|Year : 2019 | Volume
| Issue : 1 | Page : 1-7
Knowledge, awareness, and attitude about sexual harassment among saudi preparatory and secondary school students in Western Region, Kingdom of Saudi Arabia
Mamdouh Kamal Zaki1, Rawan Maatouk Kheimi2, Azhar Muslim Aljohani3, Shaher Odah Aldadi4, Marwah Mohammad Amen Fallatah2
1 Department of Forensic Medicine, Forensic Medicine Center, Jeddah, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
2 Medical Researcher, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
3 Preventive Medicine Resident, Al Madinah Residency Program of Preventive Medicine, King Faisal Hospital, Makkah, Kingdom of Saudi Arabia
4 Internal Medicine Resident, Internal Medicine Residency Program, King Faisal Hospital, Makkah, Kingdom of Saudi Arabia
|Date of Submission||17-Aug-2019|
|Date of Decision||31-Oct-2019|
|Date of Acceptance||23-Dec-2019|
|Date of Web Publication||21-Jul-2020|
Mamdouh Kamal Zaki
2502-Al-Faisaleyah District, Zip Code 23442, Additional Number 8859, Jeddah
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Sexual harassment among school students is a critical public health issue associated with considerable physical and psychological consequences. In Islamic countries, the issue is more problematic because most of the victims would not report their harassment for fear of social stigma. Aim of Work: The current work aims to assess knowledge and attitude toward sexual harassment among middle and secondary school Saudi students in Makkah, Jeddah, and Al-Madinah in the Kingdom of Saudi Arabia. In addition, the study aims to promote awareness about the knowledge of sexual harassment among selected study group. Subjects and Methods: This descriptive cross-sectional study was conducted in the three cities based on educational administration official approval in the period of 3 months from January to March 2018. Ethical approval was obtained from the Ministry of Education's general departments of education in Makkah, Jeddah, and Al-Madinah, and informed consent forms were offered for all participants' guardians before conducting it. Data were collected through a predesigned validated self-administered face-to-face questionnaire of six questions. The questionnaire was distributed to almost 27,000 students at schools addressing questions about sexual harassment. The research team presented a prequestionnaire presentation to define sexual harassment before participation. Results: Among 27,636 respondents, 38% and 35% reported that media and friends' experience were the source of sexual knowledge, respectively. Age, gender, and residency were significant determinants of the level of knowledge about sexual harassment.Conclusion and Recommendations: There is a significant lack of knowledge and awareness about sexual harassment among Saudi students. Health-care, media, and social authorities are highly recommended to adopt new health education strategies that target those vulnerable students as well their parents, to improve their knowledge about sexual harassment, and to modulate their attitudes toward this problem whenever happened. A nationwide survey is needed to assess the whole problem.
Keywords: Al-Madinah, awareness, Jeddah, knowledge, Makkah, Saudi Arabia, sexual harassment
|How to cite this article:|
Zaki MK, Kheimi RM, Aljohani AM, Aldadi SO, Amen Fallatah MM. Knowledge, awareness, and attitude about sexual harassment among saudi preparatory and secondary school students in Western Region, Kingdom of Saudi Arabia. Saudi J Forensic Med Sci 2019;2:1-7
|How to cite this URL:|
Zaki MK, Kheimi RM, Aljohani AM, Aldadi SO, Amen Fallatah MM. Knowledge, awareness, and attitude about sexual harassment among saudi preparatory and secondary school students in Western Region, Kingdom of Saudi Arabia. Saudi J Forensic Med Sci [serial online] 2019 [cited 2020 Aug 5];2:1-7. Available from: http://www.sjfms.org/text.asp?2019/2/1/1/290349
| Introduction|| |
Exposure to sexual harassment or abuse, particularly among school students, is a major public health issue owing to its potential negative impact on the students' physical and mental health. Exposure to sexual abuse is known to increase the risk of the victims to depression, violence, substance abuse, and various psychological comorbidities. Sexual harassment is common among children and students, and a meta-analysis conducted in 2009 in 22 countries (from America, Europe, Asia, and Africa) reported a mean prevalence of 13.9% among students. Data from the Middle (preparatory) East are scarce. A report from Turkey in 2006 stated that 13.4% of female students were exposed to sexual abuse. In Kuwait, the prevalence was reported to be 15.3% among school students in 2012. A small cross-sectional study carried out in Saudi Arabia in 2008 on 45 female students reported that 10% of them were exposed to sexual abuse. A larger study that was conducted among 16,010 students between 15 and 18 years of age found that 65% were psychologically abused, 50% were physically abused, and 10% reported sexual abuse.
