Understanding family food purchasing behaviour of low-income urban UK families: An analysis of parent capability, opportunity and motivation

Objective Family food purchasing decisions have a direct influence on children's food environments and are powerful predictors of obesity and dietary quality. This study explored parents' capability, opportunities, and motivations regarding food purchasing for their families, as well as barriers and facilitators of healthy food purchasing behaviour, in an ethnically diverse, low-income area. Design Semi-structured interviews with parents of under-11-year-old children were conducted to investigate family food purchases, both when eating inside and outside the home. Interviews were analysed using framework analysis mapped against the COM-B model (Michie et al., 2011). Setting An ethnically diverse, low-income area in Birmingham, UK. Participants Sixteen parents (13F, 3M) of under-11-year-old children. 75% Pakistani, 12.5% White British, 6.3% White and Black Caribbean, and 6.3% “Other”. Results Four themes were identified: i) I know how to provide healthy meals for my family, ii) Family food purchase decisions are complex, iii) I want what they are eating and iv) Healthy eating is important but eating outside of the home is a treat. The barriers of healthy family food purchasing were predominantly at family and community levels, including time, cost, and both parents' and children's food enjoyment and preferences. Facilitators of healthy family food purchasing were primarily identified at an individual level, with high levels of capability and motivation for healthy food provision. Conclusions Attempts to enhance parental capability to improve healthy food purchasing through nutrition education is not likely to be a useful intervention target in this group. Emphasis on enjoyment, palatability and value for money could be key to increasing parental motivation to purchase healthy family foods

Psychological support needs for children with food allergy and their families: a systematic review

This systematic review aimed to review the evidence for psychological support for children with food allergies and their families, identify effective psychological interventions, and highlight the support needs for this group. A systematic search was undertaken across six databases (up to October 2023). Articles were checked by three reviewers for inclusion. Study data were extracted, and quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was undertaken. A total of 11 papers were included (n = 838 participants). Intervention types were based on cognitive behavioral therapy (CBT; n = 7); psycho-education (n = 1); peer mentoring (n = 1); self-regulation theory (n = 1); and coping (n = 1). Two interventions were for children only, three were for children and parents and six for parents only. Cognitive behavioral therapy-based interventions with highly anxious parents or children or those facilitated by a psychologist showed significant improvements with moderate-to-large effect sizes. The one self-help CBT-based online program showed no effects. Other intervention types reported mainly trends in improvement due to small sample sizes. Most interventions were aimed at supporting children or parents in day-to-day management of food allergy, measuring outcomes such as quality of life, self-efficacy, anxiety, worry, and depression. One intervention was designed to assist with oral immunotherapy outcomes. The majority of the studies had small sample sizes and were feasibility or proof-of-concept studies. Available research evidence points to effectiveness of facilitated CBT-based interventions for those that have high food allergy-related anxiety, but as many studies have small sample sizes and few report effect sizes, no firm conclusions can yet be drawn. A stepped care approach is likely to be useful for this population. Research using large interventional designs, particularly for children and adolescents, are needed

Co-Development of a Novel Treatment Adherence Intervention for Young People with Inflammatory Bowel Disease (IBD)

Rates of treatment non-adherence could be as high as 93% amongst young people with Inflammatory Bowel Disease (IBD). However non-adherence to prescribed treatment plans can have significant clinical consequences for young people with IBD. Subsequently, additional support is needed to help young people maintain their IBD treatment adherence behaviours. Paediatric IBD treatment plans contain multiple complex self-management behaviours, including medication taking and following lifestyle advice. Currently, published interventions solely aim to improve adherence to oral medication among young people with IBD. This thesis details the co-development of a novel online, evidence-based theory-driven user-centred behaviour change intervention to improve treatment adherence in young people (aged 13-18) with IBD. Findings from a systematic review evaluating the effectiveness of treatment interventions as well as outcomes of a framework analysis of young people with IBD’s adherence experiences and support needs, were synthesised and mapped onto psychological constructs. The Behaviour Change Wheel approach informed the intervention’s development, and supported the identification of relevant behaviour change theories and techniques. An online Patient and Public Involvement and Engagement group of young people (aged 13-17) with IBD co-developed the intervention’s components and delivery methods; resulting in novel youth-led intervention functions. To strengthen the intervention’s acceptability, feedback from young people with IBD and their parents were incorporated into the intervention prototype. The co-developed intervention, A Self-led Self-management Intervention to Support Teenagers with IBD (ASSIST-IBD), contains ten interactive modules informed by psychological theory and constructs. ASSIST-IBD aims to empower young people to follow their IBD treatment plan and autonomously perform self-management behaviours. Within each intervention module, young people are supported to develop user-centred action plans to improve their treatment adherence behaviours. This research highlights how co-developing interventions can enrich the intervention development process and result in an acceptable and relevant intervention for young people with IBD

Co-development of a behavioural intervention to support treatment adherence in young people with inflammatory bowel disease

