Violent Discipline Behaviors in Mothers of Preschool Children in Malatya,East Anatolia

Abstract

Violent parenting behavior, whether physical or psychological, give harms to child well-being. This study was conducted to describe and compare the prevalence of discipline methods used by mothers of 2- to 5-year-old children in Malatya, Turkey. This is a cross sectional study and 552 mothers were administered a face-to-face questionnaire describe the methods they use to discipline their children in the year previous the survey. It was observed that nine of 10 women used violence on their children physically and psychologically. The study showed that nine of 10 mothers used physical and/or psychological punishment toward their children in the previous year. Nonviolent discipline was less prevalent than punitive discipline, such as psychological and physical punishment. The most commonly used method was psychological punishment. Significant sociodemographic associations with discipline methods were found. Mother’s educational level, family income, child gender, and child age were the independent predictors that explained discipline methods used by mothers. Starting parenting classes and strengthening the child protection systems at national level were suggested.

Keywords

child abuse cultural contexts children exposed to domestic violence domestic violence domestic violence and cultural contexts

Introduction

Children are in need of not only caring and nutrition but also love and attention from their mothers and fathers. The next generations’ well-being depends on the attitudes and behaviors of their parents, who mold them. For this reason, the attitude and behavior of parents toward their children and the environment they grow up in are important for developing a healthy personality and healthy relationships with other adults (Aral, 1997).

Child discipline is an integral part of child rearing in all cultures. Children, by nature, are curious. They just want to be free to share their thoughts, free to make their own choices, ask questions, and behave as they wish. Parents try to control children’s lives through discipline methods. These discipline methods can also have positive impacts on their feelings about self-confidence, self-respect, and problem-solving abilities; on the contrary, they can cause negative impacts such as disillusion and low self-respect. Child discipline can be thought of as deliberate actions that are designed to teach children self-control and acceptable behavior. The need for child discipline is generally recognized, but there is considerable discussion and debate concerning violent physical and psychological disciplinary practices (UNICEF Turkey & Republic of Turkey Prime Minister Family Research Institute, 2010). Discipline methods include punishment and reward and they can be positive and negative. One negative behavior being used to apply discipline is punishment. Punishment includes negative verbal and physical warnings to decrease or prevent a misbehavior. Physical and psychological violence applications to discipline children can influence a child’s personality development negatively. Violent applications are accepted as a threat to physical and psychological well-being of children. Violent discipline practices especially physical punishment is not considered as an effective method in modifying the undesirable behaviors of children over the long term because it can create a lose-lose situation (Clement, Chamberland, Aubın, & Dubeau, 2005).

Violence toward children is perceived differently among cultures and nations. All around the world there are several cultures using violence as a discipline tool. Adults who were beaten or suffered abuse as children can do the same when they grow up in solving problems (Bahar, Savaş, & Bahar, 2009; Desbois & Konstantareas, 2001; Diaz, Simantov, & Rickert, 2002; Gershoff, 2002; Kerr, Lopez, Olson, & Sameroff, 2004; Shor, 2000; Hultmann & Broberg, 2016). In Turkey, the saying “spare the rod and spoil the child,” “rose grows where your mother/teacher hits,” or “beating is come from the heaven” has been a prevailing child-rearing belief for generations. Practices involving violent discipline seem to be accepted by the whole country. According to studies on child discipline in Turkey, punishment is first preferred method. It was reported that 70% of parents exposed the violence and 40% of parents used violence methods toward their children (Pelendecioğlu & Bulut, 2009; UNICEF Turkey & Republic of Turkey Prime Minister Family Research Institute, 2010).

It is a problem that physical punishment methods are accepted as a method of traditional discipline. The perception of greater normativeness of physical discipline strategies seems to be related to more frequent use of this strategy (Lansford et al., 2010) and to not regarding physically abusive behaviors such as slapping, hitting, or spanking as physical abuse. Therefore, it could be accepted that if the prevalence of physical discipline is high, it is an acceptable way of discipline in the society (Mbagaya, 2010).

