Determinants of parental communication practices to prevent child sexual abuse: A cross-sectional study in Indonesia

Determinants of parental communication practices to prevent child sexual abuse: A cross-sectional study in Indonesia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of parental communication practices to prevent child sexual abuse: A cross-sectional study in Indonesia Tetti Solehati, Helmy Bin Hazmi, Muhammad Yusuf, Yanti Hermayanti, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6614468/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Enhancing parent–child communication is a key strategy for preventing child sexual abuse (CSA) by addressing potential risks before they occur. To educate children effectively about CSA prevention, parents must possess strong communication skills. Understanding parental demographic characteristics and knowledge related to communication practices is essential for successful prevention efforts. This cross-sectional study aimed to examine how demographic factors and knowledge influence parents’ communication practices in preventing CSA. Methods A total of 207 parents from elementary schools in Bandung and Sumedang Regencies, West Java, Indonesia, participated in this study, which was conducted between March and December 2024. Participants were selected via stratified random sampling. Data were collected through an anonymous self-administered questionnaire distributed via Google Forms developed by the research team. The questionnaire assessed demographic characteristics, CSA-related knowledge, and communication practices. Univariate analysis (percentages) was used to describe participant characteristics, knowledge, and communication practices. Chi-square tests were used to examine associations between demographic and knowledge variables and communication practices. Multivariate logistic regression was performed to identify key predictors of communication practices. Results Most respondents were of Sundanese ethnicity (91.3%) and demonstrated poor knowledge (70%) and poor communication practices (51.7%) regarding CSA prevention. Knowledge (p = 0.021) and ethnicity (p = 0.048) were significantly associated with communication practices. Multivariate analysis revealed that both knowledge (OR: 2.073; 95% CI: 1.114–3.860) and ethnicity (OR: 2.122; 95% CI: 1.006–4.478) were significant predictors of communication practices. Other factors, including age, gender, occupation, education, marital status, income, access to CSA prevention information, number of family members, living arrangements with children, and caregiving roles, were not significantly associated with communication practices. Conclusions Parental knowledge and ethnicity have a significant effect on CSA prevention communication; nonetheless, many engaged parents lack the requisite skills. This emphasizes the importance of culturally specific, knowledge-driven interventions, as well as additional studies on sociocultural determinants and long-term program efficacy. Reporting guidelines: This study followed the STROBE reporting guidelines. Child sexual abuse communication practices Indonesia parents prevention Introduction Child sexual abuse (CSA) is recognized as a serious adverse childhood experience ( 1 ). In recent decades, CSA has transcended national, continental, and socioeconomic boundaries ( 2 ). Children are especially vulnerable to abuse because of their developmental immaturity and limited capacity for self-protection ( 3 ). In Indonesia, CSA remains a critical concern. According to the Ministry of Women’s Empowerment and Child Protection (Kemen PPPA), 9,588 CSA cases were reported in 2022 ( 4 ). CSA leads to numerous adverse outcomes, including both physical and psychological harm, that may begin in childhood ( 5 ) and persist into adulthood ( 6 ). Children require consistent attention and protection to ensure healthy physical, mental, and social development ( 3 ). Parents play a central role in safeguarding children through education about personal safety and CSA prevention ( 7 , 8 ). Studies suggest that prevention efforts should focus on family members, particularly parents, because children typically form stronger attachments with them than with teachers or peers ( 9 ). Therefore, parents and guardians should be equipped through structured programs to prevent their children from becoming victims of CSA ( 10 ). As part of a bottom-up approach to crime prevention, parents should transfer this knowledge to their children through open parent–child communication ( 10 ). The family, as the primary socializing agent, serves as an effective medium for implementing this strategy ( 11 ) ( 12 ) ( 13 ). Effective prevention requires proactive, family-centered approaches, where parents function as the first and most critical line of defense through open, age-appropriate communication. Both mothers and fathers play vital roles in ensuring children's safety. Since adult involvement enhances the efficacy of prevention programs ( 14 , 15 ), engaging parents is essential for CSA prevention efforts ( 16 ). However, many Indonesian parents lack sufficient knowledge or confidence to address CSA ( 17 ). Research by Solehati et al. revealed that many parents are uninformed about CSA, feel uncomfortable discussing it ( 18 ), and struggle to implement prevention strategies effectively ( 19 ). This limited knowledge directly influences how, or whether, parents discuss sensitive topics such as body safety and sexual abuse with their children. In low- and middle-income countries (LMICs), such as Indonesia, conversations about CSA are often constrained by cultural taboos and socioreligious norms. These barriers restrict open dialog and prevent the development of effective parent–child communication on topics related to sexuality and abuse. Consequently, many parents lack both the knowledge and skills required to empower their children to recognize, avoid, and report abuse. Encouraging children to confide with trusted adults, especially their parents, can provide a crucial layer of protection ( 20 , 21 ). Poor parent–child communication has been identified as a risk factor for CSA, whereas strong familial bonds are recognized as protective ( 9 ). Among the most effective prevention strategies are active, informed communication between parents and children ( 10 ). Through such interactions, experienced adults can teach children to identify and avoid abusive behavior ( 10 ). One effective way to address CSA is to strengthen preventive communication before abuse occurs ( 11 ). Strong communication skills are essential for parents to educate their children about personal safety. Various factors influence parent‒child communication, including socioeconomic status, religious beliefs, stigma, and the misconception that sex education promotes deviant behavior ( 10 ). Demographic characteristics, such as age, sex, education level, marital status, employment, ethnicity, income, family structure, number of cohabiting family members, and access to CSA-related information, are also believed to shape parental communication practices. Although studies have explored the role of parents in CSA prevention in countries such as Syria ( 22 ) and China ( 23 ), there is limited empirical evidence from LMICs, including Indonesia. Much of the available literature is qualitative or descriptive and does not systematically examine how parental knowledge and demographic characteristics influence communication practices. Furthermore, no quantitative studies have explored this issue in Bandung and Sumedang Regencies, two culturally diverse regions in West Java, where local norms and family dynamics may substantially influence CSA prevention practices. Given this limitation, further investigation is necessary to understand how parents communicate with their children about CSA prevention and what factors influence these practices. This research is the first to explore the factors associated with parents’ communication practices in the context of CSA prevention in Indonesia. This study aims to identify and analyze the factors associated with parents’ communication practices in the context of CSA prevention. Using a cross-sectional design, the study surveyed parents of elementary school-aged children in Bandung and Sumedang Regencies and assessed the influence of key demographic factors (including age, sex, education level, marital status, occupation, ethnicity, income, household size, number of cohabiting family members, and experience accessing CSA prevention information) and parental knowledge on communication behavior. The findings from this research are expected to inform the development of culturally sensitive, evidence-based, family-centered interventions while contributing to the broader discourse on child protection in Indonesia and other LMICs. Methods Study design and setting This cross-sectional quantitative study was conducted between March and December 2024 in West Java, Indonesia, specifically at two elementary schools in Bandung Regency and two elementary schools in Sumedang Regency. These locations were selected because of the relatively high prevalence of child sexual abuse (CSA) cases reported in these areas. Participants and procedure Data were collected from parents whose children were enrolled in the selected schools. Using G*Power software, the required sample size was calculated on the basis of a significance level of 0.05, a statistical power of 0.80, a 95% confidence interval, and a medium effect size (0.3), yielding a minimum sample size of 111. A total of 234 parents were invited to participate, of whom 207 voluntarily consented, whereas 27 declined. The eligibility criteria included ( 1 ) being the parent or guardian of an elementary school-aged child enrolled in one of the four selected schools, ( 2 ) being in good physical and mental health, ( 3 ) being able to read and understand Indonesians, and ( 4 ) owning a smartphone to access the online survey. Stratified random sampling was employed to recruit participants. The researchers introduced the study's objectives and provided instructions on how to complete the questionnaire. Informed consent was obtained from those who agreed to participate in the study. Informed consent was obtained from all participants prior to data collection. Each participant received a unique numerical code to maintain anonymity throughout the study process. The survey was administered via a self-reported online questionnaire that was completed during a 40-minute session at each school in a private setting. The study team arranged seating to minimize interaction among participants and ensure confidentiality. The respondents were informed of their right