Peer-reviewed article
Enhancing nursing and other healthcare professionals' knowledge of childhood sexual abuse through self-assessment: A realist review.
Adisa O, Tyrrell K, Allen K ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This realist review examines how self-assessment tools help healthcare professionals, especially nurses, improve their knowledge and confidence in responding to childhood sexual abuse and exploitation (CSA/E). The researchers reviewed 247 articles and found that existing self-assessment tools are scarce and underdeveloped for CSA/E specifically, though some tools exist for related areas like domestic violence and trauma-informed care. The review suggests that self-assessment at individual and organizational levels can improve healthcare responses to survivors, but more research is needed to develop and test CSA/E-specific tools.
Key points
- Many nurses feel reluctant to enquire about abuse and underprepared for disclosures from survivors
- Only 25 of 247 articles reviewed met inclusion criteria, with just 8 included in final synthesis
- Two main families of self-assessment interventions were identified: PREMIS (for domestic violence and abuse knowledge) and Trauma-informed Practice/Care protocols
- Individual self-assessment can promote organizational accountability for improving responses
- Self-assessment tools specifically designed for CSA/E remain underdeveloped and under-studied
Limitations
This is a realist review of existing literature rather than an evaluation of a specific intervention, so it cannot demonstrate the effectiveness of self-assessment tools in practice. The review identifies gaps in the evidence base rather than providing outcome data on what works to improve healthcare professionals' responses to CSA/E.
Abstract
Aim To explore how child sexual abuse/exploitation (CSA/E) self-assessment tools are being used to enhance healthcare professionals' knowledge and confidence. Background Child sexual abuse/exploitation is common and associated with lifelong health impacts. In particular, nurses are well-placed to facilitate disclosures by adult survivors of child sexual abuse/exploitation and promote timely access to support. However, research shows that many are reluctant to enquire about abuse and feel underprepared for disclosures. Self-assessment provides a participatory method for evaluating competencies and identifying areas that need improvement. Evaluation Researchers adopted a realist synthesis approach, searching relevant databases for healthcare professionals' self-assessment tools/protocols relevant to adult survivors. In total, researchers reviewed 247 full-text articles. Twenty-five items met the criteria for data extraction, and to assess relevant contexts (C), mechanisms (M) and outcomes (O) were identified and mapped. Eight of these were included in the final synthesis based on papers that identified two key 'families' of abuse-related self-assessment interventions for healthcare contexts: PREMIS, a validated survey instrument to assess HCP knowledge, confidence and practice about domestic violence and abuse (DVA); Trauma-informed practice/care (TIP/C) organisational self-assessment protocols. Two revised programme theories were formulated: (1). Individual self-assessment can promote organisational accountability; and (2). Organisational self-assessment can increase the coherence and sustainability of changes in practice. Conclusions There is a lack of self-assessment tools/protocols designed to improve healthcare professionals' knowledge and confidence. Our review contributes to the evidence base on improving healthcare responses to CSA/E survivors, illustrating that self-assessment tools or protocols designed to improve HCP responses to adult survivors of CSA/E remain underdeveloped and under-studied. Refined programme theories developed during synthesis regarding DVA and TIP/C-related tools or protocols suggest areas for CSA/E-specific future research with stakeholders and service users.