Association Between Applying a Mobile Health Decision Aid and Education Application and Caregivers' Behavioral Change in the Management of Child Febrile Illnesses - Use of Antibiotics, Antipyretics, and the Healthcare System: A Single-Arm Prospective Pre-Post Intervention Study (Preprint)

Abstract

Feverish illnesses are common among children, presenting a management challenge for caregivers. Despite evidence supporting beneficial immunological effects, the practical implementation of this knowledge is lacking and a prevailing negative attitude towards fever persists. The overuse of antipyretics and antibiotics in general pediatric practice, along with the associated risk of antimicrobial resistance, underscores critical considerations in healthcare.

The goal of this study was to evaluate the mHealth intervention FeverFriend, a personalized decision aid mobile phone application connected with a knowledge base. The aim was to enhance health literacy to improve health literacy among caregivers of children with feverish illnesses and to teach fever management adherent to the NICE (2021) guideline. It was hypothesized, that the users following the app usage would administer less antipyretics, antibiotics, and seek less frequent consultations with doctors compared to their practices before using the app.

This study had a single-arm, prospective, pre-post evaluation design. Eligible participants were caregivers of healthy children under 18 residing in Hungary. Entering the study, participants provided demographic, anthropometric information and responded to premeasurements related to the use of 1) antibiotics, 2) antipyretics, and the 3) healthcare system (visiting a doctor) due to feverish illnesses. The prospective intervention involved the use of the FeverFriend mHealth application, followed by post-measurements on the same three dimensions, among other feverish symptoms. We assessed sample coverage by examining basic caregiver-reported sociodemographic and anthropometric measures using chi-square test for independence. We captured within-patient change applying paired binary McNemar's tests for the three user-reported baseline and post-intervention outcome measures during the 35-month period analyzed.

Caregivers enrolled a total of 22.219 healthy children with average age 3 years 1 month (SD 3.28) demonstrating good coverage of the population on gender (female 48.22% (10.714/22.219; χ21=2.517, P=.64) and number of siblings (1.67, SD 0.88; χ24=11.45, P=.56). A total of 12.948 feverish illnesses were reported, of which 4.927 (38.05%, 4.927/12.948) were reviewed in detail providing post-measurements. The outcomes of the first illness reviews per each patient (n=1.934) were utilized to ensure consistent intervention exposure for all patients. Our results support the hypotheses: after completing the mHealth intervention, caregivers administered significantly less antipyretics (McNemar χ21=13.79), antibiotics (McNemar χ21=8.17) and consult less often (McNemar χ21=128.84) with doctors (all P values <.005).

This study provides preliminary evidence that the FeverFriend mHealth intervention has the potential to reduce administration of antipyretics, antibiotics among children with feverish illnesses and users exhibited a decreased frequency of doctor visits compared to their practices before using the app. Future research should incorporate randomized trials to confirm causality and the multivariate analysis of the secondary outcome measures of the app on symptoms and parental confidence.

ClinicalTrials.gov NCT04633603; https://clinicaltrials.gov/study/NCT04633603