Randomised controlled trial of an intervention to improve parental knowledge and management practices of fever

Fever education for caregivers in the emergency room (The FEVER study)-an interventional trial

BACKGROUND

Despite the vast majority of fevers representing benign self-limiting illnesses, caregiver anxiety regarding fever is high. Empowering caregivers with knowledge to safely and appropriately manage fever at home has the potential to reduce demands upon healthcare services.

AIM

To improve caregiver knowledge about fever and its management in children via an educational intervention.

METHODS

Caregivers of children over 6 months presenting with fever to a Paediatric Emergency Department were recruited. A pre-intervention survey was completed to ascertain caregiver knowledge about fever and its management. The intervention of (i) an infographic about fever, with (ii) a short video on fever was viewed. A post-intervention survey re-assessed knowledge. The primary outcome was the correct definition of fever as a temperature ≥38 °C.

RESULTS

Caregivers (n = 51) who correctly defined fever increased from 41% (n = 21) pre-intervention to 94% (n = 48) post-intervention. There was a reduction in common misconceptions about fever, including a higher fever representing a more serious infection (76% vs. 8%). Caregivers reported they were less likely to seek emergency healthcare due to the height and nature of the fever alone.

CONCLUSIONS

A simple brief educational intervention can rapidly increase caregiver knowledge about fever in children. There is a continuing need for clear, easily-accessible information for caregivers on this topic.

IMPACT

Parental knowledge about fever and how to manage it in their children is low. A simple brief educational intervention can significantly increase caregiver knowledge about fever. A combined written and audiovisual approach is effective and well-received by parents. Educating caregivers has the potential to improve the management of childhood fever at home and to reduce the burden on healthcare services, as well as reduce unpleasant hospital visits for children and their caregivers.

Parental Concerns for Children With Cold-like Symptoms With Reduced Access to Evaluation in Primary Care Settings During the COVID-19 Pandemic: A Qualitative Study

INTRODUCTION

We aimed to explore the concerns of parents when their children had symptoms of infection during the COVID-19 pandemic.

METHOD

Two Norwegian internet forums were searched for parents' experiences when their children had upper respiratory infection symptoms in 2020-2021. A total of 197 posts were included and analyzed using thematic analysis.

RESULTS

Parents described COVID-19-related and general worries regarding their children with upper respiratory infection symptoms. The first theme, "It is not 'just a cold' during the pandemic," captures how infection control measures influenced parents' concerns. The second theme, "Concerns and consequences of fever and cold symptoms," describes general parental worries. Varying levels of worries regarding health care services, limitations of family life, and concerns for relatives were highlighted.

DISCUSSION

Knowledge of parents' concerns about cold symptoms may help primary health care providers target individual patient counseling and provide background information when policymakers develop information material for infection prevention and treatment.

Randomized controlled study: The effect of video-based distance education for approaching children with fever on parents' knowledge levels and fever management

AIM

The aim of the study was to evaluate the impact of distance learning, comprising of videos specifically designed for the management of fever in children, on parents' knowledge and practice of fever management.

METHOD

It was a randomized controlled pre/post-test study with 99 parents (mainly mothers, n = 91) of acute febrile children. The intervention group received fever management video training. "Descriptive Survey Form", "Fever and Fever Management Knowledge Form" and "Parent Fever Management Scale" were used to collect data. Cohen's d and 95% confidence interval were used to evaluate the effect size. The study was registered as NCT05707624 in Clinical Trials, retrospectively.

RESULTS

The intervention group's knowledge increased significantly from 52.2% to 65.5% (p = 0.003, d = 0.632) in the post-test. "Parent Fever Management Scale" scores of the intervention group were significantly lower (p < 0.001, d = 0.731) than the control group in the post-test.

CONCLUSION

The video training significantly enhanced parents' understanding of fever management, resulting in an effective reduction of their caregiving burden.

PRACTICE IMPLICATIONS

Fever management videos can be a valuable tool for parental education, particularly in clinical settings, aiding pediatric nurses in educating parents.

