The Journal of School Nursing
© The Author(s) 2020
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DOI: 10.1177/1059840520934183
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2022, Vol. 38(4) 336–346
This study evaluated a life skill training program on school violence given to elementary school children. A quasi-experimental study was conducted, and a 12-week intervention was implemented targeting 70 students aged between 10 and 11 years. The instruments included peer competency, attitudes toward school violence, experience of school violence, and the Self-Control Rating Scale. The data were analyzed using repeated measure analysis of variance. A significant difference was observed between the groups over time on peer competency (F = 4.17, p = .020), attitudes toward school violence (F = 6.02, p = .004), and violence experience as a victim (F = 3.49, p = .036) and as a perpetrator (F = 3.87, p = .026). In the experimental group, the mean scores for peer competency increased compared to the control group, whereas school violence experience decreased at the posttests. A 12-week program of life skill training offered to children was effective in promoting peer competency and attitudes toward school violence, while decreasing the experience of school violence.
Keywords
school violence, life skill, peer competency, attitudes, school nurse
School violence encompasses physical and psychological violence including fighting, verbal abuse, sexual violence, bullying, teasing, harassment, and alienation. A previous study reported a 3.6%–8.8% prevalence of school violence among adolescents in Korea (Lee & Ham, 2018). Of the various types of school violence among students enrolled in elementary, middle, and high schools, 34.7% reported that they had experienced verbal abuse, followed by alienation (17.2%) and stalking (11.8%; Korea Ministry of Education [KME], 2018). In Western countries, particularly in the UK, crime and violence among youth are the major societal concerns that involve gangster crime, drug use, or knife crime, and school is believed to be the place where violence starts through bullying or harassment (Grimshaw & Ford, 2018). The prevalence of school violence in South Korea is much lower (7.9%) than that in the UK (23.9%). On the other hand, the degree and pattern of school violence is becoming increasingly serious, while the age of both victims and perpetrators is becoming younger, and more groups are involved in school violence in South Korea (Park, 2012).
Regarding the initiation period of school violence, 73% answered that their first experience occurred in elementary school, with the highest prevalence in the fifth grade of elementary school, indicating that this period is critical in the prevention and management of school violence (KME, 2018). This period of life is critical for the development of intergroup orientations (Houlette et al., 2004). According to social identity theory, attitudes and behaviors toward intergroup and outer group are influenced by social context and the individuals’ psychological needs, where behaviors may include aggressive and delinquent behaviors when faced with intergroup conflict (Merrilees et al., 2013).
Life skills are the abilities for adaptive and positive behavior which enable humans to deal effectively with the demands and challenges of life in general (Tuttle et al., 2005). Life skills enable children to interact effectively with peers and maintain positive and balanced relationships with others. On the other hand, children these days lack the opportunities to obtain life skills through social interactions with peers because of the increased use of social networking services rather than off-line interactions (J. M. Kim & Choi, 2010). Thus, children may experience difficulties in dealing with problems within school, which in turn can lead to school violence. Therefore, interventions for the prevention, detection, and management of school violence are needed for the health of children and adolescents (You, 2013).
The characteristics of perpetrators of school violence have been reported to include low self-esteem, aggression, impulsiveness, and lack of self-regulation (S. R. Kim, 2015). Victims of school violence may exhibit depression and suicidal ideation, while they have an increased risk of anger, anxiety, depression, and suicidal attempts in adults (Haynie et al., 2011; Lee & Ham, 2018). Therefore, programs, such as those for self-esteem and self-regulation, are needed to promote the positive psychosocial health of children, while interventions are required to decrease the adverse psychological health problems associated with school violence through life skill training.
The World Health Organization (2009) recommended that violence among children can be prevented by developing life skills that involve cognitive, emotional, interpersonal, and social skills. Evidence suggests that social skills intervention, such as maintaining social relationships and using self-control, is effective in decreasing problem behaviors of children, including anti-social and aggressive behavior (Lynch et al., 2004). A previous intervention study, which was conducted targeting 4,858 sixth-grade students enrolled in 41 New York City public and parochial schools, reported that 15 sessions of a life skill training program were effective in decreasing physical and verbal aggression, fighting, and delinquency (Botvin et al., 2006). The life skill training included a variety of cognitive-behavioral skills, such as problem-solving, decision making, managing stress and anxiety, communicating effectively, developing healthy interpersonal relationships, and asserting one’s rights (Botvin et al., 2006).
