Intervention Review

School-based education programmes for the prevention of child sexual abuse

  1. Karen Zwi1,*,
  2. Susan Woolfenden2,
  3. Danielle M Wheeler3,
  4. Tracey O'Brien4,
  5. Paul Tait5,
  6. Katrina J Williams1

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 9 MAY 2007

DOI: 10.1002/14651858.CD004380.pub2


How to Cite

Zwi K, Woolfenden S, Wheeler DM, O'Brien T, Tait P, Williams KJ. School-based education programmes for the prevention of child sexual abuse. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004380. DOI: 10.1002/14651858.CD004380.pub2.

Author Information

  1. 1

    University of New South Wales & Sydney Children's Hospital, School of Women's and Children's Health, Sydney, NSW, Australia

  2. 2

    Liverpool Hospital, B Wing, Liverpool, NSW, Australia

  3. 3

    Community Child Health, Sydney Children's Hospital, Cochrane Child Health Field, Randwick, New South Wales, Australia

  4. 4

    Sydney Children's Hospital, Centre for Children's Cancer & Blood Disorders, Randwick, New South Wales, Australia

  5. 5

    The Children's Hospital at Westmead, Child Protection Unit, Westmead, NSW, Australia

*Karen Zwi, School of Women's and Children's Health, University of New South Wales & Sydney Children's Hospital, Sydney Children's Hospital, High Street Randwick, Sydney, NSW, 2031, Australia. Karen.Zwi@sesiahs.health.nsw.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

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Abstract

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  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

Background

Child sexual abuse is a significant problem that requires an effective means of prevention.

Objectives

To 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 methods

Electronic 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 criteria

RCTs or quasi-RCTs of school-based interventions to prevent child sexual abuse compared with another intervention or no intervention.

Data collection and analysis

Meta-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 results

Fifteen 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.

Authors' conclusions

Studies 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.

 

Plain language summary

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  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

School-based programmes for preventing child sex abuse may improve knowledge and self-protective behaviours but also increase anxiety; further research is needed

Childhood sexual abuse is a serious problem for school aged children worldwide. There is no consistent definition of sexual abuse. Some studies restrict sexual abuse to instances of sexual body contact with the child, while others define sexual abuse as any sexual behaviour in a child's presence. Whatever its form, childhood sexual abuse can have a very negative impact on a child. The United Nations' Convention on the Rights of the Child states that "children have the right to be protected from being hurt and mistreated, physically or mentally" and the international community needs to investigate ways this can be done effectively. One widespread method used is to teach school aged children, using school-based programs, about child sexual abuse and how to protect themselves from it. It is important to know if this approach works, for how long it works and if it causes any unintended harm to children and adolescents. This is the purpose of this systematic review.

While this review found improvements in knowledge and protective behaviours among children who had received school-based programs, these results should be interpreted with caution. The reasons for a need for caution is that there were problems with the way that many of the original studies were analysed, children's knowledge was tested only a short time period after the program, the studies were conducted in North America and therefore may not apply to other countries and cultures, and several studies reported harms, such as increased anxiety in children. Potential harms need to be closely monitored in future studies and existing school based programs. It is difficult to know if the changes in children's knowledge and protective behaviours seen in the studies will result in prevention of child sexual abuse. As such, school-based programs should, at best, be seen as part of a community approach to the prevention of child sexual abuse.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

预防儿童性虐待的学校教育课程

研究背景

儿童性虐待是个重大问题,需要有效的预防措施。

研究目的

评估以下方面: 学校的教育课程能否有效帮助儿童增长关于性虐待和自我保护行为的相关知识;这样的参与是否会增加性虐待的揭露,或是造成任何伤害;相关知识的维持和不同课程种类或环境的效果。

检索方法

在2006年8 月,以儿童性侵犯和随机对照试验为MESH标题和内容关键字,检索了以下电子数据库: Cochrane Central Register of Controlled Trials,MEDLINE,EMBASE,PsycINFO,CINAHL,Sociological Abstracts,Dissertation Abstracts,另外还检索了其他相关数据库。

