Story-based animation and flip-chart education improves knowledge and attitudes toward sexual violence prevention among Elementary School Students
Abstract
Background: Sexual abuse of children has long-term effects on their psychological well-being and emotional development. Primary school-aged children are particularly vulnerable because their ability to protect themselves is still limited and education prevention is not yet adequate.
Objectives: To analyze the effect of health education using a combination of animated videos and flip charts on the knowledge and attitudes of elementary school children regarding the prevention of sexual violence.
Methods: This study used a pre-experimental design with a one-group pre-post test design without control. The sampling technique used was purposive sampling with a total sample of 39 respondents. The data collection method used a questionnaire on knowledge and attitudes towards sexual violence prevention, with demonstrated axcellent content validity (I-CVI and S-CVI = 1.00) and good reliability (Cronbach’s alpha = 0.770), supported by validated video and flipchart media (I-CVI and S-CVI = 1.00). Hypothesis analysis used the Paired Sample T-Test.
Results: The average knowledge of children increased significantly from 70.26 (95% CI: 64.92–75.59) in the pretest to 94.87 (95% CI: 92.92–96.82) in the posttest (p < 0.001). Children's protective attitudes increased from 71.01 (95% CI: 66.84–75.18) to 86.77 (95% CI: 84.46–89.07) (p < 0.001). Specifically, the most notable increase in knowledge occurred in understanding the prohibition of unauthorized touching (5.1% to 97.4%), the courage to say “no” and walk away (35% to 100%), and recognition of private body parts (48.7% to 100%).
Conclusions: Health education using a combination of story-based animations and flipcharts is effective in improving primary school children’s knowledge and attitudes regarding the prevention of sexual violence. Nurses can use these materials as an educational strategy to enhance children’s self-protection skills.
References
1. Pereira C de O, Pimentel RMM, Leitão FNC, Moraes SDT de A, Maia PCGGS, Santos EV de L, et al. Sexual violence against children and adolescents taking place in schools: An integrative review. Children. 2020;7(12):1–9. https://doi.org/10.3390/children7120258
2. Salamor AM, Fadillah AN, Corputty P, Beatrix Y. Child Grooming Sebagai Bentuk Pelecehan Seksual Anak Melalui Aplikasi Permainan Daring. SASI. 2020;26(28):490–9. https://doi.org/10.47268/sasi.v26i4.381
3. (IWF) IWF. EU still hosts the most child sexual abuse material in the world [Internet]. 2023. https://www.iwf.org.uk/news-media/news/eu-still-hosts-the-most-child-sexual-abuse-material-in-the-world/
4. KPAI. Laporan Tahunan KPAI Jalan Terjal Perlindungan Anak : Ancaman Serius Generasi Emas Indonesia. 2025;
5. DP3AP2KB. Data Kekerasan Perempuan & Anak Provinsi Jawa Tengah 2025. 2025;
6. Marpaung R, Sirait S, Sitorus SR, Silaen S, Tambunan WY, Widiastuti M. Dampak Pak Terhadap Perkembangan Pada Anak Usia Sekolah Dasar. Pendidikan Sosial dan Humaniora. 2022;1(4):1–23.
7. Saracho ON. Theories of child development and their impact on early childhood education and care. Early Childhood Education Journal. 2023 Jan 1;51(1):15–30. https://doi.org/10.1007/s10643-021-01271-5
8. Kesavelu D, Sheela K, Abraham P. Stages of psychological development of child-an overview. International Journal of Current Research and Review. 2021;13(13):74–8. https://doi.org/10.31782/ijcrr.2021.131320
9. Qurotul Ahyun F, Solehati S, Prasetiya B. Faktor Penyebab Terjadinya Pelecehan Seksual Serta Dampak Psikologis Yang Dialami Korban. Al-ATHFAL: Jurnal Pendidikan Anak. 2022;3(2):92–7. https://doi.org/10.46773/alathfal.v3i2.488
10. Majebi NL, Omotayo Adelodun M, Anyanwu EC. Community-based interventions to prevent child abuse and neglect: A policy perspective. International Journal of Engineering Inventions [Internet]. 2024;13(9):367–74.
