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Food allergy is a growing public health concern. The literature suggests that a significant number of reactions occur in community services, such as schools and restaurants. Therefore, suitable training and education for education and catering professionals using viable and practical tools is needed.
The objective of this study is to evaluate the effectiveness of a Web-based food allergy training program for professionals working in schools and restaurants, designed to improve knowledge and good practices in the community.
Free learning programs which contain educational animated videos about food allergy were developed for professionals working at schools and restaurants. The learning programs comprise of nine 5-minute videos, developed in video animation format using GoAnimate, with a total course length of 45-60 minutes. The courses for professionals at both schools and restaurants include contents about food allergy epidemiology, clinical manifestations, diagnosis and treatment, dietary avoidance, emergencies, labelling, and accidental exposure prevention. Additionally, specific topics for work practices at schools and restaurants were provided. Food allergy knowledge survey tools were developed to access the knowledge and management skills about food allergy of school and restaurant staff, at baseline and at the end of the food allergy program. The courses will be provided on the e-learning platform of the University of Porto and professionals from catering and education sectors will be invited to participate.
Data collection will take place between September 2017 and October 2017, corresponding to a 2-month intervention. Final results will be disseminated in scientific journals and presented at national and international conferences.
The Food Allergy Community Program intervention may improve school and restaurant professionals’ commitment and skills to deal with food allergy in the community. Furthermore, this e-intervention program will provide an innovative contribution to understanding the impact of electronic health technologies on the learning process and the development of strategies for community interventions.
RR1-10.2196/9770
A food allergy is defined as a reproducible and specific immune response that occurs on exposure to a given food, leading to adverse health effects [
Studies show that a significant number of reactions occur in public places such as restaurants [
According to the literature, there is a consensus that there is a significant lack of information and education for the different stakeholders in the field of food allergy. Studies examining school personnel’s knowledge of food allergies have shown that teachers do not consider themselves sufficiently informed and prepared [
When considering food allergy in restaurants, two studies have stated a particularly warring discrepancy between personnel’s knowledge about food allergy and their comfort level in providing a safe meal [
When asked to identify barriers to learning about food allergies, restaurants’ personnel identified high training costs and time constraints as the main barriers [
Previous computer-based intervention programs used in both schools [
The Food Allergy Community (FAC) program is an intervention program which intends to evaluate the effectiveness of Web-based food allergy training on food allergy-related knowledge and practices of professionals in the education and catering sectors. The project began in January 2015 and data collection will occur in between September 2017 and October 2017.
The target participants in this study are professionals in the catering and education sectors from Portugal, Portuguese-speaking African countries, and Brazil, who are interested in courses on food allergy management in restaurants and schools. The e-learning courses will be held on the University of Porto e-learning platform,
The e-learning platform is private, and access will be restricted by the research team providing individual credentials to the included participants. When participants first log in to the e-platform, they will be asked to read and complete the informed consent form in order to participate in the research. The consent form includes the purpose of the study, the level of data protection, and information on participants’ right to withdraw during the study. Additional instructional videos and materials will be available for participants to familiarize themselves with the online course procedures. After gaining informed consent, participants will be asked to complete a brief questionnaire on their demographic characteristics such as gender, region, educational background, occupation, and workplace specificities (eg, the classification of the restaurant or the school’s grade level).
After agreeing to join the study and acknowledging that the intervention includes both pre- and posttests to assess the participant’s knowledge, participants will be randomly assigned into any of the 3 following groups: (1) the pretest group, (2) the posttest group, or (3) the pre- and posttest group. The existence of 3 groups will allow for the measurement of a possible interactive effect between pretesting and the intervention.
This research was conducted according to the guidelines established by the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of University of Porto (24/CEUP/2016) and by the Portuguese National Commission of Data Protection (735/2017).
Two different Food Allergy Knowledge survey tools (one for each sector) were developed after an extensive review of the literature to determine food allergy knowledge and management skills of school and restaurant staff. They were based on previous questionnaires for restaurant [
The questionnaires will be completed by the participants twice, before and after the training. The first questionnaire will assess the baseline level of knowledge of the target population which is important to generate a statistically valid baseline to determine the impact of the intervention. The questionnaire completed after completion of the e-learning modules will be used to determine the level of change in impact and outcome indicators between the baseline and final evaluations.
The first section of the questionnaire contains 20 multiple-choice questions with a single-best-answer (each scored one point if correct) to measure participants’ knowledge and skills related to food allergies. The first 11 questions are common to both surveys and evaluate six different dimensions: epidemiology, diagnosis, symptoms and treatment, dietary avoidance, emergency procedures, food labelling, and the food allergies legal framework. The last 9 questions are specific to the target group and are different in the two surveys. For the questionnaire specific for school personnel, these questions evaluate good practice at the workplace, in particular the prevention of accidental exposure and awareness of bullying. For restaurant personnel, the questions evaluate the good practice in all stages of customer service, considering the prevention of cross-contact.
To evaluate whether the knowledge and acquired skills meet the learning outcomes foreseen for the course (
The second section of the questionnaire (the section specific to each sector) corresponds to questions regarding work-related practices and perceived responsibilities.
