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A CHURCH-BASED PROGRAM TO ADDRESS SOCIAL SUPPORT AND SELF-
ESTEEM IN ADOLESCENT FEMALES

by

Valencia J. Battle

A SCHOLARLY PROJECT

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE
College of Nursing

1996

TABLE OF CONTENTS

ABSTRACT ................................................................................................................ ii
ACKNOWLEDGMENTS ............................................................................................ iii
INTRODUCTION

Page
Introduction and Background ................................................................................ 1
Statement of the Problem ........................................................................................ 3
Purpose and Significance ........................................................................................ 4

CONCEPTUAL FRAMEWORK AND LITERATURE REVIEW

Conceptual Definition ............................................................................................... 6
Conceptual Framework ............................................................................................ 9
Review of Literature ................................................................................................. 1 1
Programs Incorporating Social Support. ................................................................. 13
Church-based Programs ....................................................................... w ................... 18
PROJECT DEVELOPMENT

Project Development. ........ ‘ ........................................................................................ 1 9
Implementation of a Church-based Self-Esteem Program .................................... 19
Roles of the FCNSINP ............................................................................................... 26
Health Teaching ....................................................................................................... 27
Health Promotion Strategies ................................................................................... 28
Recommendations ................................................................................................... 29
Implications for Advanced Nursing Practice and Primary Care ............................ 30

Plan for Evaluation....1 .............................................................................................. 31

Conclusion ............................................................................................................... 32
BIBLIOGRAPHY

APPENDIX A, B

ABSTRACT

A CHURCH-BASED PROGRAM TO ADDRESS SOCIAL SUPPORT AND
SELF- ESTEEM IN ADOLESCENT FEMALES

By
Valencia J. Battle, RN., MSNc

A plan to address Social Support and Self-Esteem on teens decisions to
postpone pregnancy will be proposed in this project. The primary purpose of
this project is to propose a program to impact self-esteem and social support
in adolescent females with the goal of providing those girls with the
motivation to postpone pregnancy.

Kane’s Family Social Support Model will be used as the conceptual
framework for this project. Assumptions of the model are presented, family
characteristics and interaction processes are identified. The model proposes
that social support is not an outcome or a resource but a process of
interaction through which the family develops versatility and resourcefulness
in identifying and using resources available in its environment. The
conceptual model presents family social support as a process of relationships
between the family and its social environment.

Piaget’s cognitive developmental theory will be utilized as a second
framework in the development of the adolescent curriculum. The cognitive
stage of development will be considered in development of this Church-based
social support and self-esteem education program.

ACKNOWLEDGMENTS

I express my genuine gratitude to my Scholarly Project Committee, Dr.
Sharon King, Dr. Manfred Stommel and Patty Peek for their support, help,
patience and encouragement, many hours of reading and hard work to bring this
Project to fruition.

A special word of gratitude to my husband, Gerald for his love, patience, and
support for my education and studies abroad and encouragement to carry on.
To my children, Irene, Emuell, Brian, Ame and grandchildren, Bianca, Antonnette
and Brian Jr. who supported, prayed for me and brought me joy. To my mother,
Bessie Granberry, who nurtured and prayed for me as I traveled to and from MSU.
To my late father, William Granberry, my gratitude for instilling in me the desire to
achieve.

A special expression of gratitude to my Pastor, Rev. Dr. Avery Aldridge, Foss
Avenue Baptist Church, Flint, Michigan, for instilling In me the importance of
higher education, and who with his wife. Dr. Mildred Aldridge gave unlimited
support during my studies at MSU and in Europe. To My Foss Avenue Church
Family many of whom gave me encouragement and prayers.

To my sister’s in Christ, Earline Bragg and Barbara Gray who are always
there to support me in my endeavors. To my cousins, Marilyn Kennedy and
Nettie Williams, and members of the GPSW Family Worship for your support and
prayers. To Evelyn Gladney, my friend from MSU, thanks for all your help and
support. To Retha Bragg, my companion to Europe where we shared much and
who helped me in so many ways at MSU. To Sue Wheeler who was always there
for me. To Dr. Georgia Padonu for your help and guidance.

To Dr. Sharon King, my earthly “Angel” who counseled and gave me
emotional support and compassion which allowed me to continue on after the
birth of my special grandson. A special thank you to all others I have not
mentioned who helped me in any way during the completion of my MSN and
Scholarly Project.

Thank you to my Lord and Savior for helping me to achieve this milestone,
for on this journey I am well aware of the many days you carried me. Looking
back on the trials that I encompassed as you helped me to persevere and for the
challenge and growth experience at every level, “I Praise Your Holy Name.”

INTRODUCTION, LITERATURE REVIEW

AND CONCEPTUAL FRAMEWORK

INTRODUCTION AND BACKGROUND

In the United States and several other countries around the world
much attention, time, money and research has been applied to the
study of teenage pregnancy. Researchers (Hall 8 Taylor, 1984) have
found that high rates of teenage pregnancy go hand-in-hand with
low self-esteem, low economic achievement, poor school attendance
patterns, and low job and career expectations. Research by the Alan
Guttmacher Institute (1981) shows that the incidence of pregnancy
goes up as the level of education falls, and goes down as education
levels and employment rates rise.

Every day, approximately 2,700 teenage girls age 15 through 19,
in the United States become pregnant. Of this number, it is estimated
that 1300 will give birth, 1100 will have abortions and three hundred
will miscarry. Most of these pregnancies will occur during the first
three months after the adolescent becomes sexually active. Each
year, 9,490 adolescents of the age of 13 or 14 have their first baby,
and 4,740 16 year olds have their second child (Dickman 8. Gordon,

1989). (Alan Guttmacher Institute, 1990) It has been reported that

2
teenagers in the United States have the highest pregnancy rates in

the Western world - twice as high as in Great Britain, France and
Canada, three times as high as in Sweden, and seven times as high
as in the Netherlands.

