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HOME > J Korean Acad Community Health Nurs > Volume 27(1); 2016 > Article
Original Article
Survey Study of Current Status of and Need for Mental Health Education Enhancing Protective Factors in the Elementary Schools
Ji-Hyun Lee, Hyeoun-Ae Park
Journal of Korean Academy of Community Health Nursing 2016;27(1):9-20.
DOI: https://doi.org/10.12799/jkachn.2016.27.1.9
Published online: March 12, 2016

College of Nursing, Seoul National University, Seoul, Korea

Corresponding author: Park, Hyeoun-Ae College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8827, Fax: +82-2-765-4103, E-mail: hapark@snu.ac.kr
• Received: January 8, 2016   • Revised: March 17, 2016   • Accepted: March 17, 2016

Copyright © 2016 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to survey the current status of mental health education and need for mental health education enhancing protective factors in the elementary schools.
  • Methods
    We surveyed 10 school health teachers and 328 fifth- and sixth-grade students using 19- and 20-item questionnaires, respectively.
  • Results
    All of the teachers and 65.2% of the students replied that they were either teaching or being taught mental health in school. Topics covered suicide, depression, school violence, and Internet addiction. All of the teachers and 84.1% of the students expressed the need for mental health education enhancing protective factors in school. Both groups replied that two sessions are enough. The teachers preferred role play and discussion as teaching methods, and audiovisual materials and computer as instructional media. The students preferred lecture and role play as teaching methods, and audiovisual materials and smartphone as instructional media. Both groups ranked self-esteem, parent-child relationship, peer relationship, and emotional regulation as the most important topics to be covered in the education.
  • Conclusion
    There is a high demand for mental health education enhancing protective factors. Therefore, it is recommended to develop educational programs enhancing protective factors by enabling formal and informal learning using smartphone.
  • Key Words: School nursing; Health education; Mental health; Needs assessment
Table 1.
General Characteristics of the Study Subjects
Participants Variables Categories n (%)
School health teachers (n=10) Age 40~44 6 (60.0)
45~49 4 (40.0)
Clinical Experience as mental health nurse Yes 0 (0.0)
No 10 (100.0)
Length of teaching career (in year) ≤10 2 (20.0)
11~15 1 (10.0)
16~20 5 (50.0)
≥21 2 (20.0)
Number of classes Under 18 2 (20.0)
Over 18 8 (80.0)
Number of students 400~499 2 (20.0)
500~599 1 (10.0)
600~699 4 (40.0)
700~799 3 (30.0)
Students (n=328) Grade 5th 158 (48.2)
6th 170 (51.8)
Gender Boys 148 (45.1)
Girls 180 (54.9)
Smart phone ownership Yes 233 (71.0)
No 95 (29.0)
Religion Yes 180 (54.9)
No 148 (45.1)
Parent(s) who live together Mother & Father 311 (94.8)
Mother 12 (3.7)
Father 3 (0.9)
Other 2 (0.6)
Relationship with parents Very good 233 (71.0)
Good 91 (27.8)
Bad 4 (1.2)
Very bad 0 (0.0)
Relationship with siblings Very good 119 (36.3)
Good 146 (44.5)
Bad 20 (6.1)
Very bad 3 (0.9)
No siblings 40 (12.2)
Family life satisfaction Very satisfied 209 (63.7)
Satisfied 109 (33.2)
Dissatisfied 9 (2.7)
Very dissatisfied 1 (0.3)
Relationship with teachers Very good 172 (52.4)
Good 152 (46.3)
Bad 3 (0.9)
Very bad 1 (0.3)
Relationship with friends Very good 187 (57.0)
Good 140 (42.7)
Bad 1 (0.3)
Very bad 0 (0.0)
School life satisfaction Very satisfied 166 (50.6)
Satisfied 155 (47.3)
Dissatisfied 6 (1.8)
Very dissatisfied 1 (0.3)
Major consultant Mother 202 (61.6)
Father 7 (2.1)
Teacher 2 (0.6)
Friend (same sex) 93 (28.4)
Friend (opposite sex) 2 (0.6)
Siblings 10 (3.0)
Other 5 (1.6)
No person 7 (2.1)
Feeling of happiness Very happy 186 (56.7)
Happy 130 (39.6)
Unhappy 11 (3.4)
Very unhappy 1 (0.3)
Table 2.
Status of Mental Health Education from School Health Teacher and Students
Participants Variables Categories n (%)
School health teachers (n=10) Health education Yes 10 (100.0)
No 0 (0.0)
Number of hours (per year) 5th grader
Over 17 6 (60.0)
Under 17 3 (30.0)
Not applicable 1 (10.0)
6th grader
Over 17 4 (40.0)
Under 17 4 (40.0)
Not applicable 2 (20.0)
Mental health education Teach a class Yes 10 (100.0)
No 0 (0.0)
Number of hours (per year) 5th grader
3 1 (10.0)
2 4 (40.0)
1 4 (40.0)
Not applicable 1 (10.0)
6th grader
3 1 (10.0)
2 3 (30.0)
1 4 (40.0)
Not applicable 2 (20.0)
Topics† Suicide 4 (21.1)
Depression 3 (15.8)
School violence 3 (15.8)
Internet addiction 2 (10.5)
Friendship 2 (10.5)
Self-esteem 2 (10.5)
Emotion 2 (10.5)
Stress 1 (5.3)
Teaching method† Lecture 9 (39.1)
Discussion 6 (26.1)
Role play 3 (13.0)
Case 'study 4 (17.4)
Self-directed learning 1 (4.3)
Instructional media† Printed media such as textbook 2 (11.1)
Audiovisual media such as video 10 (55.6)
Non-projected media such as real objects 2 (11.1)
Computer media such as multimedia 4 (22.2)
Smart media such as smart phone 0 (0.0)
Source of teaching material† Book 2 (10.0)
Periodical 0 (0.0)
Internet 10 (50.0)
Peer school health teacher 8 (40.0)
Information leaflet 0 (0.0)
Difficulty‡ Mental health education
Low priority 3 (17.6)
No method and time for feedback 3 (17.6)
Lack of materials 3 (17.6)
Lack of capacity of health teacher 3 (17.6)
Health education
Lack of time 3 (17.6)
Excessive school health task 2 (11.8)
Students (n=328) Mental health education Yes 214 (65.2)
No 114 (34.8)
Never 79 (69.3)
Don't remember 24 (21.1)
Other 11 (9.6)
Topics† Response 202 (94.4)
Internet addiction 120 (43.8)
Suicide 76 (27.7)
Depression 37 (13.5)
Psychosis 14 (5.1)
Don't remember 14 (5.1)
School violence 9 (3.3)
Friendship 1 (0.4)
Self-esteem 2 (0.7)
Stress 1 (0.4)
Non-response 12 (5.6)

