Zwi K, Woolfenden S, Wheeler DM, O'Brien T, Tait P, Williams KJ. (2007). School-based education programmes for the prevention of child sexual abuse. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD004380.
A vast amount of research has found that survivors of childhood sexual abuse often have negative psycho-social outcomes later in life. This research has spawned numerous educational programs implemented within elementary and secondary schools. Aimed at decreasing the occurrence of sexual abuse, the efficacy of these programs remains unclear. This systematic review completed by the Campbell/Cochrane Collaboration aimed to evaluate the effectiveness of school-based education programmes for the prevention of child sexual abuse.
The authors only included randomized or quasi-randomized controlled trials for this review. Participants were either in elementary or secondary school, and the programs evaluated focused on protective behavioural skills or knowledge of sexual abuse concepts. Fifteen studies were included in the final review, with the longest follow-up period being twelve months. However, many studies could not be synthesized due to the unavailability of key outcome measures and other methodological problems. The reviewers concluded that there were substantial knowledge gains in terms of children being able to identify sexual abuse. As well, there were some gains in terms of knowledge about protective strategies to avoid victimization. However, the findings should be interpreted with caution due the presence of numerous methodological flaws in the included studies. Further, gains in knowledge do not always necessarily translate into actual changes in behaviour or decreased incidences of sexual abuse. In addition, some of the studies in this review found harmful effects, such as increases in anxiety. The reviewers encourage further studies to analyse the effectiveness of school-based programs, with more attention paid to methodological design.
While this review posed interesting empirical questions, the studies chosen for the review lacked significant information such as reliability of outcome measures and demographic information of participants. This author supports the reviewers’ conclusions that more research is necessary and, until such methodologically sound research is completed, education programmes aimed at reducing childhood sexual abuse should, at most, be considered part of a community approach to prevention. That is, these interventions should not be relied upon as the only source of prevention, and care should be taken to avoid increasing the anxiety level of children in school.
This Campbell/Cochrane Systematic Review followed a prescribed and transparent method of retrieving, appraising and synthesizing empirical studies relevant to the research question. This study was vetted by both experts in the field of practice and by experts specializing in data synthesis methodologies. Systematic reviews of existing literature are increasingly being used to harness existing research evidence while addressing many of the biases inherent in narrative reviews. Systematic reviews differ from narrative reviews because they have more rigorous information retrieval strategies; they follow an explicit and transparent criteria for appraising the quality of existing research evidence, they attempt to identify and control for different types of bias in existing studies; and they have explicit ways of establishing the comparability (or incomparability) of different studies. These steps increase the scientific merit of combining studies to establish a cumulative effect of what the existing evidence is telling us about the research question. In reviewing systematic reviews, it is important to consider both the overall effects and the effects based on sub-analyses, as systematic reviews can provide rich details about the complexity of trying to apply this new knowledge to a practice and/or policy context.