Exposure to Violence of Secondary School Children with Visual Impairment

Abstract

Although violence is a serious issue that children face all over the world, there is little known about the extent of the violence children with disabilities experience. This study was conducted to identify the frequency of exposure to violence that students with visual impairment experience in any environment, directly or as a witness, and the factors associated with this exposure. The study was conducted as descriptive research at a Secondary School for the Visually Impaired in 2011-2012 with 84 individuals. A questionnaire on demographics, a Violence Exposure Scale, and face-to-face interviews were used as data collection tools. It was found that the large majority of the children with visual impairment in the study had encountered violence on one occasion or more, recently or in the past. The number of students recently exposed to violence was higher than the number of children encountering violence in the past. The mean scores of the students who had recently experienced violence were higher than the scores for exposure to violence in the past. A large majority of the students with visual impairment in the study, all of the boarding students, and most of the day students had been exposed to violence once or more both recently and in the past. It was found that being male, having a congenital visual impairment, and living as a boarding student were risk factors in terms of violence. It may be recommended that school nurses more closely monitor this group of students for signs of violence.

Keywords

violence visual impairment student school nurse children exposed to domestic violence violence exposure

Introduction

Violence is both an individual and a societal issue that is steadily increasing in the world and in Turkey. Exposure to violence in childhood, exploitation, and negligence leave deep scars and adversely affect mental health. There is a high probability that a child or young person who has experienced violence as a means of problem solving, punishment, or as a method of attaining status or respect will practice the same violence later on in adulthood, particularly with respect to the individual’s spouse or children (Korkmazlar, Engin, & Büyükyazıcı, 2010; Turkish Grand National Assembly, 2007).

Although violence is a widespread and serious issue that children may have faced all over the world, there is little known about the extent of the violence disabled children experience. It is a fact however that the risk of exposure to violence among children with disabilities is considerably high (American Academy of Pediatrics, 2001; Arıkan, 2001; Flynt & Morton, 2004; Hershkowitz, Lamb, & Horowitz, 2007; Hughes et al., 2012; Pinheiro, 2006). In fact, one study has demonstrated that compared with their healthy peers, the probability of exposure to violence among disabled children is 3 to 4 times higher (Hughes et al., 2012).

The connection between violence and disability is two-sided. Disabled children are not only more exposed to violence, but at the same time, violence may be a major cause of their mental or mental and physical disability. Despite the fact that it is seen that children with disabilities are generally subjected to certain kinds of violence, differentiating and identifying these forms of violence is difficult. Frequent forms of emotional violence to which disabled children are subjected are humiliation, derision, or the exhibition of a fear of physical contact (Filippini et al., 2004).

Goals for 2020 for “Healthy Human Beings” have emphasized in Goal 9, which discusses individuals with disabilities, that it is imperative that the people with disabilities are furnished with a healthier environment at home, at school, at work, and wherever they may be (Pourciau & Vallette, 2014). As a part of the World Health Organization’s (WHO; 2014) global disability action plan, at the 66th World Health Assembly, the United Nations Organizations and participating Member States issued a declaration for 2014-2021 for the purpose of achieving the best level of health and health care possible for all persons with disabilities.

To ensure that children and adolescents become healthy and successful adults, health institutions must be able to first identify those individuals who are subjected to violence and abuse as well as their families, and then to provide the needed treatment and rehabilitation (Kaya & Bilgin, 2012). The research carried out by the Turkish Social Services & Child Protection Agency (SSCPA) on “Child Exploitation and Intra-Familial Violence in Turkey” has made various assertions about the necessity of protecting children from exploitation and preventing violence in the family. In this context, it has emphasized that it will not be sufficient to work only with children and their families but that research should be carried out in different aspects of the issue and in different areas (Korkmazlar et al., 2010). In this context, schools constitute one of these areas. Schools are the places where students spend most of their time during the day. Schools are not only responsible for providing students with education, but they are also obligated to ensure their safety. Besides being settings where students can benefit from a maximum level of education, they are also environments in which there are potential dangers. Researchers have found that happy, healthy, and socially adapted students can only thrive in safe and secure environments. It is also known that students who are brought up in safe surroundings achieve better academic performance, are less aggressive, more well adjusted, and demonstrate social and emotional balance. In contrast, any physical or emotional trauma that a student may be subjected to may cause lifelong injury or mental breakdown. All of these are of even more importance in the case of a disabled student (Centers for Disease Control and Prevention, 2001; WHO, 2013).

