The Evidence Base for Healthcare Clowning
Grounded in Research.
Transparent About What We Know.
Healthcare clowning is not a feel-good add-on. It is a clinical intervention with a growing, peer-reviewed evidence base. IAHC is committed to making that evidence accessible to every practitioner, institution, and funder who needs it.
The IAHC Resources Library is being built to bring together systematic reviews, research summaries, clinical guidelines, practice tools, and curated publications, all in one place. We are also transparent about the limits of the current evidence and the research questions that remain open.
Full access to the library, including practice tools, recorded lectures, and member-only publications, will be available to IAHC members once the platform is established. Core evidence summaries and research curation are intended to be freely accessible to all.
What the Research Shows
Over four decades of clinical practice have generated a substantial body of research. Here is a summary of the four most well-evidenced areas of impact.
Pain & Anxiety Reduction
A substantial body of peer-reviewed evidence demonstrates that healthcare clowning significantly reduces procedural pain and pre-operative anxiety in paediatric patients. Dionigi (2017) identifies clowning as a complementary approach that reduces iatrogenic effects in paediatrics, while Finlay, Baverstock, and Lenton (2014) document its clinical utility across paediatric practice settings. A 2024 scoping review of clown care in hospitalised children (Xin et al., 2024) confirms consistent pain and anxiety reduction across multiple study designs.
Key Findings
- Clowning as a complementary approach reducing iatrogenic effects in paediatrics (Dionigi, 2017)
- Clinical utility across paediatric practice settings, including procedural and pre-operative contexts (Finlay, Baverstock & Lenton, 2014)
- Consistent pain and anxiety reduction across hospitalised children confirmed in scoping review (Xin et al., 2024)
- Role of clowns in paediatric intensive care units examined (Mortamet et al., 2017)
Psychosocial Wellbeing
Research across paediatric, oncology, geriatric, and palliative settings documents meaningful improvements in mood, emotional wellbeing, and quality of life. Linge (2011, 2012) provides rich qualitative evidence of joy and magical attachment in children's relationships with hospital clowns. Santarpia, Romani-Cesaro, and Simonds (2023) examine hospital clown narratives in paediatric palliative care. Koller and Gryski (2008) propose a model of therapeutic clowning for life-threatened children grounded in evidence-based complementary medicine.
Key Findings
- Joy without demands: qualitative evidence of wellbeing in ailing children (Linge, 2011)
- Magical attachment: children in therapeutic relations with hospital clowns (Linge, 2012)
- Hospital clown narratives in paediatric palliative care (Santarpia, Romani-Cesaro & Simonds, 2023)
- Model of therapeutic clowning for life-threatened children (Koller & Gryski, 2008)
- Humour and resiliency: a process model of coping and growth (Kuiper, 2012)
Family & Caregiver Impact
Healthcare clowning benefits extend beyond the patient. Ford, Courtney-Pratt, Tesch, and Johnson (2014) document the impact of clown doctor rounds on children, families, and staff, finding effects that reach well beyond the bedside encounter. Dionigi and Canestrari (2016) examine clowning in healthcare settings from the perspective of adults, including parents and caregivers. Tener et al. (2016) document medical clowning interactions with children undergoing invasive examinations, with implications for family experience.
Key Findings
- Clown doctor rounds: impact for children, families, and staff (Ford et al., 2014)
- Clowning in healthcare settings from the adult and caregiver perspective (Dionigi & Canestrari, 2016)
- Medical clowning with children undergoing invasive examinations (Tener et al., 2016)
- Importance of play in promoting healthy child development and parent-child bonds (Ginsburg, 2007)
Mechanisms of Action
Emerging research maps the psychological and relational mechanisms through which healthcare clowning produces its effects. Pendzik and Raviv (2011) establish a family resemblance between therapeutic clowning and drama therapy, grounding clowning within established expressive arts frameworks. Van Blerkom (1995) situates clown doctors within the anthropology of healing. Korin and Babis (2024) examine practices, training, and perception in medical clowning in hospitals. Nogueira-Martins et al. (2014) document healthcare students' perceptions of hospital clown training.
