Mandala coloring reduces anxiety and pain in circumcised children: A randomized controlled trial

Background: Boys often experience significant fear and anxiety before the circumcision procedure, and postoperative pain is linked to increased fear and anxiety in children. Objectives: The aim of this study was to determine the effect of mandala coloring on fear, anxiety, emotional symptoms and postoperative pain of circumcised children. Methods: This randomized controlled trial was conducted in the pediatric clinic of a state hospital in eastern Turkey. Children were divided into two groups using a computer program: Group 1 (control) included children with no intervention (n = 40), and Group 2 (mandala coloring) included children who received mandala coloring (n = 38). Statistical analyses were performed using the Kolmogorov-Smirnov test to assess the normality of the data, the chi-squared test to compare categorical variables between groups, the paired samples t-test for within-group comparisons, the independent samples t-test for between-group comparisons, and mixed model repeated measures ANOVA (rANOVA) to evaluate the temporal changes in pain and anxiety scores across groups. Findings: Children's fear, anxiety, emotional symptom, and postoperative pain scores were similar in all groups before the nursing intervention, and the fear, anxiety, and emotional symptom scores of the mandala painting intervention group were statistically lower than the control group after the nur csing intervention. The pain scores of the children in the mandala coloring group were lower than the control group after surgery. Conclusion: Mandala coloring intervention can be used to reduce emotional symptoms, fear, anxiety and postoperative pain in children aged 6–12 years undergoing circumcision.