Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka.
Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
J Health Popul Nutr. 2021 Nov 8;40(1):48. doi: 10.1186/s41043-021-00267-6.
Child neglect is a form of child maltreatment and it is a neglected area of research. As similar to other forms of maltreatment, neglect also results in negative health outcomes for children. Child neglect is concentrated in disadvantaged communities. The community-centered health promotion approach empowers communities to identify and address determinants of perceived health issues. This study aimed to implement a health promotion intervention to enable a disadvantaged community to address determinants of child neglect and evaluate the effectiveness of the intervention.
A quasi-experimental study design was used. Two disadvantaged communities in Anuradhapura District, Sri Lanka with similar socio-demographic characteristics were purposively selected as the experimental and control study settings. The mothers who have at least one child in the age range 5-18 years were included in the sample. The sample included 42 mothers from the experimental group and 44 mothers from the control group. The elder children of mothers in the experimental group were selected to be the agents of change. A health promotion intervention was implemented only with the experimental setting. The steps of the intervention included; (1) identifying prevention of child neglect as a goal, (2) understanding the determinants, (3) analyzing determinants and identifying actions and (4) implementing and modifying the actions. The total study duration was 1 year, with the intervention taking an average of 6 months. Data were collected at both pre and post-intervention phases from mothers and children through interviewer-administered questionnaires.
Mothers of the experimental group improved their knowledge on child neglect significantly in comparison to the control group (p < 0.05). In the post-intervention phase, there were significant differences in attitudes related to child neglect between experimental and control groups (p < 0.05). Following the health promotion intervention, mothers of the experimental group had significantly improved their practices related to the safety, education, nutrition of children, relationships with the child and social support for child caring (p < 0.05) when compared with the control group.
The health promotion intervention was effective in addressing the selected determinants of child neglect in a disadvantaged community. Children could act as active agents of change to deliver the interventions to their mothers (perpetrators).
儿童忽视是一种虐待儿童的形式，也是一个被忽视的研究领域。与其他形式的虐待一样，忽视也会给儿童的健康带来负面影响。儿童忽视主要集中在弱势社区。以社区为中心的健康促进方法使社区能够识别和解决感知健康问题的决定因素。本研究旨在实施健康促进干预措施，使弱势社区能够解决儿童忽视的决定因素，并评估干预措施的有效性。
采用准实验研究设计。斯里兰卡阿努拉德普勒区的两个具有相似社会人口特征的弱势社区被有目的地选为实验组和对照组的研究地点。样本包括年龄在 5-18 岁之间至少有一个孩子的母亲。实验组的样本包括 42 名母亲，对照组的样本包括 44 名母亲。实验组母亲的大孩子被选为变革推动者。仅在实验组实施健康促进干预措施。干预措施包括以下步骤：（1）确定预防儿童忽视为目标；（2）了解决定因素；（3）分析决定因素并确定行动；（4）实施和修改行动。整个研究持续了 1 年，干预措施平均持续了 6 个月。通过访谈式问卷，在干预前和干预后两个阶段从母亲和孩子那里收集数据。
实验组母亲在儿童忽视知识方面的得分显著高于对照组（p<0.05）。在干预后阶段，实验组和对照组在与儿童忽视相关的态度方面存在显著差异（p<0.05）。在健康促进干预后，实验组母亲在儿童安全、教育、营养、与孩子的关系以及儿童照顾的社会支持方面的做法显著改善（p<0.05）与对照组相比。
健康促进干预措施在解决弱势社区儿童忽视的选定决定因素方面是有效的。儿童可以作为积极的变革推动者，向他们的母亲（施害者）提供干预措施。
