Received date: 30/08/2017; Accepted date: 11/09/2017; Published date: 19/09/2017
Copyright: © 2017 Elarousy W, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Child abuse and neglect (CAN) is considered a huge problem that leads to immediate harm and long-term consequences extending from the childhood till adulthood. Teachers play a great role in detecting and reporting CAN and can make contribution to the prevention and early detection of child abuse by reporting suspected cases of child abuse and neglect. The current study aimed to investigate the effectiveness of educational program on teachers' awareness on identifying and reporting suspected cases of CAN in primary schools in Makkah region. A quasi experimental design was used. Educational program was developed and implemented for teachers from 4 different primary schools from Makkah region using convenient sampling. A structured self-report questionnaire was used before and after the educational program. Validity and reliability were tested for the questionnaire. Results: It was found that there is a significant difference in the ability to identify CAN before and after the program. In relation to the reporting CAN, none of them oriented about the child hot line before compared with 84.9% of them after the program. The study concluded the need of involvement of the teachers in awareness activities of CAN to improve their abilities in recognizing and reporting suspected cases of CAN.
Child abuse, Educational program, Teachers
Child abuse and neglect (CAN) is defined as physical, sexual, emotional abuse, or neglect that leading to actual or potential harm to the health of the child, dignity or survival, trust or power . CAN is considered a huge problem that lead to immediate and long-term consequences extending from the childhood till adulthood. These consequences affect social, health, economic and quality of life of the child depending on the type of abuse [2-4]. The size of CAN problem was not recognized because of lack of accurate statistics about the incidence of CAN. Unwell identification and reporting of CAN lead to decrease the services for the victims and their families .
The recognition of child protection in Saudi Arabia started in 2000 when various or many governmental programs conducted to reduce CAN. National Family Safety Program (NFSP) is one of the national programs that was established on 18th November 2005 and it has the full approval and support from the government to defend on the rights of individuals and help the victims of domestic violence .
Mandatory reporting of CAN is desired from educators, health care providers and child care providers, but the reporting is not limited to them . Teachers play a great role in detecting and reporting CAN especially physical abuse . According to Hawkins, he pointed out "no other professionals like teachers have such close, continuous, daily contact with child abuse victims on a day-to-day, long-term basis". Studies found that internationally teachers lacked confidence and skills to accurate detection of suspected cases of CAN . In addition, Goldman  found that teachers are unsure about their abilities to identify any type of CAN. Furthermore, Kenny  found that there was lack of knowledge regarding recognition of child maltreatment and how to report among teachers. Underreporting cases are associated with less educated teachers or teachers who think or believe that reporting would effects on them or on the child . More experienced teachers found to be more likely to report suspected cases of CAN than less experienced teachers . On the other ways, when CAN is severe, reporting this case will be more likely to occur, involve physical and sexual abuse or when disclosure of the abuse by the child occur . The goal of mandatory reporting by teachers is to protect the children from further abuse and harm .
Teachers can make contribution to the prevention and early detection of child abuse by reporting suspected cases of child abuse and neglect . Teachers’ decision to report child abuse is influenced by many factors such as their knowledge about the signs and symptoms of abuse, the policies and procedure of reporting CAN. In addition, teachers’ believes and attitude toward child abuse and whether the consequences of the reporting will be positive or negative . The main step for starting any strategies to increase reporting of CAN is to understand the teacher's current knowledge toward CAN .
Nurses have a great role in the prevention and early detection of CAN as well as the proper treatment. Their role is to make the community aware about the problem of CAN and how that each individual has a role to prevent it. Also, provide health education to teachers to make them knowledgeable about identifying and reporting suspected cases of CAN. So, the current study intended to answer the following questions; what are the barriers of reporting suspected cases of CAN among teachers in primary school in western region and what is the effectiveness of educational program on teachers' awareness on identifying and reporting suspected cases of CAN in primary schools in western region.
To investigate the effectiveness of educational program on teachers' awareness on identifying and reporting suspected cases of CAN in primary schools in western region and to identify the barriers of reporting suspected cases of CAN among teachers in primary school in western region.
There will be a significant improvement on teachers' awareness on identifying and reporting suspected cases of CAN in primary schools in western region.
The study was conducted in the Makkah region in Saudi Arabia, two primary schools from Bahra and two primary schools from Jeddah. Quasi experimental design was used to evaluate the educational program when pre-post-test is used without control group and\or random selection is not possible or practical . A non-probability convenient sampling technique was used as the study included the most easily accessible schools and teachers . Eighty-six teachers in primary schools were recruited for the study. Schools principles were welcoming and provide all needed facilities to facilitate the implementation of the educational program.
A structured self-report data collection method was applied before and after the educational program.
The structured questionnaire includes two parts:
• Part 1, includes participant's demographic characteristics as age, year of experience.
