Knowledge, attitude and behaviors of health workers working in van province about child abuse

The aim of this study is to examine the knowledge, attitude and behaviors of health workers about child abuse and neglect. The study group was consisted of 251 volunteer participants including physicians, nurses, midwives and emergency medical technicians (EMTs) working in the Van Province Yüzüncü Yıl University Dursun Odabaş Medical Center and in the Primary Care Clinics in the center of the Van province. The research is a cross-sectional descriptive survey study. To obtain data on the sociodemographic characteristics and their knowledge, attitudes, and behaviors related to child abuse and neglect of the health workers participating in our study, Sociodemographic Information Form and the Scale for Diagnosing Symptoms and Risks of Child Abuse and Neglect (SDSRCAN) were used. One-way Analysis of Variance and Duncan test were used for statistical analysis. 52.5% (n = 132) of the participants were physicians, 35.8% (n = 90) were nurses, 7.9% (n = 20) were midwives and 3.1% (n = 8) were EMTs. Of those included in the study, 52.9% (n = 133) were female and 47.1% (n = 118) were male. Health workers who participated in the study were mostly between the ages of 26-30 years with 41% (n = 103). Those who have at least one child were consisting 43.8% (n = 110) of the total number of participants. The rate of participants who have encountered child abuse was 53% (n = 133) and they have encountered the most physical abuse with 57% (n = 76) followed by sexual abuse with 47% (n = 63), neglect with 45% (n = 60), emotional abuse with 27% (n = 36) and economic abuse with 14% (n = 19). The health workers included in our study have shown the parents' reaction with 48.6% (n = 90) as the most challenging situations in the cases of abuse. Other compelling situations are listed as medical history taking with 32% (n = 60), physical examination with 23% (n = 43), reporting to the judicial authorities with 20% (n = 37). The participants have selected mostly the police and Child Monitoring Center as the places to be notified in cases of child abuse. The health care workers participating in our study have put the concern that the abused child could suffer from this process to the first place with 42% (n = 63) as a reason for not making a notice. The other reasons for not making any notices were as not having self-confidence on making the diagnosis with 23% (n = 34), not knowing the procedure with 23% (n = 34) and wanting to protect themselves from the situations that they may encounter socially with 12% (n = 19). Those, who think that talking loudly, shouting, slapping, etc in order to correct the child's behavior on any subject, to show the child's mistake may be included in the abuse, got higher scores from SDSRCAN; and compared to those who think they may not be included in the abuse, it was statistically significant (p <0.05). The mean scores for Physical Symptoms of Abuse on Children (PSAC), Behavioral Symptoms of Child Abuse and Neglect (BSAC) and Symptoms of Neglect on Child (SNC) subscales of those who say 'I am more attentive and polite to him/her' for their patients with a sexual abuse history who came for examination with any other reason, were lower; and the difference between them and the ones who say 'I treat them just as the same as how I treat my other patients' is statistically significant (p <0.05). As a result, it is determined that the knowledge of child abuse and neglect of health workers in our study is insufficient and the noticing rates are not complete for some reasons. Emotional and economic abuse and neglect which do not have obvious findings like especially in physical and sexual abuse, should be identified, and the need to take the necessary protective measures should be addressed. Since they are the most easily and directly accessible healthcare workers, family physicians and family health workers who serve at primary health care centers need to be more competent in prevention, diagnosis, treatment and noticing of the abuse and they should dwell upon this subject more carefully. In order to achieve this, before and after graduation, the awareness and knowledge levels of primary health care workers about child abuse and neglect should be increased, the steps to resolve the reasons for not noticing should be taken, in addition, in order to increase the social sensitivity on this subject, educations in the primary care health service centers should be conducted.