The Journal of School Nursing2024, Vol. 40(4) 361–371© The Author(s) 2022Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405221094282journals.sagepub.com/home/jsn
Abstract
This study aimed to investigate the effects of a violence-prevention education program using empathy (VPEP-E) on elementary school students. This quasi-experimental design examined fifth-grade students’ (a) empathy level, (b) perception of violence, and (c) permissive and negligent attitudes toward violence, using a pre- and post-test design. A total of 101 students participated: the experimental group (n = 48) received eight sessions of VPEP-E, whereas the control group (n = 53) received violence prevention education through classroom lectures. Significant differences were observed between the groups’ empathy level (t = 6.81, p < .001), perception of violence (t = 2.79, p = .006), and permissive and negligent attitudes toward violence (t = -2.21, p = .030; t = -2.02, p = .046). Thus, a school-based VPEP-E may help elementary school students. Long-term studies evaluating behavioral changes from VPEP-E implementation are needed for establishing the effects on violent behavior.
Keywordschild, education, program, school nursing, violence
In recent years, different kinds of violence such as murder, theft, and arson have increased, and when it comes to both the victims and perpetrators, school-age children are no exception (Hong, 2012). Violence is the physical force or power used against others intentionally that may cause them physical or psychological harm (Centers for Disease Control and Prevention, 2020). According to a Korean Educational Development Institute report (2017), approximately 12% of elementary school students had experienced school violence more than once, and six out of 10 perpetrators were students in the same class. School violence refers to violence that takes place in a school setting (Centers for Disease Control and Prevention, 2021). The results of the 2021 school violence survey conducted by the Korean Ministry of Education showed that the violence victim rates of middle and high school students slightly decreased (0.1% and 0.06%, respectively) in comparison to one year earlier. Simultaneously, the violence victim response rates of elementary school students increased by 0.7% as compared to the previous year (South Korea Ministry of Education, 2021). It has also been reported that over the last 10 years, the rate of violent crime has increased by 29.6% among youths (Kwon et al., 2019). Furthermore, the Korea Youth Counseling and Welfare Institute report (2021) revealed that among the youths who had witnessed school violence, 50.7% had experienced it themselves and 14.1% had participated in bullying their peers. These results indicate that elementary school students experience violence and that it is affecting a growing number of children. Like in adults, violence by school-age children may be a means of demonstrating superiority over others through force, ultimately to maintain one’s dominant position among one’s peers (Castro-Sanchez et al., 2019).
Violence has direct negative consequences, including death. A child who is a victim undergoes the negative experience as well as learning violent behavior (Castro-Sanchez et al., 2019). Students who are victims of violence suffer negative aftereffects such as depression, chronic school refusal, lower grades, and difficulty forming stable peer relationships. Therefore, violence occurring during childhood may lead to more irreducible trauma, affecting the individual’s physical, emotional, and psychological well-being (Segura et al., 2020).
Recognizing the severity of this problem, the Korean Ministry of Education implemented various programs with the aim of reducing school-age children’s violent behavior (Korean Educational Development Institute, 2017). Violent behavior in school-age children can strengthen over time, getting carried forward into adolescence as well as adulthood (Luengo-Kanacri et al., 2017). Therefore, it is necessary to control the potential development of violence, and identify factors that can prevent it, among children. Among the preventive factors related to the development of violent behavior is empathy (Castro-Sanchez et al., 2019).
Empathy is divided into cognitive and emotional aspects (Davis, 1980). Cognitive empathy is the ability to accurately learn about the thoughts of others, while emotional empathy is to know exactly the emotional responses or feelings of others. Empathy defined as understanding others’ thinking, feelings, identifying emotional states, responding effectively to the needs of others, and being congruent with others’ emotional situations or conditions (Decety et al., 2018; Mathews & Collin-Vezina, 2016; Zhai & Xie, 2015; Zych et al., 2019). Since it is a complex concept that includes all elements, regarded as a combined concept rather than a separate classification. Davis (1980) viewed empathy as a complex multidimensional concept and developed an empathy scale to measure separately for adults. However, the most widely used measure of empathy in children has characteristically combined responses to both types of items (cognitive and affective qualities) into a single empathy score (Feshbach & Feshbach, 2009).
