Effects of Animated Cartoon Information on Cooperation and Preparation Time in Preschool Children with Congenital Heart Disease Undergoing Cardiac Catheterization: A Quasi-experimental Study
DOI:
https://doi.org/10.60099/prijnr.2025.274618Keywords:
Cartoon animation, Cooperation, Cardiac catheterization, Children, Congenital heart disease, Pediatric nursingAbstract
Cardiac catheterization is a threatening condition that affects pediatric patients physically, emotionally, and psychologically.Therefore, emotional and psychological preparation is essential to enhance cooperation and reduce the time required for preparation before cardiac catheterization. This quasi-experimental study investigated the impact of providing information accompanied by cartoon animation on cooperation and preparation time for cardiac catheterization among preschool-aged children with congenital heart disease.A total of 70 children were purposively recruited based on the inclusion criteria. The first 35 children were assigned to the control group and received routine nursing care. The remaining 35 children were placed in the experimental group, receiving animated cartoon information regarding cardiac catheterization in addition to routine care. Data were collected using the Demographic and Clinical Characteristics Questionnaire, as well as the Thai version of the Children’s Emotional Manifestation Scale (CEMS). Descriptive statistics and Quade’s nonparametric ANCOVA were used for data analysis.
The results showed that the experimental group demonstrated a significantly higher level of cooperation than the control group. Additionally, the experimental group had a significantly shorter average preparation time for cardiac catheterization than the control group. Therefore, pediatric nurses can use this program as a guideline to effectively provide information that enhances cooperation and reduces the preparation time for cardiac catheterization in preschool children with congenital heart disease. However, further studies using a larger sample size across multiple sites are needed before it can be widely applied.
References
Liu Y, Chen S, Zühlke L, Black GC, Choy MK, Li N, et al. Global birth prevalence of congenital heart defects 1970–2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019;48(2):455–63. doi:10.1093/ije/dyz009 DOI: https://doi.org/10.1093/ije/dyz009
Xu J, Li Q, Deng L, Xiong J, Cheng Z, Ye C. Global, regional, and national epidemiology of congenital heart disease in children from 1990 to 2021. Front Cardiovasc Med. 2025;12:1522644. doi:10.3389/fcvm.2025.1522644 DOI: https://doi.org/10.3389/fcvm.2025.1522644
Kuptanon C, Kulsu A, Phurahong S, Khata D, Siriwong N. Prevalence of congenital abnormalities in Thailand between 2008 and 2022: a retrospective study from a standard health data center. J Health Syst Res. 2025;19(1):11-20. Available from: https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3023 (in Thai).
O’Byrne ML, Huang J, Asztalos IB, Smith CL, Dori Y, Gillespie MJ, Rome JJ, Glatz AC. Pediatric/congenital cardiac catheterization quality: an analysis of existing metrics. JACC Cardiovasc Interv. 2020; 13(24): 2853-64. DOI: https://doi.org/10.1016/j.jcin.2020.09.002
Nigro M, Righini A, Spitale M. Exploring the use of social robots to prepare children for radiological procedures: a focus group study. arXiv. 2025. doi:10.48550/arXiv.2504.13881
Sajeev MF, Kelada L, Nur ABY, et al. Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth. 2021;127(4): 608-19. doi: 10.1016/j.bja.2021.06.039 DOI: https://doi.org/10.1016/j.bja.2021.06.039
Jin Y, Jiang A, Jiang W, et al. Self-produced audio-visual animation introduction alleviates preoperative anxiety in pediatric strabismus surgery: a randomized controlled study. BMC Ophthalmol. 2021;21:163. doi: 10.1186/s12886-021-01922-6 DOI: https://doi.org/10.1186/s12886-021-01922-6
Santiago MG, Benitez JR, Lopez LL, Otero AN, Martos IC, Valenza MC, Ciuro, AH. Effects of non-drug interventions to alleviate anxiety in children undergoing surgery: a systematic review and meta-analysis. J Hosp Manag Health Policy. 2025;9:9 doi: 10.21037/jhmhp-24-99 DOI: https://doi.org/10.21037/jhmhp-24-99
Vakili R, Feizi R, Salimi Y, Mottahedi M, Rizevandi P. Play dough or balloon blowing? A clinical trial comparing creative interventions for reducing preoperative anxiety in children aged 4-8 years. BMC Pediatr. 2025;25:384. doi: 10.1186/s12887-025-05718-1 DOI: https://doi.org/10.1186/s12887-025-05718-1
Santapuram P, Stone AL, Walden RL, Alexander L. Interventions for parental anxiety in preparation for pediatric surgery: a narrative review. Children. 2021;8:1069. doi: 10.3390/children8111069 DOI: https://doi.org/10.3390/children8111069
Fulton DR, Mah DY, Newburger JW. Cardiac catheterization and intervention in children. In: Moss and Adams' Heart Disease in Infants, Children, and Adolescents 10th ed. Philadelphia: Wolters Kluwer; 2021.