The theoretical framework of this study was social cognitive theory (SCT; Bandura, 1977). The premise of SCT includes dynamic interactions among personal, behavioral, and environmental factors, whereas the interaction products affect the shaping of human health behavior (McAlister et al., 2008). The key concepts of SCT include reciprocal determinism, self-efficacy, observational learning, incentive motivation, and self-regulation. Reciprocal determinism is defined as environmental factors that influence an individual or group, but the individual (group) influences their environments and regulates their behavior. Self-efficacy is a person’s belief in their ability to successfully implement the target behavior, while observational learning is learning by observing the behavior of others, including peers and mass media. Incentive motivation is one of the methods to promote (motivate) a desired behavior by providing positive or negative reinforcement (incentives). The strategies for self-regulation include controlling oneself through self-monitoring, goal setting, and feedback (McAlister et al., 2008).
A previous study argued that interventions using the concepts of SCT, such as observational learning, self-efficacy, and self-regulation, were useful in developing the life skill competencies of elementary students (Bembenutty et al., 2016). Therefore, by applying the concepts of SCT, the present study included observational learning (i.e., role-playing), self-efficacy (i.e., solicit active participation in self-planning of skill development), and self-regulation (i.e., control anger through self-monitoring) to promote the life skills of elementary school children in order to modify attitude and behaviors associated with school violence. School nurses who work with children and families have an opportunity to promote healthy lifestyles by providing health education in schools because many of the problem behaviors, such as violence and alcohol and tobacco use, begin and are reinforced during childhood (Lee & Ham, 2012). Nurses employed in primary and secondary schools perform both roles of school nurses and health teachers in Korea (Korea Ministry of Government Legislation [KMGL], 2019). In particular, school nurses in Korea are encouraged to recognize and prevent school violence, and the local office of education provides in-service training in areas of school violence (Lee & Ham, 2012).
This study aimed to evaluate a 12-week life skill training program developed based on the concepts of SCT (Bandura, 1977) and incorporate the concepts of self-efficacy, interpersonal relationships, and communication with peers, which was offered to elementary school children to modify their self-regulation, peer competency, attitudes toward school violence, and experience of school violence as a victim and perpetrator.
This study was a quasi-experimental study. The participating elementary schools were recruited from a single rural community in South Korea. The schools are located near the demilitarized zone of South Korea, with 47,000 residents. In this community, agriculture is the main industry with a declining economic situation (Cheorwon-gun, 2019). A former study reported that the prevalence of peer problems and rule violations was higher among adolescents in rural areas compared to those in urban areas (Lee et al., 2018). Therefore, this study was conducted in a rural setting. The institutional review board from the authors’ affiliation approved the study.
Study Participants
Sixteen elementary schools are located within the district. All of the fifth-grade students (N = 385) enrolled in 16 elementary schools within the district were invited as potential participants. Among them, 12 schools were excluded because they had no school nurse (9 schools), fewer than 10 students in the fifth grade (1 school), or no health education curriculum (2 schools). Therefore, all the remaining elementary schools participated in the study (four schools), and interventions were offered to fifth-grade students enrolled in participating schools (N = 4). The study participants included 70 students aged between 10 and 11 years enrolled in the fifth grade of the four elementary schools located in the district. The principal investigator (PI) visited the participating schools and met with principals to obtain permission to conduct the study in their schools. The parents and students were recruited using school newsletters.
The exclusion criteria included those who were planning to transfer to another school, absent from school for more than 2 weeks, those who required special education, and whose parents did not agree to participate in the study. A total of 84 students were enrolled in the four elementary schools; 14 students were excluded based on the exclusion criteria (5 students from the experimental group and 9 students from the control group). Four schools were allocated to the experimental (n = 2) and control group (n = 2). The schools that provided health education classes in the spring semester within the school curriculum, which were delivered by school nurses, were allocated to the experimental group, whereas the schools that provided health education classes in the fall semester were allocated to the control group (Figure 1).
Power analysis was performed using G*Power Version 3.12. With a small effect size of f = 0.25 (Mun & Lee, 2015), a total of 50 students were required to achieve 90% power (α = .05) in the repeated measure analysis of variance (RM ANOVA). Considering attrition, this study recruited 70 participants.
