Implementation of early peanut introduction among providers in a southern US state

Peanut allergy prevention guidelines recommend early dietary introduction among infants in the first year of life, yet implementation remains limited.

This study's purpose was to assess guideline implementation and identify barriers and needs among pediatric providers in a largely rural state in the southern United States.

A 21-item, anonymous survey was given to pediatric providers in the Arkansas Children's Care Network to assess implementation of the 2017 National Institutes of Health/National Institute of Allergy and Infectious Disease guidelines. Survey invitations were sent via e-mail link between May 2022 and December 2023. Descriptive statistics were performed, and the results were assessed in aggregate as well as by urban or rural practice location.

Of 130 providers, 35 (27%) responded (62% urban and 38% rural). All respondents reported guideline familiarity, yet only 37% reported full implementation and 41% estimated that less than 50% of caregivers introduce peanut at home. The top barriers to early peanut introduction included conducting in-office peanut feedings (60%), lack of clinic time (41%), and parental concerns for allergic reactions (31%). The primary barriers to allergist referral differed by practice locale as follows: timely access was mentioned by 86% of respondents (cited by more urban providers than rural providers), and distance from home was mentioned by 54% of respondents (cited by more rural than urban providers). The top resource needs included parental handouts on home feeding (cited by 72% of respondents), guides to assessment and/or recommendations (cited by 62%), online tutorials (cited by 57%), and scripts for explaining guidelines (cited by 44%).

Pediatric providers in Arkansas reported guideline awareness but suboptimal implementation (defined largely as practice-based resource limitations and parental hesitancy, factors that were heightened among providers based in rural areas). These findings demonstrate a need for accessible, efficient resources and toolkits tailored to providers' unique needs, with innovative strategies to expand allergists' reach (particularly in rural settings).