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 growing body of RCT evidence demonstrates that healthcare clowning significantly reduces procedural pain and anxiety in paediatric patients, with effect sizes comparable to pharmacological interventions in some contexts.
Key Findings
- Reduced cortisol levels during venipuncture (Bertini et al., 2011)
- Lower pain scores during wound dressing changes (Wolyniez et al., 2013)
- Decreased pre-operative anxiety in children aged 3–12 (Vagnoli et al., 2005)
Psychosocial Wellbeing
Research across paediatric and oncology settings demonstrates meaningful improvements in mood, emotional wellbeing, and quality of life following healthcare clowning interventions. Qualitative evidence from geriatric and palliative settings is growing.
Key Findings
- Reduced emotional distress and improved wellbeing in hospitalised children with cancer (Lopes-Júnior et al., 2020)
- Positive effects on mood and social engagement in nursing home residents, documented across qualitative and mixed-methods studies in the European literature
- Improved quality of life and reduced anxiety in paediatric oncology patients receiving clown interventions (Lopes-Júnior et al., 2020)
Family & Caregiver Impact
Healthcare clowning benefits extend beyond the patient. Research shows significant reductions in parental anxiety and improvements in family experience of care during hospitalisation.
Key Findings
- Reduced parental anxiety during paediatric procedures (Vagnoli et al., 2010)
- Positive impact on children's and families' experience of hospitalisation in Swedish paediatric wards (Linge, 2012)
- Hospital clown interactions reported to ease family distress and support sibling wellbeing during inpatient stays (Linge, 2012)
Mechanisms of Action
Emerging research is beginning to map the neurobiological and psychological mechanisms through which healthcare clowning produces its effects, including humour-mediated stress modulation and the therapeutic relationship.
Key Findings
- Humour and laughter as modulators of the HPA stress axis (Martin, 2001)
- Play as a vehicle for emotional regulation in hospitalised children (Koller & Goldman, 2012)
- The therapeutic relationship in healthcare clowning (Warren & Spitzer, 1999)
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.
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.