Relationship between Self-Esteem and Aggressive behavior among Foster Care Children at Minia Governorate, Egypt

Introduction:

Foster care services are provided for children who cannot live with their original families due to birth out of wedlock, family breakup, poverty, parental death, or child abuse, and includes runaway children (Yoon et al., 2019). Compared with the general population, children in foster care are at greater risk of having higher rates of mental health problems, low self-esteem, developmental health problems and behavior problems (Carthya et al., 2018). Characteristics of the foster placement itself might also influence the likelihood that a foster child will develop problematic aggressive behaviors.

Self-esteem refers to an overall evaluation of one’s worth or value as a person (Thompson et al., 2016). Levels of self-esteem during childhood influence the longer term course of development into adulthood (Robins & Trzesniews, 2018). In this respect; Coopersmith (1981), reported thatself-esteem as self-worth which is a product of development that serves as an important protective factor for positive development(Linares et al., 2016). Foster care children are at risk of developing low self-esteem and related psychological problems due to their experience of separation from their parents, and tend to grow up in a more difficult environment with a greater sense of stigma (Hiemstra et al., 2020).

Children's aggression remains a critical global concern that may cause harm to other children's behavioral, emotional and psychological, social, and academic functions (Kim & Lee, 2020). Aggression, in socio-psychological perspective, was defined as a psychological phenomenon which depicts a large category of intentional behavior of bringing harm to other or self by means of physical or verbal attacks. The behavior of aggression can lead to violence such as school bulling, murder, self-injury, and suicide. Being a bully in childhood was demonstrated to be correlated with higher aggression in adulthood (Yu, et al., 2020).

Significance of the study

Levels of self-esteem during childhood influence the longer term course of development into adulthood (Orth & Robins, 2018). Parental neglect or lack of warmth is known to both undermine healthy self-esteem development and cultivate children’s aggressive behavior (Mwakany & Yizhen 2019). Children in foster care have been found to report higher levels of internalizing and externalizing behaviors than the general population, a higher prevalence of behavioral problems exists for children entering foster care and these problems may also impact an individual throughout their lifetime, in a study of 148 foster children, 82% of them reported physical aggression, 14% beat-up, 41% kicking, and 69% pushing (Linares, et al., 2016). Similarly; Thompson et al., (2016) reported that the prevalence of behavioral problem in foster children has ranged from approximately 20 to 80%. The prevalence of behavior problems in a US study among 2–14 year, exhibited by foster children has been estimated to be 47.9% olds and 29– 49% among Australian children (Jacobsena, et al., 2020). In Egypt, Fawzy & Fouad, (2010) reported that,23% of children had low self-esteem in a study conducted in  4 orphanages at Sharkia governorate.

Aim of the study

This study aimed to assess the relationship between self-esteem and aggressive behavior among foster care children at Minia governorate.

Subjects and Methods

Research design:

A descriptive correlational research design was utilized in this study.

Setting

This study was conducted in foster care centers at Minia governorate which includes two foster cares (Minia institution for boys and Minia institution for girls).

Minia institution for boys in Minia city includes five floors that receive children from one day after birth to 18 years of old (about 123 children). However, Minia institution for girls localizes in Minia city consists of four floors and receives female children from 6 years old up to marriage age (about 39 children). They provide food, shelter, health care, clothes and education.

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Subjects:                                                          

A purposive sample consisted of 51 children from the foster care children aged from 6-12 years old (23 of them were females and 28 were males) included in the study.

Inclusion Criteria:

• Both genders aged from 6-12 years old.
• Length of stay was more than one year on the foster care.

Tools of Data Collection:

A well-designed questionnaire was used to collect the data of the foster care children. It comprised of three parts.

Part (I) included demographic data as age, gender, educational level, reason of entry foster care and duration of stay.

Part (II): Aggressive behavior scale:

Aggressive behavior scale (Adel, 1993): Arabic structured scale designed by Adel Ahmed Hussein (1993) for measuring aggressive behavior among foster care children. This scale consists of 36 items including forms of aggression. Verbal aggression toward others is 12 items, 16 items of physical aggression, 4 items aggression toward things and 4 items aggression toward self. Responses of the scale ranged from 0 for No, 1 for Sometimes to 2 for Yes.

The levels of aggressive behavior were:

• From 0-24 : Mild aggressive behavior
• From 25-48: Moderate aggressive behavior.
• More than 48: Severe aggressive behavior

Part (III): Hare Self-Esteem Scale (HSS, 1975).

Hare Self-Esteem Scale developed by Hare, 1975.The HSS measure self-esteem of school aged- children across three domains (peer, school, home) and allows for a general assessment of self-esteem when is summed. These three areas are the major points of an indicator of interaction for a child where self-esteem is developed. It consists of 30 items (10 items per subscale). Response scale ranges from 1 (strongly disagree) to 4 (strongly agree). The scale was modified to use “foster parents” instead of “parents,” because this research focuses on children in foster care. Higher score on this scale indicates a higher self-esteem. Participants’ scores ranged from 30 to 120 (Hugan, 2005).

Reliability: The reliability of the tool were done by the statistician and revised by the supervisors. The internal consistencies of the questionnaire were calculated using Cronbach's alpha coefficients test. The Cronbach’s alpha of the questionnaires was 0.76, indicate good reliability.

Content Validity: The tools were submitted to five experts in psychiatric mental health nursing to test their validity (Minia, Assiut and Cairo Universities, Faculty of Nursing, Psychiatric Nursing department) and the necessary modifications were done.

