Effects of Cartoons and Mobile Games on Preoperative Anxiety and Fear in Children With Appendicitis: An RCT

Apandisit Tanısı Ile Cerrahi Servise Yatırılan Çocuklarda Preoperatif Kaygı ve Korkunun Azaltılmasında Çizgi Film ve Mobil Oyunların Etkisi: Randomize Kontrollü Bir Araştırma

his study aims to evaluate the effects of cartoon viewing and mobile game playing on preoperative anxiety and fear levels in children aged 7-12 years who are hospitalized for appendicitis surgery. The study is designed as a randomized controlled trial with three groups: a cartoon group, a mobile game group, and a control group receiving routine care.

Children in the intervention groups will watch a cartoon or play a mobile game for 10 minutes before surgery. Anxiety and fear levels will be measured using validated scales before and after the intervention. The findings of this study are expected to contribute to atraumatic care practices by providing simple and effective non-pharmacological methods to reduce preoperative anxiety and fear in children.

Study Overview

• Status: Recruiting
• Conditions: Children; Preoperative Anxiety; Fear; Appendicitis (Diagnosis)
• Intervention / Treatment: Behavioral: Cartoon-Assisted Distraction (Şüko Ameliyat Oluyor); Behavioral: Mobile Game

Detailed Description

Preoperative anxiety and fear are common among children undergoing surgery and may negatively affect both perioperative outcomes and postoperative recovery. Non-pharmacological, atraumatic care interventions are recommended to minimize psychological distress in pediatric patients. Among these interventions, distraction techniques such as cartoon viewing and mobile game playing are widely used due to their practicality and accessibility.

This randomized controlled trial aims to compare the effects of cartoon viewing and mobile game playing on preoperative anxiety and fear levels in children aged 7-12 years diagnosed with appendicitis and admitted to a pediatric surgery unit. Participants will be randomly assigned to one of three groups: a cartoon intervention group, a mobile game intervention group, or a control group receiving routine care.

Children in the intervention groups will receive a 10-minute distraction intervention (cartoon viewing or mobile game playing) prior to surgery, while the control group will receive standard clinical care without any additional intervention. Anxiety and fear levels will be assessed before and after the intervention using validated measurement tools.

This study is expected to provide evidence-based data on the effectiveness of simple, low-cost, and easily applicable non-pharmacological interventions in reducing preoperative anxiety and fear in children. The findings may contribute to the development of atraumatic care practices and improve pediatric surgical care outcomes.

• Study Type: Interventional
• Enrollment (Estimated): 69
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Eda Emine Yetkin, MSc Student; Phone Number: +905 30 137 58 79; Email: edaayetkinn@outlook.com

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Recruiting
    • Ankara Bilkent City Hospital
    • Contact: Pediatric Surgery Service (4A and 4B Pediatric Surgery Service; Phone Number: 0312 552 60 00; Email: ankarasehir@saglik.gov.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Being hospitalized in the Pediatric Surgery Service with a diagnosis of appendicitis.
• Being between the ages of 7 and 12 years.
• Voluntary consent/assent from both the child and their parents to participate in the study.
• Absence of any visual, auditory, or cognitive problems that prevent communication.
• Not having received any analgesics before the intervention.

Exclusion Criteria:

• Refusal to participate in the study voluntarily.
• Having a condition that prevents communication due to vision, hearing, speech, or mental health status.
• Being in an agitated state or unable to cooperate.
• Having received analgesics due to pain before the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group; Participants in this group will receive standard hospital care and routine preoperative preparation without any additional digital distraction interventions.
Experimental: Cartoon Group; Participants in this group will be exposed to a cartoon-assisted distraction intervention designed to explain the surgical process and reduce anxiety before surgery.	Behavioral: Cartoon-Assisted Distraction (Şüko Ameliyat Oluyor); Participants will watch the cartoon titled "Şüko is Having Surgery," which explains the surgical process in child-friendly language, on an iPad Mini 6 with headphones for 10 minutes.
Experimental: Mobile Game Group; Participants in this group will engage in age-appropriate mobile games on a tablet computer as a digital distraction intervention prior to their surgical procedure.	Behavioral: Mobile Game; Children will be asked to play a game of their choice for 10 minutes on a tablet from among games selected according to their age group and PEGI standards (Head Ball 2, Subway Surfers, and Magic Tiles 3).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Preoperative Anxiety Level	The Modified Yale Preoperative Anxiety Scale (m-YPAS) will be used. This scale provides an observational assessment across five categories (activity, emotional expressivity, state of arousal, vocalization, and use of parents). Total scores range from 5 to 22, with higher scores indicating higher levels of anxiety.	Baseline (upon admission to the pediatric surgery inpatient unit prior to the intervention) and post-intervention (immediately before transfer to the operating room).
Children's Fear Level	The Children's Fear Scale (CFS) will be used. This scale consists of five different facial expressions scored between 0 and 4. A score of 0 indicates "no anxiety/fear," whereas a score of 4 indicates "the highest level of fear."	Baseline (upon admission to the pediatric surgery inpatient unit prior to the intervention) and post-intervention (immediately before transfer to the operating room).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart Rate	The participants' heart rate will be measured to evaluate physiological stability. The values will be recorded in beats per minute (bpm).	Measured at two time points: baseline (pre-intervention) and immediately post-intervention.
Blood Pressure	The participants' systolic and diastolic blood pressure values will be measured. The values will be recorded in millimeters of mercury (mmHg).	Measured at two time points: baseline (pre-intervention) and immediately post-intervention.
Oxygen Saturation	The participants' peripheral oxygen saturation (SpO2) levels will be monitored. The values will be recorded as a percentage (%).	Measured at two time points: baseline (pre-intervention) and immediately post-intervention.

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent
• Collaborators: Ankara Yildirim Beyazıt University

Study record dates

Study Major Dates

• Study Start (Actual): October 10, 2025
• Primary Completion (Estimated): May 30, 2026
• Study Completion (Estimated): May 30, 2026

Study Registration Dates

• First Submitted: May 6, 2026
• First Submitted That Met QC Criteria: June 8, 2026
• First Posted (Actual): June 10, 2026

Study Record Updates

• Last Update Posted (Actual): June 10, 2026
• Last Update Submitted That Met QC Criteria: June 8, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Intestinal Diseases; Infections; Digestive System Diseases; Gastrointestinal Diseases; Gastroenteritis; Cecal Diseases; Intraabdominal Infections; Pathological Conditions, Signs and Symptoms; Disease; Appendicitis
• Other Study ID Numbers: TABED 1/1735/2025; TYL-2026-2917 (Other Grant/Funding Number: Ankara Yildirim Beyazit University BAP Department)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No