Recent theories view empathy as a construct that represents the human capacity to understand and share others’ subjective feelings (Derksen et al., 2013). Moreover, it is considered a multidimensional concept encompassing behavioral, emotional, cognitive, moral, and relational domains (Derksen et al., 2013). The characteristics described most often in empathy deficit include a lack of awareness of others’ emotional experiences (Vachon et al., 2014). The components of empathy are an integral part of the foundation of prosocial behavior in children and, more generally, their ability to function in society (Decety et al., 2018). A low level of empathy is an important predictor of antisocial behavior, and a high level of empathy of prosocial behavior (Zych et al., 2022). These authors reported that although the correlation between empathy and prosocial and antisocial behaviors needed to be confirmed, increasing empathy contributed to preventing and reducing antisocial behavior such as violence (Zych et al., 2022). Empathy is considered a key component of treatments designed for aggressive offenders (Vachon et al., 2014), and extreme violence is strongly associated with empathy deficit. Therefore, aggressive behavior such as violence may be related to “lower empathy capabilities owing to an elevated manifestation of alexithymia” (Winter et al., 2017).
Previous studies on empathy have reported stable, increased, or decreased levels of it in an individual during their lifetime (Ebner et al., 2017). If individuals can experience empathy through both cognitive and interpersonal processes, aggressive behavior tends to decrease (Ding et al., 2020; Wilson & Ray, 2018). It has also been suggested that children can conceptually understand empathy even when they are young and do not have the opportunity to experience empathy (Wilson & Ray, 2018). Especially, the cognitive and moral development levels of fifth-grade students regarding the motives of moral actions and the value of human life, develop to the stage where they can please and help others, namely, empathize with others (Craig & Oja, 2013; Hoffman, 2000). Indeed, schoolbased violence prevention programs may develop social and emotional skills, promote interpersonal relationships, and teach emotion management, which would reduce interpersonal conflict and disruptive behaviors such as violence (Espelage et al., 2013).
However, there have been few attempts to promote empathy during the learning and teaching to prevent violence among school-age children (Wu & Kim, 2019). The two authors pointed out that empathy education at different developmental ages was likely to be more effective. Education to promote empathy is a core component of training programs, including violence prevention programs for elementary schoolchildren (Vachon et al., 2014). Accordingly, an effective strategy that leads to optimal behavior, such as violence prevention, is implementing an educational program in a school setting (Fryda & Hulme, 2015). Children in particular benefit from school-based educational programs (Pulido et al., 2015). According to Walsh et al. (2018), school is the primary place for providing children with access to official education resources. Therefore, if a violence prevention program is conducted as part of the school curriculum, it is expected to be effective.
To test the effects of a violence prevention education program using empathy (VPEP-E), Hoffman’s theory of moral psychology and development was applied—it states that humans’ moral motivation related to the behavior of doing something stems from empathy (Figure 1). This theory emphasizes the role of empathy, which provides motivation for judgement, decision-making, and action (Hoffman, 2000). For the present study, elementary school students were considered as subjects with the empathic ability to understand, accept, and communicate with other people’s perspectives, so that they could understand violence from the victim’s viewpoint. Accordingly, simulated situations suitable for their developmental level and systematically designed were utilized.
The focus of this study was to raise the students’ empathy level, which was closely connected to violence prevention through education. To achieve this, a VPEP-E was deemed necessary.
The purpose of this study was to test the effects of a VPEP-E on fifth-grade students’ (a) empathy level, (b) perception of violence, and (c) permissive and negligent attitudes toward violence.
