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Child Abuse & Neglect 146 (2023) 106489
Available online 5 October 2023
0145-2134/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Invited review
Effectiveness of child sexual abuse prevention programs on
knowledge acquisition: A meta-analytical study
Marta Ferragut
a
,
*
, M. Victoria Cerezo
a
, Margarita Ortiz-Tallo
b
,
Raquel Rodríguez-Fernandez
c
a
Department of Psychobiology and Methodology of Behavioral Sciences, Psychology and Speech Therapy Faculty, University of Malaga, Spain
b
Asociacion Con, Ciencia, Escuela de Psicoterapia y Creatividad, Malaga, Spain
c
Department of Methodology of Behavioral Sciences, Psychology Faculty, Distance Learning National University (UNED), Spain
ARTICLE INFO
Keywords:
Prevention programs
Effectiveness
Child sexual abuse
meta-analysis
Abuse and trauma
ABSTRACT
Background: Child sexual abuse (CSA) is a type of maltreatment considered a global health
problem. CSA is a traumatic experience with important consequences for the victim’s health. It is
essential to report the effectiveness of CSA prevention programs to offer society useful tools to
combat this abuse.
Objective: We aimed to study the effectiveness of CSA prevention programs on the knowledge
acquisition based on comparing pre- and post-treatment changes, and also if their effectiveness is
related to program-related and methodological variables.
Participants and settings: Standardised mean change (with studies that report pre-post program
measures) of the effectiveness of CSA prevention programs published between 2014 and 2021
was carried out.
Methods: The general effectiveness of these programs and whether the results were inuenced by
program-related variables (the duration, the target population, participants’ age, or the type of
intervention) or by methodology-related factors (the agent who taught them, the geographical
area where they were carried out or the way the programs were evaluated) were analysed. A total
of 43 samples analysing knowledge about CSA as a dependent variable were included.
Results: The results reported a combined effect size considered large (d
MR
= − 0.96, 95 % CI
[−1.10, −0.82], p <.001). High inter-study heterogeneity was observed in the meta-analysis,
although only the geographic area where the studies were conducted appears as a signicant
moderator.
Conclusions: In conclusion, the prevention programs included in this analysis signicantly
improved the participants’ knowledge acquisition.
* Corresponding author at: Department of Psychobiology and Methodology of Behavioral Sciences, Psychology and Speech Therapy Faculty,
University of Malaga, C/ Doctor Ortiz Ramos, 12, Ampliacion de Teatinos, 29010 Malaga, Spain.
E-mail address: mferragut@uma.es (M. Ferragut).
Contents lists available at ScienceDirect
Child Abuse & Neglect
journal homepage: www.elsevier.com/locate/chiabuneg
https://doi.org/10.1016/j.chiabu.2023.106489
Received 26 May 2023; Received in revised form 24 September 2023; Accepted 27 September 2023
Child Abuse & Neglect 146 (2023) 106489
2
1. Introduction
1.1. Child sexual abuse
Child sexual abuse (CSA) is a type of maltreatment that involves the participation of a minor in sexual activity that they cannot
understand, for which they are not prepared, and in which they are not in a position to give their consent (World Health Organization
(WHO), 2017). Abuse may or may not include physical contact, with abuse through electronic means becoming increasingly frequent,
especially in new generations (Ferragut et al., 2021a; Finkelhor et al., 2022). There are key aspects to be considered when dening
CSA: a power dynamic, where the child is in a position of inequality; the exploitation of the child’s vulnerability to their detriment; and
the absence of consent (Mathews & Collin-V´
ezina, 2019). This abusive experience is considered a global health problem because it can
produce signicant consequences for the physical, psychological, social, and sexual health of the victims both during childhood and
their subsequent adult development (Guiney et al., 2022; Noll, 2021; Selengia et al., 2020).
The worldwide prevalence of CSA has been the subject of numerous studies, often yielding diverse results. Different studies nd
different prevalence rates depending on the method of data collection, the instruments applied, differences in denitions of CSA used
(whether they use behaviourally-specic questions), or the population included in the analysis (Barth et al., 2013; Mathews et al.,
2020; Pan et al., 2020; Pereda et al., 2009; Stoltenborgh et al., 2011). However, in general, it can be considered a widespread problem
in society, and the data are alarming (Mathews et al., 2023; Singh et al., 2014). The European Council estimates that 1 in 5 minors are
victims of CSA, and recent research in our country nds prevalences ranging between 2.8 % and 18.5 %, depending on the different
types of abusive experiences evaluated (Ferragut et al., 2021a), analysing the data retrospectively in a nationally representative
sample. Consistently, in prevalence studies, females report higher rates in almost all types of CSA (Barth et al., 2013; Ferragut et al.,
2021b; Guziak, 2020), although the most recent study conducted with the Spanish population has indicated that there are no sig-
nicant differences between males and females in terms of certain types of abuses, particularly those involving penetration (Ferragut
et al., 2021a).
As mentioned earlier, there are numerous and varied consequences of CSA on the victims and they affect the physical, psycho-
logical, sexual and social health of those who suffer this experience. CSA has been linked to signicant sequelae that affect children’s
development (Friedrich et al., 2001; Noll, 2021; Putnam, 2003) and their subsequent adult life (Easton et al., 2011; Guiney et al., 2022;
Hornor, 2010; Maniglio, 2009; Ortiz-Tallo & Calvo, 2020; Sarasua et al., 2013). Many victims of CSA subsequently experience dif-
culties in intimate relationships and often have to struggle to feel joy, as if they had no right to love and/or sex (Echeburúa-Odriozola,
2020). Although the specic impact of CSA may depend on variables such as the victim’s age when the abuse began, their relationship
with the perpetrator, and the frequency or duration of the abuse (Hornor, 2010), suffering this experience is associated with a high
lifetime risk of suicide (Dube et al., 2001; Sapp & Vandeven, 2005). The impact of these consequences intensies when the victim
delays disclosing their situation, as they may not be able to seek help promptly, increasing the risk of the situation becoming chronic
and resulting in long-lasting consequences.
In addition, it is a severe type of abuse that is difcult to detect (Save the Children, 2012), estimating that 85 % of cases remain
concealed from society and the authorities (Save the Children, 2017). It is worth noting that victims often face signicant barriers
when attempting to disclose such situations (Alaggia et al., 2017; Lemaigre et al., 2017).
The need to detect CSA early is evident through the analysis of its consequences. For this purpose, it is considered essential to
address knowledge about CSA, demolishing myths and providing tools and resources with real and updated information. The lack of
knowledge, together with misperceptions on the subject, can be an obstacle to engaging people in its prevention (Ferragut et al., 2020;
Rueda et al., 2021).
The victim’s shame, the pact of silence to which they are subjected, the lack of resources in society, and the closeness of the
perpetrators make this problem difcult to approach. It is necessary to emphasise prevention, providing effective tools to help detect
the abusive situation, the disclosure of those who suffer CSA, and the management and help of responsible adults.
