Enhancing nursing and other healthcare professionals' knowledge of childhood sexual abuse through self-assessment: A realist review.

Aim: To explore how child sexual abuse/exploitation (CSA/E) self-assessment tools are being used to enhance healthcare professionals' knowledge and confidence. Background: Child sexual abuse/exploitation is common and associated with lifelong health impacts. In particular, nurses are well-placed to facilitate disclosures by adult survivors of child sexual abuse/exploitation and promote timely access to support. However, research shows that many are reluctant to enquire about abuse and feel underprepared for disclosures. Self-assessment provides a participatory method for evaluating competencies and identifying areas that need improvement. Evaluation: Researchers adopted a realist synthesis approach, searching relevant databases for healthcare professionals' self-assessment tools/protocols relevant to adult survivors. In total, researchers reviewed 247 full-text articles. Twenty-five items met the criteria for data extraction, and to assess relevant contexts (C), mechanisms (M) and outcomes (O) were identified and mapped. Eight of these were included in the final synthesis based on papers that identified two key 'families' of abuse-related self-assessment interventions for healthcare contexts: PREMIS, a validated survey instrument to assess HCP knowledge, confidence and practice about 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; and (2). Organisational self-assessment can increase the coherence and sustainability of changes in practice. Conclusions: There is a lack of self-assessment tools/protocols designed to improve healthcare professionals' knowledge and confidence. Our review contributes to the evidence base on improving healthcare responses to CSA/E survivors, illustrating that self-assessment tools or protocols designed to improve HCP responses to adult survivors of CSA/E remain underdeveloped 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.