University of Oulu

Kerimaa, H., Hakala, M., Haapea, M., Vähänikkilä, H., Serlo, W., He, H.-G., & Pölkki, T. (2023). Effectiveness of a mobile app intervention for preparing preschool children and parents for day surgery: Randomized controlled trial. Journal of Medical Internet Research, 25, e46989.

Effectiveness of a mobile app intervention for preparing preschool children and parents for day surgery : randomized controlled trial

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Author: Kerimaa, Heli1,2; Hakala, Mervi1,2,3; Haapea, Marianne1,4;
Organizations: 1Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
2Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
3Oulu University Hospital, Oulu, Finland
4Research Service Unit, Oulu University Hospital, Oulu, Finland
5Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
6Division of Pediatric Surgery, Oulu University Hospital, Oulu, Finland, Oulu, Finland
7Oulu University Unit of Clinical Medicine, University of Oulu, Oulu, Finland
8Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
9National University Health System, Singapore, Singapore
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: JMIR Publications, 2023
Publish Date: 2023-10-17


Background: Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children.

Objective: This study aims to evaluate the effectiveness of a mobile app intervention on preschool children’s fear and pain and parents’ anxiety and stress in preparing children for day surgery.

Methods: This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2–6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents’ and children’s outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material.

Results: Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children’s pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children’s fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81).

Conclusions: The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods.

Trial Registration: NCT03774303;

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Series: Journal of medical internet research
ISSN: 1439-4456
ISSN-E: 1438-8871
ISSN-L: 1439-4456
Volume: 23
Article number: e46989
DOI: 10.2196/46989
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Funding: This research received grants from the Research Foundation of the Mannerheim Child Protection Union, the Pediatric Research Foundation, and the Society for Research in Nursing Sciences.
Copyright information: ©Heli Kerimaa, Mervi Hakala, Marianne Haapea, Hannu Vähänikkilä, Willy Serlo, Hong-Gu He, Tarja Pölkki. Originally published in the Journal of Medical Internet Research (, 29.09.2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.