11. Nirmalasari DY. Analisis Perlindungan Hukum Anak terhadap Kejahatan Kekerasan Seksual. KONSENSUS: Jurnal Ilmu Pertahanan, Hukum dan Ilmu Komunikasi. 2024;1(4):356–67.
12. Friedman-Hauser G, Katz C. Where is the disability? A critical analysis of case reports of online sexual abuse of children with disabilities. Child Protection and Practice. 2025 Oct 1;6:1–10. https://doi.org/10.1016/j.chipro.2025.100207
13. Lätth J, Landgren V, McMahan A, Sparre C, Eriksson J, Malki K, et al. Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet. Internet Interventions. 2022 Dec 1;30:1–9. https://doi.org/10.1016/j.invent.2022.100590
14. Nation A, Pacella R, Monks C, Mathews B, Meinck F. Prevalence of violence against children in the United Kingdom: A systematic review and meta-analysis. Child Abuse & Neglect. 2023;146(July):106518. https://doi.org/10.1016/j.chiabu.2023.106518 PMID: 37944361
15. Noll JG. Child sexual abuse as a unique risk factor for the development of psychopathology: The compounded convergence of mechanisms. Annual Review of Clinical Psychology. 2021 May 7;17:439–64. https://doi.org/10.1146/annurev-clinpsy-081219-112621 PMID: 33472010
16. Sadati SMH, Mitchell C. Serious game design as research-creation to address sexual and gender-based violence. International Journal of Qualitative Methods. 2021;20:1–16. https://doi.org/10.1177/16094069211046130
17. Balante J, Candelaria D, Perez D, Koo F. Nursing students’ experiences of using flipcharts as a learning tool during the COVID-19 pandemic. Nurse Education Today. 2023;120(November 2022):105650. https://doi.org/10.1016/j.nedt.2022.105650 PMID: 36423406
18. Griffin KW, Botvin GJ, Williams C, Sousa SM. Using virtual reality technology to prevent substance misuse and violence among university students: A pilot and feasibility study. Health Informatics Journal. 2024 Oct 1;30(4):1–20. https://doi.org/10.1177/14604582241290712 PMID: 39397725
19. Abu-Ras W, Idris LB, Aboul-Enein BH. Effectiveness of Cartoons, Comics, and Animation-Based Sexual Health Promotion and Education Interventions: A Scoping Review. International Journal of Sexual Health. 2025;37(2):221–39. https://doi.org/10.1080/19317611.2024.2421882
20. Nagamatsu M, Ooshige N, Sonoda N, Niina M, Hara K ichi. Development of a program to prevent sexual violence among teens in Japan: Education using DVD video teaching materials and web-based learning. Environmental Health and Preventive Medicine. 2021 Dec 1;26(1):1–10. https://doi.org/10.1186/s12199-021-00964-y PMID: 33771099
21. Hermawan H, Wulandari MD. Flipbook (FP3SA) development to improve self protection. Advances in Social Science, Education and Humanities. 2022;662.
22. Zeyzus Johns BA, Casola AR, Rea O, Skolnik N, Fidler SK. Safe-guarding youth from online sexual exploitation in the digital era: A role for primary care. American Journal of Lifestyle Medicine. 2025 Feb 1;19(2):307–13. https://doi.org/10.1177/15598276241268236
23. Utami P, Mulyanti S, Insanuddin I, Supriyanto I. Efektivitas Media Flip Chart Dan Video Pembelajaran Dalam Meningkatkan Pemahaman Tentang Karies Gigi Pada Anak Kelas V Sd Negeri Karang Jalak 2 Kota Cirebon. Jurnal Kesehatan Siliwangi. 2021;2(2):678–83. https://doi.org/10.34011/jks.v2i2.674
24. Catahan GL, Mangulaban LP, Perez DC, Visda VBL, Tolentino JCG. BookCanBee: Revolutionizing drug education content through digital modules. Multidisciplinary Journal for Education, Social and Technological Sciences. 2025 Apr 14;12(1):29–79. https://doi.org/10.4995/muse.2025.22356
25. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. 9th ed. Philadelphia: Wolters Kluwer; 2018.
