Attitude toward Child Abuse among Mothers Referring Health Centers of Tabriz

Abstract

Introduction: Parental attitude is an important factor in prediction of child abuse. Awareness of people's attitudes is important in the prediction of their behavior and controlling it. This study was conducted to determine the mothers' attitudes toward child abuse. Methods: In this cross-sectional study, 261 mothers referred to the 13 health centers of Tabriz with children aged 2-12, they were selected by a multistage method and their attitudes were assessed using a questionnaire within 2 months. Higher score were representing more negative attitudes. Results: The results showed that the mean score of total attitude toward child abuse was significantly higher than the middle and was significantly associated with mothers' educational level, employment status, attendance status, number of children they have, and economic status. Conclusion: The results showed that although the mothers' attitudes toward child abuse were negative, because of the relationship between mothers' attitudes with their demographic characteristics, it is necessary to enhance mothers' quality of life, and their social and spiritual support to improve their attitudes and prevent the child abuse.

Introduction

Family is the most important and influential factor on education. Children are ready and talented from the birth to get what they see and hear from others. Therefore, the family could be the first educational environment so the bases of the personality would form in the family.¹Since mothers are more involved in child-rearing, they have an impressive role on children's education. Comparing the connections of a child with his mother rather than his father, show that they are very different and not comparable. Even so after a mother gives birth to her child, he/she is raised by his/her mother's hand for a long time, and so he/she is with his/her mother and has more relationship with her rather than others until school-age. ²

Support, monitoring, and discipline are central dimensions of parental behavior that are linked with children’s adjustment, development, and well-being.³ Despite these explanations, sometimes home goes to be a place of physical and psychological problems for children. Parental abuse and using the punishment is one of the most important factors in the development of social, emotional and behavioral disorders in children.⁴

Child abuse leads to behavioral disorders and adult diseases such as cancer, asthma, heart diseases and also reduces a child's self-efficacy and becomes a background of health problems in the future.^5,6

The World Health Organization (WHO) defines child abuse as all forms of physical, emotional and sexual abuse, neglect and exploitation that leading to actual and potential damage to a child's health and development.⁷ Child abuse occurs for various reasons, including risk factors in parents and caregivers, risk factors in children, relationship factors, community and social factors ⁸ and each of these categories include many cases. Gender of parent is one of the parental factors that contribute to a child abuse. Studies have shown that since mothers spend more time with their children, they could commit more child abuse than fathers.^9,10

Parental attitudes are also important factors in the prediction of parental child abuse. As a general rule, more favorable attitudes and subjective norms, and greater perceived behavioral control, strengthen the individual’s intentions to perform a behavior. According to the theory of planned behavior, attitude is one of the main causes of a behavior.¹¹

Several studies have examined the effect of individuals' attitude on their behavior. For example Ashton¹² and Jackson et al.,¹³ have examined and approved the relationship between attitude and behavior. Vittrup et al., study has shown that there is a significant relationship between mothers' attitudes toward the physical punishment and the physical punishment. Mothers with a positive attitude toward the physical punishment, often use this kind of punishment to discipline.¹⁴ Since the attitude is an important factor in predicting and controlling of a behavior¹⁵, and the awareness of people's attitudes along with the primary prevention has great importance in the prevention of events¹⁶ and since there were not any studies in Tabriz on the attitudes toward child abuse, this study was conducted to determine the mothers' attitudes toward child abuse.

