Effect of Digital Health Education Towards Anxiety among Pre-Operative Patients: A Systematic Review

  • Daniel Nong Danche Faculty of Nursing, Universitas Airlangga
  • Tintin Sukartini Faculty of Nursing, Universitas Airlangga
  • Aria Aulia Nastiti Faculty of Nursing, Universitas Airlangga
  • Ira Suarilah Faculty of Nursing, Universitas Airlangga
Keywords: anxiety, digital health, health risks, health service, surgery


Anxiety is a major issue that worsens clinical symptoms and often arises when patients undergo surgery. However, the review of the impact of digital health education on pre-operative patients with anxiety is still limited. This study aimed to determine the effectiveness of digital health education in reducing anxiety in pre-operative patients. Methods: A systematic review of quantitative studies was conducted. Relevant full-text articles were sourced from four databases: Web of Science, Science Direct, Proquest, and PubMed, from January 1, 2019, to December 31, 2024. The quality of the included studies was assessed by the Joanna Briggs Institute (JBI). A narrative analysis was performed to present the effectiveness of digital health education on pre-operative patients with anxiety. Results: A total of 13 studies were identified, involving 1,394 pre-operative patients. The age of the participants ranged from 5 to 68 years. The effectiveness of digital health education for pre-operative patients with anxiety was seen as a mixed program combining images, audiovisual materials, and interactive features that allowed patients to communicate with each other and healthcare professionals. Conclusion: This study highlights that digital health education interventions are a promising avenue in healthcare delivery due to advancements in technology and information.


Abate, S. M., Chekol, Y. A., & Basu, B. (2020). Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. International Journal of Surgery Open, 25, 6–16. https://doi.org/10.1016/j.ijso.2020.05.010

Adwas, A. A., Jbireal, J. M., & Azab, A. E. (2019). Anxiety: Insights into signs, symptoms, etiology, pathophysiology, and treatment. East African Scholars Journal of Medical Sciences, 2(10), 580–591.

Afrassa, N., Nega Kassa, R., & Girma Legesse, T. (2022). Preoperative anxiety and its associated factors among patients undergoing cardiac catheterization at saint peter Specialized Hospital and Addis Cardiac Center, Addis Ababa, Ethiopia. International Journal of Africa Nursing Sciences, 17, 100430. https://doi.org/10.1016/j.ijans.2022.100430

Akkuş, F., Doğru, Ş., Atci, A. A., Akkuş, M., & Gezginç, K. (2023). The Effect of Video Information on Amniocentesis-Related Anxiety Levels: A Case-Control Study. Journal of Clinical Obstetrics & Gynecology, 33(4), 221–227. https://doi.org/10.5336/jcog.2023-98485

Anthony, C. A., Rojas, E. O., Keffala, V., Glass, N. A., Shah, A. S., Miller, B. J., Hogue, M., Willey, M. C., Karam, M., & Marsh, J. L. (2020). Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. Journal of Medical Internet Research, 22(7), e17750. https://doi.org/10.2196/17750

Antonis, T. (2022). Health Psychology Perioperative Psychiatric Disorders. Journal of Medical Practice and Review, 6(2), 755–765.

Borkovec, T. D., Ray, W. J., & Stober, J. (1998). Worry: A Cognitive Phenomenon Intimately Linked to Affective, Physiological, and Interpersonal Behavioral Processes. Cognitive Therapy and Research, 22(6), 561–576. https://doi.org/10.1023/A:1018790003416

Daf, A., & Patil, D. S. (2024). Impact of Virtual Rehabilitation in Adjunct to Conventional Physical Therapy on Proximal Humerus Fracture: A Randomized Controlled Trial. Cureus. https://doi.org/10.7759/cureus.56022

Dobrina, R., Cassone, A., Dal Cin, M., Ronfani, L., Giangreco, M., Schreiber, S., Zanchiello, S., Starec, A., Brunelli, L., Brumatti, L. V., & Bicego, L. (2023). Study protocol for a randomised controlled trial to determine the effectiveness of a mHealth application as a family supportive tool in paediatric otolaryngology perioperative process (TONAPP). Trials, 24(1), 355. https://doi.org/10.1186/s13063-023-07376-z

Ghinassi, C. W. (2010). Anxiety. Bloomsbury Publishing USA.