†Multiple responses are possible;

‡Free text response.

Table 3.
Needs for Protective factors in Mental Health Education from School Health Teachers (N=10)
Variables Categories n (%)
Demand Extremely Very 10 (100.0) 0 (0.0)
Moderately Slightly 0 (0.0) 0 (0.0)
Not at all 0 (0.0)
Goal Understanding of concept and knowledge Acquisition of attitude and value 0 (0.0) 8 (80.0)
Practice of health behaviour Development of critical thinking 1 (70.0) 1 (70.0)
Frequency 3 4 (40.0)
2 1 5 (50.0) 0 (0.0)
Other 1 (10.0)
Teaching method† Lecture Discussion 1 (4.0) 8 (32.0)
Role play Case study 10 (40.0) 5 (20.0)
Self-directed learning 1 (4.0)
Instructional media† Printed media such as textbook Audiovisual media such as video 1 (5.3) 10 (52.6)
Non-projected media such as real objects Computer media such as multimedia 2 (10.5) 4 (21.1)
Smart media such as smart phone 2 (10.5)
Accessibility to information Very good Good 0 (0.0) 0 (0.0)
Fair Poor 2 (20.0) 7 (70.0)
Very poor 1 (10.0)
Issues to consider‡ Aspect of health education in school
Enough time for health education 5 (23.8)
Competency for the school health teacher 4 (19.0)
Aspect of mental health education Development of the practical teaching materials 7 (33.3)
Connection with mental health resources Strategies to self-directed learning 3 (14.3) 2 (9.5)

†Multiple responses are possible;

‡Free text response.

