As with other existential dimensions of human beings, sexual instinct needs pedagogy. Hence, knowledge, attitude, and parents’ skills, especially mothers, play the most important Role in training the sexual behaviors of children in the preschool era . As a child, children discover their sexual organs and their sexual instinct becomes activated, which should be accompanied by the observation and control of parents because premature sexual behaviors can culminate in irrecoverable harm. By training sexual care for children at an appropriate age, parents can gradually immune their children from sexual abuse . The present study investigates the effect of educational intervention based on the Theory of planned behavior on mothers’ skills in sexual care of preschool children in Fasa, Iran, in 2019.
Before the educational intervention, the score of mothers’ knowledge of sexual care of their children in the two studied groups was low; however, 3 months after educational intervention, the mean score of knowledge of the experimental group showed significant enhancement compared to the control group. The most important information sources in studied participants about sexual care of children were, respectively, books, doctors, health officials, the Internet, and teacher or consultant. In a study by Rashid and Hosseini Nazarbu , holding seven educational sessions caused an increase in sexual knowledge and the responsibility of parents about the sexual training of their children. Parents’ knowledge about sexual issues, such as understanding natural and unnatural sexual behaviors, treating children suffering from sexual abuse, the time of educating sexual issues, forming the sexual identity of the child, puberty, relationship with peers, information sources of children, etc. are effective factors in preventing inappropriate behaviors in children and improving self-efficacy of parents . In the study by Mobredi et al. , mothers’ attitudes and knowledge about sexual training in preschool children were mean, and a significant relationship was found between mothers’ attitude and their educational level. In studies by Aral et al.  and Kurtuncu et al. , participants believed that sexual training should be started in the preschool era. Haruna et al.  used sexual health education program for adult students through game-based learning and indicated that, after educational intervention, significant statistical differences were observed in the knowledge and attitude of participants. Margo Rule et al.  investigated effective factors for mandatory reporting of sexual abuse in children by primary school teachers in South Africa based on TPB and found that almost 25% of teachers had reported at least one case of sexual abuse in children during their teaching career and 7% of them had failed to report the suspected sexual abuse case. According to the results of the present study, it can be concluded that the current education has a greater effect on raising the level of mothers’ awareness than non-systematic education and therefore, it is necessary to train children in sex care centers.
In the current study, 3 months after educational intervention, significant enhancement was observed in the mean attitude score in the experimental group. Also, a positive attitude caused an increase in mothers’ skills in the sexual care of children. Presenting educational films, animations, group discussions, and presenting beliefs caused the creation of positive attitudes toward learning and performing skills and modifying negative attitudes of mothers. Also, sending educational and motivational SMS helped the promotion of participants’ attitudes. In a study by Moeini et al. , educational intervention based on the Theory of planned behavior caused an increase in participants’ attitudes toward healthy sexual behaviors in the experimental group. In Bayley et al.  study based on the Theory of planned behavior, attitude predicted the intention. Results of the present study are in good agreement with the results of Sanberk et al. , who investigated the attitude of Turkish mothers having a child with the age of 48-66 months and revealed that educational intervention caused the increase in participants’ attitude, and also with the study of Khani Jeihooni et al.  who studied prevention behaviors from sexually transmitted diseases. Nagpal et al.  indicated that important changes had been created in parents’ attitudes toward sexual training in children, and in recent years, parents’ attitudes have changed from negative to positive. Investigating sexual behaviors in developing countries was always influenced by different and conflicting attitudes. Due to cultural limitations, sexual training is not performed in schools, and discussing sexual issues with children is unnatural for parents . Forouzi et al.  indicated that most parents have negative attitudes toward sexual training in teenagers and suggested changing attitudes and increasing parents’ knowledge in this field. Kalantari et al.  studied mothers’ experiences in training puberty and the sexual behaviors of their daughters. They concluded that, unlike recent cultural changes in Iran, sexual training is insufficient due to the dominant common culture in society and families about sexual puberty.
The mean score of perceived behavioral control had significant enhancement in the experimental group 3 months after the intervention, while the control group had no changes. Perceived behavioral control is an individual's beliefs about the availability or unavailability of sources and chances for doing a specific behavior, and when encountered with challenges, the individual feels that he/she can control that behavior . In this study, presenting educational films and images, training sexual care by psychologists, interesting mothers in learning skills, increasing their self-confidence, providing Whatsapp groups for exchanging information, and sending educational and motivational SMS caused the increase in the mean score of perceived behavioral control in the experimental group. Preventing sexual abuse in children is the adults’ responsibility. The best prevention and protection method is adults’ consciousness who never abandon their children in difficult conditions, understand their discomfort, and listen to their words. Therefore, families should educate life principles and patterns in social relationships because family is one of the most efficient structural patterns in training skills, such as having appropriate behavior in dangerous conditions, including sexual abuse [51, 52]. In the study of Jalam badani et al. , the experimental group's mean scores of knowledge, attitude, perceived behavioral control and intention of sexual function were significantly increased after the educational intervention.