1.2. CSA prevention programs
Numerous efforts have been made to develop CSA prevention programs, especially in school contexts, as schools have been
considered optimal places to work universally on prevention and education (Wurtele & Kenny, 2010). These programs often include
tools for minors, providing them with knowledge and skills to recognise and avoid potentially sexually abusive situations, as well as to
minimise harm by seeking appropriate help in case of abuse or attempted abuse (Walsh et al., 2018). In addition, some prevention
programs involve adults by offering strategies to respond quickly and effectively to potential disclosures so that they can protect
children from further abuse. In general, these programs aim to transfer the knowledge and skills learned by the child or adolescent in
the classroom to real-life situations (Gubbels et al., 2021; Walsh et al., 2018).
Most of the published prevention programs are conducted in school contexts and target minors. Studies have been published that
analyse the effectiveness of this type of program. A broad variety of programs and a multitude of evaluation measures are used. Some
meta-analyses and systematic reviews report an improvement in minors’ knowledge about sexual abuse, with interventions to detect
and disclose abuse proving effective (Del Campo & F´
avero, 2020; Gubbels et al., 2021; Walsh et al., 2018).
Prevention programs are designed to reduce the incidence of CSA experiences or, at the very least, to detect them early. The initial
step involves enhancing the knowledge of both children and adults to aid in the identication of CSA. The knowledge imparted in these
programs typically encompasses a range of topics, including understanding one’s own body (naming and identifying private parts),
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
3
setting personal boundaries, recognizing inappropriate touches, distinguishing between good and bad secrets, and identifying
manipulation techniques used by perpetrators, as well as identifying trusted adults with whom to communicate (Walsh et al., 2018).
These types of knowledge are often assessed using standardised and published instruments, such as the Children’s Knowledge of Abuse
Questionnaire (CKAQ) developed by Tutty (1995), the Child Sexual Abuse Myth Scale created by Collings (1997), or through ques-
tionnaires specically designed by program authors to evaluate the knowledge imparted by each program.
Recently, a meta-analysis of prevention programs for all forms of child maltreatment in the school context has analysed which
variables of these interventions may inuence their effectiveness (Gubbels et al., 2021). In particular, the duration of the program and
the number of sessions signicantly moderate the effect size of improving children’s knowledge. Programs with a longer duration and
more sessions report signicantly stronger effects on knowledge about CSA, indicating that knowledge gains can be achieved by
increasing the time spent learning about prevention and child maltreatment (Gubbels et al., 2021). At the same time, larger effect sizes
are found for programs with shorter sessions, arguing that programs in which content is divided into shorter segments allow the
children to pay attention to the entire session, leading to greater content retention (Davis & Gidycz, 2000). Finally, it has been shown
that participatory methodologies, which involve minors in the sessions and use recreational resources such as games, puppets, music or
videos may increase the effectiveness of these programs (Davis & Gidycz, 2000; Gubbels et al., 2021; Scholes et al., 2014).
Some previous studies have also evaluated the effectiveness of CSA prevention programs targeting parents and educators. A recent
systematic review (Rudolph et al., 2023) revealed that studies consistently reported positive outcomes for parents who participated in
prevention programs. These outcomes included improved behavioral intentions, response efcacy, capabilities, and self-efcacy,
although ndings on knowledge and parental attitudes towards sexual abuse were less consistent. Some studies have also
conrmed that adults who have adequate training can be highly effective as educators in transmitting knowledge and skills about
sexual abuse (Wurtele & Kenny, 2010).
When analysed together, school programs that actively involve participants’ parents show the largest effect sizes in preventing CSA
(Gubbels et al., 2021). Research suggests that preschoolers are more likely to learn skills when they are introduced by their parents and
they have the opportunity to repeatedly rehearse these skills through role-playing in different settings (Boyle & Lutzker, 2005;
Deblinger et al., 2001).
Although a number of meta-analyses on child sexual abuse interventions have been published in recent years, some have focused on
maltreatment (Cohen & Katz, 2021; Gubbels et al., 2021), others on online abuse (Patterson et al., 2022), and those that have directly
addressed child sexual abuse interventions have not focused on knowledge but on other processes such as self-compassion (Zhan et al.,
2021).
There are two recent meta-analysis that analyzes the effectiveness of CSA knowledge prevention programs. Walsh et al. (2018)
included studies up to 2015 (although only one study was analysed that year), of programs carried out only in a school context with
students in countries mainly of medium-high socioeconomic status, and >60 % of the programs were carried out in the United States.
The authors nd that children’s participation in activities of CSA prevention programs at school increases self-protection skills and
knowledge about CSA (Walsh et al., 2018). On the other hand, Lu et al. (2022) includes studies since 1986, but only three of them are
published from 2018, being the last studie published in 2020. This meta-analysis results informed that larger interventions (more than
three sessions) and those with older children (upper 8 years old) are more effective.
We highlight that during the last few years, a wide variety of interventions aimed at preventing CSA are being implemented, which
were not included in these meta-analysis. Therefore, it is crucial to continually providing scientic knowledge about the effectiveness
of these programs and their particularities (Lu et al., 2022; Walsh et al., 2018) with the more recent literature.
The scientic literature has highlighted the importance of reporting the effectiveness of CSA prevention programs (essential to
eradicate this type of abuse). Therefore, considering the growing number of scientic articles that analyse the programs, the scarcity of
data on their specicities and on programs that include prevention tools and strategies targeting the adults in charge of the minors, a
meta-analysis study was carried out on the effectiveness of CSA prevention programs that analyse the knowledge acquired and that
have published the effectiveness data before 2022. Specically, the objective of this paper is to answer the following questions:
- What is the overall effectiveness of the prevention programs on knowledge acquisition about CSA, based on comparing pre- and
post-treatment changes?
- Are the program knowledge outcomes related to their duration, and/or to other characteristics such as the participants’ age, the
target population, or the type of intervention; and/or to other methodological characteristics of the studies, such as the agent who
delivers them or the mode of evaluation of the programs?
2. Method
2.1. Search and selection of studies
This meta-analysis of the effectiveness of CSA prevention programs was carried out following the PRISMA guidelines (Page et al.,
2021) and the Cochrane Handbook for Systematic Reviews of Interventions (Higgins et al., 2022). For the literature search, the
following inclusion criteria were considered: 1) being a study that analysed the effectiveness of a CSA prevention program by
measuring knowledge of CSA in one or more samples of participants; 2) being published between January 2014 and December 2021; 3)
collecting quantitative data before and after implementing the prevention program; and 4) being written in English or Spanish.
Excluded were studies that: 1) evaluated another dependent variable other than knowledge; 2) even if they applied a prevention
program about knowledge of CSA, they did not report quantitative data on its effectiveness; 3) were not primary studies (i.e.,
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
4
systematic reviews or meta-analyses); 4) included measurements only after participation in the program (no pre-data).
We searched into the following databases to identify the studies: PsycInfo, Eric (both via EBSCO Host), Web of Science (via
Clarivate platform), and Scopus (via Scopus platform). The search equation was “prevention program” AND “child sexual abuse” AND
“knowledge” limited to the abstract sections, using the lters to narrow the years of publication to the results between January 2014
and December 2021. The owchart reects the results obtained in the search process (see Fig. 1). This search was done between March
and September 2022.