26. Dahlan S. Besar sampel dalam penelitian kedokteran dan kesehatan. 5th. Ed. Jakarta: Penerbit Salemba Medika; 2020.
27. Dahlan S. Statistik untuk kedokteran dan kesehatan. 6th Ed. Jakarta: Epidemiologi Indonesia; 2021.
28. McPherson L, Gatwiri K, Graham A, Rotumah D, Hand K, Modderman C, et al. What helps children and young people to disclose their experience of sexual abuse and what gets in the way? A systematic scoping Review. Child Youth Care Forum. 2025 Apr 1;54(2):515–44. https://doi.org/10.1007/s10566-024-09825-5
29. Kwangmuang P, Jarutkamolpong S, Duangngern P, Gessala N, Sarakan P. Promoting analytical thinking skills development in elementary school students through animated cartoons. Computers in Human Behavior Reports. 2024 Aug 1;15. https://doi.org/10.1016/j.chbr.2024.100467
30. Hayati F, Fidiawati L, Helnita, Afdal, Helminsyah. Sharia-based collaborative counseling model to prevent child sexual abuse and violence. Multidisciplinary Science Journal. 2025 May 1;7(5):1–7. https://doi.org/10.31893/multiscience.2025236
31. Avouac M Lou, Bonnetain R, Morel S, Teigné D, Hommey N, Rousseau R. Intersectoral professionals’ understanding of the prevention of sexual violence against children, their role and that of the GP: A study using semi-structured interviews: Prevention of sexual violence against children. Archives de Pediatrie. 2025 Feb 1;32(2):132–7. https://doi.org/10.1016/j.arcped.2024.11.004 PMID: 39875215
32. Liu S, Feng J, Yang Z, Luo Y, Wan Q, Shen X, et al. COMET: “Cone of experience†enhanced large multimodal model for mathematical problem generation. 2024 Jul 16;1–16.
33. Harini R. Strengthening the Role of Peer Counselors for Reproductive Health among Adolescent: From Philosophy into Practice [Internet]. 2022. https://doi.org/10.20944/preprints202206.0327.v1
34. Krisnana I, Rachmawati PD, Kurnia ID, Wahyuni L, Rithpo P. Developing a parental empowerment model to prevent health risk behaviors among adolescents in East Java, Indonesia. Jurnal Ners. 2024 May 1;19(2):188–96. https://doi.org/10.20473/jn.v19i2.54203
35. Stirling J, Gavril A, Brennan B, Sege RD, Dubowitz H, Haney SB, et al. The pediatrician’s role in preventing child maltreatment: Clinical report. Pediatrics. 2024 Aug 1;154(2):1–15. https://doi.org/10.1542/peds.2024-067608 PMID: 39034825
36. Jian OQ, Jumrah MH, Ridaryanthi M. Safeguarding generation alpha: A parental responses and digital media literacy approach for navigating the “Elsagate 2.0†crisis on youtube kids. Pena International Journal of Media [Internet]. 2025;2(1):8–32. https://doi.org/10.37934/pijmjmc.2.1.832
2. Salamor AM, Fadillah AN, Corputty P, Beatrix Y. Child Grooming Sebagai Bentuk Pelecehan Seksual Anak Melalui Aplikasi Permainan Daring. SASI. 2020;26(28):490–9. https://doi.org/10.47268/sasi.v26i4.381
3. (IWF) IWF. EU still hosts the most child sexual abuse material in the world [Internet]. 2023. https://www.iwf.org.uk/news-media/news/eu-still-hosts-the-most-child-sexual-abuse-material-in-the-world/
4. KPAI. Laporan Tahunan KPAI Jalan Terjal Perlindungan Anak : Ancaman Serius Generasi Emas Indonesia. 2025;
5. DP3AP2KB. Data Kekerasan Perempuan & Anak Provinsi Jawa Tengah 2025. 2025;
6. Marpaung R, Sirait S, Sitorus SR, Silaen S, Tambunan WY, Widiastuti M. Dampak Pak Terhadap Perkembangan Pada Anak Usia Sekolah Dasar. Pendidikan Sosial dan Humaniora. 2022;1(4):1–23.
