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The Effectiveness of Picture Books on Reducing Preoperative Anxiety in Children: A Systematic Review and

Chengyang Li1, Qionghong Chen1, Xueting Zhuang1

  • 1The School of Nursing, Fujian Medical University, Fuzhou, China.

Journal of Clinical Nursing
|April 4, 2025
PubMed

Insights

Picture books effectively reduce preoperative anxiety in children. This systematic review found moderate evidence that these books help children cope with upcoming medical procedures, suggesting their use in pediatric care.

Area of Science:

  • Pediatric Psychology
  • Medical Education
  • Evidence-Based Practice

Background:

  • Children face significant stress during medical procedures.
  • Picture books can alleviate this anxiety by familiarizing children with medical experiences.

Purpose of the Study:

  • To synthesize and evaluate the effectiveness of picture books in reducing preoperative anxiety in children and their parents.
  • Assess the impact of picture book interventions on pediatric patients' emotional well-being before surgery.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple databases (PubMed, CINAHL, EMBASE, Cochrane, CNKI, Wanfang) from inception to January 2024.
  • Assessed risk of bias using Cochrane Risk of Bias Tool v2.0 and conducted meta-analysis using Review Manager 5.4.

Main Results:

  • Included 5 studies with 418 patients.
  • Picture books significantly reduced children's preoperative anxiety (SMD = -0.57, p < 0.001).
  • The certainty of evidence for effectiveness was rated as moderate.

Conclusions:

  • Picture books are effective in reducing preoperative anxiety in children.
  • They serve as valuable preoperative educational material for pediatric patients.
  • Healthcare providers should integrate picture books into preoperative health education for children.
Abstract

Keywords:
anxietychildrenmeta‐analysispainpicture booksystematic review

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