Agbayani CJG, Fortier MA, Kain ZN. Non-pharmacological methods of reducing perioperative anxiety in children. BJA Education. 2020;20(12): 424-30. doi: 10.1016/j.bjae.2020.08.003 DOI: https://doi.org/10.1016/j.bjae.2020.08.003
Sektrakul M, Chaiyawat W, Rojnawee S. The effect of nursing intervention by giving information and distraction on cardiac preoperative fear in preschoolers. J of Nurs Sci., Chulalongkorn University. 2021;33(3): 58-70. Available from: https://he01.tci-thaijo.org/index.php/CUNS/article/view/254392 (in Thai).
Karakul A, Akgul EA, Yaliniz R, Mese T. Effectiveness of music during cardiac catheterization on children’s pain, fear, anxiety, and vital signs: a randomized, blind controlled trial. J Pediatr Nurs. 2022;65: e56-e62. doi: 10.1016/j.pedn.2022.02.009 DOI: https://doi.org/10.1016/j.pedn.2022.02.009
Huang YL, Xu N, Huang ST, Wang ZC, Cao H, Yu XR, Chen Q. Impact of music therapy on preoperative anxiety and degree of cooperation with anesthesia induction in children with simple congenital heart disease. J Perianesth Nurs. 2021;36(3):243-6. doi: 10.1016/j.jopan.2020.08.004 DOI: https://doi.org/10.1016/j.jopan.2020.08.004
Mathias E, Pai M, Guddattu V, Bramhagen A-C. Non-pharmacological interventions to reduce anxiety among children undergoing surgery: a systematic review. J Child Health Care. 2023;27(3):466-87. doi: 10.1177/13674935211062336 DOI: https://doi.org/10.1177/13674935211062336
Liu J, Serrano TR, Nguyen T, Newcomer CA, Wagner JP, Comulada WS. Evaluating the feasibility and acceptability of surgery prep, a virtual reality perioperative walkthrough designed to help pediatric patients psychologically prepare for surgery. J Child Life Psychosoc Ther Pract. 2024;5(2). doi:10.55591/001c.126782 DOI: https://doi.org/10.55591/001c.126782
Chen H, Zhang J, Li S, Zhang H, Wei L. Non-pharmacological interventions for preoperative anxiety in children: a systematic review and network meta-analysis. J Clin Nurs. 2025;34:1493-507. doi: 10.1111/jocn.17582 DOI: https://doi.org/10.1111/jocn.17582
Yang Y, Zhang M, Sun Y, Peng Z, Zheng X, Zheng J. Effects of advance exposure to an animated surgery-related picture book on preoperative anxiety and anesthesia induction in preschool children: a randomized controlled trial. BMC Pediatrics. 2022;22:92. doi:10.1186/s12887-022-03136-1 DOI: https://doi.org/10.1186/s12887-022-03136-1
Nassar HMI, Abdelmasieh HMN, Mohamed EA, Ayed MMA, Mohammed AA. Impact of animated stories for children undergoing surgical procedure on their preoperative anxiety and postoperative pain level. Egypt J Health Care. 2022;13(3):18-28. DOI: https://doi.org/10.21608/ejhc.2022.249352
Tang X, Zhang M, Yang L, Tao X, Li Y, Wang Y, Wang X, Hu X. Individual cartoon video for alleviating perioperative anxiety and reducing emergence delirium in children: a prospective randomized trial. BMJ Pediatr Open. 2023;7:e001854. doi: 10.10.1136/bmjpo-2023-001854. DOI: https://doi.org/10.1136/bmjpo-2023-001854
Haddad N, Jafar Alshraideh JA, Nassar O, Yacoub, NR. An animated education program to reduce anxiety, vascular complications, and flat time among children undergoing cardiac catheterization: a randomized control trial, study protocol. Multidiscip Sci J. 2024 [cited 2025 March 17, 2025]. doi: 10.31893/multiscience.2025138 DOI: https://doi.org/10.31893/multiscience.2025138
