A behavioral economics intervention to encourage epinephrine-carrying among food-allergic adults: a randomized controlled trial

Cannuscio, Carolyn C.; Dupuis, Roxanne; Graves, Amy J.; Seymour, J; Kounaves, Sarah; Strupp, Emily; Leri, Damien; Frasso, Rosemary; Grande, David; Meisel, Zachary F.

doi:10.1016/j.anai.2015.05.018

Cited by 15 publications

(11 citation statements)

References 31 publications

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“…Middle‐ and high‐school are periods when school supports are particularly crucial to protect against adolescent impulsivity, peer approval‐seeking, and risk‐taking, especially given that students are less likely to have emergency action plans in place after the fifth grade . Preliminary evidence suggests that behavioral economics approaches, including text message prompts and financial incentives, may help students more safely manage their allergies. However, the literature currently lacks policy implementation studies demonstrating effective institutional approaches to food allergy management.…”

Section: Discussionmentioning

confidence: 99%

Food Allergy Management at School

Dupuis

Kinsey

Spergel

et al. 2020

Journal of School Health

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BACKGROUND: Approximately 8% of schoolchildren in the United States experience potentially life-threatening food allergies.They must diligently avoid allergenic foods and have prompt access to epinephrine to treat anaphylaxis. These prevention strategies must be sustained without interruption, posing a range of challenges at school. METHODS:We conducted semi-structured interviews with 178 participants about their experiences managing food allergies outside the home. Interviews were transcribed and analyzed using an iterative approach in NVivo 10. RESULTS:Participants reported highly varied school experiences across the ecological model. They described the need to be proactive and self-sufficient to manage food allergies. Whereas food allergy-related social exclusion was common, participants also described positive peer interactions, including intensive peer engagement and support. They perceived that formal school policies were limited in scope and inconsistently implemented. Prevention-oriented policies were more common in lower grades than in higher grades. CONCLUSIONS:Poorly defined and implemented policies disrupted students' social and educational experiences at school, families' relationships with school staff, and, ultimately, the safety and wellbeing of students with allergies. Given the high prevalence of food allergies among children, these findings demonstrate the need for multiple layers of support to facilitate safe, socially inclusive food allergy management at schools. F ood allergy prevalence is on the rise, and an estimated 8% of children ages 0-17 in the United States are affected. 1 Food-induced anaphylaxis, a severe, life-threatening allergic reaction, resulted in a 285% increase in pediatric (ages 5-17) emergency department visits between 2005 and 2014. 2 Food allergy management demands diligent avoidance of allergenic foods and uninterrupted access to life-saving epinephrine. Both strategies require sustained behavioral control, presenting particular challenges for adolescents. Approximately 18% of children with food allergies experience a reaction at school over

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Section: Discussionmentioning

confidence: 99%

Food Allergy Management at School

Dupuis

Kinsey

Spergel

et al. 2020

Journal of School Health

Self Cite

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“…However, broader details on the platform were not well detailed [22]. Beyond summative evaluations, qualitative studies have sought to explore user perceptions of mobile tools and/or health information messaging programs in the US [23, 24], New Zealand [25], and India [26–29]. However, none of these present quantitiative data on the technological performance of the program; instead focusing on reported perceptions of the technology, including feasibility, usability and/or acceptability.…”

Section: Discussionmentioning

confidence: 99%

Mobile Technology for Community Health in Ghana: what happens when technical functionality threatens the effectiveness of digital health programs?

