EDUCATIONAL VIDEO ON PREVENTION OF SEXUAL VIOLENCE AGAINST CHILDREN FOR FAMILY CAREGIVERS: DEVELOPMENT, VALIDATION AND EVALUATIONABSTRACT
Objective: to describe the development, validation, and evaluation of an educational video on the prevention of sexual violence against children for family caregivers.
Method: Methodological study developed in three stages: 1) Development of the educational video; 2) Content and appearance validation with 22 referees; and 3) Semantic evaluation with 11 family caregivers. Validated data collection instruments were used for content and appearance validation with referees, as well as for semantic evaluation. The validation criterion was agreement above 80%, analyzed using the content validity index, binomial test and absolute frequency. For semantic evaluation, intentional non-probabilistic sampling was used.
Results: the video included elements such as concept, victim and aggressor profile, identification (child's report and signs and symptoms), forms of prevention, forms of reporting, and protection network, distributed in opening, eight scenes, and closing, with a total time of nine minutes and 35 seconds. In content validation, agreement was satisfactory, with an average content validity index of 0.99, and in appearance validation, the average content validity index was 0.83. The semantic evaluation, conducted with 11 representatives of the target audience, obtained 100% agreement for all evaluated items.
Conclusion: the video was considered valid in terms of content and appearance by the referees and understandable by representatives of the target audience, becoming a technology that can contribute to the prevention of sexual violence against children.
DESCRIPTORS:
Educational films and videos; Educational technology; Sexual Offenses; Child; Caregivers; Child maltreatment; Sexual abuse in childhood
RESUMO
Objetivo: descrever a elaboração, validação e avaliação de um vídeo educacional sobre a prevenção da violência sexual infantil para cuidadores familiares.
Método: estudo metodológico desenvolvido em três etapas: 1) Elaboração do vídeo educacional; 2) Validação de conteúdo e aparência com 22 juízes; e 3) Avaliação semântica com 11 cuidadores familiares. Para a validação de conteúdo e aparência com os juízes, bem como para a avaliação semântica, utilizaram-se instrumentos de coleta de dados validados. O critério para a validação foi a concordância superior a 80%, analisada por meio do índice de validade de conteúdo, teste binomial e frequência absoluta. Para a avaliação semântica, utilizou-se amostragem não probabilística intencional.
Resultados: o vídeo contemplou elementos como conceito, perfil da vítima e do agressor, identificação (relato da criança e sinais e sintomas), formas de prevenção, formas de denúncia e rede de proteção, distribuídos em abertura, oito cenas e fechamento, com tempo total de nove minutos e 35 segundos. Na validação de conteúdo, a concordância foi satisfatória, com média do índice de validade de conteúdo de 0,99, e na validação de aparência, a média do índice de validade de conteúdo foi de 0,83. A avaliação semântica, realizada com 11 representantes do público-alvo, obteve concordância de 100% para todos os itens avaliados.
Conclusão: o vídeo foi considerado válido quanto ao conteúdo e à aparência pelos juízes e compreensível pelos representantes do público-alvo, tornando-se uma tecnologia que pode contribuir para a prevenção da violência sexual infantil.
DESCRITORES:
Filme e vídeo educativo; Tecnologia educacional; Delitos sexuais; Criança; Cuidadores; Maus-tratos infantis; Abuso sexual na infância
RESUMEN
Objetivo: describir el desarrollo, validación y evaluación de un video educativo sobre prevención de la violencia sexual infantil para cuidadores familiares.
Método: estudio metodológico desarrollado en tres etapas: 1) Elaboración del video educativo; 2) Validación de contenido y apariencia por 22 jueces; y 3) Evaluación semántica por 11 cuidadores familiares. Para la validación de contenido y apariencia por los jueces, así como para la evaluación semántica, se utilizaron instrumentos validados de recolección de datos. El criterio de validación fue la concordancia mayor al 80%, analizada mediante el índice de validez de contenido, prueba binomial y frecuencia absoluta. Para la evaluación semántica se utilizó un muestreo no probabilístico intencional.
Resultados: el video incluyó elementos como concepto, perfil de la víctima y del agresor, identificación (relato del niño/a, signos y síntomas), formas de prevención, formas de denuncia y red de protección, distribuidos en apertura, ocho escenas y cierre, con tiempo total. de nueve minutos y 35 segundos. En la validación de contenido, la concordancia fue satisfactoria, con un índice de validez de contenido promedio de 0,99, y en la validación de apariencia el índice de validez de contenido promedio fue de 0,83. La evaluación semántica, realizada con 11 representantes del público objetivo, obtuvo un 100% de acuerdo para todos los ítems evaluados.
