Welcome to the

QoL Questionnaire

Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) (Shortened Version) for
Parents of children aged 0-17 years

Instructions to Parents

The following are scenarios that parents have told us affect children’s quality of
life because of food allergy/ anaphylaxis /eczema/drug allergy.

Please indicate how much of an impact each scenario has on your child’s quality
of life by placing a rating of 0 to 6.

Response Options

1 = not at all, 2 = a little bit, 3 = slightly, 4 = moderately, 5 = quite a bit, 6 = very much, 7 = extremely

not at all

extremely

All information given is completely confidential. This questionnaire will only be
identified by a PASSCODE number provided by T E A C H.

All the fields are required

    Because of anaphylaxis/food allergy/drug allergy/eczema/chronic hives my child('s)...

    Feels different from other children

    • Not at all

    • Extremely

    Is afraid to try unfamiliar foods/new medications

    • Not at all

    • Extremely

    Experiences physical and/or emotional distress

    • Not at all

    • Extremely

    Has a lack of variety in his/ her diet

    • Not at all

    • Extremely

    Social environment is restricted because of limitations on restaurants and/or holiday destinations we can safely go to as a family

    • Not at all

    • Extremely

    Ability to take part in social activities (sleepovers, parties, playtime, etc.) has been limited

    • Not at all

    • Extremely

    Feels concerned when going to unfamiliar places

    • Not at all

    • Extremely

    Feels frustrated by restrictions on social activities (e.g. need to plan ahead; need to carry autoinjector)

    • Not at all

    • Extremely

    Is more cautious and /or concerned in general than other children of his/her age

    • Not at all

    • Extremely

    Wishes his/her food allergy/drug allergy allergy/other allergy/eczema/chronic hives would go away

    • Not at all

    • Extremely

    Thank you for your help

    There are 4 steps to participate in this study,

    1. We will give you a questionnaire to fill out before the educational video.
    2. You will watch a 3 to 5-minute video about anaphylaxis or chronic urticaria.
    3. We will give you the same questionnaire to fill out after the educational video.
    4. You will be contacted 12 months later by our research team by email and given a link to repeat steps 1 to 3.

    The completion of the questionnaire will be interpreted as your informed consent to participate and that you confirm that you are at least 18 years of age. You may refuse to take part in the research or exit the questionnaire at any time without penalty. All information obtained during the study will be kept confidential as required or permitted by law. The information in this study will be used only for research purposes. Any shared personal information that could identify you will be removed or changed before files are shared with other researchers or results are made public.