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Children's Perceptions of Pictures Intended to Measure Anxiety During Hospitalization

Journal article
Authors Stefan Nilsson
Josefine Holstensson
Cajsa Johansson
Gunilla Thunberg
Published in Journal of Pediatric Nursing : Nursing Care of Children and Families
Volume 44
Pages 63-73
ISSN 0882-5963
Publication year 2019
Published at Institute of Health and Care Sciences
Pages 63-73
Language en
Subject categories Nursing


Many children experience anxiety during a hospital stay, which can have an adverse impact on their recovery and response to future hospital care. To facilitate assessment of anxiety in young children and children with communicative disabilities, the short S-STAI (short version of the State scale of the State-Trait Anxiety Inventory), has previously been adapted to a visual format. The aims of the present study were (a) to validate the pictures used to represent emotions and the steps of a quantitative scale (‘a lot’ – ‘some’ – ‘a little’), including to determine whether any of them should be replaced, and (b) to assess different pictures to be used for a qualitative scale (‘good/like’ – ‘in between/so-so’ –‘bad/dislike’) in the same instrument. A total of 103 children aged 5–8 years were asked to choose verbal labels for pictures of facial expressions intended to represent emotions, match those pictures with the emotional categories used in the short S-STAI (Tense/Nervous, Worried/Afraid, Calm/Relaxed, and Happy/Content) and indicate their preferences for pictures intended to represent the steps of a quantitative scale and a qualitative one. The children understood both scales and the differences between positive and negative emotions in the short S-STAI. The older children (aged 7 and 8) significantly more often chose a picture for each step of the scales that was intended to represent that particular step. The article discusses implications for the choice of pictures representing emotional states in the short S-STAI and presents recommended pictures.

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