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Comparison of a hand puppet, video viewing, and a coloring book in reducing pain and fear in children during blood sampling: A randomized controlled trial.

Created on 19 Sep 2026

Authors

Elif Simay Koç, Gamze Akay

Published in

Journal of pediatric nursing. Sep 18, 2026. Epub Sep 18, 2026.

Abstract

This study aimed to compare the effectiveness of a hand puppet, video viewing, and a coloring activity in reducing pain and fear in children during blood sampling.
In this randomized controlled trial, children aged 3-6 years were randomly assigned to intervention and control groups. Children in the intervention groups received one of the following during blood sampling: a hand puppet (n = 30), cartoon video viewing (n = 30), or a coloring activity (n = 30), while no intervention was applied in the control group (n = 30). Pain and fear were assessed before, during, and after the procedure.
The groups were similar in demographic characteristics; however, homogeneity was not achieved regarding previous hospital experience. Pain and fear scores during the procedure were significantly higher than post-procedure scores in all groups (p < 0.05). According to child self-reports and nurse assessments, the control group had significantly higher pain and fear scores than other groups (p < 0.05). The lowest pain scores were observed in the hand puppet group, while the lowest fear scores were found in the hand puppet and coloring groups. According to ANCOVA analysis, all intervention groups showed significant reduction in post-procedural pain and fear levels compared to the control group (p < 0.001). Hand puppet and coloring interventions were more effective than video viewing.
All distraction methods, including hand puppets, coloring, and video viewing, were effective in reducing pain and fear during blood sampling in children. However, hand puppet and coloring interventions demonstrated a stronger effect, particularly compared to video viewing.

PMID:
42760147
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.

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