Nurses' intention to report child abuse in Taiwan: a test of the theory of planned behavior

Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self-efficacy of reporting suspected child abuse and neglect

AIM

To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self-efficacy of reporting child abuse and neglect.

DESIGN

A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey.

METHODS

A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores.

RESULTS

Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self-efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self-efficacy of reporting child abuse and neglect.

CONCLUSION

This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters.

IMPACT

This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self-efficacy in reporting suspected child abuse and neglect.

REPORTING METHODS

The authors of this study have adhered to relevant EQUATOR guidelines: STROBE.

PATIENT OR PUBLIC CONTRIBUTION

There is no patient or public contribution as the study only looked at nurses.

Decision-making process regarding passive euthanasia: Theory of planned behavior framework

BACKGROUND

Nurses have an essential role in caring for end-of-life patients. Nevertheless, the nurse's involvement in the passive euthanasia decision-making process is insufficient and lower than expected.

OBJECTIVES

To explore factors associated with nurses' intention to be involved in non-treatment decisions (NTD) regarding passive euthanasia decision-making versus their involvement in the palliative care of patients requesting euthanasia, using the Theory of Planned Behavior (TPB) framework.

DESIGN

A cross-sectional study utilizing a random sample.

PARTICIPANTS AND RESEARCH CONTEXT

The study was conducted in one of the largest hospitals in Israel among 125 nurses employed in internal and surgical care wards. Data was collected through face-to-face interviews between March and April 2019.

METHOD

A closed structured questionnaire was developed according to TPB instructions. A paired sample t test and two multiple hierarchical regressions were conducted. Variance explained (R2) and the significance of F change were calculated for each regression. The study used the STROBE statement guideline.

ETHICAL CONSIDERATIONS

The study was approved by the hospital's Helsinki Committee (#20.11.2017).

FINDINGS

A paired sample t test revealed that nurses' involvement in the palliative care of patients requesting passive euthanasia was significantly higher than in NTD regarding euthanasia. Regression analyses revealed that nurses' position and attitudes explain their intention to be involved in decision-making; attitudes and perceived behavioral control explain nurses' intention to be involved in the care of patients requesting euthanasia.

CONCLUSIONS

According to the TPB, nurses' attitudes explained their intention to participate in decision-making regarding passive euthanasia. It is recommended to enhance open discussion of this complex issue to encourage nurses' willingness to participate in NTD decision-making regarding euthanasia.

Development and psychometric evaluation of the reporting suspected child abuse and neglect (RSCAN) scale for United States registered nurses

PURPOSE

In the United States (US), nurses have a mandated duty to report child abuse and neglect (CAN). Despite comprising the highest proportion of the US healthcare workforce, limited research has explored the institutional barriers they face in reporting suspected CAN. Furthermore, there is no existing valid and reliable measure of reporting relevant to US. The purpose of this research is to develop and psychometrically evaluate a scale to measure nurse knowledge and self-efficacy as CAN mandated reporters.

DESIGN AND METHODS

The Reporting Suspected Child Abuse and Neglect (RSCAN) tool was developed from two existing international tools to examine institutional barriers and facilitators to US nurses' professional knowledge and reporting of CAN. A convenience sample of one hundred and sixty-six US nurses primarily from the Pacific Northwest responded to an online survey. An exploratory factor analysis (EFA) and Cronbach's α were used to examine validity and internal consistency, respectively, of an initial 16-item scale.

RESULTS

A two-factor model consisting of eight items indicated good model fit (CFI = 0.986, RMSEA = 0.049, and SRMR = 0.028) and was internally consistent (Cronbach's α = 0.822).

CONCLUSION

RSCAN is the first US instrument to reliably measure nurses' professional knowledge and self-efficacy of reporting suspected CAN.

PRACTICE IMPLICATIONS

Future research can build upon these findings to recognize and support nurses in their mandated role to report CAN.

Development and Evaluation of the Teacher Reporting Questionnaire for South African Foundation Phase Educators (TRQ-SA) in Measuring Teachers' Intentions to Report Child Sexual Abuse Suspicions

Globally teachers are mandated by law to report suspected child sexual abuse (CSA). The Teachers' Reporting Questionnaire (TRQ) was constructed to assess teachers' intentions to report CSA suspicions in Australia. The current research examines the development of the Teacher Reporting Questionnaire for South African foundation phase educators (TRQ-SA) and provides an evaluation of the TRQ-SA as a survey instrument for utilization in other studies. The TRQ-SA is a self-administered survey instrument used in a cross-sectional quantitative study that investigated teacher reporting intentions using the theory of planned behavior (TPB). A stratified random sample of 399 teachers from the eight school districts in the Western Cape province of South Africa was achieved. Before the TRQ-SA was developed, a qualitative elicitation study was conducted. Once developed, the questionnaire was pre-tested before the quantitative central study survey was administered. Cronbach's alpha was used to indicate reliability of scales, where a minimum α coefficient of .7 is considered acceptable. In the quantitative survey, the TRQ-SA had the following results: α = .74 was achieved for the attitude towards reporting scale, α = .78 for the subjective norm scale, α = .74 for the perceived behavioral control scale and α = .79 for the intention to report scale. The TRQ-SA achieved good internal consistency for all its TPB scales. The TRQ-SA is a valid and reliable survey instrument which could be used "as is" or amended in similar settings and countries testing the TPB in their own contexts.

Organizational factors affecting nurses' tendency to report child abuse and neglect

OBJECTIVE

To examine the factors that affect the tendency of nurses working in mother and child health clinics (MCHC) to report child abuse to the authorities.

DESIGN

Cross-sectional survey.

SAMPLE

Three hundred and forty-one female nurses working in MCHC across Israel.

MEASUREMENTS

(1) Social and organizational variables; (2) the tendency to report child abuse and neglect; (3) attitudes toward reporting child abuse and neglect.

