A cross-cultural perspective of medical clowning: comparison of its effectiveness in reducing pain and anxiety among hospitalized Bedouin and Jewish Israeli children

Figures & data

Figure 1 Faces pain scale-revised.

Table 1 Demographic characteristics of the study population

Characteristics		Jewish (n=39)	Bedouin (n=50)	p-value
Age, mean (SD)		9.8 (1.49)	9.7 (1.5)	0.16
Gender	Male	18 (46.2%)	25 (50.0%)	0.38
	Female	21 (53.8%)	25 (50.0%)
Place of residence	City	29 (74.4%)	14 (28.0%)	0.000
	Village	–	18 (36.0%)
	Unrecognized Bedouin village	–	18 (36.0%)
	Other	10 (25.6%)	–
Parental education level	No formal education	2 (5.1%)	13 (26.0%)	0.001
	Elementary school	4 (10.3%)	6 (12.0%)
	High school	15 (38.5%)	26 (52.0%)
	Higher education	18 (46.2%)	5 (10.0%)
Parents’ employment	Both parents unemployed	1 (2.6%)	18 (36.0%)	0.000
	One working parent	6 (15.4%)	24 (48.0%)
	Both parents working	32 (82.1%)	8 (16.0%)
Number of siblings	0–3	30 (77.0%)	19 (38.0%)	0.004
	4+	9 (23.0%)	31 (62.0%)

Table 2 Levels of pain and anxiety before and after the medical-clowning intervention within each cultural group

Cultural group	Variable		M	SD	t	p-value
Jews	Children’s level of pain	Before	1.72	1.70	3.21	0.003
		After	1.21	1.63
	Children’s level of anxiety	Before	3.79	3.43	3.73	0.001
		After	2.74	2.84
	Parents’ level of anxiety	Before	4.42	2.76	2.93	0.009
		After	3.16	2.06
Bedouin	Children’s level of pain	Before	0.94	0.65	8.60	0.000
		After	0.18	0.39
	Children’s level of anxiety	Before	3.56	1.49	11.52	0.000
		After	1.68	0.98
	Parents’ level of anxiety	Before	3.88	2.25	8.2	0.000
		After	2.08	1.16

Table 3 Reductions in levels of anxiety and pain among Jews and Bedouins

Variable		M	SD	t	p-value
Reduction in children’s pain levels	Jews	0.51	1.00	−1.36	0.180
	Bedouins	0.76	0.63
Reduction in children’s anxiety levels	Jews	1.05	1.76	−2.54	0.013
	Bedouins	1.88	1.15
Reduction in parental anxiety levels	Jews	1.26	1.88	−1.21	0.277
	Bedouins	1.80	1.55

Table 4 Enjoyment of various components of the clown intervention within each cultural group

Variable		M	SD	t	p-value
Body language	Jews	4.38	0.86	−1.51	0.136
	Bedouins	4.62	0.64
Facial expressions	Jews	4.32	0.78	−1.97	0.046
	Bedouins	4.62	0.64
Verbal humor	Jews	4.63	0.59	0.49	0.623
	Bedouins	4.56	0.73
Costume	Jews	4.03	1.27	−1.88	0.065
	Bedouins	4.46	0.79
Accessories	Jews	4.59	0.96	0.63	0.529
	Bedouins	4.48	0.74
Joking with doctors	Jews	4.20	0.92	−0.62	0.541
	Bedouins	4.38	0.83
Jokes regarding medical devices	Jews	4.57	0.76	0.75	0.456
	Bedouins	4.40	0.76
Jokes regarding the medical staff and hospital	Jews	4.83	0.41	2.33	0.041
	Bedouins	4.36	0.83

Table 5 Hierarchical multiple regression model for predicting the change in the children’s level of pain following the intervention based on children’s levels of pain before the intervention and their enjoyment of the clowns’ verbal and nonverbal humor

Variable	β	p	R^2	F
Step 1
Children’s pain pre-intervention	0.69	0.000	0.47	59.64
Step 2
Children’s pain pre-intervention	0.51	0.000	0.16	29.39
Children’s enjoyment of verbal humor	−0.44	0.003
Step 3
Children’s pain pre-intervention	0.48	0.001	0.02	4.18
Enjoyment of verbal humor	−0.35	0.009
Enjoyment of nonverbal humor	−0.19	0.042

Notes: In the interest of clarity, only variables that contributed significantly to the model are presented in the table. β, standardized regression coefficient (refers to how many standard deviations a dependent variable will change, per standard deviation increase in the predictor variable), R², proportion of variance explained in each step.

Figure 2 The ability to predict children’s anxiety levels after the intervention based on the interaction between the child’s enjoyment of the clown’s verbal humor and the child’s culture.

Table 6 Hierarchical multiple regression model for predicting the change in children’s anxiety levels following the medical-clowning intervention based on children’s levels of anxiety before the intervention, their enjoyment of nonverbal humor, and enjoyment of verbal humor × culture interaction

Variable	β	p	R^2	F
				Step 1
Children’s anxiety pre-intervention	0.74	0.000	0.55	81.82
				Step 2
Children’s anxiety pre-intervention	0.60	0.000	0.15	32.74
Children’s enjoyment of nonverbal humor	−0.41	0.005
				Step 3
Children’s anxiety pre-intervention	0.63	0.000	0.03	7.69
Children’s enjoyment of nonverbal humor	−0.44	0.003
Children’s enjoyment of verbal humor × culture	−0.19	0.043

Notes: In order to keep the data organized, only variables with significant contribution to the model are presented in the table. β, standardized regression coefficient; R², proportion of variance explained in each step.