Investigation of Food Allergy Training and Child Nutrition PDF
Preview Investigation of Food Allergy Training and Child Nutrition
INVESTIGATION OF FOOD ALLERGY TRAINING AND CHILD NUTRITION PROFESSIONALS‟ KNOWLEDGE AND ATTITUDES ABOUT FOOD ALLERGIES by YEE MING LEE B. S., (Honors) Universiti Sains Malaysia, 2004 M.S., Texas Woman‟s University, 2008 AN ABSTRACT OF A DISSERTATION submitted in partial fulfillment of the requirements for the degree DOCTOR OF PHILOSOPHY Department of Hospitality Management and Dietetics College of Human Ecology KANSAS STATE UNIVERSITY Manhattan, Kansas 2012 Abstract Food allergies affect 1 in 25 school-aged children in the U.S., and Child Nutrition Professionals (CNPs) need more vigilance serving them. To assess CNPs‟ knowledge, attitudes about food allergies including barriers to providing food allergy training, as well as current training practices; an online survey was conducted with randomly selected 1,500 CNPs nationwide. The survey instrument was developed based on focus groups, pilot-tested, and sent to the sample via email. About 24% or 340 CNPs completed the survey. Descriptive and inferential statistics including hierarchical and logistic regressions were calculated using SPSS. A majority of respondents currently provide allergen free meals in their districts (n=256). The mean food allergy knowledge score of CNPs was 31.9 (Standard Deviation=3.3) of 39. Respondents scored lowest on recognizing symptoms of food allergic reactions and understanding food allergen-related terminology. Years of managerial experience and previous food allergy training were positively associated with the knowledge scores. Most participants viewed food allergy as an important issue, but they faced challenges fulfilling last-minute allergen-free meal requests and purchasing allergen-free products. Sixty percent (n=200) did not provide any food allergy training. Of those who provided some sorts of training (n=140), the training was provided in groups (n=96), “one-on-one” basis (n=30), or combination of both methods (n=14). The employees were trained annually (n=76), once a year if they worked directly with the students with food allergies (n=52), and/or when they were newly hired (n=33). Lack of time and funding were barriers to providing food allergy training. Previous food allergic reactions and regulatory requirements served as cues to providing food allergy training. Previous food allergy training, knowledge, and self-efficacy were factors differentiating if food allergy training had or had not been provided in past 12 months. Systematic and regular food allergy training may be needed to ensure allergen-free meals are properly prepared. Food allergy training for CNPs to improve knowledge and self-efficacy may increase food allergy training at school food service establishments. INVESTIGATION OF FOOD ALLERGY TRAINING AND CHILD NUTRITION PROFESSIONALS‟ KNOWLEDGE AND ATTITUDES ABOUT FOOD ALLERGIES by YEE MING LEE B. S., (Honors) Universiti Sains Malaysia, 2004 M.S., Texas Woman‟s University, 2008 A DISSERTATION submitted in partial fulfillment of the requirements for the degree DOCTOR OF PHILOSOPHY Department of Hospitality Management and Dietetics College of Human Ecology KANSAS STATE UNIVERSITY Manhattan, Kansas 2012 Approved by: Approved by: Co-Major Professor Co-Major Professor Junehee Kwon Deborah D. Canter Copyright YEE MING LEE 2012 Abstract Food allergies affect 1 in 25 school-aged children in the U.S., and Child Nutrition Professionals (CNPs) need more vigilance serving them. To assess CNPs‟ knowledge, attitudes about food allergies including barriers to providing food allergy training, as well as current training practices; an online survey was conducted with randomly selected 1,500 CNPs nationwide. The survey instrument was developed based on focus groups, pilot-tested, and sent to the sample via email. About 24% or 340 CNPs completed the survey. Descriptive and inferential statistics including hierarchical and logistic regressions were calculated using SPSS. A majority of respondents currently provide allergen free meals in their districts (n=256). The mean food allergy knowledge score of CNPs was 31.9 (Standard Deviation=3.3) of 39. Respondents scored lowest on recognizing symptoms of food allergic reactions and understanding food allergen-related terminology. Years of managerial experience and previous food allergy training were positively associated with the knowledge scores. Most participants viewed food allergy as an important issue, but they faced challenges fulfilling last-minute allergen-free meal requests and purchasing allergen-free products. Sixty percent (n=200) did not provide any food allergy training. Of those who provided some sorts of training (n=140), the training was provided in groups (n=96), “one-on-one” basis (n=30), or combination of both methods (n=14). The employees were trained annually (n=76), once a year if they worked directly with the students with food allergies (n=52), and/or when they were newly hired (n=33). Lack of time and funding were barriers to providing food allergy training. Previous food allergic reactions and regulatory requirements served as cues to providing food allergy training. Previous food allergy training, knowledge, and self-efficacy were factors differentiating if food allergy training had or had not been provided in past 12 months. Systematic and regular food allergy training may be needed to ensure allergen-free meals are properly prepared. Food allergy training for CNPs to improve knowledge and self-efficacy may increase food allergy training at school food service establishments. Table of Contents List of Figures ............................................................................................................................... xii List of Tables ............................................................................................................................... xiii Acknowledgements ....................................................................................................................... xv Dedication .................................................................................................................................. xviii CHAPTER 1 - INTRODUCTION .................................................................................................. 1 Introduction ................................................................................................................................. 1 Statements of Problems .............................................................................................................. 5 Justification ................................................................................................................................. 6 Purpose ........................................................................................................................................ 7 Objectives and Null Hypotheses ................................................................................................. 7 Significance of the Study ............................................................................................................ 9 Assumptions .............................................................................................................................. 11 Limitations ................................................................................................................................ 11 Definition of Terms .................................................................................................................. 12 References ................................................................................................................................. 14 CHAPTER 2 - LITERATURE REVIEW ..................................................................................... 18 Overview of Food Allergies ..................................................................................................... 18 Causes, Diagnostic Tests, and Treatment of Food Allergies .................................................... 21 Impacts of Food Allergies ......................................................................................................... 23 Children with Food Allergies ................................................................................................ 23 Parents of Children with Food Allergies............................................................................... 25 School Personnel ................................................................................................................... 