When students encounter incidents of violence or abuse, among the first adults that they seek help from are school nurses (National Association of School Nurses, 2012). For this reason, important responsibilities fall on the shoulders of school nurses in terms of early identification of cases of violence and the treatment of adverse outcomes. It is believed that nursing initiatives may be effective in preventing incidents of violence and that nurses may be able to coordinate the care that is needed when violent events are in the process of occurring (Korkmazlar et al., 2010; Muscari, 2003). Only a few studies could be found on the subject of violence toward the visually impaired in Turkey in a scan of the literature in the field. According to Albayrak and Gur’s (2014) study, students with visual impairment stated that their experience with violence was mostly in the form of beating and being beaten rather than in other forms of physical violence; their experiences with verbal abuse were mostly in the form of being teased, being subjected to name-calling and being insulted.

This study was conducted to identify the frequency of exposure to violence that students with visual impairment experience in any environment, directly or as a witness, and the factors associated with this exposure.

Method

Universe Sample

The universe for this descriptive research consisted of 93 sixth-, seventh-, and eighth-grade students with visual impairment. The goal for the study was to reach the whole of the universe without making use of any type of sampling method. Students with visual impairment who were experiencing difficulties in comprehension, communicating, as well as those who were enrolled in a pilot study were excluded from the study. For this reason, the study was completed with the participation of 84 individuals.

Place and Time

The study took place in a secondary school for the visually impaired over the period from October 3, 2011, to January 6, 2012. The school had an infirmary. A nurse was not employed at the infirmary full-time. School hours for students at the school are from 9:00 a.m. to 3:30 p.m.

Data Collection

As part of the research, the students were admitted individually in a designated and partitioned area in the health office. The students were informed about the purpose of the study and told that they would not be asked for any identification information. In consideration of the students’ sense of privacy, the data were collected using the face-to-face interview technique. The researcher filled the questionnaire according to the student’s responses.

Data Collection Instruments

A questionnaire on demographics and a Violence Exposure Scale (VES) were used as data collection tools.

The questionnaire included the following: eight questions related to demographic characteristics—gender, age, grade level, parents’ living, parent’s living together, boarding situation, whether the student had a congenital, or acquired visual defect. The demographic characteristics comprised the study’s independent variables and the score obtained from the VES was considered the study’s dependent variable. The VES was adapted to the Turkish language by Kaya and Bilgin (2012). It is an instrument based on self-reporting that evaluates the types and frequency of violence that children, early adolescents, and adolescents (ages 9-18) were exposed to, directly or as a witness, in the last year or in the past (prior to the last year) at any location (at home, in the neighborhood or at school). The VES is made up of a total of 38 items and consists of two subscales, a Recent Exposure to Violence Scale (REVS) and a Past Exposure to Violence Scale (PEVS). The REVS comprises 26 items and six factors; its Cronbach’s alpha value is .91. The minimum possible score on REVS is 0, maximum is 78. REVS assesses instances of experiencing or witnessing violence in the last year, covering different types of violence (threatening/slapping, punching/beating, attacking by beating/whipping or with a knife/shooting a firearm/targeting with a firearm/sexual abuse). The scale devotes its items to threats (6 items), slapping–punching–hitting (6 items), beating–whipping (6 items), attacking with a knife (2 items), shooting a firearm (4 items), and sexual abuse (2 items). The environment (home/school/neighborhood) in which three types of violence (threat/slapping, punching, hitting/beating) took place is additionally queried. The PEVS comprises 12 items and three factors; its Cronbach’s alpha value is .90. These 4-item Likert-type scales are scored such that never = 0 points and almost every day = 3 points. The minimum possible score on PEVS is 0; maximum is 36. PEVS assessing the different types of violence experienced or witnessed in the past, excluding the last year (threatening/slapping, punching, hitting/beating, whipping/attacking with a knife/shooting with a firearm/sexual abuse). The scale queries threatening (2 items), slapping–punching–hitting (2 items), beating–whipping (2 items), attacking with a knife (2 items), shooting with a firearm (2 items), and sexual abuse (2 items). The higher the score, the more concentrated is the exposure to violence. In this study, the Cronbach’s alpha value for the REVS was found to be .84, and that for the PEVS was .78. A pilot study was conducted with five students to determine whether the questions were comprehensible and could be answered properly.