After explaining the purpose of the study, written consent was obtained from the participating children and their parents. Confidentiality and anonymity of the participants were secured throughout the study. During data collection, children provided their nicknames instead of their real names. The participants were informed that they could withdraw from the study at any time without penalty. Students and parents were informed that participation or withdrawal from the study did not influence their school grade. Those in the control group were provided with life skills training in the fall semester after the study.
Self-reported data collection was performed using paper-and-pencil instruments on the general characteristics, self-regulation, peer competency, attitudes toward school violence, and school violence experience.
The general characteristics of the students included gender, academic performance, and economic status of the family. Academic performance (low, middle, high, and very high) and student’s subjective perception of the family’s economic status (poor, moderate, and wealthy) were measured using ordinal scales.
A 33-item Self-Control Rating Scale (SCRS) developed by Kendall and Wilcox (1979) was used to measure the level of self-regulation. The SCRS measures the level of self-control of elementary students within the school environment (Kendall & Wilcox, 1979). The SCRS has both cognitive and behavioral domains and included items such as impatience, breaking things, rules breaking, distraction, and others. The SCRS was translated and modified for use with Korean children in previous studies (Kwon, 2006; Mun & Lee, 2015). The current study used the Korean version of the SCRS (Kwon, 2006), which has 23 items in two subcategories, including self-control (11) and impulsivity (12). Example questions included “I keep my promise” for self-control, and “I have to do what I want right away” for impulsivity. The items were measured using a 5-point Likert-type scale (1 = never and 5 = always). Impulsivity questions were reverse coded, and the total scores ranged from 23 to 115; higher scores indicated more self-control. The convergent validity of the Korean version of the SCRS was verified in a previous study, and the SCRS was strongly correlated with the Korean Self-Regulation Scale (K. C. Kim & Oh, 2014; Lee, 2003). The Cronbach’s α was .85 in the former study (Mun & Lee, 2015) and .81 in the present study.
Peer competency was measured using a 15-item Peer Competency Scale developed by Park and Rhee (2002) and modified for use on elementary school children by Yoon (2007). The construct validity of the scale was verified using factor analysis and classified into three subcategories: sociability, prosocial behavior, and leadership. An example question included, “I keep good relationships with many friends.” The items were measured with a 5-point Likert-type scale from 1 = strongly disagree to 5 = strongly agree. The total scores ranged from 15 to 75, with higher scores indicating better peer competency. The Cronbach’s α was .88–.93 in the former study (Park & Rhee, 2002) and .92 in the present study.
The attitudes toward school violence were measured using a 10-item instrument developed by the Korea Commission on Youth Protection, (2004) and modified by Jang (2005). The instrument measures the attitudes toward the bully/victim of school violence, positive attitude toward school violence, and coping attitude of school violence. The items were measured using a 5-point Likert-type scale from 1 = strongly disagree to 5 = strongly agree. The total scores ranged from 10 to 50, with higher scores indicating a more positive attitude toward school violence. Example questions included, “I think teasing or beating a friend as a joke is not school violence.” A previous study verified the validity of the instrument (E. J. Kim, 2015). The Cronbach’s α was .79 in the former study (E. J. Kim, 2015) and .83 in the present study.
The experience of school violence as a bully and victim during the past 1 month was measured on a 14-item scale developed by Olweus (1986) and translated and modified for use with Korean children by the Youth Hope Foundation of Korea (2002). Example questions included “other students take away money or other things from me or hide them” for the victim question, and “I spread false rumors about others or put bad stories about others on the Internet” for a bully question. The items were measured using an ordinal scale (1 = none, 2 = once/month, 3 = 2–3 times/month, and 4 = at least 4 times a month). The total scores ranged from 7 to 28; higher scores indicated more frequent experience of bullying and being a victim. The concurrent validity was verified in a previous study, and school violence experience correlated significantly with peer nominations for bullying others (Lee & Cornell, 2010). The Cronbach’s α was .79 in a previous study (H. J. Kim & Lee, 2004) and .92 in the present study.