In an Islamic country like Saudi Arabia where sexual abuse is religiously prohibited, victims of sexual abuse may not report their abuse for fear of bad reputation and social stigma, particularly if they were young students. Sexual abuse in Islamic countries is considered a critical issue that may not be self-reported to responsible authorities and forensic bodies. Victims would tend to conceal the event of sexual abuse and subsequently will be prone to depression, violence, or even suicide.,
Furthermore, both school educators and the vast majority of parents fail to provide adequate scientific knowledge regarding sexual abuse for young individuals. Schools in Saudi Arabia are deficient in education programs about sexual health, and teaching self-protection from sexual assault might be the first introduction to the children about this issue.,
In a recent study, the participants mentioned the bullying or physical violence in Saudi Arabia and importance of communication between family members to decrease child maltreatment.
Thus, it was fundamental to conduct a large-scale population survey to study the prevalence of sexual harassment among Saudi students and to explore their awareness and knowledge about sexual abuse. To the best of our knowledge, there is no large-scale population study in Saudi Arabia that was carried out to address this potentially critical issue. Hence, the aim of this research was to assess knowledge and attitude toward sexual harassment and to create awareness among middle and secondary school students in Makkah, Jeddah, and Al-Madinah in the Kingdom of Saudi Arabia (KSA).
| Subjects and Methods|| |
- This is a descriptive cross-sectional study conducted at selected middle and secondary schools in Makkah, Jeddah, and Al-Madinah based on educational administration official approval in the period of 3 months from January to March 2018.
- The target population: Students in all levels (from the first, middle, to third secondary year) who accepted to participate in the study from both sexes
- The exact number of all students in all middle and secondary public schools was obtained from official websites of related General Departments of Education (www.medu.sa, ww.makkah.gov.sa/page/makkah, www.makkah.gov.sa/page/jeddah)
- Online sample size calculator (www.surveysystem.com/sscalc.htm) was used to calculate the sample size of the study and was found to be approximately 27,000 students [Table 1].
|Table 1: Sample size of the studied groups in Makkah and Al-Madinah Provinces, 2018|
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- Inclusion criteria: Saudis, students in middle and secondary public schools
- Exclusion criteria: Non-Saudi, students in Quran recitation schools.
- Ethical approval was obtained at Taibah Medical College Ethical Committee, Al-Madinah
- Official approval was obtained from each of the General Departments of Education, Ministry of Education, in the three regions. The corresponding departments selected the participating schools representing different regions in each city.
- Informed consent was offered for all participants guardians before conducting the survey as most of the students were less than 18 years old after explaining the aim and nature of the study.
Data collection tool
- Data were collected through a predesigned self-administered face-to-face questionnaire
- The validity and reliability of the questionnaire were tested through a pilot study, in which fifty students from all levels were randomly selected to explore if there is any ambiguity or items leading to misunderstanding in the questionnaire in order to reach its current final form.
- Nearly fifty medical students, from the 5th and 6th years in corresponding cities, distributed the questionnaire to approximately 27,000 students at selected schools. As data collectors and active field members, they received a lecture from the authors in areas related to ethical conduct, confidentiality protection, performing of anonymous questionnaire, methodology and aim of the current study.
- An introductory ten-minutes pre-questionnaire presentation was presented by data collectors to students to define sexual harassment, followed by questionnaire administration.
- Social supervisors in the involved schools were invited to provide postquestionnaire awareness and clarifications of misnomers for some forms of harassment
- Participants were allowed to withdraw from the study if they chose not to continue without any consequences
- Postquestionnaire Ministry of Health pursue for harassment awareness (in the form of descriptive flyers) was distributed to all participants to ensure the proper delivery of needed information and conveying proper modes of reporting to authorities.
Data analysis was carried out using statistical package for the social sciences (IBM SPSS®, IBM Corporation, USA). Descriptive analysis were expressed as frequency, percentages and standard deviations. Categorical variables were tested using Chi square and Student's t test.
| Results|| |
The response rate was 99.4% from all the 27,000 distributed questionnaires. The participants from middle and secondary schools were nearly equal as they represented 49.8% and 50.2%, respectively. In addition, the sample was almost even distribution between both sexes as shown in [Table 2].
|Table 2: Sociodemographics, knowledge, and attitudes of all participants|
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As for residency, 34.6%, 32.9%, and 32.5% of the respondents were from Jeddah, Makkah, and Al-Madinah, respectively [Table 2]. Regarding the educational level, students at first-, second-, and third-grade middle schools constituted 12.5%, 21.4%, and 16.1% of the sample, respectively. First-, second-, and third-grade secondary school students constituted 15.1%, 17.2%, and 17.9%, respectively [Table 2].