RESULTS

On average, the participants perceived that they have good collaboration with other staff members and with welfare services. They showed a favorable attitude toward reporting child abuse, but less than half (44.8%) would report child abuse suspicion to the authorities. None of the organizational variables (MCHC type, collaboration among staff, collaboration with welfare services) were correlated with the tendency to report child abuse and neglect, yet all three variables were significantly correlated with attitudes toward reporting child abuse. Nurses' attitudes toward reporting were mediated by the organizational variables.

CONCLUSIONS

The effect of the organizational factors on the actual tendency to report child abuse is mediated by nurses' attitude toward reporting. Organizational constraints probably encourage MCHC nurses to be cautious before reporting child abuse and neglect to the authorities, restricting adherence to the law, which requires direct reporting.

Understanding factors associated with barefoot social workers' decision making in assessing and reporting child physical abuse in China

BACKGROUND

Mandatory reporting is new in China, and barefoot social workers are responsible for detecting and reporting child maltreatment.

OBJECTIVE

Guided by the decision-making ecology, this study examined factors associated with barefoot social workers' decision making in assessing and reporting child physical abuse in China.

PARTICIPANTS AND SETTINGS

Cross-sectional data were collected from barefoot social workers (N = 1489) in a metropolitan city in Southern China.

METHODS

Descriptive, bivariate, and binary logistic regression analyses were conducted. Dependent variables were barefoot social workers' assessments of and intention to report child physical abuse in two cases.

RESULTS

For a less severe physical abuse case, case severity (OR = 2.78, p < .001), receiving a social worker license (OR = 1.64, p = .03), and having a reporting history (OR = 23.55, p = .03) were associated with higher odds of assessments, whereas being younger (OR = 0.97, p = .04) was associated with lower odds. For a more severe physical abuse case, case severity (OR = 3.64, p < .001) and child welfare training (OR = 2.27, p = .03) were associated with higher odds of assessments. Across two cases, case severity (Case 1: OR = 1.44, p < .001; Case 2: OR = 1.34, p < .001), assessment of whether it is abuse (Case 1: OR = 11.48, p < .001; Case 2: OR = 15.98, p < .001), impacts of reporting on the family (Case 1: OR = 1.21, p < .001; Case 2: OR = 1.25, p < .001), and perceived behavior control (Case 1: OR = 1.06, p = .01; Case 2: OR = 1.10, p = .01) were associated with higher odds of reporting. Impacts of reporting on the child (OR = 1.27, p < .001) were associated with higher odds of reporting the less severe case. Attitudes regarding punishment of offenders or victims of child abuse (OR = 1.09, p = .01) and subjective norms of reporting (OR = 1.09, p = .01) were associated with higher odds of reporting the more severe case.

CONCLUSIONS

This study identified factors associated with barefoot social workers' decision making in assessing and reporting child physical abuse in China. Results of this study indicate the importance of providing training to barefoot social workers on recognizing, detecting, and reporting child physical abuse. It is also important to encourage them to receive continued social work training and obtain a social work license, which may increase their confidence in decision making. Furthermore, increasing the effectiveness of mandatory reporting is needed.

Factors influencing intention to intervene in elder abuse among nursing students

Purpose

This study aimed to identify the factors influencing the intention to intervene in elder abuse among nursing students.

Methods

A descriptive survey design was used, and questionnaires were completed by 182 nursing students. Statistical analysis was performed on the data collected, using SPSS 25.0, χ²-test, t-test, correlation, and regression analysis to confirm predictors of intention to intervene in elder abuse.

Results

Awareness of abuse, legal and institutional knowledge, and attitude were positively correlated with the intention to intervene in elder abuse. Factors influencing the intention to intervene by nursing students were education courses about elder abuse, awareness of elder abuse, legal and institutional knowledge, and attitude.

Conclusion

The findings suggest that it is necessary to provide educational protocols for nursing students to improve their awareness and knowledge of elder abuse. Based on the findings of this study, there is a need for specific education programs and guidelines to increase the assessment of, and intervention in, elder abuse.

Factors Associated With the Intention to Participate in Coronavirus Disease 2019 Frontline Prevention Activities Among Nursing Students in Vietnam: An Application of the Theory of Planned Behavior

Introduction: Medical students have been serving as a key part of the frontline health workforce responding to the coronavirus disease 2019 (COVID-19) pandemic globally. Their contribution is especially important in the resource-scarce settings of developing nations such as Vietnam. Yet, the intention of medical students, in particular, nursing students, to participate in COVID-19 frontline prevention activities has not been well-understood. This study aimed to examine factors associated with the intentionto participate in COVID-19 frontline prevention activities among Vietnamese nursing students.

Methods: A cross-sectional study was conducted on a total of 597 students in December 2020 in Hanoi, Vietnam. Information regarding the socioeconomic characteristics of participants, their source of COVID-19 related knowledge, and their perception and attitude toward participating in COVID-19 frontline activities [based on Theory of Planned Behavior (TPB)] was collected. A hierarchical regression model was employed to examine the association between intentions of students and associated factors.

Results: A positive intention to participate in COVID-19 frontline prevention activities was found (mean score of 25.3 over 35; SD = 4.4; min = 5; max = 35). Attitude toward behavior, subjective norms, and perceived behavioral control (PBC) was found to be significantly associated with the intention of students. These variables explained the 37% variation in the intention of students in the model. Among three factors, subjective norm showed the strongest correlation with intention of students (β = 0.358; p < 0.001). Obtaining information from official sources and community was also found to be positively correlated with intention to participate.

Conclusion: Most of the respondents reported a positive intention to participate in COVID-19 frontline prevention activities. The findings suggested that the TPB was a good instrument to predict the intention to perform behavior among Vietnamese students. Enhancing the positive attitude of students, encouraging family and community supports, and providing adequately essential resources will contribute to optimizing the participation of students to confront COVID-19.

Using Dyadic Modeling in Nursing Research: Introduction of Theory and Application

Use of dyadic modeling in nursing has theoretical and practical importance, as the interpersonal processes related to health behaviors can be captured. Theoretical models focusing on dyadic coping with chronic illness and illness management are established in family nursing. However, few studies utilized dyadic designs in empirical research, as most studies are patient-centric or care partner-centric. With theoretical elaborations and examples, we first review how conventional health models have been extended using a dyadic perspective and then briefly review the major dyadic frameworks in nursing. Five frequently used dyadic models are described with examples from health and nursing research fields. Statistical applications and cultural considerations are reviewed. We conclude that dyadic modeling provides a useful lens for nursing research but continues to be underutilized.

