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Edutainment as A Strategy of Child Sexual Abuse Prevention: Literatur Review

BACKGROUND: Child sexual abuse is the most serious public health problem in all cultures and societies that will have an impact in the future on a lost generation. The United Nations Children’s Fund (UNICEF) estimates that around 120 million girls under 20-year old have been sexually abused. AIM: This study aimed to determine the effectiveness of preventing sexual abuse in children using an edutainment approach. METHODS: This study used an online journal database that provided free articles and journals in PDF such as Proquest, Google Scholar, Pubmed, Elsevier, and Scinapse. Literature was collected from the past 10 years, 2010– 2020, using the following keywords: Edutainment, child sexual abuse, child sexual abuse prevention, and child sexual abuse education program. RESULTS: This study examining the effectiveness of edutainment in preventing child sexual abuse showed that edutainment in preventing child sexual abuse through children’s play had succeeded in increasing awareness about sexual abuse in children and parents, as well as improving children’s self-protection skills to recognize potential situations of abuse and resist inappropriate touch requests. CONCLUSIONS: Intervention model with edutainment approach is effective for the prevention of child sexual abuse. Edited by: Eli Djulejic Citation: Aswadi A, Suriah S, Stang S, Jafar N, Ibrahim E, Amiruddin R, Syahrir S. Edutainment as A Strategy of Child Sexual Abuse Prevention: Literature Review. Open Access Maced J Med Sci. 2022 Mar 03; 10(F):141-145. https://doi.org/10.3889/oamjms.2022.7670 Keyword: Intervention model; Edutainment approach; Sexual abuse; Child *Correspondence: Aswadi Aswadi, Department of Public Health, Doctoral Student of Public Health Hasanuddin University, Makassar, Indonesia. E-mail: aswadi19k@student.unhas.ac.id Received: 22-Oct-2021 Revised: 19-Feb-2022 Accepted: 23-Feb-2022 Copyright: © 2022 Aswadi Aswadi, Suriah Suriah, Stang Stang, Nurhaedar Jafar, Erniwati Ibrahim, Ridwan Amiruddin, Sukfitrianty Syahrir Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons AttributionNonCommercial 4.0 International License (CC BY-NC 4.0)


Introduction
Child sexual abuse is the most serious public health problem facing children in all cultures and societies [1]. The United Nations Children's Fund (UNICEF) estimates that approximately 120 million girls under the age of 20 years (about 1 out of 10) have experiencing forced sexual intercourse or other forced sexual acts [2].
The prevalence of child sexual abuse worldwide by gender is that the average number of cases in females is higher than males [3]. In the United States, the number of cases of child sexual abuse is 16.3% for females and 6.7% for males. In Australia, 11% of females and 5% of males reported having experienced sexual harassment. Meanwhile, in Japan, the rate of sexual harassment in females ranged from 1.3 to 8.3%, while for males is around 0.5-1.3% [4], [5], [6]. In Indonesia, child sexual abuse is also a serious problem; nine studies investigating the prevalence of child sexual abuse in Indonesia are estimated to range from 0% to 66% [7]. Sexual abuse of children is done as persuading, forcing, or encouraging a child to do a sexual activity that is not only touching hands [8]. As for the more severe forms of harassment on children, they are sexual violence, making direct, intentional contact by touching a vitalsexual body part, or without direct contact in the form of exposure to the use of child pornography, as well as commercial sexual exploitation [8].
Many factors increase the risk of child sexual abuse, including individual, family, environmental, and social factors [9], [10]. Children with physical disabilities, mental disabilities, or other behavioral disorders are also at high risk of abuse, especially if the family does not have the socioeconomic resources to support the children [9]. In cases of child sexual abuse, the perpetrator is often a close individual with the victim, such as a close relative or even a parent [9].
Child sexual abuse has long-term consequences on physical and mental health and well-being [9]. https://oamjms.eu/index.php/mjms/index Conditions that can be experienced in adulthood include mental health disorders, anxiety, depression, low self-esteem, low academic performance, addiction to tobacco, alcohol, drugs forbidden, social phobia, post-traumatic stress disorder, and also the occurrence of interpersonal conflicts [9], [11], [12], [13], [14]. In addition, victims of child sexual abuse are at high risk of becoming victims of intimate partner violence and sexual violence in adulthood [9].
Children who are unable to protect themselves from sexual abuse are more likely to become victims. They have difficulty in identifying sexual harassment situations, denying them, and reporting them. To address this problem, several researchers have highlighted the importance of comprehensive educational programs designed to prevent children from being sexually abused [15].
At present, the most widely used strategy to prevent child sexual abuse in the western world is educating children to develop knowledge and skills [16]. Various school-based prevention programs have been developed and implemented to educate children, parents, and professionals, who have shown their effectiveness in increasing awareness of sexual harassment behavior, improving children's selfprotection skills, and reducing risk [17]. This study aimed to determine the effectiveness of preventing sexual abuse in children using an edutainment approach.

