|Year : 2015 | Volume
| Issue : 3 | Page : 177-182
Knowledge and attitude in regards to physical child abuse amongst medical and dental residents of central Gujarat: A cross-sectional survey
Anshula Deshpande, Chirag Macwan, KS Poonacha, Seema Bargale, Steffi Dhillon, Prriya Porwal
Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
|Date of Web Publication||9-Jul-2015|
Dr. Chirag Macwan
Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara - 391 760, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Context: Child abuse is a state of emotional, physical, economic, and sexual maltreatment met out to a person below the age of 18 and is a globally prevalent phenomenon. However, in India, there has been no understanding of the extent, magnitude, and trends of the problem. Aims: The aim of this study was to determine the level of knowledge and attitudes of medical and dental residents with regards to physical child abuse of central Gujarat. Materials and Methods: A cross-sectional survey was conducted among the medical and dental residents of central Gujarat. Data were collected from a self-administered questionnaire for a total of 130 residents, in which 89 medical and 41 dental residents responded. Results: Knowledge regarding the social indicator of child abuse was found to be poor in 27.7% (n = 36), average in 68.5% (n = 89), and good in 3.8% (n = 5); and for physical indicator it was found to be poor in 10.8% (n = 14), average 66.9% (n = 87), and good 22.3% (n = 29). Forty-nine percent (n = 64) of the respondents reported having formal training in recognizing child abuse, and 32% (n = 42) had read literature on the topic. Fifty-five percent (n = 72) stated that education regarding child abuse is extremely important. Conclusions: Result of the present study found that medical and dental residents are not sufficiently prepared to endure their role in protection of child from abuse. A significant gap existed between recognizing signs of physical child abuse and responding effectively. Improvements in child abuse education and continuing education courses are advised to provide adequate knowledge.
Keywords: Child abuse knowledge, education, residents
|How to cite this article:|
Deshpande A, Macwan C, Poonacha K S, Bargale S, Dhillon S, Porwal P. Knowledge and attitude in regards to physical child abuse amongst medical and dental residents of central Gujarat: A cross-sectional survey. J Indian Soc Pedod Prev Dent 2015;33:177-82
|How to cite this URL:|
Deshpande A, Macwan C, Poonacha K S, Bargale S, Dhillon S, Porwal P. Knowledge and attitude in regards to physical child abuse amongst medical and dental residents of central Gujarat: A cross-sectional survey. J Indian Soc Pedod Prev Dent [serial online] 2015 [cited 2019 Jul 20];33:177-82. Available from: http://www.jisppd.com/text.asp?2015/33/3/177/160344
| Introduction|| |
Children are a heritage from the LORD; offspring a reward from him (Psalm 127:3, Holy Bible), but humans fails to respect that. Physical child abuse is now documented as an international issue and has been reported in many countries.  However, in India there has been no understanding of the extent, magnitude, and trends of the problem till 2007. Study on child abuse scenario was done across the India in 2007 and result suggested that, (i) two out of every three children are physically abused and (ii) 72.2% children in the age group of 5-12 years were being physically abused. This study demonstrated colossal incidence of physical child abuse across India. 
Medical and dental professionals are in a unique position for the diagnosis of physical child abuse as 50% of injuries occur in head and neck region and easily assessed.  However, research analysis from different parts of the world have indicated that healthcare providers fail to report suspected cases of abuse, mainly due to lack of knowledge. ,, Therefore, the quality of the medical education is an important aspect to increase the revealing and documentation of child maltreatment.
The aim of this study was to assess the educational experience and knowledge of medical and dental residents of central Gujarat with regards to physical child abuse and to assess the difference in educational experiences among medical and dental residents.
| Materials and Methods|| |
A cross-sectional survey was carried out between May and June 2013. Ethical approval was obtained from Sumandeep Vidyapeeth Institutional Ethics Committee (SVIEC/ON/Dent/SRP/13233). An anonymous, self-administered, 18-question survey was constructed using a multiple choice or true-false format based on previous questionnaires on the topic. , A field test was conducted with 10 professors and 10 residents to measure concurrent and content validity. All of the professors had extensive knowledge regarding the topic. Concurrent validity for social indicator was 62.46% and for physical indicator was 71.39%. The content validity score for the entire questionnaire was calculated by the Lawshe's (1975) content validity ratio (CVR) formula (CVR = (n e - N/2)/(N/2); where CVR= content validity ratio, n e = number of SME panelists indicating "essential", N = total number of SME panellists, and SME = subject matter expert). CVR for the questionnaire was 0.8333, that is, 83.33% content validity. Questionnaire was modified as per the expert suggestions. The modified final version of the questionnaire was then used in the study.