Table 4.
Needs for Protective Factors in Mental Health Education from Students (N=328)
Variables Categories Boys
 Girls
 Total
n (%) n (%) n (%)
Demand Extremely 86 (58.1) 107 (59.4) 193 (58.8)
Very 34 (23.0) 49 (27.2) 83 (25.3)
Moderately 24 (16.2) 20 (11.1) 44 (13.4)
Slightly 3 (2.0) 2 (1.1) 5 (1.5)
Not at all 1 (0.7) 2 (1.1) 3 (0.9)
Frequency 3 31 (20.9) 52 (28.9) 83 (25.3)
2 74 (50.0) 81 (45.0) 155 (47.3)
1 37 (25.0) 36 (20.0) 73 (22.3)
Other 6 (4.1) 11 (6.1) 17 (5.2)
Teaching method† Lecture 59 (39.9) 58 (32.2) 117 (26.0)
Discussion 55 (37.2) 53 (29.4) 108 (24.0)
Role play 38 (25.7) 77 (42.8) 115 (25.6)
Case study 26 (17.6) 29 (16.1) 55 (12.2)
Self-directed learning 17 (11.5) 38 (21.1) 55 (12.2)
Instructional media† Printed media such as textbook 15 (10.1) 20 (11.1) 35 (7.1)
Audiovisual media such as video 109 (73.6) 126 (70.0) 235 (47.7)
Non-projected media such as real objects 25 (16.9) 23 (12.8) 48 (9.7)
Computer media such as multimedia 34 (23.0) 41 (22.8) 75 (15.2)
Smart media such as smart phone 41 (27.7) 59 (32.8) 100 (20.3)

†Multiple responses are possible.

Table 5.
Priority of Topics Enhancing Protective Factors in Mental Health Education
Participants Topics Rank
 Weighted score Overall priority
1
 2
 3
 4
 5
 6
 7
n (%)
 n (%)
 n (%)
 n (%)
 n (%)
 n (%)
 n (%)
School health teachers (n=10) Parent-child relationship 4 1 3 1 0 1 0 5.5 2
(40.0) (10.0) (30.0) (10.0) (0.0) (10.0) (0.0)
Peer relationship 1 4 1 1 2 0 1 4.7 3
(10.0) (40.0) (10.0) (10.0) (20.0) (0.0) (10.0)
Self-esteem 5 2 2 1 0 0 0 6.1 1
(50.0) (20.0) (20.0) (10.0) (0.0) (0.0) (0.0)
Self-efficacy 0 0 1 1 5 1 2 2.8 5
(0.0) (0.0) (10.0) (10.0) (50.0) (10.0) (20.0)
Emotional regulation 0 2 0 4 2 2 0 3.8 4
(0.0) (20.0) (0.0) (40.0) (20.0) (20.0) (0.0)
Optimism 0 1 0 1 0 4 4 2.2 7
(0.0) (10.0) (0.0) (10.0) (0.0) (40.0) (40.0)
Resilience 0 0 3 1 1 2 3 2.9 6
(0.0) (0.0) (30.0) (10.0) (10.0) (20.0) (30.0)
Students(n=271) Parent-child relationship 96 65 43 29 14 18 6 5.5 1
(35.4) (24.0) (15.9) (10.7) (5.2) (6.6) (2.2)
Peer relationship 45 70 54 31 25 12 34 4.7 2
(16.6) (25.8) 19.9) (11.4) (9.2) (4.4) (12.5)
Self-esteem 70 29 40 32 44 32 24 4.5 3
(25.8) (10.7) (14.8) (11.8) (16.2) (11.8) (8.9)
Self-efficacy 14 29 36 61 61 33 37 3.6 5
(5.2) (10.7) (13.3) (22.5) (22.5) (12.2) (13.7)
Emotional regulation 26 39 42 46 44 39 35 3.9 4
(9.6) (14.4) (15.5) (17.0) (16.2) (14.4) (12.9)
Optimism 9 23 30 38 42 74 55 3.1 6
(3.3) (8.5) (11.1) (14.0) (15.5) (27.3) (20.3)
Resilience 12 17 27 34 40 62 79 2.9 7
(4.4) (6.3) (10.0) (12.5) (14.8) (22.9) (29.2)

