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Development and evaluation of an educational picture book targeted at perioperative psycho-behaviors among children
Yao Tang1, Ka Yan Ho2, Jinlin Ye3
1Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China; School of Nursing, University of Virginia, Charlottesville, Virginia, USA.
Insights
A new picture book effectively reduces anxiety and improves coping for children undergoing tonsillectomy and/or adenoidectomy (T&A). This child-friendly tool helps manage perioperative psycho-behavioral responses, enhancing patient care.
Area of Science:
- Pediatric Surgery
- Child Psychology
- Health Education
Background:
- Tonsillectomy and/or adenoidectomy (T&A) can cause significant perioperative psycho-behavioral distress in children.
- Effective interventions are needed to mitigate anxiety, improve coping, and manage post-operative behavioral changes.
- Current standard care may not adequately address the psychological needs of pediatric patients undergoing T&A.
Purpose of the Study:
- To develop an educational picture book for pediatric patients (aged 6-12) undergoing T&A.
- To evaluate the effectiveness of this picture book in reducing perioperative psycho-behavioral responses.
- To assess the book's impact on resilience, anxiety, anesthetic compliance, delirium, and behavioral changes.
Main Methods:
- Phase 1: Qualitative development involving observations, interviews, and expert consultations.
- Phase 2: Non-randomized controlled study with 68 pediatric T&A patients.
- Intervention group read the picture book; control group received standard care.
Main Results:
- The picture book group showed significantly lower preoperative anxiety (p < 0.001).
- Improved anesthetic compliance (p < 0.05), higher resilience (p < 0.05), and fewer behavioral changes (p < 0.05) were observed.
- High acceptability (9.56/10) and reduced anesthesia emergence delirium (p < 0.05) were noted.
Conclusions:
- The educational picture book is an effective tool for preventing perioperative psycho-behavioral problems in pediatric T&A patients.
- The book is a feasible, child-friendly educational intervention for integration into routine care.
- Healthcare providers can utilize this resource to enhance patient well-being during the T&A process.
Purpose:
This study developed an educational picture book for pediatric patients aged 6-12 undergoing tonsillectomy and/or adenoidectomy (T&A) and evaluated its effectiveness in reducing perioperative psycho-behavioral responses.
Design And Methods:
Phase 1 used qualitative methods, including field observations, interviews with children, parents, and healthcare providers, and expert consultations, to inform the book's development. A multidisciplinary team incorporated elements promoting psychological well-being and coping skills into the storyline. In Phase 2, a non-randomized controlled study was conducted at a tertiary hospital from July to September 2022, involving 68 children. The intervention group read the picture book depicting a child protagonist using positive coping strategies during T&A, while the control group received standard care.
Results:
Outcomes included resilience, preoperative anxiety, anesthetic compliance, anesthesia emergence delirium, post-hospitalization behavioral changes, and acceptability, measured from the preoperative visit through one month postoperatively. Compared with controls, the intervention group showed significantly lower anxiety (p < 0.001), better anesthetic compliance (p < 0.05), higher resilience (p < 0.05), fewer cases of anesthesia emergence delirium (p < 0.05), and fewer behavioral changes three days after surgery (p < 0.05). No significant group differences were observed at one month (p > 0.05). The picture book demonstrated high acceptability, with a mean liking score of 9.56 out of 10.
Conclusion:
The findings indicate that the picture book effectively helps prevent perioperative psycho-behavioral problems in pediatric T&A patients.
Practice Implications:
The picture book provides a feasible, child-friendly educational tool that healthcare providers can integrate into routine perioperative care.
