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Objective: We conducted a comprehensive meta-analysis comparing educational preparation interventions with control conditions in children undergoing medical procedures. The analysis evaluated the effects of these interventions on four primary outcomes: fear, anxiety, emotional behavior, and cooperation. It also identified factors associated with intervention effectiveness.
Introduction: Children undergoing medical procedures often experience intense fear and anxiety because their developmental stage can limit their understanding of the necessity and nature of treatment. This psychological distress can trigger negative emotional responses and reduce cooperation with healthcare professionals. Helping children undergo procedures safely and comfortably remains a critical challenge in pediatric nursing. Educational preparation is widely used to address these issues, but its effectiveness varies across implementation methods, target ages, and types of medical procedures. A systematic quantitative evaluation is therefore needed to clarify the overall effect of educational preparation and identify factors associated with successful intervention.
Methods: Comprehensive literature searches were conducted in Ichushi-Web and MEDLINE in 2026. We screened 283 reports and identified 30 randomized and non-randomized controlled trials involving children aged 2 to 18 years. Methodological quality was assessed using JBI critical appraisal tools. Data were synthesized for meta-analysis using Review Manager software, version 11.6.1 (Copenhagen: The Nordic Cochrane Centre, Cochrane).
Results: Four reports were judged to be of low methodological quality, but all were included in the analysis. Meta-analysis showed statistically significant effects favoring the intervention group for fear, based on 5 studies (standardized mean difference [SMD]: −0.64, 95% confidence interval [CI]: −0.88 to −0.41), and anxiety, based on 27 studies (SMD: −0.74, 95% CI: −1.14 to −0.34). Sensitivity analyses confirmed that these findings remained robust after low-quality reports were excluded. For anxiety, subgroup analyses showed no significant differences according to the inclusion of children younger than 5 years, delivery format (analog vs. digital), or timing of measurement (preoperative vs. postoperative). However, studies including children aged 12 years or older showed a significantly larger intervention effect than studies that did not include this age group (P < 0.05). No statistically significant effects were observed for emotional behavior, based on 3 studies (SMD: −0.28, 95% CI: −1.34 to 0.77), or cooperation, based on 5 studies (MD: −1.26, 95% CI: −3.79 to 1.28).
Discussion: Educational preparation interventions effectively reduced fear and anxiety. The absence of significant differences by delivery format supports flexible implementation in clinical settings. The stronger effect among children aged 12 years or older suggests that greater cognitive maturity may help children use information as a coping strategy. Non-significant findings for emotional behavior and cooperation likely reflect the limited number of studies. The individual studies suggested that developmentally tailored programs integrating interactive exchanges with concrete, realistic simulated experiences—rather than the mere distribution of materials—are important in stabilizing behavior and improving cooperation.
Conclusions: Educational preparation effectively reduced psychological distress in children undergoing medical procedures, particularly among children aged 12 years or older. Practitioners can adapt delivery formats to different clinical settings. Future studies with larger sample sizes are needed to clarify the effects of educational preparation on behavioral outcomes.
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