# Efficacy comparison of clown care therapy versus virtual reality distraction on venipuncture-induced anxiety in preschool children: a retrospective cohort study

## TL;DR

This study compares clown therapy and virtual reality to reduce anxiety in young children during blood draws, finding clown therapy more effective in a Chinese hospital setting.

## Contribution

The study provides a direct comparison of clown care therapy and virtual reality distraction for preschool children's venipuncture anxiety in a Chinese cultural context.

## Key findings

- Clown care therapy reduced anxiety scores, heart rate increases, and crying duration more effectively than virtual reality distraction.
- Clown therapy improved clinical efficiency with higher first-attempt success rates and shorter sampling times.
- Parents reported higher satisfaction with clown care therapy compared to virtual reality distraction.

## Abstract

Venous blood sampling is a common medical procedure in preschool children that often induces significant anxiety, affecting procedural success and long-term medical adaptation. Clown care therapy (CCT) and virtual reality distraction (VRD) are non-pharmacological interventions with potential to alleviate children’s anxiety, but existing research primarily focuses on Western populations, lacking direct comparisons in the Chinese cultural context, and often relies on subjective scales with insufficient use of objective physiological indicators.

To compare the efficacy of CCT and VRD in reducing anxiety during venous blood sampling in preschool children, and evaluate their clinical application value using both subjective and objective metrics.

This single-center, retrospective cohort study was conducted at Dongcheng District, the First Affiliated Hospital of Anhui Medical University. Medical records of 220 preschool children aged 3–6 years who underwent venous blood sampling between January 2022 and January 2025 were reviewed. Based on the non-pharmacological distraction method administered as part of routine clinical care and documented in their medical records, participants were categorized into two groups: the CCT group (n = 110), which received interactive play by medical clowns, and the VRD group (n = 110), which used virtual reality devices during the procedure. Outcomes included subjective anxiety scores (modified Yale Preoperative Anxiety Scale, m-YPAS), objective physiological indicators (heart rate, crying duration, cortisol changes), clinical operation indicators (cooperation level, first-attempt success rate, sampling time), and parental satisfaction. Inter-group comparisons were conducted to assess intervention efficacy.

The CCT group suggested significantly lower anxiety scores during blood sampling (t = 4.128, p < 0.001), smaller increase in heart rate (t = 5.217, p < 0.001), shorter crying duration (t = 6.384, p < 0.001), and less cortisol change (t = 3.724, p < 0.001) compared to the VRD group. Cooperation level was better in the CCT group (p < 0.001), first-attempt success rate was higher (χ2 = 5.143, p = 0.023), and sampling time was shorter (t = 4.926, p < 0.001). Parental satisfaction was higher in the CCT group (p < 0.001). Multivariate analysis indicated CCT was independently associated with greater anxiety reduction (p < 0.001).

In this retrospective analysis, CCT was associated with better outcomes than VRD in alleviating anxiety induced by venous blood sampling in preschool children, significantly improving subjective anxiety, physiological stress responses, clinical efficiency, and parental satisfaction. Its interactive, human-centered nature may be particularly acceptable in this setting, though this requires further investigation.