纳入标准

纳入了预防儿童性虐待的随机对照试验或半随机对照试验,这些试验进行了基于学校的干预措施与其它干预措施或无干预的比较研究。

数据收集与分析

用两个假定的ICC(组内相关系数)0.1和0.2。对四个结局指标(保护性行为、基于问卷的知识、短文式的知识,对虐待的揭露)进行了Meta-分析和敏感性分析。而对于知识的维持、伤害的可能性、不同课程种类和环境的效果等指标,无法使用Meta-分析。

主要结果

共纳入15个试验。这15个试验都对儿童进行了以学校为基础的性虐待干预,并测量了儿童相关知识和行为的改变。有超过半数的试验,在Meta-分析开始时,其数据合成都存在误差。在行为改变方面,有两个试验的数据适合做Meta-分析,其结果显示干预组的效果更好(OR: 6.76, 95% CI: 1.44∼31.84);但有中等程度的异质性 (I2 = 56.0%);用ICC进行调整后,其结果也没有明显改变。在以问卷为基础的知识方面,有9个试验被纳入Meta-分析,结果发现相关知识有所增加(SMD: 0.59;0.44∼0.74);存在异质性 (I2 = 66.4%);调整ICC为0.1和0.2 后, SMD分别为0.6 (0.45∼0.75) 和0.57 (0.44∼0.71);异质性随着ICC的增加而降低了。在短文式的知识方面,有4个试验被纳入Meta-分析,结果显示干预组效果更好 (SMD: 0.37,0.18∼0.55);且不存在异质性 (I2 = 0.0%);调整ICC后,其结果也没有显著性变化。在虐待的揭露方面,Meta-分析显示组间差异没有统计学意义。

作者结论

纳入本系统评价的研究报道,儿童的知识及保护性行为都有显著的改善。如果能获得真实的ICC值或是能获得整群调整后的结果,最后的结果可能会有改变。几项研究报道了伤害的存在,提示需要对类似干预措施的影响进行监测。另外,知识的维持应该在3–12个月以后进行测量。需要开展进一步的研究,探讨相关知识的最佳表达方式和接受课程的最佳年龄。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

预防儿童性虐待的学校教育课程

预防儿童性虐待的学校教育课程虽然可能改善儿童性虐待相关知识和自我保护行为,但是也会增加他们的焦虑;需要开展进一步的研究。

在世界各地,儿童性虐待都是学龄期儿童的一个严重问题。对于性虐待还没有一致性的定义。一些研究把性虐待限定在与儿童身体上的性接触,但其它研究则将有儿童在场的任何性行为均定义为性虐待。不论哪种形式的儿童性虐待对儿童都有严重的负面影响。联合国儿童权力宣言指出: 儿童有在身体和心理上被保护的权利,不应受到伤害或被虐待。国际社会需要探讨,采用什么样的方式能最有效地实现这个目标。一个普遍使用的方法,是采用学校教育课程,教育学龄儿童了解儿童性虐待的相关知识并学会保护自己。因此重要的是,我们需要知道学校教育课程是否有效,效果会持续多长时间,以及它对儿童和青少年是否会造成任何意想不到的伤害;这也是本系统评价的目标。

尽管本研究发现,接受学校教育课程的儿童在性虐待知识和自我保护行为方面有改善,但结果需要小心诠释,其原因在于许多原始研究的分析方法有问题,儿童的知识仅在教育计划结束后的短时间内进行了评估;研究均在北美进行,因此或许不适用于其他国家或文化背景;此外,几个研究报道了学校教育课程造成的危害,比如增加了儿童的焦虑。在今后的研究和现行的学校教育计划中,需要密切监测其潜在的危害。从研究中发现的儿童知识和保护性行为方面的改变,能否预防儿童性虐待,这是很难得知的。因此,学校教育课程应该作为预防儿童性虐待的社区干预措施的一部分。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

翻译注解":本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。: China Effective Health Care Network

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. 摘要

背景

預防孩童性虐待之學校教育課程

孩童性虐待是個重大的問題,需要有效的預防方法。

目標

評估目標在於:學校的教育課程是否可以有效的提升關於性虐待和自我保護行為的相關知識;這樣的參與是否會造成增加揭露性虐待,或是造成任何傷害;相關知識的維持和不同課程種類設置之效果。

