Efficacy of a Child Sexual Abuse Prevention Program for Turkish Second-Grade Primary School Children

Abstract

School-based prevention programs may play a crucial role in protecting children against child sexual abuse. However, only a few prevention programs have been implemented for primary school children in Türkiye so far. Ultimately, we aimed to develop a child sexual abuse prevention program and explore its efficacy using a pretest-posttest comparison group design. We carried out the study with 104 second graders aged 6-8 years (Mage = 6.99, SD = 0.49). Using a quasi-experimental design with comparison group, children’s classrooms were randomly assigned to either the intervention group (n = 66) or the wait-list comparison group (n = 38). All the children were recruited to a pretest and a posttest using the Child Sexual Abuse Knowledge Form, the Self-Protection Skill Form, and the Good Touch-Bad Touch Test. The students in the intervention group participated in the 4-hour child sexual abuse prevention program. To investigate effectiveness of the program on children’s knowledge levels, we used the three-state latent Markov model with (SABIC = 2067.7511, AIC = 2091.4234) and without (SABIC = 2075.4711, AIC = 2095.0264) intervention and wait-list comparison groups as a covariate variable. This result implied that the program was effective for the children in the intervention group since the transition probabilities between the intervention and wait-list comparison groups were significantly different. The findings revealed that the children in the intervention group demonstrated significant improvements in knowledge. Their self-protection skills (number of responses, effective strategies, diversity of response) also showed significant improvements. (respectively (F(1, 101)= 4.280, p <.05, η2= .04, F(1, 101)= 4.539, p <.05, η2= .04, F(1, 101)= 10.029, p <.05, η2= .09). Hence, we can confidently highlight the importance of the prevention program for second graders, and the child sexual abuse prevention program can be utilized as a primary prevention program in Turkish primary schools.

Keywords

• Child sexual abuse
• prevention
• school-based program
• primary school

References

1. Akgül, E., Darak, S., Sisman, F. N., & Ergun, A. (2021). Hemşire Liderli Bedenimin Kahramanıyım programının çocukların cinsel istismar bilgi düzeylerine etkisi: Yarı deneysel çalışma. Psikiyatri Hemşireliği Dergisi, 12(2), 156-164. https://doi.org/10.14744/phd.2020.54775
2. Alikasifoglu, M., Erginoz, E., Ercan, O., Albayrak-Kaymak, D., Uysal, O., & Ilter, O. (2006). Sexual abuse among female high school students in Istanbul, Turkey. Child Abuse & Neglect, 30, 247-255. https://doi.org/10.1016/j.chiabu.2005.10.012
3. Almuneef, M. (2021). Long term consequences of child sexual abuse in Saudi Arabia: A report from national study. Child Abuse & Neglect, 116, 103967. https://doi.org/10.1016/j.chiabu.2019.03.003
4. Banyard, V. L., Williams, L. M., & Siegel, J. A. (2001). The long-term mental health consequences of child sexual abuse: An exploratory study of the impact of multiple traumas in a sample of women. Journal of Traumatic Stress, 14(4), 697-715. https://doi.org/10.1023/A:1013085904337
5. Beitchman, J. H., Zucker, K. J., Hood, J. E., DaCosta, G. A., Akman, D., & Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child Abuse & Neglect, 16(1), 101-118. https://doi.org/10.1016/0145-2134(92)90011-F
6. Bozatlı, L., & Görker, I. (2025). Retrospective evaluation in child and adolescent victims of sexual abuse: Analysis of gender and age differences. Cyprus Journal of Medical Sciences, 10(4), 250-257. https://doi.org/10.4274/cjms.2024.2024-99
7. 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
8. Cederbaum, J. A., Negriff, S., & Molina, A. P. (2020). Child maltreatment and romantic relationships in adolescence and young adulthood: The mediating role of self-perception. Child Abuse & Neglect, 109, 104718. https://doi.org/10.1016/j.chiabu.2020.104718