Data Analysis

Descriptive statistics, the Mann–Whitney U test, and the t test were used in the evaluation of the data.

Ethics

Prior to beginning the study, written permission was obtained from the researchers who had previously adapted the scale for use in Turkey as well as from the local Directorate of National Education. The research was conducted in compliance with the criteria of the Helsinki Declaration. The children were informed about the study before the data collection forms were implemented and participation was accepted on a voluntary basis. The purpose of the research was explained to the students and their verbal consent was obtained. For parental consent, the school administrators informed the families via text messages about the objective and procedures of the study and requested their permission. Ultimately, 90% of the target sample was reached.

Results

Of the students in the study, 75.0% had been exposed to violence in the last year, 65.5% had experienced violence in past years, and 77.4% said that they had experienced violence both recently and in the past on more than one occasion (Table 1).

Table 1.

General Exposure of Vision-Impaired Students to Violence (N = 84).

Exposure to Violence	Frequency (n)	%
Recent exposure to violence (the last year)
Yes	63	75
No	21	25
Past exposure to violence (prior to the last year)
Yes	55	65.5
No	29	34.5
Exposure to violence: Recently and in the past
Yes	65	77.4
No	19	22.6
Total	84	100.0

Of the students in the study, 84.5% had congenital and 15.5% acquired vision impairment. Of the students, 54.8% were boys; their mean age was 12.92 ± 1.43 (minimum = 11, maximum = 17), 13.1% were the children of separated parents, and 23.8% were boarding students (Table 2).

Table 2.

Distribution of Children in the Study by Demographic Characteristics (N = 84).

Demographic Characteristics	Frequency (n)	%
Visual impairment
Congenital	71	84.5
Acquired	13	15.5
Gender
Girls	38	45.2
Boys	46	54.8
M age	12.92 ± 1.43 (minimum = 11, maximum = 17)
Grade
Sixth grade	23	27.4
Seventh grade	28	33.3
Eighth grade	33	39.3
Mother/father alive?
Both alive	82	97.6
Mother deceased	2	2.4
Mother/father living together?
Living together	73	86.9
Separated	11	13.1
Boarder?
Day student	64	76.2
Boarder	20	23.8

The study found the general mean score of the students with visual impairment on REVS to be 5.27 ± 5.79 (minimum = 0, maximum = 19) in terms of their recent exposure to violence. The distribution of the scores of recent exposure to violence of the children with visual impairment was 1.70 ± 2.08 for being witness to violence at school or in the neighborhood, 0.23 ± 0.63 for witnessing/experiencing a stabbing or shooting, 1.26 ± 1.93 for experiencing violence at school or in the neighborhood, 0.92 ± 1.98 for witnessing violence at home, 0.88 ± 1.62 for experiencing violence at home, and 0.26 ± 0.60 for being sexually abused.

The general mean score of the students for being recently exposed to violence was distributed as 5.65 ± 6.10 for the congenitally visually impaired and 3.23 ± 3.06 for the students with acquired visual impairment; statistically, there was no significant difference between the two groups (Z = 1.011; p = .312). There was a statistically significant difference between the mean scores of the visually impaired on the REVS (Z = −2.171; p = .030).

The mean scores on the REVS were 4.87 ± 5.83 for the girls and 5.61 ± 5.80 for the boys. There was a statistically significant difference by gender in experiencing violence recently at school or in the neighborhood (t = 2.563; p = .012).

The general mean scores on the REVS for those whose parents were living together were 4.55 ± 5.20; for those whose parents were separated, it was 10.09 ± 7.37 (Z = −2.690; p = .007). There were statistically significant differences in terms of whether the parents were together or separated in experiencing violence at school/in the neighborhood (Z = 2.379; p = .017), witnessing violence at home (Z = −2.588; p = .010), experiencing violence at home (Z = −3.064; p = .002), and being sexually abused (Z = −3.151; p = .002).

While the REVS mean scores for nonboarding students were 4.88 ± 5.65, those of the boarding students were 6.55 ± 6.19 (Z = −1.335; p = .182). There was a significant difference between the mean scores of the students in terms of their being boarders or nonboarders and their having experienced violence recently at home (Z = −2.296; p = .022; Table 3).

