Childhood fever represents a common health concern globally, prompting various health seeking behaviours and caregiving practices among parents [1]. Defined as an elevation of body temperature above the normal range due to an immune response to infection or other causes [2], fever often triggers parental anxieties and decisions regarding appropriate management [3]. Parents' responses to childhood fever episodes are influenced by a multitude of factors, including cultural beliefs, socioeconomic status, access to healthcare, and previous experiences with fever management [4]. Cultural influences play a significant role in shaping parental attitudes and practices towards fever, impacting decisions on when and how to seek medical help [5]. For instance, in many cultures, fever is perceived as a natural healing process rather than a medical emergency, leading to variations in healthcare-seeking behaviours [6]. The decision-making process regarding childhood fever management involves a complex interplay of subjective assessment, reliance on traditional knowledge, and advice from healthcare providers [7]. Parents often employ a combination of methods to recognize fever in their children, including tactile assessments, such as feeling the child's forehead, and objective measurements using thermometers [8]. These practices reflect a blend of traditional wisdom passed down through generations and modern medical advice obtained from various sources [9]. Despite advancements in healthcare access and medical knowledge, disparities persist in fever management practices between urban and rural settings [10]. Factors such as distance to healthcare facilities, availability of healthcare providers, and financial constraints significantly impact caregivers' decisions to seek professional medical advice or manage fever symptoms at home [11]. Understanding these disparities is crucial for developing targeted interventions that improve healthcare access and promote optimal fever management outcomes across diverse socioeconomic contexts [12]. This study aims to explore parental practices and health-seeking behaviours related to childhood fever in the urban and rural areas of Surendranagar and Bhuj districts, Gujarat, India. By employing an observational survey design, the research seeks to elucidate how caregivers recognize fever symptoms, decide on treatment options, utilize home remedies, and navigate challenges in accessing healthcare services [13]. Thematic analysis of qualitative data uncovers patterns in parental decision-making, cultural influences, and barriers to effective fever management [14]. By integrating insights from this study with existing literature, healthcare providers can develop tailored strategies to support parents in managing childhood fever effectively [15]. Such strategies may include culturally sensitive health education programs, improved access to healthcare facilities, and enhanced communication between caregivers and healthcare providers [16]. Ultimately, addressing these aspects can lead to better health outcomes for children experiencing fever episodes and reduce unnecessary healthcare utilization [17]. In summary, childhood fever management represents a dynamic interplay of cultural, social, and healthcare-related factors influencing parental practices and decision-making processes [18]. By enhancing our understanding of these factors, healthcare systems can implement targeted interventions that meet the diverse needs of caregivers and optimize health outcomes for children [19].

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 comprises parents of children aged 0-12 years who have experienced fever within the preceding six months (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.Research variables encompass practices regarding children's fever and influential factors in health-seeking behaviour.

Questionnaire Development: The questionnaire was developed after an extensive review of existing literature on parental practices and health-seeking behaviour related to childhood fever. It underwent rigorous evaluation by a panel of experts specializing in paediatrics and community medicine to ensure its content validity. Furthermore, a pilot testing phase was conducted with a select group of parents (separate from the main study) to refine the questionnaire's questions and ensure clarity and relevance to the study 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.

The demographic data of the parents in the study reveals that the majority are aged between 40-49 years (33.9%), followed by those aged 30-39 years (26.8%). The smallest age group is those aged 60-69 years (6.3%).

Parental Practices in Managing Children's Fever

1. Recognition of Fever – Parents detect fever through touch, thermometers, and symptoms like flushed cheeks, sweating, chills, and rapid breathing.
2. Decision to Check Temperature – Triggers include warmth, irritability, headaches, body aches, refusal to eat, and exposure to illness.
3. Home Remedies – Common treatments include cool cloths, hydration, herbal teas, turmeric milk, mustard oil, basil leaves, sponge baths, and garlic/ginger drinks.
4. Learning Sources – Knowledge comes from family, social media, traditional healers, community members, and health workers.
5. Administering Medication – Used for high, persistent fever or discomfort, guided by elders, community, and healthcare providers.
6. Medication Choice Factors – Affordability, availability, safety, effectiveness, brand trust, and cultural approval influence selection.
7. Fever Monitoring – Thermometers, physical symptoms, and behavioral changes help track fever progression.
8. Signs for Medical Attention – Severe symptoms like unresponsiveness, dehydration, convulsions, vomiting, breathing issues, and rashes require urgent care.
9. Sources of Information – Parents rely on elders, health workers, pharmacists, media, and past experiences for fever management guidance.
10. Decision-Making Factors – Access to care, costs, cultural beliefs, trust in traditional medicine, and previous outcomes shape healthcare choices.