It is required to distinguish between disciplining children and abusing them. It is accepted that violent disciplinary practices either physical or psychological punishment have the potential to result in harm to the child and can be considered clear forms of maltreatment. In consideration of convention on the rights of the child, ıt can be concluded that mothers as parents are responsible to provide “direction and guidance” to their children but this guidance should not involve any kind of violence. Studies on child discipline, however, have mostly been carried out in North America and Europe (Waterston, 2000). To protect children from abuse, it is important to train society about physical punishment methods and abuse to realize social sensibility (Backman & Secord, 1974; Howard, 1991; Simsek, Ulukol, & Bingöler, 2004). Studies conducted in developed countries and even in low-income families showed that if the parents trained on child discipline, the percentages of negative attitudes and practices related to punishment decreased. Little is known about what disciplinary methods are actually used in low- and middle-income countries and which groups of children in these countries are at the greatest risk of exposure to violent discipline practices (Madhani et al., 2017; Stoltenborgh, Bakermans-Kranenburg, van ijzendoorn, & Alink, 2013; UNICEF Turkey & Republic of Turkey Prime Minister Family Research Institute, 2010). Surveillance of parenting behaviors for the well-being of children and societies are recommended.

This study has been carried out to determine the types and frequency of disciplinary behaviors used by mothers toward their 2- to 5-year-old children in Malatya, and the associated sociodemographic factors.

Method

Research Type

This is a cross-sectional descriptive study.

Participants

The research population consisted of mothers with children ages 2 to 5 years and residing in the city of Malatya. In total, there were 8,500 mothers with children ages 2 to 5 years living in the city center. Childhood between the ages of 2 and 5 years has become important in personality development and so dependency on the mother decreases. Therefore, mothers with children ages 2 to 5 years living in Malatya were included in this study. Malatya is a province in eastern Turkey with a population of 740,643 in 2010. The city center population was 388,000.

Sample

Thirty-cluster sampling method was used based on the probability proportional to size cluster sampling methodology. World Health Organization (WHO) Expanded Programme on Immunization (EPI) methodology’ (30 by 7) was modified as 30 by 20 (Republic of Turkey Ministry of Health & WHO, 2007; WHO, 2005). Thus, sample size was determined as 600 mothers. Family physician units were defined as primary sampling units (clusters). To choose the clusters that will be studied, first a list of all of the family physician units in the city with their population sizes was obtained from the Directorate of Health. After calculating cumulative population, 30 family physician units were chosen by systematic sampling method. Twenty mothers from each family physician units were interviewed. If the mother had two children between the ages of 2 to 5 years, the information about the youngest child was also collected.

In the Turkish health care system, all reproductive-aged women are registered at a midwife at a family physician unit. Women are provided with protective health care services, and their records are renewed every 6 months. In the last stage of the sampling, records of mothers with children ages 2 to 5 years were selected randomly and the women were invited to the family physician unit for the interview.

The data were collected from the 552 mothers during face-to-face interviews by researchers, over 5 weekdays at the family physician unit. This was an effort to establish a relaxed setting for data collection. Data collection was done between January 2 and March 20, 2010. The response rate was 92.0%.

