The Impact of Cartoon Masks & Standard Masks on Doctor-Patient Communication in Pediatrics

The Impact of Cartoon Masks & Standard Masks on Doctor-Patient Communication in Pediatrics | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Cartoon Masks & Standard Masks on Doctor-Patient Communication in Pediatrics Mukadas Rahman, Aonan Zhao, Xiaoli Li, Xiaorong Su, Jie Jiang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1990756/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: As the COVID-19 pandemic rages rampantly worldwide, wearing masks has become necessary. However, it remains unexplored concerning the impact of different types of masks on communication between pediatricians and patients. Objective : Against this backdrop, this study aims to investigate the influence of cartoon masks and standard masks on doctor-patient communication in pediatric treatment. Research design : A randomized controlled trial was conducted in the pediatric clinic of Ruijin Hospital affiliated to Shanghai Jiao Tong University between April and August 2021. Parents were divided into cartoon mask group and standard mask group based on the masks worn by the attending doctors. A questionnaire was conducted immediately after the visit to discern the demographic variables and evaluate the effect of communication. Statistical analysis was performed using SPSS 23.0 and ROST CM6 Chinese Sentiment Dictionary. Results: 200 valid questionnaires are subject to the statistical analysis. Results suggest that parents are in favor of cartoon masks, which can better reflect the sincerity of pediatricians (100 vs 88, p < 0.001) and imply that they are really listening (94 vs 84, p = 0.024). Besides, cartoon masks indicate more attention is paid to children (99 vs 85, p < 0.001). It is shown that parents tend to comment more positively on pediatricians wearing cartoon masks (74.28% vs 28.57%). However, 60% of pediatricians indicate they are less likely to choose cartoon masks. Conclusion: Results show parents prefer doctors who wear cartoon masks, for it shows their sincerity and really listening, and much more attention is paid to their children’s feelings. Therefore, this study argues that cartoon masks exert a largely positive impact on the effectiveness of doctor-patient communication and thus they are highly recommended for pediatricians. Figures Figure 1 Research Background Effective doctor-patient communication is the foundation for developing a harmonious doctor-patient relationship, which plays a critical role in improving consultation [1, 2] . Over time, doctor-patient relationship has progressed into a patient-centered pattern while highlighting the practical needs of patients. In previous studies, high-quality doctor-patient communication has been found to contribute to effective treatments, whereas poor quality has been associated with reduced patient satisfaction, treatment adherence, and poor health [3] . Nonverbal communication has been proven to play a crucial part in the consultation process [4] . As noted by Mehrabian and Ferris, the influence of verbal communication accounts for only 7% of the overall impact of communication while the figure for vocal and facial communication amounts to 38% and 55% respectively [5] . With the COVID-19 pandemic spreading overwhelmingly across the globe, wearing masks is undoubtedly the most effective measure for epidemic prevention and control, given the fact that the novel coronavirus possibly will coexist with humans for quite a long time [6, 7] . However, problems arise since wearing a mask may pose potential challenges to the effectiveness of doctor-patient communication [8, 9] . Some studies have suggested that clear masks may promote communication with patients suffering from dysaudia [10] . In addition, surgeons wearing clear masks are more likely to be empathic and establish greater trust with patients than those wearing standard covered masks [11] . Nevertheless, the effect of different designs of masks in pediatrics remains uncertain. Focusing on the communication between parents and their children and pediatricians who wear different styles of masks during the visit, this study addresses the question of the opinions of parents and children on different types of masks and the way they influence the effectiveness of doctor-patient communication in pediatrics. 1. Data And Methods 1.1 Participants Data were collected from the parents who accompanied their kids to the pediatric clinic of Ruijin Hospital affiliated to Shanghai Jiao Tong University between April and August 2021. The selection of the research objective aligns with the following criteria: 1) Only those parents involved in the whole process of consultation are included; 2) It should be the first time for a parent to have a face-to-face communication with the attending doctors; 3) Voluntary participation is also the prerequisite. On the contrary, parents fit in with the following aspects are excluded: 1) The child is in the acute stage of disease (or has a recent fever, which is needed to visit the fever clinic as the hospital’s policy requires); 2) It is not the first time for a parent to have face-to-face communication with doctors; 3) The parents who accompanied their children to specialist clinic should be excluded. 1.2 Research design A randomized controlled trial was carried out. Pediatricians were randomly divided into a standard mask group and a cartoon mask group. Cartoon masks were offered by researchers to pediatricians, which have a blue background imprinted with children’s favorite animated characters like SpongeBob and Patrick Star. Due to safety concerns, pediatricians in the cartoon mask group were required to wear a cartoon mask on top of a standard mask. Both groups of pediatricians were asked to wear masks throughout the consultation. The pediatricians performed their consultations as usual. If children and parents asked about their masks, they would answer that they were participating in a study. Children and their parents wore masks based on their own choice during the consultation. Upon finishing the visit, a trained surveyor in the waiting hall classified parents into a standard mask group and a cartoon mask group according to the types of masks worn by the pediatrician. After receiving verbal consent from the parents, the surveyor asked parents to complete an anonymous questionnaire. The questionnaire is based on the Consultation and Relational Compassion (CARE) that was developed by Mercer et al. and has been widely attested in the evaluation of compassion between doctors and patients [12] . The Chinese version of CARE is considered to be highly effective as a means of assessing doctor-patient communication [13] . Our questionnaire covers three sections: 1) Demographic information about parents and children; 2) Parents’ opinions on the masks; 3) Parents’ satisfaction with the consultation process, which is measured by questions 1-6 from the Chinese version of CARE and additional questions 7-9 which are employed to assess trust and compassion. The survey is quantitative, based on a four-point Likert scale which includes “completely satisfied”, “partially satisfied”, “partially dissatisfied” and “completely dissatisfied”. At the end of the research, doctors (n=10) are interviewed as to the possibility of choosing a cartoon mask in the future and the corresponding reasons. The oral interviews are then transcribed into written texts. 