Table 3.

Recent Exposure to Violence of Visually Impaired Students by Demographic Characteristics (N = 84).

Variables	Factor 1		Factor 2		Factor 3		Factor 4		Factor 5		Factor 6		REVS
	Witnessing Violence in School or in the Neighborhood		Witnessing a Knifing or Shooting		Experiencing Violence at School or in the Neighborhood		Witnessing Violence at Home		Experiencing Violence at Home		Sexual Abuse		Total Score
	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD	M	SD
	1.70 ± 1.70		0.23 ± 0.63		1.26 ± 1.93		0.92 ± 1.98		0.88 ± 1.62		0.26 ± 0.60		5.27 ± 5.79
Minimum–maximum	0-7		0-3		0-8		0-9		0-9		0-3		0-19
Visual impairment
Congenital (n = 71)	1.82	2.17	0.21	0.63	1.27	1.93	1.04	2.11	1.01	1.71	0.30	0.64	5.65	6.10
Acquired (n = 13)	1.08	1.38	0.38	0.65	1.23	2.09	0.31	0.75	0.15	0.55	0.08	0.28	3.23	3.06
Statistics	Z = −0.951; p = .342		Z = −1.554; p = .120		Z = −319; p = .750		Z = −1.338; p = .181		Z = −2.171; p = .030		Z = −1.239; p = .215		Z = 1.011; p = .312
Gender
Girls (n = 38)	1.42	1.90	0.13	0.53	0.68	1.38	1.21	2.16	1.16	2.01	0.26	0.60	4.87	5.83
Boys (n = 46)	1.93	2.22	0.33	0.70	1.74	2.21	0.70	1.81	0.65	1.18	0.26	0.61	5.61	5.80
Statistics	t = 1.128; p = .263		t = 1.410; \|p = .162		t = 2.563; p = .012		t = 1.189; p = .238		t = 1.437; p = .155		t = 0.017; p = .986		t = 0.581; p = .563
Age
11-13 years (n = 56)	1.67	2.11	0.196	0.553	1.19	1.93	1.00	2.19	0.83	1.64	0.303	0.685	5.21	6.20
14-16 years (n = 28)	1.75	2.04	0.321	0.772	1.39	1.96	0.785	1.49	0.96	1.57	0.178	0.390	5.39	4.94
Statistics	Z = −0.405; p = .686		Z = −0.521; p = .603		Z = −0.364; p = .716		Z = −0.338; p = .735		Z = −0.835; p = .403		Z = −0.482; p = .630		Z = −0.709; p = .479
Parents living together?
Yes (n = 73)	1.66	2.08	0.23	0.66	1.03	1.72	0.71	1.69	0.74	1.61	0.18	0.48	4.55	5.20
Separated (n = 11)	2.00	2.14	0.27	0.47	2.82	2.64	2.36	3.07	1.82	1.40	0.82	0.98	10.09	7.37
Statistics	Z = −0.635; p = .525		Z = −0.991; p = .322		Z = 245.0; p = .017		Z = −2.379; p = .010		Z = −3.064; p = .002		Z = −3.151; p = .002		Z = −2.690; p = .007
Boarder?
Day student (n = 64)	1.64	2.01	0.25	0.67	0.25	0.67	0.92	1.94	0.75	1.68	0.25	0.62	4.88	5.65
Boarder (n = 20)	1.90	2.34	0.20	0.52	0.20	0.52	0.95	2.16	1.30	1.34	0.30	0.57	6.55	6.19
Statistics	Z = −0.293; p = .769		Z = −0.100; p = .920		Z = −1.758; p = .079		Z = −0.152; p = .879		Z = −2.296; p = .022		Z = −0.601; p = .548		Z = −1.335; p = .182

Note. REVS = Recent Exposure to Violence Scale.

The general mean scores related to exposure to violence in the past were found to be 2.89 ± 3.16 (minimum = 0, maximum = 13). Mean scores for witnessing violence were 1.34 ± 1.75, 1.78 ± 0.51 for witnessing a stabbing or shooting and 1.36 ± 1.61 for experiencing violence.

