Assess the Effectiveness of Informational Booklet on Knowledge Regarding School Refusal among the Parents of School-Going Children

Mayur Bhaskarrao Wanjari^1* and Pooja Kasturkar²

^*Correspondence: Mayur Bhaskarrao Wanjari, Department of Community Health Nursing, Smt. Radhikabai Meghe, Memorial College of Nursing, Datta Meghe Institute of medical Sciences (Deemed to be University), Sawangi (M) Wardha Maharashtra, India, Email:

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Introduction

School life is the most exciting period in one’s life. It is the time when one learns the first lessons of socialization. Often people recollect the events where they cried with their heart –at two instances-the times they first enter the school and the time they leave the school forever. But today the environment in our school is creating situations where children refuse to go to school not only as of the beginner but throughout the period [1].

School refusal can be defined as any refusal by a child to attend a school or to have difficulty attending classes regularly. School refusal is a serious emotional problem that is associated with significant short- and long-term squeals. Fear of going to school was first termed school refusal in 1941. An alternative term, school refusal was used in Great Britain to define similar problems in children who didn’t attend school because of emotional distress [2].

School refusal differs from truancy, in that children with school refusal feel anxiety or fear towards school, whereas truant children generally have no feelings of fear towards school, often feeling angry or bored with it instead. School refusal is a broader term that recognizes that children have problems attending school for a variety of reasons. However, these reasons might not be the expression of a true refusal such as separation or social anxiety [3].

Approximately up to 8% of all school-aged children have school refusal. The rate is similar between boys and girls. Although school refusal can occur at all ages, it is more common in children 5 to 11 years. No socio-economic differences have been noted [4].

There is a fairly equal representation of gender, racial and income groups among children who refuse school. However, school refusal tends to be more prevalent among young adolescents and students entering a new school building for the first time. More specifically children entering kindergarten or first grade, middle school, and high school are at an increased risk of school refusal behavior [5].

There is usually the gradual onset of school refusal symptoms in youth. These symptoms sometimes begin after a holiday or illness. In addition, some children may have trouble returning to school after weekends or vacations. Although some children leave home in the morning and develop difficulties as they approach school making it difficult to proceed, others make no attempt at all to get to school [6].

Although some cases of school refusal behavior are not triggered by any clear stimuli, many cases are also triggered by specific stimuli. Specific stimuli include academic underachievement, family and marital conflict and transitions, illness, school-based challenges, threats and traumatic experiences. Certain characteristics such as school refusal, depression and dysfunctional relationships are also common among school refuses [7].

Parents are aware of the absence. The child often tries to persuade parents to allow him to stay home. During school hours child usually stays home because it is considered a safe and secure environment. Sometimes a child is absent from school or attends school initially but leaves during the school day [8].

In this condition, children will have severe emotional distress about attending school, may include anxiety, and temper tantrum, depression or somatic symptoms. Children will go to school following crying, clinging, tantrums or other intense behavioural problems. They exhibit unusual distress during school days that leads to future absenteeism [9].

Background of the study

School refusal is a serious emotional problem that is associated with significant short- and long-term squeal. Fear of going to school was first termed school refusal in 1941. An alternative term, school refusal, was used in Great Britain to define similar problems in children who did not attend school because of emotional distress. Children with school refusal differ in important ways from truant children, although the behaviours are not mutually exclusive. School refusal/school avoidance/ school refusal is a term used to describe children who have a pattern of avoiding or refusing to attend school. Different from truancy, these behaviours occur in approximately 2% of school-aged children. Historically called "school refusal," many researchers now prefer to use the terms "school avoidance" or "school refusal." There is confusion regarding the terms because children who experience significant difficulty in attending school do so for different reasons and exhibit different behaviours. In general, children who refuse to attend or avoid school stay in close contact with their parents or caregivers, and are frequently (although not always) anxious and fearful. They may become very upset or become ill when forced to go to school. Truants may be distinguished from this group by their antisocial or delinquent behaviours, their lack of anxiety about missing school, and the fact that they are not in contact with parents or caregivers when they are avoiding school [10,11].