• Part 2, includes participant's ability to identify and report CAN which was developed by Walsch et al. . Approval to use the tools was obtained from the author by E-mail. Modifications and translation were done by the researchers. The translated questionnaire was revised by Arabic teacher for the accuracy of the translation. The questionnaire includes: attending lectures/training about child abuse, teachers’ confidence in identifying CAN, previously suspected CAN, previously reported suspected CAN, barriers that inhibit reporting .it also includes three vignettes to test the teachers’ abilities to identify suspected cases of CAN using 5-likert scale (two of them is abused and one is not abused). Validity was tested by asking expert and necessary modification was done. Reliability was tested using Crohnbach alpha. According to Burns et al. , 0.70 is acceptable for a newly developed instrument. For the current study the reliability was 0.768 for questions related to the participants’ knowledge about identifying child abuse and 0.715 for questions after scenarios to measure the probability of suspecting child abuse while it was 0.697 for questions about how to report the suspected child abuse.
• The program was developed by the researchers. Power point presentation was used to deliver the information. The program covered the following objectives:
• Define the CAN.
• Identify the types of physical abuse.
• Differentiate between physical abuse and accidental injuries.
• Describe physical abuse indicators.
• Identify forms of sexual abuse.
• Identify forms of emotional abuse.
• Describe types of child neglect.
• Identify factors that increase the prevalence of child abuse and neglect.
• Describe the consequences of CAN.
• Identify National Family Safety Program and child help line.
• The research proposal was submitted to the King Abdullah International Medical Research Center (KAIMRC) and IRB approval was obtained.
• Approval was obtained from school principals of the four primary schools and the agreement on the appropriate time was done.
• Questionnaire (part 1 and 2) was distributed to the available teachers in the primary schools. The time for the completion of the questionnaire was about eight minutes.
• The educational program of CAN was implemented and the time for the completion of the program was about 60 minutes.
• Questionnaire part 2 (post-test) was distributed to teachers after the educational program. The time for the completion of the questionnaire was about seven minutes.
Statistical package for social science software (SPSS version 20.0) was used for statistical analysis. Descriptive statistics was calculated to describe the demographical characteristics of the respondents. In addition to this, detecting relationship between pre-test and post-test was investigated. The significance level is pre-set at P<0.05.
The research proposal was submitted to the King Abdullah International Medical Research Center (KAIMRC) and IRB approval was obtained.
All respondents indicated their willingness to participate in the study by signing the informed consent and filling the questionnaire.
Confidentiality was ensured in this study by using code names rather than respondents’ real names during data collection and analysis. All information given will be used for the purpose of study.
Eighty sex teachers participated in the current study, their age ranged from 25 to 55 years with mean age of 39.76 ± 5.82. Majority of the participants (88.4%) were married and have children. Regarding their teaching experiences, 66.3% of them have more than 10 years of experience, 72.1% of teachers are having bachelor degree while 26.7% of them are having diploma, and only one teacher is having a master degree. Most of teachers did not have any training about CAN while only 10.5% of them attended training program about CAN.
|I'm afraid from consequences on the children||28||32.60%|
|I don't know to whom to report||18||20.90%|
|It's normal for parents to abuse their children||16||18.60%|
|I'm afraid from consequences on me||7||8.10%|
|Reporting is not my responsibility||2||2.30%|
|Reporting is not important||1||1.20%|
Table 1. Participants’ barriers that inhibit reporting CAN.
Table 1 shows the participants’ barriers that inhibit reporting CAN. The most common barriers that inhibit are afraid from reporting consequences on the child as reported by 32.6% of teachers. “I don’t know to whom to report” was reported by 20.9% of them while 18.6% of them consider CAN from the parents as a normal behavior and 8.1% of them reported that they afraid from the consequences of reporting CAN on themselves.
Teachers were asked two key questions after reading three vignettes about suspected cases of child abuse and neglect: a detection question (How likely is it that this child has been abused or neglected?); and a reporting question (How likely is it that you will report this case?). Responses were rated on a 5-point Likert type scale with 1 indicating most unlikely and 5 indicating most likely as illustrated in Table 2. The first and third vignettes represented abused cases, teachers’ mean ability to identify the cases were improved after the educational program (4.6 compared with 4.2 and 4.7 compared with 4.4, respectively). It was also improvement in their decision to reporting (4.5 compared with 3.9 and 4.6 compared with 4.2, respectively) and the differences between before and after the educational program was statistically significant. The second vignette was non-abused case, the teachers’ ability of identification of the vignette were improved after the program than before either in identifying that the case is non-abused with the mean of probability of 2.1 compared with 2.5 before.
|Before (Mean)||After (mean)||T-test|
|Vignette 1 (abused)||Mean||Mean|
|Probability of abuse||4.3023||4.6279||0.0201|
|Vignette 2 (non-abused)||Mean||Mean|
|Probability of abuse||2.5||2.1395||0.0571|
|Vignette 3 (abused)||Mean||Mean|
|Probability of abuse||4.4767||4.7558||0.0071|
Table 2. Participants’ distribution according to their evaluation of 3 vignettes about suspected cases of CAN.