Survey of knowledge, practice, and associated factors toward home management of childhood fever among parents visiting Gondar health facilities in 2022

Background

Fever is a typical symptom of many sicknesses, but for children under the age of five, fever can have devastating consequences and represents a source of worry for parents. To the best of our knowledge, no research on home management of fever in children has been conducted in Ethiopia. We aimed to assess knowledge, practices, and associated factors towards home management of childhood fever among parents visiting Gondar Town health facilities in 2022.

Method

This multicenter institutional-based cross-sectional study was conducted in Gondar public health facilities from June 1st-June 30th, 2022. Participants were fathers and mothers of children aged 0-5 years. A stratified random sampling technique was used. Data were collected through face-to-face interviews using a pretested structured questionnaire.

Results

Approximately, 40.2% (95% CI: 35.5%, 45.2%) of parents had good knowledge and only 12.8% (95% CI: 9.7-15.8) of parents practiced home fever management. Being married [Adjusted odds ratio [(AOR) = 2.1 (1.2, 3.2)], having a primary or higher level of education [AOR = 2.4 (1.17, 4.9)] [AOR = 2.0 (1.02-4.6)], respectively, and number of children [AOR = 1.8 (1.63, 2.03)] were factors associated with parental knowledge. Likewise, being married [AOR = 3.05 (2.27.50-3.83)], receiving counseling from health care providers [AOR = 2.12 (1.53-3.32)], and being male [AOR = 2.03 (1.50-3.00)] were significant predictors of practice.

Conclusion

Inadequate levels of knowledge and numerous irrational practices related to home fever management were predominant among parents, which needs to be addressed. Evidence-based health education is essential for parents to enhance their level of knowledge and practice to effectively treat fever at home.

Parents' Knowledge and Management of Fever: "Parents Versus Fever!"

OBJECTIVE

Parents' lack of knowledge about fever causes fear and incorrect practices. This study aims to investigate the fever knowledge level, concerns, and practices of parents of preschool children.

MATERIALS AND METHODS

In this descriptive, cross-sectional study, conducted between July 2021 and July 2022, a survey was conducted among parents of children aged 6 months to 5 years who did not have a history of febrile seizure and/or chronic disease, either in themselves or their siblings.

RESULTS

A total of 386 parents, with a mean age of 33.6 ± 6.38 years and a mean number of children of 1.85 ± 0.9, participated in the study. Approximately one-third of parents started giving antipyretics to their child before the body temperature reached 38°C (32.4%) and/or used them alternately (34.5%). Moreover, approximately two-thirds (67.1%) tended to seek medical help within the first 12 hours. Parents who could not define fever correctly (66.6%) were more likely to start giving antipyretics before the child's body temperature reached 38°C [odds ratio (OR) 2.83 (1.70-4.71), P .001] and seek medical help within the first 12 hours [OR 1.81 (1.16-2.82), P = .008]. As the number of children or length of parenting increased, parents started giving antipyretics before the body temperature reached 38°C [OR 1.61 (1.26-2.06), P < .001; OR 1.04 (1.01-1.08), P = .048] and used them alternately [OR 1.07 (1.03-1.11), P = .001; OR 1.28 (1.02-1.62), P = .031].

CONCLUSION

This study demonstrates that a substantial proportion of parents still cannot define fever correctly, and inappropriate antipyretic use is more prevalent among experienced parents with multiple children and/or longer lengths of parenting.

Video Tutorials to Empower Caregivers of Ill Children and Reduce Health Care Utilization: A Randomized Clinical Trial

Importance

Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services.

Objective

To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children.

Design, Setting, and Participants

Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022.

Intervention

The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage.

Main outcomes and measures

The primary outcome was caregivers' self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period.

Results

In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67; P = .04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tutorials (27% vs 35%; adjusted OR, 0.67; 95% CI, 0.55-0.82). Randomization to video tutorials did not increase adverse outcomes.

Conclusions and relevance

In this randomized clinical trial, offering caregivers video tutorials significantly and safely increased self-efficacy and reduced use of telephone triage. Children had fewer hospital assessments when caregivers watched videos. This suggests a future potential of health care information to empower caregivers and reduce health care utilization.

Trial Registration

ClinicalTrials.gov Identifier: NCT04301206.