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Abstract

Background:

Cyberbullying, which occurs when information and communication technologies are used to harm individuals, is one of the most important problems for adolescents today. This study evaluated the effectiveness of nurse-led cyberbullying awareness training for 7th-grade middle school students.

Methods:

This study was conducted as an experimental study. A total of 122 students, 62 in the control group and 60 in the intervention group, were included in the study. “Introductory Information Form” and “Cyberbullying Awareness Scale (CAS)” prepared by the researchers in line with the literature were used as data collection tools. The level of cyberbullying awareness of all students selected for the intervention and control groups was determined before the training program. The training program was given in four sessions. Three months after the training, students in both the intervention and control groups were asked to fill out the CAS.

Results:

It was determined that the control and intervention groups had a homogeneous distribution in terms of demographic characteristics. In terms of their pre-test and post-test mean scores on the CAS, there was no statistically significant difference between the control and intervention groups (P > .05). However, within the control group, a statistically significant difference was found between the pre-training and post-training CAS scores (Z = −2.890; P = .004 < .05). In contrast, the intervention group showed no statistically significant difference between their pre-training and post-training CAS scores (P > .05).

Conclusions:

This study evaluated the effects of nurse-led training program aimed at increasing cyberbullying awareness. Comprehensive and long-term awareness programs led by nurses are likely to produce more lasting and effective outcomes for young individuals.

Keywords

Cyberbullying adolescents awareness training

Introduction

Bullying in childhood and adolescence is an important public health problem that causes negative health, social, and educational outcomes.¹ The widespread use of electronic communication through the Internet and cell phones has led to the emergence of cyberbullying, a new form of violence.² The concept of cyberbullying is defined as the behavior of deliberately and intentionally harming another person by using information and communication Technologies.³

Cyberbullying refers to the act of using electronic communication platforms such as social media, instant messaging, or online forums to harass, intimidate, or humiliate someone. It can take various forms, such as sending hurtful messages, spreading rumors, sharing embarrassing photos or videos, or creating fake profiles to impersonate or bully others.⁴ Cyberbullying has become a major concern, especially among school-aged children and adolescents. Its impact can be severe, leading to emotional distress, low self-esteem, depression, anxiety, academic difficulties, and even suicidal thoughts or actions.⁵ Therefore, it is crucial to raise awareness about cyberbullying, educate students about responsible Internet use, and create strategies for prevention and intervention.

Cyberbullying can happen anywhere there is an Internet connection. While traditional, face-to-face bullying is still more common, data from the US Cyberbullying Research Center shows that one in four young people have experienced cyberbullying, and about one in six have been perpetrators. One in five children (aged 9-12) has been involved in cyberbullying.⁶ A study of 461 middle school students in Canada and China found that 55.6% of boys and 54.5% of girls knew someone who had been bullied online. It was also found that about 30% of the respondents were victims of cyberbullying and about 18% were involved in cyberbullying.³

In a study conducted in Türkiye, it was determined that the rates of adolescents being exposed to physical, verbal, relational, and cyberbullying varied between 5% and 17%. It was also found that boys, 7th-9th graders, those whose parents punish them, and those with low academic achievement were more likely to be exposed to cyberbullying and bullying.⁷ In another study, it was found that cyberbullying continues to increase rapidly in schools, and that the knowledge and awareness levels of parents, teachers, and school administration, as well as students, are effective among the reasons for this increase. In this context, it was emphasized that among the preventive activities, education, seminars, and guidance services should be provided to both students, teachers, and parents on the subject.⁸

Schools play a vital role in combating cyberbullying. They can provide training for students, teachers, and parents to recognize the signs of cyberbullying, report incidents, and support victims.⁹ School-based programs in cyberbullying prevention have proven to be effective in reducing the negative impact of bullying on students.^10,11 The Cyberbullying Awareness Program, which was conducted in 10 sessions in Türkiye, was found to have a positive effect on adolescents’ cyberbullying awareness and coping skills.¹²

Prevention and intervention of cyberbullying in schools should be carried out with a multidisciplinary team. The nurse in this team can provide comprehensive nursing care in collaboration with schools as an educator, facilitator, and counselor. School nursing focuses on providing health services and promoting health in the school environment. School nurses play a crucial role in supporting students’ physical and mental well-being and promoting a healthy school environment. In this context, school nurses should be at the center of the multidisciplinary management of cyberbullying.¹³

