Evaluating Teachers' Knowledge and Attitude toward Food Allergy and Anaphylaxis: A Pilot Simulation-Based Questionnaire Study in Rabigh Elementary Schools

Nojoud A Faqerah¹Saddiq Habiballah²Majdi Damanhori³Abdullah Alsaggaf⁴Manal Halwani^2*

• ¹Department of Clinical Microbiology and Immunology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
• ²Department of Pediatrics, Faculty of Medicine Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
• ³Department of Anatomy, Faculty of Medicine Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
• ⁴Department of Pediatrics, Unit of Allergy and Immunology, King Abdulaziz University, Jeddah, Saudi Arabia

Background: Simulation-based learning is an effective tool for educating teachers and school staff about anaphylaxis. This pilot exploratory study aimed to assess knowledge and attitudes toward food allergy and anaphylaxis policies and protocols in schools for the management of severe allergic reactions. Materials and Methods: A simulation-based education program was conducted using a standardised case scenario in elementary schools in Rabigh, targeting teachers and staff from randomly selected schools. Knowledge and attitudes were assessed before and after the simulation using structured questionnaires. Paired pre–post responses (n = 97) were analysed. McNemar's test was applied for categorical outcomes, and the Wilcoxon signed-rank test was used for ordinal attitude scores. Data were summarised as frequencies and percentages, with a significance level set at p < 0.05. Results: A total of 101 teachers and staff from six elementary schools participated, with 97 completing both pre-and post-simulation assessments. Recognition of key anaphylaxis symptoms improved significantly post-intervention, particularly for swelling of the lips, tongue, face, and eyes (55.4% vs. 79.4%) and shortness of breath (28.7% vs. 78.4%) (both p < 0.001, McNemar's test). Attitudes toward anaphylaxis management protocols also improved, with a significant reduction in median attitude scores post-simulation (p = 0.001, Wilcoxon signed-rank test). Readiness to use an epinephrine auto-injector increased markedly from 18.8% before the intervention to 84.5% after the intervention (p < 0.001). Conclusion: This pilot exploratory study demonstrates that simulation-based education can significantly improve teachers' knowledge, attitudes, and readiness to manage food allergy and anaphylaxis. While the findings are promising, they should be interpreted with caution due to the modest sample size and single-city setting. Larger, multi-centre studies