2.1.1. Titles and abstracts screening
Of the total documents extracted from the database search (n =348), after discarding duplicates and studies that did not include
prevention programs, programs that were not on CSA, and review studies or meta-analyses, 77 papers evaluating CSA prevention
programs were examined.
2.1.2. Full text screening
Of the 77 works examined, 19 were excluded due to one of the exclusion criteria. Finally, of the articles evaluated as eligible (n =
58), those that did not include data necessary to calculate the effect size (n =16), those written in a language other than English or
Spanish (n =3), those that did not analyse knowledge about sexual abuse separately (n =1), or those that included data repeated in
another previous article (n =1) were discarded.
2.1.3. Data extraction
A total of 31 pre-post studies were included in the meta-analysis (Bustamante et al., 2019; Czerwinski et al., 2018; Daigneault et al.,
Fig. 1. Search owchart.
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
5
2015; Dale et al., 2016; Edwards et al., 2020; G´
amez-Guadix et al., 2021; Gushwa et al., 2019; Hudson, 2018; Jin et al., 2017; Jones
et al., 2020; Kim & Kang, 2017; Mamani-Benito et al., 2020; Martin et al., 2020; Morris et al., 2017; Muller et al., 2014; Navaei et al.,
2018; Nickerson et al., 2018; Nickerson et al., 2019; Nurse, 2017; Orak & Okanli, 2021; Ozgun & Capri, 2021; Pulido et al., 2015;
Samson & Kulkarni, 2019; Tunc et al., 2018; Tutty et al., 2020; Urbann et al., 2020; Vi˜
nas et al., 2015; Warraitch et al., 2021; Weeks
et al., 2021; Wulanyani et al., 2019; Zhang et al., 2014). Seven out of the 31 studies include more than one treatment group. Every
treatment group was included as specic sample in the meta-analysis, resulting in a total of 43 samples analysed.
This meta-analysis included all the studies published in scientic journals between 2014 and 2021. The coding of countries was
carried out according to their geographical area, with 6 categories: Europe, North America, South America, Asia, Australia, and
Turkey; that is, 5 categories similar to the existing continents, except for Turkey, which has been considered separately due to its
belonging to two different continents. Specically, studies were found in 13 different countries on all the continents, with Europe being
the geographical area that provides the most samples in research. Most of the programs took place in the school context, in person, and
with a school-aged population. More than half were implemented by professionals, included a participatory methodology, and used an
evaluation instrument developed during the research (see Table 1).
Table 2 shows the summary data of all the included studies and their main coded characteristics: rst author, year of publication,
geographical area of the study, sample size, type of population, percentage of males, mean age of the sample, mean knowledge about
pre- and post-treatment CSA, and pretreatment standard deviation for meta-analysis of related groups.
3. Results
We used the standardised mean change index to analyse the effect size of the studies, comparing the means of pre-post-treatment
measures.
To perform a combined effect-size estimation of the 43 selected studies following a random-effects model, as taking into account
both intra- and inter-study variability makes it a more realistic model. We used the R Studio program and the metafor package to carry
Table 1
Characteristics of studies included in the meta-analysis of related samples (pre-post).
Characteristics N studies (Percentage) Mean
Methodological Sample size <200 33 (76.74) 65.19
>200 10 (23.26) 10,106.60
Type of instrument Author elaboration 25 (58.14)
Standardised 18 (41.86)
Program Number of sessions 4.07
Treatment duration (days) 17.29
Type of program Participatory 31 (72.09)
Non-participatory 1 (2.33)
Not explicit 11 (25.58)
Type of intervention Face-to-face 37 (86.05)
Web 4 (9.30)
Book 1 (2.32)
Not explicit 1 (2.32)
Program implementer Professionals 31 (72.09)
Teaching staff 9 (20.93)
Parents 1 (2.32)
Not explicit 2 (4.65)
Participants Mean age Minors 33 (76.74) 9.16
Adults 10 (23.26) 37.22
Context Academic 35 (81.39)
Religious 1 (2.33)
Social 6 (13.95)
Rural 1 (2.33)
Geographical area of the study Europe 12 (27.91)
Australia 3 (6.98)
North America 11 (25.58)
Asia 9 (20.93)
South America 3 (6.98)
Turkey 5 (11.63)
Extrinsic Year of the study 2014 2 (4.65)
2015 3 (6.98)
2016 1 (2.33)
2017 5 (11.63)
2018 10 (23.26)
2019 5 (11.63)
2020 10 (23.26)
2021 7 (16.28)
Publication Source Scientic journal 43 (100)
N total samples =43.
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
6
out these calculations. The combinated effect size obtained by the model is −0.96 (standard error =0.07), with a CI of [−1.10, −0.82],
indicating an effect size considered large and statistically different from zero. Fig. 2 presents the Forest Plot, showing the results of the
effect sizes and their CIs for each study, as well as the graphic representation of the weights assigned to each one.
As can be seen, one study presents a very broad CI, although it has a small assigned weight, which may be an atypical case that
could be inuencing the results. To analyse these possible inuences, the leave1out function of the metafor package was applied, which
allows for analysing the size of the combined effect and the inter-study variance if one of the primary studies is eliminated each time.
This analysis found no substantial variation by eliminating any of the primary studies, so we decided not to rule out any of them.
In general terms, the representativeness of the obtained combined effect relies heavily on the homogeneity of the effect sizes among
themselves. To investigate this, we conducted a heterogeneity analysis, which revealed signicant differences in the effect sizes among
the studies. This became evident as the Q coefcient reached high and statistically signicant values (Q(42) =536.2089; p <.0001).
Furthermore, the I
2
statistic has a value above 94 %, which is considered very high [69], so it can be assumed that the effect sizes of the
included studies are heterogeneous.
The values obtained in the Q and I
2
statistics of the random effects model indicate a high heterogeneity of the effect sizes of the
studies, so we must examine what moderating variables could be the cause of this heterogeneity. For this purpose, each moderating
variable was analysed by applying regression models (meta-regression). As shown in Table 3, most of the combined effect sizes of each
category were signicant (except for the South America category of the Geographic Area variable), showing the effectiveness of the
programs in the studies included in all these categories. However, when comparing the differences between these effect sizes, only the
geographical area showed statistically signicant results to explain the variability of the effect size between categories (QM =16.14, p
<.05). However, after including this variable as a moderator in the model, there was still unexplained variance in the effect sizes (QE
=489.31, p <.0001). The inclusion of the geographical area as moderator was conrmed through a likelihood ratio test, conrming
Table 2
Coding of the studies included in the meta-analysis of related groups (pre-post).