Life skill training intervention was developed based on a literature review, a review of previous life skill training programs, and expert consultations. The intervention was developed based on skill streaming and the SCT (Bandura, 1977; Begun, 2009). Skill streaming is a social skills training method that incorporates modeling, feedback, role-playing, and coaching (Begun, 2009). Violence prevention skills include conflict resolution and positive interpersonal relationships. The life skills program was developed considering the cognitive abilities of the participating children. Using fairy tales, fables, and role-playing, children were encouraged to understand the feelings of others and to change their perceptions and attitudes toward violence, while emphasizing the importance of sympathy and attentive listening in interpersonal relationships. Children also practiced I-message communication in a range of conflict situations.
The research team developed a 40-min weekly session program for 12 weeks. The content validity was verified with five experts, including two professors in the field of community health nursing and health education, and three school nurses who had more than 3 years of experience in school health. The intervention was modified and finalized based on the experts’ comments. The concepts of intervention included self-awareness, self-efficacy, self-regulation, communication, interpersonal relationship, and observational learning (Table 1). The intervention was 45-min classroom activities for one unit. The school nurse encouraged the active participation of the students using small group activities. The classroom activities also included problembased learning, role-playing, braining storming, discussion, game, quiz, and feedback.
The PI visited four elementary schools that participated in the study and acquired permission from the principals to conduct research in their schools. The PI also met with school nurses and homeroom teachers to explain the purpose of the study, data collection methods, and intervention. School newsletters were sent out to parents of fifth-grade students with consent forms. Students whose parents consented for their children to participate in the study and submitted written consent were included in the data collection and intervention. The life skill training program was provided as a part of the school health curriculum; thus, all students enrolled in fifth grade in the experimental group were provided the life skill training education. On the other hand, pretest and posttest data collection did not include the students whose parents did not agree to participate in the study (n = 6).
A trained research assistant visited each school and collected the pretest data before the intervention using a self-reporting method. Posttest data were collected 1 week and 3 months after the 12-week intervention. The research assistants collecting the data were blinded to the group allocation. The PI and one school nurse employed in the experimental school delivered the life skill training intervention for the children in the experimental schools. The workshop was held to train school nurses in the experimental group (interveners), and the training of school nurses was provided by the PI using the video materials and coaching guide. The classroom activities during the intervention were videotaped and shared with school nurses in the experimental group to ensure program fidelity and consistency. In Korea, all school nurses were provided with in-service training in the areas of school violence and were encouraged to recognize and prevent school violence by the local office of education. Thus, the school nurses who participated in the present study were qualified to provide the life skills intervention. Pretest data collection was performed in March 2016. Life skill training was offered between April and July 2016, and Posttests 1 and 2 were performed in July (at 1 week) and October (3 months after the 12-week intervention) 2016.
IBM SPSS Version 25.0 was used for data analysis (IBM Corp., Armonk, NY). The baseline characteristics of the experimental and control groups were compared using a χ2, Fisher’s exact, t test, or Mann–Whitney U test. The effects of life skill training intervention were analyzed using RM ANOVA with three time points (pretest, Posttest 1, and Posttest 2). Before RM ANOVA, log transformations were performed using the natural log to normalize the data if the variables violated normal distributions (Azuero et al., 2010). The two-tailed null hypothesis of no difference was rejected if the p values were < .05.
The male students comprised 37.1% of the experimental group and 45.7% of the control group. Forty-six percent and 48.6% of the experimental and control group, respectively, answered that their school records were high or very high. Thirty-four percent and 42.9% of the experimental and control group, respectively, answered that their families were wealthy. Fifty-eight percent of mothers and 52.2% of fathers obtained at least college-level education. Overall, the two groups were not significantly different in terms of the gender distribution, school record, family economic status, and education level of parents (p > .05; Table 2).
The mean peer competency score was 49.29 (SD = 12.26, range 15–75) and 52.00 (SD = 10.11, range 15–75) for the experimental and control group, respectively. The mean self-regulation score was 82.94 (SD = 10.90, range 23–115) and 85.20 (SD = 10.40, range 23–115) for the experimental and control group, respectively. Students in the experimental and control groups had a moderate level of peer competency and moderately high level of self-regulation. In the experimental group, the mean score for the experience of school violence as a victim and perpetrator was 8.43 (SD = 3.47) and 7.94 (SD = 2.83, range 7–28), respectively. In the control group, the mean score for the victim and perpetrator was 7.40 (SD = 0.74) and 7.29 (SD = 0.67), respectively. Students in both groups had a lower level of exposure to school violence, either as a victim or as a perpetrator. The two groups were similar in terms of peer competency, self-regulation, and school violence experience (p > .05). On the other hand, the attitude toward school violence was significantly different between the groups at pretest (p < .05). The mean score for the attitude toward school violence in the experimental and control group was 17.26 (SD = 5.71, range 10–50) and 14.29 (SD = 5.28, range 10–50), respectively. The experimental group had a more positive attitude toward school violence (Table 3).
