A cross-sectional study was conducted from February 2021 until April 2021. The study population was male and female primary school teachers currently teaching at public and private primary schools belonging to Al-Kharj educational administration, which included three cities (As-Seeh, Al-Hayathem, and Ad-Dilam) during the academic year 2020–2021. The total number of teachers in the 3 cities was 3209.
The appropriate sample size was found to be 344 to obtain results at a 95% confidence level, a margin of error of 5%, and a population variance of 50%. A multistage cluster sampling was used to collect the data after a list of schools was obtained from Al-Kharj Governorate educational administration. First stage: we selected the three cities with the largest population size (As-Seeh, Al-Hayathem, and Ad-Dilam). Second stage: we selected 25% of the schools in each city by simple random sampling technique, which gave a total of 54 schools (40 public and 14 private schools). Third stage: the enrolled teachers in the study were selected from each school by convenience sampling after getting permission from the schools' principals.
A validated previously published (16) 34-item self-administered questionnaire of multiple-choice, dichotomous, checkbox, and Likert scale questions was used in the study after permission. The scale was an Arabic translation and an adaptation from the original tool used by Ercan et al.(14). Three faculty physicians with subject matter and research experience confirmed the content validity of the tool for our study.
Pre-testing was conducted on 35 teachers who were excluded from the main study. Brief cognitive interviewing was then undertaken with these teachers to explore any problem areas in the formulation and order of questions, appropriateness of length, and relevant questionnaire processes. The questionnaire covered four sections: socio-demographic characteristics of participants (13 items), teachers' knowledge about FA (12 items), teachers' practice toward FA (4 items), and Teachers' Attitude toward FA (4 items). The scoring method used is detailed in the source article (17). The minimum and maximum scores were 0 and 22 for knowledge, 5 and 20 for attitude, and 0 and 8 for practice. A score of < 60% was considered an insufficient (low) knowledge, negative attitude, and poor practice, 60–80% a moderate knowledge, neutral attitude, fair practice, and ≥ 80% a high knowledge, positive attitude, and good practice. The questionnaire included a letter explaining the study's nature and purpose to the teachers in Arabic. Participation consent was taken at the beginning of the questionnaire. Confidentiality was maintained as the questionnaires did not include names or numbers and the data were only accessible to the authors. This Study is ethically Approved by Prince Sattam Bin Abdulaziz University's Scientific Research Ethics Committee.
Socio-demographic characteristic variables included: age, gender, location and type of school, nationality, marital status, having children, educational level, specialty, years of service in education, and personal and family history of FA. The teachers' knowledge section assessed their general knowledge about FA, most common foods-causing allergy, symptoms of FA, general management of FA, and management of food-induced anaphylaxis. In the teachers' practices toward FA, 4 items examined their level of practice regarding managing FA events with EpiPen and their school readiness to manage reactions occurring at school. In the teachers' attitude section, 4 items in a five-point Likert scale format (from strongly disagree to strongly agree) evaluated their beliefs and opinions regarding FA. Data were collected through an electronic questionnaire uploaded on a website and distributed to sampled teachers working at the selected schools.
Data were entered and extracted using Microsoft Office Excel. It was revised, coded, and fed into statistical software IBM SPSS version 22 (SPSS, Inc. Chicago, IL). All statistical analyses were done using two-tailed tests. A P-value less than 0.05 was considered statistically significant. Descriptive analysis based on frequency and percent distribution was done for all variables, including socio-demographic data. Also, descriptive frequencies were tabulated for knowledge items, participants' practice, and attitudes. Crosstabulation was used to assess the distribution of knowledge, practice, and attitude levels according to participants' socio-demographic data. Relations were tested using the Pearson chi-square test and exact probability test in case of small distributions. One Way ANOVA and independent t-test were used to compare mean scores between 2 or more categories.