Investigation of Food Allergy Training and Child Nutrition

193 Pages·2012·2.63 MB·English

by  Yee Ming Lee

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