INTRODUCTION:

Every child in this world is not fortunate enough to have parents¹. It is estimated that 153 million children worldwide, ranging from infant to teenagers, have lost one or both parents (UNICEF).Over 7 million children are in institutional care worldwide. HIV/AIDS has orphaned 17.9 million children, most of them in sub-Saharan Africa and Southeast Asia (UNICEF). Orphans face number of problems such as physical, social, psychological. There are economic problems, child labour, difficulty in assessing health, difficulty in assessing education and lots more.

Among the various psychological problems faced by the orphan’s one of them is low self-esteem. Orphans continue to face many challenges and low self-esteem is one of them.

The finding of research studies reports that orphan children have low self -esteem as compared to the children living with their parents probably due to loss of their parents.²Art has been proved to raise the self-esteem and promote psychological comfort. Art therapy is the deliberate use of art-making to address psychological and emotional needs. It is a form of expressive therapy that uses the creative process of making art to improve a person’s physical, mental and emotional wellbeing³.

A four week art therapy intervention was implemented at a local school for 113 children ages 5 to 13. Art therapy was found to be an effective cross cultural intervention for these young tsunami survivors⁴.Art therapy undertaken with the orphan children of Ugarchin in northern Bulgaria announced that the children showed higher self-esteem, more independence and greater concentration⁵.A study was conducted to assess the effect of art therapy on anger and self-esteem in aggressive children in Shiraz Iran. Thirty children between the ages 7 to 11 were allotted to either a control group or an art therapy group equally and randomly. Results of this study reveal that Art therapy is an effective intervention to reduce anger and its dimension⁶.An experimental study was conducted to investigate the effect of art therapy based on painting therapy in reducing symptoms of Oppositional Defiant Disorder (ODD) in Iran⁷. A study was conducted to evaluate targeted school-based group intervention (art room) for students with emotional and behavioural difficulties in UK⁸.

MATERIALS AND METHOD:

Pre experimental one group pre test post test study design was used. Population consist of the orphans who has low self esteem residing in selected orphanages at Mangalore. Approval of the study was obtained from institution’s ethics committee. Purposive sampling technique was utilized to select the 42 subjects based on their inclusion criteria. The samples were randomly assigned. The consent was taken from the orphanage authority prior to the data collections. The data was collected by demographic proforma and Rosenberg self esteem scale scale. Pre test was assessed for all the orphans to select those with low self esteem. The orphans with low self esteem were administered art therapy. Art therapy included theme drawing, theme painting, making future portrait, free hand drawing, clay modelling, scribble drawing, paper bags making, preparing stuffed toys, finger painting and attach a drawing to a balloon. Post-test was assessed after 10 sessions of Art therapy by using Rosenberg self esteem scale

RESULTS:

Demographic variables:

Highest percentages of the orphans (47.61%) were in the age group of 11-12 years and least (9.52%) in the age group of 13-14 years. Highest percentages (52.38%) of them were studying in 6th-7th standard. All the samples were females. Majority of samples (76.19%) were Hindu and least (2.38%) were of other religion. Majority (78.57%) of samples stayed in orphanage for less than 5 years. Highest percentage (47.61%) of samples had more than 5 friends and spent 1-2 hours in recreation (54.76%).

Description of self esteem sores of orphans before and after art therapy

Table 1: Frequency and Percentage Distribution of Sample with low Self-esteem before and after art therapy n=42

Level of self-esteem	Pre-test		Post-test
Level of self-esteem	f	%	f	%
Low self-esteem(<15) Moderate self-esteem(15- 25)	42 -	100.00 -	7 35	16.67 83.33
Total	42	100.00	42	100.00

Data presented in Table 1 shows that after art therapy majority (83.33%) of sample had moderate self-esteem (15-25).

Table 2: Range, Mean, Median and Standard Deviation of Pre-Test and Post-Test Self-Esteem Scores n=42

Test	Range of score	Mean	Median	Standard deviation
Pre-test	14-10	12.62	13	1.08
Post-test	30-11	17.38	17	3.37

Data presented in Table 2 shows that the mean post-test score (17.37±3.37) was more than the mean pre-test score (12.62±1.08).

Effectiveness of art therapy on level of self esteem among orphans (8-14 years of age)

To find out the significant difference between the mean pre-test and post –test self esteem levels, paired ‘t’ test was used.

Table 3: Mean, mean difference, standard deviation and ‘t’ values of the pre test and post test level of self esteem among orphans. n=42

Test	Mean score	SD	Mean difference	‘t’ value
Pre-test	12.62	1.08	4.76	8.40^*
Post-test	17.38	3.37	4.76	8.40^*

t₍₄₁₎=1.96, p<0.05 ^*Significant

The data in Table 3 shows that the mean post-test self-esteem scores (17.38) was higher than the mean pre-test score(12.62).The calculated ‘t’ value (t₄₁=8.40)was greater than the table value(t₄₁=1.96) at 0.05 level of significance. Hence it is conclude that there was increase in the level of self esteem among the orphans and also art therapy found effective in increasing self esteem among orphans.