to withdraw at any time or to skip any questions. The researchers ensured that all the information remained confidential and safeguarded the participants' identities. Data collection tools A structured, self-administered questionnaire developed on the Google Form platform was used to gather data on participants’ demographic characteristics, knowledge, and communication practices related to CSA prevention. The questionnaire was developed by the research team on the basis of validated concepts and findings from prior CSA-related studies. The questionnaire was reviewed by four independent experts to ensure readability and comprehensibility. Its reliability and validity were previously tested on a sample of 295 parents and teachers in Bandung Regency and Bandung City. The Cronbach's alpha values for the communication practices and knowledge components were 0.608 and 0.776, respectively. The validity coefficients ranged from 0.191–0.674 for communication practices and 0.202–0.550 for knowledge items. It consists of three parts: The demographic characteristics included age, sex, education level, marital status, occupation, ethnicity, monthly income, number of family members, number of cohabiting family members, number of people who have cared for children at home, and prior exposure to CSA-related information. Knowledge about CSA: Comprises 30 multiple-choice items covering a wide range of topics, including definitions, types, risk factors, perpetrators, symptoms, legal regulations, prevention strategies, stigma, and reporting mechanisms. Each item offered three response options: one correct and two incorrect. Correct answers were scored as “1” and incorrect answers as “0”; reverse scoring was applied for negatively phrased questions. The total knowledge score ranged from 0–30, and knowledge was classified as good (≥ 80%) or poor (< 80%). The communication practices included 17 items addressing parents' practices regarding CSA prevention, such as teaching children about body autonomy, personal boundaries, avoiding strangers, recognizing signs of CSA, and accessing educational materials. The responses were scored via a 4-point Likert scale (1 = never, 2 = sometimes, 3 = often, 4 = always). Negatively worded items were reverse-coded. The total scores ranged from 17–68, with good communication practices defined as scores ≥ 80% and poor communication practices defined as scores < 80%. Data analysis All the statistical analyses were conducted via SPSS software. Descriptive statistics (percentages) were used to summarize demographic variables, knowledge, and communication practices. Chi-square tests were performed to examine associations between demographic characteristics and knowledge toward communication practices. A p value of < 0.05 was considered to indicate statistical significance. Multivariate analysis was conducted to further determine the relationships between demographic characteristics and knowledge factors related to communication practices. To explore predictors of communication practices, binary logistic regression analysis was conducted. Variables with a p value < 0.25 in the bivariate analysis were included in the multivariable logistic regression model to control for potential confounders. Prior to multivariable analysis, multicollinearity was assessed via variance inflation factor (VIF) analysis. The strength and direction of associations are reported as odds ratios (ORs) with 95% confidence intervals (CIs). Model fit was evaluated via the Hosmer–Lemeshow goodness-of-fit test; a nonsignificant result (p > 0.05) indicated adequate model fit. The final results were presented in both narrative form and tabular summaries to enhance interpretability. Ethics This study was approved by the Padjadjaran University Bandung Research Ethics Committee and was conducted in accordance with the ethical principles of the Declaration of Helsinki. The study was registered under number 2404070555, and the ethical approval certificate was issued under number 783/UN6.KEP/EC/2024. All participants received written information about the study and provided written informed consent prior to participation. Participation was entirely voluntary, and the respondents were informed of their right to withdraw at any time without penalty. All the collected data were anonymized via unique codes and securely stored in password-protected files accessible only to the research team. No monetary compensation was provided; however, the participants received small tokens of appreciation and reimbursement for travel expenses. The study posed no foreseeable physical or psychological risks to the participants. Results The demographic characteristics and knowledge associated with the frequency distribution are the outcomes. The information is displayed in Table 1 . Table 1 presents the demographic characteristics and knowledge levels of the 207 respondents. The majority of the participants were aged 36–45 years (48.8%), female (96.6%), unemployed (71.5%), had attained middle- to upper-level education (58.9%), and were married (94.2%). Most reported incomes below the regional minimum wage (77.3%) and belonged to the Sundanese ethnic group (91.3%). Furthermore, a significant proportion had previously obtained information related to child sexual abuse (CSA) prevention (84.1%). Most respondents had households comprising four or fewer family members (60.4%) and lived with both biological parents and children (73.9%). With respect to caregiving roles, 64.7% of the respondents reported that their biological parents were the primary caregivers. In terms of knowledge, 70% of the respondents were categorized as having poor knowledge regarding CSA prevention. As shown in Table 2 , parental communication practices regarding CSA prevention showed that the majority of the respondents were poor (51.7%), whereas 48.3% were classified as having good communication practices. Chi-square tests were conducted to explore associations between parental communication practices and various demographic variables, including knowledge. As presented in Table 3 , significant associations were found between communication practices and knowledge level (p = 0.015) and ethnic group (p = 0.040). No significant associations were found for other variables, such as age ( p = 0.919), gender ( p = 0.769), occupation ( p = 0.443), education level ( p = 0.212), marital status ( p = 0.889), income level ( p = 0.274), obtaining information on CSA prevention ( p = 0.134), number of family members ( p = 0.304), living at home with children ( p = 0.328), or caring for children at home ( p = 0.938). A multivariate logistic regression analysis was conducted to identify independent predictors of communication practices. The variables entered into the model included those with p values < 0.25 in the bivariate analysis: knowledge ( p = 0.015), education level ( p = 0.212), ethnicity ( p = 0.040), and obtaining information on CSA prevention ( p = 0.134). The results are shown in Table 4 . Table 4 Multivariate logistic regression results showing the odds ratios between demographic characteristics and knowledge toward CSA prevention communication practices. Variabel Independen OR 95% C.I. p value (Constant) 0.192 0.055 Knowledge 2.073 1.114 − 3.860 0.021 Education 0.784 0.485 − 1.269 0.322 Ethnic Group 2.122 1.006 − 4.478 0.048 CSA information 1.709 0.770 − 3.790 0.187 Table 4 shows that knowledge ( p = 0.021) and ethnicity ( p = 0.048) significantly contributed to CSA prevention communication practices. Multivariate analysis revealed that knowledge (OR: 2.073, 95% CI: 1.114–3.860) and ethnicity (OR: 2.122, 95% CI: 1.006–4.478) significantly contributed to CSA prevention communication practices. It was reported that knowledge level contributed 2.073 times more and ethnicity contributed 2.122 times more to CSA prevention communication practices than did other factors. In contrast, CSA information and education did not significantly contribute to CSA prevention communication practices. These findings underscore the critical role of knowledge and cultural background (ethnicity) in shaping effective parental communication practices aimed at preventing CSA. Education level and information exposure alone may not be sufficient to foster these practices without corresponding improvements in knowledge and cultural adaptation. Discussion This study examined the determinants of parental communication practices related to CSA prevention among parents in two regencies of West Java Province, Indonesia. The findings indicate that parental knowledge and ethnicity were significantly associated with communication practices, whereas other demographic factors, such as age, sex, education level, marital status, occupation, ethnicity, income, household size, number of cohabiting family members, and experience accessing CSA prevention information, did not show significant associations. The findings indicate that the majority of parents possess poor knowledge concerning CSA prevention. Parental knowledge in this area appears to be influenced by individual experiences with CSA and specific demographic variables ( 8 ). Parents who have experienced sexual abuse, either personally, through their children, or through other family members, tend to exhibit greater concern regarding CSA ( 8 ), demonstrate an enhanced ability to recognize its signs ( 24 ), and generally possess more comprehensive knowledge on the subject. Conversely, limited exposure to CSA-related experiences or insufficient education on the topic often results in inadequate knowledge ( 7 ), which poses significant challenges to effective communication with children. Consequently, the study revealed that most parents demonstrated inadequate communication practices concerning CSA prevention. The significant correlation between knowledge and communication practices in this study supports findings by Yuniyanti (2020), who reported a strong positive relationship between maternal knowledge and sexuality education communication with children ( 25 ). Parents who maintain consistent, open communication with their children are better positioned to detect early warning signs of CSA through active supervision, such as limiting unsupervised overnight stays, observing behavior changes, and being attentive to children's emotional well-being ( 26 ). To protect children from CSA, parents must possess good knowledge of CSA and teach their children how to protect themselves ( 24 ). Effective CSA prevention depends on parents’ adequate knowledge, which provides confidence and competence to initiate discussions, identify risky behaviors, and teach children how to respond to threats. However, the high prevalence of poor parental knowledge in