While separation issues are often a major component, other factors affect school refusal, as well. Among these factors are home stressors such as divorce, a death in the family, financial problems, or transfer to another school. School-related issues, such as fear of bullying, learning problems, social problems, or other stressors can also trigger or intensify a school refusal. The onset of school refusal symptoms usually is gradual. Symptoms may begin after a holiday or illness. Some children have trouble going back to school after weekends or vacations. Stressful events at home or school or with peers may cause school refusal. Some children leave home in the morning and develop difficulties as they get closer to school, they are unable to proceed. Other children refuse to make any effort to go to school. Presenting symptoms include fearfulness, panic symptoms, crying episodes, and temper tantrums, threats of self-harm and somatic symptoms that present in the morning and improve if the child is allowed to stay home. The longer the child stays out of school, the more difficult it is to return. Short-term squeal includes poor academic performance, family difficulties, and problems with peer relationships Longterm consequences may include academic underachievement, employment difficulties, and increased risk for psychiatric illness [12,13].

Methods

Research approach and design

An interventional research approach is used in this study. This approach was selected because this research study aimed to assess the effectiveness of an informational booklet on knowledge regarding school refusal among the parents of school-going children. In the present study pre-experimental one-group pre-test post-test research design used was used the study.

The setting of the study

This study is conducted in a selected area in the Wardha region. The investigator found the setting appropriate to conduct the study because an adequate number of samples was available which could be taken for the study and also the respected authorities were cooperative and gave permission to conduct the study.

Sample size and sampling technique

In this study sample size is 100 Parents of school-going children and the samples were Parents of school-going children who were fulfilling the inclusion and exclusion criteria. The sampling technique used in the study was the non-Probability- purposive samples technique.

Criteria for sample selection

Inclusion criteria

• Parents of school-going children who are all willing to participate in the study.

• Parents of school-going children who are present on the day of data collection.

• Parents of school-going children who can read and understand English, Marathi and Hindi.

Exclusion criteria

• Parents of school-going children should participate in a similar type of project.

• Parents of school-going children who are mentally ill.

• A single parent of preschool children.

Preparation of tools

A structured questionnaire consisting of 2 items including demographic data and knowledge regarding, was used to collect the data. A structured questionnaire was prepared by referring books, review of literature, journal and as per the guidance of the guide as well as based on the conceptual framework.

Development of the tool

The investigator developed the tool after updating theoretical knowledge regarding school refusal among the parents of school-going children, the investigators on experience, theoretical knowledge and guidance from the experts along with the review of literature helped in developing the tool necessary for the study.

Which divided into three sections?

Section I

The first section of the tool consisted of 9 items of selected demographic variables like age, gender, parents, parent, religions, residence, education, income, number of children, family status.

Section II

It consists of 24 structured knowledge questionnaires regarding school refusal among the parents of schoolgoing children.

Section III

It consists of an information booklet regarding school refusal among the parents of school-going children.

Methods of data collection

Investigator took permission from the concerned authority the Nagar Sevak of the selected areas of Wardha city. And then we approached the sample we introduced him and informed them about the nature of the study to ensure better co-operation during the data collection. The investigator approached the parents of school-going children explained the proposed study and how it will be beneficial for them. We inquired about their willingness to participate in the study. Investigator made the sample comfortable and oriented them to study. We administered the questionnaire with interview method to them. Doubts were clarified. Once the questionnaire is completed investigator collected them back each sample required a maximum time of 30 minutes to complete the questionnaire.

After the pretest, the information booklet was given on the same day by the investigator. Post-test will be administered with the same questionnaire on the 7th day. The collection of data was performed within the stipulated time.

After the data was gathered the investigator thanked the entire study sample as well as authorities for their cooperation.

Process of data collection

The subjects were explained about the nature and purpose of the study. Written consent was obtained from the participant before their recruitment in the study. They were assured about the confidentiality of the data. The validated tool used was a self-administered questionnaire. The pretest data collection was followed on 1st day. It took on an average of 30 minutes the answer the items. Any queries by the subjects were clarified after the given information booklet. All 100 subjects were recruited for the study. The post-test was done on the 7th day. After the data gathering process, the investigator thanked all the participants as well as their parents for their cooperation.

Plan for data analysis

The collected data will be coded, tabulated and analyzed by using descriptive statistics (mean percentage, standard deviation) and inferential statistics. Significance difference between pre and post-test readings will be tested by using t-test, associated of knowledge with demographic variables will be done by one-way ANOVA test and independent t-test. The data will be presented in the form of tables and graphs.

Results

Section A

Table 1 shows percentage wise distribution of subjects with regard to their demographic variables.

