Effectiveness of Digital Storytelling and Immersive Technology Interventions in Reducing Preoperative Anxiety Among Children: Systematic Review and Meta-Analysis

Background Preoperative anxiety affects an estimated 50% to 70% of children undergoing surgery and is associated with poorer perioperative cooperation, increased postoperative distress, and delayed recovery. Digital storytelling and immersive technologies, including virtual reality and augmented reality, have emerged as child-centered preparation tools to improve the preoperative experience. Objective This systematic review and meta-analysis aimed to synthesize and critically appraise the available evidence on the effects of these interventions in reducing preoperative anxiety among pediatric patients undergoing elective surgery. Methods A systematic search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library for studies published between January 2015 and June 2025. Randomized controlled trials and quasi-experimental studies evaluating digital storytelling (eg, narrative-based apps or videos) or immersive technologies (eg, virtual reality or augmented reality) were included. Preoperative anxiety was assessed using validated measures such as the Modified Yale Preoperative Anxiety Scale, State-Trait Anxiety Inventory, or Visual Analog Scale. Further, 2 reviewers independently screened studies and extracted data. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2. A random-effects meta-analysis was performed in R using standardized mean differences. Results A total of 379 records were identified, and 13 studies met the inclusion criteria. Most studies reported lower preoperative anxiety in intervention groups compared with standard care or conventional preparation. Further, 9 studies provided sufficient comparable data for meta-analysis, showing a significant pooled reduction in anxiety favoring digital interventions (standardized mean difference=−0.67, 95% CI −0.93 to −0.41), with substantial heterogeneity (I2=79.3%, P