Id Authors Publcation year Area N Population type % Females Mean age Pre-mean Post-mean Pre-SD
1 Muller 2014 Europe 137 Minors 47.40 9.08 0.63 0.79 0.16
2 Zhang 2014 Asia 78 Minors 50.00 4.17 2.04 3.50 0.95
3 Daigneault 2015 North America 372 Minors 56.00 16 8.23 8.99 1.29
4 Pulido 2015 North America 195 Minors 55.40 8.26 13.29 15.14 3.84
5 Vi˜
nas 2015 South America 86 Minors 45.00 6 11.53 12.94 1.55
6 Dale 2016 Australia 131 Minors 49.62 6.14 11.19 13.12 2.27
7 Jin 2017 Asia 159 Minors 52.20 7.91 6.69 9.24 2.36
8 Jin 2017 Asia 170 Minors 58.80 7.77 6.56 8.36 2.36
9 Kim 2017 Asia 39 Minors 43.60 10.56 7.59 7.97 1.25
10 Morris 2017 North America 695 Minors 51.32 9 0.56 0.83 0.2
11 Nurse 2017 North America 538 Adults 61.70 39 54.87 59.79 5.65
12 Czerwinski 2018 Europe 151 Minors 44.40 8.65 39 46.01 8.76
13 Czerwinski 2018 Europe 60 Minors 58.30 8.6 38.5 46.57 9.09
14 Hudson 2018 Europe 53 Adults 81.20 – 9.2 13 2.5
15 Hudson 2018 Europe 14 Adults 92.90 – 7.8 12.8 3.1
16 Hudson 2018 Europe 16 Adults 92.90 – 9.01 12.8 3.8
17 Hudson 2018 Europe 92 Adults 68.50 – 9.3 12.6 4.8
18 Hudson 2018 Europe 77 Adults 87.70 – 9.25 13 4.9
19 Navaei 2018 Asia 31 Adults 96.75 37.7 7.3 9.3 1.4
20 Nickerson 2018 North America 226 Adults 88.50 39.01 68.51 68.84 6.65
21 Tunc 2018 Turkey 40 Minors 42.50 4.75 5.9 20.2 6.14
22 Bustamante 2019 South America 407 Minors 53.56 9.2 60.97 68.67 14.27
23 Gushwa 2019 North America 61 Adults 97.00 34.5 71.41 89.66 20.98
24 Nickerson 2019 North America 1151 Minors 49.00 7.19 17.26 18.89 3.14
25 Samson 2019 Asia 100 Minors – 12.5 12.91 19.33 4.81
26 Wulanyani 2019 Asia 37 Minors – – 18.52 43.52 12.48
27 Edwards 2020 North America 48 Minors 62.50 10 0.72 0.78 0.12
28 Jones 2020 Australia 45 Minors 53.12 9.7 14.02 15.22 0.3
29 Jones 2020 Australia 48 Minors 53.12 9.7 13.54 15.08 0.33
30 Mamani-Benito 2020 South America 28 Minors 42.90 10.18 22.89 28.32 9.93
31 Martin 2020 Asia 40 Adults – 35.9 22 29.47 3
32 Urbann 2020 Europe 63 Minors 45.65 9.66 4.79 5.93 1.59
33 Urbann 2020 Europe 63 Minors 45.65 9.66 3.24 5.02 1.16
34 Urbann 2020 Europe 63 Minors 45.65 9.66 6.3 9.64 3.22
35 Tutty 2020 North America 1114 Minors – 6.5 4.7 7.3 2.2
36 Tutty 2020 North America 5084 Minors – 10 6 8.3 2.5
37 Gamez-Guadix 2021 Europe 320 Minors 53.70 13.41 6.96 9.87 1.95
38 Orak 2021 Turkey 20 Minors – 9.65 6.55 7.75 1.32
39 Orak 2021 Turkey 23 Minors – 9.65 7.48 9.83 1.41
40 Orak 2021 Turkey 20 Minors – 9.65 7.35 9.55 1.42
41 Ozgun 2021 Turkey 29 Minors 34.48 8.32 18.96 35.86 5.4
42 Warraitch 2021 Asia 15 Minors 100.00 12.4 1.73 9.33 1.22
43 Weeks 2021 North America 1159 Minors 51.86 – 0.7 0.78 0.16
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7
Fig. 2. Forest plot.
Table 3
Moderator analysis for the effect size.
Moderator K ES SE Z P 95 % CI Tau
2
I
2
QE QM
Agent 39 Professionals −1.48 0.69 −2.17 <0.05 −2.83
−0.14
0.16 (SE =
0.05)
94.74
%
415.39
(p <
.0001)
0.69
(p =.71)
Teaching staff −0.92 0.15 −6.02 <0.0001 −1.21
−0.62
Instrument 42 Author
elaborated
−1.00 0.09 −10.84 <0.0001 −1.18
−0.82
0.15
(SE =0.04)
94.44
%
509.37
(p <
.0001)
0.63
(p =.43)
Standardised −0.89 0.11 −8.05 <0.0001 −1.11
−0.67
Geographical
Area
42 North America −0.71 0.12 −5.78 <0.0001 −0.95
−0.47
0.16
(SE =0.05)
94.97
%
489.31
(p <
.0001)
15.96
(p =
.007) South America −0.66 0.25 −2.62 <0.05 −1.15
−0.78
Asia −1.12 0.17 −6.53 <0.0001 −1.45
−0.78
Australia −1.73 0.36 −4.77 <0.0001 −2.44 −
1.02
Europe −1.02 0.14 −7.64 <0.0001 −1.29
−0.76
Turkey −1.64 0.30 −5.39 <0.0001 −2.23
−1.04
Sample type 42 Adults −0.91 0.16 −5.80 <0.0001 −1.21
−0.60
0.16 (SE =
0.05)
94.86
%
507.86
(p <
.0001)
0.17
(p =.68)
Minors −0.98 0.08 −11.88 <0.0001 −1.14
−0.82
Mean age 34 Intercept −0.97 0.08 −12.05 <0.0001 −1.13
−0.81
0.17 (SE =
0.05)
94.91
%
417.90
(p <
.0001)
0.44
(p =.51)
Age 0.01 0.01 0.66 0.51 −0.01 0.02
Nr of sessions 39 Intercept −0.99 0.08 −12.43 <0.0001 −1.15
−0.83
0.18 (SE =
0.05)
94.61
%
447.31
(p <
.0001)
0.29
(p =.59)
Nr of sessions −0.01 0.03 0.54 0.59 −0.04 0.07
Treatment
Duration
34 Intercept −1.02 0.09 −10.80 <0.0001 −1.78
−0.82
0.24
(SE =0.07)
96.41
%
439.53
(p <
.0001)
0.01
(p =.94)
Duration 0.01 0.01 0.07 0.94 −0.01 0.01
Note: k (sample size); ES (combined effect size); SE (standard error); z (statistic value); Tau
2
(residual inter-study variance); I
2
(percentage of vari-
ability due to heterogeneity); QE (residual variance test with its probability); QM (moderator test with its probability).
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
8
through ANOVA that the difference between the model that includes the moderator and the one that does not was signicant, F(2, 7) =
16.75, p =.005. The studies carried out in Australia showed the largest effect sizes, followed by Turkey, Asia, and Europe, with the
American continent presenting smaller effect sizes.
Finally, we analysed the possible publication biases of the study. Specically, the Egger test was performed to study the asymmetry
of the Funnel Plot. The results revealed publication bias (z = − 6.39, p <.0001), showing in Fig. 3 an asymmetry that supports this
suspicion of publication bias.
