The effect of electronic and printed module about drug abuse prevention on teachers’ beliefs in Indonesia

Introduction

Drug abuse is a global health problem. Globally, the total numbers and the prevalence of drug users in the world have been on the rise, especially in developing countries. In 2009, it was estimated that there were 210 million users or the equivalent of 4.8 percent of the world's population aged 15‒64 years, while in 2018 it was estimated that there were 269 million users or 5.3 percent of the population¹. The increase in drug users was much faster in developing countries than in developed countries. This was partly due to the difference in the growth of the population of adolescents and young adults, which made up the largest proportion of those who using drugs, which grew by about 16 percent in developing countries and decreased by 10 percent in developed countries in the 2000–2008 period¹. In a study of HIV testing experience of drug users in Bali, there is evidence that most of the subjects in this study (60%) started using drugs in junior high school, aged 15-years-old or less².

Adolescence is a critical period because in this period there will be many changes in individual development, physically, psychologically and socially. In this period, adolescents will undergo many conflicts, including between the need for self-control and the need to be independent. In these conditions, adolescents require other persons to guide them. There seems to exist a general consent that education, and teachers in particular, have an important role to play by imparting knowledge, values and skills, as well as by acting as role models for students. Teachers should have adequate preparation to play their role sufficiently and effectively, which involves a combination of cognitive and practical knowledge and skills, values, motivation and attitudes. The lack of this set of preparation may impart a bad influence on the students’ learning outcomes and also students’ behaviors.

Teaching is one enabling and reinforcing factor of student’s behavior, including student’s health behavior³. Positive beliefs of teachers are needed in their role to reinforce factors and be good models for students, including in drug abuse prevention. Hanley et al. studied the influence of teacher training on the fidelity of substance use prevention programs implementation in the United States. This study concluded that teacher training on this subject significantly increased the fidelity of implementation of the prevention program⁴.

Nowadays in Indonesia and many other developing countries, in the field of media and health promotion methods on drugs and the prevention of drug abuse, it is still very rare to find media or methods of delivering messages about the danger of drug abuse and the importance of its prevention that utilizes technological advances, especially for specific individuals like teachers. The electronic messaging media are mostly just short messages via television or radio for universal targets. Media with more complete message content in the form of books or printed brochures generally only target teenagers and general society. Macedo-Rouet et al. concluded that there was a strong motivation for using electronic books, and the level of users’ satisfaction was generally very high with this type of medai⁵. Many studies have also showed that the positive valuation towards electronic books was due to their accessibility and availability^6,7. Shelburne⁸ stated that the increased availability of electronic books has influenced students’ perception and students value electronic books more than printed ones.

This research developed an alternative electronic delivery method of learning media to empower teachers in preventing drug abuse in the school setting. This study aimed to compare the effect of the electronic module with a printed module on teachers’ beliefs in drug abuse prevention among students.

Methods

Ethical approval

This study obtained approval from Balikpapan District Office of Ministry of Education (420/2180/SKT-VIII/2016) and The University Research Ethics Committee of the Universiti Putra Malaysia (UPM/TNCPI/RMC/1.4.18.1 (JKEUPM)/F1). Written informed consent was obtained from the teachers before they were recruited into the study.

Results

Table 1 describes the sociodemographic characteristics of study participants in each group. Most of the participants in both groups were female and Javanese. The mean of age was 41.53 ± 9.031 years in the group 1 and 43.19 ± 9.167 years in the group 2. The mean of duration of work was 15.79 ± 8.890 years in the group 1 and 17.00 ± 9.388 years in the group 2. There were no significant differences between groups on the mean of age and duration of work, field of teaching, proportion of gender, and ethnicity.

Table 2 describes each category of beliefs mean score from the questionnaire of participants in the two groups at baseline. There were no significant differences between groups on participants’ categories of beliefs at baseline (P value > 0.05). Table 3 describes within and between group comparison of participants’ mean changes in each component of beliefs from baseline to one month after intervention. Overall the results indicated that the teachers’ beliefs at one month after intervention were significantly higher compared with baseline, in both groups. There was significant difference between groups in mean change of perceived susceptibility from baseline to one month after intervention (P<0.001). The positive mean change and partial eta squared of perceived susceptibility in group 1 were significantly higher than group 2, which were 2.38 and 0.672 compared with 1.00 and 0.274. There were no significant differences between groups in mean changes of perceived severity, benefits, barriers, efficacy, and total beliefs from baseline to one month after intervention (P value: 0.086, 0.283, 0.261, 0.834 and 0.129, respectively).

Discussion

The objective of this study was to evaluate the effects of educational intervention for teachers using a printed and electronic module on drug abuse prevention among junior high school students. The group 1 in this study received the educational intervention using an electronic module which has developed by the researchers. The group 2 received the usual printed module, which contained the same materials as the electronic module.

Based on findings of this study, all components of beliefs in both groups at one month after intervention were significantly increased compared to baseline condition before intervention. The only significant difference between electronic and printed module groups was in terms of increased perceived susceptibility, where in the electronic module group there was a significantly higher increase compared to the printed module group.

Similarly to these findings, Dusenbury et al.¹¹ carried out a study to examine the influence of training on teacher beliefs and perceptions about norm setting and student drug use. They found that there was a significant pretest-to-posttest improvement on teacher beliefs and perceptions for several items. There was a significant improvement in teachers expectations that students to not go on to use substances (t=3.391, p=0.001); all teachers better understood how to develop lesson plans for drug education (t=5.886, p<0.001); and finally all teachers had marked improvement in their confidence to use norm setting in teaching (t=9.018, t<0.001). Our findings were also in line with a previous study which found that there was a significant correlation between knowledge on risk factors and the general score of attitude (r Pearson= 0.373, p < 0.001)¹². This means that by giving specific knowledge, a person’s attitude toward specific issues will be improved. Belief is a form of attitude.

Azwar¹³ stated that media is one of the factors influencing the formation of a closed response. Media has a fundamental task in the delivery of information. Media provides information and messages that contain suggestions which will direct one's opinion. When strong enough, the messages brought by the information will provide an effective basis for judging things, so that certain beliefs are formed. In this study, the module which was used in both groups is described as learning media. This finding was also similar with that found by Mahmoodabad et al.¹⁴, who concluded that there was significant improvement on health belief model components average scores among male students two months after receiving an educational intervention about preventive drug dependency in Iran.

According to the importance of alternative, more advanced methods in delivering drug prevention messages, this study was also relevant with Hansen et al. who studied about the impact of technological enhancements toward teachers’ attitude in delivering drug abuse prevention program in U.S. This study revealed that teachers who used the technological enhancements found it easier to implement the program compare to others who delivered the program as usual. Furthermore, teachers’ attitude about the program improved after experienced the enhancements and the majority of teachers wishing to continue using them in the future¹⁵.

Conclusions

Educational intervention using electronic and printed module significantly increased teachers’ beliefs in drug abuse prevention among students. The findings also indicated that in general both methods equally gave a positive effect on teachers' beliefs in preventing drug abuse. Therefore, both forms of delivery method of learning materials can be used as methods for teacher empowerment efforts in the prevention of drug abuse. The usual printed module was still effective and relevant to be used as learning media in drug abuse prevention, while the electronic module was an alternative that had some advantages in one category, and additionally is easy to carry everywhere, cheaper in production costs, durable, and environmentally friendly. To the best of our knowledge, there are not many studies that have evaluated the effectiveness of this module in the prevention of drug abuse especially on the target of teachers.

Data availability