Parental Understanding and Implementation of Early Peanut Introduction.

Importance: Early peanut introduction (EPI) is encouraged by National Institute of Allergy and Infectious Disease guidelines and consensus opinion among several allergy associations as a public health measure to decrease peanut allergy. Studies evaluating EPI implementation have found variable impact. Objective: To comprehensively evaluate parental understanding, beliefs, barriers, and overall implementation of EPI. Design, Setting, and Participants: For this qualitative study, parents were recruited from primary care academic clinics, federally qualified health centers, and private clinics in Chicago, Illinois, with a focus on adequate representation. Utilizing purposive sampling, all English-speaking parents of infants aged 8 to 13 months were invited to participate. Parents of infants with medical conditions that would alter solid food introduction practices or those involved in other food allergy prevention studies were excluded. Semistructured interviews were conducted with parents from September 2023 to December 2024. Interview questions were structured to follow the Theory of Planned Behavior. All interviews underwent thematic analysis with consensus agreement on all elements. Exposure: Participation in an interview about EPI. Main Outcomes and Measures: The primary outcome was EPI understanding and implementation utilizing the following Theory of Planned Behavior domains: knowledge, beliefs and opinions, practices, and information sources. A modified grounded theory approach employing the constant comparison method was used to inform thematic analysis and evaluate interviews. Results: Forty-nine interviews were conducted. Participants were primarily mothers (45 participants [92%]). Most parents reported they were at least partially aware of EPI guidelines. Eight major themes emerged: (1) EPI was to evaluate whether the infant was allergic to peanut, (2) EPI was to prevent peanut allergy, (3) family history of food allergy was the main risk factor, (4) EPI is viewed positively, (5) fear of an allergic reaction served as a barrier to EPI, (6) parents had mixed feelings about EPI's overall benefit, (7) EPI was understood and practiced with vide variability, and (8) the pediatrician was the primary source of EPI knowledge. Conclusions and Relevance: This qualitative study found that although parents were aware of EPI, there was confusion around its purpose, implementation, and risk factors. The main barrier for most parents was the risk of an allergic reaction during EPI. Clear and directive guidance from their pediatrician was a facilitator for successful EPI implementation.