At the same time, Hall 8: Taylor (1984) remark that adolescence is
a time for fun, a time for friends, and a time of confusion. The
transition between childhood and adulthood consists of exciting yet
challenging stages of development. This developmental period is
characterized by rapid physical, social, and emotional changes.
Sexual experimentation, identity exploration, and the desire to
conform to peer group norms are typical of adolescents.

Furstenberg (1989) believes that adolescents behave sometimes
without careful consideration of the consequences involved. Thus,
teenage pregnancy may be one such negative outcome. Adolescent
pregnancy often leads to truncated educational attainment and
subsequently results in a prolonged cycle of poverty and
dependence. Adolescent pmgnancy, one consequence of risk-
taking, results in some of the most extensive and long term social
problems in our society today. It has become one of our most
intractable health problems whose consequences will be felt for
many years to come. The Center for Population Options has

reported that the cost of teenage pregnancy to the American

3

Taxpayers in 1988 was 20 billion for families begun with a teenage
parent. This includes Aid for Dependent Children (AFDC), Medicaid
and food stamps. On average, each child born to a teen mother in
1988 will cost the taxpayers nearly 16,500 dollars by the year 2008
when the child reaches age 20. In summary, there is a compelling
interest in understanding the causes of this “epidemic” in teenage
pregnancies. Lee 8: Grubbs, (1993) reports that it has been
demonstrated that the health status of adolescents has declined over
the last 20 years, whereas that of all other age groups has improved.
In particular, past research seems to suggest that low self-esteem
and lack of social support contribute to a teenage girl’s risk of
becoming pregnant. This project will focus on the psychological and
social resources available to teenage females that may impact
postponement of pregnancy. I
STATEMENT OF THE PROBLEM

Little attention has been given to teens who, so far, have
managed to postpone pregnancy during their adolescent years. In
the event of a pregnancy lots of attention is given to an adolescent
to ensure that the pregnancy is a Malthy one yet, often attention is
what the teen has been missing in her relationship with others. The
purpose of this project is to propose a program that enhances the

self-esteem and social support of such teen girls. The assumption of

4
this project is that girls with a high level of self-esteem and social
support are likely to postpone adolescent pregnancy.

If higher levels of self-esteem and social support are contributing
factors to postponement of pregnancy, such knowbdge may provide
an incentive for professionals in both health care and education who
have contact with teens to foster teens’ individual awareness of their
own level of self-esteem and social support and to mobilize
resources for these adolescents. Many adolescents in society today
demonstrate conflict and confusion. This problem needs to be
addressed so that developmental changes are made that will help
the adolescent view themselves differently and become more
productive.

PURPOSE AND SIGNIFICANCE

The purpose of this project is to develop a plan for a Church-
based program aimed at boosting self-esteem and social support of
adolescent females. Boost Self—Esteem and Social Tasks (“BEST”)
will be designed to enhance social support and self-esteem among
adolescent females toward the end of influencing their decision-
making skills and empowering them to make decisions regarding
their sexuality that will lead to a postponement of pregnancy. The
FCNSINP (BEST Coordinator) will participate in the development of

this Church-based social support and self-esteem program. The

5

FCNSINP coordinator will implement various interventions within the
development of the program. Within the role of assessor and
researcher, the FCNSINP will assess the cognitive level and
functioning of the adolescent prior to employing the role of
educator, counselor, collaborator and supporter. In these roles the
FCNSINP will assist the adolescent with adapting to the stressors
andlor changes of her development phase. The program will also
stress the importance of health promotion and the significance of
the impact of the environment in order to achieve an optimal level of
health and well-being.

The (“BEST”) program is designed to be an ongoing curriculum
to assist adolescents and can be expanded to include families to
facilitate understanding of the physical psychosociallmorallcognitive
and spiritual growth and developmental stages of the adolescent.
The program also aims at preparing the parents and adolescent to
participate in ongoing communication about positive self-esteem,
seme awareness issues, promotion of social interaction with role
models, mentors and peers; assisting the adolescent in value based
decision-making skills. Although all outcomes are important, this
project will focus on the areas of social support and self-esteem.
Piaget’s cognitive development theory will be utilized to guide the

FCNSINP in the implementation of an adolescent curriculum.

Conceptual Definitions

Terms to be defined in this project are: 1) social support, and 2)
self-esteem as they are related to influencing female teens’ decisions
*0 POBtPOM PMMDCY-

Social Support:

Social Support will be defined as; emotional support,
instrumental aid, informational support and appraisal support
(House, 1984). Emotional support can be described as a feeling
resulting from a relationship with select persons that promotes
perceived feelings of empathy, caring or concern within the
adolescent. Instrumental aid refers to goods(eg.; money or clothes)
or services actually received, for example; being driven somewhere
or child care from select persons. Informational support consists of
information or advice about a situation from select persons. Finally,
appraisal support is being able to share personal feelings or
thoughts with someone in order to receive feedback that is positive
or negative or social comparison relevant to a person’s self-concept.
Social support is positive and helpful although a spanking may be
seen as negative support the intention is positive. In order for social
support to be values it must be positive, nurturing, encouraging and
counter act negative interactions.

Self—Esteem:

7

. Self-esteem is defined as the feeling that a person is capable,
significant, successful, and worthy. For the purpose of this program,
self-esteem will be defined as “one’s good opinion of one’s dignity
or worth” Webster‘s Dictionary (1987).