Instruments and Measurements

The data were collected through face-to-face interviews via a structured interview form. The interview form was based on questions modified or taken from the The International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool–Parent Version (ICAST-P) which had been developed as a survey instrument to be administered to parents to assess child maltreatment in a multinational and multicultural context (Runyan, Dunne, & Zolotor, 2009). Different versions of ISPCAN screening tools had been translated to Turkish and used in quiet a lot of study in Turkey (Sofuoglu et al., 2014). The interview questionnaire also contained items about sociodemographic characteristics of mothers and children. Pilot interviews were conducted with 10 women before the field survey. The interviewer asked mothers to report the frequency of disciplinary methods they used during the previous year on a 5-point scale: never, 1 to 2 times, 3 to 5 times, 6 to 10 times, and >10 times. Finally, the frequency responses grouped in the form of Yes (if practiced at least once) and No (if never practiced) for the statistical analysis. For statistical analysis, findings related to the mothers’ disciplinary practices divided up into four subgroups: nonviolent disciplinary methods, severe physical punishment, moderate physical punishment, and psychological discipline. Nonviolent disciplinary methods contained items to explain why the behavior was wrong, to tell child to stop, and to give child something to do. Severe physical punishment subgroup contained five serious behaviors which were harsher in character: to hit the child with an object (not on buttocks), to beat the child, to kick the child, to choke the child, and to burn the child. Moderate physical punishment has included nine applications which were mild or soft in character: to hit the child on buttocks (with object), to hit the child with knuckles, to spank buttocks (with hand), to shake the child, to twist the child’s ear, to pinch the child, to pull the child’s hair, to slap the child’s face or head, and to put hot pepper in the child’s mouth. Psychological punishment has included 13 applications: to yell or scream at the child, to refuse to speak to the child, to threaten abandonment, to call the child stupid, to curse at the child, to threaten evil spirits, to put the child to shame in society, to threaten to kick the child out of the house, withhold food, to locked the child out of the household, to force the child to his knees, dark room punishment, and to threaten the child with a knife or gun. Child sexual violence or abuse was also questioned but none was reported by mothers.

Data Analysis

The Statistical Package for Social Sciences (SPSS) software Version 19.0 was used for statistical analysis. Chi-square hypothesis test was used to test for associations between the each subgroup of disciplinary practices and the sociodemographic characteristics of mothers and children. Significance levels were set at the 5% level using the hypothesis tests. Backward logistic regression analysis was performed to evaluate the independent association existing between the potential risk factors and the disciplinary methods used. The results were presented in odds ratios and 95% confidence intervals.

Research Permission

The study protocol had been approved by the Ethical Committee of Inonu University (Ref. No: 2009/166), and verbal consent was obtained from the mothers before the interview

Results

Sociodemographic characteristics of the participated mothers and their children in the research are shown in Table 1.

Table 1.

Distribution of the Selected Sociodemographic Characteristics of Mothers and Children.

Characteristics of Children	n	%
Characteristics of Mothers	n	%
Age in years
19-29	280	51.2
30-39	225	41.1
40 and over	42	7.7
Educational attainment
Literate without formal schooling or illiterate	90	16.3
Primary school	334	60.5
University or high school	128	23.2
Marital status
Married	545	98.7
Other (discovered, widowed informal marriage)	7	1.3
Mothers’ occupation
Housewife	511	92.6
Currently working	41	7.4
Income (Turkish Liras)
<1,000TL (<$671)	223	42.4
1,001-2,000TL (<$671-$1,342)	237	42.9
>2,000TL (>$1,342)	92	17.8
Spouse occupation
Unemployed	31	5.6
Employee	231	41.9
Self-employment	224	40.7
Officer	65	11.8
Fathers’ educational attainment
Literate without formal schooling or illiterate	18	3.3
Primary	329	59.6
University or high school	205	37.1
Total	552	100.0
Age in years
2-3	266	48.1
4-5	286	51.9
Gender
Male	265	48.0
Female	287	52.0
Birth order
First-born	292	52.9
Characteristics of Mothers	n	%
Middle child	76	13.8
Last-born	184	33.3
Caregiver
Mother	524	94.6
Other (grandmother-father aunt, childminder)	28	6.4
Diagnosed diseases
No	464	84.1
Yes	88	15.9
Number of siblings
No	118	21.4
1	213	38.6
2	119	21.6
3 and over	102	18.5
Family type
Nuclear family	394	71.5
Extended family	157	28.5
Number of household members
3-4 person	235	42.6
5-6 person	198	35.9
7 and over	119	21.5
Total	552	100.0

