PHD-Department of Community Health

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Browsing PHD-Department of Community Health by Subject "Ecological Factors"

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    Exploring Ecological Factors and Child Sexual Abuse Disclosure at Thika Level 5 Hospital in Kiambu County, Kenya
    (Kenyatta University, 2022) Wamuyu, Menja Eunice; Lucy Kathuri-Ogola; Joan Kabaria Muriithi; Taren Swindle
    Child Sexual Abuse (CSA) is both a global and national social issue, as well as an epidemic in various societies. Many research studies classify CSA as a public health problem requiring early intervention practices and new policy changes to promote disclosure as well as protect children from sexual abuse. Non-disclosure of CSA only worsens and extends survivor’s suffering, and CSA long term effects can be devastating. Several studies have been done in the field of CSA and its health implications but rarely have previous studies addressed child sexual abuse disclosure (CSAD). The current study aimed at examining the Ecological Factors of CSAD at Thika Level 5 Hospital (TL5H) in Kiambu County, Kenya as explained by survivors, caregivers and service providers using a mixed method analysis. Interviews were conducted with 30 CSA survivors (25 girls and 5 boys: 5-17 years), 30 caregivers, and 10 health and service providers. Data collection included in-depth interviews and survey questionnaires. TL5H and participants were achieved through Purposive Selection. The study utilized the convergent QUAL (investigative open-ended questions and storytelling) design with a Quan component (structured survey) to identify CSA survivor’s experiences while receiving medical treatment and therapeutic intervention at TL5H. Descriptive and thematic approaches were applied to analyse qualitative data that revealed survivors’ lived experiences with CSA. For instance, survivors gave detailed accounts of types of threats and manipulation applied by perpetrators to stop them from disclosing abuse. Survivors said disclosing or not disclosing helped them cope with abuse trauma. Informed by Bronfenbrenner’s Socio-Ecological Model (SEM), saliency analysis was applied to code the recurring and important themes from the data in order to identify which factors (child, familial, perpetrator, and societal) played an important role in disclosure process. The findings showed that various factors were significant in enabling the child abuse survivors to narrate their stories. The age factor was important as those between 9-13 were more likely to disclose CSA. The gender perspective showed that the females and those with lower education levels were most likely to disclose CSA. Those under the care of females were more likely to narrate while those under threats were less likely to disclose sexual abuse. Religion was a significant factor as well as presence of institutional support in likelihood of the survivors to share their experiences. The Current findings, reinforced by literature, provide a more rational explanation of how some of the ecological factors, such as perpetrator’s characteristics, either encouraged or discouraged disclosure. Consequently, this study proposes the following multidisciplinary and multilevel approaches, aimed to increase CSAD and CSA awareness: (1) Policy makers must craft and enforce procedures to support and protect CSA victims; (2) The county government to allocate funding and resources for training service and health providers; (3) Teachers and higher education instructors to disseminate information and train caregivers, church leaders, community leaders, and first responders of Kiambu county in ways to support CSA survivors through the disclosure process. (4) All TL5H Clinical Management and Referral Centre staff be provided with more updated facilities that dispense updated treatment procedures during and after disclosure process; and (5) Kiambu County government to equip and empower all stakeholders and partners in the ecological model subsystems with CSA advocacy skills, victim protective and prevention programs; (6) All Kenyan adults should be involved in ensuring children’s safety by making mandatory reports for any CSA or any suspected cases. To close some critical gaps, further studies are recommended to address the current limitations and establish statistical significance of each of the factors in Child Sexual Abuse Disclosure.