this study underscores a critical gap in awareness that may hinder prevention efforts. Ethnicity also emerged as a significant factor influencing parental communication practices. With more than 90% of the participants identified as Sundanese, cultural norms and beliefs may have shaped their reluctance to engage in open discussions about sexuality and abuse. In many Indonesian communities, sexuality remains a taboo subject that inhibits open parent–child dialog ( 27 ) ( 28 ). These findings align with those of Nasution et al., who noted that many mothers perceive sex education as taboo, leading to discomfort and avoidance in discussing the subject with children ( 29 ). Nesfechi et al. (2023) further emphasized that cultural beliefs, communication barriers, limited parental skills, and stigma impede the delivery of sex education ( 30 ). Additionally, fear of social judgment may discourage parents from addressing sexual topics because of concerns about being misinterpreted or criticized ( 10 ). There is also a common misconception that educating children about sexuality may promote inappropriate behavior ( 10 ). These cultural and perceptual barriers present substantial challenges to effectively communicating CSA prevention information. Addressing such misconceptions is essential, as cultural norms significantly shape parental communication practices—an essential element in protecting children from CSA ( 10 ). Interestingly, variables such as education level, obtaining information on CSA prevention, age, gender, occupation, marital status, income, number of family members, cohabitation with children, or the primary caregiver of the child at home did not significantly influence communication practices in this study. These results diverge from those of several previous studies. For example, Li et al. reported that low maternal education is a risk factor for CSA, suggesting that educational attainment contributes to greater awareness of prevention strategies ( 31 ). In this study, the majority of the respondents had completed high school. Higher levels of education are generally associated with an enhanced ability to understand and process information related to CSA prevention. The literature suggests that increased parental education contributes to greater awareness and understanding of CSA prevention strategies ( 32 ). Similarly, this study did not find a significant relationship between having received CSA prevention information and communication practices, in contrast with Zhang et al. (2020), who reported that access to CSA-related information significantly improved communication practices ( 33 ). A lack of exposure to CSA prevention information among parents often leads to inadequate communication practices. Guastaferro et al. (2022) reported that nearly half of their participants had never received formal CSA prevention training, pointing to major gaps in professional preparedness. ( 34 ). Such deficiencies in information and training can limit parents’ capacity to engage in effective CSA communication with their children. Parental age also showed no association with communication practices, which is inconsistent with the findings of Zhang (2020), who identified parental age as a contributing factor in the provision of CSA education ( 33 ). This finding is consistent with those reported by AlRammah et al. (2019), who reported that there was no significant relationship between parental age and communication practices concerning CSA ( 24 ). The lack of an association between gender and communication practices in this study contrasts with the findings of AlRammah et al. (2019), who reported that gender was a significant determinant ( 24 ). In the current study, the majority of the respondents were female. Prior research by Babatsikos (2010) suggests that fathers are generally less likely than mothers to engage in discussions about CSA prevention ( 35 ). Additionally, gender differences have been observed in CSA knowledge, with mothers typically reporting a higher level of understanding than fathers do ( 36 ). Marital status was also not associated with communication practices in this study, again contradicting findings by AlRammah et al. (2019), where marital status was identified as a significant factor ( 24 ). Nesfechi et al. (2023) reported that mothers living with partners tend to exert greater control over children's exposure to sexual content, thus reducing CSA risk ( 30 ). Conversely, risk factors for CSA include the absence of a father figure (37) ( 38 ) ( 39 ), an orphan status ( 37 , 40 ), and being unmarried ( 41 ). Parental presence and involvement play critical roles in providing care, protection, and supervision for children. Parental presence and involvement are essential for supervision and protection, particularly during a child’s formative years ( 42 ) ( 43 ). Additionally, no significant relationship was observed between parental occupation or income and CSA-related communication, which differs from the findings of AlRammah et al. (2019). ( 24 ). Economic factors, particularly income, play crucial roles in CSA prevention, as poverty ( 43 , 44 ) and low socioeconomic status ( 31 ) have been consistently identified as risk factors contributing to the vulnerability of children to CSA. Most study participants lived in nuclear families with four or fewer members, suggesting manageable household sizes. However, the literature indicates that overcrowded households, parental separation or divorce, and the presence of stepfathers or nonbiological caregivers increase the risk of CSA. As noted by Cant et al. (2019) and Meinck et al. (2017), limited living space and densely populated households can increase the risk of CSA ( 40 , 45 ). Additionally, the composition of the household is significant, specifically whether the child resides with biological family members or with extended or nonrelatives within the same household. Risk factors include parental separation or divorce ( 42 , 46 ), the presence of a stepfather ( 47 ), orphanhood ( 37 , 40 ), and children not living with their biological parents ( 48 , 49 ). Furthermore, the identity and role of the child’s primary caregiver are critical. Insufficient parental or caregiver supervision ( 40 ), abusive behavior by caregivers ( 50 ) ( 51 ) ( 52 ), caregivers’ limited knowledge of the child ( 53 ), inadequate monitoring of the child's activities ( 31 , 53 ), low levels of social support, and poor caregiver‒child relationships ( 53 ) are all factors that may increase the risk of CSA. These findings highlight that in the Indonesian context, especially in more homogenous or traditional communities, cultural and cognitive factors may play a more dominant role than socioeconomic status alone. The use of a cross-sectional design, while appropriate for identifying associations, limits causal interpretation. Furthermore, reliance on self-reported practices could be subject to social desirability bias, particularly given the sensitive nature of the topic. Despite these limitations, the study offers critical empirical insights for designing culturally responsive interventions that enhance parental knowledge and support effective CSA communication strategies. Future school-based programs should incorporate culturally tailored strategies that actively involve parents as key agents in child protection. Strengths and Limitations This study has several strengths. First, it addresses an important and underexplored area in CSA prevention, particularly in the context of a low-to-middle-income country (LMIC), such as Indonesia. This study is the first in Indonesia to explore the influence of demographic characteristics and parental knowledge on communication practices related to CSA prevention, which is a significant contribution to the field. By examining parental communication practices and their determinants, this study contributes valuable knowledge to the global discourse on CSA prevention. Second, the study focuses not only on demographic characteristics but also on cognitive factors such as parental knowledge, offering a more comprehensive understanding of what influences communication practices. Third, the use of multivariate logistic regression strengthens the analytical rigor by allowing for adjustment of potential confounders and identifying independent associations between knowledge, ethnicity, and communication practices. Fourth, the sample consists of parents from two regencies in West Java Province, providing insights from a community-based perspective in a culturally rich setting. Finally, the use of a structured, culturally adapted, and pretested questionnaire administered through an accessible digital platform enhances the relevance and reliability of the collected data. However, this study also has several limitations. The cross-sectional design precludes the ability to draw causal inferences among knowledge, ethnicity, and communication practices. The reliance on self-reported data raises concerns about potential reporting bias, particularly given the socially sensitive nature of the topic. Additionally, the predominance of Sundanese ethnicity among participants may limit the generalizability of the findings to other ethnic or cultural groups within Indonesia. The absence of a qualitative component restricts the depth of understanding regarding contextual and sociocultural factors influencing parental behavior. Furthermore, the exclusive use of online data collection may have introduced selection bias, potentially excluding parents with limited access to technology or lower digital literacy. Conclusion and implications This study revealed that most parents in the sample, who were predominantly identified as Sundanese, demonstrated limited knowledge and engaged in suboptimal communication practices related to CSA prevention. Despite widespread parental involvement, the overall low levels of knowledge and protective communication behaviors reveal critical vulnerability in current prevention efforts. Parents with greater CSA-related knowledge were significantly more likely to engage in preventive dialog with their children, whereas ethnic background emerged as a culturally sensitive factor shaping communication dynamics. Parental knowledge and ethnic background emerged as significant factors influencing how parents communicate with their children about CSA. These findings suggest that both cognitive and cultural dimensions play a central role in shaping parental behavior in CSA prevention. Strengthening parents’ knowledge and addressing culturally specific contexts may enhance their capacity to engage in effective and proactive communication with their children regarding personal safety and abuse prevention. The