In the current study, 3 months after the intervention, the mean score of subjective norms of the experimental group increased, while the control group had no changes. Because subjective norms are affected by important people in an individual's life and also because of holding educational sessions for fathers, doctors, health officials, and preschool officials, subjective norms of the experimental group are enhanced. Also, the studied participants were divided into 10 groups with 10 members (friends and peers groups), which caused an increase of knowledge and positive attitude of participants and learning skills. In study of Sarayloo et al. , educational intervention caused an increase of knowledge, attitude and subjective norms of experimental group. A quasi-experimental study of Mousali et al.  indicated that, educational intervention based on TPB causes the increase of the mean score of subjective norms in the experimental group. In study of Eggers et al. , subjective norms predicted healthy sexual behaviors. In a study of Khouii et al.  entitled “Sexual training in Iranian students by health educators in elementary schools”, it was revealed that most parents believed that sexual evolution of children should happen in the family environment. Family-based sexual education is one of the topics that can help parents to be effective in the sexual behaviors of their children . This training improves parents’ knowledge, attitude and performance in sexual training in children . In the study of Hemat et al.  about maternal attitudes toward child sexual abuse, there was significant differences in mean scores of attitude and subjective norms of experimental and control groups after intervention. Results of Kurtuncu et al.  showed that, the number of correct responses given by participants regarding some behaviors of children with the age of 3-6 years and their sexual development showed significant differences in age, marital status, number of children and educational and job status of parents. It was observed that culture has an important effect on sex-related approaches and embarrassment and shyness are very common factors among people. In studies of Wilson et al.  and Knabe et al. , subjective norms predicted the intention in the experimental group.
In the study of Larki et al. , educational intervention based on TPB was performed in 7 sessions and after that, significant enhancement was observed in the mean score of perceived behavioral control, attitude and subjective norms of the experimental group about risky sexual behaviors. Wong et al.  investigated a behavioral intervention for promoting the use of condoms in prostitute women. In his study, educational intervention caused an increase of self-efficacy of the experimental group compared to the control group in terms of discussion skills and rejecting risky sexual offers. In the quasi-experimental study of Ebrahipoor et al. , after educational intervention based on TPB, knowledge, attitude and perceived behavioral control of the studied subjects increased and the sexual performance of the experimental group had significant enhancement. According to the definition of perceived behavioral control, which indicates barriers and facilities of doing a behavior  and the traditional culture of Fasa, which does not accept such behaviors, perceived behavioral control is highly important. In the current study, the mean score of perceived behavioral control showed the effect of education on removing barriers to behavior. Increasing the variables of knowledge, attitude, behavioral control, perception and abstract norms towards child sexual care are important factors that led to the promotion of intention and as a result, sexual skills of mothers and children in this study. When mothers have sufficient and correct knowledge with a positive attitude towards child sexual care and can sexually care for children, environmental factors are also at their disposal and on the other hand, contemporary abstract norms such as spouse, doctor and health workers. The therapists and education officials and preschools encourage them, and then their skills increase.
Current research results revealed that, the mean score of participants’ intention for sexual care of children and their behavior had significant enhancement 3 months after the intervention, while control group had no changes. Increasing an individual's intention for doing a specific behavior enhances the possibility of doing that behavior . The increase of knowledge, attitude, perceived behavioral control and subjective norms in sexual care of children are important factors caused the promotion of participants’ intention and sexual care skills of mothers. When mothers have proper and sufficient knowledge with a positive attitude toward sexual care of children, their ability in sexual care of their children enhances and environmental factors become under their control. On the other hand, subjective norms such as fathers, doctors, health officials and education officials encourage them and mothers’ training skills enhance.
Cha et al.  investigated the constructs of attitude, perceived behavioral control, subjective norms and participants’ intention for premarital sex and found that, perceived behavioral control do not predict the intention for premarital sex in studied participants. In the study of Moeini et al. , educational intervention based on the Theory of planned behavior caused an increase of behavioral intention and promotion of healthy sexual behaviors in the experimental group. Hashemi Bakhshi et al.  investigated the effect of theory-based educational intervention on mothers’ skills in sexual care of elementary school students. In his study, educational intervention caused significant enhancement in mean scores of attitude, subjective norms, behavioral intention and behavior in the experimental group, while the control group had no changes. In study of Khanjari et al.  to determine the effect of education on preventing child sexual abuse and parents’ performance by giving the presentation, asking and answering questions, presenting films, etc. and 6 months after the intervention, the mean score of experimental group’s performance significantly enhanced. In a study of Chen et al. , who investigated parents’ knowledge, attitude and performance in educating child sexual abuse prevention, it was revealed that 60% of parents had told their children that other people should not touch their sexual organs. On the other hand, only 4.2% of parents had provided books or other training tools about sexual abuse prevention for children and according to mentioned study, knowledge and performance of parents in preventing child sexual abuse were insufficient.
The leerlooijer et al. study showed significant associations to obtain from sexual intercourse were found for experience with sexual intercourse, perceived behavioral control, attitude and subjective norms of peers and parents, explaining 31% of the variance in abstinence intention .
Lynn Miller et al.  used TPB to the proximal and distal etiology of sexual offending. In study of Margo Rule et al. , subjective norms and perceived behavioral control predicted the intention of teachers to report child sexual abuse. A teacher who reported child sexual abuse in the past as well as a teacher with more accurate knowledge in mandatory reporting were more likely to have the intention to report such issues in future. These findings probably indicate the impact of the designed training program.
One of the limitations of this study was the self-reporting answers of participants. The other limitation was lack of appropriate cooperation of mothers due to cultural limitations and modesty in sexual training. Of course, by giving demanded information, authors tried to eliminate these limitations.