Hypothesis 1. The experimental group (EG) receiving a VPEP-E has a higher degree of empathy as compared to the control group (CG).
Hypothesis 2. The EG receiving a VPEP-E has a higher degree of perception of violence as compared to the CG.
Hypothesis 3. The EG receiving a VPEP-E has a lower degree of permissive and negligent attitudes toward violence as compared to the CG.
This study adopted a quasi-experimental design using a pre- and post-test (Figure 2). The ADDIE (analysis, design, development, implementation, and evaluation) model was utilized to develop and evaluate the VPEP-E (The VPEP-E was developed and evaluated.
Step 1: Analysis. We identified the students’ educational needs with respect to empathy and analyzed the learning environment and students’ characteristics. In addition, a literature review on empathy related to violence identification and prevention and a review for establishing VPEP-E guidelines were conducted.
Step 2: Design. The contents, number of sessions and modules, and specific educational framework based on the ARCS (attention, relevance, confidence, and satisfaction) theory (Keller, 2012) were discussed. The aim was to motivate the students at the beginning of every session, and the contents were related to actual experiences to create interest and increase the effectiveness of the teaching. Thus, an easy-to-understand and practical educational program was designed to help the students cope with real-world situations and prevent violence, and ultimately promote their healthy growth. The VPEP-E was designed to comprise eight sessions for one experimental fifth-grade class (Table 1).
Step 3: Development. The first session’s theme was “Respect me” and it was about exploring and respecting oneself. Learning activities provided the students an opportunity to open their minds through play and take time to confidently introduce themselves to their peers.
The second session’s theme was “Discovering my strengths” and the goal was to identify and express one’s own strengths through the body. Learning activities gave the students time to discover their own strengths and to talk to their peers and compliment them on their strengths.
The third session, “Looking into my emotions,” was aimed at giving the students time to understand various emotions and express them honestly. The goal was to help them learn about different types of emotions and what they feel in different situations, how to express themselves, and how to deal with negative emotions.
The fourth session, “Welcome, is this your first time having a conversation like this?”, was for developing empathy by talking about one’s own feelings and those of one’s peers using an empathy conversation card. The game’s objective was to help the students become aware of and understand each other’s feelings and recognize what to do to empathize with others’ feelings.
In the fifth session, “How to not be deprived of a beautiful heart,” the students had time to think about what they must do to protect themselves emotionally by becoming the protagonist in a fairy tale. They had time to think about the reason why the main character changed in Tolstoy’s “The Imp and the Crust” and play-act interviewing the story’s characters virtually.
In the sixth session, “Ah! School violence,” the students learned about how to understand the feelings of friends who are bullied at school and to prevent school violence. They watched a video on school violence and learned how to understand the victim’s mind, how to seek help when such violence occurs, and how to prevent it.
The seventh session’s theme was “Lovely friendship” and it involved a reconciliation program that opened with empathy. Here, they had time to think deeply about what they could do to maintain the friendships they valued. Learning activities involved thinking about losing all of one’s friends, how to make close friends, and how to express one’s feelings to a friend one wants to reconcile with.
The final (eighth) session, “Practice beautiful sharing,” was for finding out what one could do to make their school a good school without violence. In this session, the students had time to think about what they felt after watching an educational video and what they could do to practice consideration and sharing.
The content of the lessons was reviewed in three steps. First, for VPEP-E review and verification, an expert panel including three nursing professors majoring in child health nursing and two school nurses was formed. To meet the students’ needs, the panel met four times for two hours of in-depth discussion and made modifications accordingly. Considering the reading comprehension of elementary school students, easy and concise words were used to convey the contents to them. In this way, the revised VPEP-E was formatively evaluated by 15 elementary schoolteachers; it was finalized through analysis and reflection based on their opinions.