Why Healthcare and Education Professionals Underreport Suspicions of Child Abuse: A Qualitative Study

Education and healthcare professionals are crucial in detecting and reporting child abuse and neglect. However, signs of child abuse are often undetected, and professionals tend to underreport their suspicions of abuse and neglect. This qualitative study aimed to examine experiences, attitudes, perspectives, and decision-making skills of healthcare and education professionals with regard to identifying and reporting child abuse and to gain insight into how detection and reporting can be improved. Semi-structured interviews were conducted with 49 Dutch professionals working in child health care, mental health care, primary schools, and secondary schools. The I-Change model was used as a theoretical framework to organize the results. Many professionals believe they miss child abuse signs in their daily work, partially due to a lack of focus on child abuse. Further, professionals indicated having insufficient knowledge of child abuse, and lack communication skills to detect or discuss signs indicative of child abuse in conversations with parents or children. As for risk assessment, professionals barely use structured instruments even though these are regarded as very helpful in the decision-making process. Finally, professionals experience deficits in the cooperation with child welfare organizations, and in particular with Child Protective Services (CPS). Various directions for improvement were discussed to overcome barriers in child abuse detection and reporting, including developing tools for detecting and assessing the risk of child abuse and improving communication and information transfer between organizations.

Hospital Climate and Peer Report Intention on Adverse Medical Events: Role of Attribution and Rewards

Adverse medical events (AMEs) often occur in the healthcare workplace, and studies have shown that a positive atmosphere can reduce their incidence by increasing peer report intention. However, few studies have investigated the effect and action mechanism therein. We aimed to extend upon these studies by probing into the relationship between hospital climate and peer report intention, along with the mediating effect of attribution tendency and moderating effects of rewards. For this purpose, a cross-sectional survey was administered in a hospital among health professionals. We collected 503 valid questionnaires from health professionals in China and verified the hypothesis after sorting the questionnaires. The results of empirical analysis show that a positive hospital climate significantly induces individual internal attribution tendency, which in turn exerts a positive effect on peer report intention. Contract reward also helps to increase peer report intention, especially for health professionals with an internal attribution tendency. The findings contribute to the literature regarding AME management in hospitals by providing empirical evidence of the necessity for hospital climate and contract reward, and by providing insights to improve their integrated application.

Factors Associated with Nursing Students’ Intention to Report Needlestick Injuries: Applying the Theory of Planned Behavior

Background: Nursing students, like other healthcare workers, are prone to needlestick injuries. Over the years, studies have been conducted regarding needlestick injuries. However, its prevalence among Filipino nursing students’ is still not known. Also, nursing students’ intention to report needlestick injuries in the Philippines has not been explored.Purpose: The purpose of this research was to determine the factors associated with the intention to report needlestick injuries among nursing students applying the Theory of Planned Behavior.Methods: This cross-sectional study used the Needlestick Injuries Reporting Intention Scale (NIRIS) and was distributed among 233 senior nursing students in Iloilo City, Philippines. Descriptive statistics and Pearson’s correlation were utilized to analyze the data.Results: The results of the study revealed that 15% of nursing students had experienced a needlestick injury. However, only less than half (45.71%) of those who sustained needlestick injury reported the incident. Nursing students exhibited a positive attitude (M=5.41; SD=0.63) toward reporting needlestick injuries. They perceived a high social pressure (M=4.65; SD=0.46), high behavioral control (M=4.19; SD=0.45), and high intention (M=8.99; SD=1.15) in reporting needlestick injuries. Attitude (p=0.000), subjective norm (p=0.000), and perceived behavioral control (p=0.000) were significantly correlated with the intention to report needlestick injuries.Conclusion: This study supports the Theory of Planned Behavior in identifying factors influencing nursing students’ intention to report needlestick injuries.

Nurses' intention to report child abuse in Saudi Arabia: A cross-sectional study

BACKGROUND

Child abuse is a prevalent problem with short and long-term consequences. While most countries have enacted child abuse reporting laws, the Saudi healthcare system has not paid sufficient attention to nurses' role in the reporting of child abuse.

OBJECTIVE

This study aimed to 1) identify the factors associated with nurses' intention to report child abuse by testing a hypothetical model; 2) examine the patterns underlying their intention to report child abuse; and 3) investigate the differences in reporting based on clinical practice areas.

PARTICIPANTS AND SETTING

A convenience sample of 248 nurses recruited from emergency and pediatric inpatient units and primary healthcare centers in Riyadh, Saudi Arabia was used.

METHODS

In this cross-sectional study, data were collected using the Child Abuse Report Intention Scale and another self-report measure in February 2019.

RESULTS

Most nurses had not reported even one case of child abuse during their clinical practice. Knowledge about child abuse (β = .210, P = 0.000), subjective norms (β = .218, P = 0.001), and organizational support in guideline implementation (β = .138 P = 0.038) were significantly associated with the intention to report child abuse. Nurses reported a stronger intention to report child sexual abuse than other types of abuse. Clinical practice areas were significantly associated with nurses' intention to report child abuse.

CONCLUSIONS

Nurses' professional preparation for child abuse reporting is inadequate. The findings underscore the importance of enhancing their knowledge about child abuse and reporting laws, promoting social support, and creating an empowering clinical environment.

