142
Jurnal Ners dan Kebidanan.
Volume 6.
Nomor 2.
Agustus 2019, hlm.
142Ae147
JNK
JURNAL NERS DAN KEBIDANAN
(JOURNAL OF NERS AND MIDWIFERY)
http://ojs.
id/index.
php/jnk Health Education Through Illustrated Storybooks Affected the Bullying Knowledge of Primary School Students Fepryani Thresna Feoh .
Istha Leanni Muskananfola University Citra Bangsa.
Kupang.
Indonesia Corresponding Author Article Information Abstract History Article:
Received, 30/05/2024 Accepted, 02/05/2025 Published, 04/08/2025 Bullying has become more prevalent not only among secondary school (SMP and SMA) students but also in primary school (SD) students.
Children's physical and psychological development in primary school are the most crucial aspects.
However, many primary school students face physical and psychological pressure in social interactions due to bullying.
However, they are rarely reported even though they have a detrimental effect on both victims and perpetrators.
Bullying is still considered normal in social interactions and is used as a joke and a way to demonstrate strength.
One of the causes is primary school studentsAo lack of comprehension of bullying.
This research aimed to determine primary school students' knowledge about bullying before and after receiving health education and analyze the impact of bullying themed illustrated storybooks on primary school studentsAo knowledge in Kupang to prevent bullying behaviors.
The quasiexperimental approach pre-test and post-test with one group design.
There were 200 primary school students involved in intervention.
The Wilcoxon test results show that the average respondentsAo knowledge improvement after being provided with health education about bullying using illustrated storybooks was 78.
5%, with a p-value of 0.
Therefore, it can be concluded that health education using illustrated storybook positively impacts primary school (SD) studentsAo bullying knowledge in Kupang.
Collaboration between various parties, including parents, teachers, schools, and nurses, will continue to provide education about bullying for elementary school children as an effort to prevent bullying behavior in elementary school children.
Keyword:
Health Education.
Illustrated Storybooks.
Bullying A2025 Journal of Ners and Midwifery Correspondence Address:
University Citra Bangsa.
Kupang Ae East Nusa Tenggara.
Indonesia
P-ISSN : 2355-052X
Email: fepyfeoh@gmail.
E-ISSN : 2548-3811
DOI: https://doi.
org/10.
26699/jnk.
ART.
This is an Open Access article under the CC BY-SA license .
ttps://creativecommons.
org/licenses/by-sa/4.
Feoh, et.
Health Education Through Illustrated Storybooks A 107
INTRODUCTION
Bullying is one of the growing mental health issues happening at worldwide scale and within Indonesia.
Its cases can often occur in school environment, not only among secondary school (SMP and SMA) students, but also in primary school (SD) students.
At elementary psychological growth and development are the most important parts (Ulfah Jamil & Daryanti.
However, in reality many elementary school children experience physical and psychological pressure in social interactions due to bullying.
Bullying is a form of power and authority abuse by an individual or a group which involves either physical or psychological violence, intentional of repetitive, to intimidate, humiliate and isolate its victims.
In reality, cases of ridiculing, hitting, pinching, hair pulling and tripping friends while walking are seen as proper primary student behaviors, despite impacting negatively towards the bullying victims, perpetrators and witnesses (Dewi & Dewi, 2.
A lot of bullying victims are traumatized to interact with the perpetrators, self-esteem, themselves from social circles and unmotivated to learn which leads to low academic achievement, depression, and even suicide.
Concurrently, bullying perpetrators tend to possess high ego, unsportsmanlike and unempathetic characteristics towards other people and in the long term can cause criminal behavior tendency.
For bullying witnesses, aforementioned behaviors are natural and can trigger anxiety (Krisdian & Subekti, 2.
One of the factors of primary school students bullying behaviors is inadequate knowledge of bullying and its impact (Safitri, 2.
This causes children to view bullying as a permitted act in terms of companionship and have difficulties to overlook bullying behaviors (Galaresa & Al Kasanah, 2.
The 2018 Programmer for International Student Assessment (PISA) research found that Indonesia was ranked 5th from 78 countries in terms of bullying with 41.
1% of victimAos percentage (Ramadhanti & Hidayat, 2.
Indonesian Child Protection Commission (KPAI) reported 226 cases of violence towards children and adolescents (Agnes Setyowati.