Next, the expert panel verified the VPEP-E contents and resolved disagreements by consensus. Using a content validity index (CVI), eight experts (i.e., three nursing professors, two school nurses, and three elementary school teachers) validated each question. The CVI was found to be 0.8, suggesting an 80% agreement on all items and contents of the VPEP-E. Then, 10 Korean fifth-grade students were recruited to establish face validity—all of them confirmed that the contents were easy to understand and had a good flow. These 10 students were selected from other elementary schools and excluded from the study groups.
Step 4: Implementation. Setting and Participants. Participant recruitment was conducted using convenience sampling. Students satisfying the following selection criteria were selected those who (a) were in the fifth grade at an elementary school, (b) could communicate in Korean, and (c) could obtain their parent or legal guardian’s informed and written consent.
To calculate the appropriate sample size, the G*Power 3.1.9 (Faul et al., 2007) program was used and it showed that 42 participants were required in each group to achieve an effect size of .62 (Kim, 2016), power of .80, and a significance level of .05 for the t-test—in other words, 84 students was the appropriate sample size. Considering a dropout rate of 30% due to the pandemic situation, a total of 110 students was required.
Therefore, 110 fifth-grade students were recruited from two elementary schools and divided into two groups: experimental (n = 55) and control (n = 55). The allocation of schools as either the experimental or the control group was based on their own preference. In both cases, the schools were similar regarding the total number of students and their general characteristics including parents’ income levels. All participants belonged to the same province but resided in different districts. Due to the pandemic situation, nine students (seven in the experimental group and two in the control group) could not complete the program owing to their long absence, so the final analysis was conducted on 101 participants (Figure 2).
Data Collection. The VPEP-E was developed and applied with the aim of enhancing the participants’ empathy. Questionnaires were administered twice—the first, a week before the study, and then, one after it. Re-testing was conducted six weeks after the intervention. They were asked to complete the pre-test for measuring the four variables (empathy level, perception of violence, and permissive and negligent attitudes toward violence) one week before the study. After that, the VPEP-E was implemented for the experimental group and lectures on violence prevention were conducted for the control group. Following the intervention, both groups were administered the same questionnaires again; it took them approximately 15–20 min to complete.
Step 5: Evaluation. The participants responses to the pre- and post-test questionnaires were used to evaluate the VPEP-E’s effects. Both groups’ empathy level, perception of violence, and permissive and negligent attitudes toward violence were measured.
Self-report questionnaires with items assessing empathy level, perception of violence, and permissive and negligent attitudes toward violence were used.
Empathy: The participants’ empathy was measured using the Interpersonal Reactivity Index, originally developed by Davis (1980) and cross-culturally adapted into Korean by Ahn (2000). Davis’s (1980) instrument was comprised of 28 items and the target population was adults. In contrast, Ahn’s (2000) study used an adapted tool considering Korean socio-cultural factors and the comprehension abilities of 6th graders in elementary school. It is the most frequently used tool to measure the empathy of children in South Korea. Ahn’s (2000) tool, measures empathy at a level that elementary school children can understand (e.g., “When I see a poor person, I feel worried about that person and that I need to treat that person kindly.” or “Even if I get angry with a friend, I tend to put up with it in consideration of the friend’s point of view.”). It is comprised of 19 items, rated on a four-point Likert scale: 1 (strongly disagree) to 4 (strongly agree). The total score is obtained by adding together the scores for all items. A higher score indicates a higher level of empathy. In this study, Cronbach’s alpha for the total score was .81, suggesting the instrument’s good internal consistency.
Perception of violence: Perception of violence was assessed using an instrument originally developed by the Ministry of Education and Science Technology (2012) and cross-culturally adapted and validated in Korean by Park (2018). It includes questions about the understanding of school violence, recognition of the frequency of occurrences, perceptions of non-reporting, etc. (e.g., “If ‘B’ forcibly pulls his/her hand or clothes even though ‘A’ says he/she doesn’t like it, we should report this as school violence.” or “There is a lot of unreported bullying, and counter-measures are urgently needed.”). It is comprised of 14 items, rated on a five-point Likert scale: 1 (strongly disagree) to 5 (strongly agree). Possible scores range from 14 to 70—the higher the score, the better the perception of violence. In this study, Cronbach’s alpha for the total score was .70.