Studying the students' knowledge and awareness about sexual harassment, the vast majority reported that the scientific papers (38.7%) and their friends' experience (35.2%) were their main sources of information. On comparing data from the three studied cities and among all studied groups [Table 2] and [Table 3], the source of knowledge about sexual harassment was significantly different. Students in Al-Madinah reported that they got information mainly from scientific papers (58.81%), whereas students in Jeddah and Makkah got their information mainly from their friends (51.88% and 46.44%, respectively) (P < 0.001). Students' age was a significant determinant for the source of knowledge about sexual harassment. For instance, it was obvious from the results that the higher the age, the more the percentage of students getting information from scientific papers (44.4% of students aged 14–18 years and 71.3% of students aged above 18 years). Gender was another determinant of the source of knowledge. Of note, females were more likely to get their knowledge from friends (38.9%), whereas males were more likely to get information from scientific magazines (59.8%) (P < 0.001).
|Table 3: Sociodemographics, knowledge, and attitudes among participants according to their city of residency|
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Knowledge of all three major categories of sexual harassment came first among both sexes at all ages and for all residencies, followed by sexual, verbal, and nonverbal forms (11.6%, 8.7%, and 4.7%, respectively) [Table 2], [Table 3], [Table 4]. Choice of others revealed the need for clear definitions of types and subtypes of harassments as many of the mentioned types were other names for the major types.
|Table 4: Sociodemographics, knowledge and attitudes among participants according to their age groups|
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Astonishingly 47.66% of the respondents gave no response for whether they should tell their parents if they were exposed to harassment or not, whereas 41% of the respondents thought they could not tell their parents. Al-Madinah respondents were the highest by 92.6% refusal to inform their parents, 87.8% of them attributed that to their ignorance of the problem's magnitude, whereas 82.66% saw that harassment should be reported to authorities of which 37.9% thought that reporting to authorities is by calling police at 999 [Table 2] and [Table 3].
| Discussion|| |
To the best of our knowledge, this is the first large-scale population study conducted in Saudi Arabia to explore knowledge and awareness of middle and secondary school students about sexual abuse in three of the largest cities in KSA (Jeddah, Makkah, and Al-Madinah).
The results from this study showed a significant lack of knowledge and awareness about sexual harassment among Saudi students and a generally negative attitude toward this issue. For instance, more than one-third of the studied students (35.2%) were getting their information from their friends. This was evident among female students from Jeddah and Makkah. This is of particular importance to health-care authorities, and it prompts the necessity of an urgent implication of a health education program that targets these populations. Older male students in Makkah seemed to be more aware of sexual abuse and to have a correct source of information about this issue unlike many of the middle (preparatory) students.
Students in Eastern countries unlike those from developed countries get their knowledge about sex and sexual harassment from school and parents.,, Watanabe et al. in their study of Vietnamese high school students, they reported that the main sources of information about sex were school (62%) parents (37%).
On the contrary, reports from different countries like India, Iran, and China stated that friends, internet, and siblings were the main sources of sexual knowledge among students.,,,, The results of the current study were different, and Saudi students got their information from friends, magazines, and less likely media. Parents did not seem to be a source of information about this important issue.
Moreover, 11% of the students reported that they would confess exposure to sexual harassment to their parents. This result is very critical because it reflects a significant lack of communication between the students and their parents and the need for attitude change and modification. Such a result may be attributed to the fact that parents in KSA and different Islamic countries set cultural prohibitions on discussing sexual-related issues and harassment is considered a stigma. Educational programs should be primarily targeted toward parents to transfer their knowledge to their children and overcome the notable lack of knowledge among Saudi students., A more recent study concluded that qualitative research on violence is sorely lacking in the Arab region, including research on norms and attitudes, behavioral patterns, gender, and culture. Ethics and safety of researching violence against children and adolescents in the Arab region also deserve more attention.
Moreover, the results of this study threw light on importance of raising scientific-educational campaigns on sexual harassment knowledge and awareness. In addition, it was noted that the source of knowledge gained varied significantly among cities. Al-Madinah students were the most likely to receive information from media and scientific sources, whereas students from Jeddah and Makkah had their knowledge mainly from friends. This is important when considering implying health education problem because, despite the necessity of adopting an extensive health education program in all cities, health-care authorities should also be aware that in Makkah and Jeddah, the educational programs are fundamental.
| Conclusion|| |
The results of this study revealed a significant lack of knowledge and awareness about sexual harassment among school students in Saudi Arabia, associated with a negative attitude toward reporting or confessing the harassment.
Age, gender, and residency were significant determinants of the level of awareness and the variable attitudes toward sexual harassment.
Health-care, media, and social authorities are highly recommended to adopt health education strategies as illustrated posters, pursuers, and organization of media events that target those vulnerable students and their parents to improve their knowledge about sexual harassment, to modulate their attitudes toward this problem, and to change the parents' cultural prohibitions on discussing sexual-related issues.
