Fever in children is one of the most common reasons for caregivers to seek medical attention, often causing significant concern and anxiety. This widespread phenomenon is rooted in deep- seated beliefs and cultural practices that influence how caregivers perceive and manage febrile illnesses in their children. Understanding these beliefs and attitudes is crucial for healthcare providers to deliver effective and culturally sensitive care. Fever is a natural and often beneficial physiological response to infection[1], yet misconceptions and fears about its

potential harm can lead to over-treatment or delayed medical consultation, both of which carry risks [2]. Parental attitudes toward fever are shaped by a complex interplay of cultural, socio- economic, and informational factors[3]. In many cultures, fever is perceived not merely as a symptom but as a disease in itself, warranting immediate and often aggressive intervention [4]. This perception is compounded by the influence of family members and community norms, which play a pivotal role in shaping health-seeking behaviour [5]. For instance, grandparents and other relatives often provide crucial support and advice, which can either alleviate or exacerbate parental anxiety [6]. The cost of medical consultations and treatments can be prohibitive for many families, leading to a reliance on over-the-counter medications or traditional remedies [7]. This economic burden is particularly pronounced in low-income communities, where access to healthcare facilities is often limited. Furthermore, the availability of healthcare services and the ease of accessing these services play a critical role in decision- making processes. In rural areas, the lack of nearby healthcare facilities can delay medical consultation,[8],increasing the risk of complications from untreated febrile illnesses [9].Information and education about fever management are also crucial determinants of parental attitudes.[10] Misconceptions about the dangers of fever, such as the fear of febrile seizures or brain damage, persist despite evidence-based guidelines that emphasize the benign nature of most febrile episodes in children [11]. Health education programs that provide clear, evidence-based information can help mitigate these fears and promote rational fever management practices [12]. Despite this, many parents continue to harbour "fever phobia," a term coined to describe the irrational fear of fever and its supposed consequences [13]. This study aims to explore the multifaceted factors influencing parental beliefs and attitudes towards children's fever through a community-based, multi-centric approach. By examining these factors in diverse settings, we hope to uncover the underlying reasons behind health-seeking behaviours and identify potential areas for intervention.[14] The ultimate goal is to enhance the understanding of febrile illnesses in children and improve the quality of care provided to this vulnerable population. Studies have shown that interventions tailored to address specific cultural beliefs and economic constraints can significantly improve healthcare outcomes [15]. Additionally, the role of healthcare professionals in educating parents about fever management cannot be overstated. Training and resources for healthcare workers are essential to ensure they can provide accurate and reassuring information to worried parents [16]. This includes addressing common myths and misconceptions, as well as providing practical advice on when to seek medical attention [17]. In this regard, community health programs and public health campaigns play a pivotal role in disseminating knowledge and promoting best practices [18]. Moreover, the psychological impact of fever on both children and their caregivers is an area that warrants further exploration. Anxiety and stress related to fever can affect parental decision-making and overall family well-being [19]. Finally, the study underscores the importance of a collaborative approach involving healthcare providers, educators, and community leaders to foster a supportive environment for managing childhood fever [20].

The methodology employed for the study is primarily observational with a survey design. Study Design: The study entails observing and surveying parents who meet specific inclusion and exclusion criteria. Included participants must be parents of children aged 0-12 years who have managed fever in their children within the past six months. Excluded are parents of children with chronic health conditions or significant cognitive impairments. Target Population: The target population for this study consists of parents of children aged 0-12 years with a history of fever in the past six months (from August 2023 to January 2024), residing in urban and rural areas of Surendranagar and Bhuj districts. Sample Size & Period: A total of 120 participants were surveyed from February 2024 to July 2024. Of these, 60 parents were selected from each purposively chosen district, Surendranagar and Bhuj. In Surendranagar district, 30 parents were interviewed from 2 urban wards [15 from each ward] and 30 from 2 villages [15 from each village] chosen through simple random sampling. Similarly, in Bhuj district, 30 parents were interviewed from 2 urban wards [15 from each ward] and 30 from 2 villages [15 from each village] chosen by simple random sampling. Data Collection Method

Tool: Data was collected through in-depth interviews and questionnaires. The demographic variables include parent's age, gender, number of children in the household, child's age, locality, and socioeconomic status. Research variables encompass parental beliefs and attitudes. Questionnaire Development: The questionnaire was developed through a literature review on parental beliefs about childhood fever, validated by experts, and refined via a pilot test to ensure clarity and alignment with the study’s objectives.

Data Analysis: Inferential analysis was conducted using thematic analysis to identify patterns, themes, and relationships within the collected data, providing insights into parental perspectives and behaviours related to children's fever management.

Parental Demographics The majority of parents are aged 40-49 (33.9%), followed by 30-39 (26.8%), with the least in the 60-69 range (6.3%). Males dominate the sample (80.4%), while females constitute 19.6%. Children aged 10-12 years form the largest group (36.6%), while those under 1 year are the least (8.0%). Most households earn ₹20,000-40,000 (28.6%), and the most common educational level is secondary school completion (53.6%). Skilled employment (26.8%) is the largest job category, while daily wage labor (5.4%) and small business owners (6.3%) are the least represented.

