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Development and evaluation of an illustrated paediatric leaflet ‘Coming to Hospital: a guide to what goes on’


Clark EKR, Sanghavi SS, Farrell S, Fritz Z. Development and evaluation of an illustrated paediatric leaflet ‘Coming to Hospital: a guide to what goes on’. BMJ Paediatrics Open 2021;5:e000889.

Why it matters

High-quality written information for patients can improve their experience of what’s involved in a hospital visit by reducing uncertainty and anxiety. However, there may be unintended consequences of providing this information: for example patients may become concerned about things they had not previously considered.

Although many hospitals recognise the need to provide information to patients who are children and their parents or carers, most locally developed leaflets have not been formally evaluated.

This study involved the development of an information leaflet to give to children aimed at answering common questions they may have about going into hospital, and then evaluating the intended and unintended consequences of the distribution of the leaflet.


A leaflet called “Coming to hospital: a guide to what goes on” was produced in partnership with Usborne Publishing, aimed at helping paediatric patients understand what to expect about admission to hospital and to help them feel calmer about it. It was based on an Usborne book “Look inside a Hospital” and was distributed to paediatric patients (aged 4–14) at Cambridge University Hospitals NHS Foundation Trust.

A questionnaire was developed to assess patients’ views on the leaflet. The questionnaire used an emoji scale to determine what emotions the leaflet elicited, open-ended questions to gain more detailed responses, and a section for parents or carers to provide comments.

There were 3,000 copies of the leaflet printed and distributed, and 72 children were involved in the evaluation.

What we found

The results of the emoji-scale questions showed that when asked how the leaflet made them feel, 33.3% of respondents chose ‘happy’; 40.3% chose ‘calm’; 23.6% chose ‘the same’; 1.4% chose ‘worried’; and 1.4% chose ‘scared’. More than two-thirds of respondents said they ‘really liked’ the leaflet and over 80% said it was helpful.

In the detailed responses, patients said they liked the leaflet because it helped them learn about what happens in a hospital, they liked the illustrations, and they found the leaflet easy to understand. Children who said that the leaflet made them feel calm attributed this to the explanations they now had for what was going to happen in hospital.

Many of the children said the leaflet answered questions that they had had before they came into hospital, for example about blood tests and scans, being able to take toys and games with them, and having a parent stay overnight with them.

To explore any unintended consequences of the leaflet, the children were asked if anything made them more worried: only one respondent said that the operations section made them worried; another said that the ‘settling in’ heading made them feel as if they would be in hospital for a long time. As a result, the ‘settling in’ section was changed to ‘on the ward’ so that children are not led to believe they will necessarily have to stay for extended periods of time.

Parents and carers were positive about the leaflet, and particularly about the writing, illustrations and explanations. Many said they wished they had seen it before they attended hospital.

Overall, the leaflet was positively received by children and parents, and was not reported to provoke anxiety or significant numbers of new questions. In response to suggestions, the word ‘patient’ was changed to personal pronouns throughout the leaflet and other helpful sections on subjects such as visiting times and parking were added.

Wider availability of the leaflet to paediatric inpatient populations could make children feel calmer on admission to hospital. Further research on the effects of this leaflet in more diverse populations would be welcome, along with whether disease-specific leaflets would be beneficial.

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