Significant differences in peer competency (F = 4.17, p = .020), attitude toward school violence (F = 6.02, p = .004), violence experience as a victim (F = 3.49, p = .036), and violence experience as a perpetrator (F = 3.87, p = .026) were observed between the experimental and control groups over time. Self-regulation was not significant between the groups over time (p > .05; Table 4).
The mean scores for peer competency increased at the posttests in the experimental group, whereas mean peer competency scores decreased at the posttests in the control group. The mean scores for violence experience (victim and perpetrator) decreased at the posttests in the experimental group, whereas the mean violence experience scores increased at the posttests in the control group. Regarding the positive attitudes toward school violence, the mean score decreased at Posttest 1 but increased again at Posttest 2 in the experimental group. The mean scores for the positive attitude toward school violence increased at Posttest 1 but decreased again at Posttest 2 in the control group.
Based on the SCT, the current study provided a 12-week life skills training program on school violence targeting fifth-grade students in elementary schools and found that the intervention was effective in promoting peer competency while decreasing the school violence experience as a victim and as a perpetrator. The concept of the intervention included self-regulation, interpersonal relationship, communication skills, and observational learning through roleplaying and feedback. To the best of the authors’ knowledge, this is the first study to test the effectiveness of life skill training intervention in relation to school violence.
The pretest scores indicated that the students in this study had a moderate level of peer competency and self-regulation and had a firm and non-permissive attitude toward school violence. The students in both groups also had a lower level of school violence experience, either as a victim or as a perpetrator at pretest. Thus, there might have been a ceiling effect regarding violence experience, in that the results did not yield significant differences according to time and group. The KME (2018) conducted a survey targeting all students enrolled in Korean primary and secondary schools from 4th grade through 12th grade (3.9 million students). The results indicated that 1.3% had school violence experience as a victim.
On the other hand, the increase rate was highest in the upper grades of elementary schools compared to middle and high schools across South Korea (KME, 2018). Others also reported that the prevalence of school violence is increasing in elementary schools in Korea, despite the overall decrease in the prevalence of school violence in primary and secondary schools (Lim et al., 2018). Along with the trends of smoking initiation at a younger age, the mean age of school violence experience is decreasing because smoking and alcohol consumption are associated with violence and juvenile delinquency (Oh, 2016). Therefore, the prevention and management of school violence in elementary schools is critical for the healthy growth and development of school-age children in the physical and psychosocial domains of health.
The current study revealed significant improvements in peer competency after the intervention. Consistent with this study, previous studies reported that social skills training and nonviolent communication training programs were effective in promoting peer competency and peer relationship (M. J. Park et al., 2010; Yoon, 2007). The conceptual components of the intervention in this study included communication and interpersonal relationships. In particular, sympathy, attentive listening, I-message, and conflict resolution principle might have a positive impact on the peer competency among the students in the experimental group. The victims of school violence would have difficulty in developing positive relationships with their peers and may have feelings of alienation and anxiety because of the repeated exposure to school violence (H. J. Park et al., 2010). Therefore, as a result of the intervention, those in the experimental group may have obtained the skills needed for interpersonal relationships and effective communication, which in turn enabled them to have healthy relationships with their peers.
This study found that the intervention was effective in modifying the attitudes toward school violence at Posttest 1 (1 week after completing the intervention) in the experimental group. This is consistent with a previous study, which reported that strategies incorporated for conflict resolution, interpersonal relationships, and anger control were successful in modifying the attitudes toward school violence (Yang & Lee, 2009). The positive and permissive attitudes toward school violence may trigger school violence (Jang, 2005). Children with more positive views of violence committed more aggressive actions toward their peers (Vernberg et al., 1999). The attitudes regarding aggression are an important mechanism in the continuity of aggressive behavior, and the knowledge structure developed over a lifetime is partly responsible for the formation of the attitudes about aggression. Therefore, modifying the attitudes toward school violence would be an important intervention point for children (Vernberg et al., 1999), and improvements in the non-accepting attitudes toward school violence should be sought to decrease the number of victims and perpetrators of school violence.