There were significant differences between the mean scores in terms of whether the student had a congenital or acquired visual defect and in terms of their witnessing a stabbing or shooting or experiencing violence themselves (Z = −2.049; p = .040). There was no statistical difference between exposure to violence in the past in terms of gender and age (t = 1.173; p = .244; and Z = −1.132; p = .258). There was a statistical difference between total scores (Z = −2.816; p = .005) and the mean scores of experiencing violence in the past in terms of whether the student’s parents were together or separated (Z = −3.975; p = .000). There was a statistical difference between total scores (Z = −2.763; p = .005) and the students’ witnessing violence in the past in terms of whether they were boarder or day students (Z = −3.272; p = .001; Table 4).

Table 4.

Students’ Exposure to Violence in the Past by Demographic Characteristics (N = 84).

	Factor 1		Factor 2		Factor 3		PEVS
	Witnessed Violence in the Past		Witnessed a Knifing or Shooting in the Past		Experienced Violence in the Past		Total Score
Variables	M	SD	M	SD	M	SD	M	SD
	1.34 ± 1.75		1.78 ± 0.51		1.36 ± 1.61		2.89 ± 3.16
Minimum–maximum	0-8		0-3		0-6		0-13
Visual impairment
Congenital (n = 71)	1.44	1.85	0.13	0.41	1.51	1.67	3.07	3.34
Acquired (n = 13)	0.85	1.07	0.46	0.88	0.62	1.04	1.92	1.85
Statistics	Z = −0.819; p = .413		Z = −2.049; p = .040		Z = −1.827; p = .068		Z = −0.734; p = .463
Gender
Girls (n = 38)	1.21	1.63	0.11	0.39	1.13	1.61	2.45	3.12
Boys (n = 46)	1.46	1.87	0.24	0.60	1.57	1.61	3.26	3.20
Statistics	t = 0.635; p = .527		t = 1.180; p = .241		t = 1.226; p = .224		t = 1.173; p = .244
Age
11-13 years (n = 56)	1.39	1.97	0.11	0.37	1.17	1.61	2.82	3.50
14-16 years (n = 28)	1.25	1.23	0.30	0.70	1.73	1.60	3.03	2.41
Statistics	Z = −0.461; p = .645		Z = −0.972; p = .331		Z = −1.023; p = .306		Z = −1.132; p = .258
Parents living together?
Yes (n = 73)	1.25	1.65	.125	.384	1.30	1.74	2.51	2.93
Separated (n = 11)	2.00	2.37	.285	.712	1.50	1.34	5.45	3.67
Statistics	Z = −0.871; p = .383		Z = −1.381; p = .167		Z = −3.975; p = .000		Z = −2.816; p = .005
Boarder?
Day student (n = 64)	1.09	1.77	0.19	0.56	1.28	1.68	2.56	3.35
Boarder (n = 20)	2.15	1.50	0.15	0.37	1.65	1.42	3.95	2.28
Statistics	Z = −3.272; p = .001		Z = −0.206; p = .837		Z = −1.212; p = .226		Z = −2.763; p = .005

Note. PEVS = Past Exposure to Violence Scale.

Discussion

Violence toward children is a societal issue that knows no boundaries of race, class, religion, culture, and geography. Violence can take place at home, at school or on the streets, in recreational spots, or in rehabilitation or correctional facilities. Persons performing violent acts might be parents, family members, teachers, caregivers, members of the police force, or other children. Some children are more susceptible to acts of violence because of their gender, race, ethnic background, disability, or social status (Pinheiro, 2006). This study identifies the types, frequencies, and factors related to violence to which visually impaired students are exposed, directly or indirectly, as a witness, at home, in the neighborhood, or at school.

Children with disabilities are a risk group in terms of their susceptibility to physical, emotional, sexual, and verbal abuse (Hughes et al., 2012). A study asserts that children with disabilities are more at risk in terms of experiencing any type of violence (United Nations Secretary-General’s Study on Violence against Children, 2005). A study by Bilgi (2007) on Turkish adolescents showed that the mean scores on the VES and REVS were 8.39 ± 9.44 and 4.24 ± 5.45 on the PEVS. In our study too, REVS scores are higher than on the other scales. The reason for this may be that recent incidents are more easy to remember (Bilgin, 2007). The scores of the scale were low, but this may be stemming from the fact that violence is a subject that is hard to talk about. Particularly when it is considered that the victims here are children, it is understandable that the subject is a difficult one to pursue. This study showed, however, that children are direct victims or witnesses to violence at home, in the neighborhood, or in school. The reasons that children are at risk in this sense may be an outcome of societal stigmatization and discrimination, negative traditional beliefs, ignorance among the general population, the lack of support given to caregivers in the face of increasing health care needs, communication difficulties, and a steadily growing lack of confidence, among other factors. In these cases, children with disabilities have a greater probability of becoming victims of violence. Horwood, Waylen, Herrick, Williams, and Wolke (2005) have said that being visually impaired is perceived as a physical weakness and for this reason is a risk factor in terms of becoming a victim of violence.