results highlight the need for culturally responsive and knowledge-driven interventions to promote effective parental communication in the context of CSA prevention. Educational programs targeting parents should be adapted to the cultural and social realities of the communities they serve, particularly in regions where cultural norms influence communication styles and parental roles. Culturally appropriate approaches—delivered through schools, community health services, and local or religious leaders—can improve parental understanding and acceptance of CSA prevention messaging. Efforts should prioritize empowering parents with the skills, confidence, and language needed to have open, age-appropriate discussions with their children about sensitive issues. Future research should further investigate the sociocultural mechanisms at play and evaluate the long-term impact of targeted prevention programs. Policymakers and program developers are encouraged to integrate CSA prevention communication strategies into national family and child protection initiatives. Supporting parents through structured education and ongoing community-based outreach can play a key role in strengthening family-based prevention and reducing children’s vulnerability to abuse. Finally, this study contributes to the body of knowledge in nursing science by offering practical insights that can inform future research and guide the development of parent-involved, school-based CSA prevention strategies. Declarations Acknowledgments We would like to thank the Director of Research and Community Services at Universitas Padjadjaran, who funded this research. Funding The research described in this paper was financially supported by a grant from the Riset Kompetensi Dosen Unpad (RKDU), grant 2024. Disclosure The authors declare that they have no conflicts of interest. Ethics approval and consent to participate This study was approved by the Padjadjaran University Bandung Research Ethics Committee and authorized this study, which complies with the ethical criteria of the Declaration of Helsinki. Its registration number is 2404070555, and its ethical approval certificate number is 783/UN6.KEP/EC/2024. For every participant, an informed consent form was collected. Confidentiality was assured through the use of a self-administered, anonymous questionnaire. The participants may withdraw from the study at any time and choose not to answer the question. The researcher protected the respondents' information. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement (54). Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author, [TS], on reasonable request. Competing interests The authors declare that they have no conflicts of interest. References Zhang Y, Zuo X, Mao Y, Lian Q, Luo S, Zhang S, et al. Co-occurrence subgroups of child sexual abuse, health risk behaviors and their associations among secondary school students in China. BMC Public Health. 2021;21(1):1139. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. 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Journal of Education Practice. 2016;7(13):116-23. Khanjari S, Modabber M, Rahmati M, Haghani H. Knowledge, Attitudes and Practices among Parents of School-age Children after Child Sexual abuse Prevention Education Iran Journal of Nursing. 2017;29(104):17-27. Gümüş F, Duman M, Dolu R. Child sexual abuse knowledge and attitudes of Syrian refugee parents and related factors. Journal of Pediatric Nursing. 2024. Jin Y, Chen J, Jiang Y, Yu B. 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. 2017;32(4):364-73. AlRammah AA, Alqahtani SM, Al-Saleh SS, Wajid S, Babiker AG, Al-Mana AAK, et al. Parent–child communication and preventive practices for child sexual abuse among the general population: A community-based study. Journal of Taibah University Medical Sciences. 2019;14(4):363-9. Yuniyanti E. Analisis Faktor yang Mempengaruhi Kejadian Kekerasan Seksual terhadap Anak di Pusat Pelayanan Terpadu kota Semarang. Semarang: Program Studi Kesehatan Masyarakat Pascasarjana Universitas Negeri Semarang. 2020. Wong PY, How, C. H., & Yi Wong, P. C.,. Management of child abuse. Singapore Med J. 2013;54(10):533-7. Murray LK, Nguyen A, Cohen JA. Child sexual abuse. Child and Adolescent Psychiatric Clinics. 2014;23(2):321-37. Justicia R. Program Underwear Rules Untuk Mencegah Kekerasan Seksual Pada Anak Usia Dini. Jurnal Pendidikan Usia Dini. 2015;9(2):217-32. Nasution F, Rusman AA, Apriadi P. The parent perception of early sex education in children at simatahari village, the sub district of kotapinang, the district of labuhanbatu selatan. International Journal on Language, Research Education Studies. 2019;3(1):85-93. Nesfechi EF, Pouralizadeh M, Khalesi ZB, Maroufizadeh S. Approaches and styles of mothers in sex education process of children and the related factors. BMC Nursing. 2023;22(1):253. Li N, Zabin LS, Ahmed S. The childhood sexual abuse among youth in three Asian cities: Taipei, Shanghai, and Hanoi. Asia Pac J Public Health. 2015;27(2):22. Alzoubi FA, Ali RA, Flah IH, Alnatour A. Mothers’ knowledge & perception about child sexual abuse in Jordan. Child abuse & neglect. 2018;75:149-58. Zhang W, Ren P, Yin G, Li H, Jin Y. Sexual Abuse Prevention Education for Preschool-Aged Children: Parents’ Attitudes, Knowledge and Practices in Beijing, China. Journal of Child Sexual Abuse. 2020;29(3):295-311. https://doi.org/10.1080/10538712.2019.1709240. Guastaferro K, Felt JM, Font SA, Connell CM, Miyamoto S, Zadzora KM, et al. Parent-Focused Sexual Abuse Prevention: Results From a Cluster Randomized Trial. Child Maltreatment. 2020;27(1):114-25. Babatsikos G. Parents' knowledge, attitudes and practices about preventing child sexual abuse: a literature review. Child Abuse Review. 2010;19(2):107-29. Bakarman MA, Eljaaly ZO. Preventing Child Sexual Abuse, What Parents Know? Annals of King Edward Medical University. 2017;23(3). Kidman R, Palermo T. The relationship between parental presence and child sexual violence: evidence from thirteen countries in sub-Saharan Africa. Child abuse & neglect. 2016;51:172-80. Laaksonen T, Sariola H, Johansson A, Jern P, Varjonen M, von der Pahlen B, et al. Changes in the prevalence of child sexual abuse, its risk factors, and their associations as a function of age cohort in a Finnish population sample. Child abuse & neglect. 2011;35(7):480-90. Bebbington PE, Jonas S, Brugha T, Meltzer H, Jenkins R, Cooper C, et al. Child sexual abuse reported by an English national sample: characteristics and demography. Social psychiatry and psychiatric epidemiology. 2011;46(3):255-62. Meinck F, Cluver LD, Boyes ME. Longitudinal Predictors of Child Sexual Abuse in a Large Community-Based Sample of South African Youth. Journal of Interpersonal Violence. 2017;32(18):2804-36. Levenson JS, Grady MD. The influence of childhood trauma on sexual violence and sexual deviance in adulthood. Traumatology. 2016;22(2):94-103. Pérez-Fuentes G, Olfson M, Villegas L, Morcillo C, Wang S, Blanco C. Prevalence and correlates of child sexual abuse: a national study. Comprehensive Psychiatry. 2013;54(1):16-27. Butler AC. Child sexual assault: risk factors for girls. Child Abuse Negl. 2013;37(9):643-52. MacMillan HL, Tanaka M, Duku E, Vaillancourt T, Boyle MH. Child physical and sexual abuse in a community sample of young adults: Results from the Ontario Child Health Study. Child abuse & neglect. 2013;37(1):14-21. Cant RL, O'Donnell M, Sims S, Harries M. Overcrowded housing: One of a constellation of vulnerabilities for child sexual abuse. Child abuse & neglect. 2019;93:239-48. Palusci VJ, Ilardi M. Risk Factors and Services to Reduce Child Sexual Abuse Recurrence. Child maltreatment. 2019:1077559519848489-. Ayan S, Bilican Gökkaya V. Child sexual abuse: The relationship between the type of abuse and the risk factors. 2018. Perera B, Ostbye T. Prevalence and correlates of sexual abuse reported by late adolescent school children in Sri Lanka. Int J Adolesc Med Health. 2009;21(2):203-11. Tordon R, Svedin CG, Fredlund C, Jonsson L, Priebe G, Sydsjo G. Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample. Nord J Psychiatry. 2019;73(1):16-23. Sinanan AN. The impact of child, family, and child protective services factors on reports of child sexual abuse recurrence. J Child Sex Abus. 2011;20(6):657-76. Pereda N, Abad J, Guilera G. Lifetime Prevalence and Characteristics of Child Sexual Victimization in a Community Sample of Spanish Adolescents. J Child Sex Abus. 2016;25(2):142-58. Maier T, Mohler-Kuo M, Landolt MA, Schnyder U, Jud A. The tip of the iceberg. Incidence of disclosed cases of child sexual abuse in Switzerland: results from a nationwide agency survey. International journal of public health. 2013;58(6):875-83. Ward CL, Artz L, Leoschut L, Kassanjee R, Burton P. Sexual violence against children in South Africa: a nationally representative cross-sectional study of prevalence and correlates. The Lancet Global health. 2018;6(4):e460-e8. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. International Journal of Surgery. 2014;12(12):1495-9. Table 1 to 3 Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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In recent decades, CSA has transcended national, continental, and socioeconomic boundaries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Children are especially vulnerable to abuse because of their developmental immaturity and limited capacity for self-protection (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Indonesia, CSA remains a critical concern. According to the Ministry of Women\u0026rsquo;s Empowerment and Child Protection (Kemen PPPA), 9,588 CSA cases were reported in 2022 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCSA leads to numerous adverse outcomes, including both physical and psychological harm, that may begin in childhood (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and persist into adulthood (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Children require consistent attention and protection to ensure healthy physical, mental, and social development (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Parents play a central role in safeguarding children through education about personal safety and CSA prevention (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Studies suggest that prevention efforts should focus on family members, particularly parents, because children typically form stronger attachments with them than with teachers or peers (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Therefore, parents and guardians should be equipped through structured programs to prevent their children from becoming victims of CSA (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). As part of a bottom-up approach to crime prevention, parents should transfer this knowledge to their children through open parent\u0026ndash;child communication (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The family, as the primary socializing agent, serves as an effective medium for implementing this strategy (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Effective prevention requires proactive, family-centered approaches, where parents function as the first and most critical line of defense through open, age-appropriate communication. Both mothers and fathers play vital roles in ensuring children's safety. Since adult involvement enhances the efficacy of prevention programs (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), engaging parents is essential for CSA prevention efforts (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, many Indonesian parents lack sufficient knowledge or confidence to address CSA (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Research by Solehati et al. revealed that many parents are uninformed about CSA, feel uncomfortable discussing it (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), and struggle to implement prevention strategies effectively (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This limited knowledge directly influences how, or whether, parents discuss sensitive topics such as body safety and sexual abuse with their children.