An intervention to reduce anxiety/fear in hospitalized Thai school age children
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In many Thai hospitals, there is a lack of special psychological preoperative preparation programs for hospitalized Thai children and their families. The purpose of this single-blind, randomized clinical trial was to test the efficacy of a psychological preoperative preparation intervention (PPPI), in the form of a cartoon coloring book, designed to reduce anxiety/fear before surgery in hospitalized Thai school age children 8-11 years old. One hundred and four subjects, hospitalized for surgery, were randomly assigned into either an intervention or control group. Each group received the usual preoperative care given by ward staff. The experimental group received the PPPI given by the investigator. Pre-and posttest anxiety/fear of both groups were measured using the STAIC-R and CMFS-R in Thai versions. Demographic and clinical data, and information on the child's use of meditation were also collected. Descriptive statistics were used to describe demographic and clinical data. A paired-t test demonstrated significant decreases in state anxiety and medical fear means between pre- and post-intervention for the experimental group but not for the control group. Hierarchical regression analysis compared the effect of the PPPI to usual care after controlling for covariate variables. State anxiety at post-intervention was significantly less in the PPPI group than in the usual care group controlling for state- and trait anxiety at pre-intervention, the child's age, and the child's use of meditation. There was no evidence to support an effect of PPPI on post-intervention medical fear when CMFS and trait anxiety at pre-intervention, the child's age, and the child's use of meditation were controlled. The PPPI appears to be a culturally sensitive intervention for hospitalized Thai school age children. Reading and coloring the cartoon pictures distracted the children from the stressful situations and helped them focus on the content. Age appropriate narrative content in the coloring book may have helped the children assimilate information in a short time period. The possible reasons that could have accounted for the non-significant effect on fear mean scores between groups are the small sample size, the intervention diffusion between groups, and the between-group variation on state anxiety and fear scores.