Permissive attitude toward violence: Permissive attitude toward violence was measured using the School Violence Attitude Scale developed by Park (2016). This refers to aspects such as attitudes towards victims and perpetrators and coping with school violence (e.g., “Teasing or hitting a friend for pranks is not considered violence.” or “You must not make fun of or harass others by taking advantage of their physical disabilities or weaknesses.”). It is comprised of 14 items, rated on a five-point Likert scale: 1 (strongly disagree) to 5 (strongly agree); higher scores indicate a permissive attitude toward violence. In this study, Cronbach’s alpha for the total score was .70.
Negligent attitude toward violence: Negligent attitude toward violence was measured using Im and Oh’s (2014) Korean Violent Bystander Discrimination tool. It was measured with 19 items rated on a 4-point Likert scale, with questions about the participants’ self-defense, indifference, and bystander attitudes (e.g., “Have you ever sided with or bullied the bullying student?” or “Do you tend to follow what your friends do when it comes to bullying?”). Possible scores range from 19 to 76—higher scores indicate a negligent attitude toward violence. In this study, the Cronbach’s alpha for the total score was .91.
Data were analyzed using SPSS for Windows 25.0 (IBM Inc., 2017). The participants’ demographic characteristics and questionnaire scores were described and summarized using descriptive statistics. Next, to test homogeneity between the groups, a χ2-test was performed. Finally, a t-test was carried out to compare the difference in the empathy level, perception of violence, and permissive and negligent attitudes toward violence, with a two-tailed significance level of α = .05.
IRB approval was obtained from Hallym University (IRB No. HIRB-2018-017) After the study purpose and contents and the related procedure were explained to students, those with a willingness to participate and who obtained their legal guardian’s written informed consent were recruited. In addition, it was explained that anonymity was guaranteed, they could withdraw from the study at any time and there were no disadvantages to non-participation. All participants’ legal guardians signed the consent form.
Of the 101 participants, male was 34.7% (n = 35) and female were 65.3% (n = 66). Furthermore, 77.2% (n = 78) did not have sibling(s), and most of the participants (85.1%) belonged to a nuclear family, while a few (14.9%) were part of an extended family. A majority of the participants (93.1%, n = 94) had received violence prevention education at their school. Moreover, according to the sex, there is no significant differences in the perception of violence (t = 1.294, p = .199), permissive attitudes (t = -.691, p = .491), and negligent attitudes towards violence (t = -.166, p = .868) at the pre-test. However, there is a significant difference in empathy levels (t = −3.304, p = .001), showing that females had higher empathy levels than males.
Homogeneity testing was performed to determine whether the two groups were homogeneous before implementing the intervention. There were no statistically significant differences between the groups’ general characteristics, empathy level (t = -1.66, p = .100), perception of violence (t = -0.83, p = .408), and permissive and negligent attitudes toward violence (t = 0.35, p = .727; t = 0.15, p = .881) (Table 2). Therefore, the two groups were considered homogeneous.
There were significant differences between the groups’ empathy level (t = 6.81, p < .001) including cognitive and affective aspects (t = 6.194, p<.001; t = 3.881, p<.001), perception of violence (t = 2.79, p = .006), and permissive and negligent attitudes toward violence (t = -2.21, p = .030; t = -2.02, p = .046) (Table 3). These results indicated that the VPEP-E positively affected empathy and violence perception, and negatively affected permissive and negligent attitudes toward violence in the participants.