The average age of the mothers were 30.2 ± 0.2 years and 60.5% have completed primary school. Of them, 98.7% were married and 92.6% were housewife, 42.4% had low income. Mean income of the family was 1,008 Turkish Liras (minimum = 250TL maximum = 3,000TL median = 800TL). Of the children, 52% were girls and 48% were boys, 48.1% were between the ages of 2 and 3 years and 51.9% of the children were older than 3 years. The average age of the children was 3.4 ± 0.01 years. Regarding the birth order, 52.9% were first born, 33.3% were the youngest, and 13.8% fell in the middle. The caregiver of nearly all children was their mother (94.6%). Diseases were diagnosed in 15.9% of the children.

Frequency distribution of disciplinary practices as reported by mothers is presented in Table 2.

Table 2.

Frequency Distribution of Disciplinary Practices as Reported by Mothers.

Disciplinary Practices	n	%
Nonviolence methods	443	80.3
Told child to stop	489	88.6
Gave child something to do	470	85.1
Explained why the behavior was wrong	435	78.8
Severe physical punishment	98	17.8
Hit the child with an object (not on buttocks)	56	10.1
Beat the child	37	6.7
Kicked the child	22	4.0
Choked the child	10	2.0
Burned the child	4	1.1
Moderate physical punishment	444	80.4
Hit the child on buttocks (with object)	268	48.6
Hit the child with knuckles	268	48.6
Spanked buttocks (with hand)	248	44.9
Shook the child	246	44.6
Twisted the child’s ear	129	23.4
Pinched the child	126	22.8
Pulled the child’s hair	110	19.9
Slapped the child’s face or head	78	14.1
Put hot pepper in the child’s mouth	43	8.0
Psychological punishment	531	96.2
Yelled or screamed at the child	480	87.0
Refused to speak to the child	256	46.8
Threatened abandonment	187	33.9
Called the child stupid	134	24.3
Cursed at the child	137	24.8
Threatened evil spirits	108	19.6
Put the child to shame in society	22	4.3
Locked the child out of the household	16	2.9
Threatened to kick the child out of the house	10	2.0
Withhold food	10	2.0
Forced the child to his knees	10	2.0
Darkroom punishment	9	1.7
Threatened the child with a knife or gun	4	1.1

Note. The percentages were calculated based on the total number of mothers (552) because multiple response were given.

At least one episode of physical punishment toward their children was reported by 97.8% of the mothers during the year prior to the survey and 92.6% of the mothers reported at least one episode of psychological punishment toward their children and 80.3% had used nonviolent disciplinary methods in the year preceding the survey. Severe physical punishment was reported by 17.8% mothers. The most commonly used severe physical punishment methods that were reported by mothers were hitting the child with an object (10.1%), beating the child (6.7%), and kicking the child (4.0%). Hitting the child on buttocks with an object (48.6%), hitting the child with knuckles (48.6%), spanking on the buttocks with hands (44.9%), and shaking the child (44.6%) were the most commonly reported moderate physical punishment practices. The most frequently reported psychological punishment method by mothers was yelling or screaming at the child (87%) followed by refusing to speak to the child (46.8%).

The numbers and percentages of children who experienced each type of discipline by sociodemographic characteristics are shown in Table 3.

Table 3.

The Numbers and Percentages of Children Who Experienced Each Type of Discipline, by Sociodemographic Characteristics.