Residents of three dental and three medical colleges of central Gujarat were included in the study. Residents of Pedodontics and Preventive Dentistry, Oral Medicine and Radiology, Oral and Maxillofacial Surgery and Orthodontics from dental colleges; and residents of Pediatrics, Radiology, and Orthopedics from medical colleges were included. The questionnaire had an information sheet and consent form for the responders. The questionnaire pro forma was distributed personally and the residents were encouraged to complete all question on the same visit.
Data management was done in Microsoft Excel 2007 and statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 17.0 (SPSS Inc). Descriptive statistics was generated for each groups and Mann-Whitney U-test or chi-square test was used to compare between groups. Statistical significance was set at a level of 5% (P < 0.05).
| Results|| |
A total of 134 responders returned complete questionnaire, among which only four responders were of 1 st year and just enrolled in the course; hence, they were excluded from the data to be analyzed. So, total 130 responder's pro forma were analyzed.
Characteristics of the respondents
The characteristics of the respondents are shown in [Table 1].
|Table 1: Department, residentship, year of residency, and type of institute of respondents (n = 130)|
Click here to view
Knowledge of respondents regarding child abuse
The number of respondents who correctly answered each social indicator and physical indicator question is shown in [Table 2] and [Table 3], respectively.
For the social indicators, 3.8% (n = 3) of respondents answered all five correctly and 42.3% (n = 55) of the respondents answered four of five questions correctly. Four responders (3.1%) answered all questions incorrectly. For the physical indicators, 7.7% (n = 10) of respondents answered all six correctly and 14.6% (n = 19) of the respondents answered five of six questions correctly.
The mean score for all 130 respondents was 3.07 (standard deviation (SD) 1.17) for social indicators and 3.71 (SD 1.10) for physical indicators. The highest mean scores for social indicators were recorded for oral diagnosis (4.0 SD 0.0) followed by pediatrics (3.00 SD 1.28) and pedodontics (2.78 SD 0.83), and lowest scores were recorded for the orthodontics (2.73 SD 1.10). The highest mean scores for physical indicators were recorded for pedodontics (4.11 SD 1.45) followed by oral surgery (4.00 SD 1.08), and lowest scores were recorded for the orthodontics (3.47 SD 1.30). Descriptive statistical analysis has been shown in the [Table 4].
Education background and attitude of respondents
Educational background of the responders and attitude regarding the child abuse showed variations in medical and dental residents [Table 5]. Almost 48-60% of the residents had a belief for the importance of the child abuse education and the awareness of Indian laws pertaining to child protection and abuse. More than 90% of the residents wished to improve their knowledge regarding child abuse and protection.
The child abuse is found not to be reported by the residents based on suspicions, as 30% of them felt that lack of adequate history and 17% of them did not want any legal obligation or knowledge of right authority personnel to who the case can be reported [Table 6].
| Discussion|| |
This cross-sectional study was carried out to assess the knowledge and attitude of medical and dental residents of central Gujarat. The specialty which involves in diagnosis and/or treatment of the children was included. Total 134 responders have returned complete questionnaire. Amongst them, only four responders were in 1 st year and had just enrolled in the course, and hence were excluded from the study. An anonymous, self-administered questionnaire was used in the study. A field test was conducted to measure concurrent and content validity. Values of both concurrent and content validity suggest the questionnaire is valid for the study. Distribution of questionnaire pro forma was done personally through e-mail or post to avoid the temptation by the respondents to check and possibly correct their answers.