Conclusión: el video fue considerado válido en términos de contenido y apariencia por los jueces y comprensible para los representantes del público objetivo, convirtiéndose en una tecnología que puede contribuir a la prevención de la violencia sexual infantil.
DESCRIPTORES:
Película y vídeo educativo; Tecnología educativa; Delitos sexuales; Niño/a; Cuidadores; Maltrato infantil; Abuso sexual en la infancia
INTRODUCTION
Child abuse and sexual exploitation, considered human rights violations, are public health problems with significant consequences for global health. Sexual violence against children consists of sexual acts or games to which children are subjected by an aggressor, whether a stranger, a family friend or even a family member. These individuals take advantage of the child's vulnerability to satisfy their own desires and ambitions, to the detriment of the victim's well-being1-2.
In Brazil, from 2015 to 2021, 202,948 cases of sexual violence against children (n=83,571) and adolescents (n=119,377) were reported. In 2021, the number of notifications was the highest recorded during the analyzed period, totaling 35,196 cases3. Recent data from the "Overview of lethal and sexual violence against children and adolescents in Brazil" published by the United Nations Children's Fund (UNICEF)4 showed that from 2021 to 2023, only among the facts reported to the police, 164,199 rapes with victims up to 19 years old were registered in the country, with a significant increase in 2022 and 2023. In 2021, 46,863 cases were recorded in this age group; in 2022, the number rose to 53,906; and in 2023, it reached 63,4304.
There was a significant increase in rape cases of children and adolescents between 2021 and 2023, with a 6% growth between 2021 and 2022 and 13.8% in 2023. This increase was more pronounced among younger age groups, especially among children aged 0 to 9 years, who represented 35.8% of the victims4. These data highlight the severity of sexual violence against children, many of whom do not have the capacity to understand the violent act, making it even more difficult to protect victims and hold aggressors accountable.
Cases of child sexual violence can occur both within and outside the family. When the aggression is committed by someone who belongs to the child's family sphere, it is configured as intrafamilial; when the aggressor does not belong to the family context, it is characterized as extrafamilial5.
Confronting sexual violence against children requires efforts, especially when it involves family relationships or individuals for whom the child has affection. Thus, the phenomenon called "Secret Syndrome" becomes evident. This phenomenon encompasses the concealment of the truth about events experienced by the child, which can be reinforced by family members themselves, who, upon recognizing the aggressions committed, do not report them, or when they are directly involved. However, it is necessary to understand that sexual violence is silent, as is the child's request for help6.
It is thus perceived that sexual violence practiced against the child population can generate serious consequences. After experiencing violence, the child may present mental disorders such as anxiety, depression, and post-traumatic stress, which can lead to isolation and even suicide attempts2. This occurs due to the need for verbal accusation by the child and the lack of credibility that is often given to them. Furthermore, the consequences of disclosure may include physical and psychological threats, fear of being punished for revealing the truth, as well as guilt and denial for the aggression experienced6.
The advent of technology and virtual reality increasingly exposes children and adolescents to screens, often without proper parental supervision. As a result, the crime of sexual extortion against children has become a reality4. Characterized as a demand, under threat, for the practice of libidinous acts, with material sold or disseminated on networks directed to pornography7, sexual extortion has negative repercussions on the physical and mental health of these victims8.
Mothers, fathers, and other family caregivers, responsible for promoting care, giving attention, and meeting children's needs, play an important role in preventing and detecting cases of sexual violence in this population. However, when sexual violence occurs within the family, reports may be omitted and protection from the family is practically denied to the child5.
Nurses, indispensable professionals in perceiving physical, psychological, or behavioral signs and symptoms that indicate sexual violence, can analyze, in their assistance, the relationship that the child has with their family members and thus perceive possible signs of sexual violence, in order to make the notification5.
It is, therefore, opportune to develop strategies to prevent this harm against children, with digital technologies, such as the educational video addressed in this study, being a possibility for the acquisition of safe information by family caregivers, in order to contribute to the prevention of sexual violence against children and to report in cases where children are victimized. From the above, the objective is to describe the development, validation and evaluation of an educational video on prevention of child sexual violence for family caregivers.
METHOD
Methodological study of video construction, validation and evaluation, developed in three distinct stages: development of the educational video; content and appearance validation with referees; and semantic evaluation with family caregivers.
