Knowledge, Attitudes, Self-Efficacy of Children About Prevention of Sexual Violence Against Children

Child sexual violence is a global problem and tends to increase from time to time. The lack of knowledge, attitudes, and self-efficacy in children about the concept of sexual violence is a contributing factor to sexual violence against children. However, data on children's knowledge, attitudes, and self-efficacy regarding the prevention of sexual violence are still limited. This study aimed to describe children's knowledge, attitudes, and self-efficacy towards the prevention of sexual violence and the incidence of sexual violence in children. This research is quantitative with a crosssectional study approach. The population of this study was children aged 12-17 years in Pontianak City, with a total sample of 396 people. Proportional random sampling was used in six sub-districts in Pontianak City. Data analysis used univariate analysis in the form of percentages. The study results found that 68.9% had poor knowledge of sexual violence against children and its prevention, 55.8% were unsupportive of sexual violence, 47.5% had low self-efficacy in preventing sexual violence, and 56.6% of children had experienced sexual violence. A comprehensive intervention strategy is needed for parents as the first environment known to children to prevent sexual violence against children.


INTRODUCTION
Child sexual abuse is a subset of child sexual abuse of significant concern worldwide. 1,2 Globally, the prevalence of child sexual violence is 18% for girls and 7.6% for boys. 3 The World Health Organization (WHO) stated that one in 13 boys and five girls had experienced sexual violence. 4 The Ministry of Women's Empowerment and Child Protection noted that sexual violence against children and women reached the highest number in 2020, which was around 7,191 cases. Meanwhile, in 2020, the number of cases of violence against children and women reached 11,637 cases. In 2020, there were 348 complaints and non-complaints of cases of violence against children received by the West Kalimantan Regional Child Supervision and Protection Commission (KPPAD).
However, identifying the prevalence of sexual violence against children is problematic because this crime is often covered up and not reported (iceberg phenomenon) 5 In addition, there are inconsistencies in the definition of child sexual violence among researchers and organizations, which can lead to different results from scientific articles, reports, or even policies. Compounded by the culture of the child protection system, the legal system is not yet sensitive or developed enough to focus on this serious problem. 6,7,8,9 One of the efforts to protect children from sexual violence is increasing their awareness of the risks of this serious crime. Children are a vulnerable group, dependent, and lack knowledge about dangers and self-protection. 10 Efforts to increase children's awareness about sexual violence can be one solution to this serious problem.
Several studies focus on perceptions and attitudes towards child sexual abuse. The results show that communities in rural areas tend to have accepted attitudes towards sexual violence, and parental responses indicate that they have adequate knowledge about child sexual violence. 11,12,13 However, the majority of these studies are people aged 18 years and overparents with children under 18 years old, or representatives of the socio-legal system. 14, 15,16,17,18 Children most affected by the consequences of sexual violence experience, but their knowledge about sexual violence and its forms and prevention efforts is inadequate. 19 Child sexual abuse is the highest level of violence compared to physical violence and psychological.
To our knowledge, there is no research in Pontianak City that describes the knowledge, attitudes about sexual violence, and the incidence of sexual violence against children (aged 12-17 years). This information is crucial for considering primary prevention programs, believing that culturally speaking about sex is a topic that is less discussed because it is taboo. This study aims to describe knowledge, attitudes, self-efficacy towards preventing sexual violence, and the incidence of sexual violence in children in Pontianak City.

METHOD
This study is a quantitative descriptive study with a cross-sectional approach. The population of this study was all children aged 12-17 years (male and female) in the city of Pontianak. The sample of this study amounted to 396 people using proportional random sampling in six sub-districts in Pontianak City. The child's parents signed the informed consent. This research was conducted in June 2021 using a strict health protocol.
The instrument used is a questionnaire containing questions about knowledge and attitudes about sexual violence in children, selfefficacy in preventing sexual violence, and incidents of sexual violence experienced. Univariate descriptive analysis was used in the form of percentages. This research has received a letter of ethics review by the Health Research Ethics Commission, Faculty of Health Sciences, University of Muhammadiyah Pontianak.   This study found that most children who have low knowledge about the prevention of sexual violence tend to have low self-efficacy (60.1%) greater than those who have high selfefficacy (39.9%). Likewise, in children's attitudes about preventing sexual violence, most children who have negative attitudes tend to have lower self-efficacy in preventing sexual violence, which is greater than those with high self-efficacy (28.5%). The better a child's knowledge about sexual violence and its prevention will be followed by a stronger self-efficacy in preventing sexual violence that occurs to him. Likewise, the more positive the child's attitude towards preventing sexual violence, the stronger the self-efficacy in preventing sexual violence will also be ( Table 3). The Pearson product-moment test results obtained a p-value <0.05, meaning a positive correlation between knowledge and attitudes with self-efficacy in preventing sexual violence in children (Table 4).

RESULT AND DISCUSSION
Several previous studies support the findings of this study. There is a significant correlation between a person's knowledge and attitudes with self-efficacy. 23,24,25 The findings of this study provide an overview of the role of parents in educating children about sexual violence prevention, especially in the city of Pontianak, the capital Tisnawan MF. et al. Knowledge, Attitudes, Self-Efficacy… 151 city of West Kalimantan province, which is still not adequate. This study found that only 31.1% of children have good knowledge about the prevention of sexual violence. The role of parents is one of the factors that significantly affect the incidence of sexual violence in children. 26 Several studies have shown that inadequate parental knowledge about sexual violence. 15,20,28,29 , taboos 29 , low self-efficacy 30 , were contributing factors to the incidence of child sexual abuse. Sexual education about preventing sexual violence against children is very important from an early age. 31,32 Several previous studies have shown that early sexual education can be the primary prevention of a child's risky behavior 33,34,35 , including being a victim of sexual violence. A child who does not live with parents tends to have inadequate knowledge about sexual violence and its prevention and is at high risk of becoming a victim of child sexual abuse. 36 The presence of pornography also increases the risk. 37 Thus, children need to be equipped with the knowledge, attitudes, and skills to protect themselves from sexual violence.
Discussions on the prevention of sexual violence against children need a more comprehensive scope because sex education is part of the function and role of parents, educators, and society, which is a global problem. 38,39 It is necessary to increase children's knowledge, attitudes, and selfefficacy in preventing sexual violence through various comprehensive interventions, both from parents, schools, and the community.
Some limitations in this study, among others, the study design is cross-sectional. The causal relationship is not visible. Self-reported on the questionnaire causes memory bias and bias in response to social desires. This study can identify risk factors and develop primary prevention interventions to prevent sexual violence in children.

CONCLUSION
Children's knowledge and attitudes about sexual violence and prevention are still minimal, and self-efficacy towards preventing sexual violence in children is still low. The results of this study showed that children's knowledge and attitudes about sexual violence are significantly related to self-efficacy in preventing sexual violence. In addition, most children in Pontianak City have experienced some form of sexual violence. An intervention strategy is needed to prevent sexual violence in children from both the family and school environment.

ACKNOWLEDGMENTS
Thank you to the Ministry of Research and Technology of the Republic of Indonesia for funding this research in the applied research grant in 2021. Thank you also to all participants in this research.