School-based education programmes for the prevention of child sexual abuse.
BACKGROUND
Child sexual abuse is a significant problem that requires an effective means of prevention.


OBJECTIVE
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.


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.


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


METHODS
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.


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 (I(2)=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 (I(2)=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.


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.
Zwi
K J
KJ
University of New South Wales & Sydney Children's Hospital, School of Women's and Children's Health, Sydney Children's Hospital, High Street Randwick, Sydney, NSW, Australia, 2031. Karen.Zwi@sesiahs.health.nsw.gov.au
Woolfenden
S R
SR
Wheeler
D M
DM
O'brien
T A
TA
Tait
P
P
Williams
K W
KW
D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012574:Schools