Pediatric Clinician Perspectives on Implementing Peanut Allergy Prevention: A Qualitative Study
Kathryn C. Kaplan, Priyanka Dadha, Adolfo J. Ariza, Sideeq Ibrahim, Samantha Sansweet, Ruchi S. Gupta, Rinad S. Beidas, Lucy A. BilaverBACKGROUND AND OBJECTIVES
Updated clinical guidelines for the prevention of peanut allergy (PPA) recommend early introduction of peanut-containing foods for most infants. The Intervention to Reduce Early Peanut Allergy in Children (iREACH) is an evidence-based implementation approach adherence. The objective of this study is to explore perceived barriers and facilitators of the iREACH implementation approach.
METHODS
A qualitative study was conducted using a semistructured interview. A guide developed using the Consolidated Framework for Implementation Research. Pediatric clinicians were recruited from practices in the iREACH trial control arm and 3 practices not involved in the iREACH effectiveness trial. A rapid analytic technique was used to identify key themes.
RESULTS
We conducted 19 semistructured interviews across 12 different practices. iREACH was generally perceived as a welcome and important enhancement to existing peanut allergy (PA) prevention efforts. Clinicians generally supported clinical decision support tools but expressed differing views regarding the design and functionality of best practice alerts to promote adherence and others expressing concerns about workflow disruption and alert, including concerns about hard-stop alerts and preferences for integration within existing well-child visit workflows. Respondents also shared concerns about the length of clinician education modules and recommended improving language accessibility for parent handouts.
CONCLUSIONS
This study revealed support for implementation of iREACH as an approach to prevent lifelong PA in children. Recognizing potential barriers to implementation of iREACH should be addressed in future implementation efforts.