搜尋策略

在2006年8月,以電子搜尋以下資料庫:Cochrane Central Register of Controlled Trials,MEDLINE,EMBASE,PsycINFO,CINAHL,Sociological Abstracts,Dissertation Abstracts和其他相關資料庫,使用MESH的標題,和針對孩童性虐待的內容關鍵字,來找尋隨機對照試驗 (randomised controlled trial, RCT) 。

選擇標準

方式以學校為基礎的介入方式和其他種類的介入或無介入比較,對於預防孩童性虐待之隨機對照試驗或半隨機對照試驗。

資料收集與分析

使用兩個歸因之組內相關係數 (intraclass correlation coefficients, ICC, 0.1, 0.2) ,藉由統合分析 (metaanalyses) 和敏感度分析來得到四個結果:保護性行為、問卷為基礎之知識、短文式的知識,及對虐待之揭露。對於知識之維持、傷害之可能性、不同種類課程和設置的效果,無法使用統合分析。

主要結論

共有15個測量以學校為基礎之兒童性虐待的介入處理,對於相關知識和行為改變的試驗被收納進來。在每個初始的統合分析中,都有超過一半的試驗皆包含分析錯誤單位。對於行為改變來說,有兩個試驗包含適合統合分析的資料;結果是偏好介入的 (OR 6.76, 95% CI 1.44, 31.84) ,但有中等程度的異質性 (I2 = 56.0%) ,而且當調整組內相關係數之後,改變的程度就變得沒有意義。有9個試驗被收納進統合分析來評估以問卷為基礎之知識。結果指向知識的增加 (SMD 0.59;0.44,0.74,異質性 (I2 = 66.4%)) 。當調整組內相關係數0.1和0.2後,結果各自為SMD 0.6 (0.45, 0.75) 和0.57 (0.44,0.71) 。增加組內相關係數會減少異質性。有4個試驗被收納進統合分析來評估短文式的知識。結果偏好介入 (SMD 0.37 (0.18, 0.55)) ,低異質性 (I2 = 0.0%) ,當調整組內相關係數後,沒有有意義的變化。在比較關於揭露報告虐待的部分,統合分析顯示不同組別之間沒有統計學上有意義的差異。

作者結論

這個回顧的試驗顯示,在知識及保護性行為上,都有著顯著的改善。最終結論在提供真實的組內相關係數、或群體調整後的結果之後,可能有所改變。有數個試驗顯示傷害的存在,並建議監測類似介入方式之影響。關於知識的維持則需量測超過3 – 12個月。必需進一步探討最好的呈現方式,和接受課程的適合年齡。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

預防孩童性虐待的學校教育課程可能可改善知識和自我保護的行為,但是也會增加焦慮。進一步的研究是需要的。孩童性虐待,在世界各地,都是學齡兒童一個嚴重的問題。對於性虐待沒有一致性的定義。某些試驗把性虐待侷限在與孩童身體上的性接觸,但是其他試驗則定義,任何孩童在場的性行為均為性虐待。不論型式為何,孩童性虐待對孩童有非常負向的影響。美國對於孩童權力的宣言指出, ‘孩童在身體和心理上,有被保護不受傷害及不當對待的權利’ ,而且國際社會需要去探討,什麼樣的方式會最有效果。是運用學校教育課程是一個普遍被使用的方式,去教導學齡兒童有關孩童性虐待,和如何保護自己免於此。知道這樣的方式是否有效,以及對孩童與青少年,是否造成任何非預期性的傷害是很重要的。這是這篇系統性文獻回顧的目標。雖然這篇回顧發現,知識和保護性行為,在有接受學校教育的孩童上有進步,這些結果仍需小心的詮釋。要小心的原因是由於許多原始試驗的分析方式有問題,孩童的知識只在教育計畫剛結束的短期間內評估,另外試驗均在北美進行,沒有辦法適用於其他國家或文化,此外有數個試驗提到傷害,包括增加孩童的焦慮度。潛在的傷害在未來的試驗,和現行的教育計畫中,需要更緊密的監測。孩童知識和保護性行為方面的改變,是否能預防孩童性虐待,在這些試驗中很難去得知。因此,學校教育課程應該,也最好是社區介入來預防孩童性虐待的一部分。