Abstract
OBJECTIVE: To develop a multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components based on the distraction model, evaluate its efficacy in alleviating preoperative anxiety in preschool children, and provide an evidence-based non-pharmacological intervention strategy for the clinical management of preoperative anxiety in this population. METHODS: The multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components program was constructed via literature review, the Delphi method, and a pre-experiment. A total of 128 preschool children undergoing elective surgery at the Affiliated Hospital of Zunyi Medical University from November 2024 to July 2025 were randomly assigned to either a control group (receiving routine nursing care) or an experimental group (receiving routine nursing care combined with multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components). The Simplified Modified Yale Preoperative Anxiety Scale (m-YPAS-SF), Modified Behavioral Pain Scale (MBPS), Induction Compliance Checklist (ICC), and electrocardiographic monitoring were utilized to assess anxiety levels, anesthetic procedural pain, anesthesia compliance, and heart rate at three time points: pre-intervention (T0), post-intervention (T1), and during anesthesia induction (T2). RESULTS: No statistically significant differences were observed in general characteristics (gender, age, surgical approach, preference for culturally familiar cartoon images) between the two groups (P > 0.05). At T1 and T2, the experimental group exhibited significantly lower anxiety scores than the control group (P < 0.05). During anesthesia induction, the experimental group had a lower MBPS score and a superior ICC score compared with the control group (P < 0.05). Additionally, the experimental group demonstrated significantly lower heart rates at T1 and T2 than the control group (P < 0.05). CONCLUSION: The multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components effectively mitigates preoperative anxiety, reduces anesthetic procedural pain, and improves anesthesia compliance in preschool children in this single-center study, which suggests its potential clinical applicability and warrants further validation for wider promotion.