Factors that Influence Chinese Parents' Intentions to Use Physical Violence to Discipline Their Preschool Children

This study explored factors affecting parents’ intentions to use physical violence (PV) to discipline their children in the future. The theory of planned behavior (TPB) guided selection of variables. A sample of 1337 preschool children’s parents from nine kindergartens located in a county of Henan Province, China were selected by stratified random cluster sampling. Data on parents’ attitudes, subjective norms, and perceived behavioral control over PV, intentions to engage in PV to discipline their preschool children in the future, self-reported PV behavior toward their children during the past three months, and demographic characteristics were collected via a paper-based questionnaire. Multivariable logistic regression analyses examined putative predictors of parents’ intentions to use physically violent discipline. Nearly three-quarters of the sample said they definitely will not use violent discipline, while 23.4% either said they would use it, or did not rule it out. Logistic regression analysis showed that parents’ lower level of perceived behavioral control over using violence (OR 4.17; 95% CI: 2.659, 6.551), attitudes that support PV (OR 2.23; 95% CI: 1.555, 3.203), and having been physically violent with their children during the past three months (OR 1.62; 95% CI: 1.032, 2.556) were significantly associated with parents’ tendency either to include, or not exclude, the use of violent discipline. Parents’ subjective norms regarding PV had no significant impact on their intentions (p > 0.05). The influence of TPB constructs varied according to parents’ gender. Intervention programs that aim to reduce violent discipline should focus both on increasing parents’ perceived behavioral control over PV and changing their attitudes toward physically violent practices, especially among mothers and parents who have already used PV to discipline their children.

Explaining the intention of dental health personnel to report suspected child maltreatment using a reasoned action approach

BACKGROUND

This study provides an empirical test of the reasoned action approach (RAA) socio-cognitive theory with the aim of 1) predicting the intention of public dental health personnel (PDHP) to report suspected child-maltreatment to child welfare services (CWS); 2) estimating the effects of the theoretical constructs of RAA, including experiential and instrumental attitudes, injunctive and descriptive norms, and perceived capacity and autonomy regarding PDHP's behavioural intentions; and 3) exploring whether the RAA operates equivalently (i.e., is invariant) in male and female providers.

METHODS

This national cross-sectional study was conducted in Norway. An electronic survey was distributed to 1542 dentists and dental hygienists working in the public dental health service. The survey included RAA items constructed in accordance with the recommendations for the RAA model. Structural equation modelling (SEM) was used to identify factors derived from the theory of RAA to predict PDHP reporting intentions.

RESULTS

A total of 77.8% (1200) of those surveyed responded to the survey. The present study provided support for the utility of the RAA across both male and female providers in predicting their intention to report suspected child-maltreatment to the CWS. The final modified SEM model revealed that instrumental attitudes and perceived behavioural control (based on merged capacity and autonomy parameters) were the strongest predictors of intention to report, followed by the reporting of descriptive norms, injunctive norms and experiential attitudes. These factors explained 63.6% of the observed variance in the reporting intention.

CONCLUSIONS

The large amount of explained variance suggests that RAA is a well-functioning theory that predicts PDHP's reporting intentions to CWS across gender, and gives an understanding of the socio-cognitive factors involved. To strengthen reporting intention among dental personnel, this study suggests educators should focus on the value and positive consequences of reporting, the resources available and how to overcome obstacles; attention to normative expectations and individuals' feelings about reporting may also be helpful.

Dentists' intention to report suspected violence: a cross-sectional study in eight Arab countries

OBJECTIVES

This study assessed dentists' intention in eight Arab countries to report suspected exposure to violence among patients and factors associated with this intention based on the theory of planned behaviour.

METHODS

A cross-sectional study was conducted in 2016 including a convenience sample of dentists practising in public, private and academic sectors in Algeria, Egypt, Jordan, Kuwait, Libya, Palestine, Saudi Arabia and Yemen. Respondents answered a self-administered questionnaire collecting information about personal and professional background and perceived ability to identify victims of violence. The questionnaire assessed (on a scale from 1 to 10 using six negative statements) dentists' perception of healthcare system mandated reporting of suspected violence. Six statements were used to assess professional attitude towards reporting suspected violence. Logistic regression was used to assess the association between intention to report suspected violence and perceived ability, perception and attitude adjusting for confounders.

RESULTS

The response rate was 65.2% (n=2936/4506) from general practitioners (70.9%) of mean age=31 years with 56.7% women. Of those, 68.8% intended to report and 52.2% considered themselves able to identify violence victims. The mean (SD) negative perception score=5.3/10 (2.1) and the mean (SD) professional attitude score=7.5/10 (1.9). In multivariate regression, intention to report was associated with professional attitude (OR 1.08, 95% CI 1.03 to 1.14), ability to identify violence victims (OR 1.76, 95% CI 1.45 to 2.12) and negative perception that reporting is not mandated (OR 0.89, 95% CI 0.85 to 0.94). Significant differences existed among countries in intention to report.

CONCLUSION

Most dentists intended to report suspected violence and their intention could be explained by the theory of planned behaviour which offers a framework for professional development to support violence victims. Sharing of training resources, policies and guidelines is needed to ensure that practices similar to international guidelines are consistently adopted by dentists across Arab countries.

Predictors of Intention of Reporting Child Abuse among Emergency Nurses

PURPOSE

The current study investigates predictors of intention of reporting child abuse among emergency nurses in Korea.

DESIGN AND METHODS

A descriptive cross-sectional design was used. Data were collected from 200 emergency nurses in eight general hospitals in Korea through a questionnaire that asked about their general characteristics, knowledge about child abuse, perceived behavioral control, experiences of child abuse cases and reporting, and attitude toward child abuse.

RESULTS

Multiple regression analysis indicated that attitude toward child abuse was the most influential predictor of the intention of reporting child abuse among Korea's emergency nurses. Knowledge about child abuse, and perceived behavioral control were also significant influencing predictors of reporting intention. These variables explained 22.1% of the variances in the intention of reporting child abuse among emergency nurses.

CONCLUSIONS

Reporting child abuse has not yet been established as a professional responsibility among Korea's emergency nurses. Increasing the level of awareness of the characteristics of child abuse and encouraging communication among nurses about the responsibility to report suspected child abuse will increase nurses' confidence to report.

PRACTICE IMPLICATIONS

Training for reporting child abuse should be implemented in the near future to improve emergency nurses' understanding of child abuse. A support program is also needed to help emergency nurses build confidence in reporting child abuse as a professional responsibility.

