1Are you aware/informed about your child/student’s reason for being prescribed the EpiPen? | a. Yes | b. No | ||||
2. What’s the age of child in years? | a. 1–3 | b. 3–6 | c. 6–9 | d. 9–14 | ||
3. Gender | a. Male | b. Female | ||||
4. Nationality | a. Qatari | b. Non-Qatari | ||||
5. Are all these correct about anaphylaxis definition?
| a. Correct | b. Incorrect | ||||
6. What allergy does your child have? | a. Food | b. Medications | c. Bee/ant sting | d. Unknown allergy | e. Multiple allergy | |
7. What food is your child allergic to? | a. Nut allergy | b. Egg | c. Fish/milk | d. Unknown food | e. Multiple food allergy | f. N/A |
8. If you choose ‘a’, please specify? | a. Peanuts | b. Cashews | c. Pistachios | d. Unknown nuts | e. Multiple nuts allergy | f. N/A |
9. How long ago was your child first prescribed the EpiPen? | a. 0–3 months | b. 3–6 months | c. More than 6 months | |||
10. How many times have you used the EpiPen since it was prescribed? | a. Never | b. Once | c. Twice | d. Thrice | ||
11. Who prescribed the EpiPen for your child? | a. Paediatrician | b. Allergy/Immunology | c. Both | |||
12. Where did you first receive the first EpiPen prescription? | a. Emergency Department | b. Outpatient | c. Both | |||
13. Have you ever received instructions on how to use the EpiPen? | a. Yes | b. No | ||||
14. If yes, who gave you the instructions to use the EpiPen? | a. Physician | b. Non-physician, for example, nurse, pharmacist, brochure, etc | ||||
15. Where did you receive the instructions about EpiPen use? | a. Emergency Department | b. Outpatient | c. Both | |||
16. What are the symptoms you use EpiPen for? | a. Cardiorespiratory, for example, cough, breathing difficulty and or collapse | b. Non-cardiorespiratory, for example, rash, swelling, etc | ||||
17. At what temperature do you store your EpiPen? | a. Room temp | b. Refrigerator | ||||
18. How many EpiPen should your child ideally have? | a. 1 | b. 2 | c. 3 or more | |||
19. Where should your child ideally keep his/her EpiPen? | a. At home | b. With him all times | c. At school | |||
20. Have you ever checked the expiry date of the EpiPen? | a. Yes | b. No | c. N/A | |||
21. What are the correct steps involved in using the EpiPen?
| a. Correct | b. Incorrect | ||||
22. Would you use the EpiPen as soon as your child is suspected to be exposed to the allergen OR would you wait for symptoms to appear? | a. Give immediately | b. Wait for the symptoms to completely appear | ||||
23. True/False: You must remove the child’s clothes before using the EpiPen? | a. Yes | b. No | ||||
24. Is an emergency department visit required after using the EpiPen? | a. Yes | b. No |
N/A, not applicable.