\u003c/p\u003e \u003cp\u003eIn low- and middle-income countries (LMICs), such as Indonesia, conversations about CSA are often constrained by cultural taboos and socioreligious norms. These barriers restrict open dialog and prevent the development of effective parent\u0026ndash;child communication on topics related to sexuality and abuse. Consequently, many parents lack both the knowledge and skills required to empower their children to recognize, avoid, and report abuse. Encouraging children to confide with trusted adults, especially their parents, can provide a crucial layer of protection (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Poor parent\u0026ndash;child communication has been identified as a risk factor for CSA, whereas strong familial bonds are recognized as protective (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Among the most effective prevention strategies are active, informed communication between parents and children (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Through such interactions, experienced adults can teach children to identify and avoid abusive behavior (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne effective way to address CSA is to strengthen preventive communication before abuse occurs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Strong communication skills are essential for parents to educate their children about personal safety. Various factors influence parent‒child communication, including socioeconomic status, religious beliefs, stigma, and the misconception that sex education promotes deviant behavior (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Demographic characteristics, such as age, sex, education level, marital status, employment, ethnicity, income, family structure, number of cohabiting family members, and access to CSA-related information, are also believed to shape parental communication practices.\u003c/p\u003e \u003cp\u003eAlthough studies have explored the role of parents in CSA prevention in countries such as Syria (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and China (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), there is limited empirical evidence from LMICs, including Indonesia. Much of the available literature is qualitative or descriptive and does not systematically examine how parental knowledge and demographic characteristics influence communication practices. Furthermore, no quantitative studies have explored this issue in Bandung and Sumedang Regencies, two culturally diverse regions in West Java, where local norms and family dynamics may substantially influence CSA prevention practices. Given this limitation, further investigation is necessary to understand how parents communicate with their children about CSA prevention and what factors influence these practices.\u003c/p\u003e \u003cp\u003eThis research is the first to explore the factors associated with parents\u0026rsquo; communication practices in the context of CSA prevention in Indonesia. This study aims to identify and analyze the factors associated with parents\u0026rsquo; communication practices in the context of CSA prevention. Using a cross-sectional design, the study surveyed parents of elementary school-aged children in Bandung and Sumedang Regencies and assessed the influence of key demographic factors (including age, sex, education level, marital status, occupation, ethnicity, income, household size, number of cohabiting family members, and experience accessing CSA prevention information) and parental knowledge on communication behavior. The findings from this research are expected to inform the development of culturally sensitive, evidence-based, family-centered interventions while contributing to the broader discourse on child protection in Indonesia and other LMICs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eThis cross-sectional quantitative study was conducted between March and December 2024 in West Java, Indonesia, specifically at two elementary schools in Bandung Regency and two elementary schools in Sumedang Regency. These locations were selected because of the relatively high prevalence of child sexual abuse (CSA) cases reported in these areas.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and procedure\u003c/h3\u003e\n\u003cp\u003eData were collected from parents whose children were enrolled in the selected schools. Using G*Power software, the required sample size was calculated on the basis of a significance level of 0.05, a statistical power of 0.80, a 95% confidence interval, and a medium effect size (0.3), yielding a minimum sample size of 111. A total of 234 parents were invited to participate, of whom 207 voluntarily consented, whereas 27 declined.\u003c/p\u003e \u003cp\u003eThe eligibility criteria included (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) being the parent or guardian of an elementary school-aged child enrolled in one of the four selected schools, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) being in good physical and mental health, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) being able to read and understand Indonesians, and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) owning a smartphone to access the online survey.\u003c/p\u003e \u003cp\u003eStratified random sampling was employed to recruit participants. The researchers introduced the study's objectives and provided instructions on how to complete the questionnaire. Informed consent was obtained from those who agreed to participate in the study. Informed consent was obtained from all participants prior to data collection. Each participant received a unique numerical code to maintain anonymity throughout the study process.\u003c/p\u003e \u003cp\u003eThe survey was administered via a self-reported online questionnaire that was completed during a 40-minute session at each school in a private setting. The study team arranged seating to minimize interaction among participants and ensure confidentiality. The respondents were informed of their right to withdraw at any time or to skip any questions. The researchers ensured that all the information remained confidential and safeguarded the participants' identities.\u003c/p\u003e\n\u003ch3\u003eData collection tools\u003c/h3\u003e\n\u003cp\u003eA structured, self-administered questionnaire developed on the Google Form platform was used to gather data on participants\u0026rsquo; demographic characteristics, knowledge, and communication practices related to CSA prevention. The questionnaire was developed by the research team on the basis of validated concepts and findings from prior CSA-related studies. The questionnaire was reviewed by four independent experts to ensure readability and comprehensibility. Its reliability and validity were previously tested on a sample of 295 parents and teachers in Bandung Regency and Bandung City. The Cronbach's alpha values for the communication practices and knowledge components were 0.608 and 0.776, respectively. The validity coefficients ranged from 0.191\u0026ndash;0.674 for communication practices and 0.202\u0026ndash;0.550 for knowledge items. It consists of three parts:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe demographic characteristics included age, sex, education level, marital status, occupation, ethnicity, monthly income, number of family members, number of cohabiting family members, number of people who have cared for children at home, and prior exposure to CSA-related information.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eKnowledge about CSA: Comprises 30 multiple-choice items covering a wide range of topics, including definitions, types, risk factors, perpetrators, symptoms, legal regulations, prevention strategies, stigma, and reporting mechanisms. Each item offered three response options: one correct and two incorrect. Correct answers were scored as \u0026ldquo;1\u0026rdquo; and incorrect answers as \u0026ldquo;0\u0026rdquo;; reverse scoring was applied for negatively phrased questions. The total knowledge score ranged from 0\u0026ndash;30, and knowledge was classified as \u003cem\u003egood\u003c/em\u003e (\u0026ge;\u0026thinsp;80%) or \u003cem\u003epoor\u003c/em\u003e (\u0026lt;\u0026thinsp;80%).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe communication practices included 17 items addressing parents' practices regarding CSA prevention, such as teaching children about body autonomy, personal boundaries, avoiding strangers, recognizing signs of CSA, and accessing educational materials. The responses were scored via a 4-point Likert scale (1\u0026thinsp;=\u0026thinsp;never, 2\u0026thinsp;=\u0026thinsp;sometimes, 3\u0026thinsp;=\u0026thinsp;often, 4\u0026thinsp;=\u0026thinsp;always). Negatively worded items were reverse-coded. The total scores ranged from 17\u0026ndash;68, with \u003cem\u003egood communication practices\u003c/em\u003e defined as scores\u0026thinsp;\u0026ge;\u0026thinsp;80% and \u003cem\u003epoor\u003c/em\u003e communication practices defined as scores\u0026thinsp;\u0026lt;\u0026thinsp;80%.