Development and evaluation of an educational picture book targeted at perioperative psycho-behaviors among children undergoing tonsillectomy and adenoidectomy: A mixed-method study.

PURPOSE: This study developed an educational picture book for pediatric patients aged 6-12 undergoing tonsillectomy and/or adenoidectomy (T&A) and evaluated its effectiveness in reducing perioperative psycho-behavioral responses.

DESIGN AND

METHODS

Phase 1 used qualitative methods, including field observations, interviews with children, parents, and healthcare providers, and expert consultations, to inform the book's development. A multidisciplinary team incorporated elements promoting psychological well-being and coping skills into the storyline. In Phase 2, a non-randomized controlled study was conducted at a tertiary hospital from July to September 2022, involving 68 children. The intervention group read the picture book depicting a child protagonist using positive coping strategies during T&A, while the control group received standard care.

RESULTS

Outcomes included resilience, preoperative anxiety, anesthetic compliance, anesthesia emergence delirium, post-hospitalization behavioral changes, and acceptability, measured from the preoperative visit through one month postoperatively. Compared with controls, the intervention group showed significantly lower anxiety (p < 0.001), better anesthetic compliance (p < 0.05), higher resilience (p < 0.05), fewer cases of anesthesia emergence delirium (p < 0.05), and fewer behavioral changes three days after surgery (p < 0.05). No significant group differences were observed at one month (p > 0.05). The picture book demonstrated high acceptability, with a mean liking score of 9.56 out of 10.

CONCLUSION

The findings indicate that the picture book effectively helps prevent perioperative psycho-behavioral problems in pediatric T&A patients.

PRACTICE IMPLICATIONS: The picture book provides a feasible, child-friendly educational tool that healthcare providers can integrate into routine perioperative care.