RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and address (in block letters) / PREEMA PRINCE RODRIGUES
I YEAR M.Sc. NURSING
MASOOD COLLEGE OF NURSING
BIKARNAKATTE, MANGALORE
2. / Name of the Institution / MASOOD COLLEGE OF NURSING
BIKARNAKATTE, MANGALORE
3. / Course of Study and Subject / M.Sc. NURSING
PEDIATRIC NURSING
4. / Date of Admission to the Course / 1/7/2011
5. / Title of the study
“STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND KNWOLEDGE ON PRACTICE REGARDING ASSERTIVE BEHAVIOR TOWARDS PREVENTION OF SEXUAL ABUSE AMONG ADOLESCENT GIRLS IN SELECTED URBAN HIGH SCHOOLS, MANGALORE”.

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6. / Brief resume of the intended work
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6.1  Need For study
“Child abuse does not go away, but 90% of child abuse is preventable”
-  Karen Adams
Child is as soft as a flower. It is often stated that children are the world’s most valuable resources and assets, but their rights throughout the world are largely ignored often resulting into tragic outcomes. This is because of the vulnerability of children. From infancy to adolescence, children are dependent on adults for safety and ongoing nurturing and this puts them at risk of maltreatment in many forms.1 Adolescent is a stage of development transition, which means a bridge between childhood and adulthood. Adolescents face physical, social and psychological problems like general health problems, mental health problems, depression, violence, sexual abuse.2
Sexual abuse or violence against adolescents is defined as a situation in which children or adolescents are used for the sexual pleasure of an adult or older adolescent which ranges from petting, fondling of genitalia, breasts or anus, sexual exploitation, voyeurism, pornography, exhibitionism, pressuring a child to engage in sexual activities, indecent exposure of the genitals, nipples etc with intent to gratify their own sexual desires or to intimidate or groom the child.3 Sexual abuse is an especially complicated form of abuse because of its layers of guilt and shame. Exposing a child to sexual situations or material is sexually abusive, whether or not touching involved. While news, stories of sexual predators are scary, what is even more frightening is that sexual abuse usually occurs at the hands of someone, the child knows and should be able to trust-most. It is often by close relatives.4
In the world, India has the largest number of children (375 million), covering 40% of its population, out of which 69% of Indian children are victims of physical, emotional and sexual abuse. New Delhi, the nation’s capital, has an abuse rate over 83%. More than 70% of cases are unreported or unshared even with family members5.
Sexual abuse statistics of prevalence was conducted by ‘National study of child abuse’ in April 2007, covering 13 states in India and sample size of 12,446 children. Almost 22% faced severe sexual abuse, 6% sexually assaulted,53% children report facing one or more forms of sexual abuse, 50% of sexual offenders were known to the victim or were in position to trust (family member, close relative, friend or neighbor), 5-12years group faced higher levels of abuse, largely reported, boys were equally at risk as girls, severest sexual abuse in age group of 11 to 16 years, 73% of sexual abuse victims were in age group of 11-18years6.
Learning about sexual abuse prevention is necessary, but it is not enough to ensure children’s safety. Researchers point out that statistics on sexual abuse reveal only the tip of the iceberg. Feelings of guilt, helplessness and shame, combined with a fear of how those closest to them will react and of the perpetrator’s threats are the most common reasons why children, and often adults important to them who are aware of the abuse, do not report the abuse and seek help. If the abuse is reported, it is often months or years afterwards, especially if the abuser is a person close to a child7.
The perpetrators of child maltreatment may be parents, family members, care givers, friends, strangers, authority-teachers, soldiers, police officer clergy, employers, health care workers and other children8. Children highly susceptible for sexual abuse include children of single parent, children with low esteem, attraction of city life, lack of education, poverty, parent-risk behaviors, loss of job of parents, mental retarded children, violence in community, parental substance or drug abuse, physically handicapped, unloved and uncared children9.