Violence has become a major threat and challenge in modern society, including in school settings (Winter et al., 2017). This study’s distinguishing feature is that the concept of empathy (Hoffman, 2000)—humans’ motivation to engage in moral behavior—was used for elementary school students in violence prevention education. Humans are born with a capacity for empathy (Eden et al., 2017), which reduces aggression by allowing the individual to experience others’ suffering indirectly (You & Kim, 2016).
School age is a period of rapid emotional and cognitive development, while physical growth is relatively slow. Through various experiences with peer groups, cognitive and moral thinking abilities expand, and social skills are acquired (Kim & Cho, 2018). Therefore, empathy emerges very early in an individual’s development, and peer relationships and school contexts can affect individual differences in empathy (Eisenberg et al., 2016). Empathy acts as an important protective factor against the development of violent and victimization behaviors in school-age children (Castro-Sanchez et al., 2019). The VPEP-E developed for fifth-grade students can be regarded as a useful educational program for preventing violence that considers their social, cognitive, and moral development levels.
The study by Hoffman (2000), which provided the theoretical framework for the VPEP-E development, focused on empathy’s role in moral development. According to Hoffman, empathy for other people’s situations develops in the order of “egocentric,” “another’s feelings,” and “another’s life condition.” The first three of the eight sessions of the VPEP-E focused on respect for oneself, one’s strengths, and one’s emotions, to allow empathy for oneself to be prioritized before understanding others. Studies in developmental neuroscience have shown that empathy for “another’s life condition,” which is a motivation for others, is possible from the age of 10. Therefore, it is possible to understand the overall situation and welfare of others (Decety et al., 2018; Wu & Kim, 2019). Based on this point, the contents of the next three sessions (fourth to sixth) of the VPEP-E were aimed at helping the students understand and empathize with a friend’s situation.
Previous studies on school violence that used the concept of empathy (Decety et al., 2018; Ding et al., 2020; Kim & Cho, 2018; Wilson & Ray, 2018) did not focus on violence prevention but on treating aggression among and self-regulation education for elementary school students. The VPEP-E can be useful as a more active prevention strategy based on an individual’s empathy in school settings.
The VPEP-E developed in this study showed significant effects on empathy level, perception of violence, and permissive and negligent attitudes toward violence. Among the previous studies on school violence (Decety et al., 2018; Wilson & Ray, 2018; Winter et al., 2017), several have reported a significant relationship between aggression and empathy with aggression as a major influencing factor (Espelage et al., 2013; You & Kim, 2016). That is, the lower the empathy level, the more the aggressiveness and violence. You and Kim (2016) found a positive correlation between lack of emotion control (i.e., expression of aggression) and various aggressive behaviors, such as violence, in Korean fifth-grade students.
Empathy is a direct indicator of an important social and emotional abilities and is associated with low antisocial behavior and high prosocial behavior (Zych et al., 2022). Therefore, in the present study, the significant effect was verified by focusing on the improvement in empathy, which is the motivation for positive moral behavior, rather than aggression. However, two meta-analyses (Vachon et al., 2014; Zych et al., 2019) have made an important point: research is insufficient to draw clear conclusions from the link between empathy and being a cyberbully/victim and empathy’s role in aggressive behavior, nonetheless, these two studies have found and described some tendencies. Therefore, further research is suggested to build a more concrete explanation of empathy that may activate compassionate thinking and emotions focusing on its key role in violence prevention.
Furthermore, Lim et al. (2018), who conducted a study targeting elementary school students to examine the effects of a school violence prevention program, reported a significant effect on the perception of violence. The abovementioned findings demonstrate some important benefits of a school-based VPEP-E. Taken together, the present study’s findings imply that empathy education effectively decreases students’ permissive and negligent attitudes toward violence, with the understanding that violence is a harmful behavior. Further research on the relationship between violence and permissive and negligent attitudes toward it should be conducted in the future.
This study provides evidence that empathy can be cultivated and enhanced in children through educational programs and that empathic learning is a reliable approach.
