A BEME review of educational programmes on the use of play in paediatric practice: BEME Guide No. 82

Figures & data

Table 1. Eligibility criteria for inclusion of white and grey literature based on the population, concept and context framework.

Population	Healthcare professionals defined as people with professional training in healthcare at pre-graduate and postgraduate levels
Concept	Any educational programme, intervention or curriculum featuring play to communicate, support, distract and interact age appropriately with paediatric patients aged 0–18 years of age
Context	Somatic departments at hospitals

Table 2. Characteristics of the 20 studies.

	Median (Range)
Number of participants (N)	28 (1–202)
	N
Country of origin*
High-income countries
England	5
USA	5
Canada	2
Australia	1
Norway	1
Scotland	1
Spain	1
Upper-middle income countries
Brazil	1
Thailand	1
Lower-middle income countries
India	1
Pakistan	1
Study design
Intervention, no comparator (post-test only)	13
Intervention, no comparator (pre-test, post-test)	5
Case reports	2
HCPs** included as participants (from 12 of the 20 studies reporting sample size)
Clinical staff
Nurses (nursing staff)	24
Medical doctors	5
Healthcare assistant	1
Rehabilitation staff
Physiotherapists	7
Occupational therapists	3
Rehabilitation assistant	1
Students
Nursing students	317
Medical students	125
Psychology students	33
Multidisciplinary teams (nurses, doctors, dietitians, psychologists and support workers)	89

* Based on data from World Bank Group (2022).

** Healthcare professionals.

Table 3. Theoretical frameworks reported in 7 of the 20 articles.

Study	Theoretical frameworks
Banerjee-Guénette et al. 2020	Knowledge translation strategy (Research 2012) combined with decomposed theory of planned behaviour (Taylor 1995)
Cochrane 2015	Community Learning and Development (CLD Standards Council Scotland 2015)
Crovella 1992	Association for the Care of Children’s Health, Child Life Research Project guidelines on preparation for procedure, communication, medical play, and separation issues (Gaynard 1990)
Drake et al. 2012	Bandura’s (1977) self-efficacy theory
Rasheed et al. 2021	Theory of change model based on the UNICEF/WHO (UNICEF/WHO 2020) care for child development module
Singh et al. 2021	Plan-Do-Study-Act-model with day-to-day-implementation (without reference)
Husøy 2013	Teddy bear hospital method (Bloch and Toker, 2008)

Figure 1. PRISMA Flow diagram for included studies.

Figure 2. Year of publication for the 20 studies included.

Figure 3. Five main needs (green) and associated barriers (red) concerning the use of play in paediatric clinical practice.

Table 4. Roles of play in the studies.*

Role of play (N)	Studies	Content of educational programme
Procedural play (N = 8)	Ballard et al. 2017 Banerjee-Guénette et al. 2020 Chaiyaratana et al. 2020 Drake et al. 2012 Hendry et al. 2017 Kennedy and Binns 2016 Knight and Gregory 2009 Lawes et al. 2008	Use of distraction/coping kits Strategies for safe holding Explanation of procedure Use of analgesic cream
Normalising play interventions (N = 8)	Billington 1972 Chaiyaratana 2020 Duret et al. 2019 Hall and Rett 2000 Kuhns 1989 Rasheed et al. 2021 Reid-Searl et al. 2021 Singh et al. 2021	Constructive play Dressing up games Storytelling/storybooks Active play Cartoon videos Use of toys Making medical play, e.g. handwashing, wound care and measurement of pulse Knowing how to make cartoon/animal sounds, rhymes, faces and hand games
Communication improvement (N = 4)	Cochrane 2015 Crovella 1992 Guibelalde 2016 Husøy 2013	Development of a youth engagement toolkit Familiarisation with children’s language and issues concerning children Viewing and discussing ethical issues Work body language Magic tricks Music therapy Introduction of mindfulness The teddy bear hospital

* Studies include more than one role of play.

Table 5. Content and setting of educational programmes in the 20 studies.

	N
Content of intervention*
Pre-procedural play	9
Normalising play	8
Improving communication	3
Setting**
Paediatric ward
Emergency department	4
Inpatient department	2
Surgery/lab department	2
Outpatient department	1
Oncology department	1
Hospital playroom	1
Not specified	6
Nursing school	3
Rehabilitation services	1
Summary of intervention target groups for 7 of the 20 studies reporting number and age***	N (%)
Babies and toddlers, 3 months − 2 years	250 (77.2)
Pre-schoolers, 3–5 years	37 (11.4)
Grade schoolers, 6–12 years	10 (3.1)
Teens and young adults, 13–25 years	27 (8.3)

* More than one type of intervention content in some studies.

** Multiple settings used in some studies.

*** 14 studies did not report number and/or age of intervention target group.

Table 6. Educational strategies reported in 15 of the 20 studies.*.

	N
Workshops	15
Supplemental educational material (written material, audio recording, virtual learning)	5
Supervised practice	3
Scenario-based roleplay	2
Planning worksheet for doing playful activities in clinical practice	1

* Some studies included more than one educational strategy.

Table 7. Study designs and measurements applied in the 20 studies.

	N
Evaluation design
Post-test-only design	15
Pre- and post-test design	5
Methods of measurement summed up for the 20 studies*
Questionnaire/survey	8
External observation	4
Feedback/debriefing sessions	4
Feedback from parents	3
Feedback from children	2
Semi-structured interviews	2
Informal comments/reflections/essays/worksheets	3
Scales
Face, Legs, Activity, Cry and Consolability scale	1
Assessing Determinants of Prospective Take-up of Virtual Reality instrument	1
Faces Pain Scale	1
Data collection form on usage	1
Clinical student conference	1

* Studies may use more than one type of measurement.

Figure 4. Evaluation of educational programmes based on the benefits described and suggestions given for educational framework and content.

Figure 5. Application of Kirkpatrick’s non-hierarchically modified, goal-based model of evaluation to the 20 studies. Studies may be evaluated on more than one level.

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