Assertive behavior is clear and direct communication, which includes standing up for the rights without infringing on the rights of others.14 Anger and other strong feelings are expressed in a straight forward manner that takes into account the feelings and views of others10. To empower children to recognize and react effectively or assertively to potentially dangerous situations, the key concept is that everyone has the right to safety. Having the right to be safe with other people implies being responsible and caring for oneself, and knowing how to react when threatened. Once children recognize this, the more readily they will understand the need to respond. Efforts are focused on empowering children to prevent sexual abuse by preparing for daily life, identifying and responding to potentially dangerous situations, identifying and seeking help7.
A cross sectional study was conducted in USA, to assess the adolescent girls perceptions on sexual assertiveness and examine the relationship of these perceptions with developmental and interpersonal variables. The study showed that girls perceived asserting themselves between 50-75% of time with their current or most recent partner and hence the study concluded that most of the girls were perceived themselves as sexually assertive. The study recommended determining the effective ways to help girls both to communicate their sexual desires and to enhance their ability to protect themselves by designing counseling messages that incorporate sexual experience11.
From the above information and review, the researcher felt that the adolescents need more information on being assertive towards prevention of sexual abuses. A structured teaching programme for adolescents on assertive behavior towards prevention of abuses will enhance their knowledge. Hence there is a need for assessing the knowledge and knowledge on practice regarding assertive behavior towards prevention of sexual abuse among adolescents in selected urban schools, Mangalore.
6.2 Review of Literature
A cross sectional study was conducted in Goa on Gender, sexual abuse and risk behaviors in adolescents. It aims to study the gender, sexual abuse and risk behavior among adolescents. The samples for the study were adolescents who belong to the age group of 12-17years. The samples were selected by random sampling method. 811 adolescents were selected, out of which males accounted 53% and females 47%. The study showed that one-third (266 adolescents) of the population had experienced at least one type of sexual abuse among whom 47% experienced sexual abuse more than one times and some experienced other kinds of physical and verbal violence in the previous 12months period. The risk behavior or perpetrators were older students who accounted 53%, relatives for 8%, teachers for 4% and miscellaneous 27%. The major findings of this study indicate that sexual abuse and violence are common among this population. The study concluded that there was no statistical difference between males and females in overall prevalence of sexual abuse 12.
A cross sectional study was conducted in USA on childhood sexual abuse by a family member, salivary cortisol, and homicidal behavior of female prison inmates. The study aims to assess if female sexually abused by a family member as a child also experienced more childhood physical abuse and neurological histories compared with females not sexually abused by a family member. The samples were 137 female inmates, including 9 murderers and 12 noncriminal females, with logistic regression statistical analysis comparing to females who have (n=60) and have not (n=89) been sexually abused by a family member. The tool used is Muenzenmaier’s childhood abuse scale. The study showed that the final multivariate logistic regression model revealed that female victims of childhood sexual abuse by a family member experienced more childhood physical abuse (p=0.05), experienced more TBIs, (p=0.01) and displayed increased violent behaviors including homicide (p=0.05) compared with those not sexually abused by a family member. The study concluded that the risk behavior associated with sexual abuse by family member should be considered for individuals and policies to prevent potential homicide by experienced individuals.13
A cross sectional study was conducted in South Africa on risk indicators and psychopathology in traumatized children and adolescents with a history of sexual abuse. The study aims to assess the data on risk factors and the most prevalent psychological consequences of trauma. The samples were 94 participants who had exposure to at least one life time trauma out of which 59 were females and 35 males of 8-19 yrs. Sexual abuse was reported among 53% of participants with 64% of violation committed by perpetrators known to them. Multinomial logistic regression analysis revealed female gender (p= 0.002) and single parent families (p =0.001) to the significantly higher physical and emotional abuse sub scale scores and total childhood trauma questionnaire scores than non abused children depression was 33% , x(2) = 10.89 ,( p= 0.001) and post trauma stress disorder (63.8%, x(2) = 4.79 , p= 0.034 ) were the most psychologically consequent traumas and both were significantly associated with child sexual abuse. The study concluded that high rates of child sexual abuse predicted high rates of Post Traumatic Stress Disorder in this traumatized sample14.
