Health Education Research Advance Access originally published online on February 8, 2005
Health Education Research 2005 20(5):540-547; doi:10.1093/her/cyh012
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Health Education Research Vol.20 no.5, © Oxford University Press 2005; All rights reserved
Awareness of child sexual abuse prevention education among parents of Grade 3 elementary school pupils in Fuxin City, China
1 Institute of Child and Adolescent Health, Health Science Center, Peking University, Beijing 100083 and 2 College of Adult Education, Liaoning Technical University, Liaoning Province, Fuxin 123000, China
3 Correspondence to: J. Q. Chen; E-mail: g3jing_qi{at}bjmu.edu.cn
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Abstract |
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Several recent studies on child sexual abuse (CSA) in Chinese society have shown that the problem is not uncommon, and is associated with poor mental health and health-related risk behaviors of abused youth. It is very important to understand and improve public awareness of CSA prevention, especially for the parents. However, there are few published reports on the problem of parents' awareness. To fill this gap, knowledge, attitudes and practice of CSA prevention education were explored in 385 parents of Grade 3 pupils from four schools in Fuxin City of Liaoning Province in the northeast part of China by self-administered anonymous questionnaires. Among this sample, more than 80% of parents approved of school CSA prevention education. However, at the same time, 47.3% of parents expressed some concern that this education may induce the children to learn too much about ‘sex’. Overall, about 60% of parents had told their children that their ‘private parts’ should not be touched by others and discussed strategies of ‘Say "No!", Leave and Tell’ in dealing with CSA situations or the situations that may lead to CSA. Only 4.2% of parents had provided books or other material about CSA prevention for their children. The parents' CSA prevention knowledge was inadequate. The findings from this research will be useful in developing CSA prevention education programs in schools and communities, designed to improve parents' knowledge and practice of CSA prevention.
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Introduction |
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Numerous surveys on child sexual abuse (CSA) showed that CSA is a common and important problem in the world. In China, although there is still no large-scale national survey of the occurrence of CSA, some recent local retrospective studies based on convenience samples of students in Chinese society revealed that the problem of CSA is not uncommon (Tang, 2002
; Chen et al., 2002, 2003, 2004a; Chen and Dunne, 2003).
Due to the fact that CSA is so prevalent, and impairs the health and welfare of children and adolescents, a series of CSA prevention programmes have been conducted in schools and communities in the USA, Canada and some other countries since 1977 to increase public awareness of the CSA problem (Finkelhor, 1986; Finkelhor and Strapko, 1992).
Such interventions require adequate formative research, particularly among parents who play an important role in child growth and development. Parents' knowledge of CSA prevention will influence their children's CSA prevention awareness directly. Therefore, this paper raises the following questions:
- What do parents know about CSA prevention?
- What CSA topics have parents talked about with their children?
- What are the parents' attitudes towards CSA prevention education in schools?
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Methods |
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A cross-sectional study was undertaken among parents of primary school pupils in Fuxin during September 2003. The aim of this research was to understand parents' awareness about CSA prevention and to provide a basis for designing a CSA prevention programme in schools and the community. The objectives of this survey were (1) to determine the strengths and weaknesses in the factual knowledge that the parents have about CSA prevention, (2) to ascertain parents' attitudes towards CSA prevention education, and (3) to understand parents practice regarding communication with their children about CSA prevention. The study did not document CSA itself.
Four schools were chosen and, for convenience, parents of children in Grade 3 became the study population. Two Grade 3 classes in each school were selected and a total of 498 pupils were enrolled.
Among this population, 447 parents or guardians participated in this self-administered questionnaire survey and returned their completed questionnaires. Of these, 62 questionnaires were rejected due to the fact that some of the respondents were not pupils' parents or did not specify their relationship to the child. Some questionnaires could not be used because the respondents did not provide key information, such as children's gender, or missed four or more questions.
The questionnaire was based on research objectives derived from a comprehensive literature review [especially the publications of (Tutty, 1993; Finkelhor and Strapko, 1992; Calvert and Munsie-Benson, 1999; Olsen and Kalbfleisch, 2001)] and findings from our own previous in-depth interviews on the problem of CSA.
The questionnaire mainly included general demographics, CSA prevention education-related knowledge, attitudes and practice, and parents' experiences of being taught about CSA prevention in schools and at home when they were children. There were 10 questions on CSA prevention knowledge, e.g. that CSA is a common problem around the world, that children are most likely to be sexually abused by people familiar to them, that there is usually no obvious physical evidence in a sexually abused child and that boys also can be sexually abused. Responses to the 10 knowledge items were scored on a 10-point scale.
Five items were compiled regarding attitudes towards CSA prevention education. Response choices to the items were simply ‘Agree’ and ‘Disagree’, with ‘Agree’ being scored as 1 point and ‘Disagree’ as 0 points. Thus, the range of scores on the attitude scale was from 0 to 5 points, with the higher the score, the more supportive the attitude towards CSA prevention education.