An important prerequisite for reporting suspected cases of child abuse is the basic knowledge about what to look for and how to diagnose these cases. The results in this study show that the knowledge of the respondents about the indicators of child abuse was unsatisfactory with 3.8% of respondents answering all five social indicator questions correctly and only 7.7% answering all six physical indicator questions correctly. The findings of the present study indicated a problem of lack of knowledge in many areas related to signs of physical abuse, as has been reported in similar studies in other parts of the world. ,,, Comparing with the similar reports from India, Kirankumar et al., (2011)  found that medical professionals of Bagalkot district of north Karnataka had poor knowledge as they undervalued the topic. An important indicator of the quality of abuse education in responders is the self-assessed level of knowledge in our study. Most respondents indicated that they thought the level of their knowledge on the topic was not sufficient for them to undertake their future responsibility in protecting children against abuse. In addition, the fact that level of knowledge was not significantly different between medical and dental residents necessitates critical revision of the content in curriculum in regard to this topic. This signified that lack of sufficient training could be due to the fact that students learned about abuse topic in classroom settings, which was not reinforced in clinical settings as was explained by Thomas et al., 2006. 
Education is the critical factor in enhancing the ability of professionals to detect cases and increase their confidence and commitment to reporting suspicious cases.  An analysis of the sources of information about child abuse for participants showed that 46.1% medical and 56.1% dental residents had formal education in child abuse. These results are similar to that of the study from Bagalkot District (Karnataka),  but higher than that of the results from the studies in Jordan, , UK, , US, , and Scotland.  11.2% medical and 9.8% dental residents of the respondents had undertaken post-qualification training, which is lower than 16% reported in the US  and Scotland,  33% in US,  and 87% reported for dental professionals in UK.  34.8% medical and 26.8% dental residents in this study read literature on the subject, which is lower than 56% reported in US,  60% in Jordan,  and 84% reported by dentists in US. 
Education factors also influenced responding residents' beliefs in realizing how important recognizing signs of child abuse are by the medical profession. It is promising that only a small number (3%) of the respondents believed that child abuse recognition by the residents was 'not so important'. This result is comparable to the result (2%) reported by dentists in Jordan.  Also similar to results of the study reported by medical professionals of Bagalkot district, as 92% of medical professionals agree that protection of child's health is their duty.  The awareness of Indian laws pertaining to child protection and abuse of medical residents was 60.7% and 48.8% of dental residents. More than 90% of the residents wished to improve their knowledge regarding child abuse and protection, which shows their positive attitude. Almost 40% of responders wished to have continuing education course/symposium on the topic of child abuse and protection. Informed booklet and modification in regular curriculum were also one of the preferred means for improving the knowledge.
The main reasons for responders not reporting cases that had otherwise been suspicious would be lack of adequate history, possible effect on their practice, and uncertainty about diagnosis. Uncertainty about diagnosis, as an influencing factor for dentists has been reported in Australia,  Scotland,  UK,  Northern Ireland,  Denmark,  US,  and in Nigeria.  In a survey of dentists, doctors and nurses of Northern Ireland,  it was found that a lower percentage of dentists (18%) compared with nurses (44%) and general practitioners (GPs; 38%) knew the mechanisms for reporting child physical abuse and they had lower scores in identifying abuse compared with nurses and GP's. These uncertainties may be lessened by adequate child protection training.  A factor by which few responders were influenced in reporting their suspicions was fear of litigation; this finding is similar to other studies. ,, Impact on their practice was also a major reason for not reporting suspicious case, which is in contrast with the other reported studies. ,,
Conclusions and recommendations
Medical and dental residents are not sufficiently prepared to endure their role in protection of child from abuse. It was observed that there was a deficiency in recognizing and reporting signs of physical child abuse. In addition, knowledge of residents about the indicators of physical child abuse is poor and needs to be improved. The main reasons for not reporting child abuse included lack of adequate history and possible effect on practice.
The lack of knowledge in the responders might be because of the limitations of lecture-based education. Improvements/reforms in curriculum and continuing education programs on the topic of child abuse and protection should be done. The outcome of education has to be assessed on a regular basis, and constant improvement must be made according to the changing situation to better prepare residents in recognition and procedure of reporting child abuse.
| References|| |
Sharma BR, Gupta M. Child abuse in Chandigarh, India, and its implications. J Clin Forensic Med 2004;11:248-56.