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAll the statistical analyses were conducted via SPSS software. Descriptive statistics (percentages) were used to summarize demographic variables, knowledge, and communication practices. Chi-square tests were performed to examine associations between demographic characteristics and knowledge toward communication practices. A p value of \u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance. Multivariate analysis was conducted to further determine the relationships between demographic characteristics and knowledge factors related to communication practices. To explore predictors of communication practices, binary logistic regression analysis was conducted. Variables with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariate analysis were included in the multivariable logistic regression model to control for potential confounders. Prior to multivariable analysis, multicollinearity was assessed via variance inflation factor (VIF) analysis. The strength and direction of associations are reported as odds ratios (ORs) with 95% confidence intervals (CIs). Model fit was evaluated via the Hosmer\u0026ndash;Lemeshow goodness-of-fit test; a nonsignificant result (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) indicated adequate model fit. The final results were presented in both narrative form and tabular summaries to enhance interpretability.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003e This study was approved by the Padjadjaran University Bandung Research Ethics Committee and was conducted in accordance with the ethical principles of the Declaration of Helsinki. The study was registered under number 2404070555, and the ethical approval certificate was issued under number 783/UN6.KEP/EC/2024. All participants received written information about the study and provided written informed consent prior to participation. Participation was entirely voluntary, and the respondents were informed of their right to withdraw at any time without penalty. All the collected data were anonymized via unique codes and securely stored in password-protected files accessible only to the research team. No monetary compensation was provided; however, the participants received small tokens of appreciation and reimbursement for travel expenses. The study posed no foreseeable physical or psychological risks to the participants.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic characteristics and knowledge associated with the frequency distribution are the outcomes. The information is displayed in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic characteristics and knowledge levels of the 207 respondents. The majority of the participants were aged 36\u0026ndash;45 years (48.8%), female (96.6%), unemployed (71.5%), had attained middle- to upper-level education (58.9%), and were married (94.2%). Most reported incomes below the regional minimum wage (77.3%) and belonged to the Sundanese ethnic group (91.3%). Furthermore, a significant proportion had previously obtained information related to child sexual abuse (CSA) prevention (84.1%). Most respondents had households comprising four or fewer family members (60.4%) and lived with both biological parents and children (73.9%). With respect to caregiving roles, 64.7% of the respondents reported that their biological parents were the primary caregivers. In terms of knowledge, 70% of the respondents were categorized as having \u003cem\u003epoor\u003c/em\u003e knowledge regarding CSA prevention.\u003c/div\u003e\n\u003cdiv\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, parental communication practices regarding CSA prevention showed that the majority of the respondents were poor (51.7%), whereas 48.3% were classified as having \u003cem\u003egood\u003c/em\u003e communication practices.\u003c/div\u003e\n\u003cdiv\u003eChi-square tests were conducted to explore associations between parental communication practices and various demographic variables, including knowledge. As presented in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, significant associations were found between communication practices and knowledge level (p\u0026thinsp;=\u0026thinsp;0.015) and ethnic group (p\u0026thinsp;=\u0026thinsp;0.040). No significant associations were found for other variables, such as age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.919), gender (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.769), occupation (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.443), education level (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.212), marital status (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.889), income level (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.274), obtaining information on CSA prevention (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134), number of family members (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.304), living at home with children (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.328), or caring for children at home (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.938).\u003c/div\u003e\n\u003cp\u003eA multivariate logistic regression analysis was conducted to identify independent predictors of communication practices. The variables entered into the model included those with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariate analysis: knowledge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015), education level (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.212), ethnicity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040), and obtaining information on CSA prevention (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134). The results are shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate logistic regression results showing the odds ratios between demographic characteristics and knowledge toward CSA prevention communication practices.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariabel Independen\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95% C.I.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;3.860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;1.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthnic Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;4.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCSA information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;3.790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows that knowledge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021) and ethnicity (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048) significantly contributed to CSA prevention communication practices. Multivariate analysis revealed that knowledge (OR: 2.073, 95% CI: 1.114\u0026ndash;3.860) and ethnicity (OR: 2.122, 95% CI: 1.006\u0026ndash;4.478) significantly contributed to CSA prevention communication practices. It was reported that knowledge level contributed 2.073 times more and ethnicity contributed 2.122 times more to CSA prevention communication practices than did other factors. In contrast, CSA information and education did not significantly contribute to CSA prevention communication practices.\u003c/p\u003e\n\u003cp\u003eThese findings underscore the critical role of knowledge and cultural background (ethnicity) in shaping effective parental communication practices aimed at preventing CSA. Education level and information exposure alone may not be sufficient to foster these practices without corresponding improvements in knowledge and cultural adaptation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the determinants of parental communication practices related to CSA prevention among parents in two regencies of West Java Province, Indonesia. The findings indicate that parental knowledge and ethnicity were significantly associated with communication practices, whereas other demographic factors, such as age, sex, education level, marital status, occupation, ethnicity, income, household size, number of cohabiting family members, and experience accessing CSA prevention information, did not show significant associations. The findings indicate that the majority of parents possess poor knowledge concerning CSA prevention. Parental knowledge in this area appears to be influenced by individual experiences with CSA and specific demographic variables (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Parents who have experienced sexual abuse, either personally, through their children, or through other family members, tend to exhibit greater concern regarding CSA (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), demonstrate an enhanced ability to recognize its signs (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and generally possess more comprehensive knowledge on the subject. Conversely, limited exposure to CSA-related experiences or insufficient education on the topic often results in inadequate knowledge (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), which poses significant challenges to effective communication with children.\u003c/p\u003e \u003cp\u003eConsequently, the study revealed that most parents demonstrated inadequate communication practices concerning CSA prevention. The significant correlation between knowledge and communication practices in this study supports findings by Yuniyanti (2020), who reported a strong positive relationship between maternal knowledge and sexuality education communication with children (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Parents who maintain consistent, open communication with their children are better positioned to detect early warning signs of CSA through active supervision, such as limiting unsupervised overnight stays, observing behavior changes, and being attentive to children's emotional well-being (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). To protect children from CSA, parents must possess good knowledge of CSA and teach their children how to protect themselves (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Effective CSA prevention depends on parents\u0026rsquo; adequate knowledge, which provides confidence and competence to initiate discussions, identify risky behaviors, and teach children how to respond to threats. However, the high prevalence of poor parental knowledge in this study underscores a critical gap in awareness that may hinder prevention efforts.