Teachers’ Attitudes and Knowledge toward Child Maltreatment in the Kingdom of Saudi Arabia

Background: Child abuse, along with the negative impact of it has affected many aspects of children’s lives. It is now prevalent that its prevention has become a global healthcare priority. Teachers have a great role to play, as integral part of the community, in the prevention of this phenomenon. Objective: The aim of this study is to evaluate teachers’ knowledge regarding their roles, their opinions on physical punishment, signs of abuse in children, and reporting policies. Method: A cross-sectional study was conducted to 320 participants who teach in different educational stages and school levels located in Saudi Arabia’s Eastern Province. Participants completed a questionnaire assessing the ability to recognize and evaluate different types of child maltreatment, knowledge of reporting procedures, and participants’ opinions on corporal punishment as a method of child discipline. Results: Results showed a considerable improvement regarding the issue of child maltreatment among teachers. Female gender was associated with the level of significance in reporting procedures and other important legal issues surrounding child abuse. Conclusion: Teachers reported having an awareness of their roles, the signs of child abuse and reporting procedures. Since the majority of them possessed a good level of awareness Original Research Article Alhabri et al.; JPRI, 34(23B): 39-46, 2022; Article no.JPRI.84889 40 regarding the occurrence of child abuse, we encouraged them to take appropriate steps to learn how to identify different types of abuse and apply the knowledge gained through training and practical.


INTRODUCTION
Child abuse is a highly prevalent issue globally. In 2015, approximately one billion children around the world had experienced emotional, physical, or sexual violence [1]. The annual average of confirmed cases of child abuse in the United States was more than 675,000 in 2018 [2]. Furthermore, it is mandatory in the United States for employees with close relationships to children, such as teachers and healthcare providers, to report any suspicion of abuse to formal or governmental authorities [3]. In general, a high incidence of child maltreatment goes unreported and undocumented [4]. In 2017, an estimated 1,720 children died of abuse and neglect in the United States [5]. An alarmingly low proportion of cases of abuse, that may not even reach 1%, are reported by childcare providers or educators. However, not all teachers report child maltreatment even if it occurs somewhere other than at home.
The negative consequences of abuse affect many aspects of the child's health, whether in terms of mental, physical, or social wellbeing [6]. Moreover, child support and counseling is still a challenge [7]. Several studies have been conducted to assess readiness for child abuse prevention. The total mean readiness score for Gulf Cooperation Council countries in 2019 was calculated as 47.8%. When asked about risk factors related to child abuse prevention, 100% in Bahrain and Kuwait, 98.4% in Saudi Arabia, 98% in Oman, and 97.8% in UAE were able to report from one to five different risk factors as they were highly aware of different abuse risk factors. Moreover, they all achieved high prevention readiness scores in legislation, mandates, and policy awareness [8]. Overall prevention readiness in Saudi Arabia showed an improvement in the area of awareness of occurrence, increasing from 43.7% in 2011 to 47.4% in 2019 [9]. This result was expected after Saudi child prevention laws were approved in 2013, followed by the Child Protection Act in 2014 [10]. Thus, the objective of this study was to evaluate teachers' knowledge about the signs of child abuse, reporting policies, and their opinions about corporal punishment adding to the existing literature about child maltreatment in the Kingdom of Saudi Arabia.

Study Population
A cross-sectional study was conducted in the city of Khobar in the Eastern province of Saudi Arabia, the largest governess in the area. The city was divided into four large districts according to the city development plan. The largest elementary, secondary, and tertiary school from each division was chosen for the conduct of the study. The sample size was calculated minimally corresponding 280 based on the teachers' count assuming that 50% of teachers in the area had basic knowledge about child abuse with a 95% confidence interval. Luckily, a total of 320 Saudi teachers, men, and women, responded to the survey.
The questionnaire was a self-reported one distributed randomly to the teachers of the chosen schools. Informed consent was taken from each respondent assuring their voluntary involvement. The study was reviewed and approved by the Institutional Review Board (IRB) at lmam Abdurrahman Bin Faisal University.

Instruments
Based on previous literature (16,17), a survey that was derived from the Educators and Child Abuse Questionnaire (ECAQ) was used after its translation into Arabic by an expert. This translated version was revised by two experts in the field of psychology and piloted to twenty teachers that were not included in the analysis. No major changes were made to post piloting. The survey consisted of two sections. The first included questions about socio-demographic data (i.e., age, gender, level of the educational stage at which the participant taught, personal educational level, marital status, and economic status). The second part included 12 questions to assess: (a) the ability to recognize and evaluate different types of child maltreatment, (b) knowledge of reporting procedures, and (c) opinions on corporal punishment as a disciplinary method. On a five-point Likert scale, responses to statements were rated from 1 (strongly disagree) to 5 (strongly agree).

Statistical Analysis
This study utilized the Statistical Package for Social Sciences (SPSS) version 25 for statistical analysis. The procedure for statistical analysis began with descriptive statistics (i.e., finding frequency, percentage, mean, and standard deviation), followed by determining the Pearson correlation coefficients for validating internal consistency and Cronbach's alpha for reliability. The Kaiser-Meyer-Olkin (KMO) test was also used to determine the adequacy of the sample size, and the independent samples t-test was used to assess the significant differences between the means of the responses of the study sample with different variables. Finally, one-way ANOVA was used to determine whether there were any statistically significant differences between the means of the socio-demographic variables with the child abuse knowledge assessment.