Key Findings
- Therapeutic clowning and drama therapy: a family resemblance (Pendzik & Raviv, 2011)
- Clown doctors as shaman healers of western medicine (Van Blerkom, 1995)
- Medical clowning in hospitals: practices, training, and perception (Korin & Babis, 2024)
- Healthcare students' perceptions of hospital clown training (Nogueira-Martins et al., 2014)
- Resilience processes in development: ordinary magic (Masten, 2001)
Guidelines, Tools & Publications
Browse the planned IAHC resource library. Items marked In Development are being produced and will be released once the IAHC board and curriculum committee are established. Items marked Member Access will require an active IAHC membership.
IAHC Standards of Practice and Guiding Principles
A working draft of the proposed standards of practice and guiding principles for healthcare clowning practitioners seeking IAHC membership. This document has been reviewed and edited by the founding team and is made available here for prospective founding board members and supporters to preview. It remains under active development and is subject to revision prior to formal ratification.
This is a draft document. It does not yet carry regulatory or legal standing and should not be cited as a finalised standard.
IAHC Standards of Practice (v1.0)
The foundational document defining the six competency domains against which all IAHC certification candidates will be assessed. Includes definitions, indicators of competence, and assessment guidance.
IAHC Code of Ethics
The ethical framework governing all IAHC-certified practitioners. Covers patient dignity, professional boundaries, confidentiality, and the duty of care.
Infection Control Guidelines for Healthcare Clowns
Practical guidance on infection prevention and control in clinical environments, including costume and prop hygiene, hand hygiene protocols, and isolation precautions.
Healthcare Clowning: A Systematic Review of the Evidence Base
A comprehensive review of peer-reviewed studies examining the clinical outcomes of healthcare clowning interventions across paediatric, geriatric, and palliative care settings. Curated from the published literature.
For existing systematic reviews, see Lopes-Júnior et al. (2020) in Psycho-Oncology and Koller & Goldman (2012) in Social Science & Medicine.
Pain & Anxiety Reduction: Evidence Summary
A practitioner-facing summary of the RCT evidence on healthcare clowning as a non-pharmacological intervention for procedural pain and anxiety in children. Curated from the published literature.
Key studies include Vagnoli et al. (2005, 2010) and Wolyniez et al. (2013). See the citations below.
IAHC Position Statement: Healthcare Clowning as a Clinical Practice
The proposed IAHC position on the clinical status of healthcare clowning: its evidence base, scope of practice, and relationship to other allied health disciplines.
IAHC Practice Log Template
The proposed template for documenting supervised clinical practice hours, intended as a required component of the IAHC-CP certification application.
Reflective Practice Framework
A structured framework for clinical reflection, designed specifically for healthcare clowning practice. Includes guided prompts, case study templates, and portfolio guidance.
Patient Assessment Checklist
A pre-encounter assessment tool to guide practitioners in evaluating patient readiness, clinical context, and appropriate intervention approach before each session.
Introduction to Healthcare Clowning: Recorded Lecture Series
Six recorded lectures covering the history, evidence base, and clinical principles of healthcare clowning. Produced for the HC-101 Foundations course.
Clowning in Palliative Care: Navigating the Threshold
A recorded IAHC webinar exploring the unique challenges and profound possibilities of healthcare clowning in end-of-life and palliative care settings.
Recommended Reading List
A curated bibliography of books, journal articles, and grey literature recommended by the IAHC Research & Evidence Advisory Group for practitioners at all levels.
Selected Bibliography
The following citations represent the peer-reviewed and scholarly literature informing IAHC's evidence base, competency framework, and case for a professional association. Sources span clinical research, professional standards, expressive arts therapy, child development, and healthcare ethics.
Download the Full Bibliography
All 36 citations in APA format, formatted for print or citation management software.
Key Journals & Publications
Healthcare clowning research is published across a range of clinical and allied health journals. These are the most relevant sources for practitioners building their evidence literacy.
Have Research to Share?
IAHC is actively building its evidence base. If you have published research, grey literature, or clinical resources relevant to healthcare clowning, we invite you to submit them for consideration by our Research & Evidence Advisory Group (to be established, please hold submissions until further notice).
Contact the Research Advisory Group→A Note on Evidence Transparency
IAHC is committed to honest representation of the evidence base. While the research on healthcare clowning is promising and growing, we acknowledge that much of it is limited by small sample sizes, methodological heterogeneity, and publication bias.
We present the evidence as it is, not as we wish it to be. This commitment to transparency is foundational to our credibility as an international professional body.
Help Build the Evidence Hub
IAHC members will get full access to all practice tools, recorded lectures, member-only publications, and the complete resource library. Join as a founding member and help shape what we build.