1.3 Statistical methods The questionnaire data is analyzed by SPSS 23.0 statistical software. The data from the Likert scale are assumed to be dichotomous. That is to say, the choice of “completely satisfied” is classified as satisfied while the other three are dissatisfied. Then a two-tailed Chi-square test is employed to measure every factor influencing the degree of satisfaction. The result is described as statistically significant if p < 0.05. Besides, parents’ answers to the open questions are analyzed by ROST CM6 software for sentiment analysis. According to the data trends identified in the questionnaires of the first 100 participants (50 in the standard mask group and 50 in the cartoon mask group), an independent sample rate comparison is adopted to calculate the total required sample size with α=0.05 (two-tailed) and β=0.01. The calculated sample size requires at least 148 cases with 74 per group. Due to the exploratory nature of the research, 200 participants are included in this study in the end.[Figure1] 2. Results Given the fact that one parent in the cartoon mask group and three parents of the children in the standard mask group refuse to fill in the questionnaire, 200 valid questionnaires are therefore collected. 2.1 General information Table 1 displays the participants’ general information. Of the total of 200 parents, 125 (62.5%) participants are mothers, 43 (21.5%) are fathers, 13 (6.5%) are grandmothers, 13(3%) are grandfathers, and the remaining 6 (3%) are the others. With respect to the age distribution of their children, 22 children are between 0-1 year old, 39 are between 2-3 years old, 47 are between 4-6 years old, 70 are between 7-11 years old, and 22 are between 12-14 years old. Additionally, regarding the gender distribution of the pediatricians, nine doctors, or 90% of the doctors are female, while one doctor is male. There are no statistically significant differences between the cartoon mask group and the standard mask group. Table 1 Sociodemographic information about parents and children Group Standard mask （n=100） Cartoon mask (n=100) X² p Parent’s age 0.507 0.917 20-29 11 14 30-39 43 42 40-49 32 30 Above 50 14 15 Relationship with child 0.987 0.912 Mother 62 63 Father 20 23 Grandmother 8 5 Grandfather 7 6 Others 3 3 Educational level 0.482 0.487 Below a bachelor’s degree 23 19 Above a bachelor’s degree (included) 77 81 Child’s age 2.926 0.403 0-3 25 36 4-6 26 21 7-11 37 33 12-14 12 10 2.2 The effect of mask type on the doctor-patient communication The parents generally provide positive answers to the survey questions. As shown in table 2, they are fairly satisfied with the consultation. Specifically, within the cartoon mask group, the overall satisfaction rate amounts to 96%. However, within the standard mask group, this number decreases a bit to 89%. In the question “How was the doctor at showing care and compassion?” parents believe that wearing a cartoon mask is more likely to show sincerity (100 vs 88, p < 0.001). In the question “How was the doctor really listening?” Parents claim that wearing a cartoon mask shows that doctors are really listening to the description of the medical history of children (94 vs 84, p = 0.024). In the additional question, “How was the doctor caring about children’s feelings?”, parents view that wearing a cartoon mask indicates doctors pay more attention to children (99 vs 85, p < 0.001). As to the remaining questions, we don’t identify any significant differences between the two groups. Besides, participants from the cartoon mask group tend to give more positive answers than those from the standard mask group. Table 2 Analysis of parents’ satisfaction with pediatricians wearing different types of masks Question Cartoon mask n (%) Standard mask n (%) P* Fully understanding your concerns 97（97%） 94（94%） 0.306 Really listening 94（94%） 84（84%） 0.024 Making you feel at ease 95（95%） 90（90%） 0.179 Explaining things clearly 96（96%） 93（93%） 0.352 Showing care and compassion 100（100%） 88（88%） ＜0.001 Making a plan of action with you 94（94%） 88（88%） 0.138 Spending enough time 94（94%） 87（87%） 0.091 Trusting in pediatricians’ decisions 98（98%） 93（93%） 0.08 Caring about children’s feelings 99（99%） 85（85%） ＜0.001 *All P values were calculated using chi-square tests and deemed significant at less than 0.05. 2.4 Evaluations of different types of masks When asked about parents’ opinions and suggestions for the masks used by pediatricians, 74.28% (n=52) of the population express positive evaluations of the cartoon masks. 20% (n=14) give neutral evaluations while 5.71% (n=4) are negative. In terms of standard masks, parents who are positive about them account for 28.57% (n=20) while the percentage is 57.14%(n=40) and 14.29%(n=10) for those who are neutral and negative respectively. Specifically, on the one hand, within the cartoon mask group, we record positive comments like “Cartoon masks can alleviate children’s fear of doctors and shorten the distance between them. So I think it’s helpful for doctors in the stomatology department to wear them.” Other positive comments include “I feel that the doctor is very affectionate for my child” and “Doctors are very friendly.” [table3] Table 3 Analysis of parents’ impression on different types of masks Standard mask Cartoon mask Z P comments -5.154 ＜0.001 positive 20（28.57%） 52（74.28%） neutral 40（57.14%） 14（20%） negative 10（14.29%） 4（5.71%） P value was calculated using Mann-Whitney U test and deemed significant at less than0.001. 2.5 Pediatrians’ opinions When pediatricians (n=10, nine females and one male) are asked about the degree to which they will choose to wear cartoon masks, 40% of them select “very likely” or “partly likely” on the Likert scale (very likely n=2, partly likely n=2, partly unlikely n=5, completely unlikely n=1). We ask these pediatricians (n=10, nine females and one male) how likely would they wear cartoon masks in consultation in the future. Six of them express their unwillingness. For the underlying reasons, pediatricians signal that they are unaccustomed to cartoon masks (n=4) or cartoon masks may damage the image of doctors (n=2), while some pediatricians (n=6) point out that wearing two-layer masks can trigger a sense of discomfort. 