Furthermore, the 2022 Ministry of Education and Culture survey stated that 24.
of students from primary school to high school are potential victims of school (Sekar, 2.
Central Agency of Statistics (BPS) in the Province of East Nusa Tenggara stated the number of cases of violence towards children is annually increasing and it reached 503 cases throughout 2015 to 2018 (Lette & Paulus.
A child in Kupang city had attempted to commit suicide in 2019 since one had been bullied by oneAos friend with AumurdererAos childAy name calling (Nugroho, 2.
Nevertheless, there are more bullying cases in Kupang City that are remained unreported.
In Kupang City, bullying cases often occur in elementary school age children, but are not reported even though they have had a negative impact on victims and perpetrators (Armitage, 2.
Many victims of bullying experience anxiety and fear of interacting with other people, refusing to go to school, decreased academic grades, low self-esteem, depression and suicidal thoughts (Armitage.
Meanwhile, bullies feel the strongest and lack empathy for other people.
However, bullying is still considered normal in interactions with friends, used as a joke and a way to show strength (Feoh & Muskananfola.
One of the causes is the lack of knowledge of elementary school children about For this reason, there is a need for Jurnal Ners dan Kebidanan.
Volume 12.
Issue 2.
August 2025, page.
health education about bullying in elementary school children.
Bullying behaviors will increase throughout the age of 12 to 15, as it subsides at the end of high school year (Menesini & Salmivalli, 2.
The prevention of bullying tendencies must be started from its base by providing knowledge towards children (Ningtyas & Sumarsono, 2.
This definitely supports the government policy in Ministry of Education and Culture Ministerial Regulation Number 82 in 2015 that regulates Prevention and Countermeasures over Acts of Violence inside Education Unit Environment in which one of the points is to inform the children (Sudrajat et al.
, 2.
ChildrenAos cognition of bullying and its impact are essential to be implemented from an early age in terms of (Kusumawardani et al.
, 2.
Provided health education related to bullying will cause the children to comprehend, remember and conduct the gained points which build anti-bullying standpoint and behaviors even when they reach adolescent years and more complex social relations (Mardiyah et al.
, 2.
Furthermore, children will be able to differentiate between well and poor behaviors, as well as become attentive (PH et al.
, 2.
This research utilized the media of illustrated story book as it contains captivating and likeable narrative and Health education using illustrated story books can intensify primary school studentsAo interests to read and learn about bullying so as to facilitate them to remember and comprehend the given information.
This research aimed to identify primary school studentsAo knowledge regarding bullying before and after being given health education, as well as to analyze the effect of illustrated storybook about bullying towards Kupang City primary school studentsAo knowledge as an effort of bullying prevention.
METHODS
This research utilized the preexperimental layout with one group pre-post test design.
Researchers measured childrenAos knowledge on bullying before and after being given health education through illustrated This research used 200 primary school students from 4th to 6th grade distributed in 4 schools with highest number of students in Kupang City as the sample of the research.
Proportional sampling technique was utilized for the sampling.
The research instrument was AuStop Perundungan/Bullying Yuk!Ay by Directorate of Primary School.
Directorate General of Early Childhood Education.
Primary Education and Secondary Education.
Ministry of Education.
Culture.
Research and Technology .
(Supriyatno et al.
, 2.
Variable of bullying knowledge was measured by Bullying Knowledge Questionnaire which consisted of 18 questions with 6 distributed indicators as such: Definition of Bullying in question number 1.
Types of Bullying in question number 2 to 5.
Location of Bullying in question number 6 to 8.
Impact of Bullying in question number 9 to 11.
Prevention of Bullying in Countermeasures of Bullying in question number 16 to 18.
All Guttman scale statements with correct and incorrect answers, as they were arranged using comprehensible sentences designed for primary school students.
The research questionnaire has been tested for validity and reliability on elementary school children who have the same characteristics as respondents with a total of 50 respondents.
The condition for the validity of the instrument is if the calculated r value is > the r table value .
at N=50 with a significance value <0.
There were 18 valid question numbers with a calculated r value ranging between 0.
Ae 0.
572 (>0.
and a Cronbach's Alpha value Feoh, et.
Health Education Through Illustrated Storybooks A 109 = 0.
On the data collection, the first stage, prior to the health education process using illustrated storybook, researchers handed out the pre-questionnaire to assess respondentsAo bullying knowledge.