McDowell 8. Day, (1987) state low self-esteem is reported by
many to be the number one psychological problem in contemporary
society. People who do not believe they are lovable often find they
are incapable of liking others and of functioning productively in
society. These pe0ple will need some kind of boost, some kind of
infusion of self-esteem in order to feel good about themselves. Sex
is a common mechanism used in the effort to bolster weak self-
esteem. An insecure girl may try to hold a boy's affection by giving
him sex, thus making her feel secure. Or she may seek to be sexually
appealing to a lot of boys, thereby proving to herself that she has
value in their eyes. Decision making is a cognitive process, the
cognitive development of adolescents will be considered in this
project.

Piaget’s Cognitive Development Theory as a Contextual Framework:
Piaget’s cognitive development theory focuses on the cognitive

abilities of children and adolescents. This project will peruse the

cognitive abilities of adolescents, ages 12-19. According to Piaget,

the ability to think logically in terms of cause and effect, to foresee

8

certain events in the future in relation to actions in the present, to
think objectively about oneself, and to consider the rights of others,
grows markedly during adolescence as part of cognitive
development (Ginsburg 8: Opper, 1988). Piaget’s theory of cognitive
development will guide the plan for implementation based on
cognitive levels and functioning and will be discussed in the
implementation section of this paper.

A plan to address social support and self-esteem as factors that
influence teens to postpone pregnancy may serve to enhance
clinical practice as well as other areas of involvement with youth in
church and the community. Adolescents need information and
instructions both inside and outside of school about the serious
consequences of early and unprotected sex. They also need to
participate in activities that enhance self-esteem and self-control that
help them to resist peer pressure and media messages that
glamorize seme behavior.

In general, research regarding adolescents' self-esteem supports
the notion that the decision to become sexually active is a conscious
one in most cases. Although it may not be well thought out, sexual
intercourse is usually considered a possibility when a girl begins
seeing boys. Thus, the proposed program will incorporate social

support and self-esteem as vital components that must be enhanced

9

to aid female adolescents in their decision-making process to
postpone pregnancy during adolescence. Teens who have social
support resources from family, friends, social interactions are likely
to make decisions to postpone pregnancy during adolescence
(House, 1984).
CONCEPTUAL FRAMEWORK

One Conceptual Framework has been utilized in development of
this project. The primary framework is the Family Social Support
conceptual model proposed by Kane (1988). Kane’s model will guide
content. Kane’s model acknowledges three assumptions 1) the
family is a social system; and 2) social support is a social process;
and 3) social support is positive and helpful. The first assumption of
the family as a system refers to the perspective thatthe family
engages in a process of interaction within itself and the
environment. This implies that there is a flow of energy in terms of
information, goods and services, and emotions within the family and
its social network. Program literature will increase parents and
Church members as to how vital a functional social network is for
teens. Thus, helping family members understand that social support
interactions serve as a catalyst by which teens can resist the
pressures of engaging in seme behavior and foster teens’ decision

making that results in Moned pregnancy during adolescence.

10

. The second assumption regarding social support as a social
process follows from defining the family as a system. Thus, social
support is a process reflecting a pattern of interaction over time
between the family members, friends and acquaintances. This
assumption is consistent with the systems theory and emphasizes
family social support as a process rather than the sum of resources
available in times of crisis. Thus, family social support is considered
to be a process of social relationships through which resources may
or may not be accessed.

The third assumption regarding social support is that negative
interactions do happen in a social network, (i.e., an adolescent being
grounded from driving the car as a punishment) but they are not
congruent with support; thus it seems more accurate to conceive of
them as stressors rather than as “negative supports.” Family social
support is conceptualized here as positive, nurturing, and
encouraging.

The assumptions regarding family social support as a concept are
that the family is a system which is interdependent with other human
systerrrs and that social support is a process that is primarily
positive and not stressful. These assumptions provide the basis for
a working definition of a family social support system as an ongoing

pattern of social relationships between the family and its social

ll

. environment that reflects interdependence.

The conceptual model of Family Support includes family
characteristics and interactional factors (Fig. 1). Family
Characteristics describe the background from which interaction
emerges, such as size, variety, and history interact with the family
structure in terms of the family’s compatibility with its social
network to provide the ground for social interaction.

lnteractional Characteristics have been identified as important
dimensions of social support and appear more akin to process
dimensions of social support than characteristics of families and
their social networks. There are five interactional characteristics
(Fig. 1) that tap the dynamics of the social support construct,
reciprocity, frequency, quality, quantity, and trust. There is a mutual
interdependence in support relationships that is characterized by
reciprocal helping relationships. This helping occurs through system
interaction. It would seem that the more interaction there is between
the family and its network, the more opportunities for mutual helping
interactions occur.

The model posits family social support as characteristics of the
family’s social network, family structure, esteem, and stability.
REVIEW OF LITERATURE

Social Support

12

. Primary concept will be reviewed first in general conceptual
terms and then as they have been incorporated into formal
programs.

Social support that includes significant others in the adolescent'
life may be the best deterrent to sexual involvement. This support
may arise out of the girls’ relationships with their mother and father,
grandparent, godparent, siblings, church members and peers, and
leaders of social activities of which they may be involved. Kane’s
Model (Figure 1) posit that health and resources are the outcomes
of social support that become available to the family as it engages in
reciprocity, advice and feedback, and emotional involvement.
Positive social involvement is a good way to foster teen involvement
away from sexual activity.