School nurses can early diagnose psychological and behavioral problems related to cyberbullying in children.¹⁴ Therefore, in bullying prevention efforts, nurses can identify students who bully, are bullied by others, or both, and contribute to intervention.¹⁵ A scoping study on school-based nursing interventions to prevent bullying and reduce the incidence of bullying among students showed that school-based nursing interventions can be applied to prevent and reduce the incidence of bullying among students at school.¹⁶ Although intervention programs for cyberbullying are implemented in all age groups, it is known that peer bullying programs for children aged 10-15 years are more effective.¹⁷ Therefore, the sample in this study was selected from middle school students enrolled in the 7th grade. In this study, the effectiveness of nurse-led cyberbullying awareness training for middle school 7th-grade students was evaluated.

Research Hypothesis

H₁: Cyberbullying awareness training given to 7th-grade students increases their cyberbullying awareness levels.

Materials and Methods

Design, Population, and Sample

This study was planned as an experimental study. The intervention and control groups were selected from two similar schools, and the experimental study was conducted between December 2023 and June 2024. The study population consisted of 435 students studying in the 7th grade at Cumhuriyet Secondary School and IBB Barbaros Hayrettin Paşa Secondary School in Istanbul-Maltepe. The reasons for selecting these schools were their location in the same district and the fact that they had socioeconomically similar student populations. Additionally, separate schools were chosen to prevent the groups from influencing each other.

The determination of which school would serve as the intervention group (IBB Barbaros Hayrettin Paşa Secondary School) was made using a lottery method. The reason for selecting 7th graders (11-12 years old) in the study is that they are in the early adolescent period when cognitive abstract thinking and comprehension skills increase, and the foundations of risk-taking behaviors are laid.¹⁸

The inclusion criteria for students wishing to participate in the study include obtaining written consent from their parents, willingly participating in the educational process, attending all educational sessions without any absences, and signing the consent form. On the other hand, the exclusion criteria for the study include the student not wishing to participate, the parent not giving permission for participation, incomplete participation in the educational process, and failure to complete the required forms.

The G-POWER (v3.1.9.7) statistical analysis program was used to calculate the sample size required for the study. Based on the analysis with a Type I error of 0.05, a Type II error of 0.20 (80% power), and a t-test medium effect size for two groups, it was determined that a total of 102 students, 51 for the intervention group and 51 for the control group, should be included in the study. To account for potential data loss, a total of 140 students, 70 in each group, were included in the study. Four students did not participate in the study because consent forms could not be obtained from their parents. Eight students from the intervention group and six students from the control group did not fill out the follow-up forms. A total of 122 students, 62 in the control group and 60 in the intervention group, were included in the study (Figure 1).

Figure 1.

CONSORT Flow Diagram of Study.

Data Collection Tools

The “Introductory Information Form” and the “Cyberbullying Awareness Scale (CAS)” were used as data collection tools. Introductory Information Form was prepared by the researchers in line with the literature.^19,20 In this form, there are 16 questions about the identifying characteristics of the student and their family, as well as questions about screen time, ownership of digital devices, and exposure to cyberbullying.

CAS was developed by Ayas, Aydın, and Horzum (2015) to determine the level of cyberbullying awareness and adapted by Aydın (2016) for secondary school students. Regarding the consistency of the scale, Cronbach’s alpha value was found to be 0.89. Again, as a result of the clustering analysis, it was stated that the score range of 21-61 points can be expressed as low, 62-81 points as medium and 82-105 points as high cyberbullying awareness. Those who will fill out the CAS mark their level of agreement with each statement in the scale between (1) strongly disagree and (5) strongly agree. A minimum score of 21 and a maximum score of 105 can be obtained from the Scale.²⁰ The pre-test Cronbach’s alpha value of the CAS for this study was found to be 0.927 and the post-test Cronbach’s alpha value was found to be 0.939.

Data Collection

Before the data collection phase of the study, the educators received a 180-minute “Cybersecurity Awareness Training” on cyberbullying from an expert of the Turkish Informatics Association. This training covered topics such as the definition, types, effects, and coping strategies of cyberbullying. The training process aimed to enhance their knowledge on combating cyberbullying. The educational materials prepared by the trainers were initially approved by the ethics committee, then presented to the school’s guidance counselors for evaluation, and final adjustments were made based on their suggestions. The educational materials included various tools such as PowerPoint presentations, brochures, and posters, and the content of all these materials was approved by experts.

