Activation of the maternal caregiving system by childhood fever - a qualitative study of the experiences made by mothers with a German or a Turkish background in the care of their children

Background: Childhood fever represents a frequent cause to consult a primary care physician. "Fever phobia" describes a fearful and irrational view of fever shared by many parents with different cultural backgrounds. The study aims to explain the experiences of mothers of children having a fever and to analyze the role of the mothers' cultural background with regard to their experiences by comparing the accounts of mothers with a German with those from a Turkish background. Disease and context specific knowledge about the influence of culture can be important for effective counselling. Methods: We applied a qualitative approach using in-depth interviews with 11 mothers with a Turkish and 9 with a German background living in Germany. The interviews were conducted at the participants' homes from May to October 2008. Data was audio-recorded and transcribed verbatim. Grounded Theory was used as a framing methodology including open, axial and selective coding. Analysis was performed in a group with members of different professional and cultural backgrounds. Results: Mothers experienced their child's fever not merely as elevated temperature but as a potentially dangerous event. A deeply rooted urge to protect the child from harm was central to all participants' experience. The caregiving system model offers a good theoretical foundation to explain the findings as it incorporates the unique relational quality of care giving mothers to their children. The cultural background represents an important context variable influencing the explanatory models and strategies of dealing with fever. The identified culturally influenced concepts sometimes match and sometimes conflict with medical knowledge. Conclusion: By applying the caregiving system model which is a part of attachment theory (Bowlby) maternal actions can be understood as an understandable attempt to protect the child from harm. The mothers' decisions what to do when a child has a fever can be culturally influenced. This may lead either to a frequent use of services or to an underestimation of the child's state of health. The mothers' caring role and emotional state should be acknowledged; her concerns, explanatory models and strategies should be elicited and taken seriously in order to maintain a trustful relationship, provide effective counselling and thereby insuring optimal care for the children.