Teachers were asked about their abilities to identify suspected cases of CAN by using 5-likert scale. It was found that the mean of the teachers’ abilities to identify CAN was improved after the educational program and the differences were statistically significant. The mean teachers’ abilities were improved from 3.64 to 4.55 for signs of physical abuse and 2.66 to 4.01 for their ability to identify sexual abuse. For their ability to identify signs of emotional abuse it is also improved from 3.62 before to 4.35 after and it was improved from 4.1 before to 4.67 after for identifying the signs of neglect as presented in Figure 1. As shown in Figure 2, the majority of teachers became aware about the Child Help Line with a percentage of 84.9% comparing to 0% before the educational program.
One of the most significant international public health problems is child abuse and neglect. Teachers during their daily work are dealing almost with different socioeconomic students . Furthermore, children spend a third of their time in school. That's why teachers are in a unique position for early detection and prevention CAN . In order to be able to identify early signs of abuse, teachers need to acquire enough knowledge and skills regarding CAN [16,17] to be confident about their important role in identifying and reporting suspected cases of CAN . So the aim of the current study is to investigate the effectiveness of educational program on teachers' awareness on identifying and reporting suspected cases of CAN in primary schools in Makkah region.
Previously reporting system was unknown, but when National Family Safety Program (NFSP) established, it was the initiation of child protection services in Saudi Arabia . After that, NFSP established the Saudi Child Helpline (116-111) in 2010 which provides counseling and referral services . Although, many activities by the NFSP to improve public awareness about child abuse and neglect and Child Helpline in addition to organized activities from our college either in malls or in hospital in form of mothers classes by our students’ nurses in Jeddah to improve public awareness about the topic, none of the teachers in the current study oriented about the Child Helpline before the program which arise a question mark about the effectiveness of such activities and the need to direct these activities to schools environment. This is in agreement with Kenny  who found that the majority of the teachers are unaware about the signs and symptoms of CAN and the reporting system. Which is the reason that affects their ability to report and recommend the need for a structured training for types and forms of CAN and the reporting system.
The result of the current study revealed that 17.5% of teachers reported suspected cases of CAN at some point during teaching experiences. They reported only to the school counselor as they were not aware about the Child Helpline. This is in agreement with the study done by Emich-Widera et al.  who found that 58% of teachers faced cases of CAN and the majority of them reported the school counsellor about the suspected cases. On the other hands, Goebbels et al.  found different results in his study, the majority of teachers (80.7%) (n=239) had experience with reporting suspected CAN at some point during their careers.
The result of the current study revealed some of the barriers that inhibit teachers from reporting suspected cases of CAN. About one third of teachers are afraid from reporting consequences that might affect the children, while 20.9% of teachers don't know the reporting system and to whom they should report, this is evidences by none of them oriented about the Child Helpline. In addition, 18.6% of teachers considered that it's normal for parents to abuse their children. This may be contributed to culture attitude that accept physical abuse as a way to modify children behaviors and the parents’ rights to use their own way to rear their children. This result gives us another evidence for the need of training and public awareness for CAN and its preventions. A study by Kenny's  presented another barrier that could prevent teachers from reporting which are the administrative will not support them if they report and the families will use the court if they reported any case of suspected cases of CAN. While Emich-Widera et al.  found unwillingness to meddle in family issues, the reporting would not bring any desired effect and reporting is not the teachers’ responsibilities. Furthermore, Yanowitz et al.  found that lack of self-confidence in identifying if the child was the barrier that prevents teachers from reporting any suspected cases of CAN.
Teachers’ response toward CAN is very important and reporting can make a significant improvement in child protection services. That's why teachers should be included in the training and educational programs about CAN to get the desired responses from them . In the current study training was effective and it improves teachers' abilities to identify suspected cases of all types of child abuse either physical, sexual, emotional or neglect. As there were statistically significant differences before and after the program in relation to teachers' abilities to identify different types of CAN and to report to the National Family Safety Program, child helpline. That's why teachers should be included in the training and educational programs about CAN to get the desired responses from them. This is supported by Walsh et al. .
The current study concluded the need of involvement of teachers in awareness and preventive activities of child abuse and neglect. Furthermore, the effect of the educational program on building the teachers’ knowledge and awareness on identifying and reporting suspected cases of child abuse and neglect. This will improve teachers’ abilities to make important contribution in recognizing and reporting a suspected case of child abuse and neglect.
Consider the teachers in all educational program and preventive activities of child abuse and neglect. Follow-up measures should be planned to all participants to emphasize the importance of their roles on prevention and early detection of CAN. This will help in building confidence on their knowledge and abilities to identify and report the suspected cases of child abuse and neglect.
We would like express our appreciation to all teachers and school principles for their cooperation and appreciation for the researchers’ efforts in the implementation of the educational program. Further, we would like to extend our appreciation to Dr. Houiada Helal for her support in data analysis.