According to Franklin (1988) sexual intercourse among
adolescent is more likely to occur during the day in homes of
parents who are at work than in any other setting. Communication
difficulties in the parent-child relationship during these periods may
cause adolescent to be more susceptible to engaging in sexual
activity. Held (1981) report that a lack of a social support network
may lead to a lower self-esteem for the adolescent. Although some
studies have correlated divorce with poor adolescent adjustment,

other studies indicate that family conflict is more predictive of poor

l3

adolescent adjustment, regardless of parental marital status. Enos 8r
Handal (1986) reported that adolescent from high-conflict homes
had lower self-esteem, greater anxiety, and lower internal control
than did those from low-conflict homes, and they scored lower on
measures of psychological adjustrrrent.
PROGRAMS INCORPORA'HNG SOCIAL SUPPORT

Social Support has a gmat impact on an adolescent's self-esteem
according to a report of Howard 8: McCabe (Jan/Feb. 1990, p.21) who
studied adolescent at the Henry W. Grady Memorial Hospital in
Atlanta where they began a family planning-based outreach program
for eighth graders in a local school system. The program is led by
older teenagers and focuses on helping student resist peer and
social pressures to initiate sexual activity. Evaluation of the program,
based on interviews with 536 student from the hospital's low-
income population revealed that among student who had not had
seme intercourse, those who participated in the program were
significantly more likely to continue to postpone sexual activity
through the end of the ninth grade than were similar student who
did not participate in the program. Because of their lower rate of
sexual activity, program student also experienced comparatively
fewer pregnancies than non-program student.

Early evaluation of the program indicated that simply providing

14

w young teenagers with factual information about contraception was
not effective in changing sexual behavior. The young people who
had the five classes of factual and decision-making education were
not more likely to refrain rrom sexual intercourse than those who did
not have the classes, nor were they more likely to use contraceptives
or prevent pregnancy if they became sexually involved.

It is often assumed that if young people are given factual
knowledge—along with information about decision-making that will
enable them to apply such knowledge -- their attitudes and behaviors
will change. Research has shown however, that knowledge-based
approaches (including those with decision-making component) are
not particularly effective in reducing negative health behaviors
among young people. Student exposed to such programs were not
more likely to postpone sexual involvement nor were they more
likely to use contraceptives when they became sexually active
(Howard 8r McCabe, 1990).

Research has also shown that earlier and open communication
to educate adolescent about sexual activity is one way to combat
early intercourse. Furstenberg (1976) found that in homes where
both the mother and daughter reported discussing birth control,
more than half of the adolescent (52%) had sorrre experience with

birth control compared to less than one-fourth (23%) from families in

15

which no guidance was given. This led Furstenberg to conclude that
when contraception was discussed openly, the daughter was

thus allowed to acknowledge her own sexuality and to see sex as a
planned, controllable act, rather than spontaneous and
uncontrollable.

Self-Esteem:

Research result indicate that a low level of self-esteem is an
instrumental factor in adolescent pregnancies. Self-esteem is one of
the essential ingredient in a developing sense of identity and
contributes to maturation of a responsible, independent and
functional young adult. When self-esteem is challenged and the
adolescent has little feeling of self worth then high-risk behavior
may occur. Through high-risk behavior the adolescent attempt to
produce a sense of identity and self-esteem, however temporary it
may be (Folkenberg, 1991). Empirical research on levels of self-
esteem among teenagers is lacking. This gap in research might be
attributable, in part, to the fact that many service providers lack the
research skills, funding, or both to conduct sophisticated outcome
research.

Although much has been written about adolescent sexual
involvement in recent years, more research is needed to (a) evaluate

the efficacy of sex education programs, and (b) explore cultural

 

 

 

 

l6

variations pertaining to adolescent sexual activities. Teenage
pregnancy is not a new phenomenon, having existed for most of
mankind and resulting in homes for the unwed, early marriages, and
marriages to very young girls. However, there are many altematives
to early pregnancy such as long term goals of; attending college,
working, more freedom, having their own car and apartment. Yet
today, teenage pregnancy in the United States is of epidemic
proportions.

The level of self-esteem a person has regarding her own future,
having set goals, reaching to meet those goals may be the factor that
makes the difference. This goal setting normally takes place among
girls who have attained higher levels of self-esteem. There has been
a long history of sex education programs in the school systems, but
the majority of past and present curriculums lack value development
and moral decision making skills due to ambivalence. These
programs also need to offer one on one counseling regarding the
adolescent purposes and goals. Without it, these formal school
programs have shown little effect in dealing with the crisis of
teenage sexuality over the years (Gordon, 1981; Muraskin, 1986). The
impact of sex education on sexual activity, pregnancy and
contraceptive use among US. teenagers will not be altered until the

US. public resolves it ambivalence over the primary goals and

l7
. purpose of sex education programs (Marsiglio 8r Mott, 1986).

Adolescent are a relatively healthy population. The chronic
diseases of adulthood have not yet begun. As adolescent morbidity
and mortality rates are low, there are few conditions to which the
adolescent is susceptible in the immediate future. The
developmental tasks of developing an identity and independence
from the family may lead the adolescent to engage in behavior that
has serious health consequences. The adolescent may have
knowledge that this is harmful to her health, but having other needs
met takes precedence over health concerns. (McDowell 8 Day, 1987).

Rainey 8r Stevens-Simons (1992) report that the use of effective
contraceptives is increasing, and teens are most likely to use a
contraceptive if they believed a pregnancy would interfere with
future goals and plans. The population of pregnant adolescent
comprise a majority of teens who have not formulated future plans
and goals and, thus, see no conflict between those goals and their
pregnancy

Adolescent have generally not been viewed as a separate group

until recently. There exist a need for more research on their beliefs
toward health behavior. Literature support that adolescent in
general seem to be unaware of the impact of an adolescent

pregnancy and the impact it would have on their lives. In some

18

instances, teens used pregnancy to get their parent attention
hoping to unite the family (Howard 8. McCabe, 1990).
CHURCH BASED PROGRAMS

It is important to mention that past and current studies are
limited in the evaluation of Church-based approaches to the family in
areas related to education. A few Churches have implemented sex
education programs, but this author was unable to identify Church-
based cognitive empowerment programs dealing with self-esteem.
Although sex education programs include decision-making and
values as a part of their curriculum there is not an emphasis on self-
esteem. The Church is a needed and appropriate setting to provide
sex education (La Hays, 1993). The areas of health prevention,
promotion and education using a holistic approach are of primary
importance.

