{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T15:57:50Z","timestamp":1776873470315,"version":"3.51.2"},"reference-count":26,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T00:00:00Z","timestamp":1611100800000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007145","name":"Fakulti Perubatan dan Sains Kesihatan, Universiti Putra Malaysia","doi-asserted-by":"publisher","award":["GP-IPM\/2018\/9640400"],"award-info":[{"award-number":["GP-IPM\/2018\/9640400"]}],"id":[{"id":"10.13039\/501100007145","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,1,7]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The healthcare setting is stressful for many people, especially children. Efforts are needed to mitigate children\u2019s healthcare-related anxiety. Medical play using the Teddy Bear Hospital (TBH) concept can expose children to healthcare settings and help them develop positive experiences in these settings. In this role-playing game, children bring their soft toys and act as parents to the \u2018sick\u2019 teddies in a pretend hospital or clinic play setting. The objective of this systematic review is to evaluate the effectiveness of the TBH in improving children\u2019s health outcomes and well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched the reference lists of included studies from four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) from inception until November 2020. We included pre-post, quasiexperimental and case\u2013control studies, as well as randomised controlled trials (RCTs) that discussed medical play using the TBH concept as an intervention. Studies that involved sick patients and used interventions unlike the TBH were excluded. We assessed the quality of the included studies using the Cochrane Collaboration\u2019s \u2018Risk of bias\u2019 tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten studies were included in this systematic review. Five specifically investigated the TBH method, while the others involved the same concept of medical play. Only three studies were RCTs. All of the studies report more than one outcome\u2014mostly positive outcomes. Two report lower anxiety levels after intervention. Two found better healthcare knowledge, with one reporting increased feelings of happiness regarding visiting a doctor. Two studies found no change in anxiety or feelings, while another two found increased levels of fear and lowered mood after the medical play (which involved real medical equipment).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The practice of TBH has mostly positive outcomes, with lower anxiety levels and improved healthcare knowledge. Its effectiveness should be verified in future studies using a more robust methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42019106355.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-041506","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T22:31:20Z","timestamp":1611181880000},"page":"e041506","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Effectiveness of pretend medical play in improving children\u2019s health outcomes and well-being: a systematic review"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7944-1364","authenticated-orcid":false,"given":"Aneesa Abdul","family":"Rashid","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia"}]},{"given":"Ai Theng","family":"Cheong","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia"}]},{"given":"Ranita","family":"Hisham","sequence":"additional","affiliation":[{"name":"T J Danaraj Medical Library, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia"}]},{"given":"Nurainul Hana","family":"Shamsuddin","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia"}]},{"given":"Dalila","family":"Roslan","sequence":"additional","affiliation":[{"name":"Global Health Unit, Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia"}]}],"member":"239","published-online":{"date-parts":[[2021,1,20]]},"reference":[{"key":"2025120523272349000_11.1.e041506.1","unstructured":"Burns-Nader ES . The effects of medical play on reducing fear, anxiety, and procedure distress in school-aged children going to visit the doctor. University of Alabama Libraries, 2011."},{"key":"2025120523272349000_11.1.e041506.2","doi-asserted-by":"crossref","first-page":"143","DOI":"10.5409\/wjcp.v5.i2.143","article-title":"Minimizing pediatric healthcare-induced anxiety and trauma","volume":"5","author":"Lerwick","year":"2016","journal-title":"World J Clin Pediatr"},{"key":"2025120523272349000_11.1.e041506.3","first-page":"28","article-title":"Prevalence of white coat hypertension in primary health care","volume":"89","author":"Alves","year":"2007","journal-title":"Arq Bras Cardiol"},{"key":"2025120523272349000_11.1.e041506.4","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/00005721-199403000-00011","article-title":"Teddy bear clinics: a huge community project","volume":"19","author":"Santen","year":"1994","journal-title":"MCN Am J Matern Child Nurs"},{"key":"2025120523272349000_11.1.e041506.5","doi-asserted-by":"publisher","DOI":"10.1177\/1359105313488975"},{"key":"2025120523272349000_11.1.e041506.6","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1111\/j.1440-1754.2012.02482.x","article-title":"The Teddy bear hospital in Australia","volume":"48","author":"Kaufman","year":"2012","journal-title":"J Paediatr Child Health"},{"key":"2025120523272349000_11.1.e041506.7","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1207\/s15326888chc1603_5","article-title":"Medical play: an expanded perspective","volume":"16","author":"McCue","year":"1988","journal-title":"Child Health Care"},{"key":"2025120523272349000_11.1.e041506.8","first-page":"597","article-title":"Doctor, is my teddy bear okay? 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