Olweus (1994) reported that students expressed that they were a part of incidents of violence in the last 6 months either at school or in the neighborhood. Sacks and Wolffe (2006) pointed out that visually impaired adolescents have the potential of facing many more problems in the outside world compared with healthy peers and that the disabled feel less confident of themselves outside of their homes and schools. These students may have to face the challenge of having to defend or protect themselves at school or in the neighborhood they live in. Children with disabilities may appear weak and vulnerable because of their slow movements; their unsure pace may be thought to be a sign of weakness and this may give way to verbal or physical abuse, especially outside the home (Flynt & Morton, 2004). Hershkowitz et al. (2007) reported that children with disabilities are more likely than other children to experience physical violence, bodily harm, force, grave sexual abuse, physical exploitation, and verbal threat at the hands of their parents. The study states that the probability of children with disabilities becoming the victim of sexual abuse is higher than it is for their peers and that at the same time, these children have more difficulty than others in reporting such incidents. It has also been asserted that children with disabilities are more likely to be victims of physical violence rather than sexual abuse. Özönder, Sağlam, and Aksoy (2005), in a study conducted with disabled and nonboarding seventh and eighth graders, found that 24.7% of the students had been victims of sexual abuse. Contrary to these results, research conducted by Korkmazlar et al. (2010) at SHÇEK (Turkish Social Services and Child Protection Agency) reported no cases of sexual abuse. The fact that the results of the SHÇEK study are similar to those of the present research suggests that perhaps because the children involved belonged to a special group of children, they were more protected than usual. While the mean scores of the children with visual impairment in the subdimensions of the PEVS for witnessing or experiencing violence were similar, it was found in the subdimensions of the REVS that students with visual impairment witnessed/experienced more incidents of violence at school or in their neighborhoods and witnessing/experiencing this at home followed right behind; the results also revealed that they were least likely to witness/experience stabbing or shooting at home but that they did encounter sexual abuse in the home environment. The scores of the students in the categories of experiencing violence at home or in the neighborhood are higher than in the other parameters. Cultural factors may have played a role in the scant reporting of sexual abuse in this study. Particularly the belief in our culture that “matters must remain inside the walls of the home” can be cited as having an impact on the individual’s perspective on keeping personal matters secret.

According to Olofsson, Lindqvist, and Danielsson (2015), both boys and girls with disability showed higher odds of being exposed to violence than boys and girls without a disability. Other studies too have reported that male students are more likely to be exposed to violence than girls, and that subjection of boys to violence is more probable, especially when a boy appears to be less physically robust than others (Stein, Jaycox, Kataoka, Rhodes, & Vestal, 2003). Male boarding students in the fourth, fifth, and sixth grades as well as male students in the first years of elementary school experience and witness more incidents of violence than their female peers (Bilgin, 2007; Pişkin, 2006; Scheithauer, Hayer, Petermann, & Jugert, 2006). It may also be said that the hormone factor makes boys rather than girls have the tendency to take risks and be more active (Plan International, 2012). Boys are likely to exhibit more aggressive behavior and the games they play may be rougher than what girls would engage in. In the present study, the statement divulged by a girl with disability about the relationship between disability and sexuality offer insight into the issue:

There is a difference in this respect between girls and boys who are disabled. For example, a boy can go for a walk without experiencing any problems whereas a girl runs the risk of being a victim of rape or unwanted pregnancy and then has to face the possibility that her rapist will deny his responsibility in the incident. (Father of a girl with a disability; Plan International, 2012).