In the first stage, a bibliographic survey was conducted on official national and international websites on the theme, in addition to an integrative literature review, which allowed the recognition of the main signs and symptoms of sexual violence in children. The video, developed according to the methodological framework of Kindem and Musberg, followed four stages: pre-production, starting from the construction of the idea; script and storyboard elaboration for recording; production with scene selection, images, characters, and audio recording; and, finally, post-production for scene editing and synchronization with audio9.
In addition, a focus group was conducted with 16 family caregivers (mothers and grandmothers) of children between 6 and 10 years old, from a Community Peace Center [Centro Comunitário de Paz] - Compaz, located in Recife, state of Pernambuco, Brazil, to understand the knowledge demands and experiences on the theme, as well as identify the most appropriate technology, in this case, the educational video.
In the video script, constructed based on idea, conflict, characters, dramatic action, dramatic time, and dramatic unity9, adult and child voices were used, recorded in a smartphone voice recorder application, in order to make it more attractive.
In the second stage, a sample calculation of 22 referees was considered, selected according to Jasper's criteria10 (professional experience in care and teaching, specialized knowledge, academic degree, scientific publications, and awards in the area of sexual violence against children).
Initially, 30 referees were recruited on the Lattes platform through the National Council for Scientific and Technological Development (CNPq) portal. On that occasion, the "Snowball" technique was applied, in which a previously selected referee indicated another11.After reaching the sample quantity, the online form was closed for new responses.
The referees were contacted via email and received the link to the educational video via Google Forms®, in addition to the Informed Consent Form (ICF), the questionnaire for characterizing the referees and the two validated instruments: Instrument for Validation of Educational Content in Health (IVCES)12 and Instrument for Appearance Validation of Educational Technology in Health (IVATES)13.
The IVCES contains 18 questions divided into three domains: "Objectives" (purposes, goals, or aims), "Structure/presentation" (organization, structure, strategy, coherence, and sufficiency) and Relevance" (significance, impact, motivation, and interest), with responses on a Likert scale, ranging from 0 to 2: 0: disagree, 1: partially agree and 2: totally agree. For each evaluated item, there was space for suggestions of the referees12. The IVATES consists of 12 items, which evaluate the harmonization of elements that constitute the educational technology, such as colors, images, text, quantity and size of figures, with responses on a Likert scale with five options: 1: strongly disagree, 2: disagree, 3: partially disagree, 4: agree and 5: strongly agree13.
In analyzing the degree of relevance, content, and appearance validation, the items were analyzed according to the calculation of the Content Validity Index, with minimum agreement among referees of 0.80, following two forms: the I-CVI (item-level content validity index), which measures the proportion of agreement among referees for each item; and the S-CVI/Ave (scale-level content validity index, average calculation method), which calculates the average of I-CVIs11. The binomial test of the instrument items was also performed to verify the agreement ratio among referees, considering a significance level (α) of 5% = 0.05.
After content and appearance validation by referees, the third stage, semantic evaluation, was carried out. For this purpose, intentional non-probabilistic sampling was used. Eleven family caregivers were recruited in May 2023, through a printed invitation while waiting for children or performing some activity, in the same citizenship center as the focus group.
The inclusion criteria adopted were: being a mother, father, or other family caregiver of children aged between 6 and 10 years, who attended some activity at Compaz, located in Recife, state of Pernambuco, Brazil. The choice of this specific age range was motivated by the alarming increase in cases of sexual violence among children of this age3-4.
The applied instrument, composed of objective questions with "yes" or "no" answers, evaluated family caregivers' understanding of the educational video, according to the criteria of "organization" (how information was arranged), "writing style" (clear and accessible language to the public), "appearance" (distribution of information, adequacy of layout, font, and illustrations) and "motivation" (capacity for interaction, promoting interest and/or motivation of the target audience).
For the analysis of responses to the semantic evaluation criteria, descriptive statistics were applied in absolute and relative values. The Semantic Agreement Index (SAI) was used, with at least 80% agreement for "yes" responses.
The research was approved by the Research Ethics Committee of the Federal University of Pernambuco. All participants were informed about the study objectives and the right to withdraw from participating in the research at any time. Those who agreed to participate signed the Informed Consent Form (ICF).
RESULTS
The video, available athttps://youtu.be/AbkC2gU2qWg?si=pbPou85MXxFZLcsM, with a total duration of nine minutes and 35 seconds, included an opening scene; eight scenes presenting cases based on real-life situations, focusing on the disbelief of the child's report, the signs and symptoms they may manifest, the importance of family reception, education for prevention, forms of reporting, and the protection network; and a closing scene (Figure 1).
