Food allergy is a growing problem [1
], affecting between 6–8% of children in the United States [3
]. In fact, food has been shown to be the most common cause of childhood anaphylaxis [6
], a potentially fatal reaction that can be prevented only by strict avoidance of allergenic foods [3
] and results in an estimated 150 US deaths per year [9
]. Accordingly, recognition of hidden food allergens is vital to the prevention of life-threatening episodes and death.
Food is ubiquitous and often plays a central role in many types of social gatherings. It is also frequently used as a reward or a symbol for celebration for young children. As such, food allergy concerns not only the families of affected children but also schools, restaurants, and airlines, to name a few. Due to the growing nature of the problem, more attention has been brought to the disease, though little is known about the knowledge, attitudes, and beliefs of food allergy among parents of children with food allergy, primary care physicians, and the general public. Each group, however, plays a critical role in the health and well-being of affected children.
The role of parents and families of children with food allergy is well-documented; the burden of risk assessment is placed on caregivers of food-allergic children and has been shown to adversely affect quality of life [7
]. Primary care physicians, including pediatricians and family physicians, are often the first and sometimes the only clinicians to diagnose and manage food allergy in a child. The general public plays a part as well, as they often interact with young children at restaurants, entertainment facilities, and schools. Many lifestyles now depend on food prepared away from home [12
], and 76% of food allergy deaths follow food consumption outside of the home [13
]. Furthermore, approximately 18% of children with food allergy have at least 1 reaction at school within a 2-year period [8
In spite of the latter, there do not appear to be any validated, population-specific survey instruments designed to assess perceptions and understanding of food allergy. Without a cure, such instruments are necessary to characterize baseline knowledge, to develop effective education, advocacy, and prevention strategies, and to measure the impact of these strategies. The purpose of this paper is to detail the development of the Chicago Food Allergy Research Surveys, 3 validated survey instruments to assess food allergy knowledge, attitudes, and beliefs of (1) parents of children with food allergy, (2) pediatricians and family physicians, and (3) the general public.
Overview of development
Figure outlines the process undertaken in the development of each validated survey instrument. Preliminary analysis (Phase I) consisted of a review of published literature and internal collaboration to aid in the creation of initial content domains. Initial domains were then submitted to a group of experts in the field of food allergy for review, revision, and approval. Focus groups were conducted for each survey population to identify emerging themes within content domains. Survey validation (Phase II) followed, with utilization of focus group themes in the construction of initial survey items. Initial items were submitted to the expert panel to assess the importance and face validity of each item. Upon item revision and approval, cognitive interviews were conducted with members of each survey population to ensure the understandability. Items were then subject to reliability testing, to account for the consistency of participant response, followed by item reduction, to remove superfluous and nonessential survey items. Final validation was conducted in tandem with the national administration of the survey (Phase III), using a soft launch of 150 responses to assure the overall validity of each instrument.
Stages in the development of survey instruments to assess food allergy knowledge, attitudes, and beliefs of parents, physicians, and the general public.