ABSTRACT
Background:
Hospitalization is a stressful experience for children, often resulting in anxiety that affects their emotional well-being and recovery. Non-pharmacological interventions, such as origami therapy, have shown potential for managing anxiety in paediatric care.
Objective:
To evaluate the effectiveness of origami therapy in reducing anxiety levels among hospitalized children aged 6-10 years.
Materials and Methods:
Qasi-experimental pre-test and post-test control design was used. Sixty participants were divided into experimental group (30-minute origami therapy for seven days) and control group (standard hospital care). Anxiety levels were measured pre- and post-intervention using validated behavioural observation checklist.
Results:
Experimental group demonstrated significant reduction in anxiety levels after intervention (P < 0.001), whereas control group showed no significant changes (P > 0.05).
Conclusion:
Origami therapy is effective, simple, and engaging non-pharmacological intervention for reducing anxiety in hospitalized children. Its application in paediatric care can enhance the emotional well-being of young and improve overall hospital experience.
KEYWORDS: Non-pharmacological intervention, origami therapy, paediatric anxiety
INTRODUCTION
Hospitalization is distressing experience for children, leading to heightened anxiety due to unfamiliar environments, procedures, and separation from family.[1] This anxiety not only impacts children’s emotion but also hinder recovery, prolong hospital stays, and increase the burden on caregivers.[2]
Non-pharmacological interventions, particularly creative therapies, have gained attention to alleviate anxiety in children.[3] Among these, origami—the traditional Japanese art of paper folding—has emerged as a promising therapeutic tool.[4] Origami is simple, cost-effective, and engaging, fostering relaxation, concentration, and sense of accomplishment.[5]
Despite its potential, there is limited empirical evidence on impact of origami therapy in reducing anxiety among hospitalized children. This study aims to fill this gap by evaluating the effectiveness of origami therapy in alleviating anxiety levels in hospitalized children. Using a quasi-experimental pre-test and post-test control group design, the study seeks to provide robust evidence for incorporating origami therapy as a non-pharmacological intervention in paediatric healthcare.
MATERIALS AND METHODS
The study was conducted in the paediatric ward of a selected hospital in Mehsana district, Gujarat, India, included 60 children aged 6-10 years, divided into experimental (n = 30) and control group (n = 30). Participants were selected using non-probability convenience sampling. The experimental group received daily origami therapy sessions for seven days (creating simple paper-folding structures to promote relaxation, concentration, and distraction from anxiety-inducing hospital stressors), while the control group received standard hospital care.
Children hospitalized for at least five days, and experienced moderate anxiety levels assessed using a validated behavioural observation checklist were included. Children who were critically ill, post-operative, or had mild or severe anxiety levels or physical or mental disabilities were excluded.
Anxiety levels were assessed using a validated behavioural observation checklist comprised of four domains: vocalization, gaze behaviour, reaction to therapeutic procedures, reaction to loss of control. Anxiety scores ranged from 30 (mild anxiety) to 90 (severe anxiety).
Ethical approval was obtained from the hospital authorities before commencing the study. Written informed consent was secured from caregivers, ensuring participants’ rights to confidentiality and voluntary participation were upheld throughout the study.
Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to summarize demographic and anxiety-related data. Inferential statistics included paired t-tests to evaluate within-group changes, independent t-tests for inter-group comparisons, and Chi-square tests to assess associations between demographic variables and anxiety levels.
RESULTS
The association between demographic variables (age, gender, family type, residence, and income) and anxiety levels was analysed for both the experimental and control groups during the pre-test and post-test phases. In the experimental group, no significant associations were found between demographic variables and anxiety levels either before or after the intervention (P > 0.05). Similarly, in the control group, demographic factors did not significantly influence anxiety levels in either the pre-test or post-test phases (P > 0.05). These findings suggest that the reduction in anxiety observed in the experimental group was driven by the intervention rather than demographic characteristics.
DISCUSSION
The present study was conducted to assess the effectiveness of Origami therapy in reducing anxiety among hospitalized children and for the same we included 30 inpatients in each experimental and control group and recorded their demographic data [Table 1]. Present study demonstrated that origami therapy effectively reduced anxiety in hospitalized children. The experimental group showed a significant decrease in anxiety levels post intervention (P < 0.001), compared to control group [Table 2 and Figure 1]. This aligns with evidence supporting the role of non-pharmacological, creative therapies like origami in paediatric healthcare. Lanjekar and Kale reported that children who underwent origami therapy sessions for 30 minutes over five days experienced a marked reduction in anxiety.[6] Josephine et al.[7] noted significant reductions in anxiety and stress after three sessions of 30-minute origami therapy in hospitalized children.
Table 1.