Seven questions were compiled to understand the parents' practice of CSA prevention education. These questions focused on the basic content of CSA prevention education in children. These mainly included the concept of their ‘private parts’ (i.e. the genitals and breast areas), that children should be told that a person's body belongs to him or her and no other person should touch a child's private parts except for health reason, the skills of dealing with situations that may lead to sexual abuse (i.e. ‘Say "No!", Leave and Tell’), the tricks that adults may use to entice a child to accompany them, such as offers of candy, requests for help to find them lost puppies or to accompany them to the nearest shop, and whether parents had provided books or other audiovisual materials which included CSA prevention content for their children. Responses to the items dealing with practice were based on a two-point scale, ‘Yes’ or ‘No’. The ‘Yes’ response was given a score of 1. The ‘No’ response was given a score of 0. The range of scores on the parental practice scale is from 0 to 7 points. The higher the scores, the more actions the parents took regarding CSA prevention education.
Five parents were surveyed using the questionnaire to test its readability. Psychometric properties of the instrument were established using all data for internal reliability. Internal reliability analyses of subscales of knowledge, attitudes and practice produced 
levels of 0.42, 0.81 and 0.61 respectively.
The parents completed their questionnaire either in their children's classroom during school guardians' meetings (in three schools) or at their home. The definition of CSA, survey aim and methods of filling in the questionnaire were explained in the first page of the questionnaire. The participation was voluntary and the survey was anonymous.
The Statistical Package for Social Sciences was used for data analysis. Frequency, percentage and mean score of relative indicators were calculated to describe the status of knowledge, attitudes and practice of CSA prevention education in parents. Analysis was performed using the t-test, 
2-test and one-way ANOVA to identify possible influencing factors for parents' knowledge, attitudes and practice.
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Results |
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All of the 385 respondents were pupils' parents—115 fathers (29.9%) and 270 mothers (70.1%). The mean age was 34.6 ± 2.3 years for men and 33.8 ± 2.6 years for women; the women were significantly younger than the men (t = 2.81, P = 0.005). Most parents had a high school education, either at the junior (17.5%) or senior (46.0%) level. One percent had only primary school education and 35.5% had junior college education or higher level. Their children were nearly evenly divided between girls (51.9%) and boys (48.1%). At the time of the questionnaire survey, their children's mean age was 8.8 years.
More than 80% of the respondents knew that the problems of CSA exist around the world (83.9%) and that a person who has sexually abused a child will likely repeat the offense (83.6%). Nearly 80% of respondents knew that the sexually abused child was not to blame (79.0%) and that boys can also be sexually abused (78.7%). More than 70% of respondents believed that men sexually abuse children in most cases (75.7%).
Sixty percent of the parents knew that the child who was sexually abused will be ‘held back’ from disclosing the case by the abuser (61.6%) and that females also can sexually abuse children (63.4%). However, relatively few of the respondents believed that children who report sexual abuse could be believed almost all the time (40.7%); that if a child has been sexually abused, there will usually be no obvious physical evidence (28.1%); and children are most likely to be sexually abused by people familiar to them (28.2%). See Table I.
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Concerning attitudes towards school-based CSA prevention education, more than 80% of the parents supported school CSA prevention education (89.8%), were willing to let their children acquire some CSA prevention knowledge in school (87.3%), did not agree with the opinion that there is no need to conduct CSA prevention education because children will learn by themselves as they grow up (84.6%) and did not agree with the opinion that CSA is uncommon so there is no need to for children acquire such knowledge (85.9%). There were, however, still 47.3% of parents who showed some concern that CSA prevention education might lead to their children learning more ‘sex’. See Table II.
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Questions on the practice of CSA prevention education revealed that almost all of the respondents had talked to their children about not going with others, even familiar grown-ups, unless they had parental permission (95.3%). Most had told their children not to accept gifts from strangers unless they had parental permission (96.4%). Also, most had instructed their children that if an unfamiliar person wanted them to show him the way to the nearest store, they should do not go with him (96.1%).
In contrast to these topics, relatively few respondents had told their children that their private parts (parts covered by a swimsuit/bathing suit) should not be touched by others (59.0%), that if someone wants to see or touch your private parts, you should definitely say ‘No’ and leave at once (60.3%), and that if sexual abuse happens, parents or other trustworthy adults should be told (54.3%). Parents were also asked whether they had provided books or audiovisual materials about CSA prevention for their children; only 4.2% of them reported that they had done so.
Another two questions were designed to explore the information on CSA prevention education the respondents had received in school and at home. Only 7.9% of respondents reported that their parents or other adults in their family had talked to them about how to prevent CSA before they were 18 years old and 6.8% answered that they had been taught about CSA prevention by teachers while they were at school (including in kindergarten).
Further analysis explored the factors that may be associated with parents' knowledge, attitudes and practices. Parents' own gender was not associated with differences in knowledge and practice scores, but fathers showed a more positive attitude toward CSA prevention education in schools (4.2 points) than mothers (3.9). The parents were divided into two age groups: less than 35 years and 35 years or greater. There were no significant differences in knowledge, attitudes and practice scores between the two groups (Table III). The respondents were divided into three groups based on their education levels: (1) junior high school or lower, (2) senior high school/technical secondary school and (3) junior college or higher.
