Canadian parent perceptions of oral food challenges: A qualitative analysis

Abstract

Oral food challenges (OFCs) are the gold standard diagnostic test for food allergy. 1 However, families face barriers to OFCs. Data on the Canadian caregiver perspective on OFCs are lacking. 2 Therefore, our study aimed to assess perceptions of OFCs among Canadian parents of children with food allergy.We recruited parents of children with allergist-diagnosed food allergies from British Columbia (BC) and Ontario to participate in focus groups. Focus group questions (Table 1) were developed from literature reviews and expert opinions. Participants were recruited through advertisements at allergy clinics and on social media.Participants provided written informed consent. Focus groups were audio-recorded and transcribed verbatim. Data collection ended when data saturation was achieved. Data were analyzed using the constant comparative method. 3 Coding was performed using NVivo (https://www.qsrin terna tional.com/nvivo -quali tativ e-data-analy sissoftw are/home, RRID:SCR_014802), version 12.6. The study was approved by the BC Children's Hospital (BCCH) Institutional Review Board.Between June 2017 and January 2018, 51 parents participated across six focus groups (three per province). Each focus group had 8-9 participants and lasted 2-3 h. Participant demographic information is provided in Table 2. Most participants were of European origin, female, and socioeconomically advantaged. Half had children who had undergone OFCs. In Ontario, 41.5% had children with multiple food allergies-these data were not available from BC.Figure 1 summarizes perceived barriers to OFCs and solutions. Table A1 provides representative quotes for themes.Parents misunderstood the purpose of OFCs and reported doing OFCs in clinics, hospitals, homes, and outside emergency rooms (ERs). Parents described OFCs as "treatment [and] desensitization" to ensure children are "not going to have an anaphylactic experience in the future." Parents also described OFCs as "trying different foods that could possibly be a problem." Parents indicated that OFCs "should be done in hospitals" as they are "set up for a real emergency."Parents also described doing OFCs at home in BC and Ontario, and outside ERs in BC with "less severe allergens" based on low-risk testing and never having had a reaction. These experiences were