Materials and Methods

This cross-sectional study was conducted to determine mothers' attitudes toward child abuse, after obtaining permission from Research Council of the Tabriz University of Medical Sciences and the faculty of nursing and midwifery, the Ethics Committee of Tabriz University of Medical Sciences, and the administrators of the health centers, from January to February 2014. The study sample consisted of 261 mothers referred to the health centers of Tabriz. The sample size was calculated 261 based on Morgan table and consideration of the parent population in Tabriz with 95% confidence and 5% acceptable margin of error. The sampling was multi-stage: Firstly the ten districts of Tabriz were selected as a category, secondly 13 health centers were randomly selected from these districts depending on number of health center in each district as clusters, and thirdly the sampling was carried out on convenient and eligible participants. The number of mothers in each health center was allocated in proportion to the number of all cases referring to there. The inclusion criteria included: a desire to participate in the study, having 2 to 12 years old child, and exclusion criteria included: Not filling in more than 10% of a questionnaire. The data was collected through questionnaires including demographic characteristics of mothers and 30 attitudinal items about child abuse (physical, emotional and neglect). Mothers' attitudes were measured with 10 items in any kind of child abuse. It was scored using the Likert scale. Phrases with a negative attitude were rated as followings:

“Strongly agree” (5), “Agree” (4), “I can't give a definitive opinion” (3), “Disagree “(2), and “Strongly disagree” (1). The scoring was reversed in phrases with a positive attitude.

A negative attitude toward child abuse means not favoring it. The attitude scores were determined in any kind of child abuse separately from 10 to 50. So, any score higher than 30 means a negative attitude toward child abuse. Total attitude score was from 30 to 150 and the score higher than 90 indicated a negative attitude toward child abuse. To determine the validity, the questionnaire was given to ten professors of the university and their views were applied to improve it.

Reliability was determined using cronbach’s alpha coefficient which was 0.85 for the questionnaire, 0.72 for physical child abuse, 0.82 for emotional child abuse, and 0.75 for neglect.

To collect the data, individuals who were eligible for the study, recruited after explaining the purpose and importance of the study, the importance of honesty in response, not to mention the names and participants' information confidentiality, and with the consent of themselves.

So mothers were asked to read questions carefully and then indicated their opinions by marking options in the questionnaire.

After the data collection, the analysis and comparison of mean values were done using SPSS version 13 and descriptive statistics, One-Sample t-test, Independent Sample t-test, Pearson Correlation Coefficient, ANOVA with post hoc tests in P < 0.05 and considering standard error (SE).

Results

In this study, 261 mothers referred to the thirteen health centers of Tabriz, completed the questionnaires. The mean age of participants was 29 years old, some of them (49.2%) had high school education, the 85.8% of them were housewives and the 54.8% of mothers had one child. So mothers who were satisfied with their parents in the childhood were 85.4% and those who had moderate financial status were 68.5%.

The mean scores and standard deviations of attitude in physical child abuse, emotional child abuse, neglect, and the total attitude score are represented in table 1. The results comparison between the mean score of the attitude with the middle numbers, are represented in table 2. So it is shown that the mean score of the attitude in each kind of child abuse was significantly higher than the middle score (30), (P <0.001). That means mothers have a negative attitude toward child abuse. Also the mean score of the total attitude was significantly higher than the middle score (90), (P <0.001), that reflects mothers' negative attitude toward child abuse.

Table 1. The mean score and standard deviation of mothers’ attitudes toward child abuse.

Attitude toward child abuse	Mean (SD)	Min	Max
Physical	39.45 (5.25)	15	49
Emotional	39.20 (4.20)	26	50
Neglect	44.51 (4.20)	25	50
Total	123.06 (10.72)	80	145

Table 2. Comparison between the mean score of the mothers’ attitude with 30 and 90 (Middle numbers) for each kind of child abuse and the total attitude score (n=261) .

Attitude toward child abuse	Mean	Mean difference (95% CI)	P-value *
Physical	39.45	9.45 (8.81,10.09)	P<0.001
Emotional	39.20	9.20 (8.69,9.71)	P<0.001
Neglect	44.51	14.50 (13.99,15.02)	P<0.001
Total	123.06	33.06 (31.76,34.37)	P<0.001

One sample t.test, p < 0.05,^*Possible range of attitude score in each types: 10 to 50 and in total attitude score: 30 to 150

In physical child abuse, the results showed that 35.3% of mothers agreed with this item "The best child is who completely obeys orders of his parents”, and 90.4% of them agreed with “Children are at the risk of damage with physical abuse due to their small size".

