Development and implementation protocol of a child sexual abuse (CSA) primary prevention guide in paediatric primary care: an evidence-informed, practice-oriented tool to break cycles of silence

Abstract

Background: One in five children will experience child sexual abuse (CSA) during childhood, making it a major public health problem with profound short- and long- term consequences. Primary prevention interventions, which aim to strengthen protective capacities before abuse occurs, are based on a developmentally appropriate sexual education and have demonstrated effectiveness in improving children’s knowledge and self-protection skills. Paediatric primary care is considered a key setting for reinforcing these preventive messages. However, there is a lack of structured approaches to integrate CSA prevention into routine consultations. Objectives: To synthesise evidence on primary prevention interventions for CSA in children and adolescents, to develop a practice-oriented primary prevention guide for paediatric primary care, and to design an implementation and evaluation study to assess its feasibility, utility and potential to support preventive practices in routine consultations. Methods: A systematic review of the literature with narrative synthesis was conducted following PRISMA guidelines. Findings from the review, together with institutional guidance and expert input informed the development of a practice-oriented primary prevention guide addressed to primary care paediatricians. A cluster-based, pre-post evaluation study with staggered implementation was then proposed to implement the intervention and assess changes in preventive practices during consultations, as well as its perceived utility. Results: Twenty-five studies were included in the review. All identified interventions were delivered in educational settings, predominantly schools; none were implemented within routine healthcare or primary care contexts. Most studies reported significant improvements in prevention knowledge and self-protection skills. Recurrent preventive topics included safe and unsafe touch, disclosure and reporting skills, recognition of CSA, bodily autonomy and identification of trusted adults. Based on these findings, an age-structured, concise and feasible prevention guide for paediatric primary care was developed, together with a protocol study for its implementation and evaluation. Expected impacts: This project is expected to support the integration of CSA primary prevention into paediatric primary care by providing a practical, age-structured and evidence-informed tool. The intervention may enhance paediatricians’ confidence and capacity to address prevention during routine consultations, contributing to reinforce key preventive messages and strengthening protective environments around children and adolescents

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