7. Saracho ON. Theories of child development and their impact on early childhood education and care. Early Childhood Education Journal. 2023 Jan 1;51(1):15–30. https://doi.org/10.1007/s10643-021-01271-5
8. Kesavelu D, Sheela K, Abraham P. Stages of psychological development of child-an overview. International Journal of Current Research and Review. 2021;13(13):74–8. https://doi.org/10.31782/ijcrr.2021.131320
9. Qurotul Ahyun F, Solehati S, Prasetiya B. Faktor Penyebab Terjadinya Pelecehan Seksual Serta Dampak Psikologis Yang Dialami Korban. Al-ATHFAL: Jurnal Pendidikan Anak. 2022;3(2):92–7. https://doi.org/10.46773/alathfal.v3i2.488
10. Majebi NL, Omotayo Adelodun M, Anyanwu EC. Community-based interventions to prevent child abuse and neglect: A policy perspective. International Journal of Engineering Inventions [Internet]. 2024;13(9):367–74.
11. Nirmalasari DY. Analisis Perlindungan Hukum Anak terhadap Kejahatan Kekerasan Seksual. KONSENSUS: Jurnal Ilmu Pertahanan, Hukum dan Ilmu Komunikasi. 2024;1(4):356–67.
12. Friedman-Hauser G, Katz C. Where is the disability? A critical analysis of case reports of online sexual abuse of children with disabilities. Child Protection and Practice. 2025 Oct 1;6:1–10. https://doi.org/10.1016/j.chipro.2025.100207
13. Lätth J, Landgren V, McMahan A, Sparre C, Eriksson J, Malki K, et al. Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet. Internet Interventions. 2022 Dec 1;30:1–9. https://doi.org/10.1016/j.invent.2022.100590
14. Nation A, Pacella R, Monks C, Mathews B, Meinck F. Prevalence of violence against children in the United Kingdom: A systematic review and meta-analysis. Child Abuse & Neglect. 2023;146(July):106518. https://doi.org/10.1016/j.chiabu.2023.106518 PMID: 37944361
15. Noll JG. Child sexual abuse as a unique risk factor for the development of psychopathology: The compounded convergence of mechanisms. Annual Review of Clinical Psychology. 2021 May 7;17:439–64. https://doi.org/10.1146/annurev-clinpsy-081219-112621 PMID: 33472010
16. Sadati SMH, Mitchell C. Serious game design as research-creation to address sexual and gender-based violence. International Journal of Qualitative Methods. 2021;20:1–16. https://doi.org/10.1177/16094069211046130
17. Balante J, Candelaria D, Perez D, Koo F. Nursing students’ experiences of using flipcharts as a learning tool during the COVID-19 pandemic. Nurse Education Today. 2023;120(November 2022):105650. https://doi.org/10.1016/j.nedt.2022.105650 PMID: 36423406
18. Griffin KW, Botvin GJ, Williams C, Sousa SM. Using virtual reality technology to prevent substance misuse and violence among university students: A pilot and feasibility study. Health Informatics Journal. 2024 Oct 1;30(4):1–20. https://doi.org/10.1177/14604582241290712 PMID: 39397725
19. Abu-Ras W, Idris LB, Aboul-Enein BH. Effectiveness of Cartoons, Comics, and Animation-Based Sexual Health Promotion and Education Interventions: A Scoping Review. International Journal of Sexual Health. 2025;37(2):221–39. https://doi.org/10.1080/19317611.2024.2421882
20. Nagamatsu M, Ooshige N, Sonoda N, Niina M, Hara K ichi. Development of a program to prevent sexual violence among teens in Japan: Education using DVD video teaching materials and web-based learning. Environmental Health and Preventive Medicine. 2021 Dec 1;26(1):1–10. https://doi.org/10.1186/s12199-021-00964-y PMID: 33771099
21. Hermawan H, Wulandari MD. Flipbook (FP3SA) development to improve self protection. Advances in Social Science, Education and Humanities. 2022;662.