The Church can assist adolescent and their families by
implementing: 1)empowerment classes, 2) access to resources,
3)support groups, 4)professional counseling, 5) an active effective
youth program and, 6)a strong voice in the community advocating
for adolescent with schools etc. Chilman’s (1990) promotion of
healthy adolescent sexuality support the role of parents in the
communication and provision of sex education in order to change

the attitudes, behaviors and decision-making skills, therefore,

l9
reducing premature sexual activity in the adolescent that too often

lead to pregnancy. Adolescent can be taught problem-solving and
decision-making skills that will help them choose their own

behaviors responsibly (Duncan-Ricks, 1992).

PROJECT DEVELOPMENT AND CONCLUSIONS

PROJECT DEVELOPMENT
The Boost Esteem 8: Social Tasks program (BEST) define Social
Tasks for this project to mean involvement in non-sexual activities
that will boost self-esteem, e.g., support groups, youth activities,
interaction with family, Church and after school activities.

The FCNSINP (BEST Coordinator) will participate in the
development of this church-based adolescent self-esteem and social
support education program. The FCNSINP is best prepared to be
coordinator in implementing such a program, as the FANSINP’s use
theory as a guide to practice
IMPLEMENTATION OF A CHURCH-BASED PROGRAM

An important aspect of the implementation of this project is the
utilization of the FCNSINP within the Church and family setting. The
FCNSINP identified for this project. a member of the Church, is in a

unique position to implement the developed Church-based

20
adolescent self-esteem program. The roles and expertise of the

FCNSINP are a valuable asset to the Church community by assisting
the parent and their adolescentlchildren in developing their self-
esteem as it relate to the spiritual, psychological, physical and
social well-being.

Planning for this project occurred following daily discussions of a
group of female teens during Vacation Bible School that was
directed by this FCNSINP following a literature review. The FCNSINP
took the concerns and ideas for the project to the Pastor for
approval. At a meeting held later, the FCNSINP was joined by a
committee of Church members, i.e., The Pastor, Assistant Pastor,
Judge, Family Counselor, Youth Minister, Lawyer, State Children’s
Education Director, a Nurse, Church Administrative Assistant,
Church Receptionist Secretary, two grandmothers, two educators,
FamilyIYouth Activities Group, and three parent couples selected by
the committee. The committee developed goals and objectives for
the intense but flexible program that could be modified to meet the
needs of teachers, parent, children and adolescent on a yearly
basis. Many of the professionals of the team will assist the
FCNSINP, in the future education and counseling of teachers,
parent, and adolescent.

The BEST Committee will include an application into the weekly

2 1
Church bulletin inviting adolescent to participate in the program.
The application has to also be signed by their parent. An
informational meeting will be held with the adolescent and parent
who consented to participate in the program to discuss projected
plans and objectives for the comprehensive program. Feedback from
the parent and adolescent will be encouraged in order to assist the
BEST Committee with the future planning. It was decided that the
program would be kicked off with a Weekend Retreat to ascertain
data from participant and lend to an atmosphere of open
communication among the adolescent.

The Children’s Education Director will assist the FCNSINP in
developing a curriculum based on the assessment data obtained
from the adolescent at the Retreat. (Flow chart with step by step
implementation process, Appendix 8).

Curriculum program topics in these sessions tailored to the
different age groups will include: physical, cognitive, social, moral,
sexual and spiritual maturation as it relates to the stages of growth
in the adolescent; 2) sexual identity; 3) self-esteem; 4)
independence; 5) setting limit; 6) communication and listening
skills; 7) decision-making skills; 8) values and bel'mfs; 9) preparation
for dating; 10) love and relationships; 11) biblical perspectives on

self-esteem; 12) current issues/pressures related to premarital sexual

 

22

. activity among the adolescent; and 13) consequences of the
adolescent's decisions. Teaching aids may include cartoons,
posters, VCR tapes, movies and illustrated brochures.

An evaluation tool of the BEST program will be developed to
examine it influence on adolescent self-esteem levels. The
adolescent curriculum and objectives will be split into early (12-14
years) and late (15-19 years) adolescent groups to facilitate the
cognitive, physical, intellectual and social needs of each age group.
For the early adolescent (ages 12-14), teachings will review the
anatomy and physiology and changes of puberty that have and are
still occurring. The FCNSINP will help the young adolescent to
understand the transition from childhood to adulthood, coping with
the changes, self-identity, review family roles and relationships. The
FCNSINP will help the adolescent identify positive characteristics of
relationships between males and females, preparation for dating,
identification and defining infatuation vs. love, how to end a
relationship positively, and consideration of all the options and their
consequences. The FCNSINP will also aid the adolescent in putting
together an action plan, and then plan a time line for evaluation of
the result. For the purpose of this project participant will be
adolescent of a Church community. The program will last one

academic school year. Participant will meet weekly for a period of

23
two hours. Participation will be voluntary and confidential.

Curriculum topics to be used in the Church-based social support
self-esteem Program are listed in outline (Appendix A).

Curricula for the older adolescent (15-19) moving into the formal
operations stage, will target; 1) the adolescent’s rolelcommunication
with family/peers, 2) appreciation and definition of self-esteem, 3)
current cultural and biblical views of self-esteem and sexuality, 4)
dating relationships, self-respect and communication with the
opposite gender, 5) the responsibilities and consequences of
premarital sexual activity, (i.e., pregnancy, STD’s), 6) decision-
making skills regarding sexual activity and 7) goals and planning for
the future. These tasks will focus on self-awareness and help the
adolescent understand how they relate to others in various
relationships.

The adolescent cognitive level based on age initially and the
functioning level of the adolescent will be considered before the
FCNSINP employs the role of educator, counselor, and supporter.