4. Discussion
CSA is a global problem affecting an alarming number of children and producing signicant health consequences. Prevention
programs seek to provide society with tools to detect and respond effectively to this abuse. The present study proposed to carry out a
meta-analysis on the effectiveness of the CSA prevention programs carried out between 2014 and 2021 that analysed the knowledge
acquired, published efcacy data, and compared pre-post-intervention measures. Specically, the objective of this work was to
determine the effectiveness of prevention programs on knowledge acquisition about CSA; whether the results of these programs are
related to their duration, characteristics such as the participants’ age, or the type of target population; whether the results of these
interventions are inuenced by methodology-related characteristics of the studies, such as where they were carried out, the agent
delivering them, or the mode of program evaluation; and nally, whether or not the efcacy data reported by the studies that analyse
intragroup changes (pre-post measures) are similar.
A total of 31 primary studies (with 43 different units of analysis or samples and a total of 13,669 participants) were analysed, which
included knowledge about CSA before and after the prevention program as a dependent variable and that had at least a group with pre-
and post-treatment measures. The results obtained a combined effect size considered large (d
MR
= − 0.96, 95 % CI [−1.10, −0.82], p <
.001), so it can be said that the CSA prevention programs included in this analysis signicantly improved participants’ knowledge after
the intervention. Therefore, it seems that carrying out eminently participatory prevention programs with more than three sessions,
focused to school-aged population and in school contexts can be an effective intervention for participants to increase their knowledge
about this type of abuse, in line with previous studies (Lu et al., 2022; Walsh et al., 2018).
However, the results of the Cochran Q statistic and the I
2
index show that the effect sizes analysed are heterogeneous, which led to
an examination of which moderating variables could be affecting this variability of the effect sizes. The geographical area where the
study was carried out is the only variable of those analysed that explains part of the variability between the effect sizes of the pre-
vention programs, although even taking this variable into account, there is still unexplained variance. Four of the six geographic areas
included nd effect sizes >1, with Australia and Turkey reporting the largest sizes, followed by Asia and Europe. The American (both
north and south) continent presents the lowest sizes. All of them achieve a signicant improvement in the post-measures of knowledge
compared to the baseline. On the other hand, when continuous variables are taken into account, such as participants’ average age,
number of sessions, and treatment duration; as well as the rest of the qualitative variables: the agent who imparts the progams, mode of
evaluation of the programs or instrument and type of sample, the moderator test was nonsignicant and there was still a signicantly
high amount of unexplained variance after including these variables. This heterogeneity in effect sizes showed that there may be
specic variables that statistically inuence the improvement of knowledge, although they do not seem to be included in this study.
To study and ensure the validity of the meta-analysis, we considered the sources of potential threats, such as study quality, ho-
mogeneity, and publication bias. Regarding the quality of the primary studies, we considered the reporting quality. Methodological
quality was specically taken into account by including pre-test measures of knowledge in the analysis. The studies presented in this
meta-analysis could include a heterogeneity problem, as the CSA prevention programs included many different variables to assess their
effectiveness. To overcome this heterogeneity, only studies that analysed knowledge as a dependent variable were included in the
analysis. The form of knowledge evaluation was also a variable in this analysis. Different standardised instruments were used and, in
addition, about half of the included studies used an author-elaborated instrument, which hindered the homogeneity of results.
Moreover, the tests performed found publication bias. The selective publication of studies based on their ndings poses a risk to the
validity of any meta-analysis.
This meta-analysis has some limitations that must be taken into account. A large number of studies had to be excluded for not
reporting sufcient data for analyses. Some variables could be having a moderating effect that could not be taken into account, as most
of the articles included little information about the programs carried out (for example, about 20 % of the studies included in the meta-
analysis did not report whether or not the programs used a participatory methodology). The different assessment instruments used
could also affect the results, but the high variability of the instruments, both standardised and developed for each study, hindered their
analysis. On the other hand, some concentrations of data in specic variables made it impossible to compare their categories. For
example, about 90 % of the included studies were conducted in a school setting, and >80 % of the interventions were face-to-face. No
differences between genders have been conducted in this meta-analysis due to the scarce data reported in the studies, without dis-
aggregated information in the articles regarding the disparities in knowledge acquisition between boys and girls. Finally, it’s worth
noting that our search strategy was limited to using simple terms in the abstract sections of scientic literature, excluding grey
literature. Therefore, it’s possible that some relevant research may not have been included.
To improve the quality of meta-analyses in the eld of CSA prevention programs, the studies analysing the effectiveness of these
programs should present exhaustive explanations and details of the characteristics of the interventions: how they were carried out,
under what conditions, what topics were included in the program or what application methodology was used. This could signicantly
help to codify the studies and analyse these variables as potential moderators. In addition, the use of standardised instruments that can
accurately assess research-dependent variables would provide consistency and homogeneity for future meta-analyses on efcacy.
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
9
Finally, it could be valuable for authors of future primary studies to consider and include disaggregated information in their articles
regarding the disparities in knowledge acquisition between boys and girls.
To conclude, we can state that the results of this work show that these prevention programs are helpful in improving the partic-
ipants’ knowledge. To evaluate the possible inuence of other variables and analyse in depth the variability in the effect sizes, it would
be interesting for future meta-analyses to analyse possible moderating variables such as the specic characteristics of the treatments.
The studies included herein analyse knowledge through questionnaires generally designed for this knowledge, so it may be inuencing
the high effect sizes. In addition, it is necessary, or even essential, to also report in the manuscript on the reliability and validity data of
the instruments developed to assess the variables studied. Therefore, it may be advisable to include other dependent variables, such as
behaviours or self-protection skills, to analyse in depth the effectiveness of these programs. In short, prevention programs report
sufcient effectiveness to continue working and directing efforts to provide resources to minors and their responsible adults, as well as
to society. Research is responsible for shedding light on this path by disseminating results, analysing possibilities for improvement, and
guiding towards a safer society for children.
Data availability
Data will be made available on request.
Acknowledgment
Funding for open access charge: Universidad de M´
alaga / CBUA.
References
1
Alaggia, R., Collin-V´
ezina, D., & Lateef, R. (2017). Facilitators and barriers to child sexual abuse (CSA) disclosures: A research update (2000–2016). Trauma, Violence
& Abuse, 21, 1–26. https://doi.org/10.1177/1524838017697312
Barth, J., Bermetz, L., Heim, E., Trelle, S., & Tonia, T. (2013). The current prevalence of child sexual abuse worldwide: A systematic review and meta-analysis.
International Journal of Public Health, 58, 469–483. https://doi.org/10.1007/s00038-012-0426-1
Boyle, C. L., & Lutzker, J. R. (2005). Teaching young children to discriminate abusive from nonabusive situations using multiple exemplars in a modied discrete trial
teaching format. Journal of Family Violence, 20, 55–69. https://doi.org/10.1007/s10896-005-3169-4
*Bustamante, G., Andrade, M. S., Mikesell, C., Cullen, C., Endara, P., Burneo, V., … Grunauer, M. (2019). “I have the right to feel safe”: Evaluation of a school-based
child sexual abuse prevention program in Ecuador. Child Abuse & Neglect, 91, 31–40. https://doi.org/10.1016/j.chiabu.2019.02.009
Cohen, N., & Katz, K. (2021). Sobre child maltreatment en general y dirigido a practitioners. Preventing child maltreatment: Key conclusions from a systematic
literature review of prevention programs for practitioners. Child Abuse & Neglect, 118, 105138. https://doi.org/10.1016/j.chiabu.2021.105138
Collings, S. J. (1997). Development, reliability and validity of the Child Sexual Abuse Myth Scale. Journal of Interpersonal Violence, 12, 665–674. https://doi.org/
10.1177/088626097012005004
Fig. 3. Funnel plot.