The scores for experiencing violence both recently and in the past for students with separated parents are noticeably high. In a study by Sacks and Wolffe (2006), it was found that family support was much more important for adolescents with visual impairment compared with their peers with sight. Children of broken families that are separated due to death, divorce, or living apart comprise a major risk group in terms of exposure to violence. The emotions of children from broken homes or from families with various issues seriously affect their lifestyles and relationships (Bahar, Savaş, & Bahar, 2009).

All of the boarding students in the study and most of the day students stated that they had been exposed to violence either recently or in the past. There was a significant difference between exposure to violence in terms of being a day or a boarding student. Bulut (2008) examined incidents of violence by the locations where these occurred and found that 30% took place in living quarters such as dormitories, boarding houses, or boarding schools. In a study by Bozkurt, Akbıyık, Yüzük, Gördeles, and Sağkal (2011), the peer exploitation seen at the schools was identified as an issue that needed intervention and it was stated that particularly children who were boarding students were at more of a risk. The researchers found that these students felt more uncomfortable at school, in the classroom, and in the schoolyard compared with their day student peers. Sullivan (2009) reported that boarding schools are a major risk factor in terms of sexual and/or physical abuse and that children encounter violent behavior sometimes at the hands of older children and sometimes from children their own age.

Limitations

The small sample size and the fact that all the participants were in the same location may be considered a limitation of the study. The results of the research may only be generalized for the sample group. Because there are no scales in the Turkish literature that evaluates the types and frequency of violence that children with visual impairment are exposed to, this might be regarded as a limitation. Another is the possibility of a social desirability bias coming into play as the responses of the students to the questionnaire were recorded by the researcher.

Conclusion

It was found that the large majority of the children with visual impairment in the study had encountered violence on one occasion or more, recently or in the past. It was observed that the number of students recently exposed to violence was higher than the number of children encountering violence in the past. At the same time, the mean scores of the students who had been recently exposed to violence were higher than the scores for exposure to violence in the past. A large majority of the students with visual impairment in the study, all of the boarding students, and most of the day students had been exposed to violence once or more both recently and in the past. There was a statistically significant difference between the students with congenitally and acquired impairment in terms of their recent exposure to violence at home. There was a statistically significant difference between the genders in terms of recently experiencing violence. It was seen that mean scores for recent and past exposure to violence were higher in boys compared with girls, in those with congenital visual impairment compared with those with acquired impairment, in students with parents living together compared with those with separated parents, and in boarding students as compared with nonboarding students. These results have shown that pupils with visual impairment are a group that is at risk of encountering violence and that this is a steadily growing issue.

Suggestions

It was found that being male, having a congenital visual impairment, and living as a boarding student were risk factors in terms of violence. It may be recommended that school nurses more closely monitor this group of students for signs of violence. In particular, students with congenital visual impairment should be identified and given instruction as to what violence is and what they can do if they are ever confronted with violence.

It may also be suggested that boarding students are frequently monitored and that they are allowed to express themselves and become informed as to how they can protect themselves against violence. Personnel in close contact with students in boarding facilities might be provided with training on how to intervene in the event of an incident of violence.

Children with visual impairment should be advised as to how they can protect themselves outside the home. They should be taught how to ask for help if they themselves become the victim of violence or witness such an incident.

Another recommendation may be that security on schools and service busses where groups of students congregate is improved.

A further suggestion is that whenever a child with visual impairment is confronted with an act of violence, a discussion should be held with both the individual who is responsible and the victim, in an effort to avoid a repetition of the event. In particular, behavior-changing interventions might be attempted or punishments enforced when necessary.

A therapeutic environment should be ensured for children who are victims of or witness to violence; children should be referred to appropriate facilities for therapy and they should be monitored for the long term.

The researchers will follow up on the cohort of children with visual impairment in the future. Observation-based studies might be planned accordingly and comparisons made with a broader group of students without disabilities.

Footnotes

Acknowledgements

The authors thank all of the participators in this research as well as the nursing interns Sema Arslan, Fadime Doğan, and Nazmiye Aydın, who assisted with data collection. They thank the old school administration and teachers for their cooperation.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Kamer Gür, PhD, is an assistant professor at Marmara University. Her research interests include relevance of school—accident, violence, school nursing, and quality of life.

Sevil Albayrak, PhD, is a graduate of Public Health Nursing PhD’s Program from the Marmara University. She is an assistant professor at Kırıkkale University. Her PhD thesis subject is reducing the impact of bullying in school bullying prevention program.

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