LeFevre

Mohan

Hutchful³

et al. 2017

BMC Med Inform Decis Mak

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BackgroundDespite the growing use of technology in the health sector, little evidence is available on the technological performance of mobile health programs nor on the willingness of target users to utilize these technologies as intended (behavioral performance). In this case study of the Mobile Technology for Health (MOTECH) program in Ghana, we assess the platform’s effectiveness in delivering messages, along with user response across sites in five districts from 2011 to 2014.MethodsMOTECH is comprised of “Client Data Application" (CDA) which allows providers to digitize and track service delivery information for women and infants and “Mobile Midwife” (MM) which sends automated educational voice messages to the mobile phones of pregnant and postpartum women. Using a naturalist study design, we draw upon system generated data to evaluate message delivery, client engagement, and provider responsiveness to MOTECH over time and by level of facility.ResultsA total of 7,370 women were enrolled in MM during pregnancy and 14,867 women were enrolled postpa1rtum. While providers were able to register and upload patient-level health information using CDA, the majority of these uploads occurred in Community-based facilities versus Health Centers. For MM, 25% or less of expected messages were received by pregnant women, despite the majority (>77%) owning a private mobile phone. While over 80% of messages received by pregnant women were listened to, postpartum rates of listening declined over time. Only 25% of pregnant women received and listened to at least 1 first trimester message. By 6–12 months postpartum, less than 6% of enrolled women were exposed to at least one message.ConclusionsCaution should be exercised in assuming that digital health programs perform as intended. Evaluations should measure the technological, behavioral, health systems, and/or community factors which may lead to breaks in the impact pathway and influence findings on effectiveness. The MOTECH platform’s technological limitations in ‘pushing’ out voice messages highlights the need for more timely use of data to mitigate delivery challenges and improve exposure to health information. Alternative message delivery channels (USSD or SMS) could improve the platform’s ability to deliver messages but may not be appropriate for illiterate users.Trial registrationNot applicable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0421-9) contains supplementary material, which is available to authorized users.

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“…It is unclear whether providing people at risk of anaphylaxis with financial incentives increases how often they carry autoinjectors because the certainty of evidence is very low (Appendix b). One trial in people aged 18 to 30 years found that financial incentives were associated with a 27% mean increase in the proportion of people carrying their autoinjector (statistically significant, CI not reported, very low certainty) 69 …”

Section: Resultsmentioning

confidence: 99%

Diagnosing, managing and preventing anaphylaxis: Systematic review

Silva¹,

Singh²,

Muraro³

et al. 2020

Allergy

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Background This systematic review used the GRADE approach to compile evidence to inform the European Academy of Allergy and Clinical Immunology's (EAACI) anaphylaxis guideline. Methods We searched five bibliographic databases from 1946 to 20 April 2020 for studies about the diagnosis, management and prevention of anaphylaxis. We included 50 studies with 18 449 participants: 29 randomized controlled trials, seven controlled clinical trials, seven consecutive case series and seven case‐control studies. Findings were summarized narratively because studies were too heterogeneous to conduct meta‐analysis. Results It is unclear whether the NIAID/FAAN criteria or Brighton case definition are valid for immediately diagnosing anaphylaxis due to the very low certainty of evidence. There was also insufficient evidence about the impact of most anaphylaxis management and prevention strategies. Adrenaline is regularly used for first‐line emergency management of anaphylaxis but little robust research has assessed its effectiveness. Newer models of adrenaline autoinjectors may slightly increase the proportion of people correctly using the devices and reduce time to administration. Face‐to‐face training for laypeople may slightly improve anaphylaxis knowledge and competence in using autoinjectors. We searched for but found little or no comparative effectiveness evidence about strategies such as fluid replacement, oxygen, glucocorticosteroids, methylxanthines, bronchodilators, management plans, food labels, drug labels and similar. Conclusions Anaphylaxis is a potentially life‐threatening condition but, due to practical and ethical challenges, there is a paucity of robust evidence about how to diagnose and manage it.

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A behavioral economics intervention to encourage epinephrine-carrying among food-allergic adults: a randomized controlled trial

Cited by 15 publications

References 31 publications

Food Allergy Management at School

Food Allergy Management at School

Mobile Technology for Community Health in Ghana: what happens when technical functionality threatens the effectiveness of digital health programs?

Diagnosing, managing and preventing anaphylaxis: Systematic review

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