Objectives Treatment adherence in adolescents with Inflammatory Bowel Disease (IBD), ranges from 2%-93%, with the frequency of non-adherence ranging from 3%-57%.1 Non-adherence to a prescribed treatment regimen has significant clinical consequences. This research aimed to develop a novel, user-centred and theory-driven behavioural intervention to support young people (aged 13–18) with IBD adhere to their treatment plan. Methods Findings from a systematic review evaluating treatment adherence interventions for young people with IBD were synthesised with findings from exploratory, qualitative interviews with young people with IBD, parents of young people with IBD and healthcare professionals. Findings were then mapped to psychological constructs from relevant behaviour change theories and behaviour change techniques selected. Following a Behaviour Change Wheel approach,2 a novel intervention was developed, specifically addressing the treatment adherence needs of young people (aged 13–18) with IBD. A series of co-development workshops were conducted with young people (aged 13–18) with IBD. Within these workshops, young people provided feedback on the proposed intervention’s components and delivery, using a variety of participatory methods. Young people’s ideas were incorporated into a revised version of the intervention, aiming to improve its acceptability and feasibility. Further revisions were made in response to feedback collected from parents of young people with IBD. Results A prototype behavioural adherence intervention was co-developed with young people and parents to support treatment adherence in young people with IBD. Ten interactive online modules aimed to increase young people’s confidence to adhere to their treatment plan, support resilience to overcome adherence barriers, assist in the development of health communication skills and generate optimism about the future. Interactive online modules and components within each module can be tailored by the user to suit their own personal adherence challenges. Within each module young people are supported to develop user-centred action plans to improve their treatment adherence behaviours. These plans and corresponding behaviour change strategies are retained within the intervention modules, providing a personalised approach. A parent version of the intervention was also developed to support incremental transfer of responsibility for treatment adherence to young people themselves, as part of their transition to adulthood and adult services. Conclusions The Behaviour Change Wheel approach can be effectively used to co-create a user-centred and theory-driven behavioural intervention with young people. The developed intervention can be tailored to individual needs to support young people’s adherence. Further research is needed to establish the intervention’s feasibility and preliminary effectiveness

‘It’s not an illness, it’s just bad luck’: The impact of anaphylaxis on quality of life in adults

Background: An increasing number of adults are being diagnosed with anaphylaxis, but its impact on health-related quality of life (HRQol) is not known. Objective: The aim of this study was to explore the impact of anaphylaxis on HRQoL of newly diagnosed adults. Methods: Interviews were conducted with 13 adults (aged 40-71; five males) with anaphylaxis (meeting WAO diagnostic criteria) to drugs, food, venom or spontaneous anaphylaxis, recruited using purposive sampling from allergy clinics in Birmingham, UK. Data were transcribed verbatim and analysed using thematic analysis. Results: Four themes were generated from the analysis: the journey from fear to frustration; the need to maintain a healthy identity; control over uncertainty; and the supportive role of others. Participants described their first experiences of anaphylaxis as frightening. Managing the condition was associated with frustration and anxiety, in part due to uncertainty regarding when anaphylaxis might occur. Participants did not consider their allergy as an illness and wanted to retain an identity as a healthy person. They felt a strong need to have control over their anaphylaxis so that it did not take over their lives. The support from others was extremely important, but a lack of understanding of anaphylaxis sometimes hindered that support. Conclusions and Clinical Relevance: Anaphylaxis has an adverse impact on the HRQoL of adults irrespective of the cause. More information about anaphylaxis and its management from healthcare professionals may help patients gain a sense of control over their condition and reduce the worry and anxiety associated with it

Risk assessment behaviour when eating out in adults with food hypersensitivity

Background Food hypersensitivity (FHS) management requires daily risk assessments of all food and drink consumed to prevent unpleasant and potentially fatal adverse reactions. Most research has focused on food allergy in children and families. Little is known about the impact on adults or those with other FHS such as food intolerance or coeliac disease. This study assessed differences in practices and risk assessment behaviours when eating out for adults with FHS. Methods Adult UK residents (N= 930; 820 females, 90 males; 95% White; mean age 50 yrs [±16.6SD]), with food allergy (18%), food intolerance (23%) coeliac disease (44%) or multiple FHS (15%) completed an online survey. Results Adults checked information to identify foods causing a reaction always or most of the time when eating out. However, adults with food intolerance reporting checking significantly less often than adults with other FHS (all ps<0.001). Adults reporting more severe FHS, a medical rather than self-diagnosis of FHS, previous anaphylaxis, had called an ambulance or been in hospital due to a reaction checked information significantly more often (all ps<0.001), but were also less confident in the information provided (all ps<0.05). Adults with allergy, coeliac disease or multiple FHS were also less confident in written and verbal information provided than those with food intolerance (p<0.01). Type of FHS, greater perceived severity of FHS and having a medical diagnosis consistently predicted risk assessment behaviours when eating out (all ps<0.001). Conclusion Clinicians, patients and the food industry should be aware that type of FHS, patient perceived severity and past experience of reactions affect risk assessment behaviours when eating out. This should be considered when providing clinical advice and emergency plans