9. Church, P., Forehand, R., Brown, C., & Holmes, T. (1988). The prevention of sexual abuse: Examination of a program with kindergarten-age children. Behaviour Therapy, 19, 429-435. https://doi.org/10.1016/S0005-7894(88)80014-5
10. Citak Tunc, G., 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(4), 347-364. https://doi.org/10.1080/10538712.2018.1477001
11. Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences. Hoboken, NJ: John Wiley & Sons.
12. 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
13. Çeçen-Eroğul, A. R. (2016). “İyi Dokunuş Kötü Dokunuş” ölçme aracının Türkçeye uyarlanması: Geçerlik- güvenirlik çalışmaları ve cinsiyet farklılıkları [Adaptation of the “Good Touch Bad Touch Curriculum Test” into Turkish: A validity-reliability study and gender differences]. 3rd International Eurasian Educational Research Congress, Muğla. Retrieved from https://ejercongress.org/pdf/ejercongress2016program.pdf
14. Çeçen-Eroğul, A. R., & Kaf Hasırcı, Ö. (2013). The effectiveness of psycho-educational school-based child sexual abuse prevention training program on Turkish elementary students. Educational Sciences: Theory and Practice, 13(2), 725-729.
15. Daigneault, I., Hébert, M., McDuff, P., & Frappier, J. Y. (2012). Evaluation of a sexual abuse prevention workshop in a multicultural, impoverished urban area. Journal of Child Sexual Abuse, 21(5), 521-542. https://doi.org/10.1080/10538712.2012.703291
16. Dubé, R., & Hébert, M. (1988). Sexual abuse of children under 12 years of age: A review of 511 cases. Child Abuse & Neglect, 12(3), 321-330. https://doi.org/10.1016/0145-2134(88)90045-2
17. Edwards, K. M., Siller, L., Leader Charge, L., Bordeaux, S., Leader Charge, D., & Herrington, R. (2020). Efficacy of a sexual abuse prevention program with children on an Indian reservation. Journal of Child Sexual Abuse, 29(8), 900-910. https://doi.org/10.1080/10538712.2020.1847229
18. Eskin, M. (2012). The role of childhood sexual abuse, childhood gender nonconformity, self-esteem and parental attachment in predicting suicide ideation and attempts in Turkish young adults. Suicidology Online, 3, 114-123.
19. Eslek, D., & Yılmaz Irmak, T. (2022). Evaluation of the effectiveness of the “Our Lesson: Safe Relationships” program in preventing child sexual abuse. Turkish Journal of Psychology, 37(89), 36-60. https://doi.org/10.31828/tpd1300443320200824m000039
20. Finkelhor, D. (2009). The prevention of childhood sexual abuse. The Future of Children, 19, 169–194.
21. Finkelhor, D., & Dziuba-Leatherman, J. (1995). Victimization prevention programs: A national survey of children’s exposure and reactions. Child Abuse & Neglect, 19(2), 129-139. https://doi.org/10.1016/0145-2134(94)00111-7
22. Gewirtz-Meydan, A., & Finkelhor, D. (2020). Sexual abuse and assault in a large national sample of children and adolescents. Child Maltreatment, 25(2), 203-214. https://doi.org/10.1177/1077559519873975
23. Gibson, L. E., & Leitenberg, H. (2000). Child sexual abuse prevention programs: Do they decrease the occurrence of child sexual abuse? Child Abuse & Neglect, 24, 1115-1125. https://doi.org/10.1016/S0145-2134(00)00179-4
24. Goodman, L.A. (1974). The analysis of systems of qualitative variables when some of the variables are unobservable. Part IA modified latent structure approach. American Journal of Sociology, 79, 1179-1259
25. Hébert, M., Lavoie, F., Piche, C., & Poitras, M. (2001). Proximate effects of a child sexual abuse prevention program in elementary school children. Child Abuse and Neglect, 25, 505–522. https://doi.org/10.1016/S0145-2134(01)00223-X