The second stage, after the questionnaire was filled out, researchers provided the bullying themed illustrated storybooks, then let the respondents to read them which led to researchers explicated the health education according to the illustrated storybook material.
The third stage, after the health education using illustrated storybook was provided, researchers handed out the postquestionnaire to be filled out by the respondents to measure their knowledge subsequent to the health education using bullying themed illustrated storybook.
The gained data was then processed and analysed.
The pre and post-test data analysis utilized the Wilcoxon Test to discern the effect of health education using illustrated storybook towards the knowledge of primary school students, as well as to find a difference in terms of childrenAos bullying knowledge prior and subsequent to the provided health education.
This research has received ethical clearance from Faculty of Health Sciences Citra Bangsa University.
No.
051/EC/KEPK/FK/2023, dated on 4 August, 2023.
RESULT
Table 1.
Respondents Characteristics Distribution Characteristics Age
Sex
Male
53,5%
Female 46,5% Based on Table 1, there were 196 respondents aged 10 to 12 years old .
%) and 107 male respondents .
5%).
Table 2.
Kupang City Primary School studentsAo knowledge prior and subsequent to the provided health education using bullying themed illustrated storybook Characteristics Pre-Test Knowledge Lack Adequate Good Post-Test Knowledge Adequate Good Table 2 shows that there was a difference on primary school studentsAo bullying knowledge prior and subsequent to the provided health education using illustrated storybook.
Before the health education was provided using bullying themed illustrated storybook, at most 106 respondents possessed adequate bullying knowledge .
%) and at least 40 respondents possessed good bullying knowledge .
%).
As comparison, after the health education was provided using bullying themed illustrated storybook, at most 167 respondents possessed good bullying knowledge .
5%) and at least 33 respondents possessed adequate bullying knowledge .
5%).
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Table 3.
The Effect of Health Education through bullying themed illustrated storybook towards the knowledge of primary school students in Kupang City Pre-Test Knowledge Mean Rank
P Value Negative ranks Positive ranks Ties Total
0,00
78,50
0,000
Table 3 above showed 0.
000 p value which indicates that there was an effect of health education through illustrated storybook towards bullying knowledge of primary school students in Kupang City.
Furthermore.
Positive Ranks valued on 156 implies that there were 156 respondents who experienced knowledge improvement by 78.
after receiving health education through bullying themed illustrated storybook, while 44 respondents had remain the same prior and subsequent to the provided health education through bullying themed illustrated storybook.
DISCUSSION
Despite being considered as a part of the normal rites of growing up, bullying is now recognized as a significant but preventable public health problem.
The impact of bullying on victims, witnesses and perpetrators include poor physical health and poor mental health such as escalated anxiety, depression and increasing risk of disease (Flannery et al.
, 2.
Bullying can have a negative impact on both the victim and the perpetrator.
Bullying victims tend to experience anxiety, trauma, fear of meeting other people, even low self-esteem and suicide attempts.
Meanwhile, the perpetrators of bullying continue to feel selfish and feel that they are the greatest (Feoh & Muskananfola, 2.
For this reason, bullying must be prevented from an early age.
The results of this research prove that before being given health education using picture story books about bullying, most elementary school children in Kupang City knew about bullying in the categories of insufficient and sufficient.
Elementary school children in Kupang City's knowledge about bullying improved after being given health education using picture story books about bullying.
Until now, there are still many elementary school children who do not know about bullying.
This results in elementary school children continuing to carry out bullying behavior and assuming that this behavior is normal in friendships.
Many students do not have good knowledge about the meaning of bullying, types of bullying, places where bullying occurs, the impact of bullying, and how to prevent and handle bullying.
Elementary students do not know that behavior such as insulting, making fun of or ridiculing friends, grabbing, pinching and even hitting friends is bullying behavior.
Students' knowledge about types of bullying such as physical bullying (Christina Rahayuningrum et al.
, 2.
Elementary students also do not know that school is a place with the highest risk of bullying because at school students meet a lot of friends.
Elementary students also don't know how to do it.
One of the prevention actions for bullying behaviors is providing the knowledge on bullying since elementary school years.
Knowledge improvement can be done by providing health Health education can affect an individual or society to behave healthily.
Health education is an effort made to provide a decent comprehension towards individuals or communities so that they can strive to improve their health (Ayu et al.
, 2.
