The effect of educational intervention based on dramatic literature on parents of elementary schoolchildren skills in sex education

BACKGROUND: Today, one of the biggest concerns of parents is protecting their children and properly educating them about sex. The aim of this study was to determine the effect of educational intervention on parental skills in sex education on their children in elementary schools in the northwest of Tehran-Iran in 2019 based on literature. MATERIALS AND METHODS: This quasi-experimental study was conducted on 125 parents of elementary schoolchildren in the northwestern of Tehran. The data were collected by valid and reliable questionnaire. Before the intervention, two intervention and control groups filled up the pretest questionnaire; the data were collected by valid and reliable questionnaire. Before the intervention, two intervention and control groups filled the pretest questionnaire, and then the parents participated in the educational program based on dramatic literature. Two months later, the same questionnaire was completed by the control and intervention groups. Finally, the data were analyzed by regression and one-way ANOVA test. RESULTS: The results showed that there was a statistically significant difference between the mean scores of knowledge in the experimental and control groups in the posttest (P < 0.01). There was also a statistically significant difference between the mean scores of attitude in the experimental and control groups at the posttest stage (P < 0.01). There was also a statistically significant difference between the mean scores of performance based on group membership (experimental group and control group) in the posttest phase (P < 0.01). CONCLUSIONS: The findings of the study showed that educational intervention on parental skills in sex education based on the dramatic literature to their children has significant effect on parental knowledge, attitude, and performance.


Introduction
T he most vulnerable in the community are children who have the least mental awareness and background on sexuality. One of the concerns of parents is giving sex education to their children and protect them in this area. Having the insight and decision-making power to do the right thing, children are instinctively curious about sexual issues. According to an article, about 76% OF MOTHERS ARE unable to answer their children's sexual questions correctly. [1] This means about 76% of them are unable to answer a child's questions due to ignorance and lack of proper and accurate information on sexuality and how to properly transmit it to the child, lack of awareness is a problem in the path of child sexual education. These two factors prevent parents and children from communicating the truth in a principled and correct way, [2] so parents' ignorance of how to deal with this important issue and their inability to properly respond to children's questions will cause their curious children to become more curious. Including friends and unlimited social networks,which could potentially lead them to sexual issues that affect in their current and future lives. The consequences of not educating children on time are: sexual activity at an early age,unprotected sex,having multiple partners which puts young people at risks for pregnancy and venereal diseases including HIV, [3] Therefore principled teaching to parents will increase awareness strengthen insight and attitude and improve the child's performance. As a child's best mentor and then timely teaching them to raise their child's awareness, insight, attitude and behavior modification, he/she avoids child abuse in present and future life and in some cases child sexual abuse (CSA), so respond appropriately and appropriately. [4,5] A study by Wilson, Dalbert and Coe showed that parents believed in talking about sex with their children and believed that doing so could be effective, but they did not. In this work, there were a number of first obstacles. One of the obstacles was the idea of parents thinking that their children were too small and did not know how to talk to them. [6] Pre adolescence is the time for parents to transmit sexual risk prevention messages to their children before the onset of sexual behaviors. [7] Providing the child with peace and security makes the his/her aware that his or her parents are always there to respond. Although Western sex education is provided to adolescents in a variety of ways, most adolescents do not seem to have gained the necessary knowledge yet. [8] Sex is a topic that parents are afraid to tell to their children and think it will mislead them while this thinking confuses the child, and that parental hijab and confidentiality may confuse children, which is the problem. [9] One of the goals of sex education is to provide detailed information. Sexual issues cannot be ignored indifferently and avoid giving information and guidance to children and adolescents. Different verses, traditions, and decrees in Islam directly and indirectly address sexuality and its modification. Therefore, it can be concluded that this issue in Islam is essential. This problem cannot be resolved automatically over time for the individual. [10] The diversity of cultures around the world has led us to see different norms and cultures around the world and in Iran, and accordingly different values and beliefs have been formed in different regions. [11] The increase and diversity of cultures in societies to promote adolescent sexual health due to the prevalence of sexual infections has created an urgent need for health programs. [12] The aim of this quasi-experimental study was to implement educational intervention based on dramatic literature to improve the knowledge, attitude, and practice of parents in sex education, As a result of this education, they could use their skills for teaching their children in elementary schools in the northwest of Tehran in Iran.

Materials and Methods
This study is a quasi-experimental study with the aim of determining the effect of educational intervention on parental skills in sex education based on the literature presented to their children in elementary schools in the northwest of Tehran. There are 21 educational districts in Tehran, which have 1829 elementary schools and 104,000 elementary students in Tehran. They were selected by multistage cluster sampling from all the nine districts of Tehran including North, North East, North West, Center, East, West, South, South East, and South West; the Northwest territory was selected by simple random sampling method, comprising 72 boys and 65 girls in elementary schools, out of total of 137 schools, 20 schools were randomly selected, of these 20 schools, 125 parents were selected for the experimental group and another 125 for the control group.

Procedure
Two-day workshop was held for parents of the experimental groups. In this study, training on the principles of sexuality and explaining the literature of drama and how to use it in child sex education was used to increase parental sex education skills and to assess the impact of sex education on the Child Sexual Abuse (CSA) standard questionnaire in research. Chen and Chen designed the CSA to measure parental knowledge, attitude, and performance about parental skills in sex education to their children. It was reported by Cronbach's alpha method for knowledge, attitude, and practice of 0.76, 0.45, and 0.64, respectively. After obtaining permission from Khanjari et al., [13] the parents used the questionnaires once before the first training (pretest phase) and once completed 2 months after the intervention (posttest), the data were finally analyzed by SPSS software (IBM, Endicott, Newyork, USA) and using regression and one-way ANOVA tests.

