The Effectiveness of Picture Books on Reducing Preoperative Anxiety in Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND: Children experience significant psychological and physical stress during medical procedures. Picture books can help reduce anxiety by familiarising children with their upcoming procedures. AIM: To synthesise and evaluate the effectiveness of picture books on reducing preoperative anxiety in children and their parents. DESIGN: A systematic review and meta-analysis of randomised controlled trials reported following the PRISMA guidelines. METHODS: PubMed, CINAHL, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched from inception to January 1, 2024. This review includes randomised controlled trials published in Chinese or English that evaluate the efficacy of picture book interventions in reducing preoperative anxiety among children undergoing elective surgery. Studies were excluded if: (1) they were conference abstracts, protocols or repetitive publications; (2) they were not available in full text; (3) the data reported in the study could not be obtained from the authors; and (4) they were not published in Chinese or English. The Cochrane Risk of Bias Tool version 2.0 was used to assess the risk of bias of the included studies. Meta-analysis was conducted using Review Manager 5.4. RESULTS: Five studies with a total of 418 patients were included in the analysis. Picture books can significantly reduce children's preoperative anxiety (SMD = -0.57, 95% CI = -0.76 to -0.37; p < 0.001). The certainty of the evidence for the effectiveness of picture books on preoperative anxiety was considered moderate. CONCLUSIONS: Picture books can effectively reduce preoperative anxiety in children by familiarising them with the unknown. It has shown the potential to serve as preoperative educational material for paediatric patients. PATIENT OR PUBLIC CONTRIBUTION: Not applicable. RELEVANCE TO CLINICAL PRACTICE: This meta-analysis highlights the effectiveness of picture books in reducing preoperative anxiety in children undergoing medical procedures. Healthcare professionals should consider integrating these interventions into preoperative health education. TRIAL REGISTRATION: CRD42023435105 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023435105).