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    Survey Study of Current Status of and Need for Mental Health Education Enhancing Protective Factors in the Elementary Schools
    Survey Study of Current Status of and Need for Mental Health Education Enhancing Protective Factors in the Elementary Schools
    Participants Variables Categories n (%)
    School health teachers (n=10) Age 40~44 6 (60.0)
    45~49 4 (40.0)
    Clinical Experience as mental health nurse Yes 0 (0.0)
    No 10 (100.0)
    Length of teaching career (in year) ≤10 2 (20.0)
    11~15 1 (10.0)
    16~20 5 (50.0)
    ≥21 2 (20.0)
    Number of classes Under 18 2 (20.0)
    Over 18 8 (80.0)
    Number of students 400~499 2 (20.0)
    500~599 1 (10.0)
    600~699 4 (40.0)
    700~799 3 (30.0)
    Students (n=328) Grade 5th 158 (48.2)
    6th 170 (51.8)
    Gender Boys 148 (45.1)
    Girls 180 (54.9)
    Smart phone ownership Yes 233 (71.0)
    No 95 (29.0)
    Religion Yes 180 (54.9)
    No 148 (45.1)
    Parent(s) who live together Mother & Father 311 (94.8)
    Mother 12 (3.7)
    Father 3 (0.9)
    Other 2 (0.6)
    Relationship with parents Very good 233 (71.0)
    Good 91 (27.8)
    Bad 4 (1.2)
    Very bad 0 (0.0)
    Relationship with siblings Very good 119 (36.3)
    Good 146 (44.5)
    Bad 20 (6.1)
    Very bad 3 (0.9)
    No siblings 40 (12.2)
    Family life satisfaction Very satisfied 209 (63.7)
    Satisfied 109 (33.2)
    Dissatisfied 9 (2.7)
    Very dissatisfied 1 (0.3)
    Relationship with teachers Very good 172 (52.4)
    Good 152 (46.3)
    Bad 3 (0.9)
    Very bad 1 (0.3)
    Relationship with friends Very good 187 (57.0)
    Good 140 (42.7)
    Bad 1 (0.3)
    Very bad 0 (0.0)
    School life satisfaction Very satisfied 166 (50.6)
    Satisfied 155 (47.3)
    Dissatisfied 6 (1.8)
    Very dissatisfied 1 (0.3)
    Major consultant Mother 202 (61.6)
    Father 7 (2.1)
    Teacher 2 (0.6)
    Friend (same sex) 93 (28.4)
    Friend (opposite sex) 2 (0.6)
    Siblings 10 (3.0)
    Other 5 (1.6)
    No person 7 (2.1)
    Feeling of happiness Very happy 186 (56.7)
    Happy 130 (39.6)
    Unhappy 11 (3.4)
    Very unhappy 1 (0.3)
    Participants Variables Categories n (%)
    School health teachers (n=10) Health education Yes 10 (100.0)
    No 0 (0.0)
    Number of hours (per year) 5th grader
    Over 17 6 (60.0)
    Under 17 3 (30.0)
    Not applicable 1 (10.0)
    6th grader
    Over 17 4 (40.0)
    Under 17 4 (40.0)
    Not applicable 2 (20.0)
    Mental health education Teach a class Yes 10 (100.0)
    No 0 (0.0)
    Number of hours (per year) 5th grader
    3 1 (10.0)
    2 4 (40.0)
    1 4 (40.0)
    Not applicable 1 (10.0)
    6th grader
    3 1 (10.0)
    2 3 (30.0)
    1 4 (40.0)
    Not applicable 2 (20.0)
    Topics† Suicide 4 (21.1)
    Depression 3 (15.8)
    School violence 3 (15.8)
    Internet addiction 2 (10.5)
    Friendship 2 (10.5)
    Self-esteem 2 (10.5)
    Emotion 2 (10.5)