Methods
This study looked at online journal databases that provide national and international articles and journals in PDF format, such as Proquest, Google Scholar, Pubmed, Elsevier, and Scinapse. As for other sources to find references related to the topic of this research, they were namely textbooks from the library, the National Health Report. There were no restrictions on the publication date as long as the articles obtained were relevant to the research topic. However, to keep the information up to date, the information was mainly from the literature collected from the past 10 years, based on the following keyword: Edutainment, child sexual abuse, child sexual abuse prevention, and child sexual abuse education program. The systematic review process is shown in Figure 1.
Writing this literature review referred to the preferred reporting items for systematic review guidelines. The review stage was the identification of articles from the source database (identification), screening of articles based on the inclusion criteria in Table 1 (screening), selecting all articles that meet the inclusion criteria (eligibility), and determining the articles that meet the inclusion criteria (eligibility). The total number of articles obtained was seven articles. Table 2 shows that there are seven articles that examine intervention methods that can be used to deal with child sexual abuse by putting the message of education in an entertaining context. The research sample is elementary school age children, namely, 6-12-year old and involves the children's parents. The variables used are perception, awareness, selfprotection skills, knowledge, skills, and attitude, knowledge and self-protective behaviors, courses of action and self-protective skills of the children, anxiety, and touch aversion. Given the high prevalence of child sexual abuse, research attention should be directed to preventing child sexual abuse [18]. To protect children from sexual abuse and encourage victims to seek help and treatment, it is necessary to raise awareness of the phenomenon. One of the efforts to raise awareness is education through the media because children are regular consumers of various forms of media [19]. Edutainment is a communication strategy to influence attitudes and behavior through the use of media [19]. Edutainment is used to communicate sensitive topics that are difficult to discuss, such as sex [25], [26]. Edutainment has two defining features. First, educational messages intend to influence the attitudes and behavior of respondents. Second, the educational message is embedded in an entertaining narrative. Thus, respondents are expected to be  persuaded in a pleasant way rather than by dictating or preaching [27]. Several studies have revealed that edutainment effectively influences awareness, knowledge, attitudes, and behaviors related to health [19], [26], [28], [29]. Studies examining the effectiveness of edutainment on the prevention of sexual abuse in children show that preventive edutainment of sexual abuse of children through children's play has succeeded in increasing awareness about sexual abuse among Israeli parents and their children [19].

Results and Discussion
Research conducted in China using picture books to prevent child sexual abuse and improve children's self-protection skills showed that children in the experimental group significantly improved their ability to recognize potentially abusive situations and resist inappropriate touch requests [28]. Edutainment provides a pleasant learning experience, positively influences behavior [30], and can be considered a practical educational approach for children under 7 years of age who process information, especially with perceptual features such as size, shape, and color [31]. These qualitative study findings indicated that parents from low socioeconomic subgroups from the secular sector reported their awareness had been raised by viewing the play and that they received tools for holding a conversation.
We recommend that future studies observe different parents' views regarding how they hold conversations that involve sexual discourse over a longer period.
Perception, awareness 2 Preventing child sexual abuse using picture books: The effect of book character and message framing This study aimed to investigate whether and how a picture book preventing child sexual abuse can improve children's self-protection skills.