3. Discussion The overwhelming spread of the COVID-19 pandemic has had a detrimental impact on human health, economic development, and social stability. Wearing masks has become a key part of the prevention and control [ 14 ] , but it has unwittingly impaired the effectiveness of doctor-patient communication particularly in the field of pediatrics as children can’t precisely express themselves and parents are easy to get anxious. Thus, it is highly necessary for pediatricians to not only communicate with parents, but also to pay more attention to the psychological traits of children to be fully trusted. There is a strong relationship between trust and transparency in that transparency can intensify trust in contexts of uncertainty [ 15 ] . A study carried out in Hong Kong in 2013 indicates that wearing a mask has a significant negative impact on the doctor-parent communication [ 8 ] . Likewise, Kratzke, IM et al conduct a study in the field of surgery by classifying participants into a group of standard surgical masks and a group of clear masks [ 11 ] . It is noted that doctors in the group of clear masks are more likely to show empathy and get trust. In the field of pediatrics, Forgi’s study focuses how children choose between doctors wearing surgical masks and face shields. Results suggest that 59% of children don’t consider surgical masks to be frightening while 49% of children aged 4–10 prefer doctors wearing face shields [ 16 ] . However, Forgie’s study is problematic in two aspects. On the one hand, children only see static pictures of doctors and don’t interact with doctors. On the other hand, it remains unknown if it is the first impression on the doctors. Another study that targets pediatricians suggests that 82% of doctors believe masks can impede interactions with children and 63% think that children are more frightened by doctors wearing masks. In this study, 23% are willing to pick illustrated or clear masks to address the added challenges posed by wearing masks [ 17 ] . In short, our study fills the gap by approaching doctor-patient communication in the field of pediatrics. In this study, findings from the Chinese version of CARE, additional questions, and sentiment analysis of evaluations all point out that cartoon masks are preferred. When answering CARE and additional questions, more parents believe that pediatricians really listen, demonstrate care and compassion and pay more attention to children’s psychological traits. Although words uttered by doctors don’t differ by the types of masks, parents feel differently. The reasons are multifold. Doctors can interact with children in the process of consultation and carry out a physical examination of them. Besides, as one parent said, pediatric dentistry doctors look more friendly by wearing cartoon masks. Cartoon masks can distract children’s attention, reduce their terror, and make them coordinate with doctors more easily. As far as parents are concerned, cartoon masks play a critical role in shortening the distance between doctors and patients and making doctors look more friendly as children are very much familiar with the cartoon characters. More is needed to explore the age-based variation in this field of study to uncover the underlying reasons. We will leave it to future study. In the face of the COVID-19 pandemic, masks are necessary but are likely to hinder doctor-patient communication in the meantime. As far as the doctors in this study go, most of them are reluctant to wear cartoon masks. However, they also express their willingness if cartoon masks are proved helpful for doctor-patient communication. Our study has strengths. Firstly, we adopt a randomized controlled trial to avoid selective bias. Secondly, we are certain that this is the first meeting between doctors and patients. Therefore, we eliminate the possible influence of subconscious. Thirdly, doctors have dynamic interactions with parents and children throughout the consultation. Nevertheless, this study has some limitations as follows. The randomized controlled trial is based on consultation, which suggests that pediatricians are unlikely to ignore the types of masks. Additionally, only one type of cartoon mask is included in this study. In other words, the pattern is fixed. Therefore, we need to investigate further the impact of different mask types and patterns on doctor-patient communication. Finally, this study is restricted to the population in one single country, and there is a lack of focus on children’s evaluations of masks. 4. Conclusion Wearing a mask is one of the key measures for epidemic prevention and control during COVID-19. It’s necessary for clinicians to consider problems from the patients’ perspective. This study reveals that wearing cartoon masks in the consultation process plays a large part in improving the degree of satisfaction with pediatricians. Cartoon masks demonstrate their sincerity and listening, and show more attention to children’s feelings. As a result, it is highly advised that pediatricians can wear cartoon masks in the workplace to increase the degree of satisfaction of patients. Declarations Ethics approval and consent to participate An informed consent was obtained from all legal guardians of the subjects enrolled in the study for study participation. All methods were carried out in accordance with relevant guidelines and regulations or Declaration of Helsinki.（including October 1996）were approved by the General Practice,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine.The study complied with good clinical practices. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the senior author on reasonable request.( [email protected] ) Competing interests No competing interest to be declare Funding None declared. Author’s contributions Concept and design: Mukadas Rahman, Jie Jiang, Jianjing Tong; Acquisition, analysis, or interpretation of data:All authors; Drafting of the manuscript: Mukadas Rahman, Aonan Zhao.; Critical revision of the manuscript for important intellectual content: All authors; Statistical analysis: Mukadas Rahman, Aonan Zhao; Administrative, technical, or material support: Jianjing Tong.Supervision: Xiaoli Li, Xiaorong Su, Jie Jiang. Acknowledgements We would like to thank all the pediatricians who participated in the study,as this study could not have been performed without their valuable input. Authors’ information 1 Department of General Practice,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,China. 2 Department of Neurology and Institute of Neurology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,China * Correspondence: [email protected] * Correspondence: [email protected] References Swaminathan D, Meera S. Masks Mask Communication - Communicating with Children in Health Care Settings. Indian J Pediatr. 2021;88(3):283–4. Yağar F. Why Does Patient-Physician Communication Matter? More Active Patients, Decreased Healthcare Use and Costs. J patient experience. 2021;8:23743735211036524. Janz N, et al. The impact of doctor-patient communication on patients' perceptions of their risk of breast cancer recurrence. Breast Cancer Res Treat. 2017;161(3):525–35. Vogel D, Meyer M, Harendza S. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Med Educ. 2018;18(1):157. Mehrabian A, Ferris S. Inference of attitudes from nonverbal communication in two channels. J Consult Clin Psychol. 1967;31(3):248–52. Atangana E, Atangana A. Facemasks simple but powerful weapons to protect against COVID-19 spread: Can they have sides effects? Results in physics. 2020;19:103425. Catching A, et al. Examining the interplay between face mask usage, asymptomatic transmission, and social distancing on the spread of COVID-19. Sci Rep. 2021;11(1):15998. Wong C, et al. Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care. BMC Fam Pract. 