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One-way ANOVA showed that the mean knowledge scores increased with increasing educational attainment from 5.5 among those with junior high school or less to 6.6 among those with junior college or higher (F = 7.49, P = 0.001). Regarding the attitudes and practice of CSA prevention education scores, there were no significant differences between respondents who had different education levels (P > 0.05) (Table III).
Parents' knowledge and attitudes were not related to their children's gender. Comparing child's gender with CSA education practice revealed that parents were more likely to provide this to girls than boys (4.8 points versus 4.5, t = 2.47, P = 0.014). Individual practice items subsequently were analyzed to determine which items reflected a significant difference. In the item ‘telling child to disclose sexual abuse episodes to parents or other trusted adult if it happened’ (told daughter: 60.9% versus told son: 47.3%; 2 = 7.12, P = 0.008) and the item related to telling a child not to accompany an unfamiliar person to the nearest store (told daughter: 98.0% versus told son: 94.1%; 2 = 4.00, P = 0.046). Regarding the remaining five items, there were no significant differences between these two groups. See Tables III and IV.
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Finally, the parents own experiences about receiving CSA education were analyzed. Compared with the respondents whose guardians had not talked to them about how to prevent CSA, the respondents whose guardians had talked to them showed more positive attitudes towards school CSA prevention education (score 4.55 versus 3.97, t = 4.15, P = 0.000) and were more active in education practice on CSA prevention (score 5.72 versus 4.56, t = 6.51, P = 0.000). Concerning knowledge, there was no significant difference between the two groups. See Figure 1.
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Discussion |
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This study has identified some of the strengths and gaps in parents' knowledge, attitudes and practices regarding CSA. For example, although studies have shown that children are most likely to be sexually abused by familiar people (Finkelhor, 1994
; Liu, 1996; Li et al., 2000; Shang, 2002), only 28.2% of respondents in the current study believed most molesters are familiar to the child. This deficiency of knowledge was also found in questionnaire survey of 63 school health personnel from 15 provinces (Chen and Han, 2004), and a survey of 271 parents of pupils from Grades 1–5 of an elementary school in the southern part of China (Chen et al., 2004b) found only 48.1% of parents and 37.1% of school health personnel knew this.
Research has indicated that although sexual abuse may have physical consequences, the lack of signs does not imply that a child has not been sexually abused (Cantwell, 1983, Wells et al., 1995; Lu, 1997). One reason is the broad definition of CSA that includes non-penetration harassment. Also, some trauma induced by sexual abuse can heal relatively quickly (Kerns et al., 1994). The present study showed that only 28.1% of respondents believed that CSA may not leave obvious signs. Although children who report sexual abuse can be believed almost all of the time, in the current study only 40.7% of respondents believed that a child who reports sexual abuse can be believed almost all the time. These two areas of knowledge are very important in CSA education.
Boys also can be sexually abused. Although most parents knew this, 21.3% of respondents did not believe it. The findings also showed that parents were more likely to communicate CSA prevention knowledge to their daughters. This suggests that in the future CSA prevention education should clarify this fact to parents and inform them about the prevalence of CSA in the population and the impact of sexual abuse on all children, including boys.
In order to protect children from CSA, it is very important for parents to tell their child that their private parts should not be seen or touched by others. However, in our current study a considerable proportion of parents (about 40%) had not done so. Most parents just told their children to keep away from strangers or kidnappers. A possible reason why so many parents had not explored these key ideas with their children could be due to the fact that parents had not received such education themselves. Only 7.9% of them had been told about how to prevent CSA by their guardians and only 6.8% of them reported that their teachers had talked about CSA prevention during their school years.
Regarding CSA prevention education in school, more than 80% of respondents agreed on the need for CSA prevention education in school and were willing to let their children participate. At the same time, about half of the respondents expressed some concern that such education may have the negative effect of leading their children to know more about ‘sex’. Sex has been a very sensitive topic in China for a long time, and most parents had not received sex education and CSA prevention education. Even today, sex education in school is still limited (Chen and Liu, 2004). This concern also indicates that, contrary to the stated support for CSA prevention education in kindergarten and primary school, such programmes will meet some resistance. On the other hand, it is clear that the curriculum for kindergarten and young pupils in elementary school should be designed very carefully to address parents' sensitivities.
The current survey also showed that only 4.2% of the respondents had provided written or audiovisual products on CSA prevention to their children. One of the reasons is that the relevant books and audiovisual materials for young children are still few in number, and research into CSA prevention education in China is still very limited. There is an urgent need to develop relevant books and audiovisual materials for CSA prevention education in primary school and at home as soon as possible.
Overall, the findings from the current research show that parents' knowledge and practice is inadequate to protect their children from CSA. The results highlight the need for CSA prevention education programmes for parents, to improve parents' awareness and practice of CSA prevention. The results indicate the content, attitudinal and skills areas that parents need in order to educate and protect their children. Because of the sensitive nature of the topic, there must be official support for schools and parents to cooperate together in developing a CSA prevention curriculum that will meet the needs of their children.
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Acknowledgments |
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This study was funded by the Ford Foundation.
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Received on August 4, 2004; accepted on November 11, 2004
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