Research Proposal: Parental Perception of Neurofen in Chicken Pox

This research proposal investigates parental perceptions and understanding of Neurofen (ibuprofen) use in children with chicken pox. The proposal outlines a qualitative research study utilizing semi-structured interviews with parents to explore their views on fever management, the use of NSAIDs, and their awareness of potential risks, such as necrotizing fasciitis. The study employs a pragmatism research philosophy, inductive approach, and grounded theory strategy, using purposive sampling to collect data via audio-recorded interviews. The research aims to address gaps in knowledge regarding parental understanding of fever management in chicken pox and the associated risks of NSAIDs, ultimately contributing to improved parental education and child healthcare practices. The proposal includes a detailed background, research questions, methodology, sampling strategy, data collection methods, ethical considerations, and references, presenting a comprehensive plan to explore parental perspectives on this important clinical issue.

Running head: RESEARCH PROPOSAL
Research Proposal
Name of the Student
Name of the University
Author Note

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Abstract
The following is the research proposal that aims to elucidate the perception and
understanding of the parents behind the use of Neurofen in their child during chicken pox.
The research proposal also attempts to analyse the perception and understanding of the
parents about the associated risks of Neurofen and other non-steroidal anti-inflammatory
drugs. The research proposal aims to conduct a qualitative research based on the conduction
of semi-structured interview with open-ended questionnaire with 20 prospective parents. The
selection of the parents will be done from the public run hospitals. The research will use
pragmatism research philosophy with inductive research approach and rsearch strategy will
be grounded theory with cross-sectional study design. Non-probability purposive sampling
will be used. The data will be recorded in the audio-recorder, the main instrument that will be
used for the data-collection. The conduction of the research will help to get a detailed
perspective in the understanding of the parents in effective management of the fever and
other complications associated with chicken pox and use of NSAIDs.

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Table of Contents
Title of the research proposal.....................................................................................................4
1.0 Background and Justification...............................................................................................4
2.0 Research Question................................................................................................................8
3.0 Research Method..................................................................................................................9
3.1 Research design................................................................................................................9
3.1.1 Research philosophy...............................................................................................10
3.1.2 Research approach..................................................................................................11
3.1.3 Research strategy and time horizons.......................................................................11
3.1.4 Research Methods...................................................................................................12
4.0 Sampling and Recruitment.................................................................................................13
4.1 Target population...........................................................................................................13
4.2 Sample size.....................................................................................................................13
4.3 Sampling Strategy..........................................................................................................14
4.4 Inclusion and Exclusion Criteria for Sampling..............................................................14
5.0 Data Collection...................................................................................................................15
5.1. Method of data collection..............................................................................................15
5.2 Interview Question Generation......................................................................................16
5.3 Instrument for Data Collection.......................................................................................16
5.4 Validity and Reliability of the Interview process..........................................................17
6.0 Data Analysis.....................................................................................................................17

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7.0 Ethical Consideration of the Research...............................................................................19
References................................................................................................................................21
Appendix..................................................................................................................................25

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Title of the research proposal
Parents’ perception and understanding of Neurofen use in children with Chicken Pox and
associated risks
1.0 Background and Justification
According to the Centre of Disease Control and Prevention (CDC) (2019), chicken
pox is a contagious disease. It is a viral disease caused by varicella-zoster virus (VZV). It
leads to the development of itchy and blister-like rash. The rash generally appears over the
chest, back of the body and face and then spreads throughout the body. The average
incubation period is of chicken pox post exposure from the virus is 2 to 3 weeks. Children,
adolescents, pregnant women and the young adults and people who are immune-
compromised are vulnerable in getting affected with this painful viral infection. The best-way
to prevent chicken pox is vaccination with chicken pox vaccine (CDC, 2019).
In United Kingdom (UK), chicken pox is common during childhood. Approximately
three-fourths of the parent reports the history of chicken pox in their child who are below 5-
year of age (Amirthalingam and Ramsay 2016). According to Walker et al. (2017), the age
specific consultation rate of chicken pox among the various ethnic groups in UK highlighted
that the highest reported cases of chicken pox are below 6 years of age. CDC (2019) reported
that this highly contagious disease affects 80% of the population by age in the USA, Japan,
UK and the main victims are below 10 years. In India and in South East Asia the conditions
are different; the main victims include children between 20 to 30 years. Boyd et al. (2017)
reported that though the mortality rate of chicken pox is low among the children, the rate of
incidence of chicken pox is high along with high morbidity in USA and UK. UK encounters
25 death per year and USA encounter 150 deaths per year.