1
References with an asterisk (*) identify primary studies that have been meta-analyzed.
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
10
*Czerwinski, F., Finne, E., Alfes, J., & Kolip, P. (2018). Effectiveness of a school-based intervention to prevent child sexual abuse—Evaluation of the german IGEL
program. Child Abuse & Neglect, 86, 109–122. https://doi.org/10.1016/j.chiabu.2018.08.023
*Daigneault, I., H´
ebert, M., McDuff, P., Michaud, F., V´
ezina-Gagnon, P., Henry, A., & Porter-Vignola, ´
E. (2015). Effectiveness of a sexual assault awareness and
prevention workshop for youth: A 3-month follow-up pragmatic cluster randomization study. Canadian Journal of Human Sexuality, 24, 19–30. https://doi.org/
10.3138/cjhs.2626
*Dale, R., Shanley, D. C., Zimmer-Gembeck, M. J., Lines, K. M., Pickering, K., & White, C. (2016). Empowering and protecting children by enhancing knowledge, skills
and well-being: A randomized trial of Learn to BE SAFE with Emmy. Child Abuse & Neglect, 51, 368–378. https://doi.org/10.1016/j.chiabu.2015.07.016
Davis, M. K., & Gidycz, C. A. (2000). Child sexual abuse prevention programs: A meta-analysis. Journal of Clinical Child Psychology, 29(2), 257–265. https://doi.org/
10.1207/s15374424jccp2902_11
Deblinger, E., Stauffer, L. B., & Steer, R. A. (2001). Comparative efcacies of supportive and cognitive behavioral group therapies for young children who have been
sexually abused and their nonoffending mothers. Child Maltreatment, 6, 332–343. https://doi.org/10.1177/1077559501006004006
Del Campo, A., & F´
avero, M. (2020). Effectiveness of programs for the prevention of child sexual abuse: A comprehensive review of evaluation studies. European
Psychologist, 25, 1–15. https://doi.org/10.1027/1016-9040/a000379
Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted
suicide throughout the life span. JAMA, 286, 3089–3096. https://doi.org/10.1001/jama.286.24.3089
Easton, S. D., Coohey, C., O’Leary, P., Zhang, Y., & Hua, L. (2011). The effect of childhood sexual abuse on psychosexual functioning during adulthood. Journal of
Family Violence, 26, 41–50. https://doi.org/10.1007/s10896-010-9340-6
Echeburúa-Odriozola, E. (2020). Abusos sexuales en la infancia: ¿Por qu´
e se recuerdan o revelan a ˜
nos despu´
es? [Childhood sexual abuses: Why are remembered or
revealed years later?]. Revista Mexicana de Psicología, 37, 67–76.
*Edwards, K. M., Siller, L., Charge, L. L., Bordeaux, S., Charge, D. L., & Herringto, R. (2020). Efcacy of a sexual abuse prevention program with children on an Indian
reservation. Journal of Child Sexual Abuse, 29, 900–910. https://doi.org/10.1080/10538712.2020.1847229
Ferragut, M., Ortiz-Tallo, M., & Blanca, M. J. (2021a). Prevalence of child sexual abuse in Spain: A representative sample study. Journal of Interpersonal Violence, 1–20.
https://doi.org/10.1177/08862605211042804
Ferragut, M., Ortiz-Tallo, M., & Blanca, M. J. (2021b). Spanish women’s experiences of child sexual abuse. Psicothema, 33, 236–243. https://doi.org/10.7334/
psicothema2020.323
Ferragut, M., Rueda, P., Cerezo, M. V., & Ortiz-Tallo, M. (2020). What do we know about child sexual abuse? Myths and truths in Spain. Journal of Interpersonal
Violence, 37, 757–775. https://doi.org/10.1177/0886260520918579
Finkelhor, D., Turner, H., & Colburn, D. (2022). Prevalence of online sexual offenses against children in the US. JAMA Network Open, 5(10), Article e2234471. https://
doi.org/10.1001/jamanetworkopen.2022.34471
Friedrich, W., Fisher, J., & Dittner, C. (2001). Child sexual behavior inventory: Normative, psychiatric, and sexual abuse comparisons. Child Maltreatment, 6, 37–49.
https://doi.org/10.1177/1077559501006001004
*G´
amez-Guadix, M., Rom´
an, F. J., Mateos, E., & Santisteban, P. (2021). Creencias err´
oneas sobre el Abuso Sexual Online de Menores (“child grooming”) y evaluaci´
on
de un programa de prevenci´
on [Misconceptions about child grooming and evaluation of a prevention program]. Psicología Conductual, 29, 283–296. https://doi.
org/10.51668/bp.8321204s
Gubbels, J., Van der Put, C. E., Stams, G. J. J. M., & Assink, M. (2021). Efective components of school-based prevention programs for child abuse: A meta-analytic
review. Clinical Child and Family Psychology Review, 24, 553–578. https://doi.org/10.1007/s10567-021-00353-5
Guiney, H., Caspi, A., Ambler, A., Belsky, J., Kokaua, J., Broadbent, J., et al. (2022). Childhood sexual abuse and pervasive problems across multiple life domains:
Findings from a ve-decade study. Development and Psychopathology, 1–17. https://doi.org/10.1017/S0954579422001146. online.
*Gushwa, M., Bernier, J., & Robinson, D. (2019). Advancing child sexual abuse prevention in schools: An exploration of the effectiveness of the enough! Online
training program for K-12 teachers. Journal of Child Sexual Abuse, 28, 144–159. https://doi.org/10.1080/10538712.2018.1477000
Guziak, M. A. (2020). Child sexual abuse among Polish adult population: Prevalence and abuse characteristics (pp. 1–29). PsyArXiv. https://doi.org/10.31234/osf.io/
bpk7v. online.
Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2022). Cochrane handbook for systematic reviews of interventions version 6.3.
Cochrane. Available from www.training.cochrane.org/handbook.