Kacker L, Varadan S, Kumar P. Study on child abuse: INDIA 2007. New Delhi: Ministry of Women and Child Development Government of India; 2007.
Needleman HL. Orofacial trauma in child abuse: Types, prevalence, management, and the dental profession′s involvement. Pediatr Dent 1986;8:71-80.
John V, Messer LB, Arora R, Fung S, Hatzis E, Nguyen T, et al
. Child abuse and dentistry: A study of knowledge and attitudes among dentists in Victoria, Australia. Aust Dent J 1999;44:259-67.
Manea S, Favero GA, Stellini E, Romoli L, Mazzucato M, Facchin P. Dentists′ perceptions, attitudes, knowledge, and experience about child abuse and neglect in northeast Italy. J Clin Pediatr Dent 2007;32:19-25.
Saric B, Saric B, Vasilj I. Knowledge, skills and attitudes of physicians recognition on violence against children. J Soc Dev New Net Environ BH 2012;6:324-8.
Al-Jundi SH, Zawaideh FI, Al-Rawi MH. Jordanian dental students′ knowledge and attitudes in regard to child physical abuse. J Dent Educ 2010;74:1159-65.
Sonbol HN, Abu-Ghazaleh S, Rajab LD, Baqain ZH, Saman R, Al-Bitar ZB. Knowledge educational experiences and attitudes towards child abuse amongst Jordanian dentists. Eur J Dent Educ 2012;16:e158-65.
Cairns AM, Mok JY, Welbury RR. The dental practitioner and child protection in Scotland. Br Dent J 2005;199:517-20.
Thomas JE, Straffon L, Inglehart MR. Child abuse and neglect: Dental and dental hygiene students′ educational experiences and knowledge. J Dent Educ 2006;70:558-65.
Kirankumar SV, Noorani H, Shivprakash PK, Sinha S. Medical professional perception, attitude, knowledge, and experience about child abuse and neglect in Bagalkot district of north Karnataka: A survey report. J Indian Soc Pedod Prev Dent 2011;29:193-7.
Harris JC, Bradbury J, Porritt J, Nilchian F, Franklin CD. NHS dental professionals′ evaluation of a child protection learning resource. Br Dent J 2011;210:75-9.
Chadwick BL, Davies J, Bhatia SK, Rooney C, McCusker N. Child protection: Training and experiences of dental therapists. Br Dent J 2009;207:E6.
Ramos-Gomez F, Rothman D, Blain S. Knowledge and attitudes among California dental care providers regarding child abuse and neglect. J Am Dent Assoc 1998;129:340-8.
Crouse CD, Faust RA. Child abuse and the otolaryngologists: Part 1. Otolaryngol Head Neck Surg 2003;128:305-10.
Lazenbatt A, Freeman R. Recognizing and reporting child physical abuse: A survey of primary healthcare professionals. J Adv Nurs 2006;56:227-36.
Uldum B, Christensen HN, Welbury R, Poulsen S. Danish dentists′ and dental hygienists′ knowledge of and experience with suspicion of child abuse or neglect. Int J Paediatr Dent 2010;20:361-5.
Bankole OO, Denloye OO, Adeyami AT. Child abuse and dentistry: A study of knowledge and attitudes among Nigerian dentists. Afr J Med Med Sci 2008;37:125-34.
Welbury RR, MacAskill SG, Murphy JM, Evans DJ, Weightman KE, Jackson MC, et al
. General dental practitioners′ perception of their role within child protection: A qualitative study. Eur J Paediatr Dent 2003;4:89-95.
Thomas JE, Straffon L, Inglehart MR. Knowledge and professional experiences concerning child abuse: An analysis of provider and student responses. Pediatr Dent 2006;28:438-44.
Kraus C, Jandl-Jager E. Awareness and knowledge of child abuse amongst physicians - a descriptive study by a sample of rural Austria. Wien Klin Wochenschr 2011;123: 340-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]