26. Huang, S., & Cui, C. (2020). Preventing child sexual abuse using picture books: The effect of book character and message framing. Journal of Child Sexual Abuse, 29(4), 448-467. https://doi.org/10.1080/10538712.2020.1719449
27. Huang, N., Yang, F., Liu, X., Bai, Y., Guo, J. & Riem, M. M. (2023). The prevalences,changes, and related factors of child maltreatment during the COVID-19 pandemic: A systematic review. Child Abuse & Neglect, 105992. https://doi.org/10.1016/j.chiabu.2022.105992
28. Jumper, S. A. (1995). A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse & Neglect, 19(6), 715-728. https://doi.org/10.1016/0145-2134(95)00029-8
29. Karkoskova, S., & Ropovik, I. (2019). The prevalence of child sexual abuse among Slovak late adolescents. Journal of Child Sexual Abuse, 28(4), 452-471. https://doi.org/10.1080/10538712.2018.1553224
30. Kenny, M. C. (2009). Child sexual abuse prevention: Psychoeducational groups for preschoolers and their parents. The Journal for Specialists in Group Work, 34(1), 24-42. https://doi.org/10.1080/01933920802600824
31. Kenny, M. C., Wurtele, S. K., & Alonso, L. (2012). Evaluation of a personal safety program with Latino preschoolers. Journal of Child Sexual Abuse, 21(4), 368-385. https://doi.org/10.1080/10538712.2012.675426
32. Kenny, M. C., Helpingstine, C., & Long, H. (2020). College students’ recollections of childhood sexual abuse prevention programs and their potential impact on reduction of sexual victimization. Child Abuse & Neglect, 104, 104486. https://doi.org/10.1016/j.chiabu.2020.104486
33. Kızıltepe, R., Eslek, D., Yılmaz Irmak, T., & Güngör, D. (2022). I am learning to protect myself with Mika: A teacher-delivered child sexual abuse prevention program. Journal of Interpersonal Violence, 37(11-12), 10220-10244. https://doi.org/10.1177/0886260520986272
34. Kızıltepe, R., & Yılmaz Irmak, T. (2014, October 23-25). Çocuk cinsel istismarını önleyici müdahale programının geliştirilmesi [Developing a child sexual abuse preventive intervention program]. (Oral presentation). I. Uluslararası Çocuk Koruma Kongresi., İstanbul.
35. Kozak, R. S., Gushwa, M., & Cadet, T. J. (2018). Victimization and violence: an exploration of the relationship between child sexual abuse, violence, and delinquency. Journal of Child Sexual Abuse, 27(6), 699-717. https://doi.org/10.1080/10538712.2018.1474412
36. Manheim, M., Felicetti, R., & Moloney, G. (2019). Child sexual abuse victimization prevention programs in preschool and kindergarten: Implications for practice. Journal of Child Sexual Abuse, 28(6), 745-757. https://doi.org/10.1080/10538712.2019.1627687
37. Moon, K. J., Park, K. M., & Sung, Y. (2017). Sexual abuse prevention mobile application (SAP_MobAPP) for primary school children in Korea. Journal of Child Sexual Abuse, 26(5), 573-589. https://doi.org/10.1080/10538712.2017.1313350
38. Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1994). The effect of child sexual abuse on social, interpersonal and sexual function in adult life. The British Journal of Psychiatry, 165(1), 35-47. https://doi.org/10.1192/bjp.165.1.35
39. 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(4), 294-302. https://doi.org/10.1111/jcap.12334
40. Saslawsky, D. A., & Wurtele, S. K. (1986). Educating children about sexual abuse: Implications for pediatric intervention and possible prevention. Journal of Pediatric Psychology, 11, 235–245. https://doi.org/10.1093/jpepsy/11.2.235