2013;14:200. Muzzi E, et al., Short report on the effects of SARS-CoV-2 face protective equipment on verbal communication. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2021. 278(9): p. 3565–3570. Atcherson S, et al. The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss. J Am Acad Audiol. 2017;28(1):58–67. Kratzke I, et al. Effect of Clear vs Standard Covered Masks on Communication With Patients During Surgical Clinic Encounters: A Randomized Clinical Trial. JAMA Surg. 2021;156(4):372–8. Mercer S, et al. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–705. Mercer S, et al. The Chinese-version of the CARE measure reliably differentiates between doctors in primary care: a cross-sectional study in Hong Kong. BMC Fam Pract. 2011;12:43. Schünemann H, et al. Use of facemasks during the COVID-19 pandemic. The Lancet Respiratory medicine. 2020;8(10):954–5. Adashi E, Cohen I, Elberg J. Transparency and the Doctor-Patient Relationship - Rethinking Conflict-of-Interest Disclosures. N Engl J Med. 2022;386(4):300–2. Forgie S, et al. The "fear factor" for surgical masks and face shields, as perceived by children and their parents. Pediatrics. 2009;124(4):e777-81. Shack A, et al. Masked paediatricians during the COVID-19 pandemic and communication with children. J Paediatr Child Health. 2020;56(9):1475–6. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1990756","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":145453456,"identity":"17ebd38e-be77-414a-a121-23158d78335b","order_by":0,"name":"Mukadas Rahman","email":"","orcid":"","institution":"Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mukadas","middleName":"","lastName":"Rahman","suffix":""},{"id":145453457,"identity":"c3b0bdc0-321d-4deb-98cd-b0b954a9884f","order_by":1,"name":"Aonan Zhao","email":"","orcid":"","institution":"Department of Neurology and Institute of Neurology，Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Aonan","middleName":"","lastName":"Zhao","suffix":""},{"id":145453458,"identity":"220ef647-2272-4b43-a613-f2bd4642708e","order_by":2,"name":"Xiaoli Li","email":"","orcid":"","institution":"Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Li","suffix":""},{"id":145453459,"identity":"99e97073-65ad-4e01-991b-a4bdd491b4a0","order_by":3,"name":"Xiaorong Su","email":"","orcid":"","institution":"Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaorong","middleName":"","lastName":"Su","suffix":""},{"id":145453460,"identity":"88b2d71b-102a-45a4-86ea-ffc30810f0ca","order_by":4,"name":"Jie Jiang","email":"","orcid":"","institution":"Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Jiang","suffix":""},{"id":145453461,"identity":"ffd6c402-337b-4666-9472-8a812ce69556","order_by":5,"name":"Jianjing Tong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIie2RPwrCMBSHXwmYJdI14iUCBaeAB3GJFOJinTsUzFSXgquewws8CThFL+DSyblHsBW6tnETzDe94X28Pz+AQOAnQYUqlyQG0H4CA1xj4zSdGX8FyPVc2lggTPyUZYS1ZU7Pkye+aijkCugdxxZTluUyWTzURsBNZ4btlIfidLpwoHlkbGY4E+PKtLT7S/WN0p1PBPNWsM2lfTLh3WKqvaVk22GFnlzafKKsmOZNIbMjdcMKcKf6gQq6cjyd+ID9QBxoCwQCgX/mDXUeSxpmj42QAAAAAElFTkSuQmCC","orcid":"","institution":"Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Jianjing","middleName":"","lastName":"Tong","suffix":""}],"badges":[],"createdAt":"2022-08-23 15:14:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1990756/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1990756/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":28109277,"identity":"14809c5d-94cf-4b8e-8e87-575934ab359d","added_by":"auto","created_at":"2022-10-21 19:54:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":113810,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of participants in this study\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-1990756/v1/aa3bce751a7b6f5e148c5a26.png"},{"id":35930052,"identity":"14fe9440-a7f1-427e-b187-16b2ba11f83e","added_by":"auto","created_at":"2023-04-18 11:14:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":406172,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1990756/v1/c55d7fe1-0068-4121-ae2c-b3b52bbb7ae3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Cartoon Masks \u0026 Standard Masks on Doctor-Patient Communication in Pediatrics","fulltext":[{"header":"Research Background","content":"\u003cp\u003eEffective doctor-patient communication is the foundation for developing a harmonious doctor-patient relationship, which plays a critical role in improving consultation\u003csup\u003e[1, 2]\u003c/sup\u003e.\u0026nbsp;Over time, doctor-patient relationship has progressed into a patient-centered pattern while highlighting the practical needs of patients. In previous studies, high-quality doctor-patient communication has been found to contribute to effective treatments, whereas poor quality has been associated with reduced patient satisfaction, treatment adherence, and poor health\u003csup\u003e[3]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eNonverbal communication has been proven to play a crucial part in the \u0026nbsp;consultation process\u003csup\u003e[4]\u003c/sup\u003e. As noted by Mehrabian and Ferris, the influence of verbal communication accounts for only 7% of the overall impact of communication while the figure for vocal and facial communication amounts to 38% and 55% respectively\u003csup\u003e[5]\u003c/sup\u003e. With the COVID-19 pandemic spreading overwhelmingly across the globe, wearing masks is undoubtedly the most effective measure for epidemic prevention and control, given the fact that the novel coronavirus possibly will coexist with humans for quite a long time\u003csup\u003e[6, 7]\u003c/sup\u003e. However, problems arise since wearing a mask may pose potential challenges to the effectiveness of doctor-patient communication\u003csup\u003e[8, 9]\u003c/sup\u003e. Some studies have suggested that clear masks may promote communication with patients suffering from dysaudia\u003csup\u003e[10]\u003c/sup\u003e. In addition, surgeons wearing clear masks are more likely to be empathic and establish greater trust with patients than those wearing standard covered masks\u003csup\u003e[11]\u003c/sup\u003e. Nevertheless, the effect of different designs of masks in pediatrics remains uncertain. Focusing on the communication between parents and their children and pediatricians who wear different styles of masks during the visit, this study addresses the question of the opinions of parents and children on different types of masks and the way they influence the effectiveness of doctor-patient communication in pediatrics.\u003c/p\u003e"},{"header":"1.