definition of fever, 64% believed that high body temperature
should be reduced immediately, and two thirds believed that
heavier clothes should be worn in event of a fever. Over
the past 30 years, the amount and accessibility of information
available to the general public have increased significantly;
however, whether there has also been a commensurate increase
in parental understanding of fever is unclear. In a recent study
investigating fever knowledge and management of infants,
64.3% of native mothers believed that body temperature
would be consistently elevated if antipyretics were not given
and 64.3% were concerned about potential brain damage
(Yuan 2010). In Yuan’s study, only 56 Taiwanese mothers
with infants under 1 year old were study.
Do Taiwanese parents still have fever Phobia? If so,
what are their specific concerns? This study aimed to investigate
parental knowledge, concerns, and management of childhood
fever and related factors in Taiwan.
Methods
Design
The study was a cross-sectional investigation involving parents
who children attended pediatric clinics or kindergartens
inTainan City in southern Taiwan. Parents were eligible for inclusion
if they had a child under the age of 6 years and
did not have any severe chronic diseases (e.g., congenital
heart disease, diabetes, immunosuppression, or neurological
or oncological conditions).
Participants
Two pediatric clinics were selected at random from seven geographic
districts of Tainan, in which there are a total of 61 clinics. Nine kindergartens
were randomly selected from 91 registered in the geographic districts.
Consent to approach the parents was obtained from clinic administrators and
kindergarten principals.
In the clinics, a trained research assistant approached parents
of children under 6 years old and invited them to paticipate
in the study. After giving written consent, one parent
in each couple completed and returned a self-administered
research questionnaire in Chinese while waiting for their clinic
appointment. One class was randomly selected from each
kindergarten, and consent forms and self-administered research
questionnaire were sent home with each child. Parents were asked to return
questionnaire by mail within 10 days. No identifying was required on the
questionnaire or return envelope. Six hundred seventy-nine parents
agreed to participate in the study.
Instrument
Instead of adapting a questionnaire developed in other coutries
with different languages and culture, we developed the
questionnaire based on a literature review of articles written
in English and Chinese. We conducted a search of the literature
in MEDLINE, CINAHL, and the Airiti Library (article
wrltmn in Chinese). The self-developed questionnaire assessed
parental knowledge about fever, the type and extent of concerns,
and management practices. The instrument included
parents' demographic data and four subscales: knowledge of
fever (24 items), parental concerns (5 items), fever management
(11 items), and sources of information about fever (8 items).
The fever knowledge subscale was scored as 1 point
for each correct answer, with a maximum score of 24.
Questionnaire content validity was reviewed and scored
by seven experts (three pediatricians, two pediatric head
nurses, and two PhD nursing faculty). The content validity
index for the 48 items was scored by each expert as inappropriate (1),
requires modification (2), or appropriate (3).
Any item ranked lower than 3 was reviewed by the research
team and revised as needed. The content validity index was
.95. To establish face validity, 10 participants participated
in a simulated questionnaire round to evaluate the time
required and wording. Nine of the ten parents (90%) indicated
that the questionnaire adequately presented fever knowledge,
concerns, and management and was easy to understand.
Simulation-round results were referenced to create the final
questionnaire.
Item discrimination analysis was performed using total
fever knowledge score to assess the reliability of knowledge
scores. Participants in the top 27th percentile of total scores
were designated as the high-scoring group. Participants in
the bottom 27th percentile of total scores were designated as
the low-scoring group. A t test compared scores for each
item between the two groups, with significant results found
for all 24 items. A point-biserial correlation coefficient was
determined to ascertain relationships among the 24 items in
the fever knowledge subscale. One item had a point-biserial
correlation of less than .3 and was therefore deleted. The
final fever knowledge subscale was composed of 23 items;
hence, the maximum knowledge score was 23. The self-
administered questionnaire took about 15 minutes to complete.
parents prefer Western medicine approaches to manage childhood
fever, although some participants used traditional Chinese
medicine and Taiwanese folk remedies at home. Parental
knowledge about fever did not significantly correlate with
the use of complementary therapies. The range of treatments
used may reflect the lack of consistent advice from information
resources and may also reflect multicultural influences
(e.g., religious preferences).
Educational Program Consideration
We found that Taiwanese parents had relatively low fever
knowledge scores, did not understand information about
fever, and were dissatisfied with the information provided.
We also found that there was a significant relationship between
parental knowledge of fever, level of concern, and their
management approach to childhood fever. These findings
suggest that level of education about fever is low and that the
current strategies used to educate parents about treatment
are not effective. Therefore, measures should be taken to
enhance parental knowledge of fever.
Participants in this study expressed concerns about the
potential adverse consequences of fever and were therefore
inclined to administer antipyretics. Hence, fever education
should also highlight the benefits of fever and note that fever
rarely results in brain damage, seizures, or mental retardation
because of the body’s ability to self-regulate temperature.
Moreover, causes of fever, symptoms of childhood fever,
and the process/management of fever should be covered.
Although our findings are consistent with previous study findings
regarding childhood fever and parental “fever phobia,”
differences do exist, particularly in terms of parents’ definition
of chilhood fever and in the cultural aspects of home treat
Ethical Considerations
The institutional review board of the National Cheng Kung
University Hospital, Taiwan, approved this study. Participation
was voluntary, and each participant provided written consent
before completing the questionnaire.