Table 1: Percentage-wise distribution of samples with regards to selected demographic variables.

Section B

Part I

Table 2 shows the assessment of pretest knowledge regarding school refusal among the parents of schoolgoing children regards to demographic variables.

Table 2: Assessment of pretest knowledge regarding school refusal among the parents of school-going children regards to demographic variables.

Part II

Table 3 shows the assessment of post-test knowledge regarding the of school refusal among the parents of school going children regards to demographic variables.

Table 3: Assessment of post-test knowledge regarding.

Section C

Table 4 shows the effectiveness of booklet information on the knowledge regarding the school refusal among the parents of school going children.

Table 4: Percentage-wise distribution of effectiveness of booklet information on the knowledge regarding the school refusal among the parents of school-going children

.

Section D

Table 5 shows association of post-test knowledge score with selected demographic variables.

Table 5: Association of post-test knowledge score regarding school refusal among the parents of school-going children with their selected demographic variables.

Discussion

The findings of the study have been discussed in terms of objectives, theoretical base and the hypothesis formulated. The results of the present study are supported by a study conducted for assessment of knowledge regarding school phobia among parents, find out the association between knowledge regarding school phobia among parents and selected demographic variables. Prepare an information leaflet on school phobia in children and its management and prevention. The study design was a non-experimental descriptive research design. The sample was 80 parents of children between (4-10 years), using the non-probability convenience sampling technique and the data was collected using a structured knowledge questionnaire on school phobia. The result revealed that Out of 80, the majority of the subjects 45(56.3%) had average knowledge regarding school phobia. 33(41.3%) of the subjects had good knowledge and 2(2.5%) of subjects had poor knowledge. The maximum score was 26. The mean score of overall knowledge on school phobia among parents was 16.39 and the standard deviation was 3.563. There was no significant statistical association between parent’s knowledge of school phobia and selected demographic variables. The parent’s knowledge regarding school phobia is only average. Therefore, interventions need to be planned to enhance their knowledge so that they will be in a position to prevent the future occurrences of school phobia and manage a child with school phobia with minimum complications [14]. The results of the present study are supported by a study conducted to identify the existing knowledge among school teachers related to behavioural problems (pica, temper tantrum, school phobia, sleep disorders, stealing and lying) in school children and to determine the pre-test and post-test knowledge related to the behavioural problems in school children among teachers. Also, to find the relationship between the level of knowledge of school teachers with selected demographic variables. A quasi-experimental research design was used. The samples were teachers (male and female). The sample size was 60. A nonprobability convenient sampling technique was used. The results stated that the majority (93.34%) of the school teachers in the pre-test had an average knowledge whereas in the post-test majority (75%) of the school teachers had a piece of good knowledge. The other findings were the majority (45%) of the teachers were between the age group of 26-45 years and the majority of samples (88.34 %) were females. The study concluded that assessment of knowledge of teachers regarding problems of children including school phobia will help them to tackle the problem at an earlier stage and to prevent complications so this study indicates that the planned teaching is effective in increasing the knowledge of teachers regarding the behavioural problem [15].

The findings of the present study are supported by a study conducted on psychopathology in parents of children with school phobia. The purpose of the study was to examine the psychopathology in parents of children with school phobia. 2 groups of parents were selected. One is parents of children with school phobia (n=50) and the other is parents of children free of any psychiatric diagnosis (n=50). (44%) of the children in the study group were girls, (56%) were boys. (40%) of the children in the control group were girls, (60%) were boys. There were no significant differences between the 2 groups in terms of mean age and gender. The results showed that parental psychopathology was higher in parents of children with school phobia than in parents of normal children [16].

Conclusion

After the detailed analysis, this study leads to the following conclusion that. The majority of parents of school-going children had a 60 (60%) average level of pretest knowledge score regarding school refusal. The majority of parents of school-going children had 65 (65%) very good level of post-test knowledge.

There was no significant association of post-test knowledge score with age, gender, parents, monthly income of the family, number of children in the family and parent’s family status. There is a significant association of post-test knowledge score with religion, residence and education status of parents. Analysis of data showed that there was a significant difference between pretest and post-test knowledge scores. Hence it is concluded that the information booklet significantly brought improvement in the knowledge regarding the School Refusal among the Parents of School Going Children.

Now the parents are in a position to prevent the future occurrences of school refusal and manage a child with school refusal with minimum complications by the reading of this informational booklet of school refusal.

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