Parental knowledge, attitudes, and practices towards childhood fever among South-East and East Asian parents: A literature review

PLOS ONE RESEARCH ARTICLE Parental knowledge, attitudes, and practices towards childhood fever among South-East and East Asian parents: A literature review Hoi Lam Ng1, Huiyuan Li1, Xiaohuan Jin2, Cho Lee Wong ID1* 1 Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China, 2 The School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China * a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Abstract Aim The aim of this literature review was to identify, summarize, and critically appraise available empirical articles on the knowledge, attitudes, and practices towards childhood fever management among South-East and East Asian parents. OPEN ACCESS Citation: Ng HL, Li H, Jin X, Wong CL (2023) Parental knowledge, attitudes, and practices towards childhood fever among South-East and East Asian parents: A literature review. PLoS ONE 18(9): e0290172. https://doi.org/10.1371/journal. pone.0290172 Editor: Chai-Eng Tan, Universiti Kebangsaan Malaysia, MALAYSIA Received: February 1, 2023 Accepted: August 3, 2023 Design A literature review following PRISMA. Methods Articles were limited to those available in the English language. Articles had to be empirical studies that used a qualitative or quantitative research design with full-text available; focus on parental knowledge, attitudes, and practices towards fever; and be published in SouthEast and East Asia. Searches were conducted with CINAHL, PubMed and Scopus from inception to June 2022, and eleven articles were included after removing duplicates and excluding irrelevant articles. Published: September 8, 2023 Copyright: © 2023 Ng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Results Data Availability Statement: Due to the nature of the review, all relevant data are available within the manuscript, including Tables 1, 2 and 3, Fig 1, and S1 and S2 Files. Narrative synthesis was conducted according to four themes: source of fever information, knowledge level, attitudes, and practices towards childhood fever. Parents showed different fever knowledge needs and various information-seeking behaviors. A low level of fever knowledge was revealed in terms of temperature, fever causes, potential harms and influencing factors. South-East and East Asian parents mainly reported anxiety, concerns and fever phobia. Fever assessment methods and fever management strategies varied based on parents’ cultural background and beliefs. Funding: The author(s) received no specific funding for this work. Conclusions Competing interests: The authors have declared that no competing interests exist. The findings of this review highlight that inadequacy of fever knowledge and negative attitudes towards childhood fever exist in South-East and East Asian parents. Parents have PLOS ONE | https://doi.org/10.1371/journal.pone.0290172 September 8, 2023 1 / 22 PLOS ONE Parental practice to childhood fever diverse cultural practices during their children’s febrile episodes. However, some of them conflict with current medical guidelines, as they prioritize fever and body temperature reduction. This raises questions about their effectiveness and safety. Although some of them are medically discouraged, there are others that have been proven beneficial for the symptomatic relief of childhood fever. The results indicate an urgent need to develop a cultural-sensitive educational intervention for childhood fever management among South-East and East Asian parents. Unified educational interventions are needed to address parental concerns and fever-related knowledge needs. Background Fever is a temporary elevation of body temperature above the average daily range of 36.6˚C– 38˚C, as measured by a rectal thermometer [1,2]. It is a common symptom experienced by almost every child at some point. Fever can be an indicator of benign (e.g., the common cold) or severe conditions (e.g., lethal diseases and meningitis) and is usually self-limiting in children [2]. However, even in mild cases, most parents seek information about fever management and worry about the potentially severe consequences of fever, such as seizures, brain damage, and even death, although these outcomes are rare [2], leading to heightened anxiety. Despite being common, a recent systematic review of 36 studies on information needs related to childhood fever found that parents have a low level of knowledge about fever [3]. Furthermore, a review of scientific literature indicated that parental knowledge regarding the definition and management of fever is deficient [4]. Parents rarely define fever correctly and tend to have misconceptions regarding fever and engage in practices which differ from recommendations [5–7]. Parental knowledge greatly influences attitudes and fever management in their children [8]. A lack of knowledge regarding the pathophysiology and management of fever is an essential driver of fever phobia among parents; this can cause parents to become overly concerned about the height of the fever, how quickly the fever rises, the appearance and behavior of their child, and the underlying cause of the fever [9]. Parents’ inadequate knowledge about fever may also lead to unnecessary and inappropriate treatments, such as being unaware of the correct frequency of administering antipyretics at incorrect doses or intervals, which can increase healthcare-seeking behavior [10,11]. These practices can negatively affect children’s health, such as toxicity from supratherapeutic doses [12]. Parents’ unscientific and irrational attitudes towards fever can significantly impact the management of childhood fever [13,14]. Although appropriate levels of anxiety in parents are paramount to promoting health-protective behaviors in febrile children, which include close monitoring of symptoms and increasing fluid intake, studies have found that many parents (57%–68%) exhibit moderate to high anxiety levels during their children’s febrile episodes [15–18]. These findings align with the long-lasting phenomenon of fever phobia, which refers to an “unrealistic fear of fever expressed by parents” [19]. Parents’ fever-related anxiety and concern often lead them to practice non-evidence-based strategies to reduce temperature, which can cause further stress for children and parents [14] and increase emergency room visits [20]. A study in Hong Kong showed that caregivers of paediatric patients with fever symptoms were more than twice as likely to consult more than one doctor during an illness episode without a referral [21]. These actions inflict adverse psychological and financial consequences for families and burden the healthcare system unnecessarily [21]. PLOS ONE | https://doi.org/10.1371/journal.pone.0290172 September 8, 2023 2 / 22 (...truncated)