The overall objective of the BEST program curriculum is to
involve the adolescent in the process of developing into a holistic
human who is able to delay pregnancy until other goals in life have
been attained. The final goal of this church-based social support

and self-esteem program is to: put adolescent in touch with their

24

own feelings of self-worth, help them to understand the present level
of their self-esteem at the start of the program and boost their level
of self-esteem by the end of the program. Provision of feedback to
the Church for possible adoption of the program as an ongoing
curriculum to be taught to other youth (male and female) in the
church and community during youth meetings, bible study classes,
retreat and vacation bible school, will be an expected outcome of
the praiect

The expected outcomes and goals of this program are: increased
adolescent self-esteem; increased respect for others, ability of the
adolescent to process decision making skills related to their
sexuality, and decreased premarital sexual activity of the adolescent
and increased involvement in social activities. Keeping in mind that
teens with low self-esteem may exhibit self-punishment
characteristics, come from dysfunctional families with one parent
dominating and/or have a lovelhate relationship with either parent
and provide individualized support and referrals to these individuals.
The curriculum will include several informal assessment tools that
allow the adolescent to answer questions in a non- threatening way
that helps them to take a look at how they view themselves and
others.

Four critical factors that Piaget identified as necessary for

25

. cognitive development are maturation, equilibrium, social
interaction, and active experience. The interaction of these variables
which may differ from individual to individual, are essential for the
adolescent's cognitive development. These variables based on age
as to delineating cognitive age levels will be taken into consideration
as this program is delivered. Academic indicators will be utilized to
ascertain the adolescents cognitive development level. Piaget’s
concept that adolescents think in concrete and in later teens formal
thinking stages, are able to understand, distinguish and consider
options and employ role-playing in the decision making process will
be incorporated into the implementation of this project. Piaget’s
cognitive theory postulates that the adolescent (1247) can
simultaneously consider several factors or variables in solving
problems, consider the possibilities, and their thoughts are enlarged
to include the perspective of others (Santrock, 1993). Therefore, we
can conclude that cognitive development can incorporate some of
the decision-making skills regarding personal sexuality, love,
relationships and sexual activity in the adolescent age. Given the
difference between concrete and formal operations, Marcellino,
(1993) advises that health professionals and child development
educators consider the cognitive stage of development when

considering programs and outcomes.

26
. Adolescents (ages 17-19) in the formal thinking stge need less

nurse direction to attach given information to personal health care
decisions than do adolescent in the concrete thinking stage. Role
playing works best with the adolescent (17-19) playing the role and
identifying key decisions, options and consequences. The FANSINP
in both situations can help the adolescent to evaluate all possible
options and reinforce the use of the decision-making process.
ROLES OF THE FCNSINP

It is important that the FCNSINP implementing the BEST program
consider the different needs of families with different levels of
resources information will be ascertained during the application
process. lnforrnation offered by the FCNSINP and other health care
professionals will then be congruent with the adolescent’s measured
level of self-esteem. Regarding health related issues the FCNSINP
will be better able to offer appropriate guidance. The FCNSINP can
guide the adolescent through the decision-making process,
identification of the problem, consideration of all the options and
their consequences, selection of an action plan and how to follow it
through, and then plan for evaluation of the result. Self-esteem may
be bolstered and success measured by attaining goals which
include: better school attendance, better grades, making friends with

someone, parent for helping around the house, not becoming

27

sexually involved, or not getting pregnant.
HEALTH TEACHING

Nursing interventions the FCNSINP may utilize are a specific
example of a situation that the adolescent can readily identify with
and use role playing to help the adolescent assess options,
exploring the consequences of each option. Other situations, such
as current health-related decisions are related to the process, where
the adolescent can successfully resolve the problem. Adolescent in
the formal thinking stage need less nurse direction to connect given
information to personal health care decisions than do adolescent in
the concrete thinking stage. For example, the twelve-year old in the
concrete stage will understand “being given a ride to the doctor,”
whereas the older adolescent should be thinking in abstract terms
(e.g.; “l have this network of family and community that cares about
me”). The adolescent in the formal operations level of thinking can
most often cite the problem and identify some of the options and
consequences without much reinforcement. Role playing works best
with the adolescent playing the role and identifying the key
decisionsloptionslconsequences. The FCNSINP in both situations
can help the adolescent to evaluate all possible options and

reinforce the use of the decision-making process.

28

, HEALTH PROMONON STRATEGIES
In order for adolescent to delay pregnancy, they must have the

capacity and the motivation to do so. To have the capacity, they need

knowledge of reproduction, abstinence, birth control and access to
services. Motivation implies the knowledge of the consequences
and the willingness to prevent negative consequences of early
parenthood and the mality of these consequences. The primary
focus of this project is based on the need to identify the adolescent’
level of self-esteem so that educational, learning, and taching
strategies’ appropriate to their level of self-esteem can be employed
to empower the adolescent' to use their decision-making skills to
avoid the reality of an early unplanned pregnancy.

Strategies include:

, 1. Increase Church member’s awareness of the interrelatedness of
poverty, low achievement, low self-esteem, early childbearing,
and ramifications of adolescent pregnancy.

2. Develop new strategies to reach high risk adolescent in the
Church by including self-esteem classes in Sunday School,
Vacation Bible School, youth activities and retreat.

3. Offer sexuality programs based on adolescent cognitive
development for parental awareness.

4. Have adolescent programs taught by peer groups on values

29
. clarification, postponing sexual involvement, self-esteem and
decision-making.
RECOMMENDATIONS

Recommendations for future research would be to use
instrument that assess levels of social support and self-esteem in
adolescent. The assessment of the adolescent’ level of social
support and self-esteem would allow educational and counseling
programs aimed at pregnancy prevention to be based on the
adolescent’s social support and self-esteem level.