\tData And Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Data were collected from the parents who accompanied their kids to the pediatric clinic of Ruijin Hospital affiliated to Shanghai Jiao Tong University between April and August 2021. The selection of the research objective aligns with the following criteria: 1) Only those parents involved in the whole process of consultation are included; 2) It should be the first time for a parent to have a face-to-face communication with the attending doctors; 3) Voluntary participation is also the prerequisite. On the contrary, parents fit in with the following aspects are excluded: 1) The child is in the acute stage of disease (or has a recent fever, which is needed to visit the fever clinic as the hospital\u0026rsquo;s policy requires); 2) It is not the first time for a parent to have face-to-face communication with doctors; 3) The parents who accompanied their children to specialist clinic should be excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Research design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA randomized controlled trial was carried out. Pediatricians were randomly divided into a standard mask group and a cartoon mask group. Cartoon masks were offered by researchers to pediatricians, which have a blue background imprinted with children\u0026rsquo;s favorite animated characters like SpongeBob and Patrick Star. Due to safety concerns, pediatricians in the cartoon mask group were required to wear a cartoon mask on top of a standard mask. Both groups of pediatricians were asked to wear masks throughout the consultation. The pediatricians performed their consultations as usual. If children and parents asked about their masks, they would answer that they were participating in a study. Children and their parents wore masks based on their own choice during the consultation. Upon finishing the visit, a trained surveyor in the waiting hall classified parents into a standard mask group and a cartoon mask group according to the types of masks worn by the pediatrician. After receiving verbal consent from the parents, the surveyor asked parents to complete an anonymous questionnaire.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questionnaire is based on the Consultation and Relational Compassion (CARE) that was developed by Mercer et al. and has been widely attested in the evaluation of compassion between doctors and patients\u003csup\u003e[12]\u003c/sup\u003e. The Chinese version of CARE is considered to be highly effective as a means of assessing doctor-patient communication\u003csup\u003e[13]\u003c/sup\u003e.\u0026nbsp;Our questionnaire covers three sections: 1) Demographic information about parents and children; 2) Parents\u0026rsquo; opinions on the masks; 3) Parents\u0026rsquo; satisfaction with the consultation process, which is measured by questions 1-6 from the Chinese version of CARE and additional questions 7-9 which are employed to assess trust and compassion. The survey is quantitative, based on a four-point Likert scale which includes \u0026ldquo;completely satisfied\u0026rdquo;, \u0026ldquo;partially satisfied\u0026rdquo;, \u0026ldquo;partially dissatisfied\u0026rdquo; and \u0026ldquo;completely dissatisfied\u0026rdquo;. At the end of the research, doctors (n=10) are interviewed as to the possibility of choosing a cartoon mask in the future and the corresponding reasons. The oral interviews are then transcribed into written texts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Statistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire data is analyzed by SPSS 23.0 statistical software. The data from the Likert scale are assumed to be dichotomous. That is to say, the choice of \u0026ldquo;completely satisfied\u0026rdquo; is classified as satisfied while the other three are dissatisfied. Then a two-tailed Chi-square test is employed to measure every factor influencing the degree of satisfaction. The result is described as statistically significant if p \u0026lt; 0.05. Besides, parents\u0026rsquo; answers to the open questions are analyzed by ROST CM6 software for sentiment analysis.\u003c/p\u003e\n\u003cp\u003eAccording to the data trends identified in the questionnaires of the first 100 participants (50 in the standard mask group and 50 in the cartoon mask group), an independent sample rate comparison is adopted to calculate the total required sample size with \u0026alpha;=0.05 (two-tailed) and \u0026beta;=0.01. The calculated sample size requires at least 148 cases with 74 per group. Due to the exploratory nature of the research, 200 participants are included in this study in the end.[Figure1]\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003eGiven the fact that one parent in the cartoon mask group and three parents of the children in the standard mask group refuse to fill in the questionnaire, 200 valid questionnaires are therefore collected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 General information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 displays the participants\u0026rsquo; general information. Of the total of 200 parents, 125 (62.5%) participants are mothers, 43 (21.5%) are fathers, 13 (6.5%) are grandmothers, 13(3%) are grandfathers, and the remaining 6 (3%) are the others. With respect to the age distribution of their children, 22 children are between 0-1 year old, 39 are between 2-3 years old, 47 are between 4-6 years old, 70 are between 7-11 years old, and 22 are between 12-14 years old. Additionally, regarding the gender distribution of the pediatricians, nine doctors, or 90% of the doctors are female, while one doctor is male. There are no statistically significant differences between the cartoon mask group and the standard mask group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Sociodemographic information about parents and children\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003eStandard mask\u003c/p\u003e\n \u003cp\u003e（n=100）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.4083%;\" valign=\"top\" width=\"13.513513513513514%\"\u003e\n \u003cp\u003eCartoon mask\u003c/p\u003e\n \u003cp\u003e(n=100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.908%;\" valign=\"top\" width=\"14.054054054054054%\"\u003e\n \u003cp\u003eX\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eParent\u0026rsquo;s age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e0.917\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003e\u0026nbsp; 40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eAbove 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eRelationship with child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e0.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eGrandmother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eGrandfather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eBelow a bachelor\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eAbove a bachelor\u0026rsquo;s degree (included)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003eChild\u0026rsquo;s age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e2.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003e\u0026nbsp; 0-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003e7-11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9027%;\" valign=\"top\" width=\"22.52252252252252%\"\u003e\n \u003cp\u003e12-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5742%;\" valign=\"top\" width=\"14.594594594594595%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.7426%;\" valign=\"top\" width=\"12.072072072072071%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.5737%;\" valign=\"top\" width=\"15.495495495495495%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.7414%;\" valign=\"top\" width=\"13.873873873873874%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 The effect of mask type on the doctor-patient communication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe parents generally provide positive answers to the survey questions. As shown in table 2, they are fairly satisfied with the consultation. Specifically, within the cartoon mask group, the overall satisfaction rate amounts to 96%. However, within the standard mask group, this number decreases a bit to 89%. In the question \u0026ldquo;How was the doctor at showing care and compassion?