Building workforce capacity to detect and respond to child abuse and neglect cases: A training intervention for staff working in emergency settings in Vietnam

BACKGROUND

Too many children are brought to hospital emergency departments on numerous occasions before they are recognised as victims of child abuse and neglect. For this reason, improving knowledge and response behaviors of emergency staff at all levels is likely to have a significant impact on better outcomes.

AIM

An Australian based training programme was the first of its kind to address this issue in a Vietnamese Emergency Department. Titled 'Safe Children Vietnam', the programme aimed to improve knowledge, attitudes and reporting behaviors concerning child abuse in the emergency setting.

METHOD

A pre-post test design was used to evaluate the impact of 'Safe Children Vietnam' on emergency staff knowledge, attitudes and intentions to report child abuse and neglect.

RESULTS

Emergency staff including doctors, nurses and healthcare staff (n=116) participated in the clinical training programme. Linear Mixed Model analyses showed that on programme completion, they were more likely to recognise serious cases of all types of abuse.

CONCLUSION

The 'Safe Children Vietnam' programme was effective at improving emergency staff knowledge of child abuse and neglect. A systems wide approach may be necessary to impact on emergency staff attitudes towards reporting cases of abuse.

Precordial electrode placement accuracy by nurses in a large midwestern tertiary care hospital

A quality improvement project to increase the knowledge of nurses and the accuracy of electrocardiogram precordial lead placement among intensive care unit and progressive care unit staff was conducted using a single-group, pretest-posttest preexperimental design. Educational interventions based on the theory of planned behavior were developed from focus group data. A tip card, poster, and video were sequentially presented to more than 1,600 nurses. This resulted in statistically significant gains in both knowledge and accuracy (p < 0.02). This project supports the use of focus groups and the theory of planned behavior to guide education related to quality improvement.

Factors associated with acceptability of child circumcision in Botswana -- a cross sectional survey

Background

Safe male child circumcision has been recently adopted as a potential strategy to prevent HIV/AIDS transmission in later life in Botswana.

Methods

Data used was derived from a cross-sectional survey, the Botswana AIDS Impact Survey (BAIS) IV, conducted in 2013. A total sample of 7984 respondents in ages 15–64 years who had successfully completed the individual questionnaire during the survey were selected and included for analysis. Both descriptive and multivariable analyses were used to explore factors associated with acceptability of child circumcision. Data was analysed using SPSS version 22 program.

Results

Results indicate that about 84 % of participants said they would circumcise their male children aged 18 years and below, while 93 % were aware of the safe male circumcision program. Bivariate analyses results show that acceptability of child circumcision was significantly associated with sex, age, education, religion, residence, HIV status of the parent, fathers circumcision status, father's intention to circumcise and parent's knowledge about the safe male circumcision program. Multivariable analyses results indicate positive association between respondent's HIV positive status (OR, 3.5), Men's circumcision status (OR, 3.7), men's intention to circumcise (OR, 9.3) and acceptability of child circumcision.

Conclusion

Results of this study indicate some relatively high acceptability levels for child circumcision. Some individual behavioural factors influencing acceptability of child circumcision were also identified. This study provides a proper understanding of factors associated with acceptability of child circumcision which will ultimately enhance the successful roll-out of the school going children circumcision program in Botswana.

What factors increase Dutch child health care professionals' adherence to a national guideline on preventing child abuse and neglect?

Guidelines to support health care professionals in early detection of, and responses to, suspected Child Abuse and Neglect (CAN) have become increasingly widely available. Yet little is known about professionals' adherence to these guidelines or the determinants that affect their uptake. This study used a cross-sectional design to assess the adherence of Dutch Child Health Care (CHC) professionals to seven key activities described in a national guideline on preventing CAN. This study also examined the presence and strengths of determinants of guideline adherence. Online questionnaires were filled in between May and July 2013 by 164 CHC professionals. Adherence was defined as the extent to which professionals performed each of seven key activities when they suspected CAN. Thirty-three determinants were measured in relation to the guideline, the health professional, the organisational context and the socio-political context. Bivariate and multivariate regression analyses tested associations between determinants and guideline adherence. Most of the responding CHC professionals were aware of the guideline and its content (83.7%). Self-reported rates of full adherence varied between 19.5% and 42.7%. Stronger habit to use the guideline was the only determinant associated with higher adherence rates in the multivariate analysis. Understanding guideline adherence and associated determinants is essential for developing implementation strategies that can stimulate adherence. Although CHC professionals in this sample were aware of the guideline, they did not always adhere to its key recommended activities. To increase adherence, tailored interventions should primarily focus on enhancing habit strength.

The decision of out-of-home placement in residential care after parental neglect: Empirically testing a psychosocial model

Out-of-home placement decisions in residential care are complex, ambiguous and full of uncertainty, especially in cases of parental neglect. Literature on this topic is so far unable to understand and demonstrate the source of errors involved in those decisions and still fails to focus on professional's decision making process. Therefore, this work intends to test a socio-psychological model of decision-making that is a more integrated, dualistic and ecological version of the Theory of Planned Behavior's model. It describes the process through which the decision maker takes into account personal, contextual and social factors of the Decision-Making Ecology in the definition of his/her decision threshold. One hundred and ninety-five professionals from different Children and Youth Protection Units, throughout the Portuguese territory, participated in this online study. After reading a vignette of a (psychological and physical) neglect case toward a one-year-old child, participants were presented with a group of questions that measured worker's assessment of risk, intention, attitude, subjective norm, behavior control and beliefs toward residential care placement decision, as well as worker's behavior experience, emotions and family/child-related-values involved in that decision. A set of structural equation modeling analyses have proven the good fit of the proposed model. The intention to propose a residential care placement decision was determined by cognitive, social, affective, value-laden and experience variables and the perceived risk. Altogether our model explained 61% of professional's decision toward a parental neglect case. The theoretical and practical implications of these results are discussed, namely the importance of raising awareness about the existence of these biased psychosocial determinants.

