Dental Practitioners’ Knowledge of the Management of Child Abuse and Neglect
: Survey and Development of an Online Training Program

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: There is evidence that dental professionals have an important role in safeguarding children in the dental practice. Dentists have the ability to recognize child abuse and neglect and report suspected abuse to relevant agencies. However, several barriers that prevent dentists from taking action and reporting child maltreatment were reported by others. That is why training dentists in child protection is so essential; training increases awareness and knowledge about signs and symptoms that are related to child abuse and neglect, eliminates misconceptions that might be perceived as barriers preventing reporting child maltreatment, as well as acquiring knowledge about current local pathways regarding referral of child maltreatment. No reported research was found related to knowledge, experience, attitudes and training in child protection for dentists working in Saudi Arabia. Objectives: To cast light on this topic, two studies were undertaken, Firstly, a survey was carried out on dental practitioners working in Saudi Arabia to analyze their experience, knowledge in identifying child abuse and neglect, as well as their attitudes towards reporting child abuse and neglect, barriers preventing reporting and any previous training in safeguarding children they might have taken. Their results were compared to results of dentists living in the UK. The UK group was chosen as a baseline in this study because it was already established that the subject of safeguarding children is an integral part of dental training in the UK. Finally an online training program in basic child protection was then designed for dental practitioners living in Saudi Arabia and was tested and rated using pre- and post- training questionnaires embedded in the training package and one month post-training survey. Materials and Methods: The first part of this project comprised a cross sectional self-report questionnaire survey. The questionnaire used assessed knowledge, experience, attitudes, perceived barriers preventing child abuse reporting and history of training in child abuse and neglect. It was pilot tested, then presented in two formats; paper-pencil and online for easy access. A random sample of 600 dentists living in the UK was chosen from the 2009 General Dental Council register. They received both formats and were able to choose the preferred one. Members of the Saudi Dental Society in Saudi Arabia received the online format via an e-mail from the Saudi Dental Society due to absence of postal addresses for this group. The second part of the project consists of developing an online basic child protection training program for dental practitioners living in Saudi Arabia. The content of the training program was developed on the basis of previous studies (Kempe et al., 1962; Becker et al., 1978; Wright & Thornton, 1983; Needleman, 1986; Schmitt, 1986; Da Fonseca et al., 1992; Welbury & Murphy, 1998b&c; Tsang & Sweet, 1999; Naidoo, 2000; Hibbard & Sanders, 2004; Cairns et al., 2005b; Kellogg, 2005; Harris et al., 2007; Leeners et al., 2007; Harris et al., 2009a; Nuzzolese et al., 2009; Asnes et al., 2010; Balmer et al., 2010; Sujatha et al., 2010; Hinchliffe, 2011). An invitation was sent to dental practitioners registered with the Saudi Dental Society to join the research. Volunteers had to complete a 3-4 hour online training program. A certificate from King’s College London was used as an incentive for dentists to participate, and 82 participants completed the whole training package, including pre- and post- training program surveys and a set of questions rating the training program. Sixty-two participants completed the one month post training survey that assessed change of attitudes related to child protection in participants one month after completing the training package. Results: In the first survey, 168 dental practitioners living in the UK participated in this study and 122 dentists identified from the Saudi Dental Society participated from the Saudi group. Knowledge about child abuse and neglect varied between the two groups. Dentists in the UK group identified more cases of dental neglect throughout a year (67.3 per cent) compared to 29.5 per cent cases by the Saudi group. However, a large proportion (59.0 per cent) of dentists from the Saudi group suspected some form of child maltreatment in their practice in the last 5 years; which was around double the percentage found in the UK group. Dentists living in the UK took more positive action after suspecting abuse when compared to the Saudi Arabian group. The proportion of participants working in Saudi Arabia who did not take any action after suspecting abuse was around three fold that of participants working in the UK. And perceived barriers to reporting child maltreatment were higher in dentists from the Saudi group. Dentists working in the UK had significantly more training in child abuse and neglect while dentists working in Saudi Arabia barely had any previous training (3.3 per cent), although training was found to be an important predictor for knowledge, attitudes and experience with child abuse and neglect in this study. In the second study; 82 participants completed the whole training package and 62 completed the one month post-training survey. More than half these Saudi dentists (57.3 per cent) worked in Universities and 54.9 per cent were GDPs. The results of the study show that there was a significant increase in knowledge after taking part in the child protection training program in comparison to their baseline knowledge (p < 0.001). Very good appraisals were given to the program upon rating it. Since the training program, 21.0 per cent have or will adopt a child protection policy in their practice, 29.0 per cent identified a staff member to lead on child protection since the program, almost all participants have been aware of child abuse and neglect (CAN) signs in their daily practice and 27.4 per cent have made a report of a suspected case of CAN in the last month since the training. Conclusions: There is a need for further training and support for dental practitioners in recognizing child abuse and neglect and identifying appropriate care pathways for children who are victims of abuse. The web-based training program in child protection received positive appraisal from dental practitioners and dental students living in Saudi Arabia. The program was effective in increasing knowledge in Saudi dentists and changing attitudes to be more positive and proactive in safeguarding children.
Date of Award2014
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorTim Newton (Supervisor) & Koula Asimakopoulou (Supervisor)

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