A prospective study was conducted in Australia on Impact of child sexual abuse on mental health. The study aims to examine the association between child sexual abuse in both boys and girls and subsequent treatment for mental disorder. The study used prospective cohort design. The samples of the study were children (n=1612, 1327 females) ascertained as sexually abuse. The study showed that male and female victims of abuse had significantly higher rates of psychiatric controls (12.4% v. 3.6%). Rates were higher for childhood mental disorders, personality disorders, anxiety disorders and major affective disorders but not schizophrenia. Male victims were significantly more likely to have had treatment than females (22.8% v. 10.2%). The study concluded that it demonstrates an association between child sexual abuse validated at the time and subsequent increase in rates of childhood and adult mental disorders15.
A cross sectional study was conducted in Beijing, China on child sexual abuse(CSA). The study aims to ascertain the prevalence of CSA, explore the impact of CSA and provide useful reference for prevention of sexual abuse. The samples of the study were 892 female students of medical school. The study showed that, comparing to the students who had not experienced CSA, the students who had experienced had higher level of depression score (18.78 vs. 16.68, p=0.005), lower levels of health status self evaluation score (3.53 vs. 3.78, p=0.003), a higher percentage engaged in sexual intercourse (19.3% vs.5.9%, p=0.000), being involved on physical fight (score 16.7% vs. 5.6%, p= 0.000). The study concluded that CSA of girls is not uncommon and is associated with poor mental health and risky behaviors. The study recommended that there is further need for research into CSA epidemiological characteristics, health service for victim abused sexually, sexual abuse prevention programs in schools and general community16.
6.3 Statement of the problem
“A study to evaluate the effective of structured teaching programme on knowledge and knowledge on practice regarding assertive behavior towards prevention of sexual abuse among adolescents girls in selected urban high schools, Mangalore.”
6.4 Objectives of the study
a)  To determine the level of knowledge and knowledge on practice regarding assertive behavior towards prevention of sexual abuse among adolescent girls.
b)  To find the effectiveness of structured teaching programme on knowledge and knowledge on practice regarding assertive behavior towards prevention of sexual abuse among adolescent girls in selected urban schools, Mangalore.
c)  To find the association between pre-test level of knowledge regarding assertive behavior towards prevention of sexual abuses among adolescent girls and their selected demographic variables.
d)  To find the association between pre-test level of knowledge on practice regarding assertive behavior towards prevention of sexual abuse among adolescent girls and their selected demographics.
6.5 Operational definitions.
·  EFFECTIVENESS: In this study, effectiveness refers to the extent to which structured teaching programme will enhance the knowledge and knowledge on practice of the adolescent girls regarding assertive behavior towards prevention of abuses in terms of post test knowledge scores.
·  STRUCTURED TEACHING PROGRAMME: In this Study, Structured teaching programme refers to a teaching material developed for improving the knowledge and knowledge on practice regarding assertive behavior towards prevention of abuses which will include definition, incidence, causes, types, risk factors, clinical features, prevention and management.
·  KNOWLEDGE: In this study knowledge refers to the information obtained from adolescent girls regarding assertiveness towards prevention of abuses as measured by a structured knowledge questionnaire and interpreted in terms of adequate, moderately adequate and inadequate level of knowledge.
·  KNOWLEDGE ON PRACTICE: It refers to the knowledge of the adolescents on practicing assertive behavior towards prevention of sexual abuses as measured by a structured knowledge on practice questionnaire and interpreted in terms of adequate, moderately adequate and inadequate level of knowledge on practice.
·  ASSERTIVE BEHAVIOR: It refers to the right behavior adopted by the adolescent girls during different kinds of abuses to protect, prevent or protest against the situation without any undue anxiety and psychological or physical trauma.
·  SEXUAL ABUSE: In this study, sexual abuse is a form of abuse in which an adult or older adolescent abuses an adolescent who is studying in high school for sexual stimulation.
·  ADOLESCENT GIRLS: In this study, adolescent girls are the girls who are studying in 8th, 9th and 10th standard in selected urban high schools, Mangalore.
6.6 Assumptions
The study assumes that,
Ø  The adolescent girls may have some basic knowledge and knowledge on practice regarding assertive behavior towards prevention of sexual abuses.
Ø  STP may be effective to enhance the knowledge and knowledge on practice regarding assertive behavior towards prevention of sexual abuse among adolescents girls in selected urban high schools, Mangalore.