A qualitative exploration of factors that facilitate and impede adherence to child abuse prevention guidelines in Dutch preventive child health care

RATIONALE, AIMS AND OBJECTIVES

In the Netherlands, evidence-based child abuse prevention (CAP) guidelines have been developed to support child health care professionals (CHPs) in recognizing and responding to suspected child abuse. The aim of this study was to identify factors related to characteristics of the guidelines, the user, the organization and the socio-political context that facilitate or impede adherence to the CAP guidelines.

METHODS

Three semi-structured focus groups including 14 CHPs working in one large Dutch child health care organization were conducted in January and February 2012. Participants were asked questions about the dissemination of the guidelines, adherence to their key recommendations and factors that impeded or facilitated desired working practices. The interviews were audiotaped and transcribed. Impeding and facilitating factors were identified and classified. An innovation framework was used to guide the research.

RESULTS

CHPs mentioned 24 factors that facilitated or impeded adherence to the CAP guidelines. Most of these factors were related to characteristics of the user. Familiarity with the content of the guidelines, a supportive working environment and good inter-agency cooperation were identified as facilitating factors. Impeding factors included lack of willingness of caregivers to cooperate, low self-efficacy and poor inter-agency cooperation.

CONCLUSIONS

The results indicate that a broad variety of factors may influence CHPs' (non-)adherence to the CAP guidelines. Efforts to improve implementation of the guidelines should focus on improving familiarity with their contents, enhancing self-efficacy, promoting intra-agency cooperation, supporting professionals in dealing with uncooperative parents and improving inter-agency cooperation. Recommendations for future research are provided.

Risk factors for child abuse: quantitative correlational design

The aim of this research study is to identify risk factors typical of different types of suspected child abuse reported at a hospital. The study was based on 114 cases of children for whom some type of abuse was reported. Physical abuse was the most frequently reported of all types of suspected child abuse. Most victims of sexual abuse were female and at least half the cases of neglect and physical abuse were attributed to parents. Most cases were identified in the emergency room by nurses. Children older than 10 were more susceptible to physical abuse and neglect.

Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions

BACKGROUND

Decision-makers in organizations providing continuing professional development (CPD) have identified the need for routine assessment of its impact on practice. We sought to develop a theory-based instrument for evaluating the impact of CPD activities on health professionals' clinical behavioral intentions.

METHODS AND FINDINGS

Our multipronged study had four phases. 1) We systematically reviewed the literature for instruments that used socio-cognitive theories to assess healthcare professionals' clinically-oriented behavioral intentions and/or behaviors; we extracted items relating to the theoretical constructs of an integrated model of healthcare professionals' behaviors and removed duplicates. 2) A committee of researchers and CPD decision-makers selected a pool of items relevant to CPD. 3) An international group of experts (n = 70) reached consensus on the most relevant items using electronic Delphi surveys. 4) We created a preliminary instrument with the items found most relevant and assessed its factorial validity, internal consistency and reliability (weighted kappa) over a two-week period among 138 physicians attending a CPD activity. Out of 72 potentially relevant instruments, 47 were analyzed. Of the 1218 items extracted from these, 16% were discarded as improperly phrased and 70% discarded as duplicates. Mapping the remaining items onto the constructs of the integrated model of healthcare professionals' behaviors yielded a minimum of 18 and a maximum of 275 items per construct. The partnership committee retained 61 items covering all seven constructs. Two iterations of the Delphi process produced consensus on a provisional 40-item questionnaire. Exploratory factorial analysis following test-retest resulted in a 12-item questionnaire. Cronbach's coefficients for the constructs varied from 0.77 to 0.85.

CONCLUSION

A 12-item theory-based instrument for assessing the impact of CPD activities on health professionals' clinical behavioral intentions showed adequate validity and reliability. Further studies could assess its responsiveness to behavior change following CPD activities and its capacity to predict health professionals' clinical performance.

How do public child healthcare professionals and primary school teachers identify and handle child abuse cases? A qualitative study

Background

Public child healthcare doctors and nurses, and primary school teachers play a pivotal role in the detection and reporting of child abuse, because they encounter almost all children in the population during their daily work. However, they report relatively few cases of suspected child abuse to child protective agencies. The aim of this qualitative study was to investigate Dutch frontline workers’ child abuse detection and reporting behaviors.

Methods

Focus group interviews were held among 16 primary school teachers and 17 public health nurses and physicians. The interviews were audio recorded, transcribed, and thematically analyzed according to factors of the Integrated Change model, such as knowledge, attitude, self-efficacy, skills, social influences and barriers influencing detection and reporting of child abuse.

Results

Findings showed that although both groups of professionals are aware of child abuse signs and risks, they are also lacking specific knowledge. The most salient differences between the two professional groups are related to attitude and (communication) skills.

Conclusion

The results suggest that frontline workers are in need of supportive tools in the child abuse detection and reporting process. On the basis of our findings, directions for improvement of child abuse detection and reporting are discussed.

Pharmacy students' attitudes toward reporting serious adverse drug events

OBJECTIVES

To determine pharmacy students' attitude toward and knowledge of reporting serious adverse drug events (ADEs) to the Food and Drug Administration (FDA).

METHOD

A 58-item survey questionnaire constructed to measure respondents' intention to report ADEs (3 items), attitude toward reporting ADEs (20 items), knowledge of ADE reporting (9 items), and demographic data was administered to all third-year (final-year) pharmacy students at the Appalachian College of Pharmacy.

RESULTS

The majority of the 58 students who responded (91% response rate) intended (84%) and planned (85.3%) to report serious ADEs when they encounter them. Most respondents had favorable attitudes toward reporting serious ADEs to the FDA; respondents believed that reporting serious ADEs was valuable (5.6 ± 1.5, mean ± SD), good (3.0 ± 1.7), and beneficial (5.7 ± 1.5). Many students also believed that ADE reporting resulted in increased risk of malpractice, compromised relationships with physicians, broken trust with patients, disruption of the normal workflow, and was time consuming. Many students had inadequate knowledge on reporting ADEs.

CONCLUSION

Although pharmacy students had strong intentions and favorable attitudes toward ADE reporting, they had inadequate knowledge of how to report serious ADEs.