Frequency and percentage of participants
| Demographic variable | Experimental group (n=30) | Control group (n=30) |
|---|---|---|
| Age | ||
| 6-8 years | 18 (60%) | 15 (50%) |
| 9-10 years | 12 (40%) | 15 (50%) |
| Gender | ||
| Male | 15 (50%) | 9 (30%) |
| Female | 15 (50%) | 21 (70%) |
| Family | ||
| Nuclear | 14 (46.66%) | 12 (40%) |
| Joint | 16 (53.33%) | 18 (60%) |
| Residence | ||
| Urban | 21 (70%) | 20 (66.66%) |
| Rural | 9 (30%) | 10 (33.33%) |
| Caregiver | ||
| Mother | 27 (90%) | 28 (93.33%) |
| Grandparents | 3 (10%) | 2 (6.66%) |
Table 2.
Comparison of pre-test and post-test anxiety scores
| Group | Assessment | Mean anxiety score | Standard deviation (SD) | Mean difference | t | P |
|---|---|---|---|---|---|---|
| Experimental group | Pre-test | 51.86 | 7.19 | |||
| Post-test | 33.73 | 4.05 | 18.13 | 13.50 | <0.001 | |
| Control group | Pre-test | 62.53 | 5.97 | |||
| Post-test | 60.80 | 8.07 | 1.73 | 1.83 | >0.05 |
Figure 1.
Graph showing comparison of anxiety level in experimental and control groups
Thakur et al.[8] found that daily origami sessions reduced anxiety in children admitted to paediatric wards, emphasizing the therapy’s accessibility and simplicity.
Studies suggest that origami therapy, implemented in a structured manner, provides meaningful emotional relief for young patients and lacks significant associations between demographic variables [Table 1] and anxiety levels.
Literature suggests the role in reducing fear and anxiety while enhancing self-confidence and fostering social connections among seriously ill children. Significant improvements in anxiety levels post-origami intervention were noted underscoring its potential as holistic approach.[9] Our study confirmed that the reduction in anxiety observed in the experimental group was due to the intervention itself rather than demographic variables. This finding is supported by Juwita et al.,[9] who concluded that play therapies, including origami, effectively mitigate anxiety irrespective of socio-demographic factors. This association highlights origami therapy as a universally effective tool for managing paediatric anxiety.
The findings across studies consistently point to the effectiveness of origami therapy in reducing anxiety among hospitalized children. Its ease of implementation, minimal costs, and ability to provide psychological relief make it a valuable addition to paediatric care settings.
CONCLUSION
Combining the insights from our study and prior research, it is evident that integrating origami therapy into routine hospital care can significantly enhance the emotional well-being of young patients. Future research should explore its long-term psychological benefits. The present study strengthens the case for origami therapy as non-pharmacological approach to paediatric anxiety management, aligned with global trends in patient-centred care.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Lerwick JL. Minimizing paediatric healthcare-induced anxiety and trauma. World J Clin Pediatr. 2016;5:143–50. doi: 10.5409/wjcp.v5.i2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders in pediatric medical settings: Prevalence, phenomenology, and a research agenda. Arch Pediatr Adolesc Med. 2010;164:965–72. doi: 10.1001/archpediatrics.2010.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Stoll RD, Pina AA, Schleider J. Brief, non-pharmacological, interventions for paediatric anxiety: Meta-analysis and evidence base status. J Clin Child Adolesc Psychol. 2020;49:435–59. doi: 10.1080/15374416.2020.1738237. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Ahmed AR, Gauntlett OC, Camci-Unal G. Origami-inspired approaches for biomedical applications. ACS Omega. 2020;6:46–54. doi: 10.1021/acsomega.0c05275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Kuo ZK, Chang TH, Chen YS, Cheng CM, Tsai CY. Two potential clinical applications of origami-based paper devices. Diagnostics (Basel) 2019;9:203. doi: 10.3390/diagnostics9040203. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Lanjekar PD, Joshi SH, Lanjekar PD, Wagh V. The effect of parenting and the parent-child relationship on a child's cognitive development: A literature review. Cureus. 2022;14:e30574. doi: 10.7759/cureus.30574. doi: 10.7759/cureus.30574. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Josephine MJC, Singarayan V, Poornima RN. Effectiveness of origami on stress and anxiety of hospitalized children. Int J Res Paediatric Nurs. 2022;4:19–25. [Google Scholar]
- 8.Thakur M, Kaur N, Pooni PA. Effectiveness of origami on hospitalized anxiety among children admitted in paediatric units of a selected tertiary care hospital Ludhiana, Punjab. Int J Pediatric Nurs. 2021;7:1–9. [Google Scholar]
- 9.Juwita H, Fitriani, Syahrir A, Taslim M, Hidayah N, Arbianingsih, et al. Effectiveness of multimodal interventions play therapy: Colouring and origami against anxiety levels in toddler ages. J Health Sci Prev. 2019;3:3S. [Google Scholar]