Zheng C, Li C, Zhuang L, Chen Y, Wu Y, Hu R. Effects of digital picture books on young children undergoing cardiac catheterization and their family caregivers: a randomized controlled trial. J Adv Nurs. 2025;81(4):2125-35. doi: 10.1111/jan.16447. DOI: https://doi.org/10.1111/jan.16447
Pakdeto R, Sakulrungjalas T. Effects of a cartoon animation as an intravenous therapy program on fear perception and cooperation behavior in school-age children: a randomized controlled trial study. Thai Red Cross Nurs J. 2023;16(1):26-44. Available from: https://he02.tci-thaijo.org/index.php/trcnj/article/view/259960/180279 (in Thai)
Triana KY, Sukmandari NMA, Lestari MPL. The effect of animated education and cartoon video on children’ anxiety during intravenous insertion. J Aisyah J Ilmu Kesehat. 2023;8(3):1005-10. doi: 10.30604/jika.v8i3.1943 DOI: https://doi.org/10.30604/jika.v8i3.1943
Barbazi N, Shin JY, Hiremath G, Lauff CA. Exploring health educational interventions for children with congenital heart disease: scoping review. JMIR Pediatr Parent 2025;8: e64814. doi:10.2196/64814 DOI: https://doi.org/10.2196/64814
Piaget J. The origins of intelligence in children. New York: International Universities Press; 1952. DOI: https://doi.org/10.1037/11494-000
Gagne RM, Wager WW, Golas CK, Keller MJ, Russell DJ. Principles of instructional design. 5th ed. Perform Improv. 2005;44(2):44-6. doi: 10.1002/pfi.4140440211 DOI: https://doi.org/10.1002/pfi.4140440211
Chow CHT, Van Lieshout RJ, Schmidt LA, et al. Systematic review: audiovisual interventions for reducing preoperative anxiety in children undergoing elective surgery. J Pediatr Psychol. 2016;41(2):182-203. doi: 10.1093/ipepsy/jsv094 DOI: https://doi.org/10.1093/jpepsy/jsv094
Oktaviani JR, Singgih NA. Audiovisual technology intervention for reducing preoperative anxiety in children undergoing general anesthesia: a systematic review and meta-analysis. Educ Health Promot. .2024;11:13:222. doi: 10.4103/jehp.jehp_1344_23. DOI: https://doi.org/10.4103/jehp.jehp_1344_23
Noviyanti M, Chodidijah S, Rachmawati IN. Application of audiovisual intervention to increase compliance during the anesthesia induction process in children undergoing surgery. JOTING. 2024;6(1):1545-53. doi: 10.31539/joting.v6i1.10204 [in Indonesian] DOI: https://doi.org/10.31539/joting.v6i1.10204
Steinbauer P, Bichler M, Fuiko R, Seferagic S, et al. Cartoon-based educational intervention for children to foster hygiene knowledge and emotional resilience in preschool children: a randomized controlled trial. Front Pediatr. 2025;13:1514793. doi: 10.3389/fped.2025.1514793 DOI: https://doi.org/10.3389/fped.2025.1514793
Muangchan N, Suphapan T, Phulphol P, Silapath A, Rodpai T. Development and evaluation of the achievement of 2D cartoon animation media to enhance knowledge about hand, foot and mouth disease for pre-school children, Ubon Ratchathani province. J Health Sci. 2021; 30(Supplement 3): S481–90. Available from: https://thaidj.org/index.php/JHS/article/view/11305 (in Thai).
