The effect of hospital clown intervention on anxiety, fear, pain, and satisfaction levels of children undergoing circumcision

Circumcision is a surgical procedure that can often trigger negative emotional reactions, such as anxiety and fear, in boys. This study aimed to examine the effects of a hospital clown intervention on anxiety, fear, pain, and satisfaction levels in circumcised boys. The research was conducted with an experimental design with a pretest-posttest control group between October 2024 and March 2025 at the Pediatric Surgery Ward of Afyonkarahisar Health Sciences University Health Application and Research Center. The study sample consisted of 75 children aged 5-12 who met the specified inclusion criteria. 38 of the participants were in the experimental group and 37 in the control group. The hospital clown intervention was applied to the children in the experimental group, while the routine care procedure was continued in the control group. Data were collected via face-to-face interviews using the Descriptive Information Form, the Child Fear Inventory, the Child Anxiety Scale - State, the Wong-Baker Faces Pain Scale, and the Child and Parent Satisfaction Scale. The research was planned and conducted in accordance with the Consolidated Standard Reporting Trials (CONSORT) guidelines. The data obtained were analyzed using descriptive statistics, independent groups t-test, dependent groups t-test and intraclass correlation coefficient (ICC) using SPSS 26.0 for Windows package program. Children who received the hospital clown intervention had significantly lower anxiety and fear levels than the control group. A significant decrease in pain levels was observed in children in the experimental group, while a significant increase in pain levels was observed in children in the control group. Children and their parents in the experimental group reported higher satisfaction with the hospital clown intervention than the control group (p < 0.05). High ICC scores in the scales indicate that inter-observer agreement was achieved. This study demonstrates that the hospital clown intervention is an effective method for reducing circumcision-related anxiety, fear, and pain in children. Furthermore, it was determined that the intervention contributes to the development of child-friendly healthcare services by increasing child and parent satisfaction. The integration of such interventions into healthcare services is recommended to enhance children's surgical experiences. Keywords: Anxiety, Pain, Child, Hospital Clown, Fear, Circumcision.