Characteristics of Children	Nonviolent Discipline		Severe Physical Punishment		Moderate Physical Punishment		Psychological Punishment		Total
	Yes	No	Yes	No	Yes	No	Yes	No	Total
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n
Child’s gender
Male	217 (81.8)	48 (18.2)	56 (21.1)*	209 (78.9)	214 (80.7)	51 (19.3)	255 (96.2)	10 (3.8)	265
Female	226 (78.7)	61 (21.3)	42 (14.6)	245 (85.4)	230 (80.1)	57 (19.9)	276 (96.1)	11 (3.9)	287
Age in years
2-3	212 (79.6)	54 (20.3)	37 (13.9)	229 (86.1)	211 (79.3)	55 (20.7)	256 (96.2)	10 (3.8)	266
4-5	231 (80.7)	55 (19.3)	61 (21.4)*	225 (78.6)	233 (81.4)	54 (18.6)	275 (96.1)	11 (3.9)	286
Birth order
First born	229 (78.4)	63 (21.6)	56 (19.1)	236 (80.9)	225 (77.0)	67 (23.0)	280 (95.8)	12 (4.2)	292
Middle born	65 (85.5)	11 (14.5)	14 (18.4)	62 (81.6)	63 (82.8)	13 (17.2)	73 (96.0)	3 (4.0)	76
Last born	149 (80.9)	35 (19.1)	28 (15.2)	156 (84.8)	156 (84.7)	28 (15.3)	178 (96.7)	6 (3.3)	184
Total	443 (80.3)	109 (19.7)	98 (17.8)	454 (82.2)	444 (80.4)	108 (19.6)	531 (96.2)	21 (3.8)	552

Note. Values in parentheses indicate row percentages.

Chi-square test p < .05.

Differences by the age and gender of child were found within the particular type of physical punishment used. Boys were more likely than girls to experience severe physical punishment: 21.1% compared with 14.6% (p < .05). Children aged 4 to 5 years were more likely to experience severe physical punishment than younger children: 21.4% of 4- to 5-year olds compared with 13.9% of 2- to 3-years-old (p < .05). Although there was no significant difference, the youngest children were much less exposed to severe physical violence (15.2%) and the oldest children more likely to experience nonviolent discipline (78.4%).

The numbers and percentages of mothers who used each type of discipline toward their children, by sociodemographic characteristics, are shown in Table 4.

Table 4.

The Numbers and Percentages of Mothers Who Used Each Type of Discipline Toward Their Children, by Sociodemographic Characteristics.

Sociodemographic Characteristics	Nonviolent Discipline		Severe Physical Punishment		Moderate Physical Punishment		Psychological Punishment		Total
	Yes	No	Yes	No	Yes	No	Yes	No	Total
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n
Age in years
19-29	217 (77.5)	63 (22.5)	44 (15.7)*	236 (84.3)	232 (82.8)	48 (17.2)	272 (97.1)	8 (2.9)	280
30-39	187 (83.1)	38 (16.9)	44 (19.5)	181 (80.5)	178 (79.1)	47 (20.9)	213 (94.6)	12 (5.4)	225
≥40	35 (83.3)	7 (16.7)	9 (21.4)	33 (78.6)	29 (69.0)	13 (31.0)	41 (97.6)	1 (2.4)	42
Educational attainment
Literate without formal schooling or illiterate	71 (78.8)	19 (21.2)	17 (18.8)	73 (81.2)	67 (74.4)	23 (25.6)	85 (94.4)	5 (5.6)	90
Primary school	259 (77.5)	75 (22.5)	61 (18.2)	273 (81.8)	268 (80.2)	66 (19.8)	322 (96.4)	12 (3.6)	334
High school/university	113 (88.2)*	15 (11.8)	20 (15.6)	108 (84.4)	109 (85.1)	19 (14.9)	124 (96.8)	4 (3.2)	128
Income
<1,000TL (<$671)	168 (75.3)	55 (24.7)	46 (20.6)	177 (79.4)	175 (78.4)	48 (21.6)	213 (95.5)	10 (4.5)	223
1,000−2,000TL($671-$1,342)	193 (81.4)	44 (18.6)	39 (16.4)	198 (83.6)	193 (81.4)	44 (18.6)	228 (96.2)	9 (3.8)	237
>2,000TL (>$1,342)	82 (89.1)*	10 (10.9)	13 (14.1)	79 (85.9)	76 (82.6)	16 (17.4)	90 (97.8)	2 (2.2)	92
Total	443 (81.3)	109 (18.7)	98 (17.8)	454 (82.2)	444 (80.4)	108 (19.6)	531 (96.2)	21 (3.8)	552

Note. (%) Row percentages.