Understand the differences between food allergies, food sensitivities, and intolerances
List the most common food allergens
Recognize the symptoms of severe food allergic reactions and anaphylaxis
Identify the diagnostic procedures of a food allergy
Realize that an allergic reaction can be triggered not only by the consumption of the food but also by inhalation or skin contact
Be aware that there is no routine treatment for food allergy, apart from dietary avoidance
Be aware of how to avoid allergen exposure, including food labelling interpretation
Respond safely and appropriately if an allergic reaction occurs
Know the current legislation on the protection of the consumer with food allergy
Prevent accidental exposure at school, namely in the canteen, classroom, playground, or bus
Recognize bullying as one of the main psychosocial impacts of food allergy in children and teenagers
Communicate effectively with food-allergic customers to ascertain their needs
Prepare and serve a safe meal to a food-allergic customer, considering the prevention of cross-contact
The responses will be addressed either through yes or no questions or a 5-point Likert-type scale, ranging from 1 (“Strongly disagree”) to 5 (“Strongly agree”), to examine whether personal experiences and training would impact food allergy risk perception and communication. After completing the Food Allergy Knowledge and Practice Survey Tools, participants will be able to join to the free online courses from the FAC Program.
The intervention consists of an online asynchronous training program, which comprises of several lectures in video format about general concepts related to food allergy and food allergy management in schools and restaurants.
The training modules were developed based on the European Academy of Allergy and Clinical Immunology guidelines [
After considering the learning needs of the target audience, it was determined that the courses should both have a theoretical and a practical component (
The participants will have 4 weeks to complete the entire course (9 modules), and two to three modules will be launched per week. The platform does not restrict the number of times the modules are accessed during the course.
In addition to the course modules, the platform will also provide complementary readings and tools, including expert interviews and a live demonstration of how to use self-injectable epinephrine devices, as well as an interactive forum where participants can share their doubts and experiences. The participants who complete the course and obtain a grade higher than 9.5, out of 20 possible points, will receive a certificate of participation from the FAC Program.
After the food allergy Web-based intervention program for schools and restaurants has been completed, statistical analysis of scores’ improvement and differences between the three groups will be performed using SPSS Statistical Software (SPSS Inc, Chicago, IL, USA) and R software program (The R Foundation for Statistical Computing, Vienna, Austria).
Descriptive analysis (proportions) will be performed to characterize the participants and to summarize the answers to the Practice and Perceptions Survey Tools. To access the improvement on the participants’ knowledge, General Linear Model for Repeated Measures test will be performed, allowing the 3 intervention groups to be compared. A
Modules included in the Food Allergy Online Course for Schools and Restaurants.
Module number | Module name | |
1 | Food allergy: General concepts | |
2 | Food allergy: clinical manifestations, diagnosis, and treatment | |
3 | Food allergen avoidance: Why it is so difficult? | |
4 | Emergencies: What can I do? | |
5 | Food allergen labelling | |
6 | Food allergy prevention: Is it possible? | |
7 | Food allergy in school I: Basics and canteen | |
8 | Food allergy in school II: Inside the classroom and playground | |
9 | Bullying and the psychosocial burden of food allergy | |
7 | Communication and client’s attendance | |
8 | Cooking for allergic clients and meal service | |
9 | Organization and storage: A helpful way to reduce the risk |
Item response theory using the two-parameter logistic model will be performed to determine the quality (difficulty and discrimination) of the questions from the food allergy knowledge survey.
Data collection will take place between September 2017 and October 2017, corresponding to a 2-month intervention. Final results will be disseminated in scientific journals and presented at both national and international conferences. Additionally, after the results of the study have been obtained, the courses could be permanently integrated into the training offered by the University of Porto, providing an added value for the formation of the community.
Progress in e-learning and related technologies are creating the basis for developments in the education and teaching, with a gradual change from traditional and on-site teaching to a modern teaching, which is mainly Web-based [
In 2002, the United Nations Educational, Scientific and Cultural Organization (UNESCO) proposed Open Educational Resources, which are defined as “Teaching, learning, and research materials in any medium, digital or otherwise, that reside in the public domain or have been released under an open license that permits no-cost access, use, adaptation, and redistribution by others with no or limited restrictions” [
Wahl et al [
Regarding studies on food allergy interventions for restaurants, Bailey et al designed and evaluated a food allergy educational intervention consisting of a 1-hour lecture about food allergy basics, accidental exposure, food labelling, emergencies, and proper communication with costumers [
Finally, and more comprehensively, a review of massive open online courses related to health and medicine reported that there was potential to use massive open online courses to educate health care practitioners and students and to increase health literacy among the public [
Our study has some limitations, namely that (1) all participants require internet and basic computer knowledge, (2) the self-enrollment of the participants raises questions about the representativeness of the sample of participants and whether the participants are already interested and educated about food allergy, and (3) the higher possibility of drop-outs compared to on-site training. However, studies in both areas conclude that food allergy training and new information and communication technologies may be an effective tool to enhance knowledge in the fields of food allergy, food science, and food safety.
Additionally, the FAC Program will provide an innovative and important contribution to understanding the impact of new information and communication technologies on people's learning, which seems to be crucial for ongoing development of online training programs. Furthermore, it will provide more data on the basic knowledge of catering and education professionals, which is extremely useful since these data are scarce in Europe. The information on professionals' basic knowledge is not only useful for the continuity of the training in new editions of the program, but also for the development of better strategies for community interventions and new governmental and public health guidelines. Professionals may find that they can make use of this program as learning tool without great impact on their routine and budget, which could improve their commitment and their skills to deal with food allergies, leading to a greater awareness about food allergy and an increase on food allergic-patients’ safety and integration in the community.
Environmental Health Specialists Network
Food Allergy Community
United Nations Educational, Scientific and Cultural Organization
None declared.