Tool Used to Assess Parents’ Management of Child Anaphylaxis, Autoinjector Administration

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The Parental Self-efficacy in Managing Anaphylaxis (PSEMA) questionnaire may be an effective tool for assessing parents' self-efficacy in their managing of childrens’ anaphylaxis and adrenaline via auto-injector, according to new findings.¹

Findings on this assessment tool were the result of new research led by Laura Polloni of the Food Allergy Referral Centre at Padua University Hospital in Italy. Polloni and her team highlighted the life-threatening nature of anaphylaxis, as well as its link to mental health burden among both patients and their caregivers.

The investigators also wrote that Intramuscular adrenaline through auto-injector use has been recommended as a treatment for anaphylaxis management in settings outside of the hospital. However, auto-injectors are often underused.

“The present study aimed to assess parental self-efficacy in managing child's anaphylaxis and administering (adrenaline via autoinjector) by using an ad-hoc tool, in order to understand how to support parents to effectively manage food-induced anaphylactic reactions at home,” Polloni and colleagues wrote. “The research is part of a wider project on quality of life and management of (food-induced anaphylaxis) and anaphylaxis in the family.”^1,2

Background and Design

The investigators conducted a cross-sectional observational analysis, requiring those who would participate to have a confirmed medical diagnosis of an IgE-mediated food allergy, in addition to a prescription for an adrenaline auto-injector for emergency situations. A clinician would, each year, provide hands-on training to caregivers.

Parents in the study were also given a written emergency protocol for their child’s school. Among a total of 83 eligible parents, the research team found 75 who agreed to join their analysis, with recruitment having taken place at the Food Allergy Referral Centre in the Veneto region of Padua, Italy.

The investigators’ questionnaire for evaluating parents’ self-efficacy in handling food-induced anaphylaxis and administering auto-injectors. Their questions were also rated on a Likert scale from 1 to 5, with the total scores having a range from 18 - 90.

Parents’ clinical appointments involved filling out paper-based questionnaires on an individual basis, with no missing data being permitted by the team. The questionnaire’s inquiries were made available to both the participants and to the primary researcher.

During the investigators’ recruitment process, lasting a single year, they also gathered socio-demographic and clinical information on subjects.

Cronbach’s alpha was implemented by the research team to assess the internal consistency, and they used the Anderson–Rubin approach to estimate factor scores and provide a kernel density for their distributions. Linear regression analysis was used to look into the association between the total factor and subjects’ overall scores.

Significant Findings

In their exploratory factor analysis, 5 key areas were identified: management of the injection, use of the auto-injector device, handling anaphylaxis, responding to emergencies, and management of emotions. The questionnaire was shown to have high internal consistency, and there was a Cronbach's alpha of 0.91 (95% CI: 0.87–0.94).

The team found that the variation in subjects' total score explained 90% of the variation in the factor score. Their evaluation led to the conclusion that parental self-efficacy had been lowest in managing anaphylaxis, handling their child's emotional responses, and determining when to implement the adrenaline auto-injector, suggesting these as areas where caregivers felt less confident in the managing of anaphylactic episodes.

“Though preliminary analysis showed good internal consistency, the scale needs further analysis and a larger sample would be desirable,” they wrote. “Participants were the parents of children who were attending a referral centre for food allergy, where an expert multidisciplinary team properly manages patients; this could limit the generalizability of the results.”

References

1. ^{Polloni L, Baldi I, Bianconi S, et al. Assessment of parental self-efficacy in managing child food-induced anaphylaxis and using adrenaline autoinjectors. Pediatr Allergy Immunol. 2024; 35:e14265. doi:10.1111/pai.14265.}
2. ^{Polloni L, Baldi I, Amadi M, et al. Management of children with food-induced anaphylaxis: a cross-sectional survey of parental knowledge, attitude, and practices. Front Pediatr. 2022; 10:886551.}