Results
The present study investigated the effect of educational intervention on parental skills in sex education based on dramatic literature to their children. The intervention group was designed and implemented based on the findings of parental need assessment and the new educational method based on dramatic literature.
The mean score of knowledge of the samples in the experimental group about sex education to children after the intervention was significantly different from that of before the intervention. In this study, as shown in Table 1, there was a statistically significant difference between the mean scores of the two groups in the posttest (P < 0.01). Therefore, educational intervention has been effective on parental awareness. The effect was 65% in the posttest. The results indicated that there was a significant difference between the parents' knowledge of the experimental and control groups in the posttest [ Table 1].
In this study, the mean score of attitude of the test subjects in the experimental group on child sexual education, after the intervention, increased when compared to that of before the intervention, as shown in Table 2, between the mean scores of the two groups' attitude and test scores. There was a statistically significant difference in control at posttest (P < 0.01). Therefore, educational intervention is effective on parents' attitude. Moreover, the effect of interference on attitude was 77.6% in the posttest. The results indicate that there is a significant difference between the attitude of the experimental and control groups in the posttest [ Table 1].
In this study, the mean score of performance of the samples in the experimental group on sexual education to children after intervention increased compared to that of preintervention [ Table 1].
Most of the participants were female (67%) and 60% of them were aged above 30 years. The demographic variables are shown in Table 3. Table 2 shows the results of the univariate analysis of covariance which demonstrates the effects of group on coping strategies. As shown in Table 2, there was a statistically significant difference between the mean scores of the two experimental and control groups in the posttest (P < 0.01). Therefore, the intervention has improved the performance of parents in sex education of their children. This effect was 79.0% in the posttest. The results showed that there was a significant difference between the parents' performance in the experimental and control groups in the posttest.

Discussion
The present study investigated the effect of educational intervention on parental skills in sex education based on dramatic literature to their children. The target group intervention was designed and implemented based on the findings of parental need assessment and the new educational method based on the peer-reviewed literature. Parental awareness is effective. This finding is consistent with that of many studies. Concerning knowledge in the research, [13] the mean score of knowledge in the experimental group has almost doubled. Numerous studies have repeatedly confirmed the importance of mothers' knowledge. In a study conducted by Naghshineh et al. to investigate the effect of family variables on the level of awareness of adolescent girls about adolescent health, based on the results of a multivariate regression analysis, it was found that mothers' level of knowledge has been the strongest predictor of adolescents' awareness of puberty health. [14] On the other hand, by reviewing the total number of articles published in domestic and international journals from 1 to 2 years in one area of awareness, attitude and health performance of adolescent girls had matured, Alimoradi concluded in his research that there is a lack of research on the awareness and attitude of mothers about different aspects of sexual health. [15] On the extent of mothers' awareness of each of the posteducation awareness questions between the intervention and control groups, there was no statistically significant difference in control [ Table 3], but this difference was statistically significant when we examined the overall progression of awareness between the control and intervention groups (P < 0.001), indicating the effect of    [16] finding in 2017 on the views of Turkish mothers who had a 16 to 48 month old child and were trained in sexual abuse prevention , increased their attitude's score. The results of Bakhshi et al.'s [17] study showed that the effect of theory-based educational intervention on mothers' skills on child sexual care after the educational intervention demonstrated an increase in the attitude score of the intervention group toward the nonintervention group. The impact of sexual abuse prevention education on parents' knowledge, attitude, and practice of school-age children was consistent. In the research of Ali-Moradi and Simbar [15] on the rate of change in mothers' attitudes, there was a significant difference between the intervention and control groups. [15] There was a statistically significant difference in mothers' performance improvement between the intervention and control groups. The highlight of this study is the 5% increase in parents' willingness to provide their children with books and audio-visual resources for prevention education. The limitations of this study are (1) lack of cooperation in sex education for children despite the fact that the centers are welcomed, one of the serious limitations was this; (2) this study has only examined parents of primary schools in northwest Tehran, so generalization of results to other parents in other areas of Tehran and other cities should be done with caution; (3) participants initially tried to find the correct answer, which did not affect the accuracy of the participants' answers, but they were told not to view the questionnaires as a test sheet and to transfer only what they were doing to the questionnaire. Practical suggestions of this research are (1) professionals can incorporate dramatic literacy-style interventions into children's curriculum and textbooks, (2) future research suggests that the effectiveness of other new approaches to child sex education and other innovations be influenced by these strategies, and (3) establishment of child sex education and training centers that provide a safe and specialized environment for educators, learners, parents, and teachers with an interest in learning and education should be made possible.

Conclusions
Comparison of mean performance scores before and after the intervention showed a significant difference in the experimental group. It is suggested that future research on child sex education be explored in other new educational strategies and that interfering factors such as economic status, marital status, gender, and educational attainment be considered. Specialists can incorporate dramatic literacy interventions into children's curriculum and textbooks, as well as establish children's sex education and training homes, providing a safe and specialized environment for educators, learners, parents, and mentors. It is suggested that further research into the effectiveness of other new methods in the field of sexuality education for children and other innovations on these strategies be proposed.