REVIEW PROTOCOL

Best practices for the prevention and management of child maltreatment in primary care: a protocol for a scoping review

Letícia de Assis Santos1, Fernanda Garcia Bezerra Góes1, Maithê de Carvalho e Lemos Goulart1, Victórya da Costa Barreto Pinto Pires1, Fernanda Maria Vieira Pereira-Ávila1, Aline Cerqueira Santos Santana da Silva1, Allana de Lacerda Uzeda1

1Universidade Federal Fluminense, Rio das Ostras, RJ, Brazil

ABSTRACT

Objective: To map the scientific evidence on best practices related to the prevention and management of child abuse to be implemented by nurses in primary health care. Method: This is a protocol for a scoping review developed following the Joanna Briggs Institute (JBI) methodology, addressing the research question: “What are the best practices related to the prevention and management of child maltreatment for nurses in primary health care?”. The search is conducted across eight information sources. After removing duplicates using EndNote software, the studies will be exported to Rayyan software for the selection phase. The research will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Review (PRISMA-ScR) guidelines. Data will be presented as tables, charts, and a descriptive summary that demonstrates how the results relate to the objective and research question.

Descriptors: Child; Child Abuse; Primary Health Care.

INTRODUCTION

Child maltreatment includes all forms of abuse and neglect of persons under the age of 18. As such, it represents a global public health challenge that results in a variety of adverse effects, both measurable and immeasurable, on the lives of children and adolescents, either immediately or over time(1).

According to the World Health Organization (WHO), in 2021, approximately one billion children and adolescents between the ages of 2 and 17 will be victims of physical, sexual or psychological violence worldwide. In Brazil, data from the Sistema de Informação de Agravos de Notificação (SINAN) indicate that 362,303 cases of child abuse will be reported between 2019 and 2021(2-3). These figures highlight the urgent need to implement effective prevention and intervention measures for child maltreatment(4).

Primary health care (PHC) is the main entry point into the Brazilian health system and plays a central role in health promotion initiatives and disease prevention. This role is essential, especially for urgent issues that need to be addressed, such as child abuse, which is often mistakenly culturally accepted as a method of disciplining children(5-6).

Thus, health workers, especially nurses, who have a close relationship with users, have the potential to act assertively with this group and their families to reduce rates of violence against children. To do so, however, it is necessary to identify and apply the best health practices in the face of this adverse, complex scenario(7).

Preventing child maltreatment involves a range of actions aimed at reducing or mitigating the likelihood of violence, regardless of the presence of risk factors. Managing child maltreatment, on the other hand, concerns the actions taken to deal with the situation when this form of harm occurs. Therefore, best practices for the prevention and management of child maltreatment can be seen as an integration of existing theoretical and practical knowledge, providing evidence that points to more effective health promotion interventions(4,8).

A preliminary search of the Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) Evidence Synthesis, International Prospective Register of Systematic Reviews (PROSPERO), Open Science Framework (OSF), and Biblioteca Virtual da Saúde (BVS) databases was conducted on August 23, 2023. Neither recent or ongoing systematic reviews nor current or developing scoping reviews or protocols on this topic were identified. However, primary studies on the topic are available and confirm the feasibility of this scoping review.

Therefore, this review aims to map the scientific evidence related to best practices for the prevention and management of child maltreatment that can be implemented by nurses in PHC.

METHOD

This is a scoping review protocol based on the methodological framework proposed by JBI, which consists of nine steps: (1) establish the objective and question; (2) develop inclusion criteria according to the objective and question; (3) detail the search strategy, selection, data extraction, and evidence presentation; (4) search for evidence; (5) select evidence; (6) extract evidence; (7) appraise evidence; (8) present findings; (9) synthesize findings according to the objective of this review, draw inferences, and observe the implications of the findings (9).

It is important to note that the protocol has been registered at OSF (https://osf.io) under DOI 10.17605/OSF.IO/PE85J.

Review question

Using the PCC mnemonic (Population [Child], Concept [Child Maltreatment], Context [Primary Health Care]), the following question was formulated for the review: “What are the best practices related to the prevention and management of child maltreatment to be implemented by nurses in primary health care?”.

Eligibility criteria

Primary or secondary studies related to children up to 12 years of age, under the age criterion adopted in the Statute of the Child and Adolescent(10), that address best practices in PHC for the prevention and treatment of child maltreatment in its various forms, including physical, sexual, psychological, emotional abuse, neglect, and commercial exploitation(1), will be included. Best practices are considered to be essential and evidence-based interventions that can change a pattern or context and demonstrate health benefits(8).

Publications that deal with secondary or tertiary care will be excluded, as these sources would not be suitable for the objective of the review. There will be no restrictions on language, year, or country of studies. Duplicate articles will be counted only once.

Types of sources of evidence

The review will include experimental and quasi-experimental study designs, randomized or non-randomized clinical trials, time-series studies, epidemiologic, observational, cross-sectional, analytical, prospective or retrospective cohort studies, case series, individual case reports, and relevant grey literature such as clinical guidelines, manuals, and organizational documents. Qualitative research and systematic reviews are also included.