Chi-square test p < .05.

As seen in Table 4, age, education, and economic status of mothers were associated with the different type of discipline methods used. The use of severe physical punishment was lower with parents 19 to 29 years old (15.7%) when compared with older parents. At least one episode of severe physical punishment was highest among mothers whose age was 40 years or over (21.4%). The use of nonviolent discipline methods (88.2%) was high among mothers who have graduated from high school or university when compared with less educated mothers. Nonviolent discipline (75.3%) was more likely and psychological punishment (95.5%) was less likely to be used by high-income mothers. Although there was no significant difference, severe physical punishment were much less used by mothers who have graduated from high school or university and who had a monthly income less than 1,000TL, 15.6% and 14.1% in order.

A model was established with sociodemographic characteristics of mothers and their children and then analyzed using backward stepwise logistic regression test. The results of the logistic regression test are presented in Table 5. After logistic regression analysis, independent predictors of nonviolent discipline were found to be high school/university-level educational attainment (OR = 1.4) and high family income (OR = 1.7). Being at the age of 4 to 5 years (OR = 1.6) and being male (OR = 1.5) were found to be the independent predictors of severe physical punishment.

Table 5.

The Logistic Regression Model for Impact of Using Punishments’ Type on Sociodemographic Characteristics (N = 552).

Factors	β	SE	p	OR	95% CI
Nonviolence discipline
Mothers’ education (high school /university)	0.680	0.300	.023	1.437	[1.096, 3.550]
Income (>2,000TL or >$1,342)	0.547	0.220	.013	1.728	[1.123, 2.659]
Severe physical punishment
Child age (4-5)	0.522	0.229	.022	1.685	[1.077, 2.638]
Child’s gender (male)	0.447	0.225	.047	1.563	[1.006, 2.428]

Note. OR = odds ratio; CI = confidence interval.

Discussion

Our study which was conducted in Malatya in 2010 indicated that the use of violent discipline practices by mothers toward their 2- to 5-year-old children was highly common. Of the mothers, 96.2% reported having used psychological, 80.4% moderate physical, and 17.8% severe physical punishment as disciplinary methods in the previous year before the study. The use of nonviolent disciplinary methods was reported 80.3% of the mothers.

Psychological punishment was the most frequently used disciplinary method in every demographic group of mothers and children with similar percentage distribution. The most commonly used psychological punishment method by mothers was yelling or screaming at the child (87.0%) followed by refusing to speak to the child (46.8%) comparable with the literature. In the five countries of the World Studies of Abuse in the Family Enviroment (WorldSAFE study; Chile, Egypt, India, Philippines, USA), the incidence rates of yelling or screaming at child in the previous 6 months ranged 70% to 85% and refusing to speak to the child ranged 15% to 48% (WHO, 2002). In research carried out in Quebec, Canada, with 3,148 mothers via telephone, it was observed that 80% of the mothers used psychological violence on their children (Clement et al., 2005). In our study, the least commonly used forms of psychological punishment were withholding food, forcing the child to his knees, dark room punishment, and threatening the child with a gun.

A large majority of mothers (80.4%) reported at least one episode of moderate physical punishment toward the child during the year prior to the study. Moderate physical punishment behaviors are accepted as soft or mild kind of punishment behaviors in some cultures. Thus, the high percentage in our study can be explained as a reflection of the mothers’ attitudes in Malatya. They probably accepted moderate punishment behaviors as soft methods. No significant demographic differences were found for the use of moderate physical punishment. The most frequent form of moderate punishment used by mothers were hitting the child on buttocks with an object and hitting the child with knuckles, which both were reported by nearly half of mothers (48.6%) followed by spanking buttocks with hand (44.9%) and Shaking the child (44.6%). We know from our experiences and observations that slippers are the most used object by mothers to hit the child on buttock. Generally mothers take off their slippers and throw to the child targeting buttocks. Hitting the child with knuckles on the forehead or on the top of the head with knuckle joint is common in Turkish society with having a name “goat sign” indicating the pain or swelling on the skin on forehead after knuckle. Goat sign is coming and spank is coming are the sentences which parents use to show their dislike about children behaviors.