Implications for Future Research:

In addition to preventive health strategies, this project has
implications for future research for other disciplines. Any discipline
that works with adolescent may benefit by screening the adolescent
for her level of self-esteem and planning strategies based on the
level of self-esteem identified. Research should be done that would
obtain data assessing adolescent level of self-esteem at program
entry, midpoint and conclusion. Piaget’s concept will be taken into
account throughout the program’s assessmentlevaluation
component.

Recommendations for Future Project:
Future recommendations for project also include expanding

program’s network to involve:

3O

1. Bring together a broad-based group to develop a community -
based education plan on adolescent pregnancy and monitor its
implementation (Church Health Team).

2. Establish an adolescent consultationlcollaboration network
working with professionals knowledgeable of community
resources. ‘

3. Offer teaching seminars for professionals and to learn how to
utilize social support and self-esteem assessment tools in their
setting.

4. Continue to educate professionals and public on the needs of the
adolescent to participate in activities that elevate self-esteem.

5. A program to address social support and self-esteem levels in the
adolescent male may help to decrease their involvement in teen
pregnancy.

6. The community can be involved with helping adolescent by
participating in Vacation Bible School, youth retreat and helping
to implement other youth activities.

IMPLICATIONS FOR ADVANCED PRAC11CE AND PRIMARY CARE

The FCNSINP will need to address self-esteem as part of the
ongoing assessment of the adolescent during the health
prevention/promotion visit in the Church/community setting. This

will be an excellent opportunity to assess needs, resources,

3 l
anticipatory guidance, counseling, education, sexuality, referral to
other resources in the community and evaluation of
adolescentlfamily needs on an ongoing basis.

Adolescent self-esteem education skills are not only important
within the family structure but also within the community. The
FCNSINP can take an active role in designing, implementing and
evaluating the self-esteem programs in the local community (family,
Church, school) and in promoting a multi-disciplinary and holistic
approach to increasing self-esteem education. With the
encouragement of parental involvement, this mum-disciplinary
approach will be in a better place to influence the adolescent
population and the familylindividual values and decision-making
skills regarding their self-esteem. The FANS/NP can make an impact
within these families and adolescent in promoting and helping to
develop a healthy holistic individual with high self-esteem.

PLAN FOR EVALUATION

The BEST program could be evaluated annually using
assessment questionnaires, self-esteem posturveys to mess
cognitive changes, feedback, outcomes and continued participation
in the program. This annual assessment will enable the FANSINP
and BEST Committee to evaluate the effectiveness of the program as

demonstrated by documented changes in self-esteem levels,

32

decision-making skills and premarital sexual behaviors among the
adolescent in this Church community. The program’s effectiveness
could also be evaluated by keeping records of any teen pregnancies
and comparing them to local, state and national statistics. Evaluation
could be designed to ascertain feedback and suggestions from
participant and parent. Research program could be implemented
to measure self-esteem throughout and at conclusion of the
program. An important evaluation measure is how many participant
continue to the end of program. A comparison group from another
similar Church without program might be used to determine impact
of the program. The program could later be expanded to other
Churches in the community and their program evaluated and
compared for effectiveness.
CONCLUSION

A Church-based self-esteem program can be implemented with
the goal of influencing the decision-making skills of the Church's
adolescent members” regarding their level of self-esteem.
Teenagers also need to understand that the future does not often
held gmat promise for a teenage mother and her child (Rainey &
Stevens-Simon (1992). Thus, that teenagers acquire a realistic sense
of the risks involved, is one of our greatest challenges. Teenagers do

not always realize the consequences of early sexual activity and the

33
responsibilities it can bring. Teen premarital pregnancy often causes
strained teen-parent relations. The consequences of becoming
sexually active may not always be carefully considered when a
teenage girl makes that decision. “Toward a State of Esteem”
(California Task Force, Jan.1990, p.13) links self-esteem to our
reputation with our ’selves. Sexuality develops in the family of origin.
The parent’ attitudes and their perception of their own sexuality is
the greatest influence on children and adolescent (Santrock, 1993).
Parental and religious values and beliefs need to be reinforced; and
the boundaries of sexual activity within the scope of Biblical
teachings need to be emphasized. The FCNSINP will need to
consider for program quality, that it will be necessary to specifically
design this program to the demographics, culture, socioeconomics,
family structure, attitudes and level of communication the adolescent
experiences. Family and adolescent demographic and social support
information will assist the FCNSINP in evaluating the factors that
may influence the outcomes of the Church program.

Adolescence can be a very traumatic time, but it can also be a
period of hope and excitement. From a developmental perspective, it
is a transition period in which there is growth physically, spiritually,
psychologically, socially and cognitively. If self-esteem education is

to succeed, then the programs need to include the “holistic” aspect

34

in their teachings. The Church and family can assist these
adolescent in moving toward positive growth and making healthy
decisions based on family and Biblical values.

Therefore, the FCNSINP strongly recommends that an educational
component with the parent of adolescent be an integral part of this
Church-based adolescent self-esteem education program. This
program can be tailored to utilize in any Church setting and
designed to coincide with the values, traditions, and paradigms of

the particular Church community.

BIBLIOGRAPHY
Alan Guttmacher Institute. (1981). Imam W the Emblem that 11ml!

firm: Away, New York : Alan Guttmacher Institute.

Chilman, C. (1990). Promoting healthy family sexuality. Family Belgians , 32 ,

123-131.

Dickman, I. R. and S. Gordon. (1989). "Schools and Sex Education: New
Perspectives." - Public Affairs [manic], No. 654.

Duncan-Ricks, E. (1992). Adolescent sexuality and peer pressure, Cullen
Adolescent WW . 2 (4) i 319-327-

Enos, D. M. and P. J. Handal. (1986) "The Relation of Parental Marital Status and
Perceived Family Conflict to Adjustment in White Adolescent." Journal 11L
Wing and Clinical [mum Volume 54. p. 820-824.