Effect of social influences on pharmacists' intention to report adverse drug events

OBJECTIVES

To identify the groups or individuals that influence pharmacists' decision making to report adverse drug events (ADEs), determine the differences in social influence or subjective norm between intenders and nonintenders, and determine the relationship between subjective norm toward reporting serious ADEs and practice and demographic characteristics.

DESIGN

Nonexperimental cross-sectional study.

SETTING

Texas during June and July 2009.

PARTICIPANTS

1,500 Texas pharmacists.

INTERVENTION

As part of a larger survey, 3 and 18 items were used to assess pharmacists' intentions and subjective norm, respectively, to report serious ADEs to the Food and Drug Administration (FDA).

MAIN OUTCOME MEASURE

Pharmacists' subjective norm toward reporting serious ADEs.

RESULTS

The survey had a response rate of 26.4% (n = 377). Most pharmacists intended to report serious ADEs that they would encounter (15.87 ± 4.22 [mean ± SD], possible range 3-21, neutral = 12). The mean subjective norm scores were moderately high and positive (28.75 ± 9.38, 1-49, 16), indicating that the referents had a moderate influence on pharmacists regarding reporting serious ADEs to FDA. FDA had the greatest (34.82 ± 12.16) and drug manufacturers the lowest (21.55 ± 13.83) social influence. The most important salient referents (important others) in pharmacists' decisions to report serious ADEs were FDA, patients, pharmacy associations, pharmacy managers/bosses, and hospitals and hospital groups. Gender (female equals higher), pharmacists' years of experience (negative correlation), and knowledge of ADE reporting (positive correlation) were associated with subjective norm.

CONCLUSION

Pharmacists had a moderately high subjective norm, suggesting that ADE reporting intentions is influenced by others and that the opinions of others are of great importance in pharmacists' intentions regarding ADE reporting. The main drivers of subjective norm were FDA, patients, pharmacy associations, and managers/bosses.

Factors affecting medical and nursing staff reporting of child abuse

AIM

The purpose of the current research was to examine whether the theory of planned behaviour (TPB) succeeds in predicting nursing and medical staff reporting of suspected child abuse.

BACKGROUND

Despite the rising incidence of child abuse in Israel, medical and nursing staff reports of suspected child abuse remain low.

METHODS

This descriptive, correlational, cross-sectional study was based on TPB. The Child Abuse Report Intention Scale questionnaire was administered to 143 nurses and 42 doctors who work with children in various departments of a central Israeli hospital and in a large affiliated community-based clinic. Descriptive, correlational and linear regression statistics were calculated.

RESULTS

Objection to child abuse, views of professional responsibility on this issue, degree of self-control and subjective beliefs, affect reporting of suspected child abuse. Differences in reporting are evident between doctors and nurses and also between medical and nursing staff from the Arab and Jewish sectors. Doctors report more than nurses and Jewish staff members report more than their Arab colleagues. Medical and nursing staff's number of own children has a direct effect on their inclination to report child abuse.

CONCLUSIONS

The TPB model succeeds in partly predicting medical and nursing staff reporting of suspected child abuse. This model can serve as a basis for intervention plans aimed at developing medical and nursing simulations of coping with conflict issues involving child abuse in an attempt to eradicate and treat inadequate reporting.

Influence of attitudes on pharmacists' intention to report serious adverse drug events to the Food and Drug Administration

AIM

To investigate the influence of pharmacists' attitudes on intention to report serious adverse drug events (ADEs) to the Food and Drug Administration (FDA).

METHODS

This cross-sectional study used a mail survey to collect data from hospital and community pharmacists practicing in Texas, United States. Three and 16 items were used to measure intention and attitudes, respectively, using a seven-point bipolar scale. Pharmacists' demographic and practice characteristics, and past reporting were also measured.

RESULTS

The response rate was 26.4% (n= 377/1500 pharmacists). Most pharmacists intended (n= 297, 78.8%) to report serious ADEs that they will encounter to the FDA through MedWatch. Overall, pharmacists held favourable attitudes towards reporting serious ADEs (mean = 24.5, SD = 6.7, possible range 1-49, neutral = 16). Pharmacists intending to report serious ADEs had more favourable attitudes than those who did not (P < 0.001). About 90% of the pharmacists believed that reporting serious ADEs would improve patient safety. However, 72.6% indicated that reporting serious ADEs was time consuming and over half (55.5%) of the respondents believed that reporting serious ADEs disrupted the normal workflow. Non-intenders held stronger beliefs that ADE reporting would disrupt the normal workflow and was time consuming compared with intenders. Years of experience, number of hours worked and practice setting were associated with pharmacists' attitudes towards reporting (P < 0.05).

CONCLUSIONS

Most pharmacists held moderately favourable attitudes and high intentions toward reporting serious ADEs to the FDA. This study's findings contribute to an increased understanding of individual factors that influence pharmacists' attitude and intention towards reporting serious ADEs to the FDA.

Understanding adolescent peer sexual harassment and abuse: using the theory of planned behavior

This study examines intentions to take protective action against peer sexual harassment and abuse (PSHA). The theory of planned behavior (TPB) proposes that attitudes about protective action, perceptions of what others would think about doing this (subjective norms), and behavioral control would be important predictors. A total of 1,531 Chinese secondary school students (769 boys and 762 girls) from Hong Kong were surveyed to test this model. Results showed that the TPB model was predictive for girls, but only subjective norms and behavioral control significantly predicted boys' intentions to protect themselves. Results supported the influence of subjective norms and perceived behavioral control on youths' intentions to reject PSHA. These factors may be useful in guiding the development of an educational program for prevention of PSHA.

[Factors associated with cancer screening intention in eligible persons for national cancer screening program]

OBJECTIVES

To identify factors associated with cancer screening intention using the Theory of Planned Behavior (TPB).

METHODS

Among 55,920 eligible persons for National Cancer Screening Program (NCSP) in J city, 1,100 individuals were contacted. Of these, 797 were interviewed using a structured questionnaire. Thirty-six responses were excluded due to incomplete data. The remaining 761 completed questionnaires were analyzed to find factors associated with cancer screening intention.

