JMIR Publications

ABSTRACT

Background:

Anaphylaxis is a potentially fatal allergic reaction. However, many patients at risk of anaphylaxis who ought to permanently carry an Epinephrine Auto Injector (EAI) do not have access to one at the moment of allergen exposure and thereby expose themselves to immediate life threats.

Objective:

A promising strategy to speed the delivery of EAI to a patient in an acute anaphylactic event is to use proximity-based Emergency Response Communities (ERC) in which patient-peers carrying EAI are alerted to respond and give their EAI to a nearby patient in need. To generate an effective intervention in acute anaphylactic events we identified patients behavioral and spatial factors influencing their decision to respond to ERC emergency requests.

Methods:

Data was collected and analyzed in two phases. 1) we clustered 10, 000 records from the European Anaphylaxis Registry to determine typical acute anaphylactic scenarios. 2) We conducted a two-center scenario-based survey of adults and parents of minors with severe allergy and prescribed EAI, originated in Israel and Germany. Each group received a four-part survey which examined the effect of two behavioral constructs: 1) shared identity, and 2) diffusion of responsibility; and two spatial factors: 1) time of emergency, and 2) emergency location, in addition to sociodemographic data. We preformed descriptive, linear correlation, ANOVA and t tests to identify the factors influencing allergy patients’ decision to respond to ERC alert.

Results:

126 Israeli and 121 German participants completed the survey and met the inclusion criteria. 80 % of Israeli participants were parents of minor patients with the risk of anaphylaxis due to food allergy. They averaged 32 years and 67% were female. 20% were adult patients who averaged 21 years of age, 48% were female. 121 German patients with EAI prescription were adults who averaged 47 years old. 63% were female. 61% suffered from food allergy; 39% were allergic to venom, drug or had other allergies. The overall willingness to respond to ERC events was high. Shared identity and the willingness to respond was positively correlated (r=0.51, p<0.01) in the parents’ group. Parents had a stronger sense of shared identity than adult patients (t(243)= -9.077, p<0.01). The bystander effect decreased the willingness to respond of all patients besides the parents group (F(1, 269)= 28.27, p<0.01). An interaction between location and time of emergency (F(1,473)= 77.304, p<0.01) revealed lower levels of willingness to respond in strange locations during nighttime.

Conclusions:

An Emergency Response Community Allergy app has the potential to improve outcomes in the case of anaphylactic events but doing so is dependent on patient-peers’ willingness to respond. Our study identified the behavioral and spatial factors that could influence the willingness to respond through a two-stage process providing a basis for future research of proximity-based mHealth communities.