Moderate physical discipline practices reported by mothers ranged from 17.1% (Quebec) to 89% (rural Bhopal) worldwide (Clement et al., 2005). In several countries, spanking the child’s buttocks by hand is used very often; 67% in the United States (Wissow, 2001), and it is used less than other actions in Egypt (%29; WHO, 2002). In the Republic of Korea (Hahm & Guterman, 2001), it has been observed that two out of three families slap the child’s face (which was 14.1% in our study).

In our study, 17.8% of mothers used severe physical punishment methods. It might be assessed as a positive finding that the severe methods used much less often, but still at very high percentages. The most frequently used severe physical punishment forms were hitting the child with an object (10.1%), beating the child (6.7%), kicking the child (4.0%), choking the child (2.0%), and burning the child (1.1%). The objects or methods used in physical punishment differed according to the cultural, social, economic, environmental, and even psychobiological factors of the perpetrators. Wood, tongs, fork or knife, slippers or in the absence of an external object hand, elbow, foot or knuckle joint were the tools come to mind to be used to give harm to the child. There are great differences among societies in the use of severe punishment methods. In the Republic of Korea (Hahm & Guterman, 2001), 45% of the families beat the child with an object or kick the child. In cross-sectional research (Youssef, Attia, & Kamel, 1998) carried out in Egypt, children are beaten by 37% of the parents and hit by a belt. In Romania (Browne et al., 2002), it has been observed that 4.6% of the children are very often exposed to some serious physical violence methods like being hit with an object, not given food, or being burned.

Girls and young children were less exposed to severe physical violence than were males and older children (p < .05) in our study. As well, there was a nonsignificant trend for children who had two older siblings to be exposed to severe physical violence than were children who were first born and children who had one older sibling. Severe violence forms were much less used by mothers who have higher education and high income (15.6% and 14.1%, respectively). The mothers’ age was significantly associated with the use of severe physical punishment. The use of severe physical punishment was much less common among mothers in the 19 to 29 years age group (15.7%) than mothers of age 40 or over (21.4%). It is known that younger children are affected by violence more. However, the age groups of the children and the violence usage changes from country to country. For example; the violence not causing nonfatal violence peaks in age groups 3 to 6 years in China (Tang, 1998), it peaks in age groups 6 to 11 years in India (Hunter, Jain, Sadowski, & Sanhueza, 2000), and at 6 to 12 years of age in the United States (Straus & Hamby, 1997).

Nonviolent methods of discipline were used by 80.3% of the mothers at least once in the previous year before the survey. The use of nonviolent methods in the literature ranged from 28.05% to 98.3% in Quebec (Clement et al., 2005). In our study, to tell child to stop was the most common type (85.1%) followed by giving child something to do (85.1%) and to explain why the behavior was wrong (78.8%). In Turkey, other studies also found that parents used nonviolent discipline methods such as explained why the behavior was wrong, sent to child’s room, and read the book (between 3,5%- %80; Bilgin & Kartal, 2009). Nonviolent discipline rates were reported 48% in 1,000 U.S. children (explained why something was wrong rates 18.3%, gave him or her something else to do instead of what he or she was doing rates 12.2%, took away privileges or grounded him or her rates 10.8%, sent to room rates 13%; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998).

Educational attainment and family income were positively associated with the use of nonviolent discipline methods. Mothers who had high income were more likely to use methods of nonviolent discipline (89.1%); 88.2% of the mothers graduated from high school or university used nonviolent methods of discipline.

