Scale assesses satisfaction with life among patients with food allergy
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Key takeaways:
- Satisfaction with life indicates how patients cognitively evaluate their own lives.
- Satisfaction is linked to distresses that can grow in a context of constant fear and to indicators of a healthier life.
Unlike other assessments, the Food Allergy Satisfaction with Life Scale assesses how individuals impacted by food allergy cognitively evaluate their own lives, according to a letter published in Clinical and Translational Allergy.
Other questionnaires address objective factors that can influence well-being and miss this self-reflection, Gabriel Lins de Holanda Coelho, PhD, postdoctoral researcher, School of Applied Psychology, University College Cork, and colleagues wrote.
As a construct, satisfaction with life is negatively linked to a range of distresses including depression, stress and suicide ideation that can grow in a context of constant fear, which many patients with food allergy experience, the researchers said.
But satisfaction with life also is positively linked to optimism, self-esteem and other indictors of a healthier life, the researchers continued.
The researchers adapted the five items in the Satisfaction with Life Scale to focus on food allergy and facilitate the measurement of the specific impact that food allergy has on satisfaction with life. The five items include:
- “In most ways, my life with a food allergy is close to my ideal.
- The conditions of my life with food allergy are excellent.
- I am satisfied with my life with food allergy.
- So far, I have all the important things I want in my life, despite my food allergy.
- If I could live my life over, I would change almost nothing, including my food allergy.”
Using the Prolific crowdsourcing platform, the researchers administered the Food Allergy Satisfaction with Life Scale (FASWLS), the Food Allergy Quality of Life Questionnaire (FAQLQ) and the Food Allergy Anxiety Scale (FAAS) to 201 patients (63.7% women; mean age, 37.12 years).
These patients all had a food allergy diagnosis, including 50.7% diagnosed by a general practitioner and 27.4% diagnosed by an allergist, and 73.6% reporting a severe allergic reaction. Allergens included peanut (39.3%), tree nuts (33.8%) and shellfish (18.9%).
The unidimensional structure of the FASWLS had a good model fit, the researchers said, with a comparative fit index of 0.98, a Tucker-Lewis index of 0.96 and a standardized root mean square residual of 0.027. Factorial loadings ranged from 0.6 for the fifth item on the FASWLS to 0.9 for the second item.
A Cronbach’s alpha score of 0.88 and a McDonald’s omega score of 0.89 indicated that the FASWLS also had good reliability, the researchers continued. Additionally, the FASWLS negatively correlated with the FAAS (r = –0.51; P < .001).
The FASWLS positively correlated with all the factors in the FAQLQ as well, which included emotional impact (r = 0.52), health (r = 0.47), risk (r = 0.48) and social and dietary limitations (r = 0.58; P < .001 for all).
Overall, the researchers said, participants with higher scores pertaining to satisfaction with food allergy life also had lower scores for food allergy anxiety and higher scores for food allergy quality of life, validating the FASWLS as a psychometrically sound scale.
Further, the researchers said, the FASWLS can enhance research in health-related quality of life by providing a focused understanding of the link between food allergy and satisfaction with life.
For example, the researchers said, a patient could have a high food allergy health-related quality of life score because they have a low perceived risk but still have a low FASWLS score because of the presence of food allergy and the burdens it brings.
Other current questionnaires that specifically assess food allergy do not assess this subjective construct, the researchers continued. But the FASWLS provides a standardized approach for doing so for a broader and more comprehensive analysis of food allergy’s impact on the individual patient.
By resolving knowledge gaps and driving patient-centered innovations in treatment, practice and policy, the researchers concluded, the FASWLS will benefit researchers, clinicians and patients.
Perspective
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I was happy to see life satisfaction being explored in those managing food allergy, and that the findings from this study validated the FASWLS as a psychometrically sound scale.
Quality-of-life assessment tools such as the FAQLQ provide valuable data on the impacts of living with food allergy. However, understanding one’s satisfaction with life while managing food allergy offers additional insights that can be utilized to develop personalized interventions helping to effectively manage the burden of food allergy. As such, I believe that satisfaction with life should be evaluated and could easily be incorporated as part of a quality-of-life assessment.
Quality of life refers to a measurable assessment of well-being based on a variety of factors including physical and mental health, stress, education, employment, environment and social belonging. It is no surprise that in the context of food allergy, ongoing cautiousness, increased perception of risk, elevated anxiety levels and fear of unexpected reactions would negatively impact one’s quality of life.
As noted in this study, satisfaction with life refers to a cognitive evaluation, including one’s feelings about their life and acceptance of circumstances. It is more subjective and provides additional insight into how one lives with food allergy. Because there can be a negativity bias when living with food allergy, gaining insight into one’s perspectives and thoughts about their diagnosis and how that impacts their ability to live the life they envision offers rich context. This context would help health care practitioners facilitate conversations about food allergy management. It would also assist clinical mental health providers in meeting patients where they are at as they help them develop balanced approaches to life with food allergy.
In my clinical practice, my patients who have developed the skills and mindset to effectively manage food allergy anxiety tend to report a higher satisfaction and quality of life, as they are more willing to engage in life experiences that they would have otherwise avoided due to an overwhelming fear of allergic reactions.
Therefore, it makes sense that the participants in this study who presented a higher score in satisfaction with food allergy life also presented lower scores in food allergy anxiety and higher scores in food allergy quality of life, as these factors are correlated. Those managing food allergy anxiety that impacts daily functioning often experience elevated stress levels that lead to a worsened quality of life, as previous food allergy studies have illustrated.
Because the FASWLS is brief, it can easily be incorporated into intake appointments and repeated on an annual basis to evaluate changes in life satisfaction. Additionally, the scale could be utilized with patients at various health literacy levels due to its brevity and conversational assessment questions. I would not want to add additional questions, as making it lengthier would decrease the likelihood of use during appointments. However, I would encourage health care providers to expand conversations beyond these questions to gather additional insights, if useful.
Finally, I would like to see the FASWLS utilized as an evaluation tool in a study offering evidence-based, practical food allergy management guidance to measure the satisfaction of life prior, during and after the development of beyond-basic skills, such as assessing and managing food allergy risk.
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