The effect of Mandala Art Therapy on anxiety and comfort levels in living donor kidney transplant recipients: A mixed-methods study

Objective: This study aims to evaluate the effect of Mandala Art Therapy on anxiety and comfort levels among living donor kidney transplant recipients. Method: This mixed-method study was conducted between March 2024 and September 2025 at a university hospital located in southern Türkiye. Of the participants, 62.5% were male, with a mean age of 38.6±12.7 years. The quantitative phase was designed as a single-blind randomized controlled trial. A total of 54 participants were included, with 27 assigned to the intervention group and 27 to the control group. The intervention group received three sessions of Mandala Art Therapy. Data were collected using the State-Trait Anxiety Inventory and the General Comfort Questionnaire (ClinicalTrials.gov Identifier:NCT06263257, Unique Protocol ID:2023-631). In the qualitative phase, semi-structured interviews were conducted with 15 volunteers from the intervention group within a phenomenological framework, and the data were analyzed using descriptive analysis. Results: Quantitative findings indicated a significant decrease in the State Anxiety Inventory scores and a significant increase in the total and subscale mean scores of the General Comfort Questionnaire in the intervention group compared to the control group (p<0.05). Qualitative findings revealed two main themes: "Gains from the Mandala Training Process" (with subthemes: gaining awareness and insight, changes in anxiety levels, and experiences related to relaxation and comfort) and "Views and Suggestions Regarding the Mandala Training Process" (with subthemes: opinions about the training process and suggestions for improvement). Furthermore, the mixed-method results showed that the qualitative findings supported the quantitative results. Conclusion: The findings suggest that Mandala Art Therapy can be utilized as a complementary nursing intervention that contributes to reducing anxiety and enhancing comfort, thereby supporting holistic well-being among living donor kidney transplant recipients. Key words: Anxiety, comfort, kidney transplantation, living donor, mandala