Rajan, D., Lakshmanan, G., & Gupta, S. K. Effect of recorded maternal voice on child’s cooperation during cardiac catheterization: A randomized controlled trial. Indian Pediatr. 2017;54(3):204–7. doi: 10.1007/s13312-017-1031-4 DOI: https://doi.org/10.1007/s13312-017-1031-4
Massoth G, Vorhofer E, Spuck N, Mikus M, Mimi N, Strassberger-Nerschbach J, et al. Impact of the mother’s voice on sedation need and stress during cardiologic examination of children (SMUSS study): a prospective, interventional, randomized, controlled, monocentric study. Cardiol Young. 2024;34:2437-44. doi: 10.1017/s1047951124025757. DOI: https://doi.org/10.1017/S1047951124025757
Watthanaprakarnchai W, Chungsomprasong P, Wansanit K, Phrudprisan S, Thou-Kaw S, Nimmannit A. Effect of cooperative protocol on choloral hydrate usage in aged 6 months to 3 years pediatric patients receiving transthoracic echocardiographic examination. J Nurs Sci. 2015;33(2):68-76. Available from: https://he02.tci-thaijo.org/index.php/ns/article/view/42299 (in Thai).
Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4): 1149-60. DOI: https://doi.org/10.3758/BRM.41.4.1149
Li HC, Lopez V. Children's Emotional Manifestation Scale: development and testing. J Clin Nurs. 2005;14(2):223-9. doi: 10.1111/j.1365-2702.2004.01031.x DOI: https://doi.org/10.1111/j.1365-2702.2004.01031.x
Cash M, Giambra B, Stone L, Magness M, Luebbe K, Moore S, et al. Hank the Heart and animation-based education for pulmonary hypertension. Pulm. Circ. 2025;15:e70072. https://doi.org/10.1002/pul2.70072. DOI: https://doi.org/10.1002/pul2.70072
Praveen CK, Srinivasan K. Psychological impact and influence of animation on viewer’s visual attention and cognition: a systematic literature review, open challenges, and future research directions. Comput Math Methods Med. 2022;31:2022. doi: 10.1155/2022/8802542 DOI: https://doi.org/10.1155/2022/8802542
Ozdemir S, Ayyildiz TK. The effect of video-based education program applied before children’s pediatric Magnetic Resonance Imaging (MRI) on anxiety in Turkey: a randomized controlled study. J Pediatr Nurs. 2024;77:e81-e89. https://doi.org/10.1016/j.pedn.2024.03.034 DOI: https://doi.org/10.1016/j.pedn.2024.03.034
Ustun N, Akgol BB, Bayram M. Cartoon-assisted visual/auditory distraction usage in paediatric dental care, assessment of effects on patient anxiety, pain and behaviour: a randomized crossover clinical trial. BMC Oral Health. 2025;25:425. http://dx.doi.org/10.1186/s12903-025-05770-4 DOI: https://doi.org/10.1186/s12903-025-05770-4
Moe-Byrne T, Evans E, Benhebil N, Knapp P. The effectiveness of video animations as information tools for patients and the general public: a systematic review. Front Digit Health. 2022;31:1-14. https://doi.org/10.3389/fdgth.2022.1010779 DOI: https://doi.org/10.3389/fdgth.2022.1010779
Sanchez FF, Grima Murcia MD, Lopez-Pineda A, Juste Ruiz M, Orozco Beltran D, Carratala-Munuera C, et al. Effects of watching cartoons during an echocardiography on infants and preschool children: a prospective randomized study. Front Pediatr. 2019;7:184. doi:10.3389/fped.2019.00814. DOI: https://doi.org/10.3389/fped.2019.00184
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