Development and validation of a scenario-based judgment skills scale on parental fever management

Fever management among caregivers has often been described through the lens of "fever phobia," that is, the exaggerated fear of fever, frequently attributed to knowledge deficits and assessed using non-validated questionnaires. This study developed and validated the first standardized instrument to assess caregivers' judgment skills in managing childhood fever, focusing on how knowledge and other factors interact to shape decision-making.

A cross-sectional study was conducted among 290 caregivers of children recruited from pediatric clinics and social media in Southern Switzerland (March 2024-May 2025). Participants completed nine realistic fever-management scenarios, each featuring four response options ranked by expert pediatricians. Agreement between participants and experts was evaluated using Spearman's rank correlation coefficients (ρ) and compared to 200 sets of simulated random responses. Hierarchical multiple regression identified sociodemographic (sex, education, country) and psychological (knowledge, concern, self-efficacy) predictors of expert-aligned judgment.

Caregivers demonstrated moderate alignment with expert judgment, performing substantially better than chance. Sociodemographic characteristics explained a modest proportion of differences in judgment accuracy. Adding psychological factors significantly improved prediction: greater fever knowledge was associated with more accurate judgment, whereas higher levels of concern were associated with less accurate decisions. Self-efficacy showed a small additional contribution.

This validated, scenario-based instrument offers a reliable way to assess parental decision-making about childhood fever. Findings emphasize that emotional and cognitive factors, rather than sociodemographic background alone, drive judgment accuracy. The tool provides a foundation for targeted education and intervention strategies to improve fever management.