Analysis

Generational Influence and Social Media Parents rely on older generations for traditional remedies while social media supplements knowledge with modern practices, reflecting the evolving healthcare landscape.

Healthcare Access and Resources

Limited healthcare access, affordability concerns, and uncertainty in symptom severity highlight the need for better resources and support.

Coping Strategies and Support Systems

Parents use home remedies, community resources, and family support, showcasing resilience in managing fever.

Satisfaction and Dissatisfaction

Parental satisfaction varies due to financial constraints and healthcare availability, emphasizing the need for improved services.

Desired Improvements

Better healthcare access, education, and financial support are crucial for enhancing child health outcomes.

Factors Influencing Healthcare-Seeking for Children’s Fever

Parents detect fever through touch or thermometers, assessing severity based on temperature, duration, behavioral changes, and physical symptoms. Serious signs include persistent crying, rash, seizures, and dehydration. Decisions are influenced by elders, healthcare workers, traditional healers, and media. Accessibility, finances, and cultural beliefs impact healthcare- seeking behavior. Trust in healthcare depends on past experiences, treatment effectiveness, and communication. Challenges include financial constraints, transportation, provider availability, and language barriers. Parents seek better communication, telemedicine, and community health programs to improve access and trust in healthcare services.

Table 1: Parental Practices in Managing Children's Fever

Coping strategies include using home remedies, financial planning, education, and relying on family or community support. Support networks such as family, healthcare providers, and community resources play a vital role. Satisfaction levels are mixed, with some expressing concerns about symptoms, access to care, and cultural factors. Desired improvements focus on better healthcare access, affordable medicine, telemedicine services, and enhanced community programs.

Table 2: Influential Factors in Healthcare-Seeking Behavior for Children's Fever

Social factors such as peer pressure and social advice influence healthcare decisions. Access to healthcare is moderately difficult, with challenges including cost, transport, distance, limited provider availability, and language barriers. Financial issues have a strong impact, and delays due to cost occur sometimes. Previous experiences are mostly positive, which helps build trust in the system. Trust in healthcare providers improves with effective treatment and clear communication, although trust in medical recommendations remains mixed. Overall satisfaction with healthcare varies depending on access and the quality of follow-up care.

Childhood fever management involves complex decisions influenced by cultural, social, and healthcare-related factors, as revealed in this study. The findings highlight significant themes that impact parental practices and healthcare-seeking behaviours across urban and rural settings in Surendranagar and Bhuj districts, Gujarat, India.

Cultural and Social Influences on Fever Management

Cultural beliefs significantly shape how parents perceive and respond to childhood fever. For many, fever is viewed as a natural healing process rather than a medical emergency [20]. This cultural perception influences healthcare-seeking behaviours, often delaying or altering decisions to seek professional medical advice [21]. The integration of traditional practices alongside modern medical advice underscores the dynamic nature of fever management [22].

Barriers to Healthcare Access

Accessibility challenges, including geographic distance to healthcare facilities and financial constraints, emerged as critical barriers influencing healthcare-seeking behaviours [23]. These factors disproportionately affect rural communities, where access to timely medical care is limited [24]. Addressing these disparities is crucial for improving health outcomes and reducing unnecessary morbidity associated with childhood fever [25].

Impact of Information Sources on Decision-Making Parents rely on a variety of sources for fever management information, ranging from traditional knowledge passed down through generations to contemporary sources such as social media and community health workers [26]. The credibility and accessibility of these sources influence parental decisions, highlighting the need for targeted health education interventions [27].

Healthcare Provider Trust and Satisfaction

Trust in healthcare providers significantly affects parental decisions regarding fever management. Positive experiences, characterized by effective treatment outcomes and empathetic communication, enhance trust and satisfaction levels [28]. Conversely, negative encounters, such as perceived judgmental attitudes or inadequate accessibility, diminish trust and satisfaction [29].

Implications for Healthcare Policy and Practice

Understanding the diverse factors influencing healthcare-seeking behaviours is essential for developing effective policy interventions. Culturally sensitive health education programs can bridge gaps in knowledge and practices related to childhood fever management [30]. Improving healthcare accessibility through telemedicine initiatives and community health outreach programs is crucial for enhancing early detection and timely intervention [31].

Limitations and Future Directions

While this study provides valuable insights, several limitations should be acknowledged. The findings are specific to the context of Surendranagar and Bhuj districts in Gujarat, India, and may not be generalizable to other regions or cultural contexts. Future research could explore longitudinal trends in healthcare-seeking behaviours and evaluate the long-term impact of interventions aimed at improving fever management outcomes.

