Date of Award
Summer 7-22-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Counselor Education and Counseling Psychology
First Advisor
Amy Van Hecke
Second Advisor
Christopher Warrren
Third Advisor
James Hoelzle
Abstract
Food allergy (FA) is a prevalent and often severe condition affecting approximately 8% of U.S. children (Gupta et al., 2018; Robson & Assa’ad, 2024). The responsibility for daily management of FA, including making critical health management decisions, often falls to caregivers. These responsibilities can impose significant psychosocial demands on caregivers, particularly as treatment options expand and require more nuanced decision-making (Collins et al., 2024; Hamadi et al., 2024; Knibb & Jones, 2024; Lieberman, 2024; Umetsu, 2024). Caregivers' decisions are shaped by a range of individual needs, experiences, and sociodemographic characteristics (Dale & Hemmerich, 2009; Hoefel, O’Connor, et al., 2020). As children age and begin to manage their own care, decision-making becomes more dynamic and collaborative. Involving children and adolescents in health decisions is associated with improved outcomes, greater adherence, and enhanced self-efficacy (V. A. Miller, 2018b; V. A. Miller et al., 2017; V. A. Miller & Jawad, 2014, 2019). Empowering youth to participate also prepares them for effective self-management. However, there is limited research on how caregiver decisional needs, conflict, and anxiety evolve across decision-making stages in pediatric food allergy management, and how these factors affect youth involvement in shared decision-making (SDM). This dissertation examined caregiver decision-making experiences and youth involvement in SDM. Findings revealed significant variation in caregiver experiences by decision stage and type. Notably, caregiver anxiety played a key role in shaping how caregivers engaged with children during SDM. These results offer a clearer understanding of the psychosocial landscape of FA decision-making and emphasize the need for tailored support. Interventions that reduce decisional conflict and enhance caregiver preparation—especially in earlier stages or high-stakes scenarios—may improve outcomes for both caregivers and children. Promoting effective SDM requires attention not only to medical guidance but also to the emotional and cognitive readiness of families making these decisions together.