Table 1: Parent Demographics

Table 2: Gender Distribution

Table 3: Child's Age Range

Table 4: Household Income Range

Table 5: Highest Level of Education Attained by the Parent

Table 6: Employment Status

Parental Beliefs about Fever Parents commonly view fever as a sign of infection or illness. Some recognize it as the body’s defense mechanism, while others attribute it to environmental factors. Many observe symptoms such as fatigue, loss of appetite, and increased heart rate. Some parents express uncertainty about fever severity, associating it with serious conditions, vaccinations, teething, or dehydration.

Table 7: Parental Beliefs about Children's Fever

Parental Attitudes about Fever Parents’ emotional responses range from worry and caution to hopefulness and resignation. Some consider fever serious, while others view it as a common occurrence. Anxiety, stress, and frustration are frequent reactions. Attitudes toward fever- reducing medications vary, with some parents hesitant and others supportive. Challenges include healthcare access, financial barriers, and obtaining reliable medical advice.

Table 8: Parental Attitudes about Children's Fever

Peer Influence on Healthcare Decisions Parents frequently discuss fever management with peers in various settings, including social media and community gatherings. Peer support influences confidence, decision-making, and treatment choices.

Table 9: Peer Influence on Healthcare Decisions

Healthcare Provider Influence Parents trust medical professionals and rely on their recommendations. Availability, empathy, and support from healthcare providers shape parental decisions and comfort in fever management.

Table 10: Interaction with Healthcare Providers

Fever Management Approaches & Satisfaction Parents adopt varied strategies, including traditional remedies, modern medicine, and financial considerations. Satisfaction levels range from confidence to concern.

Table 11: Attitudes Towards Managing Children's Fever

Desired Improvements in Healthcare Parents seek better healthcare access, affordable medications, and community education. Mobile clinics, telemedicine, and financial aid are suggested solutions.

Table 12: Desired Improvements and Additional Support

Fever in children is a common reason for caregivers to seek medical attention, driven by deep- seated beliefs and cultural practices influencing how febrile illnesses are perceived and managed [21]. Despite fever being a natural response to infection, misconceptions and fears about its potential harm often led to either over-treatment or delayed medical consultation, both of which can pose risks [22]. Parental attitudes towards fever are shaped by cultural, socio- economic, and informational factors. In many cultures, fever is not merely seen as a symptom but as a disease itself, prompting immediate and sometimes aggressive intervention [23]. This perception is compounded by the influence of family members and community norms, which play pivotal roles in shaping health-seeking behaviours [24]. Economic factors significantly influence healthcare-seeking behaviour, with the cost of medical consultations and treatments often prohibiting access for many families, thereby increasing reliance on over-the-counter medications or traditional remedies [25]. This economic burden is particularly pronounced in low-income communities where access to healthcare facilities is limited, leading to delayed medical consultation and potential complications [26]. Information and education about fever management are critical determinants of parental attitudes. Despite evidence emphasizing the benign nature of most febrile episodes, misconceptions persist, such as fears of febrile seizures or long-term neurological damage [27]. Health education programs providing evidence-based information can help mitigate these fears and promote rational fever management practices [28]. Nonetheless, many parents continue to harbour "fever phobia," underscoring the ongoing need for education and reassurance [29]. This study employs a community-based, multi-centric approach to explore factors influencing parental beliefs and attitudes towards children's fever. By examining these factors across diverse settings, insights are gained into health-seeking behaviours, aiming to identify areas for intervention and improve care for children [30]. Interventions tailored to address cultural beliefs and economic constraints have shown promising results in improving healthcare outcomes [31]. Healthcare professionals play a crucial role in educating parents about fever management, emphasizing evidence-based guidelines and dispelling myths [32]. The emotional and psychological impact of fever on children and caregivers warrants further exploration, given its influence on decision-making and family well-being [33]. In conclusion, collaborative efforts involving healthcare providers, educators, and community leaders are essential to support effective fever management and improve outcomes for children [34].

The thematic analysis of caregivers' healthcare-seeking behaviour for children's fever revealed critical themes: cultural beliefs, financial constraints, and accessibility issues. Cultural beliefs led to reliance on traditional remedies and delays in seeking medical care. Financial barriers and accessibility challenges further hindered timely medical intervention. Caregivers viewed fever both as a natural defence mechanism and a sign of illness, causing anxiety and prompting swift healthcare-seeking behaviour. Common causes of fever included viral infections, vaccination side effects, and environmental factors like weather changes and poor hygiene. Caregiver education on fever management and recognizing severe symptoms is crucial. Trust in information sources varied, with preferences for traditional remedies and scepticism towards pharmaceuticals influencing decision-making. Satisfaction with fever management varied, with many caregivers expressing high satisfaction when their child's condition improved. Needs identified by caregivers include accessible and affordable healthcare services, improved availability of medicines, educational workshops, and support for traditional healing practices. Addressing these needs requires a multifaceted approach to effectively manage childhood fevers.

Source of support: Nil

Conflict of interest: None declared

AUTHOR CONTRIBUTION:

Author 1 provided overall study guidance, ensured methodological rigor, coordinated data collection, and contributed to result interpretation and manuscript writing. Author 2 developed survey tools, coordinated field data collection in Surendranagar and Bhuj, and contributed to analysis and manuscript drafting. Author 3 provided clinical expertise, reviewed survey tools, interpreted findings, and critically revised the manuscript. Author 4 focused on pediatric data collection, ensured ethical standards, assisted in survey development, contributed to analysis, and helped write and revise the manuscript.The manuscript has been read and approved by all the authors.

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