22. Zeyzus Johns BA, Casola AR, Rea O, Skolnik N, Fidler SK. Safe-guarding youth from online sexual exploitation in the digital era: A role for primary care. American Journal of Lifestyle Medicine. 2025 Feb 1;19(2):307–13. https://doi.org/10.1177/15598276241268236
23. Utami P, Mulyanti S, Insanuddin I, Supriyanto I. Efektivitas Media Flip Chart Dan Video Pembelajaran Dalam Meningkatkan Pemahaman Tentang Karies Gigi Pada Anak Kelas V Sd Negeri Karang Jalak 2 Kota Cirebon. Jurnal Kesehatan Siliwangi. 2021;2(2):678–83. https://doi.org/10.34011/jks.v2i2.674
24. Catahan GL, Mangulaban LP, Perez DC, Visda VBL, Tolentino JCG. BookCanBee: Revolutionizing drug education content through digital modules. Multidisciplinary Journal for Education, Social and Technological Sciences. 2025 Apr 14;12(1):29–79. https://doi.org/10.4995/muse.2025.22356
25. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. 9th ed. Philadelphia: Wolters Kluwer; 2018.
26. Dahlan S. Besar sampel dalam penelitian kedokteran dan kesehatan. 5th. Ed. Jakarta: Penerbit Salemba Medika; 2020.
27. Dahlan S. Statistik untuk kedokteran dan kesehatan. 6th Ed. Jakarta: Epidemiologi Indonesia; 2021.
28. McPherson L, Gatwiri K, Graham A, Rotumah D, Hand K, Modderman C, et al. What helps children and young people to disclose their experience of sexual abuse and what gets in the way? A systematic scoping Review. Child Youth Care Forum. 2025 Apr 1;54(2):515–44. https://doi.org/10.1007/s10566-024-09825-5
29. Kwangmuang P, Jarutkamolpong S, Duangngern P, Gessala N, Sarakan P. Promoting analytical thinking skills development in elementary school students through animated cartoons. Computers in Human Behavior Reports. 2024 Aug 1;15. https://doi.org/10.1016/j.chbr.2024.100467
30. Hayati F, Fidiawati L, Helnita, Afdal, Helminsyah. Sharia-based collaborative counseling model to prevent child sexual abuse and violence. Multidisciplinary Science Journal. 2025 May 1;7(5):1–7. https://doi.org/10.31893/multiscience.2025236
31. Avouac M Lou, Bonnetain R, Morel S, Teigné D, Hommey N, Rousseau R. Intersectoral professionals’ understanding of the prevention of sexual violence against children, their role and that of the GP: A study using semi-structured interviews: Prevention of sexual violence against children. Archives de Pediatrie. 2025 Feb 1;32(2):132–7. https://doi.org/10.1016/j.arcped.2024.11.004 PMID: 39875215
32. Liu S, Feng J, Yang Z, Luo Y, Wan Q, Shen X, et al. COMET: “Cone of experience†enhanced large multimodal model for mathematical problem generation. 2024 Jul 16;1–16.
33. Harini R. Strengthening the Role of Peer Counselors for Reproductive Health among Adolescent: From Philosophy into Practice [Internet]. 2022. https://doi.org/10.20944/preprints202206.0327.v1
34. Krisnana I, Rachmawati PD, Kurnia ID, Wahyuni L, Rithpo P. Developing a parental empowerment model to prevent health risk behaviors among adolescents in East Java, Indonesia. Jurnal Ners. 2024 May 1;19(2):188–96. https://doi.org/10.20473/jn.v19i2.54203
35. Stirling J, Gavril A, Brennan B, Sege RD, Dubowitz H, Haney SB, et al. The pediatrician’s role in preventing child maltreatment: Clinical report. Pediatrics. 2024 Aug 1;154(2):1–15. https://doi.org/10.1542/peds.2024-067608 PMID: 39034825
36. Jian OQ, Jumrah MH, Ridaryanthi M. Safeguarding generation alpha: A parental responses and digital media literacy approach for navigating the “Elsagate 2.0†crisis on youtube kids. Pena International Journal of Media [Internet]. 2025;2(1):8–32. https://doi.org/10.37934/pijmjmc.2.1.832
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