The educational program for the students was prepared using the resources from the “Awareness Against Cyberbullying in Schools” project, developed in cooperation with the Ministry of National Education of Turkey and UNICEF, which is available on the Ministry’s website.

Data collection was carried out in two stages. Data were collected using the “Introductory Information Form” and the “Cyberbullying Awareness Scale” (CAS). These forms were administered to both groups. To maintain the anonymity of the students, they were asked to choose a nickname for both evaluation forms and were reminded not to forget it. The students used the same nickname on both forms. After the primary data collection, the intervention group received the “Cyberbullying Awareness Training,” while the control group did not receive any training. Three months after the training, both groups were reassessed using the “Introductory Information Form” and the CAS. After the data collection, the control group also received the “Cyberbullying Awareness Training.”

The training program consisted of four sessions, each lasting 30 minutes. The educational process was structured with an interactive and student-centered approach. Active participation from students was encouraged in each session. In the first session, the aim was for students to learn basic information about cyberbullying, cyberbullies, cyber victims, bystanders, and the prevalence of cyberbullying. In the second session, cyberbullying tools and practices, which behaviors should be considered cyberbullying, and case studies were discussed. The goal was to teach students how to recognize cyberbullying and how to respond to it. The third session focused on the causes of cyberbullying and its academic, social, psychological, and physical effects. The aim was to explain the multifaceted impacts of cyberbullying on individuals. In the fourth and final session, strategies for coping with cyberbullying, such as creating strong passwords, using secure links, and personal responsibility in combating cyberbullying, were emphasized. Students were taught ways to improve their personal security against cyberbullying.

Active participation was ensured in each session, and students were encouraged to reflect on the lesson through questions. At the end of each session, the effectiveness of the lesson was measured through verbal evaluation questions and group discussions. Brochures were distributed to the students, and posters were displayed on the classroom walls.

With the support of the school administration, a parental consent form was signed by the students’ parents, and this form was applied to the students. The study was conducted with children whose parents consented to participate. The trainings were conducted in collaboration with the school, during appropriate times in the students’ own classrooms.

Data Analysis

IBM SPSS 24.0 program was used to evaluate the data. The compatibility of the numerical variables with normal distribution was determined by Kolmogorov–Smirnov test, kurtosis-skewness values and histogram examinations. It was determined that the data did not show normal distribution. Descriptive statistics were expressed as mean, standard deviation, minimum, maximum; categorical variables were expressed as number and percentage. Intergroup differences in categorical variables were analyzed by Pearson Chi-Square test. Mann–Whitney U test (U) was used for pairwise comparisons between groups and Wilcoxon Signed Ranks (Z) test was used for within-group comparisons. The results were evaluated at 95% confidence interval and P ˃ .05 significance level. The internal consistency of the scale to be used in the study was evaluated with Cronbach’s alpha coefficient and statistical significance was evaluated at P < .05 level.

Ethical Considerations

The research was conducted within the framework of ethical considerations stated in the Declaration of Helsinki. Prior to the study, necessary permissions were obtained from the Non-interventional Research Ethics Committee of the Maltepe University (Protocol no: 2023/17-14) and the Istanbul Provincial Directorate of National Education (Protocol no: E-59090411-20-91109874). Volunteering of both children and their parents was prioritized in the participation of children in the study. The parents of the children were informed about the procedure of the study and the confidentiality of the data and their verbal and written consents were obtained. Clinical trial registration has been made with protocol number 2023/17-14 and ID NCT06203028.

Results

The average age of mothers in the control group was determined to be 39.37 ± 4.77, while in the intervention group it was 38.42 ± 4.75. Similarly, the average age of fathers was 42.5 ± 5.06 in the control group and 42.7 ± 5.19 in the intervention group. No statistically significant difference was observed between these values (P > .05).

In terms of gender distribution, 53.2% of the students in the control group were female, compared to 58.3% in the intervention group. Regarding mothers’ employment status, 35.5% of the students in the control group had working mothers, whereas this percentage was 38.3% in the intervention group. Examining educational levels, it was found that 64.5% of the mothers in the control group had completed middle school or a lower level of education, whereas in the intervention group, this rate was 58.3%. When considering fathers’ educational levels, 50% of the fathers in the control group had an education level of middle school or below, whereas this rate was 45% in the intervention group. For employment status, all fathers in both groups were found to be working in income-generating jobs. Analyzing the number of siblings, 45.2% of the students in the control group had one sibling, 29% had two or three siblings, and 17.7% had four or more siblings. In contrast, in the intervention group, these percentages were 56.7%, 20%, and 11.7%, respectively. When the sociodemographic characteristics of the students in the control and intervention groups were analyzed, no statistically significant difference was found, indicating that the groups were homogeneously distributed (P > .05).