In emotional abuse, 51.6% of mothers agreed with “threatening to various type of punishment will not harm children” and 95.4% of them agreed with “Necessity of parental love toward a child with all his characteristics”.

In neglect, 13.1% of mothers agreed with “Leaving their children to become strong and self-raised”, and 98.1% of them had belief in “Necessity of parents' awareness of their children's educational qualifications”.

Statistical analysis was conducted to examine the relationship between demographic characteristics of mothers with their attitude. The results were as following: There were not any significant relationship between maternal age, child gender, satisfaction of parents, and any mean scores of the attitude in physical child abuse, emotional child abuse, neglect, or the total attitude (P >0.05).

This survey in the relationship between mothers' educational levels with their attitude has shown that there are significant differences between mean of the total attitude score and mean of the attitude scores in physical child abuse, emotional child abuse and neglect, through five educational groups. This means that mothers who had higher educational levels, had a more negative attitude toward child abuse.

On the impact of mothers' employment on their attitude, Independent Sample t-test showed that the mean of the total attitude score has a significant difference among employed and unemployed mothers (P<0.05). This means employed mothers had a more negative attitude toward child abuse.

The effect of attendance status on mothers' attitudes toward child abuse, revealed that the mean of the attitude scores in neglect was significantly different among the single parents and two-parents (P <0.05), that means mothers who have taken the care of their children shared with husbands, have had more negative attitude toward child abuse in neglect.

The results of the relationship between attitude toward child abuse with the number of children in the family, showed that the mean of the attitude scores in physical child abuse varies significantly with the number of children they have (P <0.05), and mothers with fewer children, had more negative attitudes toward physical child abuse.

Also the results of the relationship between the attitude toward child abuse with mothers' economic status, are represented in table 3 showed that the mean of the total attitude score and the mean of the attitude scores in emotional child abuse and neglect are significantly different in mothers' economic status (P <0.05) which means mothers with better financial status have more negative attitude toward child abuse.

Table 3. Comparison between the mean score of the mothers’ attitude with their economic status.

Attitude toward child abuse	Comparison groups	Mean difference	95% confidence interval of Mean difference	P-value *
Physical	Weak- Moderate	2.63	-0.72, 5.99	0.124
	Weak- Excellent	2.98	-0.51, 6.64	0.094
	Moderate- Excellent	0.34	-1.10, 1.79	0.638
Emotional	Weak- Moderate	2.83	0.16, 5.52	0.038
	Weak- Excellent	2.41	-0.37, 5.20	0.089
	Moderate- Excellent	0.42	-0.73, 1.58	0.469
Neglect	Weak- Moderate	3.29	0.64, 5.95	0.015
	Weak- Excellent	4.09	1.34, 6.85	0.004
	Moderate- Excellent	0.80	-0.34, 1.94	0.168
Total	Weak- Moderate	8.19	1.38, 15.01	0.019
	Weak- Excellent	8.76	1.68, 15.84	0.015
	Moderate- Excellent	0.56	-2.36, 3.50	0.703

^*Post hoc test: Least Significant Difference, P < 0.05

Discussion

This study showed that mothers' attitudes toward child abuse are negative. In other words, they disagreed with physical or emotional child abuse and neglect. In a similar study that has been conducted by Agha Bakhshi et al., the results showed that mothers' attitudes toward child abuse were moderate.¹⁷In the present study, 67.2% of mothers were absolutely opposed to children corporal punishment. These results are similar to study of Medora et al., that showed, regardless of the ethnic differences, mothers disagreed with physical and violent punishment against children.¹⁸ But the findings of a study by Qasem et al., about child physical abuse were not consistent with our results and showed that 86% of parents agreed with physical punishment as a method of discipline.¹⁹

Cultural differences and common beliefs about parenting styles could be responsible for the difference in results. In some countries, violence and stressful form of punishment, is common.⁵ Ceballo believes that parental attitudes and knowledge have important role in parental behavior and parenting styles.²⁰

The results showed that a considerable number of mothers were agreed that children should be completely obedient to the orders of their parents. Also a large number of mothers had positive attitude to threaten children for different types of punishment, as a way of punishment.