27 Financial Costs of Food Allergies ......................................................................................... 27 Food Allergic Reactions at School and School Interventions .................................................. 28 Incidence of Food Allergic Reactions at Schools ................................................................. 28 Causes of Food Allergic Reactions and Fatalities ................................................................ 30 Food Allergy Policies at Schools .......................................................................................... 31 Controversies regarding Food Allergy Policies at Schools .................................................. 34 viii Food Allergy Legislation .......................................................................................................... 35 Food Allergy Training .............................................................................................................. 38 Food Allergy Intervention ..................................................................................................... 38 Food Allergy Training in Food Service Establishments ....................................................... 39 Barriers to Implementing Employee Training ...................................................................... 42 Theoretical Concept .................................................................................................................. 44 Health Belief Model .............................................................................................................. 44 References ................................................................................................................................. 51 CHAPTER 3 - METHODOLOGY ............................................................................................... 63 Selection of Sample .................................................................................................................. 64 Elicitation Study: Focus Groups ............................................................................................... 65 Instrument Development ........................................................................................................... 69 Demographic Characteristics of Respondents ...................................................................... 69 Food Allergy Training Practices ........................................................................................... 70 Food Allergy Knowledge ...................................................................................................... 70 Other Variables ..................................................................................................................... 71 Attitudes toward food allergies ......................................................................................... 71 Issues involved in dealing with food allergies .................................................................. 71 Perceived barriers in providing food allergy training ....................................................... 71 Cues to actions in providing food allergy training............................................................ 72 Self-efficacy in providing food allergy training ............................................................... 72 Pilot Study ................................................................................................................................. 72 Data Collection ......................................................................................................................... 74 Data Analysis ............................................................................................................................ 75 References ................................................................................................................................. 77 CHAPTER 4 - RESULTS ............................................................................................................. 78 Qualitative Research: Focus Groups ......................................................................................... 79 Participants ............................................................................................................................ 79 Attitudes toward Food Allergies ........................................................................................... 79 Issues in Dealing with Food Allergies .................................................................................. 80 Practices of Food Allergy Training ....................................................................................... 81 ix Perceived Barriers to Providing Food Allergy Training to the Employees .......................... 82 Triggers for Food Allergy Training ...................................................................................... 83 Quantitative Research: Online Survey ...................................................................................... 84 Demographic Characteristics ................................................................................................ 84 Respondents‟ Previous Food Allergy Training ..................................................................... 86 Food Allergy Documentation, Incidences and Training Practices in ................................... 87 School Food Service ............................................................................................................. 87 Food Allergy Knowledge ...................................................................................................... 89 Attitudes toward Food Allergies ........................................................................................... 93 Issues in Dealing with Food Allergies .................................................................................. 95 Perceived Barriers to Providing Employee Food Allergy Training ...................................... 98 Triggers for Food Allergy Training .................................................................................... 100 Self-efficacy ........................................................................................................................ 101 Food Allergy Training Decision ......................................................................................... 103 CHAPTER 5 - DISCUSSIONS AND IMPLICATIONS ........................................................... 105 Qualitative Research: Focus Groups ....................................................................................... 105 Quantitative Research: Online Survey .................................................................................... 108 Food Allergy Training ........................................................................................................ 108 Food Allergy Knowledge .................................................................................................... 111 Attitudes about Food Allergies in School Food Service ..................................................... 112 Issues for Dealing with Food Allergies .............................................................................. 114 Perceived Barriers for Food Allergy Training .................................................................... 115 Triggers for Food Allergy Training .................................................................................... 117 Self-efficacy ........................................................................................................................ 118 References ............................................................................................................................... 119 CHAPTER 6 - SUMMARY AND CONCLUSION ................................................................... 123 Summary of Research ............................................................................................................. 123 Qualitative Research: Focus Groups ................................................................................... 124 Quantitative Research: Online survey ................................................................................ 125 Implications and Future Research ........................................................................................... 132 Limitations .............................................................................................................................. 135 x
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