Gu, S., Ping, J., Xu, M., & Zhou, Y. (2021). TikTok browsing for anxiety relief in the preoperative period: A randomized clinical trial. Complementary Therapies in Medicine, 60, 102749. https://doi.org/10.1016/j.ctim.2021.102749

Jin, Y., Jiang, A., Jiang, W., Wu, W., Ye, L., Kong, X., Liu, L., & Jin, Z. (2021). Self-produced audio-visual animation introduction alleviates preoperative anxiety in pediatric strabismus surgery: a randomized controlled study. BMC Ophthalmology, 21(1), 163. https://doi.org/10.1186/s12886-021-01922-6

Kakde, A., Lim, M. J., Shen, H., Tan, H. Sen, Tan, C. W., Sultana, R., & Sng, B. L. (2023). Effect of music listening on perioperative anxiety, acute pain and pain catastrophizing in women undergoing elective cesarean delivery: a randomized controlled trial. BMC Anesthesiology, 23(1), 109. https://doi.org/10.1186/s12871-023-02060-w

Kaynar, A. M., Lin, C., Sanchez, A. G., Lavage, D. R., Monroe, A., Zharichenko, N., Strassburger, M., Saucier, K., Groff, Y. J., Klatt, B. A., O’Malley, M. J., Szigethy, E., Wasan, A. D., & Chelly, J. E. (2023). SuRxgWell: study protocol for a randomized controlled trial of telemedicine-based digital cognitive behavioral intervention for high anxiety and depression among patients undergoing elective hip and knee arthroplasty surgery. Trials, 24(1), 715. https://doi.org/10.1186/s13063-023-07634-0

Knapp, P. W., Keller, R. A., Mabee, K. A., Pillai, R., & Frisch, N. B. (2021). Quantifying Patient Engagement in Total Joint Arthroplasty Using Digital Application-Based Technology. The Journal of Arthroplasty, 36(9), 3108–3117. https://doi.org/10.1016/j.arth.2021.04.022

Kondylakis, H., Chicchi Giglioli, I. A., Katehakis, D. G., Aldemir, H., Zikas, P., Papagiannakis, G., Hors-Fraile, S., González-Sanz, P. L., Apostolakis, K. C., Stephanidis, C., Núñez-Benjumea, F. J., Baños-Rivera, R. M., Fernandez-Luque, L., & Kouroubali, A. (2022). A Digital Health Intervention for Stress and Anxiety Relief in Perioperative Care: Protocol for a Feasibility Randomized Controlled Trial. JMIR Research Protocols, 11(11), e38536. https://doi.org/10.2196/38536

Kwon, H., Lee, J., Park, Y. S., Oh, S.-H., & Kim, J. (2023). Effects of preoperative education using virtual reality on preoperative anxiety and information desire: a randomized clinical trial. Journal of Clinical Monitoring and Computing, 37(5), 1401–1407. https://doi.org/10.1007/s10877-023-00988-5

Lader, M., & Marks, I. (2013). Clinical anxiety. Butterworth-Heinemann.

Lahti, S., Suominen, A., Freeman, R., Lähteenoja, T., & Humphris, G. (2020). Virtual Reality Relaxation to Decrease Dental Anxiety: Immediate Effect Randomized Clinical Trial. JDR Clinical & Translational Research, 5(4), 312–318. https://doi.org/10.1177/2380084420901679

Luengo, T. D., Rivas, A. B., Loureido, E., & Vargas, E. (2023). Reducing preoperative anxiety in parents of surgical patients. Heliyon, 9(5), e15920. https://doi.org/10.1016/j.heliyon.2023.e15920

Lunkenheimer, F., Domhardt, M., Geirhos, A., Kilian, R., Mueller-Stierlin, A. S., Holl, R. W., Meissner, T., Minden, K., Moshagen, M., Ranz, R., Sachser, C., Staab, D., Warschburger, P., & Baumeister, H. (2020). Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACHCD): study protocol for a multicentre randomized controlled trial. Trials, 21(1), 253. https://doi.org/10.1186/s13063-019-4041-9

Maulina, L., Susilowati, Y., & Diel, M. M. (2023). Perbedaan Tingkat Kecemasan Pemberian Informed Consent Pada Pasien Pra Operasi. Jurnal Kesehatan, 12(2), 189–198.