Similarly, the examination of various characteristics related to cyberbullying among the students in the control and intervention groups revealed no statistically significant difference (P > .05) (Table 1). Comparing the CAS scores of the control and intervention groups according to their categories also showed no statistically significant difference between the groups (P > .05) (Table 2).

Table 1.

Comparison of Various Characteristics Related to Cyberbullying Among Participants.

Variables	Control Group (n = 62)		Intervention Group (n = 60)		Test	P
Variables	n	%	n	%	Test	P
Tablet Present Absent	23 39	37.1 62.9	20 40	33.3 66.7	0.189^a	.664
Smartphone Present Absent	47 15	75.8 24.2	50 10	83.3 16.7	1.060^a	.303
Computer Present Absent	28 34	45.2 54.8	28 32	46.7 53.3	0.028^a	.868
Gaming console Present Absent	9 53	14.5 85.5	5 55	8.3 91.7	1.147^a	.284
Social media Present Absent	46 16	74.2 25.8	46 14	76.7 23.3	0.101^a	.751
Daily Internet usage 0–1 hour 1–2 hours 2–3 hours 4 hours and above	13 25 13 11	21 40.3 21 17.7	9 25 15 11	15 41.7 25 18.3	0.838^a	.840
Exposure to cyberbullying Yes No	30 32	48.4 51.6	20 40	33.3 66.7	2.857^a	.091

Note: a = Pearson Chi-Square.

In terms of their pre-test and post-test mean scores on the CAS, there was no statistically significant difference between the control and intervention groups (P > .05). However, within the control group, a statistically significant difference was found between the pre-training and post-training CAS scores (Z = −2.890; P = .004 < .05). In contrast, the intervention group showed no statistically significant difference between their pre-training and post-training CAS scores (P > .05) (Table 3).

Table 2.

Comparison of Pre-test and Post-test Scale Scores by Categories Between Control and Intervention Groups.

Variables	Control Group (n = 62)		Intervention Group (n = 60)		Test	P
Variables	n	%	n	%	Test	P
Pre-test Low (21–61) Medium (62–81) High (82–105)	4 21 37	6.5 33.9 59.7	11 13 36	18.3 21.7 60.0	5.131^a	.077
Post-test Low (21–61) Medium (62–81) High (82–105)	11 27 24	17.7 43.5 38.7	8 23 29	13.3 38.3 48.3	1.233^a	.540

Note: a = Pearson Chi-Square.

Table 3.

Comparison of Pre-test and Post-test Scale Scores Between Control and Intervention Groups.

	n	Pre-test Mean ± SD (min-max)	Post-test Mean ± SD (min-max)	Z**	P
Control	62	81.41 ± 14.65 (32–103)	74.4 ± 17.45 (21–102)	–2.890	.004***
Intervention	60	79.8 ± 16.5 (45–105)	77.16 ± 17.28 (22–104)	–0.930	.353
U*		1794.0	1660.5
P		0.735	0.307

Note: *Mann–Whitney U Test; **Wilcoxon Signed Ranks Test; ***P <.05.

SD, standard deviation.

Discussion

Increasing cyberbullying awareness is crucial for creating a safer online environment. Schools can foster a supportive and informative atmosphere for cyberbullying awareness and prevention efforts, empowering students to navigate the online world responsibly and stand against cyberbullying. Therefore, this study was conducted to develop cyberbullying awareness in middle school students.

In this study, 48.4% of the control group and 33.3% of the intervention group were exposed to cyberbullying. Considering the differences in measurement tools, target population, time interval, and research methodology in existing epidemiological studies, the prevalence of cyberbullying worldwide is highly variable.^21–23 A systematic review examining the global prevalence of cyberbullying and cyber victimization²⁴ found the average prevalence of cyberbullying to be 25.03% (range = 6.0%–46.3%) and the prevalence of cyber victimization to be 33.08% (range = 13.99%–57.3%). The results regarding cyberbullying victimization in this study are similar to the global distribution.

