The Canadian anaphylaxis action plan for kids: development and validation

Abstract
Objectives
We designed a written Canadian Anaphylaxis Action Plan for Kids (Kids’ CAP) which incorporates validated pictograms with written instructions. Using a patient-centered approach, we aimed to validate the Kids’ CAP and assess its impact on anaphylaxis recognition and treatment, and to determine its’ perceived usefulness.

Patient Involvement
Children and their parents were involved in appraising the design and written contents of the Kids’ CAP.

Methods
The design process consisted of a development phase and clinical validation phase. First, we assessed the readability and understandability of the Kids’ CAP using validated instruments. Then, patients (12–17 years of age) and parents of patients (<12 years of age) were given the Kids’ CAP during the first consultation with allergy specialists or an Emergency Department visit for anaphylaxis. Subsequently, we conducted a phone interview 2–3 weeks later to assess their comprehension of anaphylaxis management. We also used the Consumer Information Rating Form to measure the participants’ perception of the design quality and usefulness of the Kids’ CAP.

Results
Of the 230 participants enrolled, 205 (89%) completed the follow-up interview. The written contents of the Kid’s CAP were modified to match grade 7 readability level. The total mean score of the Consumer Information Rating Form for comprehensibility was 23.1 (SD 2.4), and 25.1 (SD 2.3) for design quality. The mean comprehension score was 11.3 (SD 1.8) (reference range 0–12), with no significant difference between participants with and without previous experience with anaphylaxis, or high vs. low literacy level.

Conclusion
Engaging children and parents in the design and contents of written anaphylaxis action plan is an innovative approach to produce a useful document for the end-users.