Association of Level of Self-Esteem with Demographic Variables

There was no association of pre-test and post-test self-esteem scores with socio-demographic variables

DISCUSSION:

In the present study highest percentage (53.16%) of the orphans were selected with low self-esteem. These findings are supported by a study which aimed to investigate differences in self-esteem of orphan children and children living with both parents in their homes in Lahore city of Pakistan. The children in orphanages reported lower degree of self-esteem than the children living with their parents (t₁₄₈=2.66, p<.01)⁹

The findings of the present study showed a significant difference in the mean self-esteem score (t₄₁=8.40, p<0.05) before and after the art therapy. Thus Art therapy was effective in improving the level of self-esteem among the orphans. The study is supported by the finding of a similar study conducted to assess the effect of art therapy on anger and self-esteem in aggressive children in Shiraz Iran. Thirty children between the ages 7 to 11 were allotted to either a control group or an art therapy group equally and randomly. After 10 weeks of art therapy group showed significant reduction of anger (p<0.001, F=13.24) and improved self-esteem of aggressive children (p<0.0001, F=36.85). Results of this study reveal that Art therapy is an effective intervention to reduce anger and its dimension⁶.

The study is also supported by an experimental study which was conducted to investigate the effect of art therapy based on painting therapy in reducing symptoms of separation anxiety disorder (SAD) in elementary school boys. The results of the F-test support the effect of painting therapy on symptoms of separation anxiety disorder (1, 27) =35.062, P<0.05.Boys showed reducing symptoms of separation anxiety disorder¹⁰.

Another supportive study was conducted to evaluate targeted school-based group intervention (art room) for students with emotional and behavioural difficulties in UK. Following participation in Art Room, students reported a significant improvement (M=2.07, SD=2.55; t₅₄=4.62,p<0.001) with less than 4% classified as depressed⁸.The result of these studies showed that Art therapy is effective in improving level of self-esteem. Art is the language of mind. Emotions and feeling can be best expressed through art. Art therapy can be applied to deal with self-esteem problems.

The investigator found no significant association between the self-esteem scores and socio-demographic variables such as age, class studying, gender, religion, duration of stay in orphanage, number of friends and number of hours spent in recreation. The study is supported by another study which investigated the differences in self-esteem of orphans children and children living with both parents. The children in orphanages reported lower degree of self-esteem than the children living with their parents (t₁₄₈=2.66,p<.01).The findings further suggest no significant gender differences in self-esteem of orphan children and children living with both parents⁹.

CONCLUSION:

The findings of the present study indicated that art therapy was effective in increasing the level of self esteem among orphans.

BIBLIOGRAPHY:

1. Drench M, Noonan A, Sharby, Ventura. Psychosocial aspects of health care. USA: Prentice Hall; 2003.p. 25.

2. Aroson E, Wilson T, Akert R. Social psychology.2^nd ed. USA: Addison-Wesley Educational Publishers Inc.; 1997. p. 19-21.

3. Gorman SD. Psychosocial nursing for general patient care. 3^rd ed. New Delhi: Jaypee Brothers Publication. p. 8-9.

4 Worldwide orphan statistics-SOS children’s village. SOS Publications. [online]. Available from: URL:http://www.sos-usa.org

5 Matt, Chris, Lewis. Global orphan crises-facts and statistics. [online]. Available from: URL:http://www.unicef.org/statistics/index step1.php

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7 Khaddar M. Babapour J. Sabourimoghaddam H. The effects of art therapy based on painting therapy in reducing symptoms of ODD in elementary school boys. Procedia-Social and Behavioural Sciences 2013;84:1872-8.

8 Cortina M, Fazel M. The art room; an evaluation of a targeted school based group intervention for students with emotional and behavioural difficulties. The Arts in Psychotherapy2015;42:35-40.

9 Ssewamala M, Alicea S, Bannon W, Ismayilova L. A novel economic intervention to reduce HIV risks among school-going AIDS orphans in rural Uganda. Journal of Adolescent Health2008; 42(1):102-4.

10 Khaddar M, Babapour J, Sabourimoghaddam H. The effect of art therapy based on painting therapy in reducing symptoms of SAD in elementary school boys. Procedia-Social and Behavioural Sciences 2013; 84:1697-703.

Received on 17.10.2016 Modified on 18.12.2016

Asian J. Nur. Edu. and Research.2017; 7(3): 376-378.

DOI: 10.5958/2349-2996.2017.00075.1