Threatening and frightening of children and forcing them to completely do their parents' commands, are considered child abuse and parents should be given the necessary knowledge about them.^21-23

In the recent study, mothers who had higher levels of education had more negative attitudes toward child abuse. Luster and McAdoo showed that mothers' educational level was related to their negative attitudes toward child abuse, which is consistent with our results. Luster and McAdoo's study also demonstrated that mothers' educational level is an important factor in their children's educational progress and academic success.²⁴ Agha Bakhshi et al., found similar results in their study and showed that mothers' educational level has an important role on the desirability of their attitudes .¹⁷

The results obtained in this study indicated that there is a relationship between mothers' attitude with their employment status, and employed mothers have more negative attitudes toward child abuse. Nuhu and Nuhu showed, unemployed parents are more likely to agree with some types of child abuse.²⁵ According to Gillham et al., child abuse by employed mothers was less than unemployed mothers.²⁶ Christoffersen showed that incidences of child abuse or neglect was higher in families that mothers were unemployed long-term.²⁷

The present study showed that women, who are single parent, have more positive attitudes toward child abuse. This is consistent with the results of Nuhu and Nuhu that showed parents who take care of their children singly, have more positive attitude toward child abuse.²⁵ Children who live in single-parent families are at greater risk for child abuse.²⁸

The results of this study showed that, there is a significant relationship between the mothers' attitudes and the number of children in the family. This means that mothers with fewer children had more negative attitudes toward child abuse. Agha Bakhshi et al., showed that there was a significant relationship between mothers' attitudes toward child abuse with the number of their children.¹⁷ The populous family is a factor for child abuse.^29,30

The findings of this study demonstrated that mothers, who had a better economic status, had more negative attitudes toward child abuse. Kamii and Radin write that mothers who belong to the lower levels of education and economic, pay less attention to their children's needs and have more tendencies to be obeyed from their children.³¹ Studies have shown that family poverty is strongly associated with the child abuse.^32,33 Many parental and environmental characteristics that are correlated with child abuse are linked to poverty.²⁸

Conclusion

The results showed that although mothers' attitudes were negative toward child abuse, however because of the significant relationship between mothers' attitude with their educational level, employment status, economic status, attendance status, and since a positive attitude toward a behavior is a predictor of that behavior, therefore, mothers who belong to lower socio-economic levels or take care of their children singly, are prone to child abuse. So they should be supported with economical and social aids of governmental organizations. It is also necessary to enhance mothers' awareness in parenting by nurses in health centers to improve their attitudes.

It is also necessary that nurses and midwives check out the attitudes of parents referred to the health centers, and take action to educate the parents about the physical and psychological effects of child abuse, if they have positive attitudes toward child abuse, in prevention of that.

The research environment was the limitations of this study, because most of mothers referred to health center to follow the health of their children. So it is more probable that these mothers would have negative attitudes toward child abuse. Therefore, the generalization of the results to all mothers should be cautious.

It is suggested that a study would be conducted to determine the prevalence of child abuse in Tabriz. Also the attitudes of parents, whose children have been hospitalized for child abuse, would be examined.

Acknowledgments

Researchers are grateful to the honorable parents who kindly agreed to participate in this study as well as to the research vice-chancellor of Tabriz University of Medical Sciences who provided financial support for this study.

Ethical issues

None to be declared.

Conflict of Interest

The authors declare no conflict of interest in this study.