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

Background: Peanut allergy prevention guidelines recommend early dietary introduction among infants in the first year of life, yet implementation remains limited. Objective: 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. Methods: 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. Results: 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%). Conclusion: 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).