Unpacking School-Based Child Sexual Abuse Prevention Programs: A Realist Review

Background: Existing efforts to understand school-based child sexual abuse (CSA) prevention programs mainly focus on the effectiveness of these programs in increasing participants’ CSA knowledge and self-protective skills. There are currently no reviews addressing the underpinning pathways leading to these outcomes. In order to increase our understanding about the underpinning causal and contextual factors and inform the further development of school-based CSA prevention programs, a realist review was conducted to synthesize existing evidence from a broad range of data. Methods: An iterative search of electronic databases and grey literature was conducted, supplemented with citation tracking to locate relevant literature. For quantitative evidence, we considered evaluation studies that focused on students aged 5–18 years, who were enrolled in primary or secondary schools; for other types/formats of studies/documents, no population restrictions were applied. We included school-based CSA prevention programs that focused on improving knowledge of CSA or self-protective skills. Outcomes of interest included knowledge of CSA or self-protective skills. We did not apply methodological filters in terms of the types of studies to be included. Thematic content analysis was conducted to synthesize data. Results: Sixty-two studies were included. Five themes and five overarching Context-Strategy-Mechanism-Outcome configurations (CSMOs) that contributed to the success of school-based CSA interventions were identified, including tailoring programs to participants’ cognitive developmental levels, repeated exposure of key concepts and skills, utilization of interactive delivery methods and positive feedback, delivery of positive information and application of the ‘train-the-trainer’ model. Implications: Findings from this realist review provide insights into the underlying program theory of school-based CSA prevention programs, which can aid in the development and implementation of these programs in the future.


Search
Data collection and analysis thoroughly and conducted; provided.Reasonable level of contextual detail provided; no theoretical frameworks were referenced.Good discussion of how and why findings apply to particular groups.
2 Barbee (1992) Bubbylonian Encounter This study's research questions are: 1) Is the effectiveness of a sexual abuse prevention program dependent upon the format employed?2) Is the effectiveness of a sexual abuse prevention program grade-related? 3) Is an increase of knowledge evident after participation in a sexual abuse prevention program?4) Do students who participate in a sexual abuse prevention program retain the acquired knowledge?
Data collection and analysis reported in the paper; substantial detail on theoretical framework (cognitive development theory).
Details on the program mechanism reported; no contextual information provided due to the nature of the study type.

Keeping ourselves safe
The study was designed on problem-solving lines to establish whether children could identify and respond safely to a wide range of potentially unsafe situations.
Limitation of the data collection method reported (lack of the rigor of a strong experimental design); contextual information collected and reported.

Keeping ourselves safe
This is a follow up study highlighting a developmentally appropriate school-based protection program.
Though the study reported follow-up findings of the program in two countries (Australia and New Zealand), contextual information was limited to demographics and locations rather than details directly relating to implementation.9 Bright, Huq, Patel, Miller, & Finkelhor (2020)

Child Safety Matters
The goal of the curriculum is to educate and empower students to prevent, recognize, and respond appropriately to bullying, cyberbullying, the four types of child abuse, and digital dangers.
Thorough data collection and analytic process; Demographic information collected and reported; limitation of the findings reported ("These results could also be due to the nature of the knowledge itself or failures of the measurement process.Indeed, some of the knowledge tested with the questionnaire had little room for growth.")10 Brown (2017)

Safer smarter kids
This study assessed the effectiveness of the Safer, Smarter Kids kindergarten sexual abuse prevention curriculum in increasing children's knowledge of safety risks and self-protection strategies.
Data collection and analysis reported; no theoretical frameworks discussed; contextual information provided but was limited to the study location rather than details directly relating to implementation.The purpose of this integrative literature review was to determine the state of the science on schoolbased CSA prevention programs.
Comprehensive review of the literature on CSA; lack of theoretical considerations; limitations reflected.

22
Fuqua (2008) Safe@Last The purpose of this study was to evaluate the Safe @ Last curriculum by assessing the amount of knowledge that was retained by the participants of the study.
Lack of contextual information provided but was limited to the study location rather than details directly relating to implementation.
The primary goal of the current study was to determine whether rates of child sexual abuse differed among undergraduate women who either had or had not participated in a sexual abuse prevention program during childhood.A secondary goal was to determine whether differences emerged in sexual satisfaction or avoidance of sexual activity between those women who had or had not participated in such a program.
Mechanism of disclosure discussed; clear discussion of the underlying reason for CSA prevention.However, the design is retrospective, subject to recall bias, and the sample is largely Caucasian, and was a convenience sample of undergraduate Psychology students.Some phenomena were also assessed using single item questions.
Relevance is on the "thin" end of the spectrum, as there is little description of sexual abuse prevention programsdescribed broadly as good touch/bad touchpresumably to cover a wide range of programs.

Tweenees
The current exploratory study seeks to address four methodological limitations identified in the literature.These are as follows: the inclusion of high school students, the recording of disclosures within and beyond program lessons, and the introduction of experimental measures of program fidelity and cost.
No theoretical framework provided; No detail regarding contextual factors that related to the program implementation process.

Body Safety Training
The aim of this present study was to evaluate the effectiveness of a child sexual abuse (CSA) prevention curriculum toward children and to compare the knowledge gains between children who were taught by teachers and their parents.

Talking about touching
To examine the effectiveness of a CSA prevention program, 'Talking About Touching".
Data collection and analysis reported; no information on the intervention theory and the context that related to the program implementation.Schools were not randomly chosen, so some impact on sampling and bias.Seems like instruments were developed specifically for the study and were not previously validated.Overall sample size is low for the kind of questions it seeks to answer.Pre-testing may also have affected results.Mainly descriptive analyses.

Number
Data collection and analysis reported; school context provided.However, theoretical underpinning of Safe Touches was not described at all.There wasn't much discussion of the context and other factors which may have contributed to the results.Relatedly, the program seems to have been adapted to be "culturally appropriate", but details are not provided.
Explanations presented in Discussion but given sample limitations, generalisability is limited (this is however addressed in Limitations).To test the effectiveness of the Enough!Program.Detailed descriptions of implementation processes; data collection and analysis reported.No detail regarding contextual factors that related to the program implementation process.Data collection and analysis reported; lack of reflection on theoretical frameworks and mechanisms.
Data collection and analysis reported; Cultural contextual factors reported.Lack of reflection on the theoretical framework of the program.

Studies that used for the development of initial program theory (n=44)
Data collection and analysis reported; lack of information on the intervention theory and the context that related to the program implementation process.
Appendix C.