The effectiveness of educational strategies in improving parental/caregiver management of fever in their child: a systematic review.

Abstract

"Fever phobia" has been identified as a common problem among parents, and may result in unnecessary use of medical facilities, overuse and inappropriate dosage of antipyretics, and unnecessary parental anxiety. Current research findings support the claim that parents have serious misconceptions, misinformation, and limited skills regarding fever management. The objective of this review was to determine what educational interventions are effective in influencing parents to provide effective care for their febrile child. A comprehensive search of databases covering nursing and medical literature was performed, and all quantitative studies conducted between 1980 and 2008 were included. The principal reviewer and a second reviewer each independently assessed methodological quality against the appropriate standardised JBI critical appraisal checklist. There were four cases of disagreement, which were then independently assessed by a third reviewer. The final decision to include or exclude the study was discussed by the review panel. The reviewers extracted data from included studies using a standardised data extraction tool appropriate to the study design, from the JBI Meta Analysis of Statistics Assessment and Review Instrument (MAStARI). There were no disagreements between the reviewers regarding the data extraction. It was found that the studies outcome measures differed to the extent that the results were unable to be pooled. Consequently a meta-analysis was unable to be conducted. Instead studies were grouped according to outcome measures and level of intervention, and presented in narrative summary. The review included ten studies, of which six were trials, two were cohort studies, and two were surveys, and involved 1977 participants. The studies which looked at formal educational interventions involving mixed methods of written, verbal and interactive material on parental knowledge, found a statistically significant improvement. This improvement was found by one study to be sustained until 6 months. The studies using semiformal methods of education, such as written and audiovisual materials, also showed a statistically significant improvement in parental knowledge, however the effects did not appear to be long lasting. Studies using informal methods of education, which were largely parent dependent, were not found to be effective in improving parental knowledge. Parental knowledge, attitudes, confidence and satisfaction did not necessarily equate with improved behaviours. The research suggests that formal education involving mixed methods of written, visual, interactive and verbal material in a structured or repeated session, was effective in significantly improving parental knowledge about fever management in children. What is required are more studies of the formal investigations included in this review which have been shown to be effective, with replication of the outcome measures. Those strategies delivered by health care providers, formal in structure, and relevant to current situations, i.e. in close proximity to the time of fever, with multidimensional methods, and reinforced, have been shown to be more effective in improving parental management of fever in their child. One-dimensional methods such as written material alone did not appear to be statistically significant in affecting behaviours, however did decrease anxiety and improve satisfaction.