Presentation
From Fear to Trust: Human-Centred Kansei Engineering Applications in Pediatric Nuclear Medicine
SessionPoster Session 1
DescriptionSummary
Background: Patient safety is a fundamental priority in pediatric nuclear medicine, where the combination of radiopharmaceutical injections and diagnostic imaging often triggers high levels of fear and resistance among young patients. They frequently displayed crying, screaming, and disruptive movements during injection and imaging processes, creating risks for both themselves and healthcare providers. Moreover, patients are typically accompanied by only one parent or caregiver due to radiation safety protocols. After the injection of radiopharmaceuticals, caregivers are required to leave the room, with contact limited to viewing their child through small observation windows. This separation often heightened anxiety for both children and families, which in some cases is expressed as frustration toward healthcare staff. Combined with the demands of working in a high-stress environment, these conditions contribute to the loss of experienced pediatric nurses–professionals who are especially difficult to replace given the specialized skills required in pediatric venous access and patient care.
Objective: These combined factors highlight the need for human-centred design strategies to improve the emotional experience for patients, families, and healthcare providers in pediatric nuclear medicine. To address these challenges, this study applied Kansei Engineering principles to design affective, child-centred interventions, which resulted in reduced anxiety and improved procedural safety. Kansei Engineering is a user-centred product development methodology extending traditional Ergonomics by translating consumers’ psychological feelings, emotions, and impressions into design elements and engineering parameters (1). By systematically linking subjective experiences with objective design features, it enables designers and engineers to create products that evoke desired affective responses while meeting functional requirements.
Methods: This study was conducted at a pediatric nuclear medicine imaging division of a hospital with 200 participants, as children aged 5–11 years (mean age 7.5), over a two-month data collection period. Baseline observations were obtained during a three-month pre-intervention period in which nursing staff – who had been informed that the interventions would begin approximately three months later – continued routine care without any Kansei-based or affective enhancements. More than twice the number of children included in the intervention phase were observed during this period, and none of the children in the intervention cohort had prior exposure to the department or the interventions. These observations served as the reference for assessing changes in cooperation, anxiety, and safety. This pre-intervention phase allowed us to establish a clear baseline for comparison, ensuring that any observed changes during the intervention could be attributed to the Kansei-based enhancements. The logic behind the study design and developed interventions were guided by both previous literature and cultural considerations to maximize engagement and reduce anxiety.
The interventions involved three components. First, small handcrafted felt dolls (turtle, rabbit, chick, and lion – animal figures symbolizing friendliness or strength) were introduced at the injection phase, which children could pick from and receive, as a reward, after they had their injection. Referring to the concept of animal-assisted therapy (AAT) (2), which involves introducing an animal to individuals to foster beneficial effects on their health and well-being, the selection of these animals was guided by existing literature as well as considerations of the relevant cultural context (3, 4). The dolls were ordered to be specifically designed and produced using Kansei Engineering principles. Children were also encouraged to describe the reasons for their choice of doll. This initiated additional conversations to further distract the children and reduce their anxiety. In cases of continued crying or resistance, they were further motivated by the promise of receiving an additional doll if they cooperated calmly and explained their preference in more detail.
Second, in line with the doll therapy (DT) approach and its documented benefits (5), a large fluffy doll was placed in the waiting area, where children remained for approximately an hour before entering the imaging room. This arrangement was intended to promote tactile and verbal interaction, thereby helping to reduce the children’s perception of waiting time. Their textures and colours were carefully selected based on Kansei Engineering principles to evoke comfort and positive emotions (6). To maintain awareness of the hospital context, the dolls were arranged in small hospital beds within the waiting area, subtly reinforcing the medical setting while softening its atmosphere.
Third, the imaging (CT scan) room ceiling featured a forest scene with trees and a smiling monkey, as patients would look at the ceiling while laying down for their procedure. Nurses prompted children to describe the scene during imaging, redirecting patients’ attention away from the procedure (7).
Results: Results demonstrated a marked improvement in cooperation and safety. Most boys showed a clear preference for the lion doll (approximately 80%), while girls mainly chose the rabbit (about 60%) or the chick (around 30%). Boys often associated the lion with strength and resilience, expressing that it made them feel powerful and less sensitive to pain. In contrast, girls emphasized the comforting and soothing presence of the animals, reporting that they helped alleviate feelings of discomfort. In addition, regarding the ceiling, children reported being curious about the monkey’s actions during imaging and felt that time passed quickly, indicating it served as an effective positive distraction (8). In total, over 75% of children expressed enthusiasm to complete the injection in order to obtain their toy as the reward. Compared with baseline observations of patients who had not previously received such interventions, severe crying and resistance were reduced by nearly 80%, and disruptive or unsafe movements declined to less than 15%. Furthermore, most younger children (i.e., those under 6 years old) fell asleep during imaging, indicating substantial relaxation.