To prevent school violence, the development of a program that cultivates empathy may be effective. Thus, to reduce aggressive behavior, the VPEP-E should be made part of the school curriculum that covers alternative positive behaviors.
The VPEP-E developed based on Hoffman’s theory may be a reliable resource for school nurses. School nurses are health education specialists and can apply school-based programs to prevent undesirable behaviors (Fryda & Hulme, 2015). The VPEP-E may be helpful in identifying students’ needs and developing appropriate levels of empathy to prevent violence. Based on the results of this study, it is recommended that school-based intervention programs be designed to help students develop empathy. In fact, Espelage et al. (2013) pointed out that such programs reduce aggression.
Enhancement of empathy is a component of a VPEP-E and this study may be considered especially useful for evaluating empathy training. Zych et al. (2019) emphasized that empathy programs could also enable children to become defenders. Therefore, promoting empathy-building programs through training and learning in key contexts such as school may provide students with a valuable opportunity to develop adequate strategies for social relationships (Segura et al., 2020). Thus, it can be said that the present study brings us one step closer to filling the gaps in the theory regarding empathy. Furthermore, as in this study, meticulously designed educational programs may be the basis for research and allow researchers to measure empathy and examine its effects. Therefore, it is suggested that studies using empathy be repeated with more elementary school students, and studies targeting middle and high school students be conducted as well.
The following are some of the limitations of this study First, the participants were fifth-grade students from one province in South Korea. Future studies should include students with diverse regional and ethnic backgrounds. Second, although there was no problem with the measurement instruments used, like in the vast majority of previous studies (93%), this study relied on self-reporting to measure empathy. A mixed investigation approach using both questionnaires and interviews can be used in future studies. Furthermore, measuring cognitive and affective empathy separately rather than analyzing empathy as a single score should be considered. Third, although simulated situations were designed to measure violence, there may be a gap between the questionnaire responses and real-life behavior. Thus, tools to directly observe children’s behavior should be developed. Next, the significant difference of the empathy score in the pre-test of this study implies that VPEP-E can be applied separately, according to the sex. Finally, although the results were effective, measurement was conducted only once six weeks after the intervention. To better understand the retention effects of the VPEP-E, a follow-up study is necessary.
This study contributes to enhancing knowledge of empathy’s key role in understanding violence. The effects of a VPEP-E on fifth-grade students, were as follows: significantly higher empathy and perception of violence, and lower permissive and negligent attitudes toward violence. Thus, this study highlights the importance of interventions to promote empathy for preventing violence among elementary school students.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Research Foundation of Korea, (grant number 2019R1F1A1046796).
Shin-Jeong Kim https://orcid.org/0000-0003-2582-3436
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Kyung-Ah Kang, Ph.D., RN, is a professor in the college of nursing at Sahmyook University. Dr. Kang’s research interests are in the quality of life of children and adolescents and cancer.
Shin-Jeong Kim, Ph.D., RN, is a professor in the school of nursing at Hallym University. Dr. Kim conducts research in the fields of safety and sex education of children and adolescents.
SoRa Kang, Ph.D., RN, is an assistant professor in the college of nursing at Sungshin Women’s University. Dr. Kang conducts research in the areas of adolescent obesity, NICU nursing care, children injury prevention, and nursing student education.
JungMin Lee, Ph.D., RN, is an assistant professor in the school of nursing at Hallym University. Dr. Lee is interested in the reproductive health and well-being of Korean emerging adults and has content expertise in several areas, including sexual health, risky sexual behavior, intimate partner violence, and STDs/HIV.
1 College of Nursing, Sahmyook University, Seoul, Korea
2 School of Nursing, Hallym University, Chunchon, Korea
3 College of Nursing, Sungshin Women’s University, Seoul, Korea
Corresponding Author:Shin-Jeong Kim, 1 Hallymdaehak-gil, Chuncheon, Gangwon-do, 200-702, South Korea.Email: ksj@hallym.ac.kr