Hornor, G. (2010). Child sexual abuse: Consequences and implications. Journal of Pediatric Health Care, 24, 358–364. https://doi.org/10.1016/j.pedhc.2009.07.003
*Hudson, K. (2018). Preventing child sexual abuse through education: The work of stop it now! Wales. Journal of Sexual Aggression, 24, 99–113. https://doi.org/
10.1080/13552600.2017.1383088
*Jin, Y., Chen, J., Jiang, Y., & Yu, B. (2017). Evaluation of a sexual abuse prevention education program for school-age children in China: A comparison of teachers
and parents as instructors. Health Education Research, 32, 364–373. https://doi.org/10.1093/her/cyx047
*Jones, C., Scholes, L., Rolfe, B., & Stieler-Hunt, C. (2020). A serious-game for child sexual abuse prevention: An evaluation of orbit. Child Abuse & Neglect, 107, 13.
https://doi.org/10.1016/j.chiabu.2020.104569
*Kim, S., & Kang, K. (2017). Effects of the child sexual abuse prevention education (C-SAPE) program on South Korean fth-grade students’ competence in terms of
knowledge and self-protective behaviors. Journal of School Nursing, 33, 123–132. https://doi.org/10.1177/1059840516664182
Lemaigre, C., Taylor, E., & Gittoes, C. (2017). Barriers and facilitators to disclosing sexual abuse in childhood and adolescence: A systematic review. Child Abuse &
Neglect, 70, 39–52. https://doi.org/10.1016/j.chiabu.2017.05.009
Lu, et al. (2022). School-based child sexual abuse interventions: A systematic review and meta-analysis. Research on Social Work Practice, 33, 390–412. https://doi.
org/10.1177/10497315221111393
*Mamani-Benito, O., Pinto Cahuapaza, J., Nú˜
nez Vargas, J., Quispe Cha˜
ni, F., Mamani-Ordo˜
no, S., & Vargas, R. (2020). Ecacia del programa educativo “Mi sol” para la
prevenci´
on del abuso sexual infantil en menores de edad de la ciudad de Juliaca, Perú [Effectiveness of the educational program “Mi sol” for the prevention of child sexual
abuse in minors in the city of Juliaca, Peru]. 10 pp. 130–141). Apuntes Universitarios [University Notes]. https://doi.org/10.17162/au.v10i2.4
Maniglio, R. (2009). The impact of child sexual abuse on health: A systematic review of reviews. Clinical Psychology Review, 29, 647–657. https://doi.org/10.1016/j.
cpr.2009.08.003
*Martin, J., Riazi, H., Firoozi, A., & Nasiri, M. (2020). A sex education program for teachers of preschool children: A quasi-experimental study in Iran. BMC Public
Health, 20, 692. https://doi.org/10.1186/s12889-020-08826-y
Mathews, B., & Collin-V´
ezina, D. (2019). Child sexual abuse: Toward a conceptual model and denition. Trauma, Violence & Abuse, 20, 131–148. https://doi.org/
10.1177/1524838017738726
Mathews, B., Pacella, R., Dunne, M., Simunovic, M., & Marston, C. (2020). Improving measurement of child abuse and neglect: A systematic review and analysis of
national prevalence studies. PLoS One, 15(1), Article e0227884. https://doi.org/10.1371/journal.pone.0227884
Mathews, B., Pacella, R., Scott, J. G., Finkelhor, D., Meinck, F., Higgins, D. J., … Dunne, M. P. (2023). The prevalence of child maltreatment in Australia: Findings
from a national survey. The Medical Journal of Australia, 218, 13–18. https://doi.org/10.5694/mja2.51873
*Morris, M. C., Kouros, C. D., Janecek, K., Freeman, R., Mielock, A., & Garber, J. (2017). Community-level moderators of a school-based childhood sexual assault
prevention program. Child Abuse & Neglect, 63, 295–306. https://doi.org/10.1016/j.chiabu.2016.10.005
*Muller, A. R., Roder, M., & Fingerle, M. (2014). Child sexual abuse prevention goes online: Introducing “cool and safe” and its effects. Computers & Education, 78,
60–65. https://doi.org/10.1016/j.compedu.2014.04.023
*Navaei, M., Akbari-Kamrani, M., Esmaelzadeh-Saeieh, S., Farid, M., & Tehranizadeh, M. (2018). Effect of group counseling on parents’ self-efcacy, knowledge,
attitude, and communication practice in preventing sexual abuse of children aged 2–6 years: A randomized controlled clinical trial. International Journal of
Community Based Nursing Midwifery, 6, 285–292.
*Nickerson, A. B., Livingston, J. A., & Kamper-DeMarco, K. (2018). Evaluation of second step child protection videos: A randomized controlled trial. Child Abuse &
Neglect, 76, 10–22. https://doi.org/10.1016/j.chiabu.2017.10.001
M. Ferragut et al.
Child Abuse & Neglect 146 (2023) 106489
11
*Nickerson, A. B., Tulledge, J., Manges, M., Kesselring, S., Parks, T., Livingston, J. A., & Dudley, M. (2019). Randomized controlled trial of the child protection unit:
Grade and gender as moderators of CSA prevention concepts in elementary students. Child Abuse & Neglect, 96, 12. https://doi.org/10.1016/j.
chiabu.2019.104101
Noll, J. (2021). Child sexual abuse as a unique risk factor for the development of psychopathology: The compounded convergence of mechanisms. Annual Review of
Clinical Psychology, 17(6), 6.1–6.26.
*Nurse, A. M. (2017). Knowledge and behavioral impact of adult participation in child sexual abuse prevention: Evaluation of the protecting God’s children program.
Journal of Child Sexual Abuse, 26, 608–624. https://doi.org/10.1080/10538712.2017.1328475
*Orak, O. S., & Okanli, A. (2021). The effect of preventive psychosocial interventions directed towards mothers and children on children’s knowledge about protection
from sexual abuse. Journal of Child and Adolescent Psychiatric Nursing, 34, 294–302. https://doi.org/10.1111/jcap.12334
Ortiz-Tallo, M., & Calvo, I. (2020). Child sexual abuse: Listening to the victims. Archives of Community Medicine Public Health, 6, 135–137. https://doi.org/10.17352/
2455-5479.000092
*Ozgun, S. Y., & Capri, B. (2021). The effect of sexuality education program on the sexual development of children aged 60–72 months. Current Psychology, 42,
7125–7134. https://doi.org/10.1007/s12144-021-02040-8
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … Alonso-Fern´
andez, S. (2021). Declaraci ´
on PRISMA 2020: Una guía
actualizada para la publicaci´
on de revisiones sistem´
aticas [PRISMA 2020 statement: An updated guide for the publication of systematic reviews]. Revista Espa˜
nola
de Cardiología, 74, 790–799. https://doi.org/10.1016/j.recesp.2021.06.016
Pan, Y., Lin, X., Liu, J., & Zhang, S. (2020). Prevalence of childhood sexual abuse among women using the Childhood Trauma Questionnaire: A worldwide
metaanalysis. Trauma Violence Abuse, 22, 1181–1191. https://doi.org/10.1177/1524838020912867
Patterson, A., Ryckman, L., & Guerra, C. (2022). A systematic review of the education and awareness interventions to prevent online child sexual abuse. Journal of
Child & Adolescent Trauma, 15, 857–867. https://doi.org/10.1007/s40653-022-00440-x
Pereda, N., Guilera, G., Fons, M., & Gomez-Benito, J. (2009). The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clinical
Psychology Review, 29, 328–338. https://doi.org/10.1016/j.cpr.2009.02.007
*Pulido, M. L., Dauber, S., Tully, B. A., Hamilton, P., Smith, M. J., & Freeman, K. (2015). Knowledge gains following a child sexual abuse prevention program among
urban students: A cluster-randomized evaluation. American Journal of Public Health, 105, 1344–1350. https://doi.org/10.2105/AJPH.2015.302594
Putnam, F. W. (2003). Ten-year research update review: Child sexual abuse. Journal of American Academy of Child and Adolescent Psychiatry, 42, 269–278. https://doi.
org/10.1097/00004583-200303000-00006
Rudolph, J. I., Van Berkel, S. R., Zimmer-Gembeck, M. J., Walsh, K., Straker, D., & Campbell, T. (2023). Parental involvement in programs to prevent child sexual
abuse: A systematic review of four decades of research. Trauma, Violence & Abuse, 17. https://doi.org/10.1177/15248380231156408, 15248380231156408.
