Storytelling-Based Communication in Child Health: Cultural and Digital Interventions for Anxiety Reduction in Hospitalized Preschool Children − A Systematic Review and Meta-Analysis

Background: Hospitalization can trigger significant anxiety in preschool-aged children, affecting recovery and cooperation with care. Storytelling, especially when culturally adapted or digitally delivered, has emerged as a promising basic communication strategy to alleviate such distress. Objective: This review examined the cultural adaptability and digital potential of storytelling in pediatric care, comparing its effectiveness with alternative therapeutic approaches for reducing anxiety in hospitalized preschool children. Methods: A systematic search of PubMed, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane Library, and Google Scholar was conducted from inception to April 2025. Eligible studies included randomized controlled trials and quasi-experimental designs involving traditional, culturally adapted, or technology-assisted storytelling interventions in hospitalized preschool children. Two reviewers independently performed study selection, quality appraisal, and data extraction. Random-effects meta-analysis and meta-regression explored subgroup effects by cultural adaptation, delivery mode, and implementer training. All computations were conducted using RevMan 5.4 and STATA 16. Results: Twelve studies with 1,048 participants from seven countries met the inclusion criteria. Storytelling significantly reduced anxiety compared with standard care or alternative activities (Hedges' g = −0.84, 95% CI: −1.07 to −0.61, p < 0.001). Culturally adapted stories had greater effects than non-adapted formats, while digital delivery provided benefits comparable to in-person methods. Structured implementer training improved outcomes by about 18%. Storytelling was more effective than game-based interventions for procedural anxiety but showed similar results during prolonged hospitalization. Conclusion: Culturally tailored and digitally enhanced storytelling is an effective, adaptable, and feasible approach to reducing anxiety in hospitalized preschool children. Incorporating it into pediatric care training may support wider clinical application.