Studies such as letters, commentaries, editorials, expert opinion articles, and event abstracts will be excluded. The aim is to obtain a variety of materials and evidence to expand the scope of the topic.

Search strategies

The following databases will be searched: MEDLINE/PubMed, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scientific Electronic Library Online (SCIELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados da Área da Enfermagem (BDENF) and Google Scholar.

The search strategy to locate the studies was developed using Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH), with Boolean operators AND and OR, considering the specificities of each information resource. The search strategy is adapted to each database and no filters are used (Figure 1).

Figure 1 – Search strategy model for document retrieval. Rio das Ostras, RJ, Brazil, 2023

Selection of the sources of evidence

Once the search is complete, all identified studies are retrieved and exported to EndNote Web, and duplicates are removed. The studies are then exported to the Rayyan software, which is used in the selection phase. Initially, titles and abstracts are read and assessed independently by two reviewers, in a double-blind fashion, on different computers, according to the inclusion and exclusion criteria of the review. In case of disagreement, the selection will be resolved by consensus or by a third reviewer. The selected studies will be read in full to exclude those that do not meet the review question for any reason.

Reasons for excluding sources of evidence whose full texts do not meet the pre-established criteria will be detailed in the scoping review. In case of disagreement among the reviewers, a meeting will be held to discuss and reach a consensus on the matter, with the participation of a third independent reviewer. The final scoping review will include a full description of the search conducted and the stages of study inclusion and will be presented in the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Review (PRISMA-ScR) flow chart(11).

Data extraction

Data will be extracted from the articles included in the scoping review using a data extraction tool (Excel spreadsheet) developed by the authors based on the JBI Manual for Evidence Synthesis. Data collected will include: authors; year of publication; country; objectives; population and sample; study type; recommended best practices (techniques, processes, and/or activities based on scientific evidence); and key findings and conclusions (Figure 2). Data extraction is performed by two reviewers who receive the same number of articles for data collection, with the intervention of a third reviewer in case of disagreement. Only practices supported by studies demonstrating beneficial and effective interventions for the prevention and management of child maltreatment within the selected research context will be considered best practices.

Figure 2 - Tool for data extraction. Rio das Ostras, RJ, Brazil, 2023

Analysis and presentation of evidence

Data will be presented in the form of tables and charts, supplemented by a descriptive summary that demonstrates how the results relate to the objective and question of the review.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

1. World Health Organization. Child maltreatment [Internet]. Geneva (CH): WHO; 2022 [cited 2023 May 12]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

2. World Health Organization. Violence against children [Internet]. Geneva (CH): WHO; 2022 [cited 2023 May 12]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/violence-against-children

3. Ministério da Saúde (BR), Superintendência de Vigilância em Saúde. Datasus - Tabnet. Violência interpessoal/autoprovocada - Brasil [Internet]. Brasília (DF): Ministério da Saúde; 2021 [cited 2023 May 13].   Disponível em: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinannet/cnv/violebr.def

4. Faraj SP, Siqueira AC. Adaptação de um programa de prevenção à violência contra criança para versão remota. Estud Interdiscip Psicol. 2023;13:01-24. https://doi.org/10.5433/2236-6407.2022.v13.46959

5. Azevedo RN, Bazon MR. Pais/Cuidadores com e sem histórico de abuso: punições corporais e características psicológicas. Psicol Cienc Prof. 2021;41(3):e207756:1-166. https://doi.org/10.1590/1982-3703003207756

6. Platt VB, Guedert JM, Coelho EBS. Violence against children and adolescents: notification and alert in times of pandemic. Rev Paul Pediatr. 2021;39:e2020267. https://doi.org/10.1590/1984-0462/2021/39/2020267

7. Sinhorinho SM, Moura ATMS de. Uso de disciplina violenta na infância- percepções e práticas na Estratégia Saúde da Família. Rev Bras Med Fam Comunidade. 2022;17(44):2835. https://doi.org/10.5712/rbmfc17(44)2835

8. Brandão MAG, Barros ALBL de, Primo CC, Bispo GS, Lopes ROP. Nursing theories in the conceptual expansion of nursing practices. Rev Bras Enferm. 2019;72(2):577-81. https://doi.org/10.1590/0034-7167-2018-0395

9. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis [Internet]. Adelaide (AUS): JBI; 2020 [cited 2023 Sept 13]. Disponível em: https://synthesismanual.jbi.global/

10. Brasil. Lei nº 8.069, de 13 de julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências [Internet]. Brasília (DF): Presidência da República; 1990 [cited 2023 Aug 31]. Disponível em:

https://www.planalto.gov.br/ccivil_03/leis/l8069.htm#

11. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. Prisma extension for scoping reviews (PRISMA-ScR):checklist and explanation. Ann Intern Med. 2018;169(7):467-73. https://doi.org/10.7326/M18-0850

Submission: 22-Nov-2023

Approved: 11-Apr-2024