Reducing Children’s Preoperative Fear with an Educational Pop‐up Book: A Randomized Controlled Trial

Abstract

Objective Preoperative education empowers children to approach surgery with positive expectations, and providers need efficient, child-focused resources. This study aimed to evaluate an interactive pop-up book as a tool for explaining surgery, managing preoperative anxiety, and strengthening coping strategies. Study Design Prospective randomized controlled trial. Setting Pediatric outpatient surgery center. Methods Patients ages 5 to 12 undergoing outpatient surgery read a pop-up book about anesthesia (intervention) or received standard care (control). Patients self-reported their preoperative fear, pain expectations, views of the procedure and preoperative explanations, and coping strategies. Outcomes also included observer-rated behavioral anxiety and caregiver satisfaction. Results In total, 148 patients completed the study. The pop-up book had a significant, large effect in reducing patients’ fear of anesthesia induction (Cohen’s d effect size = 0.94; P < .001). Intervention patients also expected less pain than control patients from the anesthesia mask and during surgery ( d = 0.60-0.80; P < .001). The book encouraged more positive views of the procedure and preoperative explanations ( P < .005). Furthermore, the book prepared patients to cope adaptively: intervention patients were significantly more likely to generate positive active coping strategies, distraction strategies, and support-seeking strategies ( P < .001). Observer-rated behavioral anxiety at anesthesia induction did not differ between groups ( P = .75). Caregivers in the intervention group were significantly more satisfied with each aspect of the surgical experience ( P≤ .02). Conclusion The educational pop-up book offers a child-focused resource that helps alleviate children’s preoperative fears, encourages positive coping, and improves caregivers’ perceptions of the experience. This study was registered at ClinicalTrials.gov (NCT04796077).

The effect of storybook reading on children's preoperative fear and anxiety levels: A randomized controlled study

“…This finding is in line with the results of previous research. Cordray et al (2022) found that reading children an educational book reduced their fear before surgery. Binay Yaz and Bal Yilmaz (2022) showed that an educational animation film was an effective method for reducing fear before surgery.…”

“…in the preoperative period are helpful in reducing children's fear, pain and anxiety (Aytekin et al, 2016; Chow et al, 2016; Forouzandeh et al, 2020; Mohamed & Elattar, 2019; Taha & El‐Sayed, 2021). Reading stories, which is one of these methods, is helpful in reducing children's fear and anxiety (Aydın & Uyar, 2021; Bülbül & Arıkan, 2018; Cordray et al, 2022; Durgut, 2021). When the literature is examined, no study has been found about the effect of reading a preoperative preparation‐themed storybook to the child by the mothers on the preoperative fear and anxiety level of the children.…”

Effect of interactive, multimedia-based home-initiated education on preoperative anxiety inchildren and their parents: a single-center randomized controlled trial

“…In this study, we investigated an approach that integrated several previous relatively independent approaches to provide children with an active participatory [23][24][25][26], multimedia-based home-initiated educational intervention prior to admission. Since this experiment incorporates parents and includes three aspects of children's audio-visual stimulation, active painting, and reading, it is more effective than other experiments.…”

A Mobile Application for Child‐Focused Tonsillectomy Education: Development and User‐Testing

“…Development of the “Ready for Tonsillectomy” mobile application began as an adaptation of an interactive book that our team previously piloted 21 . The pop‐up book was designed to engage children in hands‐on education about their surgery without requiring expert guidance from a provider or child life specialist.…”