Use of the Theoretical Domains Framework to Investigate Factors Influencing Pediatric Fever Management Practices and Antipyretic Use in Australian Emergency Departments
Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To examine the factors influencing paediatric fever management practices among Australian Emergency Department (ED) doctors and nurses using the Theoretical Domains Framework (TDF). METHODS: Cross-sectional survey of doctors and nurses across 22 Australian EDs. The survey assessed 8 of the 12 domains from the TDF using 13 questionnaire items. RESULTS: A total of 472 participants [275 (58.3%) doctors, 197 (41.7%) nurses] completed the survey (overall response rate 57.7%). Of these, 286/470 (60.9%, 95% CI: 56.4%-65.2%) were familiar with clinical practice recommendations on antipyretic administration for paediatric fever (TDF domain: Knowledge). Similar proportions indicated they had been trained to ensure antipyretic use solely when febrile children appear distressed [TDF domain: Skills; 285/469 (60.8%, 95% CI: 56.3%-65.1%)] and agreed that only administering antipyretics to febrile children who seemed distressed aligned with their professional responsibilities as ED clinicians [TDF domain: Social/Professional Role and Identity; 294/467 (63.0%, 95% CI: 58.5%-67.2%)]. More than half (268/467, 57.4%, 95% CI: 52.8%-61.8%) of participants felt pressured by parents/caregivers to give antipyretics for fever reduction, irrespective of the child's discomfort level [TDF domain: Social Influences]. Just under one-third of participants (137/470, 29.1%, 95% CI: 25.2%-33.4%) aimed to reduce fever before discharge (TDF domain: Goals). CONCLUSIONS: Overall, ED clinicians showed moderate knowledge, training, and agreement with clinical practice recommendations on antipyretic administration for paediatric fever. Notably, more than half of the respondents surveyed felt pressured by parents/caregivers to use antipyretics outside of guideline recommendations. Our findings highlight the significant emotion attached to fever management and the need for clinicians to foster trust and provide tailored evidence-based information to families.
Source: Pediatric Emergency Care
Institutions: Monash University, University of Auckland, Middlemore Hospital, Monash Health, University of Technology Sydney, Starship Children's Health, Griffith University, The University of Queensland, Gold Coast Hospital, The University of Western Australia, Princess Margaret Hospital for Children, Perth Children's Hospital, Monash Medical Centre, Barwon Health, Deakin University, Geelong Hospital, Children's Health Queensland Hospital and Health Service
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7153235052