Enhancing health care professionals’ knowledge of childhood sexual abuse through self-assessment:  A realist review

Abstract Background Healthcare professionals (HCPs) are well-placed to facilitate disclosures by child sexual abuse/exploitation (CSA/E) survivors and promote timely access to specialist support. However, research with HCPs shows that many are reluctant to enquire about abuse and feel underprepared to deal with disclosures. Self-assessment offers a participatory approach that may be employed as part of a suite of educational interventions to increase HCP knowledge and confidence. As a complex intervention involving multiple steps and actors, its effectiveness is contingent on organisational contexts. Realist reviews offer a theory-driven and contextually sensitive approach for understanding the mechanisms of change that generate specific outcomes, enabling reviewers to identify generalisable insights on how and why programmes work. Methods We adopted a realist approach to answer the following questions: how are CSA/E self-assessment tools currently being used by HCPs, what does ‘good practice’ in the use of such tools look like, under what circumstances are existing tools effective, and why? Guided by Pawson’s 5 stages, we conducted a realist review of abuse-related self-assessment tools for HCPs. Following preliminary scoping of the literature, we developed an initial programme theory which informed our search strategy and theoretical framework. Results 25 items met criteria for data extraction, and relevant contexts (C), mechanisms (M) and outcomes (O) were identified and mapped. Eight of these were included in the final synthesis. We identified two key ‘families’ of abuse-related self-assessment for healthcare contexts: PREMIS, a validated survey instrument to assess HCP knowledge, confidence and practice in relation to domestic violence and abuse (DVA); Trauma-informed practice/care (TIP/C) organisational self-assessment protocols. Two revised programme theories were formulated: 1. Individual self-assessment can promote organisational accountability 2. Organisational self-assessment can increase the coherence and sustainability of changes in practice. Conclusions Our review contributes to the evidence base on improving healthcare responses to CSA/E survivors, illustrating that self-assessment tools or protocols specifically designed to improve HCP responses to adult survivors of CSA/E remain under-developed and under-studied. Refined programme theories developed during synthesis regarding DVA and TIP/C related tools or protocols suggest areas for CSA/E-specific future research with stakeholders and service users.