    Stress 1 (5.3)
    Teaching method† Lecture 9 (39.1)
    Discussion 6 (26.1)
    Role play 3 (13.0)
    Case 'study 4 (17.4)
    Self-directed learning 1 (4.3)
    Instructional media† Printed media such as textbook 2 (11.1)
    Audiovisual media such as video 10 (55.6)
    Non-projected media such as real objects 2 (11.1)
    Computer media such as multimedia 4 (22.2)
    Smart media such as smart phone 0 (0.0)
    Source of teaching material† Book 2 (10.0)
    Periodical 0 (0.0)
    Internet 10 (50.0)
    Peer school health teacher 8 (40.0)
    Information leaflet 0 (0.0)
    Difficulty‡ Mental health education
    Low priority 3 (17.6)
    No method and time for feedback 3 (17.6)
    Lack of materials 3 (17.6)
    Lack of capacity of health teacher 3 (17.6)
    Health education
    Lack of time 3 (17.6)
    Excessive school health task 2 (11.8)
    Students (n=328) Mental health education Yes 214 (65.2)
    No 114 (34.8)
    Never 79 (69.3)
    Don't remember 24 (21.1)
    Other 11 (9.6)
    Topics† Response 202 (94.4)
    Internet addiction 120 (43.8)
    Suicide 76 (27.7)
    Depression 37 (13.5)
    Psychosis 14 (5.1)
    Don't remember 14 (5.1)
    School violence 9 (3.3)
    Friendship 1 (0.4)
    Self-esteem 2 (0.7)
    Stress 1 (0.4)
    Non-response 12 (5.6)
    Variables Categories n (%)
    Demand Extremely Very 10 (100.0) 0 (0.0)
    Moderately Slightly 0 (0.0) 0 (0.0)
    Not at all 0 (0.0)
    Goal Understanding of concept and knowledge Acquisition of attitude and value 0 (0.0) 8 (80.0)
    Practice of health behaviour Development of critical thinking 1 (70.0) 1 (70.0)
    Frequency 3 4 (40.0)
    2 1 5 (50.0) 0 (0.0)
    Other 1 (10.0)
    Teaching method† Lecture Discussion 1 (4.0) 8 (32.0)
    Role play Case study 10 (40.0) 5 (20.0)
    Self-directed learning 1 (4.0)
    Instructional media† Printed media such as textbook Audiovisual media such as video 1 (5.3) 10 (52.6)
    Non-projected media such as real objects Computer media such as multimedia 2 (10.5) 4 (21.1)
    Smart media such as smart phone 2 (10.5)
    Accessibility to information Very good Good 0 (0.0) 0 (0.0)
    Fair Poor 2 (20.0) 7 (70.0)
    Very poor 1 (10.0)
    Issues to consider‡ Aspect of health education in school
    Enough time for health education 5 (23.8)
    Competency for the school health teacher 4 (19.0)
    Aspect of mental health education Development of the practical teaching materials 7 (33.3)
    Connection with mental health resources Strategies to self-directed learning 3 (14.3) 2 (9.5)
    Variables Categories Boys
    		 Girls
    		 Total
    n (%) n (%) n (%)
    Demand Extremely 86 (58.1) 107 (59.4) 193 (58.8)
    Very 34 (23.0) 49 (27.2) 83 (25.3)
    Moderately 24 (16.2) 20 (11.1) 44 (13.4)
    Slightly 3 (2.0) 2 (1.1) 5 (1.5)
    Not at all 1 (0.7) 2 (1.1) 3 (0.9)
    Frequency 3 31 (20.9) 52 (28.9) 83 (25.3)
    2 74 (50.0) 81 (45.0) 155 (47.3)
    1 37 (25.0) 36 (20.0) 73 (22.3)