Conclusion: These findings, obtained through direct observations, confirm the effectiveness of Kansei Engineering in pediatric nuclear medicine. By aligning design elements with children’s affective needs, healthcare teams can create safer, calmer environments that benefit both patients and healthcare staff. While children showed strong verbal engagement with all three interventions, it is recommended that even if implementing all interventions simultaneously is not feasible, applying them individually can still be beneficial.
References
1. Nagamachi, M. (2002). Kansei engineering as a powerful consumer-oriented technology for product development. Applied ergonomics, 33(3), 289-294.
2. Palley, L. S., O’Rourke, P. P., & Niemi, S. M. (2010). Mainstreaming animal-assisted therapy. ILAR journal, 51(3), 199-207.
3. Jalongo, M. R., & Guth, L. J. (2023). Animal-assisted counseling for young children: Evidence base, best practices, and future prospects. Early Childhood Education Journal, 51(6), 1035-1045.
4. Součková, M., Přibylová, L., Jurčová, L., & Chaloupková, H. (2023). Behavioural reactions of rabbits during AAI sessions. Applied Animal Behaviour Science, 262, 105908.
5. Santagata, F., Massaia, M., & D’Amelio, P. (2021). The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study. BMC geriatrics, 21(1), 545.
6. Rosen, B. G., Eriksson, L., & Bergman, M. (2016). Kansei, surfaces and perception engineering. Surface Topography: Metrology and Properties, 4(3), 033001.
7. Biddle, K. S., Boggs, L. M., Wolfe, M. L., Rogers, S., Petersen, C. M., King-Singh, K., ... & Fish-Huson, C. (2025). Healing ceilings: A collaborative exploration of pediatric preferences in ceiling tile artwork. Journal of Pediatric Nursing, 81, e96-e105.
8. Jiang, S. (2020). Positive distractions and play in the public spaces of pediatric healthcare environments: A literature review. HERD: Health Environments Research & Design Journal, 13(3), 171-197.
Background: Patient safety is a fundamental priority in pediatric nuclear medicine, where the combination of radiopharmaceutical injections and diagnostic imaging often triggers high levels of fear and resistance among young patients. They frequently displayed crying, screaming, and disruptive movements during injection and imaging processes, creating risks for both themselves and healthcare providers. Moreover, patients are typically accompanied by only one parent or caregiver due to radiation safety protocols. After the injection of radiopharmaceuticals, caregivers are required to leave the room, with contact limited to viewing their child through small observation windows. This separation often heightened anxiety for both children and families, which in some cases is expressed as frustration toward healthcare staff. Combined with the demands of working in a high-stress environment, these conditions contribute to the loss of experienced pediatric nurses–professionals who are especially difficult to replace given the specialized skills required in pediatric venous access and patient care.
Objective: These combined factors highlight the need for human-centred design strategies to improve the emotional experience for patients, families, and healthcare providers in pediatric nuclear medicine. To address these challenges, this study applied Kansei Engineering principles to design affective, child-centred interventions, which resulted in reduced anxiety and improved procedural safety. Kansei Engineering is a user-centred product development methodology extending traditional Ergonomics by translating consumers’ psychological feelings, emotions, and impressions into design elements and engineering parameters (1). By systematically linking subjective experiences with objective design features, it enables designers and engineers to create products that evoke desired affective responses while meeting functional requirements.
Methods: This study was conducted at a pediatric nuclear medicine imaging division of a hospital with 200 participants, as children aged 5–11 years (mean age 7.5), over a two-month data collection period. Baseline observations were obtained during a three-month pre-intervention period in which nursing staff – who had been informed that the interventions would begin approximately three months later – continued routine care without any Kansei-based or affective enhancements. More than twice the number of children included in the intervention phase were observed during this period, and none of the children in the intervention cohort had prior exposure to the department or the interventions. These observations served as the reference for assessing changes in cooperation, anxiety, and safety. This pre-intervention phase allowed us to establish a clear baseline for comparison, ensuring that any observed changes during the intervention could be attributed to the Kansei-based enhancements. The logic behind the study design and developed interventions were guided by both previous literature and cultural considerations to maximize engagement and reduce anxiety.