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Figure: Consultation rate of Varicella in UK among various ethnic group during the tenure of
2006 to 2012
(Source: Walker et al., 2017)
The common practice among the parents for the effective management of pain arising out of
chicken pox is administration of Paracetamol and Ibuprofen. This is analgesic is given during
the initial days of the disease on-set as these two medications are two of the common over the
counter medications available in the majority of the countries (Durand et al. 2015). Neurofen
and Ibuprofen belongs to the same family of medicine known as non-steroidal anti-
inflammatory drugs (NSAIDs). A case controlled study designed by Mikaeloff et al. (2008)
over the population of UK primary healthcare service user for a tenure of 2 months
highlighted that use of NSAIDs drugs in children leads to the development of cellulitis,
infection caused by Staphylococcus along with an increases risk of necrotizing fasciitis.
However, the use of paracetamol did not show any significant health risk to the children in
comparison to NSAIDs. The study conducted by Mikaeloff et al. (2008) was supported by
previous two epidemiological studies, 1 cohort study conducted by Stone et al. (2018) and

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one case control study conducted by Zerr et al. (1999). All these studies showed the same
tend. However, the study conducted by Mikaeloff et al. (2008) is limited due to possible
misclassification of patients as many patients might have taken over the counter NSAIDs
without their GP Knowledge. Moreover there was under reporting of complications possibly
if patients ending up in hospital emergency instead of at general practice and were coded
differently. Therefore, any results found by this study could possibly be considered as lower
bound estimate of the effect.
A case report was published in British Journal of Medicine (BMJ) in May 2018 about
a 4-year-old girl who presented to emergency after three days into her Chicken pox illness
with a rapidly progressive Necrotising Fasciitis (NF) requiring antibiotics and surgical
debridement followed by a skin graft and a prolonged hospital stay. She had received two
doses of Ibuprofen in community prior to her presentation. This case report also emphasised
about not using NSAIDs at all or using cautiously in primary varicella infection as it has been
associated with development of necrotising fasciitis (NF) (Darmasseelane et al. 2018).
So, what does this all mean actually for parents? If a child is having chicken pox and
is given Ibuprofen or any other NSAID, there is a risk of developing certain complications.
Thus Mikaeloff et al. (2008) stated that it would be better to treat them only when their fever
is making them uncomfortable or upset by administering paracetamol. However, there is gap
in parent perception and understanding about the management of fever and pain symptoms of
chicken pox among their child. A cross-sectional survey conducted by Cohee et al. (2010)
over 487 parents who have their children enrolled at two different urban based paediatric
clinics in Baltimore Maryland highlighted the need for improving the understanding and
education of parents about perception and management of fever. It showed that African
American parents mainly have difficulty with appropriate dosing of antipyretics while
Caucasian and Latino parents experience difficulties in discriminating between normal

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temperature and fever temperature, thus showing “fever phobia”. Interestingly, regardless of
ethnicity most parents treat temperatures in normal range with medicines and also dose
antipyretics more frequently.
Figure: Ethnical differences in parental perceptions and management of fever
(Source: Cohee et al. 2010)
However, the cross-sectional survey by Cohee et al. (2010) demonstrated few
limitations including the confusion created between temperature calculation method between
Celsius and Fahrenheit by parents, likely creating misinterpretation and poor understanding
of normal temperature range, creating “fever phobia” as mentioned. Also, the Latino group
was least to use age appropriate method of checking temperatures i.e rectally ≤ 3 years age
and orally ≥ 3 years of age. Only half of parents could identify temperature in fever range and
treat appropriately. On a positive note, the survey demonstrated the necessity of improving
education of families about proper fever management and right dosing of antipyretics.
Walsh et al. (2007) conducted a qualitative semi-structured interview with fifteen
metropolitan parents in Queensland Australia. The aim of the study was to identify the
influences on parents’ fever management, beliefs and experiences. The results were very