\u003c/p\u003e \u003cp\u003eEthnicity also emerged as a significant factor influencing parental communication practices. With more than 90% of the participants identified as Sundanese, cultural norms and beliefs may have shaped their reluctance to engage in open discussions about sexuality and abuse. In many Indonesian communities, sexuality remains a taboo subject that inhibits open parent\u0026ndash;child dialog (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). These findings align with those of Nasution et al., who noted that many mothers perceive sex education as taboo, leading to discomfort and avoidance in discussing the subject with children (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Nesfechi et al. (2023) further emphasized that cultural beliefs, communication barriers, limited parental skills, and stigma impede the delivery of sex education (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Additionally, fear of social judgment may discourage parents from addressing sexual topics because of concerns about being misinterpreted or criticized (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). There is also a common misconception that educating children about sexuality may promote inappropriate behavior (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These cultural and perceptual barriers present substantial challenges to effectively communicating CSA prevention information. Addressing such misconceptions is essential, as cultural norms significantly shape parental communication practices\u0026mdash;an essential element in protecting children from CSA (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInterestingly, variables such as education level, obtaining information on CSA prevention, age, gender, occupation, marital status, income, number of family members, cohabitation with children, or the primary caregiver of the child at home did not significantly influence communication practices in this study. These results diverge from those of several previous studies. For example, Li et al. reported that low maternal education is a risk factor for CSA, suggesting that educational attainment contributes to greater awareness of prevention strategies (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In this study, the majority of the respondents had completed high school. Higher levels of education are generally associated with an enhanced ability to understand and process information related to CSA prevention. The literature suggests that increased parental education contributes to greater awareness and understanding of CSA prevention strategies (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, this study did not find a significant relationship between having received CSA prevention information and communication practices, in contrast with Zhang et al. (2020), who reported that access to CSA-related information significantly improved communication practices (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). A lack of exposure to CSA prevention information among parents often leads to inadequate communication practices. Guastaferro et al. (2022) reported that nearly half of their participants had never received formal CSA prevention training, pointing to major gaps in professional preparedness. (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Such deficiencies in information and training can limit parents\u0026rsquo; capacity to engage in effective CSA communication with their children.\u003c/p\u003e \u003cp\u003eParental age also showed no association with communication practices, which is inconsistent with the findings of Zhang (2020), who identified parental age as a contributing factor in the provision of CSA education (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). This finding is consistent with those reported by AlRammah et al. (2019), who reported that there was no significant relationship between parental age and communication practices concerning CSA (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe lack of an association between gender and communication practices in this study contrasts with the findings of AlRammah et al. (2019), who reported that gender was a significant determinant (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In the current study, the majority of the respondents were female. Prior research by Babatsikos (2010) suggests that fathers are generally less likely than mothers to engage in discussions about CSA prevention (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Additionally, gender differences have been observed in CSA knowledge, with mothers typically reporting a higher level of understanding than fathers do (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMarital status was also not associated with communication practices in this study, again contradicting findings by AlRammah et al. (2019), where marital status was identified as a significant factor (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Nesfechi et al. (2023) reported that mothers living with partners tend to exert greater control over children's exposure to sexual content, thus reducing CSA risk (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Conversely, risk factors for CSA include the absence of a father figure (37) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), an orphan status (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), and being unmarried (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Parental presence and involvement play critical roles in providing care, protection, and supervision for children. Parental presence and involvement are essential for supervision and protection, particularly during a child\u0026rsquo;s formative years (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, no significant relationship was observed between parental occupation or income and CSA-related communication, which differs from the findings of AlRammah et al. (2019). (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Economic factors, particularly income, play crucial roles in CSA prevention, as poverty (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) and low socioeconomic status (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) have been consistently identified as risk factors contributing to the vulnerability of children to CSA.\u003c/p\u003e \u003cp\u003eMost study participants lived in nuclear families with four or fewer members, suggesting manageable household sizes. However, the literature indicates that overcrowded households, parental separation or divorce, and the presence of stepfathers or nonbiological caregivers increase the risk of CSA. As noted by Cant et al. (2019) and Meinck et al. (2017), limited living space and densely populated households can increase the risk of CSA (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Additionally, the composition of the household is significant, specifically whether the child resides with biological family members or with extended or nonrelatives within the same household. Risk factors include parental separation or divorce (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), the presence of a stepfather (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), orphanhood (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), and children not living with their biological parents (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Furthermore, the identity and role of the child\u0026rsquo;s primary caregiver are critical. Insufficient parental or caregiver supervision (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), abusive behavior by caregivers (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e), caregivers\u0026rsquo; limited knowledge of the child (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), inadequate monitoring of the child's activities (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), low levels of social support, and poor caregiver‒child relationships (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e) are all factors that may increase the risk of CSA.\u003c/p\u003e \u003cp\u003eThese findings highlight that in the Indonesian context, especially in more homogenous or traditional communities, cultural and cognitive factors may play a more dominant role than socioeconomic status alone.\u003c/p\u003e \u003cp\u003eThe use of a cross-sectional design, while appropriate for identifying associations, limits causal interpretation. Furthermore, reliance on self-reported practices could be subject to social desirability bias, particularly given the sensitive nature of the topic.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study offers critical empirical insights for designing culturally responsive interventions that enhance parental knowledge and support effective CSA communication strategies. Future school-based programs should incorporate culturally tailored strategies that actively involve parents as key agents in child protection.\u003c/p\u003e"},{"header":"Strengths and Limitations","content":"\u003cp\u003eThis study has several strengths. First, it addresses an important and underexplored area in CSA prevention, particularly in the context of a low-to-middle-income country (LMIC), such as Indonesia. This study is the first in Indonesia to explore the influence of demographic characteristics and parental knowledge on communication practices related to CSA prevention, which is a significant contribution to the field. By examining parental communication practices and their determinants, this study contributes valuable knowledge to the global discourse on CSA prevention. Second, the study focuses not only on demographic characteristics but also on cognitive factors such as parental knowledge, offering a more comprehensive understanding of what influences communication practices. Third, the use of multivariate logistic regression strengthens the analytical rigor by allowing for adjustment of potential confounders and identifying independent associations between knowledge, ethnicity, and communication practices. Fourth, the sample consists of parents from two regencies in West Java Province, providing insights from a community-based perspective in a culturally rich setting. Finally, the use of a structured, culturally adapted, and pretested questionnaire administered through an accessible digital platform enhances the relevance and reliability of the collected data.\u003c/p\u003e \u003cp\u003eHowever, this study also has several limitations. The cross-sectional design precludes the ability to draw causal inferences among knowledge, ethnicity, and communication practices. The reliance on self-reported data raises concerns about potential reporting bias, particularly given the socially sensitive nature of the topic. Additionally, the predominance of Sundanese ethnicity among participants may limit the generalizability of the findings to other ethnic or cultural groups within Indonesia. The absence of a qualitative component restricts the depth of understanding regarding contextual and sociocultural factors influencing parental behavior. Furthermore, the exclusive use of online data collection may have introduced selection bias, potentially excluding parents with limited access to technology or lower digital literacy.