RESULTS AND DISCUSSION
According to the KMO test, the sample size of 320 participants was adequate, with a value of 0.754. The questionnaire was a reliable tool as the results of the Pearson correlation coefficient showed that the statistical significance for all items of the questionnaire were at 0.01 or lower, indicating that the questionnaire was a valid tool. The overall reliability of the tool was 0.760 for the total of 12 items as measured by Cronbach's alpha indicating that the tool was characterized by great stability. Table 1 shows the descriptive statistics of the study participants' socio-demographic data. Most of them were females (61.3%); the femaleto-male ratio was estimated at 1.7:1. Most of the participants were between the ages of 40 and 49 years (50.9%). A majority (54.4%) of the participants worked in primary schools, while the remainder were employed in intermediate (39.4%) and secondary (6.3%) schools. The overwhelming majority (95%) of respondents held bachelor's degrees, and they were predominantly married (88.4%) with a high socioeconomic status (57.5%).  Table 2 lists the descriptions of items according to the percentages, means, standard deviations, and the ranks of each item with their interpretations. It should be noted that the study sample were in a consensus over reporting procedures and the important legal issues surrounding child abuse as the overall mean of ECAQ was 3.76 (SD ± 1.03).
The gender's relation to reporting procedures and the important legal issues surrounding child abuse was found to be significant favoring the female gender (p = 0.02) as shown in Table  3. Table 4 shows that there was no significant difference in terms of reporting procedures and legal issues associated with sociodemographic variables. In general, the results showed considerable improvement regarding the issue of child abuse among teachers.
The Kingdom of Saudi Arabia began calling a considerable amount of attention to the issue of child maltreatment since the first local article concerning the subject was published in 1991 [11]. Several measures have also been taken by the kingdom, including the ratification of the United Nations Convention on the Rights of a Child (CRC) in 1996 [13]. Despite the scarcity of policies since it has been established, there has been a substantial increase in the number of child maltreatment cases reported in Saudi Arabia. For example, in 2011, the number of registered cases had skyrocketed to 616 [13] from 292 cases 2010 [14]. Such a high incidence of abuse thus reflects the need to determine the levels of awareness possessed by the professionals who deal with children. Teachers are one of the groups of professionals who are in frontline contact with the victims of child maltreatment. Previous studies have shown that most educational professionals in Saudi Arabia have a low-intermediate level of awareness of children maltreatment [15]. The current study's results have shown a considerable improvement regarding coping with children maltreatment among educational professionals; a great number of teachers in Saudi Arabia's Eastern Province have shown an appropriate level of knowledge about the identifying signs of children maltreatment and procedures for reporting it. The results of this study demonstrated the ability of teachers to recognize the signs of child neglect and physical abuse. Their ability to recognize the signs of child sexual abuse was rather low compared to their ability to recognize the signs of child neglect and physical abuse. However, sexual abuse was one of the least common types of abuse to be reported in the region [16]. Furthermore, sexual abuse cases were only 4.6% of the total cases reported in the annual National Family Safety Registry (NFSR) [14]. Nevertheless, the low incidence rate of sexual abuse does not minimize its risk or consequences on children and their communities. Therefore, the existing training programs organized by the Saudi Ministry of Education still require further improvement to reach optimum levels of childcare.
The present study showed that most of the participating teachers attested to awareness of the policies and procedures for reporting child maltreatment in the country. The highest percentage of teachers believed that their administrations support them in reporting any form of child maltreatment. Furthermore, most of the teachers were found to be relatively aware of the legal issues that surround the reporting of child maltreatment. Many teachers were also against any form of corporal punishment as a disciplinary method. Previous studies have shown that teachers' disapproval of corporal punishment by not permitting it in their schools, indicated that physical discipline is deemed as an unacceptable method of conflict resolution [17]. However, the relationship between teachers' attitudes toward corporal punishment and their attitude toward child abuse needs to be explored in further studies.
Regarding reporting procedures and legal issues surrounding child maltreatment, female teachers showed a significantly higher level of awareness than males (p < 0.05). However, the reasons for this are unclear; it cannot be explained by exposure to formal training or education since male and female schools utilize the exact same curriculum formulated by the Ministry of Education. Hence, this higher level of awareness in female teachers may be due to females' typically greater receptivity to emotional cues than males [15]. Fortunately, the Eastern Province has eight teams, consisting of forty professionals, who work to protect children from abuse [18]. These teams may help to increase awareness regarding children maltreatment [19][20][21][22][23][24][25][26].

CONCLUSION
Children maltreatment is one of the main negative influences on a child's developmental growth. With that in mind, this research shows that teachers are aware of their roles in protecting children from maltreatment. Based on findings obtained from our study sample, teachers are aware of the signs and symptoms of different types of children maltreatment. Teachers also seem to be aware of the policies in place for reporting cases of child abuse. Moreover, administrations tend to support teachers in reporting suspected cases of abuse. Finally, most of the participants disagreed with the use of corporal punishment as a method for disciplining school children.

LIMITATIONS
This was a cross-sectional study, and our findings were from one region of Saudi Arabia. Therefore, they may not be generalizable to the nation's other provinces. The questionnaire was also based on self-reporting, which may have affected the study results.

CONSENT
Informed consent was taken from each respondent assuring their voluntary involvement.

ETHICAL APPROVAL
The study was reviewed and approved by the Institutional Review Board (IRB) at lmam Abdurrahman Bin Faisal University with IRB Number: IR3 -UGS-2019-01-342.