A study conducted in Türkiye found that parents’ sociodemographic characteristics affected their children’s cyberbullying experiences, with higher socioeconomic levels increasing cyberbullying behaviors. The schools where this study was conducted included students from both high and low socioeconomic backgrounds. It was found that 74.2% of the control group and 76.7% of the intervention group used social media. It is known that adolescents’ use of social media increases their experiences with cyberbullying.²⁵

The American Academy of Pediatrics (AAP) recommends limiting screen time to two hours a day for children older than two years.²⁶ In our study, more than half of the students in both groups used the Internet for up to two hours a day, aligning with the AAP’s recommendation, which can be considered a positive finding. A study of 181,000 adolescents from 42 countries found that intensive social media use, problematic use during adolescence, and frequent online contact with strangers were each independently associated with cyberbullying.²⁷

Comparing the pre-test and post-test mean scores on the CAS between the control and intervention groups revealed no statistically significant difference. Additionally, when the scores of the control and intervention groups were compared according to their categories, no statistically significant difference was found between the groups. The fact that no significant difference was found between the intervention and control groups after the training program suggests that in-class training alone may not be sufficient. This may be due to the fact that after receiving training, students may have a better grasp of the complexity of the topic and therefore rate their level of awareness lower. Furthermore, the long-term effects of short-term interventions may be limited, indicating the need for longer-term programs. In the literature, various programs have been designed to combat bullying, including cognitive behavioral programs,²⁸ educational programs,²⁹ and peer support programs.³⁰ Among these, the KiVa program focuses on encouraging bystanders to support and protect their victimized peers, with proven effectiveness in countering both traditional bullying and cyberbullying.²⁹ The ViSC program, designed to reduce cyberbullying, has been used in two studies.³¹ Interventions involving the whole school community have been shown to be more effective than those limited to classroom curriculum or social skills training.³²

In the study, the observed decrease in the awareness scores of the intervention group following the education program on cyberbullying awareness is an unexpected outcome. However, this finding can be explained not by the ineffectiveness of the program, but rather by a change in how participants evaluate their own level of awareness. According to the response shift theory, individuals may change the way they assess their awareness or quality of life after an intervention. This change is related to a shift in how the person perceives the measured construct, the values they prioritize, or their internal standards.³³ After the training, an individual may perceive their initial evaluation as “overly optimistic” and adopt a more critical stance, thereby assigning a lower score. The decrease in scores in the intervention group suggests that knowledge and awareness regarding cyberbullying may diminish over time, highlighting the need for continuous education and reinforcement on such topics. In the impact analysis of education programs, using multidimensional evaluation approaches supported by qualitative data—rather than relying solely on quantitative data—can more comprehensively reveal the true effects of the program.³⁴ The exclusive use of quantitative evaluation in this study limited a deeper understanding of the participants’ experiences and the changes in their levels of awareness.

A meta-analysis found that studies excluding stakeholders such as teachers and parents in cyberbullying interventions were generally not effective.³ Previous studies suggest that schools should utilize technology-savvy content experts to train teachers on managing cyberbullying more effectively.³⁵ The UPRIGHT project developed an evidence-based, whole-school intervention to increase resilience as a protective factor supporting mental well-being in adolescents from an international perspective.³⁶

In conclusion, the training program implemented to develop cyberbullying awareness in middle school students was not effective. It is recommended to implement a holistic educational approach with continuous, comprehensive cyberbullying programs involving the whole school community. Cyberbullying awareness trainings can be designed to involve the school community, including teachers, parents, and school administrators. Parents, in particular, can play a crucial role in reinforcing the educational messages at home and supporting their children to cope with cyberbullying incidents. Accordingly, parents can be included in future training programs.

Interactive methods such as case studies, role-playing and real-life scenarios can be used more in the training content. Hands-on activities and group exercises can help participants develop practical skills and apply their knowledge in realistic situations. Cyberbullying awareness can be developed through a long-term and continuous approach. Follow-up sessions, refresher courses, and regular reinforcement of training content can help maintain awareness and strengthen skills over time.

Limitations of this study include that the intervention was limited to students only and teachers and parents were not included. Future studies could expand on these findings with more comprehensive interventions that include all stakeholders. In the future, longer-term interventions and peer-led interactive discussions could be included in the training programs.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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