\u0026rdquo; parents believe that wearing a cartoon mask is more likely to show sincerity (100 vs 88, p \u0026lt; 0.001). In the question \u0026ldquo;How was the doctor really listening?\u0026rdquo; Parents claim that wearing a cartoon mask shows that doctors are really listening to the description of the medical history of children (94 vs 84, p = 0.024).\u003c/p\u003e\n\u003cp\u003eIn the additional question, \u0026ldquo;How was the doctor caring about children\u0026rsquo;s feelings?\u0026rdquo;, parents view that wearing a cartoon mask indicates doctors pay more attention to children (99 vs 85, p \u0026lt; 0.001). As to the remaining questions, we don\u0026rsquo;t identify any significant differences between the two groups. Besides, participants from the cartoon mask group tend to give more positive answers than those from the standard mask group.\u003c/p\u003e\n\u003cp\u003eTable 2 Analysis of parents\u0026rsquo; satisfaction with pediatricians wearing different types of masks\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"529\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eQuestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003eCartoon mask n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003eStandard mask\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003eP*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eFully understanding your concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e97（97%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e94（94%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eReally listening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e94（94%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e84（84%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eMaking you feel at ease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e95（95%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e90（90%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eExplaining things clearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e96（96%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e93（93%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eShowing care and compassion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e100（100%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e88（88%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eMaking a plan of action with you\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e94（94%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e88（88%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eSpending enough time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e94（94%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e87（87%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eTrusting in pediatricians\u0026rsquo; decisions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e98（98%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e93（93%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.78260869565217%\"\u003e\n \u003cp\u003eCaring about children\u0026rsquo;s feelings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e99（99%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.465028355387524%\"\u003e\n \u003cp\u003e85（85%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.013232514177695%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e*All P values were calculated using chi-square tests and deemed significant at less than 0.05.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Evaluations of different types of masks\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen asked about parents\u0026rsquo; opinions and suggestions for the masks used by pediatricians, 74.28% (n=52) of the population express positive evaluations of the cartoon masks. 20% (n=14) give neutral evaluations while 5.71% (n=4) are negative. In terms of standard masks, parents who are positive about them account for 28.57% (n=20) while the percentage is 57.14%(n=40) and 14.29%(n=10) for those who are neutral and negative respectively. Specifically, on the one hand, within the cartoon mask group, we record positive comments like \u0026ldquo;Cartoon masks can alleviate children\u0026rsquo;s fear of doctors and shorten the distance between them. So I think it\u0026rsquo;s helpful for doctors in the stomatology department to wear them.\u0026rdquo; Other positive comments include \u0026ldquo;I feel that the doctor is very affectionate for my child\u0026rdquo; and \u0026ldquo;Doctors are very friendly.\u0026rdquo; [table3]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Analysis of parents\u0026rsquo; impression on different types of masks\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"27.551020408163264%\"\u003e\n \u003cp\u003eStandard mask\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.510204081632654%\"\u003e\n \u003cp\u003eCartoon mask\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.244897959183673%\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.408163265306122%\"\u003e\n \u003cp\u003ecomments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"27.551020408163264%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.510204081632654%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.244897959183673%\"\u003e\n \u003cp\u003e-5.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.408163265306122%\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"27.551020408163264%\"\u003e\n \u003cp\u003e20（28.57%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.510204081632654%\"\u003e\n \u003cp\u003e52（74.28%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.244897959183673%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.408163265306122%\"\u003e\n \u003cp\u003eneutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"27.551020408163264%\"\u003e\n \u003cp\u003e40（57.14%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.510204081632654%\"\u003e\n \u003cp\u003e14（20%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.244897959183673%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"20.408163265306122%\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"27.551020408163264%\"\u003e\n \u003cp\u003e10（14.29%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25.510204081632654%\"\u003e\n \u003cp\u003e4（5.71%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.244897959183673%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eP value was calculated using Mann-Whitney U test and deemed significant at less than0.001.