5-to 6-year-old children. Experimental groups
Results suggested that the prevention picture books were more effective when using a human character and a gainframed message. The explanation for this was that human characters simulated children's perceived norm and gainframed messages increased children's message recall, perceived self-efficacy, and positive attitude toward the message, all of which in turn positively affected children's self-protection skills.
Future research may seek to understand parents' perceptions of CSA-prevention picture books targeting young children and examine the effectiveness of the books instructed by parents. Additionally, as most picture books for children contain a reading guide for parents, the reading guidance could be an important future data source for analysis to find out what key messages should be provided to parents.
Self-protection skills. 3 Preventing child sexual abuse: body safety training for young children in Turkey The "Body Safety Training Program" was an education program aimed at ensuring children were informed about their bodies and acquire selfprotection skills This study focused on 5-and 6-year old children. Quasiexperimental design "Body Safety Training program" effectively increased knowledge, skill, and attitude toward personal safety in the children. However, as the children were not observed longitudinally, it cannot be undisputedly stated that the BST program prevents CSA [20] One way to ensure children are protected against CSA is to include BST programs in the preschool curriculum.
It is recommended that the information and the training about the program are provided to all professionals working with children, parents, the public, and related public institutions.
Knowledge, skill, and attitude 4 A serious game for child sexual abuse prevention: An evaluation of orbit The study evaluated the impact of complementary classroom lessons and part completion of the Orbit game.
Children were aged 8-10 years. A randomized control trial Children in the orbit play and lesson groups were significantly (p < 0.001) increased their CKAQ SF scores, while those in the control group did not. Furthermore, those children who completed all of the Orbit significantly (p < 0.001) increased their post-test CKAQ scores, whereas those who did not complete the game did not [21] Resources need to be incorporated into the school curriculum, providing more exposure to prevention concepts, attitudes, and beliefs. The SAP_MobAPP program improved recognition (awareness) and the child's skills to avoid child sexual abuse situations, long-lasting effects. However, differences between groups were not statistically significant. This study developed a sexual abuse prevention application and verified its effectiveness. After app education, awareness and skills to avoid child sexual abuse increased immediately after training and 4 weeks later [22].
Research on a larger scale is needed to confirm the effect of the SAP_MobAPP, and the development of a personalized SAP education program for upper primary school students is suggested.

Awareness and skills 6
Effects of the child sexual abuse prevention education (C-SAPE) program on south Korean fifth-grade students' competence in terms of knowledge and self-protective behaviors The present study aimed to implement the school-based C-SAPE program to empower the children by providing competence in terms of knowledge and self-protective behaviors related to CSA Fifth-grade elementary school students from three schools in Chuncheon City, South Korea. A quasiexperimental study used a pre-/posttest design and included a control group C-SAPE program possible effective in improving self-protection behavior of elementary school students related to sexual harassment [23].
The content of the sexual educational intervention needs to be linked and incorporated into the school curriculum. In this study, the C-SAPE program was conducted only with elementary school students. Future studies should include teachers and parents as well.
Knowledge and self-protective behaviors 7 Effectiveness of a schoolbased intervention to prevent child sexual abuseevaluation of the German IGEL program This paper aimed to present the evaluation results of a school-based prevention program for primary school children in Germany.
Children and their parents. This study was conducted using a quasi-experimental design The results demonstrated increased CSArelated knowledge and courses of action in children from the intervention group compared to the control children. These effects were medium-sized and sustained for at least three months after the last session. No meaningful adverse side effects were detected in the evaluation for either the children or parents [24] The IGEL program can be seen as an important step in developing such a comprehensive approach because the children and their teachers have been involved, and their parents and the whole school staff.
Knowledge, courses of action and selfprotective skills of the children, anxiety and touch aversion https://oamjms.eu/index.php/mjms/index The effectiveness of edutainment rests on the premise that its behavioral recommendations are not considered didactic but interesting. In other words, edutainment provides a fun learning experience. The positive effects generated when processing entertainment content can easily be transferred to the recommended behavior and lead to a positive response to the behavior [30].

Conclusions
The intervention model with an edutainment approach, which is applied in several countries, provides an overview of a model that can be developed to deal with child sexual abuse by inserting the message of education into an entertaining context.