Abstract
School‐based education programmes on the prevention of sexual abuse may increase children's knowledge and protective behaviour but this does not necessarily reduce the number of incidents of abuse. The programmes should be seen as part of a community approach to prevent child sexual abuse. This is the conclusion of this Campbell/Cochrane systematic review of the best international research findings.AbstractBackgroundChild sexual abuse is a significant problem that requires an effective means of prevention.ObjectivesTo assess: if school‐based programmes are effective in improving knowledge about sexual abuse and self‐protective behaviours; whether participation results in an increase in disclosure of sexual abuse and/or produces any harm; knowledge retention and the effect of programme type or setting.Search strategyElectronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, CINAHL, Sociological Abstracts, Dissertation Abstracts and other databases using MESH headings and text words specific for child sexual assault and randomised controlled trials (RCTs) were conducted in August 2006.Selection criteriaRCTs or quasi‐RCTs of school‐based interventions to prevent child sexual abuse compared with another intervention or no intervention.Data collection & analysisMeta‐analyses and sensitivity analysis, using two imputed intraclass correlation coefficients (ICC) (0.1, 0.2), were used for four outcomes: protective behaviours, questionnaire‐based knowledge, vignette‐based knowledge and disclosure of abuse. Meta‐analysis was not possible for retention of knowledge, likelihood of harm, or effect of programme type and setting.Main resultsFifteen trials measuring knowledge and behaviour change as a result of school‐based child sexual abuse intervention programmes were included. Over half the studies in each initial meta‐analysis contained unit of analysis errors. For behaviour change, two studies had data suitable for meta‐analysis; results favoured intervention (OR 6.76, 95% CI 1.44, 31.84) with moderate heterogeneity (I2=56.0%) and did not change significantly when adjustments using intraclass coefficients were made. Nine studies were included in a meta‐analysis evaluating questionnaire‐based knowledge. An increase in knowledge was found (SMD 0.59; 0.44, 0.74, heterogeneity (I2=66.4%). When adjusted for an ICC of 0.1 and 0.2 the results were SMD 0.6 (0.45, 0.75) and 0.57 (0.44, 0.71) respectively. Heterogeneity decreased with increasing ICC. A meta‐analysis of four studies evaluating vignette‐based knowledge favoured intervention (SMD 0.37 (0.18, 0.55)) with low heterogeneity (I2=0.0%) and no significant change when ICC adjustments were made. Meta‐analysis of between‐group differences of reported disclosures did not show a statistically significant difference.Reviewers’ conclusionsStudies evaluated in this review report significant improvements in knowledge measures and protective behaviours. Results might have differed had the true ICCs from studies been available or cluster‐adjusted results been available. Several studies reported harms, suggesting a need to monitor the impact of similar interventions. Retention of knowledge should be measured beyond 3‐12 months. Further investigation of the best forms of presentation and optimal age of programme delivery is required.
Highlights
Child sexual abuse is a significant global problem in both magnitude and sequelae
The studies included in this review show evidence of improvements in protective behaviours and knowledge among children exposed to school-based programmes, regardless of the type of programme
Programme participation does not generate increased or decreased child anxiety or fear, there is a need for ongoing monitoring of both positive and negative short- and long-term effects
Summary
Child sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school-based education programmes. Recent meta-analyses of data collected from retrospective studies of adults in countries and cultures worldwide estimate that 10% to 20% of female children, and 5% to 10% of male children, have experienced child sexual abuse on a spectrum from exposure through unwanted touching to penetrative assault before the age of 18 years (Barth 2013; Ji 2013; Pereda 2009; Stoltenborgh 2011) These data are likely to underestimate its true prevalence because two-thirds of individuals never disclose their victimisation (London 2005) and most cases go unreported to authorities (Wyatt 1999). The time of greatest vulnerability for child sexual abuse is between 7 and 12 years of age (Finkelhor 1986)
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