The current study found that the positive attitude toward school violence increased again at Posttest 2 in the experimental group (3 months after completing the intervention) after an initial decrease at Posttest 1. The survey period may have influenced the study results. The pretest, Posttest 1, and intervention were completed during the spring semester, whereas Posttest 2 was performed in the fall semester. Therefore, the attitude toward school violence may have regressed to the baseline level during the summer vacation when the influence of school programs is minimal. In contrast, a positive attitude toward school violence increased slightly at Posttest 1, while it decreased again at Posttest 2 in the control group, despite the changes being insignificant. As described earlier, schools that provided health education classes in the spring and fall semesters were allocated to the experimental and control groups, respectively. Therefore, the fall classes of health education provided to students in the control group (period of Posttest 2) might have influenced the decreased positive attitude toward school violence in the control group.
In addition, the current study did not include parent involvement in the intervention. A previous study reported that parent involvement in the intervention was effective in promoting the self-efficacy of overweight/obese children (H. S. Kim et al., 2016). Therefore, parent involvement in the intervention, such as parent counseling and parent education, may help maintain the non-accepting attitude toward school violence during the vacation period.
The current study also found that the intervention was effective in decreasing the school violence experience as a victim and as a perpetrator. The frequency of violence experience was decreased continuously in the experimental group, whereas the frequency increased in the control group. Consistent with this study, a previous study reported that a school violence prevention program was effective in positively adjusting the bullying inclination (H. J. Kim & Lee, 2004), whereas others found that a 10-week school violence prevention education was successful in decreasing the level of verbal violence, including insults, gossip, and teasing (Tak, 2012). The national survey on school violence found that the causes of school violence were just for fun, followed in order by no special reason and misunderstanding/conflicts between peers (KME, 2018). Accordingly, components of the intervention in the present study, such as role-playing with emotions, conflict resolution, and dealing with anger, may have influenced the study results in decreasing the experience of school violence as a victim and as a perpetrator.
Despite self-regulation being one of the main concepts of SCT and is included as a main domain in the life skills training, the present study failed to generate significant results with regard to self-regulation at the posttests. The researchers showed that self-monitoring, goal setting, feedback, and social support are some of the mechanisms to achieve self-regulation (McAlister et al., 2008). Self-regulation training in the current study focused on emotional aspects including recognizing emotion and anger control. This method of approach was insufficient to promote self-regulation among the children in the experimental group. Therefore, future studies will need to include behavioral strategies for self-regulation, such as self-monitoring, self-evaluation, and rule compliance (Kendall & Wilcox, 1979).
According to previous studies, the perpetrator characteristics may include low self-esteem and self-regulation as well as high aggressiveness and impulsivity, whereas those for victims include maladjustment to school life, lack of interpersonal skills, loss of confidence, and depressive mood (Haynie et al., 2011; Na & Jang, 2013; Vassallo et al., 2014). Children exposed to continuous school violence may develop severe traumatic symptoms, such as anger, anxiety, and depression, as adults, which may lead to suicide attempts (Haynie et al., 2011; Vassallo et al., 2014). Therefore, the early detection and prevention of school violence are important for the healthy growth and development of children in terms of the physical, psychological, and social domains of health. In the development of interventions, the characteristics of the victims and perpetrators should be considered, while the intervention components should include life skills training incorporating self-regulation, peer competency, and attitudes toward school violence.
The concept of SCT posits that individual, social, and environmental factors interplay, and individual behavior is shaped under the influence of social and environmental contexts (McAlister et al., 2008). Therefore, improving the self-regulation, peer competency, and attitude toward school violence through life skills training will help modify the school environment that is conductive to preventing and eliminating school violence in elementary schools.
