Challenges facing Healthcare Professionals (HCPs) in their roles of identifying and responding to victims of Child Sexual Abuse (CSA) in Nigeria

ABSTRACT Child sexual abuse is a global social and public health issue, the effects of which create long-lasting impacts on victims, their families, and wider society. Healthcare professionals possess a wealth of knowledge, skills, and experience and are strategically placed to identify and provide care to victims of child sexual abuse. Little is known about the challenges facing healthcare professionals performing their role in a Nigerian context. This study aimed to explore the challenges of supporting victims of child sexual abuse in Nigeria as well as the implications of those challenges for healthcare professionals and service users. Methods: This qualitative study used a constructivist grounded theory approach and used purposive and theoretical sampling techniques to identify twenty-six healthcare professionals who specialise in supporting victims of child sexual abuse. Participants were recruited from hospitals and Sexual Assault Referral Centres to participate in online semi-structured interviews. Data were analysed using a constant comparison method. Findings: Healthcare professionals play a vital role in ensuring victims receive medico-legal care, psychosocial support, access to justice, and protection from re-victimisation. Identifying and responding to sexually abused children presented inherent challenges and was described as a complex, sensitive, and traumatic process for healthcare professionals. There are key areas of conceptual disagreement among healthcare professionals’ regarding their understanding of the construct of child sexual abuse, which hinders an effective multi-professional approach to victim care. Socio-cultural norms, including traditional practices, increased the child's vulnerability to sexual abuse, isolated them, and prevented them from disclosing the abuse. Using a grounded theory approach, a ‘practice challenges theory’ was developed, which proposes that challenges faced by healthcare professionals are inherent in the dimensions and context of practice. The theory provides an encompassing framework indicating these challenges resulted from the complex interplay of individual and socio-ecological contextual factors. Conclusion: The main conclusion of this study is that it is important to use approaches that systematically target change mechanisms at each level of influence, with a focus on the context and dimensions of practice.