Rueda, P., Ferragut, M., Cerezo, M. V., & Ortiz-Tallo, M. (2021). Knowledge and myths about child sexual abuse in Mexican women. Journal of Interpersonal Violence,
37, 1–18. https://doi.org/10.1177/0886260521993927
*Samson, B. C., & Kulkarni, M. S. (2019). A study to assess the effectiveness of planned teaching programme on knowledge regarding prevention of abuse among the
children of 11–14 years of age at selected schools of Sangli, Miraj, Kupwad Corporation Area. Indian Journal of Public Health Research & Development, 10, 163–167.
https://doi.org/10.5958/0976-5506.2019.01555.9
Sapp, M. V., & Vandeven, A. M. (2005). Update on childhood sexual abuse. Current Opinion in Pediatrics, 17, 258–264. https://doi.org/10.1097/01.
mop.0000158731.64293.c7
Sarasua, B., Zubizarreta, I., de Corral, P., & Echeburúa, E. (2013). Tratamiento psicol´
ogico de mujeres adultas víctimas de abuso sexual en la infancia: Resultados a
largo plazo [Psychological treatment of adult female victims of childhood sexual abuse: Long-term outcomes]. Anales de Psicología, 29, 29–37. https://doi.org/
10.6018/analesps.29.1.145281
Save the Children. (2012). Guía de recursos para la prevenci´
on y atenci´
on del abuso y la explotaci´
on sexual infantil. [Resource guide for the prevention and care of
child sexual abuse and exploitation]. Available online: https://resourcecentre.savethechildren.net/node/7046/pdf/7046.pdf.
Save the Children. (2017). Violencia viral. An´
alisis de la violencia contra la infancia y la adolescencia en el entorno digital [Viral violence. Analysis of violence against
children and adolescents in the digital environment]. Available online: https://www.savethechildren.es/sites/default/les/imce/docs/informe_violencia_viral_1.
pdf.
Scholes, L., Jones, C., & Nagel, M. (2014). Boys and CSA prevention: Issues surrounding gender and approaches for prevention. The Australian Journal of Teacher
Education, 39, 1–15. https://doi.org/10.14221/ajte.2014v39n11.1
Selengia, V., Thuy, H. N. T., & Mushi, D. (2020). Prevalence and patterns of child sexual abuse in selected countries of Asia and Africa: A review of literature. Open
Journal of Social Sciences, 8, 146–160. https://doi.org/10.4236/jss.2020.89010
Singh, M. M., Parsekar, S. S., & Nair, S. N. (2014). An epidemiological overview of child sexual abuse. Journal of Family Medicine and Primary Care, 3, 430–435.
https://doi.org/10.4103/2249-4863.148139
Stoltenborgh, M., Van Ijzendoorn, M. H., Euser, E., & Bakermans-Kranenburg, M. (2011). A global perspective on child sexual abuse: Meta-analysis of prevalence
around the world. Child Maltreatment, 16, 79–101. https://doi.org/10.1177/1077559511403920
*Tunc, G. C., Gorak, G., Ozyazicioglu, N., Ak, B., Isil, O., & Vural, P. (2018). Preventing child sexual abuse: Body safety training for young children in Turkey. Journal
of Child Sexual Abuse, 27, 347–364. https://doi.org/10.1080/10538712.2018.1477001
Tutty, L. (1995). The revised Children’s Knowledge of Abuse Questionnaire: Development of ameasure of children’s understanding of sexual abuse prevention
concepts. Social Work Research, 19, 112–120.
*Tutty, L. M., Aubry, D., & Velasquez, L. (2020). The “who do you tell?”TM child sexual abuse education program: Eight years of monitoring. Journal of Child Sexual
Abuse, 29, 2–21. https://doi.org/10.1080/10538712.2019.1663969
*Urbann, K., Bienstein, P., & Kaul, T. (2020). The evidence-based sexual abuse prevention program: Strong with Sam. Journal of Deaf Studies and Deaf Education, 25,
421–429. https://doi.org/10.1093/deafed/enaa019
*Vi˜
nas, B. M., Mejía, M. A., Martínez, Y., & Islas, J. Y. (2015). Sexualidad Positiva y prevenci´
on de abuso sexual infantil en la frontera norte de M´
exico [Positive
sexuality and prevention of child sexual abuse in the northern border of Mexico]. PSIENCIA. Revista Latinoamericana de Ciencia Psicol´
ogica [Latin American Journal
of Psychological Science], 7, 9–16.
Walsh, K., Zwi, K., Woolfenden, S., & Shlonsky, A. (2018). School-based education programs for the prevention of child sexual abuse: A Cochrane systematic review
and Meta-analysis. Research on Social Work Practice, 28, 33–55. https://doi.org/10.1177/1049731515619705
*Warraitch, A., Amin, R., & Rashid, A. (2021). Evaluation of a school-based sexual abuse prevention program for female children with intellectual disabilities in rural
Pakistan - A feasibility study. Applied Nursing Research, 57, 151391. https://doi.org/10.1016/j.apnr.2020.151391
*Weeks, E. A., Whitaker, D. J., Pendarvis, S., Finkelhor, D., Neal-Rossi, C., & Rivers, D. (2021). Evaluation of the child safety matters curriculum for improving
knowledge about victimization among elementary school children: A randomized trial. Journal of Child Sexual Abuse, 30, 977–993. https://doi.org/10.1080/
10538712.2021.1960458
World Health Organization (WHO). (2017). Responding to children and adolescents who have been sexually abused: WHO clinical guidelines. Available online
https://www.who.int/publications/i/item/9789241550147.
*Wulanyani, N. M. S., Setyani, I. G. A. P. W. B., Marheni, A., & Pratama, P. Y. S. (2019). How animated videos and the snakes–ladders game can prevent sexual abuse
in children. Advances in Social Science, Education and Humanities Research, 399. https://doi.org/10.2991/assehr.k.200130.114
Wurtele, S. K., & Kenny, M. C. (2010). Primary prevention of child sexual abuse: Child-and parent-focused approaches. In K. L. E. Kaufman (Ed.), The prevention of
sexual violence: A practitioner’s sourcebook (pp. 107–119). Holyoake, MA: NEARI Press.
Zhan, H., Li, J., Sun, B., & Wei, Q. (2021). Solo sobre self-compassion (no knowledge). Effects of childhood maltreatment on self-compassion: A systematic review and
meta-analysis. Trauma, Vioence, & Abuse, 24, 1–13. https://doi.org/10.1177/15248380211043825
*Zhang, W., Chen, J., Feng, Y., Li, J., Liu, C., & Zhao, X. (2014). Evaluation of a sexual abuse prevention education for Chinese preschoolers. Research on Social Work
Practice, 24, 428–436. https://doi.org/10.1177/1049731513510409
M. Ferragut et al.