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Pediatrians\u0026rsquo; opinions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen pediatricians (n=10, nine females and one male) are asked about the degree to which they will choose to wear cartoon masks, 40% of them select \u0026ldquo;very likely\u0026rdquo; or \u0026ldquo;partly likely\u0026rdquo; on the Likert scale (very likely n=2, partly likely n=2, partly unlikely n=5, completely unlikely n=1). We ask these pediatricians (n=10, nine females and one male) how likely would they wear cartoon masks in consultation in the future. Six of them express their unwillingness. For the underlying reasons, pediatricians signal that they are unaccustomed to cartoon masks (n=4) or cartoon masks may damage the image of doctors (n=2), while some pediatricians (n=6) point out that wearing two-layer masks can trigger a sense of discomfort.\u0026nbsp;\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThe overwhelming spread of the COVID-19 pandemic has had a detrimental impact on human health, economic development, and social stability. Wearing masks has become a key part of the prevention and control\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, but it has unwittingly impaired the effectiveness of doctor-patient communication particularly in the field of pediatrics as children can\u0026rsquo;t precisely express themselves and parents are easy to get anxious. Thus, it is highly necessary for pediatricians to not only communicate with parents, but also to pay more attention to the psychological traits of children to be fully trusted.\u003c/p\u003e \u003cp\u003eThere is a strong relationship between trust and transparency in that transparency can intensify trust in contexts of uncertainty\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. A study carried out in Hong Kong in 2013 indicates that wearing a mask has a significant negative impact on the doctor-parent communication\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Likewise, Kratzke, IM et al conduct a study in the field of surgery by classifying participants into a group of standard surgical masks and a group of clear masks\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. It is noted that doctors in the group of clear masks are more likely to show empathy and get trust. In the field of pediatrics, Forgi\u0026rsquo;s study focuses how children choose between doctors wearing surgical masks and face shields. Results suggest that 59% of children don\u0026rsquo;t consider surgical masks to be frightening while 49% of children aged 4\u0026ndash;10 prefer doctors wearing face shields\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. However, Forgie\u0026rsquo;s study is problematic in two aspects. On the one hand, children only see static pictures of doctors and don\u0026rsquo;t interact with doctors. On the other hand, it remains unknown if it is the first impression on the doctors. Another study that targets pediatricians suggests that 82% of doctors believe masks can impede interactions with children and 63% think that children are more frightened by doctors wearing masks. In this study, 23% are willing to pick illustrated or clear masks to address the added challenges posed by wearing masks\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In short, our study fills the gap by approaching doctor-patient communication in the field of pediatrics.\u003c/p\u003e \u003cp\u003eIn this study, findings from the Chinese version of CARE, additional questions, and sentiment analysis of evaluations all point out that cartoon masks are preferred. When answering CARE and additional questions, more parents believe that pediatricians really listen, demonstrate care and compassion and pay more attention to children\u0026rsquo;s psychological traits. Although words uttered by doctors don\u0026rsquo;t differ by the types of masks, parents feel differently. The reasons are multifold. Doctors can interact with children in the process of consultation and carry out a physical examination of them. Besides, as one parent said, pediatric dentistry doctors look more friendly by wearing cartoon masks. Cartoon masks can distract children\u0026rsquo;s attention, reduce their terror, and make them coordinate with doctors more easily. As far as parents are concerned, cartoon masks play a critical role in shortening the distance between doctors and patients and making doctors look more friendly as children are very much familiar with the cartoon characters. More is needed to explore the age-based variation in this field of study to uncover the underlying reasons. We will leave it to future study.\u003c/p\u003e \u003cp\u003eIn the face of the COVID-19 pandemic, masks are necessary but are likely to hinder doctor-patient communication in the meantime. As far as the doctors in this study go, most of them are reluctant to wear cartoon masks. However, they also express their willingness if cartoon masks are proved helpful for doctor-patient communication.\u003c/p\u003e \u003cp\u003eOur study has strengths. Firstly, we adopt a randomized controlled trial to avoid selective bias. Secondly, we are certain that this is the first meeting between doctors and patients. Therefore, we eliminate the possible influence of subconscious. Thirdly, doctors have dynamic interactions with parents and children throughout the consultation. Nevertheless, this study has some limitations as follows. The randomized controlled trial is based on consultation, which suggests that pediatricians are unlikely to ignore the types of masks. Additionally, only one type of cartoon mask is included in this study. In other words, the pattern is fixed. Therefore, we need to investigate further the impact of different mask types and patterns on doctor-patient communication. Finally, this study is restricted to the population in one single country, and there is a lack of focus on children\u0026rsquo;s evaluations of masks.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eWearing a mask is one of the key measures for epidemic prevention and control during COVID-19. It\u0026rsquo;s necessary for clinicians to consider problems from the patients\u0026rsquo; perspective. This study reveals that wearing cartoon masks in the consultation process plays a large part in improving the degree of satisfaction with pediatricians. Cartoon masks demonstrate their sincerity and listening, and show more attention to children\u0026rsquo;s feelings. As a result, it is highly advised that pediatricians can wear cartoon masks in the workplace to increase the degree of satisfaction of patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn informed consent was obtained from all legal guardians of the subjects enrolled in the study for study participation.\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations or Declaration of Helsinki.（including October 1996）were approved by the\u0026nbsp;General Practice,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine.The study complied with good clinical practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the senior author on reasonable request.