RESULTS

Cancer screening intention was significantly associated with behavioral attitude (p<0.01) and subjective norm (p<0.01), but not with perceived behavioral control (p=0.29) in the TPB model. These three constructs explained 29.7% of cancer screening intention in multiple linear regression analysis. External factors such as socio-demographic status, health and health behavior variables explained 8.9% of screening intention. Among them, household monthly income, past cancer screening experience, exercise and daily eating habit were significantly associated with screening intention.

CONCLUSIONS

Cancer screening intention may be influenced by focusing attitude, subjective norm in TPB model and other external factors. However, further studies are warranted to identify factors influencing cancer screening intention and behavior.

Kindergarten teachers' experience with reporting child abuse in Taiwan

OBJECTIVE

The objectives were to examine factors associated with reporting child abuse among kindergarten teachers in Taiwan based on the Theory of Planned Behavior (TPB).

METHOD

A stratified quota sampling technique was used to randomly select kindergarten teachers in Taiwan. The Child Abuse Intention Report Scale, which includes demographics, attitudes about child discipline, punishment for perpetrators, and professional responsibility for reporting, subjective norms regarding support for reporting from the general and specific important persons, perceived behavioral control, and vignettes of child abuse, was used to collect data. A total of 598 kindergarten teachers (return rate 47%) provided data.

RESULTS

While 97% of teachers reported having no experience with reporting a child abuse case, 11% indicated they had failed to report a suspected case of child abuse. Multiple regression revealed that, except for social norms, attitudes toward child discipline, punishments for perpetrators, and professional responsibility as well as perceived behavioral control explained 22.4% of variance of kindergarten teachers' intention to report child abuse.

CONCLUSIONS

With the exception of the subjective norms, the findings of this study supported the TPB that kindergarten teachers' intention to report child abuse is associated with attitudes toward child discipline, punishment for perpetrators, professional responsibility, and perceived behavioral controls over reporting. This study revealed the problem of underreporting child abuse among kindergarten teachers in Taiwan, and highlighted the discrepancy between child abuse training and expected reporting outcomes suggesting an insufficiency in the current training programs on child abuse.

PRACTICE IMPLICATIONS

There is a need to scrutinize the current training in child abuse and develop standardized training and clear reporting guidelines that will increase kindergarten teachers' confidence when confronted with suspected victims and perpetrators of child abuse in Taiwan.

Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories

BACKGROUND

There is an important gap between the implications of clinical research evidence and the routine clinical practice of healthcare professionals. Because individual decisions are often central to adoption of a clinical-related behaviour, more information about the cognitive mechanisms underlying behaviours is needed to improve behaviour change interventions targeting healthcare professionals. The aim of this study was to systematically review the published scientific literature about factors influencing health professionals' behaviours based on social cognitive theories. These theories refer to theories where individual cognitions/thoughts are viewed as processes intervening between observable stimuli and responses in real world situations.

METHODS

We searched psycINFO, MEDLINE, EMBASE, CIHNAL, Index to theses, PROQUEST dissertations and theses and Current Contents for articles published in English only. We included studies that aimed to predict healthcare professionals' intentions and behaviours with a clear specification of relying on a social cognitive theory. Information on percent of explained variance (R(2)) was used to compute the overall frequency-weighted mean R(2) to evaluate the efficacy of prediction in several contexts and according to different methodological aspects. The cognitive factors most consistently associated with prediction of healthcare professionals' intention and behaviours were documented.

RESULTS

Seventy eight studies met the inclusion criteria. Among these studies, 72 provided information on the determinants of intention and 16 prospective studies provided information on the determinants of behaviour. The theory most often used as reference was the Theory of Reasoned Action (TRA) or its extension the Theory of Planned Behaviour (TPB). An overall frequency-weighted mean R(2) of 0.31 was observed for the prediction of behaviour; 0.59 for the prediction of intention. A number of moderators influenced the efficacy of prediction; frequency-weighted mean R(2) varied from 0.001 to 0.58 for behaviour and 0.19 to 0.81 for intention.

CONCLUSION

Our results suggest that the TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention. In addition, given the variations in efficacy of prediction, special care should be given to methodological issues, especially to better define the context of behaviour performance.

Promoting evidence-based childhood fever management through a peer education programme based on the theory of planned behaviour

AIMS AND OBJECTIVES

This study examined effectiveness of a theoretically based education programme in reducing inappropriate antipyretic use in fever management.

BACKGROUND

Paediatric nurses' inconsistent, ritualistic antipyretic use in fever management is influenced by many factors including inconsistent beliefs and parental requests. Determinants of antipyretic administration, identified by the theory of planned behaviour, were belief-based attitudes and subjective norms.

DESIGN

A quasi-experiment explored group effects of a peer education programme, based on the theory of planned behaviour, on factors influencing paediatric nurses' antipyretic administration. Surveys and chart audits collected data from medical wards at experimental and control hospitals one month pre and one and four months postpeer education programme.

METHODS

All nurses employed in targeted wards were eligible to participate in surveys and all eligible charts were audited. The peer education programme consisted of four one-hour sessions targeting evidence-based knowledge, myths and misconceptions, normative, attitudinal and control influences over and rehearsal of evidence-based fever management. All nurses in experimental hospital targeted wards were eligible to attend. Peer education and support facilitated session information reaching those unable to attend sessions.

RESULTS

Two-way univariate anovas explored between subject, experimental and control group and within subject factors, pre, post and latency data. Significant interactions in normative influence (p = 0.01) and intentions (p = 0.01), a significant main group effect in control influence (p = 0.01) and a significant main effect between audit data across time points (p = 0.03) highlight peer education programme effectiveness in behaviour change. Normative, control and intention changes postpeer education programme were maintained in latency data; mean temperature was not.

CONCLUSION

The peer education programme, based on a behaviour change theory, initiated and maintained evidence-based intentions for antipyretics use in fever management.

RELEVANCE TO CLINICAL PRACTICE

The promotion of evidence-based change in organizational unit intentions and behaviour highlights the crucial role peer support and education can play in continuing educational programmes.