Moon, E., Go, Y., Woo, G., Seo, H., & Lee, B.-J. (2019). Preoperative anxiety can cause convulsion and severe hypotension immediately after spinal anaesthesia for caesarean delivery: a case report. Journal of International Medical Research, 47(10), 5323–5327. https://doi.org/10.1177/0300060519873473

Obuchowska, I., & Konopinska, J. (2021). Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review. Psychology Research and Behavior Management, Volume 14, 781–793. https://doi.org/10.2147/PRBM.S314214

Rich, C. (2020). Perioperative stress and anxiety in the surgical patient. Pudner’s Nursing the Surgical Patient E-Book, 39, 39–46.

Sui, Y., Kor, P. P. K., Li, M., & Wang, J. (2023). Effects of a Social Media–Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial. JMIR Formative Research, 7, e42861. https://doi.org/10.2196/42861

Tadesse, M., Ahmed, S., Regassa, T., Girma, T., & Mohammed, A. (2022). The hemodynamic impacts of preoperative anxiety among patients undergoing elective surgery: An institution-based prospective cohort study. International Journal of Surgery Open, 43, 100490. https://doi.org/10.1016/j.ijso.2022.100490

Townsend, C. B., Bravo, D., Jones, C., Matzon, J. L., & Ilyas, A. M. (2021). Noise-Canceling Headphones and Music Decrease Intraoperative Patient Anxiety During Wide-Awake Hand Surgery: A Randomized Controlled Trial. Journal of Hand Surgery Global Online, 3(5), 254–259. https://doi.org/10.1016/j.jhsg.2021.05.008

Wong, S. S. Y., Cheung, H. H. Ti., Ng, F. F., Yau, D. K. W., Wong, M. K. H., Lau, V. N. M., Leung, W. W., Mak, T. W. C., & Lee, A. (2022). Effect of a patient education video and prehabilitation on the quality of preoperative person-centred coordinated care experience: protocol for a randomised controlled trial. BMJ Open, 12(9), e063583. https://doi.org/10.1136/bmjopen-2022-063583

Xing, J., Gong, C., Wu, B., Li, Y., Liu, L., Yang, P., Wang, T., Hei, Z., Zhou, S., & Chen, C. (2023). Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery. Heliyon, 9(10), e20536. https://doi.org/10.1016/j.heliyon.2023.e20536

Yang, Y., Li, Y., Zhang, H., Xu, Y., & Wang, B. (2021). The efficacy of computer-assisted cognitive behavioral therapy (cCBT) on psychobiological responses and perioperative outcomes in patients undergoing functional endoscopic sinus surgery: a randomized controlled trial. Perioperative Medicine, 10(1), 28. https://doi.org/10.1186/s13741-021-00195-3

Yıldız, E., & Karagözoğlu, Ş. (2023). The Effects of a Web-Based Interactive Nurse Support Program Based on the Health Promotion Model on Healthy Living Behaviors and Self-Efficacy in Patients Who Regained Weight after Bariatric Surgery: A Randomized Controlled Trial. Obesity Surgery, 33(10), 3212–3222. https://doi.org/10.1007/s11695-023-06795-w

Zheng, Y., & Yan, Q. (2023). Effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures. BMC Nursing, 22(1), 395. https://doi.org/10.1186/s12912-023-01530-3.

How to Cite
Danche, D. N., Sukartini, T., Nastiti, A. A., & Suarilah, I. (2024). Effect of Digital Health Education Towards Anxiety among Pre-Operative Patients: A Systematic Review. Indonesian Journal of Global Health Research, 6(6), 3463-3474. https://doi.org/10.37287/ijghr.v6i6.3772