels were higher in cases vs controls (P < .05). Among the cases, neither overall nor domain-specific Food Allergy Quality of Life Questionnaire scores differed between age groups (0-3 vs 4-7 years), even after adjustment for confounding variables, including childcare during the pandemic. Qualitatively, the following 3 themes were identified: unexpected challenges of food shopping; less food-related food anxiety during the pandemic; and differences and delays in food allergy testing and therapy.

Conclusion

Mothers of children with food allergy reported high anxiety and poor health-related QoL. Yet, qualitatively, day-to-day food allergy management was better during the pandemic.

S.O.S! My Child is at School: A Hermeneutic of the Experience of Living a Chronic Disease in the School Environment

PURPOSE

The purpose of the present study is to understand the experience of living a chronic disease in the school, from the perspective of the parents.

DESIGN AND METHODS

A Grounded Theory study was proposed with a sample of 14 affected families with children between three and eleven years old, all of them from the west and south of Spain. Information was collected using semi-structured surveys and the constant comparative method was used for the analysis.

RESULTS

Results are divided into three main themes: SOS! My child is at school, The Systems (don't) Answer and Families Answer. Parents live school enrolment in a state of constant alertness, characterized by distrust, worry, fear, anguish, and indignation. The responses to the problem given by the education and health systems are insufficient, uncoordinated and inefficient. Therefore, parents end up not expecting anything, they transmit the information, organize training sessions, and solve any occurring incident by themselves, often at the expense of quitting their jobs.

CONCLUSION

The presence of a school nurse would mean for these parents the integration between the education and health systems.

PRACTICE IMPLICATIONS

As findings highlight, more collaboration and sensitivity between the healthcare and educational system is needed, and the school nurse has been indicated as a crucial figure in this matter.

Living with a Severe Allergy: Lived Perspectives from Swedish Adolescents and their Parents

BACKGROUND

During adolescence, the young person should gradually develop independence from his or her parents. However, having a chronic disease like a severe allergy may add stress and challenges beyond normal development and involves a struggle between adapting socially, feeling healthy, and managing the disease.

OBJECTIVE

To describe experiences of living with a severe allergy from the perspective of adolescents and their parents.

METHOD

A qualitative study with six focus group interviews were performed, two with adolescents and four with their parents (10 adolescents, 10-16 years old and 21 parents). The transcribed data were analyzed using systematic text condensation.

RESULT

Four themes emerged: Feeling different (adolescents and parents), shift in responsibility (adolescents and parents), the importance of parents (only adolescents) and the importance of healthcare providers (only parents). The adolescents relied on their parents, while also taking responsibility for managing their disease. The parents expressed a need to protect their children; but they did not seem to be aware of the responsibility their children took. The parents highlighted the importance of support from healthcare providers but this was not mentioned by the adolescents.

CONCLUSION

This study showed that both the adolescents and their parents stated that they took responsibility for managing the disease, but in different ways. For healthcare providers, this needs to be taken into account in order to support both adolescents and parents for self-management and shift in responsibilities which begins during adolescents.

Parents Experiences Raising a Child with Food Allergy; A Qualitative Review

PROBLEM

Food allergies are one of the fastest growing public health concerns without a cure, affecting approximately 8% of the world's child population. Being the parent of a child with allergies may lead to concerns, and affect everyday life in the family. The aim was to synthesize and describe parents' experiences of living with food allergies in families when one of the children has a food allergy.

ELIGIBILITY CRITERIA

A systematic search using subject terms and text words was performed in Cinahl (Ebsco), Swemed+, Medline (OVID) and Scopus in October 2017. The search was limited to parents with children and adolescents, for the years from 2006 to October 2017.

SAMPLE

One hundred and forty articles were screened and 24 were included.

RESULTS

A meta-summery of the results from the included studies were conducted. The parents lived in fear, after their child had their first reaction and had become allergic, a life threatening experience. They tried to live an ordinary family life and parents had to learn how to be one-step ahead and understand early signs. The family's social life was also influenced. Parents asked for support and information from health professionals and more knowledge and skills increased parents' manageability.

CONCLUSION

Parents need support and a seamless encounter with health professionals, with multidisciplinary collaboration and knowledge sharing to develop the parents' self-efficacy.

IMPLICATIONS

Health professionals must provide information and support parents on their path through the health-care system in having a child with a food allergy.

Health-Related Quality of Life Is Severely Affected in Primary Orthostatic Tremor

Background

Primary orthostatic tremor (POT) is a movement disorder characterized by unsteadiness upon standing still due to a tremor affecting the legs. It is a gradually progressive condition with limited treatment options. Impairments in health-related quality of life (HQoL) seem to far exceed the physical disability associated with the condition.

Methods

A multi-center, mixed-methodology study was undertaken to investigate 40 consecutive patients presenting with POT to four movement disorder centers in France. HQoL was investigated using eight quantitative scales and a qualitative study which employed semi-structured interviews. Qualitative data were analyzed with a combination of grounded-theory approach.

Results

Our results confirm that HQoL in POT is severely affected. Fear of falling was identified as the main predictor of HQoL. The qualitative arm of our study explored our initial results in greater depth and uncovered themes not identified by the quantitative approach.

Conclusion

Our results illustrate the huge potential of mixed methodology in identifying issues influencing HQoL in POT. Our work paves the way for enhanced patient care and improved HQoL in POT and is paradigmatic of this modern approach for investigating HQoL issues in chronic neurological disorders.