Elsevier

Child Abuse & Neglect

Volume 53, March 2016, Pages 118-127
Child Abuse & Neglect

Research article
What factors increase Dutch child health care professionals’ adherence to a national guideline on preventing child abuse and neglect?

https://doi.org/10.1016/j.chiabu.2015.11.006Get rights and content

Abstract

Guidelines to support health care professionals in early detection of, and responses to, suspected Child Abuse and Neglect (CAN) have become increasingly widely available. Yet little is known about professionals’ adherence to these guidelines or the determinants that affect their uptake. This study used a cross-sectional design to assess the adherence of Dutch Child Health Care (CHC) professionals to seven key activities described in a national guideline on preventing CAN. This study also examined the presence and strengths of determinants of guideline adherence. Online questionnaires were filled in between May and July 2013 by 164 CHC professionals. Adherence was defined as the extent to which professionals performed each of seven key activities when they suspected CAN. Thirty-three determinants were measured in relation to the guideline, the health professional, the organisational context and the socio-political context. Bivariate and multivariate regression analyses tested associations between determinants and guideline adherence. Most of the responding CHC professionals were aware of the guideline and its content (83.7%). Self-reported rates of full adherence varied between 19.5% and 42.7%. Stronger habit to use the guideline was the only determinant associated with higher adherence rates in the multivariate analysis. Understanding guideline adherence and associated determinants is essential for developing implementation strategies that can stimulate adherence. Although CHC professionals in this sample were aware of the guideline, they did not always adhere to its key recommended activities. To increase adherence, tailored interventions should primarily focus on enhancing habit strength.

Section snippets

Study Design

This study used a cross-sectional design. An online survey was conducted among CHC professionals working in seventeen Dutch preventive CHC organisations. Data collection took place in 2013 between May 13 and July 5.

The CAN Guideline

One of the first clinical guidelines on preventing CAN in The Netherlands was developed specifically for preventive CHC professionals. This clinical guideline on early detection and responses to suspected CAN was published and implemented nationwide in 2010 (Fleuren et al., 2015,

Response

From the 328 respondents (response rate 31.0%), 164 were excluded from further analyses, because they did not represent the target group (n = 2), only answered questions about background characteristics (n = 44), were not aware of the guideline or had not read it (n = 46), did not have suspicions of CAN in the twelve months preceding their participation in the study (n = 27) or did not have valid answers on all variables relevant for the multivariate analysis (n = 45). Appendix B presents a complete

Discussion

This study investigated the extent to which Dutch CHC professionals adhered to seven key activities described in a national clinical practice guideline on preventing CAN directed at the preventive CHC setting. This study also examined the presence and strength of determinants of adherence to the CAN guideline. The study was restricted to participants who were familiar with the guideline and had reported at least one suspicion of CAN between May 2012 and May 2013.

Acknowledgements

The authors would like to thank the Dutch Centre for Child Health (NCJ) for facilitating contact with all Dutch preventive child health care organisations. We would also like to express our gratitude to the preventive child health care organisations and professionals who contributed to this study.

References (49)

  • American Medical Association

    Diagnostic and treatment guidelines on child physical abuse and neglect

    (1992)
  • M.D. Cabana et al.

    Why don’t physicians follow clinical practice guidelines?: A framework for improvement

    Journal of the American Medical Association

    (1999)
  • Central Committee on Research Involving Human Subjects. Retrieved from...
  • B.-Z. Cohen

    Measuring the willingness to seek help

    Journal of Social Service Research

    (1999)
  • Committee on Child Maltreatment Research, Policy, and Practice for the Next Decade, Phase II et al.

    New directions in child abuse and neglect research, 4. Consequences of child abuse and neglect

    (2014)
  • I. Cukovic-Bagic et al.

    Child protection: Legal and ethical obligation regarding the report of child abuse in four different countries

    Journal of Forensic Odonto-Stomatology

    (2014)
  • D.M. Davidov et al.

    Mandatory reporting in the context of home visitation programs: Intimate partner violence and children's exposure to intimate partner violence

    Violence Against Women

    (2012)
  • D.A. Davis et al.

    Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines

    CMAJ

    (1997)
  • K. Deater-Deckard

    Parenting stress and child adjustment: Some old hypotheses and new questions

    Clinical Psychology: Science and Practice

    (1998)
  • Dutch Ministry of Health Welfare and Sport

    Meldcode Kindermishandeling en Huiselijk geweld

    (2013)
  • J.Y. Feng et al.

    Nurses’ intention to report child abuse in Taiwan: A test of the theory of planned behavior

    Research in Nursing and Health

    (2005)
  • A. Field

    Discovering statistics using IBM SPSS Statistics

    (2013)
  • A.K. Fingarson et al.

    Improving physician identification and reporting of child abuse

    Journal of Clinical Outcomes Management

    (2011)
  • M.L. Fishman et al.

    Guideline-based peer-to-peer consultation optimizes pegfilgrastim use with no adverse clinical consequences

    American Journal of Managed Care

    (2012)
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    • Mandatory reporting between legal requirements and personal interpretations: Community healthcare professionals’ reporting of child maltreatment

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      Variations in the likelihood of reporting suspicions of child abuse and neglect (SCAN) among HCPs is a recurring finding (Flaherty et al., 2008; Fraser et al., 2010; Herendeen, Blevins, Anson, & Smith, 2014; Pietrantonio et al., 2013; Sege et al., 2011). HCP characteristics identified in the local and international literature as having an impact on reporting practices in various settings include having a parental role; training in child maltreatment; knowledge about where, how, and how soon to report; attitudes towards reporting duty; prior experience with CPS; fear of violent or legal reprisal; concerns about losing the family as a patient; and worries of making a report that would not be substantiated (Feng, Fetzer, Chen, Yeh, & Huang, 2010; Foster, Olson-Dorff, Reiland, & Budzak-Garza, 2017; Fraser et al., 2010; Herendeen et al., 2014; Konijnendijk et al., 2016; Pietrantonio et al., 2013; Tirosh, Shechter, Cohen, & Jaffe, 2003; Vulliamy & Sullivan, 2000). As to the impact of case characteristics, the likelihood to report was found to vary by child’s age, type of abuse, type of injury and its circumstances, and prior familiarity with the family (Flaherty et al., 2008; Fraser et al., 2010; Herendeen et al., 2014; Sege et al., 2011).

    • In-house consultation to support professionals’ responses to child abuse and neglect: Determinants of professionals’ use and the association with guideline adherence

      2017, Child Abuse and Neglect
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      As hypothesized in the previous study on overall CAN guideline adherence (Konijnendijk et al., 2016), this study indeed showed that more, and also other determinants were associated with in-house CAN consultation when compared with the determinants associated with overall CAN guideline adherence, including in-house CAN consultation. The previous study on determinants of overall CAN guideline adherence, for which data were collected simultaneously with the data collection for the current study, found that participants who integrated use of the guideline in their work routine were more inclined to perform guideline related activities (Konijnendijk et al., 2016), whereas the current study identified better recollection of consulting the in-house expert (i.e. not forgetting to consult the in-house expert), familiarity with the tasks of the in-house CAN expert, attitudes and beliefs, descriptive norms and subjective norms in relation to in-house CAN consultation as important determinants of seeking in-house CAN consultation. As such, the current study provides more useful directions for organizations that aim to improve in-house CAN consultation compared to the study on overall CAN guideline adherence.

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    This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw) (Grant Number 159010003).

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