The limitations of the study included the use of convenience sampling methods, which may have limited the generalizability of the study results. In addition, the current study was conducted in a single geographical region; thus, interpretation of the study results may be limited to children in rural areas of South Korea. Use of a self-report method for school violence experience and other psychosocial variables may have generated a response bias, such as a social desirability bias. The unit of the analysis was a group in this study. On the other hand, the school effect was not assessed when evaluating the intervention effects because a school code was not assigned during data collection. If the school effect was included in the analysis, different results might have been yielded, and the significance of the interactions could have been tested in terms of the group by school by time. In the present study, health education was provided to the control group during the Posttest 2 data collection period (fall semester). Therefore, it might have influenced the fluctuations of the study results, particularly, the attitudes toward school violence. As another limitation, this study did not consider the violence experience and environmental factors within the family, which may have influenced the study results.
The study results provide important information on the development of interventions to prevent school violence. Based on the study results, school nurses could develop school health and education programs to decrease the level of school violence among elementary school children. In Korea, school nurses also perform the roles of health teachers (KMGL, 2019). According to the KME, the contents of health education in elementary schools should include lifestyle and health; disease prevention and management; alcohol, tobacco, and other drug use prevention; sex education; mental health; social health; and injury prevention (Lee & Ham, 2012). Therefore, violence prevention programs should be implemented as a part of a school health curriculum targeting all schoolchildren. The programs incorporating life skill training and the components of SCT, such as self-regulation, self-efficacy, interpersonal relationship, communication skills, and observational learning, could help to decrease the prevalence of school violence, either as perpetrators or as victims. The screening of school violence experience regularly will help to detect victims of school violence and enable the provision of appropriate counseling and intervention in the early stages, which will, in turn, prevent the further deterioration of physical and psychosocial health problems of both the victims and perpetrators.
Based on SCT, the 12-week life skill training program on school violence provided to fifth-grade elementary students was partly effective in promoting peer competency and attitudes toward school violence, while decreasing the school violence experience. The program aimed to promote self-regulation, self-efficacy, interpersonal relationship, and communication skills, whereas the components of the life skill training included sympathy, refusal, assertiveness, stress and anger management, and I-message communication. Multiple classroom activities were implemented during the intervention period, such as discussion, role-playing, and peer feedback. All of these elements might have influenced the study results and helped enhance peer competency and non-permissive attitudes toward school violence, but reduced the frequency of school violence experience among children in the experimental group.
Future studies will need to include parent involvement intervention, which will help sustain the effects of the program, but it will also provide opportunities to promote awareness on domestic violence. Using qualitative research methods, it is recommended to explore school violence experience targeting the victims and perpetrators of school violence, incorporating school and family environmental factors.
All authors contributed to the conception of the manuscript, prepared the drafts, gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy. Jae Yeon Lee and Ok Kyung Ham contributed to the acquisition and analysis of the data and were involved in the critical revisions of the manuscript.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ok Kyung Ham, RN, PhD, MCHES https://orcid.org/0000-0001-9063-4020
Young Ko, RN, PhD https://orcid.org/0000-0003-2708-8543
Bongjeong Kim, RN, PhD https://orcid.org/0000-0002-8344-164X
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Jae Yeon Lee, RN, PhD, is a postdoctoral researcher at Department of Nursing in the Inha University, Incheon, South Korea and a health teacher at Sejong Jangyeoungsil High School, Sejong, South Korea.
Ok Kyung Ham, RN, PhD, MCHES, is a professor at Department of Nursing in the Inha University, Incheon, South Korea.
Hyun Soo Oh, RN, PhD, is a professor at Department of Nursing in the Inha University, Incheon, South Korea.
Eun Jin Lee, RN, PhD, is an associate professor at Department of Nursing in the Inha University, Incheon, South Korea.
Young Ko, RN, PhD, is an associate professor at the College of Nursing in the Gachon University, Incheon, South Korea.
Bongjeong Kim, RN, PhD, is an assistant professor at Department of Nursing in the Cheongju University, Cheongju, South Korea.
1 Department of Nursing, Inha University, Incheon, South Korea
2 Sejong Jangyeoungsil High School, Sejong, South Korea
3 College of Nursing, Gachon University, Incheon, South Korea
4 Department of Nursing, Cheongju University, South Korea
Corresponding Author:
Ok Kyung Ham, RN, PhD, MCHES, Department of Nursing, Inha University, 100 Inha-ro, Nam-gu, Incheon 22212, South Korea.Email: okkyung@inha.ac.kr