41. Stoltenborgh, M., Van Ijzendoorn, M. H., Euser, E. M., & Bakermans-Kranenburg, M. J. (2011). A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreatment, 16(2), 79-101. https://doi.org/10.1177%2F1077559511403920
42. Türkkan, T., & Odacı, H. (2024). Assessment of effectiveness of school-based child sexual abuse prevention programs: A meta-analysis. Hacettepe Egitim Dergisi, 39(1), 146-162. http://dx.doi.org/10.16986/HUJE.2024.514
43. Ünsal Seydooğulları, S., & Kapçı, E. G. (2023). Development and effectiveness of psycho-education program prevention of sexual abuse for primary school grade 3. and 4. Turkish Psychological Counseling and Guidance Journal, 13(70), 301-314.
44. Vermunt, J. K., & Magidson, J. (2002). Latent class cluster analysis. In J. A. Hagenaars & A. L. McCutcheon (eds.), Applied latent class analysis, (pp. 56-85). Cambridge, UK: Cambridge University Press.
45. Vermunt, J. K., & Magidson, J. (2016). Technical guide for Latent GOLD 5.1: Basic, advanced, and syntax. Belmont, MA: Statistical Innovations Inc.
46. 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(1), 33-55. https://doi.org/10.1177%2F1049731515619705
47. Wolfersteig, W., Diaz, M.J. & Moreland, D. (2022). Empowering elementary and middle school youth to speak up and be safe: Advancing prevention of child maltreatment with a universal school-based curriculum. International Journal of Environmental Research and Public Health, 19, 11856. https://doi.org/10.3390/ijerph191911856
48. Wurtele, S. K. (2008). Behavioral approaches to educating young children and their parents about child sexual abuse prevention. The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention, 1(1), 52-64. http://dx.doi.org/10.1037/h0100434
49. Wurtele, S. K., Kast, L. C., Miller-Perrin, C. L., & Kondrick, P. A. (1989). Comparison of programs for teaching personal safety skills to preschoolers. Journal of Consulting and Clinical Psychology, 57(4), 505–511. https://doi.org/10.1037/0022-006X.57.4.505
50. Wurtele, S. K., & Kenny, M. C. (2012). Preventing child sexual abuse: An ecological approach. In P. Goodyear-Brown (Ed.), Handbook of child sexual abuse: Identification, assessment, and treatment (pp. 531–565). Hoboken, NJ: Wiley Press.
51. Wurtele, S. K., & Kenny, M. C. (2019). Talking to young children about sexual abuse prevention. In J. Pozzulo & C. Bennell (Eds.), Working with trauma-exposed children and adolescents: Evidence-based and age-appropriate practices (pp. 69–93). UK: Taylor & Francis.
52. Wurtele, S. K., & Owens, J. S. (1997). Teaching personal safety skills to young children: An investigation of age and gender across five studies. Child Abuse & Neglect, 21(8), 805-814. https://doi.org/10.1016/S0145-2134(97)00040-9
53. Yılmaz Irmak, T., Kızıltepe, R., Aksel, Ş., Güngör, D., & Eslek, D. (2018). “I am learning to protect myself with Mika”: Efficacy of sexual abuse prevention program. Turkish Journal of Psychology, 33(81), 41-61
54. Yi-Chuen, C., Beverly, L. F., & Kai-Wen, T. (2012). Pilot evaluation of a sexual abuse prevention program for Taiwanese children. Journal of Child Sexual Abuse, 21(6), 621-645. https://doi.org/10.1080/10538712.2012.726699
55. 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(4), 428-436. https://doi.org/10.1177%2F1049731513510409
56. Žukauskienė, R., Bakaitytė, A., Kaniušonytė, G., Segal, A., Ustinavičiūtė-Klenauskė, L. & Santtila, P. (2023). The lifetime prevalence of child sexual abuse assessed in young adults in Lithuania. Child Abuse & Neglect, 138, 106061. https://doi.org/10.1016/j.chiabu.2023.106061