Improvement of national antisexual harassment policy is highly recommended, according to the needs of different age groups, as discussed in the current work. It is necessary to expand quantitative and qualitative research on sexual harassment. A nationwide survey is needed to assess the whole problem in different regions, to measure the needed psychological, to evaluate the progress of social support services, and to adopt social change culture toward reporting of these events and dealing with its consequences.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Alikasifoglu M, Erginoz E, Ercan O, Albayrak-Kaymak D, Uysal O, Ilter O. Sexual abuse among female high school students in Istanbul, Turkey. Child Abuse Negl 2006;30:247-55.
Pereda N, Guilera G, Forns M, Gómez-Benito J. The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clin Psychol Rev 2009;29:328-38.
Al-Fayez GA, Ohaeri JU, Gado OM. Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: Association with family characteristics, anxiety, depression, self-esteem, and quality of life. Soc Psychiatry Psychiatr Epidemiol 2012;47:53-66.
Al-Quaiz AJ, Raheel HM. Correlates of sexual violence among adolescent females in Riyadh, Saudi Arabia. Saudi Med J 2009;30:829-34.
Al-Eissa MA, Saleheen HN, AlMadani S, AlBuhairan FS, Weber A, Fluke JD, et al
. Determining prevalence of maltreatment among children in the kingdom of Saudi Arabia. Child Care Health Dev 2016;42:565-71.
Joiner TE Jr., Sachs-Ericsson NJ, Wingate LR, Brown JS, Anestis MD, Selby EA. Childhood physical and sexual abuse and lifetime number of suicide attempts: A persistent and theoretically important relationship. Behav Res Ther 2007;45:539-47.
Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Med 2012;9:e1001349.
Alquaiz AM, Almuneef MA, Minhas HR. Knowledge, attitudes, and resources of sex education among female adolescents in public and private schools in central Saudi Arabia. Saudi Med J 2012;33:1001-9.
AlQuaiz AM, Kazi A, Al Muneef M. Determinants of sexual health knowledge in adolescent girls in schools of Riyadh-Saudi Arabia: A cross sectional study. BMC Womens Health 2013;13:19.
Al-Eissa MA, ElChoueiry N, AlBuhairan F, Saleheen HN, Almuneef MA. Child maltreatment prevention strategies: Saudi youth perspectives. Int J Pediatr Adolesc Med 2018;5:92-8.
Gökengin D, Yamazhan T, Ozkaya D, Aytuǧ S, Ertem E, Arda B, et al
. Sexual knowledge, attitudes, and risk behaviors of students in Turkey. J Sch Health 2003;73:258-63.
Coleman LM, Testa A. Sexual health knowledge, attitudes and behaviours: Variations among a religiously diverse sample of young people in London, UK. Ethn Health 2008;13:55-72.
Sommart J, Sota C. The effectiveness of a school-based Sexual Health Education Program for junior high school students in Khon Kaen, Thailand. Procedia Soc Behav Sci 2013;91:208-14.
Watanabe K, Saruta R, Kato N. Sources of sexual knowledge among Vietnamese high school students. Adv Reprod Sci 2014;2:83-7.
Tang CS. Childhood experience of sexual abuse among Hong Kong Chinese college students. Child Abuse Negl 2002;26:23-37.
Chen J, Dunne MP, Han P. Prevention of child sexual abuse in China: Knowledge, attitudes, and communication practices of parents of elementary school children. Child Abuse Negl 2007;31:747-55.
Malek A, Abbasi Shokoohi H, Faghihi AN, Bina M, Shafiee-Kandjani AR. A study on the sources of sexual knowledge acquisition among high school students in northwest Iran. Arch Iran Med 2010;13:537-42.
Dutt S, Manjula M. Sexual knowledge, attitude, behaviors and sources of influences in Urban college youth: A study from India. Indian J Soc Psychiatry 2017;33:319. [Full text]
Kumar R, Goyal A, Singh P, Bhardwaj A, Mittal A, Yadav SS. Knowledge attitude and perception of sex education among school going adolescents in Ambala District, Haryana, India: A Cross-Sectional Study. J Clin Diagn Res 2017;11:LC01-4.
Gilligan P, Akhtar S. Cultural barriers to the disclosure of child sexual abuse in Asian communities: Listening to what women say. Br J Soc Work 2006;36:1361-77.
Carr A. Prevention: What Works with Children and Adolescents? A Critical Review of Psychological Prevention Programmes for Children, Adolescents and Their Families. Taylor & Francis e-Library; 2006. p. 1 420.
Mendelson T, Letourneau EJ. Parent-focused prevention of child sexual abuse. Prev Sci 2015;16:844-52.
Elghossain T, Bott S, Akik C, Ghattas H, Obermeyer CM. Prevalence of key forms of violence against adolescents in the Arab region: A systematic review. J Adolesc Health 2019;64:8-19.
[Table 1], [Table 2], [Table 3], [Table 4]