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interesting and showed antipyretics were first line of treatment by many parents irrespective
of temperature. Some preferred specific antipyretic like Ibuprofen as first choice and some
showed over dosing as well when using in combination with other antipyretics. Parents’
management of fever and practices were greatly influenced by their beliefs, knowledge,
source of information, number of children in family. Although this study achieved its target
of finding the objectives and important influences were identified, the limitations of were, it
was not generalised, the parents who participated were well educated and were from
metropolitan areas. So, a more generalised study with more sample size is required to confirm
these findings.
2.0 Research Question
In the light of above information and detailed relevant literature review, it is quite
evident that use of Neurofen or any other NSAIDs in children increases the risk of skin
infections including necrotising fasciitis. The analysis of the review also leads to the
identification of few areas in the research that might require further analysis. Like the parents
understanding of the fever management with or without medication is not clear. Some parents
are found to use medication while other parents fail to identify the initial signs and symptoms
or the severity of the fever. One particular group of population was found to use antipyretics
in the treatment of the fever and few others are found to be suspicious behind the usage of
antipyretics. Thus overall it can be said that the clear understanding of the parental perception
about the management of fever in chicken pox with medication and other interventions is
lacking. In other words it can be said that few unanswered questions, which evolved from the
review include:
1. What is the perception and understanding of parents about fever in children?
2. What is the parental approach in early self-management of fever in children?

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3. What is the perception of parents of use of antipyretics especially neurofen/NSAIDs
in chickenpox infection?
4. Are parents aware of associated risks of use of NSAIDs in chickenpox infection?
The overall purpose of this study is to discuss and find out about the perception and
understanding of parents about use of Neurofen or any other NSAIDs in children with
chicken pox infection. The main question is; Parents whose children have had a diagnosis of
chicken pox, which antipyretic did they use during initial management of fever and if they
were aware of associated risks and complications of NSAID / neurofen use?
3.0 Research Method
Research Methodology is an important part of the research. It mainly deals with the
procedure of data collection (Bell, Bryman and Harley 2018). In other words, it can be said
that research methodology helps the scholars to described and simultaneously analyze the
methods of research (Miller and Salkind 2002).
3.1 Research design
The relevance of research design is extracted from its importance in drawing critical
connection between the theories and arguments that inform the domain from which the
research and the empirical data is being collected (Denzin and Lincoln 2008). According to
Saunders, Lewis and Thornhill (2007), research design is like an onion and each layer of the
opinion constitute each layer of the research.

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Figure: Research Onion
(Source: Saunders, Lewis and Thornhill 2007)
3.1.1 Research philosophy
The first layer of research onion is research philosophy. It is the idea of collection,
interpretation and analysis of the data that is collected. There are different types of research
philosophies namely pragmatism, interpretivism, positivism and realism. Pragmatism
research philosophy is suitable in this case as it will help in exploring the relationship
between the parental perception and use of antipyretic in the children affected with chicken
pox. The pragmatism research philosophy is based on lived experiences and thus will be
helpful in extracting the lived experience of parents who have nurtured their children through
the chicken pox disease progression and thereby helping to understanding their perceptions of
fever management and risk factor behind the use of the NSAIDs (Simpson 2009). Though
interpretivism also deals with qualitative analysis of the humanised behaviour, pragmatism
was selected over intrepretivism. This is because pragmatism deals with action and change

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and the interplay between knowledge and action. Thus, helping to gain a detailed
understanding of the parents’ perception. However, interpretivism does not enable to study
the relationship between the knowledge and the set of action and thus pragmatism was
selected. Positivism deals with analysis of the quantitative data (Simpson 2009). Quantitative
data falls outside the scope of the study thus positivism research was opted out.
3.1.2 Research approach
It is the second layer of the research onion (Saunders 2011). There are two types of
research approach, deductive and inductive. The deductive research approach concentrates on
use of literature for the identification of theories that the researcher will test by the existing
data. Inductive research approach deals with collection of new data and development of new
theories based on the result (Saunders 2011). This study will help in the development of new
theory based on the parents’ perception and thus the main research approach will be
inductive.
3.1.3 Research strategy and time horizons
They are the third and the fourth layer of the research onion (Saunders, Lewis and
Thornhill 2007). There are two types of time horizons: cross-sectional study and longitudinal
study. The cross sectional study design enables the researcher to compare different variables
at the same time. Thus it might help in comparing the educational status, ethnicity and
income of the parents in order to understanding the difference in the varying perception.
Moreover, cross-sectional sectional studies mainly offer snapshot of a single moment in time.
Thus it might be helpful in understanding the perception of the parents during a single
snapshot of time based on their education, income or socio-economic status (Saunders, Lewis
and Thornhill 2007). Longitudinal study is however, observational study that helps to
compare observation between two different intervals. However, the observation or the data
collection will be done once in this study and hence cross-sectional time horizon is chosen.