Health education is also the provision of information or knowledge and abilities carried out through instructional techniques or learning practices (Putri et al.
, 2.
The target of health education is behavior transformation (Mardiyah et , 2.
With health education about bullying, primary school students can cognize the definition of bullying, types of bullying, locations of bullying, the impact of bullying, the prevention of bullying and countermeasures of bullying, so that antibullying attitudes and behavior can be formed and bullying incidents in the future can be subsided.
Feoh, et.
Health Education Through Illustrated Storybooks A 111 Knowledge is the result of knowing and can occur when someone has done sensing on certain The majority of knowledge and information received by an individual come from eyes and ears.
The cognitive or knowledge field is an important domain in shaping human behavior or actions (Darsini et al.
, 2.
To understand the primary school studentsAo knowledge about bullying, researchers measured studentsAo knowledge before and after being given health education.
The knowledge received by children can be through the senses of sight and hearing which can be comprehended by the brain.
There was a difference in studentsAo knowledge about bullying prior and subsequent to the provided health Through health education using illustrated storybooks, researchers were able to convey information and transfer knowledge about bullying to primary school students so that their knowledge about bullying improved.
Afore-mentioned improvement in knowledge occured because primary school students had received health education about bullying using illustrated storybooks which includes the definition of bullying, types of bullying, locations of bullying, prevention of bullying and its countermeasures.
Apart from health education itself, the utilized media is also noteworthy.
Health promoting media is one of the tools or effort that can be employed to display the intended health messages or information so as to improve knowledge which is ultimately expected to change individualAos behaviors in a positive direction or to support health (Yolanda & Budiyati, 2.
This research utilized illustrated storybook as a medium for health education about bullying towards primary school students.
Illustrated storybook is book that contains narratives about certain topics which includes text along with pictures that are used as illustrations (Ramadhani & Setyaningtyas, 2.
There are many factors that affecting primary school studentsAo knowledge about bullying i.
age, level of education and sources of information (Kesuma et al.
, 2.
This corresponds with the results of this research where most respondents were aged 10-12 years, which according to theory, at the age of 7-12 years children are more likely to be fond of things with captivating illustrations, and prefer to read texts in illustrated storybooks compared to books with long texts (Ramadhani & Setyaningtyas, 2.
When health education is provided through illustrated storybooks, primary school students will understand it more easily because it contains simple and interesting messages.
In addition, primary school students are more interested in reading material in the form of colorful illustrations (Dessiane & Hardjono, 2.
For this reason, researchers initiated illustrated storybooks with simple sentences that were captivating to read.
This bullying themed illustrated storybook was able to improve the primary school studentsAo knowledge about the definition of bullying, types of bullying, locations of bullying, the prevention of bullying and its countermeasures.
The hope is that after cognizing about bullying and its impacts, primary school students will not become the perpetrators or victims of bullying in the future, even when they have moved to a higher level of education and wider social Children must not be perpetrators, victims or witnesses of bullying.
CONCLUSION
Health education through illustrated storybooks about bullying has proven to have an effect on improving primary school studentsAo knowledge about bullying.
For this reason, the findings of this research can be used as a reference in providing health education about bullying to primary school students.
SUGGESTION
Based on the results of this research, it is hoped that collaboration between various parties, including parents, teachers, schools, and nurses, will continue to provide education about bullying for elementary school children as an effort to prevent bullying behavior in elementary school children.
This effort also helps in achieving the Government's Work Plan regarding mental revolution and cultural development by forming good character and Jurnal Ners dan Kebidanan.
Volume 12.
Issue 2.
August 2025, page.
manners in children from elementary school age, one of which is anti-bullying behavior.
ACKNOWLEDGEMENTS
Appreciation towards for the schools, especially the respondents, in this case primary school students in Kupang City, who participated in this research.
Further gratitude to DRTPM Dirjen DIKTIRISTEK for funding this research in 2023 with contract number 191/E5/PG.
PL/2023
and also thank you to Universitas Citra Bangsa.
FUNDING
This research was funded by DRTPM Dirjen DIKTIRISTEK in 2023.
CONFLICTS OF INTEREST
The authors have no conflicts of interest.
AUTHOR CONTRIBUTIONS
All authors fully contribute to research activities starting from the planning process, research, data tabulation, data analysis, and preparation of results, including publishing articles in this journal.
REFERENCES