Abstract

Feverish illnesses are common among children, presenting a challenge in their management for caregivers. There is a prevailing negative attitude towards fever, which persists despite the evidence of beneficial immunological effects and lack of practical implementation of this knowledge among both healthcare professionals and the lay public. It results in overuse of healthcare providers, medication as antibiotics and antipyretics as a burden for the healthcare sector. After it ̨`s implementation, the effectiveness of the FeverFriend Program was investigated in promoting behavioral change in fever management.

Methods
The FeverFriend Program includes a decision aid with risk assesment based on a complex algorithm. This unique algorithm was based on the NICE quidelines adapted to local properties by an expert group, resulting in a standard RAG triage and behavioral advice. The App is connected to a knowledge base. Both are free available. A prospective, observational registry study was conducted within a mobile app with self-selectedusers. Patient`s and caregiver`s anonymized in-app data of a 42-month period (12/2020-05/2024) were analyzed. The FeverFriend app incorporates four different observational units. Users, patients level including baseline characteristics, fever measurement and result level, closing with illness review.

Results and Discussion
Results: Among 21,137 Hungarian users following app use, the results indicated that all three hypotheses remained statistically significant (p > 0.01). Overall, our analysis (McNemar’s test) provides robust evidence for the significant changes observed in the use of antibiotics, antipyretics and doctor visits due to fever, even after considering multiple testing adjustments. Discussion: Sociological research attributes parental attitudes to feverish pediatric illnesses to a number of factors such as unjustified fear, help-seeking behavior, complex
behavioral patterns of symptom avoidance and comfort-seeking. In the light of recent research, the target points of improvement in attitudes are linked to healthcare literacy among health professionals and lay people. In our program self-reporting EMA, real time and real-life circumstances were captured. The good coverage of our data observed in key sociodemographic and anthropometric measures provides confidence in the validity of our findings and their applicability to the broader population of small children. After rigorous risk assessment, it has been found that most cases of childhood febrile illnesses can be managed with a delayed or no prescription strategy for antibiotics, resulting in satisfactory patient outcomes and
uncomplicated clinical courses.

Conclusions
The FeverFriend Program, as a best practice example of evidence based integrative approaches is available in 9 languages worldwide. It proves to be a safe and effective tool for promoting behavior change in fever management among the nonrandomized population of caregivers of children. These findings contributed to a new Guideline on Management of Childhood Fever in Hungary released in March 2025, implementing the added value of integrative approaches into the existing healthcare system.