([email protected])\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo competing interest to be declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcept and design: Mukadas Rahman, Jie Jiang, Jianjing Tong;\u0026nbsp;Acquisition, analysis, or interpretation of data:All authors; Drafting of the manuscript: Mukadas Rahman, Aonan Zhao.;\u0026nbsp;Critical revision of the manuscript for important intellectual content: All authors; Statistical analysis: Mukadas Rahman, Aonan Zhao;\u0026nbsp;Administrative, technical, or material support:\u0026nbsp;Jianjing Tong.Supervision:\u0026nbsp;Xiaoli Li, Xiaorong Su, Jie Jiang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the pediatricians who participated in the study,as this study could not have been performed without their valuable input.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of General Practice,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,China.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Neurology and Institute of Neurology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eCorrespondence:[email protected]\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eCorrespondence:[email protected]\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eSwaminathan D, Meera S. Masks Mask Communication - Communicating with Children in Health Care Settings. Indian J Pediatr. 2021;88(3):283\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYağar F. Why Does Patient-Physician Communication Matter? More Active Patients, Decreased Healthcare Use and Costs. J patient experience. 2021;8:23743735211036524.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eJanz N, et al. The impact of doctor-patient communication on patients\u0026apos; perceptions of their risk of breast cancer recurrence. Breast Cancer Res Treat. 2017;161(3):525\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVogel D, Meyer M, Harendza S. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Med Educ. 2018;18(1):157.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMehrabian A, Ferris S. Inference of attitudes from nonverbal communication in two channels. J Consult Clin Psychol. 1967;31(3):248\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAtangana E, Atangana A. Facemasks simple but powerful weapons to protect against COVID-19 spread: Can they have sides effects? Results in physics. 2020;19:103425.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eCatching A, et al. Examining the interplay between face mask usage, asymptomatic transmission, and social distancing on the spread of COVID-19. Sci Rep. 2021;11(1):15998.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWong C, et al. Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care. BMC Fam Pract. 2013;14:200.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMuzzi E, et al., \u003cem\u003eShort report on the effects of SARS-CoV-2 face protective equipment on verbal communication.\u003c/em\u003e European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2021. 278(9): p.\u0026nbsp;3565\u0026ndash;3570.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAtcherson S, et al. The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss. J Am Acad Audiol. 2017;28(1):58\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKratzke I, et al. Effect of Clear vs Standard Covered Masks on Communication With Patients During Surgical Clinic Encounters: A Randomized Clinical Trial. JAMA Surg. 2021;156(4):372\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMercer S, et al. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMercer S, et al. The Chinese-version of the CARE measure reliably differentiates between doctors in primary care: a cross-sectional study in Hong Kong. BMC Fam Pract. 2011;12:43.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSch\u0026uuml;nemann H, et al. Use of facemasks during the COVID-19 pandemic. The Lancet Respiratory medicine. 2020;8(10):954\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAdashi E, Cohen I, Elberg J. Transparency and the Doctor-Patient Relationship - Rethinking Conflict-of-Interest Disclosures. N Engl J Med. 2022;386(4):300\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eForgie S, et al. The \u0026quot;fear factor\u0026quot; for surgical masks and face shields, as perceived by children and their parents. Pediatrics. 2009;124(4):e777-81.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eShack A, et al. Masked paediatricians during the COVID-19 pandemic and communication with children. J Paediatr Child Health. 2020;56(9):1475\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-1990756/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1990756/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e As the COVID-19 pandemic rages rampantly worldwide, wearing masks has become necessary. However, it remains unexplored concerning the impact of different types of masks on communication between pediatricians and patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: Against this backdrop, this study aims to investigate the influence of cartoon masks and standard masks on doctor-patient communication in pediatric treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch design\u003c/strong\u003e: A randomized controlled trial was conducted in the pediatric clinic of Ruijin Hospital affiliated to Shanghai Jiao Tong University between April and August 2021. Parents were divided into cartoon mask group and standard mask group based on the masks worn by the attending doctors. A questionnaire was conducted immediately after the visit to discern the demographic variables and evaluate the effect of communication. Statistical analysis was performed using SPSS 23.0 and ROST CM6 Chinese Sentiment Dictionary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 200 valid questionnaires are subject to the statistical analysis. Results suggest that parents are in favor of cartoon masks, which can better reflect the sincerity of pediatricians (100 vs 88, p \u0026lt; 0.001) and imply that they are really listening (94 vs 84, p = 0.024). Besides, cartoon masks indicate more attention is paid to children (99 vs 85, p \u0026lt; 0.001). It is shown that parents tend to comment more positively on pediatricians wearing cartoon masks (74.28% vs 28.57%). However, 60% of pediatricians indicate they are less likely to choose cartoon masks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Results show parents prefer doctors who wear cartoon masks, for it shows their sincerity and really listening, and much more attention is paid to their children’s feelings. Therefore, this study argues that cartoon masks exert a largely positive impact on the effectiveness of doctor-patient communication and thus they are highly recommended for pediatricians.\u003c/p\u003e","manuscriptTitle":"The Impact of Cartoon Masks \u0026amp; Standard Masks on Doctor-Patient Communication in Pediatrics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-21 19:54:00","doi":"10.21203/rs.3.rs-1990756/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"695acbab-83a9-40dd-99ba-a84ba1f316b6","owner":[],"postedDate":"October 21st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-04-18T11:14:25+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-21 19:54:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1990756","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1990756","identity":"rs-1990756","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}