Representation of scenes from the educational video for prevention of sexual violence against children for family caregivers. Recife, PE, Brazil, 2023.
In content and appearance validation, 22 referees participated, predominantly female (n=19; 86.4%), aged between 25 and 35 years (n=11; 50.0%), mostly nurses (n=12; 54.6%), working in care and teaching (n=10; 45.4%), training time between 11 and 20 years (n=9; 41.0%), working time up to 10 years (n=9; 41%) and master's degree (n=11; 50%). The most frequent activities of referees were: previous experience in developing/evaluating educational technologies (n=15; 68.2%); publications (abstracts/articles) in the area of educational technologies (n=11; 50.0%); research in the area of sexual violence against children (n=9; 40.9%), followed by publications/abstracts in the area of sexual violence against children (n=8; 36.4%).
Regarding content validity measures, it was found that the binomial test was not significant only for the items "Interactive language, allowing active involvement in the educational process" (p-value=0.154) and "Adequate video size" (p-value=0.154). However, these items also obtained and I-CVI > 0.90, indicating agreement among referees. The S-CVI/Ave presented a value equal to 0.99 and significant p-value in the binomial test, indicating greater relevance of the instrument in relation to the reference value (0.80) (Table 1).
In appearance validation, it was found that, in all evaluated items, the binomial test was not significant (p-value>0.05), indicating that the CVI value is statistically similar to the reference value, except for the item "The illustrations are in adequate size in the educational material" (p-value = 0.048), in which the CVI value was statistically higher than the reference value (0.80).
The S-CVI/Ave was 0.83, and the binomial test for comparison with the reference value was not significant (p-value=0.166). The result, however, indicates the approval of referees, considering that the average of items presented a value higher than the reference value (0.80) (Table 2).
Chart 1 presents the main suggestions of referees and the changes made to make the video more coherent with what is proposed.
Regarding semantic evaluation, 11 representatives of the target audience participated, predominantly women (n=10; 90.9%) aged between 30 and 39 years (n=4; 36.3%), mostly mothers (n=7; 63.64%) and with high school education (n=8; 72.7%). The educational video was well understood and accepted in all evaluated aspects, presenting satisfactory results in all items (Table 3).
Evaluation of family caregivers regarding organization, writing style, appearance, and motivation of the educational video. Recife, PE, Brazil, 2023.
DISCUSSION
The educational video, developed and validated in this study, offers motivating information for learning. It presents cases that resemble the reality experienced by many children and demonstrates the relevance of perceiving the intrafamilial environment, since most episodes of sexual violence committed against children have family members as the main aggressors. When the child suffers violence in the intrafamilial environment, there may be a worsening of the psychological condition, being more severe than in the case of extrafamilial aggression, since they no longer feel safe within their own home14.
The validation process of the developed video was carried out by specialists in the addressed theme and in educational technologies, conferring more reliability and adequacy of both the information and the way it was transmitted. The recommendation that the technology, before being applied, be validated by expert referees makes the product potentially effective for the propagation of health education in addressing health problems15, in this case, sexual violence against children
Sexual abuse in childhood is used as an instrument for the sexual satisfaction of adults. The frequency and facts associated with this occurrence involve the process of seduction, imposition of power through physical and emotional force, threats and blackmail16. The developed and validated educational video presents the forms of occurrence of sexual violence and the profile of aggressors, facilitating the recognition of this act by the target population.
Child sexual abuse is defined as any act of sexual nature involving the child through physical, mental violence, imposition, and/or incitement, related to acts with or without physical contact. Physical acts may include caresses, touches, anal or genital penetration, and oral sex. Acts without physical contact generally involve pornography, exhibitionism, harassment, paraphilia/voyeurism, and/or sexual exploitation17. The research results evidence phenomena that need to be discussed, interpreted and understood by family caregivers for effective actions in combating this injury.
Moreover, this debate extends when questioning the types of violence and their relationship with public health and problems such as: high incidence rates; delay in affective, cognitive, and social development; traumas; conflict between victim and family; school dropout; risk of early pregnancy; among others16.
A study shows the severity of the high incidence of sexual abuse, the consequences of this crime and the concerns of national and international child and adolescent defense bodies, aimed at protecting and guaranteeing their rights and development conditions. Interlinked actions for child and youth prevention and protection have emerged in recent years, facilitating victims' understanding, so they can identify abuses, understand their severity, and thus seek help16.