According to logistic regression analyze, independent predictors of nonviolent discipline were found to be higher educational attainment of mothers (OR = 1.4) and high family income (OR = 1.7). Mothers who were graduated from high school or university were 1.4 times, and mothers with a family income over 2,000TL were 1.7 times more likely to use nonviolent discipline methods. The reasons for situation may be the change in social environment with increasing income and the attitude with increased education. The association of low income and low education with the high use of physical violence toward children particularly in developing countries was already defined in the literature (WHO, 2002). However, in some studies the use of corporal punishment was found to be lower by parents with a high school diploma or less education than by parents with college, trade, or technical training (Best Start Resource Centre, 2014). That study reported greater use of corporal punishment with parents 44 years old, similar to our study.

There were two significant predictors of severe physical punishment within the child characteristics. Boys were 1.5 times more likely than girls and children with 4 to 5 years old were 1.6 times more likely than with 2 to 3 years old to be experienced severe physical punishment. Disciplining a boy becomes harder by mothers because he is more active and feels free as he grows. That might be the reason for higher use of severe physical punishment methods toward their son and older children by mothers in Malatya (Republic of Turkey Prime Minister Family Research Institute, 2014). Boys are more commonly exposed to corporal punishment in general as defined in the literature (Evans, 2015).

Our study has limitations that should be acknowledged. The study can be considered as a baseline survey defining the discipline practices and the magnitude of violent discipline practices in a sample of mothers. Data were collected via face-to-face questionnaire including items about types of discipline practiced in the previous year before the survey. Recall and suppressing information might have been occurred as bias. Because we did not asked all the items related to nonviolent methods such as rewarding, reading a book, and so forth, we should declare this also as a limitation. There were no variables related to violence exposure of mothers in their childhood or currently, so we cannot declare any causal relationship. Some physical discipline types cannot be compared by age and gender of children because the numbers were not enough for comparison. Further research with bigger sample sizes and detailed information is needed in this respect.

Conclusion and Implications

In conclusion, the current study contributes to existing literature describing the relatively low income mothers’ discipline tactics living in eastern Anatolia. The study showed that nine of 10 mothers used physical and/or psychological punishment toward their children in the previous year. Nonviolent discipline was less prevalent than punitive discipline, such as psychological and physical punishment. The most commonly used method was psychological punishment. This could be due to many social stressors and personal factors. Significant sociodemographic associations with discipline methods were found. Mother’s educational level, family income, child gender, and child age were the independent predictors that explained discipline methods used by mothers.

Violence is a socially learned behavior. Children can use punitive discipline methods in the future toward their children in problem solving and disciplining so the vicious cycle of violence continues in society reproducing itself (Bahar et al., 2009; Desbois & Konstantareas, 2001; Diaz et al., 2002; Fink, 2010; Gershoff, 2002; Kerr et al., 2004; Shor, 2000; Song, Wenzel, Kim, & Nam, 2017). Recent studies showed the positive effect of parenting classes on reducing the harsh violence especially for the parents with more risk factors. It is shown in low-income areas that training of mothers on parenting styles decrease the rate of physical discipline methods (Evans, 2015). In the prevention programme of violence against children particularly in child discipline, Turkey should update the action plans related to mothers and child health. In the direction of our findings, home visits by nurses, anger control, and psychological support toward parents who needed, starting parenting classes, using mass media in creating awareness on parenting styles and changing community attitudes and behavior and strengthening the child protection systems may be suggested as the activities that can be undertaken at local or national level.

Footnotes

Declaration of Conflicting Interests

The author(s) declared the following 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

Mehtap Omaç Sönmez is a registered nurse and she has a PhD in public health from Inonu University. She is working as a fulltime associate professor at nursing department in Kahramanmaras Sutcu Imam University School of Health.

Metin Fikret Genç is a medical doctor (MD) and Public Health specialist. He is working as a fulltime professor at public health department in medical faculty at Inonu University.

Leyla Karaoğlu is a medical doctor (MD) and Public Health specialist. She is working as a fulltime professor at public health department in medical faculty at Recep Tayyip Erdoğan University. She is head of the department since 2009.

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