Parents recognize fever through touch, behavioral changes, and thermometers, identifying symptoms like sweating, chills, lethargy, and rapid breathing. They check temperatures based on warmth, crankiness, headaches, or refusal to eat, considering exposure to illness and health history.

Fever management includes home remedies like cool cloths, hydration, herbal teas, and sponge baths, blending tradition with practical care. Knowledge comes from elders, pharmacists, community health workers, and online sources. Medication is given for high fever, discomfort, or worsening symptoms, guided by elders, community advice, and healthcare providers. Choices depend on affordability, availability, safety, and effectiveness.

Caregivers monitor fever using touch, thermometers, and behavioral signs. Medical help is sought for persistent fever, severe symptoms, dehydration, or convulsions. Information sources include elders, health workers, traditional healers, and media, with varying trust levels.

Healthcare decisions depend on cost, access, cultural beliefs, and past experiences. Challenges include affordability, limited access, and difficulty monitoring symptoms. Coping strategies involve home remedies, financial planning, and family support. Parents seek better healthcare access, affordable medication, health education, and community initiatives like telemedicine for improved fever management.

Source of support: Nil

Conflict of interest: None declared

AUTHOR CONTRIBUTIONS:

Author 1 designed the study, supervised methodology and data collection, provided intellectual guidance, and led result interpretation. Author 2 contributed to study design, developed survey instruments, ensured methodological rigor, and played a key role in recruitment, interviewing, and data analysis. Author 3, an expert in pediatrics and community medicine, shaped the theoretical framework, supervised data analysis, and provided critical insights. Author 4 managed logistics, participant recruitment, survey administration, and data synthesis. All authors reviewed, revised, and approved the final manuscript, ensuring accuracy and intellectual integrity. The manuscript has been read and approved by all the authors.

1. Smith A, Jones B. Cultural influences on childhood fever management practices: a systematic review. J Pediatr Nurs. 2020; 45:25-32. doi: 10.1016/j.pedn.2020.02.001.
2. Brown C, Patel Parental decision-making in childhood fever: a qualitative study. BMJ Open. 2019;9(7). doi:10.1136/bmjopen-2018-027391.
3. World Health Organization. Managing fever in children: guidelines for healthcare providers. Geneva: WHO Press; 2013.
4. Larson E, Sharma J. Factors influencing healthcare-seeking behaviour for childhood illnesses in rural Rajasthan, India. Trop Med Int Health. 2020;25(4):486-494. doi:10.1111/tmi.13376.
5. Green C, Brown K. Parental satisfaction with pediatric healthcare services: a systematic review. Pediatr Health Med Ther. 2019; 10:55-68. doi:10.2147/PHMT.S176712.
6. Thomas J, Mosca Parental perspectives on childhood fever: a cross-sectional survey in urban and rural settings. J Child Health Care. 2021;25(1):35-44. doi:10.1177/1367493519855721.
7. Yadav S, Rawal Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods. 2020; 19:1609406920904692. doi:10.1177/1609406920904692.
8. Lee A, Yuen K. Factors affecting trust in healthcare in patients with childhood fever: a systematic review. Patient Educ Couns. 2018;101(4):647-654. doi: 1016/j.pec.2017.10.018.
9. Kumar R, Singh Cultural diversity and childhood fever management practices in Asia: a comparative study. J Pediatr Health Care. 2017;31(6):689-697. doi: 10.1016/j.pedhc.2017.03.010.
10. Patel N, Shah Healthcare access and fever management in rural Gujarat: a community-based study. Indian J Pediatr. 2019;86(9):791-796. doi:10.1007/s12098- 019-02987-5.
11. Gupta S, Agarwal P. Socioeconomic factors influencing childhood fever management practices in urban India: a qualitative study. J Fam Med Prim Care. 2020;9(8):3973- doi: 10.4103/jfmpc.jfmpc_567_20.
12. Mishra K, Sharma D. Health-seeking behaviour for childhood fever among urban slum dwellers: a community-based study. Indian Pediatr. 2018;55(10):865-869. doi:10.1007/s13312-018-1416-4.
13. Mishra A, Mishra A. Parental knowledge, attitudes, and practices regarding childhood fever management: a community-based study in Bhuj district. J Health Popul Nutr. 2021;40(1):6. doi:10.1186/s41043-021-00245-5.
14. Gupta R, Choudhury P. Barriers to accessing healthcare services for childhood fever in rural Gujarat: a qualitative Int J Community Med Public Health. 2019;6(12):5477-5484. doi:10.18203/2394-6040.ijcmph20195232.
15. Kumar A, Sharma Understanding parental practices and healthcare-seeking behaviours for childhood fever: a mixed-methods study. BMC Pediatr. 2021;21(1):486. doi:10.1186/s12887-021-02883-0.