A Strong Future for Little Hearts: A Randomized Controlled Trial on the Effectiveness of a Child Sexual Abuse Prevention Education Program

Introduction Child maltreatment is a major public health problem with significant medical, legal, and social implications that can result in serious injuries, permanent disabilities, and even death. It may occur in the form of physical, emotional, or sexual abuse, or as multiple forms of maltreatment occurring simultaneously, leading to devastating consequences for children's physical, psychological, and social well-being. The World Health Organization (WHO) defines child maltreatment as all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment, exploitation, or other acts that result in actual or potential harm to a child's health, survival, development, or dignity within a relationship of responsibility, trust, or power. Children may be exposed to four main forms of maltreatment: physical abuse, emotional (psychological) abuse, sexual abuse, and neglect. Although emotional abuse and emotional neglect are recognized as among the most prevalent forms of child maltreatment, child sexual abuse is considered one of the most severe forms because of its profound and long-lasting adverse effects on children's physical and mental health. Child sexual abuse is a complex form of maltreatment that involves a child in sexual activities that he or she does not fully comprehend, is developmentally unable to consent to, or cannot legally consent to, and that are intended to provide sexual gratification or benefit to an adult or another individual who is older or in a position of power. Such acts are characterized by the absence of genuine consent and constitute abusive and unwanted experiences for the child. Child sexual abuse may involve physical contact, including touching and penetrative acts, as well as non-contact behaviors such as sexually explicit conversations, exhibitionism, and voyeurism. Accurately determining the incidence and prevalence of child sexual abuse is challenging. This is largely attributed to underreporting, children's reluctance to disclose abusive experiences, and barriers to reporting cases to legal authorities. In the WHO European Region, it is estimated that before the age of 18, approximately 18 million children experience sexual abuse, 44 million experience physical abuse, and 55 million experience emotional abuse. In Türkiye, according to the 2025 statistics of the Turkish Statistical Institute (TurkStat), 279,620 children were referred to security units as victims, of whom 240,872 were recorded as victims of crime. Among these child victims, 10.8% were victims of sexual offenses.

One of the most effective strategies for combating child sexual abuse is the development and implementation of preventive intervention programs. Accordingly, several school-based child sexual abuse prevention programs, including Body Safety Training, Talking About Touching, Feeling Yes, Feeling No, and Who Do You Tell?, have been implemented in both developed and developing countries. Although school-based child sexual abuse prevention programs were initially implemented primarily in Western countries, they have increasingly been developed and adopted in many other countries, including Ecuador, South Korea, China, Taiwan, and South Africa. In the context of child sexual abuse, the victim's age and the relationship between the victim and the perpetrator are considered important factors in understanding the characteristics of abuse. Although previous studies have reported that children of all age groups under the age of 18 are at risk of child sexual abuse, primary school age (6-12 years) has been identified as the period during which children are at the greatest risk of experiencing sexual abuse for the first time. However, our literature review found no study conducted in Türkiye that evaluated a multi-session, structured child sexual abuse prevention education program specifically designed for second-grade primary school students using a randomized controlled design. Furthermore, there is no comprehensive educational curriculum in Türkiye that systematically aims to improve awareness of child sexual abuse and self-protective skills among school-aged children. Therefore, this study aimed to evaluate the effect of the Child Sexual Abuse Prevention Education Program implemented among second-grade primary school students on children's knowledge levels and protective skills related to the prevention of child sexual abuse.

Hypothesis H1: The Child Sexual Abuse Prevention Education Program improves second-grade primary school students' knowledge of child sexual abuse.

Population and Sample The study population consisted of second-grade primary school students enrolled in two primary schools located in the relevant district center (N=500). The schools included in the study were located in the same region of the district center, served children with similar sociodemographic characteristics, had the highest student populations in the district, and were positioned at a sufficient distance from each other to prevent interaction between the Experimental group and Control group. The study was conducted with second-grade primary school students because children in this age group begin to develop body awareness, are able to identify themselves as girls or boys, have acquired basic reading and writing skills, and have reached a cognitive developmental level that enables them to benefit from education aimed at preventing child sexual abuse.

The sample size was calculated using G*Power version 3.1 software. The calculation was based on the Inappropriate Touching subscale, using the mean scores reported by Tahan et al. (2024) (16.45 ± 4.03 for Group 1 and 13.15 ± 3.04 for Group 2). For an independent samples t-test with a two-tailed design, an effect size of 0.92, α = 0.05, 90% statistical power, and an allocation ratio of 1:1, the minimum required sample size was calculated as 52 participants, with 26 participants in each group. Considering possible attrition, 15% was added to the sample size, and the study was completed with 59 participants: 32 in the Experimental group and 27 in the Control group.