The interventions involved three components. First, small handcrafted felt dolls (turtle, rabbit, chick, and lion – animal figures symbolizing friendliness or strength) were introduced at the injection phase, which children could pick from and receive, as a reward, after they had their injection. Referring to the concept of animal-assisted therapy (AAT) (2), which involves introducing an animal to individuals to foster beneficial effects on their health and well-being, the selection of these animals was guided by existing literature as well as considerations of the relevant cultural context (3, 4). The dolls were ordered to be specifically designed and produced using Kansei Engineering principles. Children were also encouraged to describe the reasons for their choice of doll. This initiated additional conversations to further distract the children and reduce their anxiety. In cases of continued crying or resistance, they were further motivated by the promise of receiving an additional doll if they cooperated calmly and explained their preference in more detail.
Second, in line with the doll therapy (DT) approach and its documented benefits (5), a large fluffy doll was placed in the waiting area, where children remained for approximately an hour before entering the imaging room. This arrangement was intended to promote tactile and verbal interaction, thereby helping to reduce the children’s perception of waiting time. Their textures and colours were carefully selected based on Kansei Engineering principles to evoke comfort and positive emotions (6). To maintain awareness of the hospital context, the dolls were arranged in small hospital beds within the waiting area, subtly reinforcing the medical setting while softening its atmosphere.
Third, the imaging (CT scan) room ceiling featured a forest scene with trees and a smiling monkey, as patients would look at the ceiling while laying down for their procedure. Nurses prompted children to describe the scene during imaging, redirecting patients’ attention away from the procedure (7).
Results: Results demonstrated a marked improvement in cooperation and safety. Most boys showed a clear preference for the lion doll (approximately 80%), while girls mainly chose the rabbit (about 60%) or the chick (around 30%). Boys often associated the lion with strength and resilience, expressing that it made them feel powerful and less sensitive to pain. In contrast, girls emphasized the comforting and soothing presence of the animals, reporting that they helped alleviate feelings of discomfort. In addition, regarding the ceiling, children reported being curious about the monkey’s actions during imaging and felt that time passed quickly, indicating it served as an effective positive distraction (8). In total, over 75% of children expressed enthusiasm to complete the injection in order to obtain their toy as the reward. Compared with baseline observations of patients who had not previously received such interventions, severe crying and resistance were reduced by nearly 80%, and disruptive or unsafe movements declined to less than 15%. Furthermore, most younger children (i.e., those under 6 years old) fell asleep during imaging, indicating substantial relaxation.
Conclusion: These findings, obtained through direct observations, confirm the effectiveness of Kansei Engineering in pediatric nuclear medicine. By aligning design elements with children’s affective needs, healthcare teams can create safer, calmer environments that benefit both patients and healthcare staff. While children showed strong verbal engagement with all three interventions, it is recommended that even if implementing all interventions simultaneously is not feasible, applying them individually can still be beneficial.
References
1. Nagamachi, M. (2002). Kansei engineering as a powerful consumer-oriented technology for product development. Applied ergonomics, 33(3), 289-294.
2. Palley, L. S., O’Rourke, P. P., & Niemi, S. M. (2010). Mainstreaming animal-assisted therapy. ILAR journal, 51(3), 199-207.
3. Jalongo, M. R., & Guth, L. J. (2023). Animal-assisted counseling for young children: Evidence base, best practices, and future prospects. Early Childhood Education Journal, 51(6), 1035-1045.
4. Součková, M., Přibylová, L., Jurčová, L., & Chaloupková, H. (2023). Behavioural reactions of rabbits during AAI sessions. Applied Animal Behaviour Science, 262, 105908.
5. Santagata, F., Massaia, M., & D’Amelio, P. (2021). The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study. BMC geriatrics, 21(1), 545.
6. Rosen, B. G., Eriksson, L., & Bergman, M. (2016). Kansei, surfaces and perception engineering. Surface Topography: Metrology and Properties, 4(3), 033001.
7. Biddle, K. S., Boggs, L. M., Wolfe, M. L., Rogers, S., Petersen, C. M., King-Singh, K., ... & Fish-Huson, C. (2025). Healing ceilings: A collaborative exploration of pediatric preferences in ceiling tile artwork. Journal of Pediatric Nursing, 81, e96-e105.
8. Jiang, S. (2020). Positive distractions and play in the public spaces of pediatric healthcare environments: A literature review. HERD: Health Environments Research & Design Journal, 13(3), 171-197.
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Hospital Environments