\u003c/p\u003e "},{"header":"Conclusion and implications","content":"\u003cp\u003eThis study revealed that most parents in the sample, who were predominantly identified as Sundanese, demonstrated limited knowledge and engaged in suboptimal communication practices related to CSA prevention. Despite widespread parental involvement, the overall low levels of knowledge and protective communication behaviors reveal critical vulnerability in current prevention efforts. Parents with greater CSA-related knowledge were significantly more likely to engage in preventive dialog with their children, whereas ethnic background emerged as a culturally sensitive factor shaping communication dynamics. Parental knowledge and ethnic background emerged as significant factors influencing how parents communicate with their children about CSA. These findings suggest that both cognitive and cultural dimensions play a central role in shaping parental behavior in CSA prevention. Strengthening parents’ knowledge and addressing culturally specific contexts may enhance their capacity to engage in effective and proactive communication with their children regarding personal safety and abuse prevention.\u003c/p\u003e\u003cp\u003eThe results highlight the need for culturally responsive and knowledge-driven interventions to promote effective parental communication in the context of CSA prevention. Educational programs targeting parents should be adapted to the cultural and social realities of the communities they serve, particularly in regions where cultural norms influence communication styles and parental roles. Culturally appropriate approaches—delivered through schools, community health services, and local or religious leaders—can improve parental understanding and acceptance of CSA prevention messaging. Efforts should prioritize empowering parents with the skills, confidence, and language needed to have open, age-appropriate discussions with their children about sensitive issues. Future research should further investigate the sociocultural mechanisms at play and evaluate the long-term impact of targeted prevention programs.\u003c/p\u003e\u003cp\u003ePolicymakers and program developers are encouraged to integrate CSA prevention communication strategies into national family and child protection initiatives. Supporting parents through structured education and ongoing community-based outreach can play a key role in strengthening family-based prevention and reducing children’s vulnerability to abuse.\u003c/p\u003e\u003cp\u003eFinally, this study contributes to the body of knowledge in nursing science by offering practical insights that can inform future research and guide the development of parent-involved, school-based CSA prevention strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Director of Research and Community Services at Universitas Padjadjaran, who funded this research.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research described in this paper was financially supported by a grant from the Riset Kompetensi Dosen Unpad (RKDU), grant 2024.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u0026nbsp;Disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Padjadjaran University Bandung Research Ethics Committee and authorized this study, which complies with the ethical criteria of the Declaration of Helsinki. Its registration number is 2404070555, and its ethical approval certificate number is 783/UN6.KEP/EC/2024. For every participant, an informed consent form was collected. Confidentiality was assured through the use of a self-administered, anonymous questionnaire. The participants may withdraw from the study at any time and choose not to answer the question. The researcher protected the respondents\u0026apos; information. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement (54).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author, [TS], on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhang Y, Zuo X, Mao Y, Lian Q, Luo S, Zhang S, et al. Co-occurrence subgroups of child sexual abuse, health risk behaviors and their associations among secondary school students in China. 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Child maltreatment. 2019:1077559519848489-.\u003c/li\u003e\n\u003cli\u003eAyan S, Bilican G\u0026ouml;kkaya V. Child sexual abuse: The relationship between the type of abuse and the risk factors. 2018.\u003c/li\u003e\n\u003cli\u003ePerera B, Ostbye T. Prevalence and correlates of sexual abuse reported by late adolescent school children in Sri Lanka. Int J Adolesc Med Health. 2009;21(2):203-11.\u003c/li\u003e\n\u003cli\u003eTordon R, Svedin CG, Fredlund C, Jonsson L, Priebe G, Sydsjo G. Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample. Nord J Psychiatry. 2019;73(1):16-23.\u003c/li\u003e\n\u003cli\u003eSinanan AN. The impact of child, family, and child protective services factors on reports of child sexual abuse recurrence. J Child Sex Abus. 2011;20(6):657-76.\u003c/li\u003e\n\u003cli\u003ePereda N, Abad J, Guilera G. Lifetime Prevalence and Characteristics of Child Sexual Victimization in a Community Sample of Spanish Adolescents. J Child Sex Abus. 2016;25(2):142-58.\u003c/li\u003e\n\u003cli\u003eMaier T, Mohler-Kuo M, Landolt MA, Schnyder U, Jud A. The tip of the iceberg. Incidence of disclosed cases of child sexual abuse in Switzerland: results from a nationwide agency survey. International journal of public health. 2013;58(6):875-83.\u003c/li\u003e\n\u003cli\u003eWard CL, Artz L, Leoschut L, Kassanjee R, Burton P. Sexual violence against children in South Africa: a nationally representative cross-sectional study of prevalence and correlates. The Lancet Global health. 2018;6(4):e460-e8.\u003c/li\u003e\n\u003cli\u003evon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. International Journal of Surgery. 2014;12(12):1495-9.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1 to 3","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Child sexual abuse, communication practices, Indonesia, parents, prevention","lastPublishedDoi":"10.21203/rs.3.rs-6614468/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6614468/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEnhancing parent\u0026ndash;child communication is a key strategy for preventing child sexual abuse (CSA) by addressing potential risks before they occur. To educate children effectively about CSA prevention, parents must possess strong communication skills. Understanding parental demographic characteristics and knowledge related to communication practices is essential for successful prevention efforts. This cross-sectional study aimed to examine how demographic factors and knowledge influence parents\u0026rsquo; communication practices in preventing CSA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A total of 207 parents from elementary schools in Bandung and Sumedang Regencies, West Java, Indonesia, participated in this study, which was conducted between March and December 2024. Participants were selected via stratified random sampling. Data were collected through an anonymous self-administered questionnaire distributed via Google Forms developed by the research team. The questionnaire assessed demographic characteristics, CSA-related knowledge, and communication practices. Univariate analysis (percentages) was used to describe participant characteristics, knowledge, and communication practices. Chi-square tests were used to examine associations between demographic and knowledge variables and communication practices. Multivariate logistic regression was performed to identify key predictors of communication practices.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost respondents were of Sundanese ethnicity (91.3%) and demonstrated poor knowledge (70%) and poor communication practices (51.7%) regarding CSA prevention. Knowledge (p\u0026thinsp;=\u0026thinsp;0.021) and ethnicity (p\u0026thinsp;=\u0026thinsp;0.048) were significantly associated with communication practices. Multivariate analysis revealed that both knowledge (OR: 2.073; 95% CI: 1.114\u0026ndash;3.860) and ethnicity (OR: 2.122; 95% CI: 1.006\u0026ndash;4.478) were significant predictors of communication practices. Other factors, including age, gender, occupation, education, marital status, income, access to CSA prevention information, number of family members, living arrangements with children, and caregiving roles, were not significantly associated with communication practices.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eParental knowledge and ethnicity have a significant effect on CSA prevention communication; nonetheless, many engaged parents lack the requisite skills. This emphasizes the importance of culturally specific, knowledge-driven interventions, as well as additional studies on sociocultural determinants and long-term program efficacy.\u003c/p\u003e\u003ch2\u003eReporting guidelines:\u003c/h2\u003e \u003cp\u003e This study followed the STROBE reporting guidelines.\u003c/p\u003e","manuscriptTitle":"Determinants of parental communication practices to prevent child sexual abuse: A cross-sectional study in Indonesia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-06 15:19:11","doi":"10.21203/rs.3.rs-6614468/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-10T17:27:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-22T14:02:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-14T15:18:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-12T13:13:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110881470811207815479913663688832520524","date":"2025-06-12T10:51:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20615033772589094302644422947988969407","date":"2025-06-10T15:10:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256449786095456050700452388210832709591","date":"2025-06-05T13:10:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-04T15:58:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-02T17:09:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-13T08:58:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-13T07:20:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-05-13T07:19:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1df3ad77-5ac6-463e-a426-40cd642d075a","owner":[],"postedDate":"June 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-20T12:53:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-06 15:19:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6614468","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6614468","identity":"rs-6614468","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}