Falkenburg, J. (1991). "Girls, Self-esteem Plummets in Teen Years." American
m Volume 10. p. 97.

Franklin, D. L. (1988). "Race, Class, and Adolescent Pregnancy: an Ecological
Analysis." Mum] 91' W , Volume 58. p.339-354.

Furstenberg, F- F- (1976)- Ilnnlanncrl Parenthood; Ills: Sada] museums: of
m Qhfldhgaflng, New York: The Free Press, Division of MacMilIan Publishing Co.,
Inc.

Furstenberg, Frank F. Jr., Jeanne Brooks-Gunn and Lindsay Chase-Lansdale.

(February 1989). "Teenaged Pregnancy and Childbearing." American W51,

44:2. p. 313-319.

Ginsburg, H. & Opper, S. (1988)- W (3rd

Page 2 Bibliography
ed.). Englewood Cliffs, New Jersey: Prentice Hall.

Gordon, S. (1981). The case of moral sex education in the schools. W
M. _§1(4) , 214-218.

Hall, Burnis and Sue Taylor. (1984). mm 91mg W and Wm
Arming mm Adnlmnt Girl: and MW Washington, D.C. : US.
Department of Education. p. 1-13.

Held, L. (Winter 1981). "Self-Esteem and Social Network of the Young Pregnant

Teenager." Agnlegnem 16:64. p. 905-912.

House,J. S. (1984). On _ r. ;

 

mm Ann Arbor, MI: The Institute for Social Research.

Howard, Marion and Judith Blamey McCabc. (January/February 1990). "Helping

Teenagers Postpone Sexual Involvement." Family Planning Wm 22:].
p. 21- 26.
Hudson, W. W. (1982). W, The Clinical Measurement Package:
A Field Manual. Chicago: The Dorsey Press.
Kane, C. (1988). Family Social Support: Toward a Conceptual Model.
Advances in Nursing Science, January 1988;10 (2), 18-25.

LaHaye, T. (1993). . «-

 

WW. Colorado Springs, CO: Alive Communications.
Lee, Sally Hughes and Laurie M. Grubbs. (September 1993). "A Comparison of Self-

Reported Self-Care Practices of Pregnant Adolescents." Nnnsg Rummage; 18:9. p. 25-29.

Page 3 Bibliography

Marcellino, B. (1993). A personal interview with a Family Psychologist regarding
family sex education in the Church. April 1, 1993.

Marsiglio, W. & Mott, F. (1986). The impact of sex education on sexual activity,
contraception use and premarital pregnancy among American teenagers. Family
W 18 (4). 151-162.

Muraskin, L. (1986). Sex education mandates: Are they the answer ? Emily
W, 13 (4), 171-174-

McDowell, J. & Day, D. (1987). Why Wait "WW
S H C . . ,.

Rainey , D. & Catherine Stevens-Simon. (1992). "Child Abuse: Relationship to Risk
of Adolescent Pregnancy." Anglican Jonmnl 91' Disabled Children. Volume 136. p. 487.

Roy, (3. & Andrew‘s. H. (1992). WWW
Norwalk, CT. Appleton & Lange.

Santrock, J. (1993). “mm” (5th ed.). Debuque, 1A.: WCB
Brown & Benchmark Publishers.

Stevens-Simon, C. (1993). "Clinical Applications of Adolescent Female Sexual
Development." In: Nuns; W 18:12. p. 18-27.

MadaStaIeMEmem: mmmnmmmmnmmmmmm
W and Personal and Social mm (January 1990). Sacramento, CA :
California State Department of Education. p. 1-161.

Webster’s Dictionary, (1987). Second Edition; Simon & Schuster.

APPENDIX A

OUTLINE OF PROJECTED CURRICULUM

Jr. High (7-9th grades)
. Changes: What we are becoming. Brief review of A8 P changes of puberty (
physical, social, spiritual, intellectual and emotional). Use the film “Changes

and Choices.” God’s gift of Sexuality-Younger Adolescents Guide.

. Review self-esteemlself-worth as it relates to their growth and development.
Use How to Build Your Self-Esteem Model (Group Active Series).

. Family roles, values, relationships, and communication. Use How to
communicate with Your Family (Group Active Series) with role play.

. Identification of sex roles/stereotypes from a Christian perspective. Identify
positive characteristics between male and females (activities and interaction
between the males and females).

. Male and female relationships, feelings, emotions, influences, and respect.

. Preparing for friendships and dating relationships. How to handle
relationships, respect, and positive ways to end a relationship (female and
male). Guy’s & Girls: Understanding Each Other (Active Bible Curriculum).

. Peer/Media Pressure: “How to Say No.” Josh McDowell’s Book and Video
Series.

. Decision-making IChoices: Active Bible Curriculum. View film “Heart of Stone”
( Urban Ministries).

. Planning for the future/consequenceslgoals.

OUTLINE OF PROJECTED CURRICULUM

(Senior High)

. Sexual health/review A 8 PIDefining sexuality, sensuality, and intimacy. God’s
Gift of Sexuality Older Adolescents Guide.

. Communication with friends, family, and others. “How to communicate with
your parents about Sex” by Pender 8 Pender.

. Relationships-family and peers. Discover healthy ways to end relationships.
Dating Decisions Group Active Curriculum.

. Peer/Media Pressure-Use “How to Say No Series” by Josh McDowell, “Heart
of Stone” Urban Ministries.

. Consequences for sexual activity (STD’s, pregnancy, etc.). How our decisions
effect the future. Biblical boundaries of sexual activity. “Next Time I Fall in
Love” video with discussion. “Sex, Lies, and The Truth” video.

. Future goals and planning. ls Marriage in your Future? Group Active Bible
Curriculum.

APPENDIX B

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