Likewise, sexual abuse negatively impacts child development, causing diverse effects such as violence, aggressiveness, irritability, depression, social withdrawal, anxiety, stress peaks, guilt, self-destructive acts, low self-esteem, suicidal thoughts, emotional blockage, fears, sexualized conduct, and insecurities7. Regardless of whether child sexual abuse is caused by incest or not, the child victim of violence experiences a feeling of helplessness, especially when the aggressor is someone who should protect and provide security18.
The absence of adequate support often generates a deep feeling of guilt in both victims and family caregivers, resulting in continuous suffering that, in many cases, can lead to the development of mental disorders14. This guilt is amplified by society, which tends to attribute responsibility to the victim, as addressed in the educational video. The feeling of guilt experienced by the child, coupled with negligence in reporting by caregivers, significantly hinders the care process and intensifies the impact of the violence suffered.
Given this scenario, the use of educational technology directed at child care emerges as a promising strategy to provide safe information, demystify erroneous concepts, and break taboos around the theme19. Recognizing this importance, the study included the evaluation of this technology by family caregivers, who considered the educational video not only understandable but also motivating. This positive evaluation highlights the relevance of educational tools in supporting caregivers, helping them deal more informedly and effectively with the complexities of child protection19.
The family represents the child's first contact with the world, being responsible for transmitting basic knowledge, promoting social coexistence and providing experiences that can profoundly influence their life trajectory and emotional support. It is up to the family to protect and care for the child, especially in situations of violence and other evils that may harm them. Strengthening the family bond and integrating the child into a healthy environment, with care adapted to their individual needs, is fundamental20. Exposure to conflictive environments can harm child development, and living in adverse, violent conditions, or conditions that limit the child's potential, destabilizes their formation process during childhood20.
In this sense, prevention of sexual violence against children at the individual level includes developing self-regulation skills, social competence, adaptive functioning and self-esteem in children, helping them deal with stressful and traumatic situations. A welcoming family environment, characterized by supportive and affectionate relationships, is crucial to provide the necessary emotional security. Moreover, drug use prevention is an important protective factor, as substance abuse is associated with an increased risk of maltreatment. Promoting a drug-free environment and supporting caregivers' mental and physical health significantly contributes to children's protection and well-being20.
In the content and appearance validation, a relevant step to ensure appropriate information for the target audience12-13 of the thirty items evaluated by the referees, only three did not reach the expected values. Nevertheless, the video was considered adequate for involving family caregivers in combating sexual violence against children, considering the averages of evaluations of all items. Furthermore, the changes made according to suggestions of the referees contributed to improving the video.
Regarding semantic evaluation, the importance of caregivers in the process of analyzing the educational video was perceived, as this allowed a view of the interaction of this target population with the chosen educational technology. Semantic evaluation allows for a technology that is more compatible with the reality of the target population, with explanation of the theme in an adequate and comprehensible manner, aiming at the construction of knowledge and attitudes that contribute to combating sexual violence against children21.
The fact that the video does not address sociocultural factors associated with sexual violence against children, as well as the semantic evaluation having been conducted with a restricted group of representatives of the target audience, linked to a single institution, are considered limitations of the study.
CONCLUSION
The educational video on the prevention of sexual violence against children, developed based on knowledge needs and experiences of family caregivers, was considered valid by the referees in terms of content and appearance, in addition to being understandable to the target audience. The video, therefore, can be used as a strategy to promote health education directed at family caregivers, encouraging protagonism and clarifying rights and duties in combating this violation. It is advisable to conduct intervention studies utilizing the proposed technology to evaluate its efficacy in achieving the intended objectives.
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20. Austin AE, Lesak AM, Shanahan ME. Risk and Protective Factors for Child Maltreatment: A Review Curr Epidemiol Rep [Internet]. 2020 [cited 2024 Aug 19];7(4):334-42. Available from: https://link.springer.com/article/10.1007/s40471-020-00252-3.
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» https://doi.org/10.1590/1980-265X-TCE-2021-0171pt.
NOTES
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ORIGIN OF THE ARTICLE
Extracted from the dissertation - Educational video on prevention of sexual violence against children directed at family caregivers, presented to the Graduate Program in Nursing, Universidade Federal de Pernambuco, in 2023.
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Universidade Federal de Pernambuco, opinion n.º5.517.174/2022, Certificate of Presentation for Ethical Appreciation: n.º58758222.6.0000.5208.
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TRANSLATED BY
Christopher J. Quinn