    Other 6 (4.1) 11 (6.1) 17 (5.2)
    Teaching method† Lecture 59 (39.9) 58 (32.2) 117 (26.0)
    Discussion 55 (37.2) 53 (29.4) 108 (24.0)
    Role play 38 (25.7) 77 (42.8) 115 (25.6)
    Case study 26 (17.6) 29 (16.1) 55 (12.2)
    Self-directed learning 17 (11.5) 38 (21.1) 55 (12.2)
    Instructional media† Printed media such as textbook 15 (10.1) 20 (11.1) 35 (7.1)
    Audiovisual media such as video 109 (73.6) 126 (70.0) 235 (47.7)
    Non-projected media such as real objects 25 (16.9) 23 (12.8) 48 (9.7)
    Computer media such as multimedia 34 (23.0) 41 (22.8) 75 (15.2)
    Smart media such as smart phone 41 (27.7) 59 (32.8) 100 (20.3)
    Participants Topics Rank
    		 Weighted score Overall priority
    1
    		 2
    		 3
    		 4
    		 5
    		 6
    		 7
    n (%)
    		 n (%)
    		 n (%)
    		 n (%)
    		 n (%)
    		 n (%)
    		 n (%)
    School health teachers (n=10) Parent-child relationship 4 1 3 1 0 1 0 5.5 2
    (40.0) (10.0) (30.0) (10.0) (0.0) (10.0) (0.0)
    Peer relationship 1 4 1 1 2 0 1 4.7 3
    (10.0) (40.0) (10.0) (10.0) (20.0) (0.0) (10.0)
    Self-esteem 5 2 2 1 0 0 0 6.1 1
    (50.0) (20.0) (20.0) (10.0) (0.0) (0.0) (0.0)
    Self-efficacy 0 0 1 1 5 1 2 2.8 5
    (0.0) (0.0) (10.0) (10.0) (50.0) (10.0) (20.0)
    Emotional regulation 0 2 0 4 2 2 0 3.8 4
    (0.0) (20.0) (0.0) (40.0) (20.0) (20.0) (0.0)
    Optimism 0 1 0 1 0 4 4 2.2 7
    (0.0) (10.0) (0.0) (10.0) (0.0) (40.0) (40.0)
    Resilience 0 0 3 1 1 2 3 2.9 6
    (0.0) (0.0) (30.0) (10.0) (10.0) (20.0) (30.0)
    Students(n=271) Parent-child relationship 96 65 43 29 14 18 6 5.5 1
    (35.4) (24.0) (15.9) (10.7) (5.2) (6.6) (2.2)
    Peer relationship 45 70 54 31 25 12 34 4.7 2
    (16.6) (25.8) 19.9) (11.4) (9.2) (4.4) (12.5)
    Self-esteem 70 29 40 32 44 32 24 4.5 3
    (25.8) (10.7) (14.8) (11.8) (16.2) (11.8) (8.9)
    Self-efficacy 14 29 36 61 61 33 37 3.6 5
    (5.2) (10.7) (13.3) (22.5) (22.5) (12.2) (13.7)
    Emotional regulation 26 39 42 46 44 39 35 3.9 4
    (9.6) (14.4) (15.5) (17.0) (16.2) (14.4) (12.9)
    Optimism 9 23 30 38 42 74 55 3.1 6
    (3.3) (8.5) (11.1) (14.0) (15.5) (27.3) (20.3)
    Resilience 12 17 27 34 40 62 79 2.9 7
    (4.4) (6.3) (10.0) (12.5) (14.8) (22.9) (29.2)
    Table 1. General Characteristics of the Study Subjects

    Table 2. Status of Mental Health Education from School Health Teacher and Students

    †Multiple responses are possible;

    Free text response.

    Table 3. Needs for Protective factors in Mental Health Education from School Health Teachers (N=10)

    †Multiple responses are possible;

    Free text response.

    Table 4. Needs for Protective Factors in Mental Health Education from Students (N=328)

    Multiple responses are possible.

    Table 5. Priority of Topics Enhancing Protective Factors in Mental Health Education

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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