Pilot study

Pilot Study was conducted on 10% from the total number which equal 5 foster care children of study sample to test the study process and to evaluate the efficiency, clarity, of tools that was used in the study. Subjects who participated in the pilot study were excluded from the actual study.

Field work

Each foster care child interviewed to collect the necessary data, the researcher went to Minia male and female institutions for two days per week from 9-11am (Saturday and Tuesday). The questionnaire was filled out by the researcher and also the researcher clarified the meaning of the questions for the children to facilitate understanding the meaning of the statements.

Administrative Design:

An official letter obtained from the dean of the Faculty of Nursing, Minia University, as well as the director of Social Solidarity & directors of male and female institution asking for permission to collect data. Oral consent obtained from the children after explaining the nature and purpose of the study through direct personal communication to gain their acceptance and cooperation.

Ethical Consideration

A written initial approval obtained from the Research Ethical Committee of the Faculty of Nursing, Minia University, there is no risk for study subjects during application of this research, the study follows common ethical participation in clinical research, and privacy was provided during data collection. Anonymity and confidentiality was assured through coding the data; and a child has the right to refuse to participate in the study without any rationale.

Statistical Analysis

Recorded data were analyzed using the statistical package for social sciences; version 26.0 Quantitative data were expressed as mean± standard deviation (SD). Qualitative data were expressed as frequency and percentage. Also, Pearson correlation was used.

Results

Table (1): Descriptive statistic of demographic characteristics of the studied sample (N= 51).

Table (1) shows the descriptive statistics of the 51 foster care children included in the study. In total, more than half of the participants were males (54.9), 58.8% of them were in age group ranged between ˃ 9:12 years old, and all children were in primary school (100%). In addition to, more than half of the studied sample was foundling (50.9%), while 17.6 of children entered foster care due to orphans and about one third of them entered because of parents' separation (divorce) (31.37%).

Figure (1): Levels of aggressive behavior among foster children N=(51)

Figure (1) shows the frequency distribution of aggressive behavior levels. It can be noted from figure that 42 (82.4%) of the studied sample had severe aggression, while only 9 (17.6%) had moderate level of aggressive behavior.

Table (2): Relation between gender and aggressive behavior among foster children (N=51).

*p-value <0.05 S;                                                     **p-value <0.001 HS

Table (2) reveals that; mean score for physical aggression was higher among males than females (43.46 ± 7.46 & 36.30 ± 6.73) respectively; while mean score for verbal aggression was higher among females than males (28.91 ± 2.48 & 28.11 ± 1.23) respectively. The total mean scores for aggressive behaviors were higher among males than females (92.07 ± 7.78 & 83.04 ± 7.38) respectively. There was highly statistically significant difference between gender and nearly all subtypes of aggressive behavior (P=0.001, 0.001, 0.000 & 0.000) respectively.

Table (3): Relation between age group and aggressive behavior among foster children (N=51).

Table (3) clarifies that; the mean scores for physical aggression and aggressive behavior toward things were higher among children in age group 6-9 yrs. than children in age group 10-12 yrs. (40.85 ± 8.46 & 10.52 ± 1.12) respectively, while mean score for aggressive behavior toward self was higher among children in age group from 10-12 yrs. than children in age group 6-9 yrs. (9.73 ± 0.58). Children in age group 6-9 yrs. were highly aggressive than other age group children (88.28 ± 10.44 & 87.80 ± 7.62) respectively. There was highly statistical significant difference between age group and aggressive behavior toward self (P = 0.000).

Table (4): Relation between reasons of entry for foster care and aggressive behavior among foster children (N=51)

Table (4) shows that; the mean scores for verbal and physical aggression were higher among children who entered foster care for reason of parents' separation (divorce) than orphan and foundling children (29.12 ± 0.80 & 41.50±9.69) respectively; while the mean score for aggressive behavior toward self was higher among foundling children (10.00 ± 0.00). There was significant difference between reason of entry foster care and aggressive behavior toward self (P=0.000).

Figure (2): Levels of self-esteem among foster children N=(51)

Figure (2) shows the frequency distribution of self-esteem levels. It can be noted from that 37 (74.5%) of the studied sample have low self-esteem, while only 14(27.4%) have middle level of self-esteem.

Table (5): Relation between gender and subitems of self-esteem among foster children (N=51):

Table (5) illustrates that; foster females had higher mean score for peer and school based self-esteem than males’ foster children (17.04 ± 1.82 & 18.39 ± 2.58) respectively; while foster male had high home based self-esteem (15.75 ± 0.88). There was highly statistically significant difference between gender and nearly all subitems of self-esteem (P=0.000, 0.097, 0.000 & 0.000) respectively.

Table (6): Relation between age group and subitems of self-esteem among foster children (N=51)

Table (6) shows that; the mean scores of global self-esteem were slightly high among children in age group from 6-9 yrs. (47.61 ± 4.95). There was no significant difference between age group and subtypes of self-esteem (P=0.42).

Table (7): Relation between reasons of entry for foster care and sub items of self-esteem among foster children (N=51).

Table (7) shows that; children who entered foster care for reason of parent separation (divorce) had lower mean score for self-esteem based home (14.75± 1.00). There was significant difference between reason of entry foster care and self-esteem based home (P=0.04).

Figure (3): Correlation between aggressive behavior and self-esteem among foster children N=(51)

*. Correlation is significant at the 0.05 level (2-tailed).

Figure (3) reveals that; there was statistically significant negative correlation between aggressive behavior and self-esteem among foster care children (r= - 0.33 at p = 0.01).