The numerous short- and long-term negative consequences associated with child sexual abuse (CSA) and its high prevalence make its prevention a societal priority.1–4 There is evidence that parents play an important role in preventive efforts against child sexual abuse.5 It is important to teach children self-protection skills and how to have healthy and respectful relationships.6,7

Different measures need to be taken to protect children from sexual abuse. One of them is to ensure they have the ability to say “no” to sexual abuse.8 When it comes to sexual abuse, one consideration is whether the child is or is not able to say “no”.9 According to Sanderson, children can protect themselves if they are informed about the dangers of sexual abuse, given permission to resist and provided with information on how to resist. Saying “no” loud and clear is a possible strategy for refusal, resistance or escape.10 It is known that children who exhibit timid attitudes and, most importantly, do not know how to say “no”, are unable to ask for help from another person or escape the situation when faced with the threat of abuse.11 In a study conducted in Nigeria, almost all parents informed their children that if someone wanted to see or touch their private parts, they should say “no” (98%) and tell a trusted adult (96%).12 The ability to say “no” helps individuals protect their own rights, respect the rights of others, behave freely13 and uphold personal values and ideals.14,15 When exercised appropriately in the right place and at the right time, it helps prevent the aggressive behaviours of other individuals.16,17 The current evidence shows that, in general, parental knowledge and attitudes in regard to sexual abuse and what they teach their children are limited and insufficient to protect children from CSA.18,19 In addition, rather than raising children as individuals that accept everything, children need to be raised to be aware of their own bodies20 and taught to say “no” to any kind of request, manipulation or threat from strangers.21 In our review of the literature, we found no study analysing both parental awareness of sexual abuse and the ability of children to say “no”. Therefore, the aim of our study was to assess parental awareness of sexual abuse and its association with the ability of children to say “no”.

In our study, the mean score of children in the refusal dimension of Ability to Say “No” scale was 25.60 (SD, 4.29) and the mean score in the resistance dimension was 24.76 (SD, 5,87) (Table 2). The mean refusal and resistance scores in children were high. It is thought that children’s developing ability to say no may play an important role in protecting themselves from the risk of sexual abuse.

In our study, the mean sexual abuse myths score was 31.45 (SD, 4.85) in mothers (Table 3) and 31.23 (SD, 4.81) in fathers (Table 4). Our study showed that parental awareness of sexual abuse myths was high. This was an encouraging finding. Similar to this study, there are studies in the literature reporting that parents have partial, moderate and good knowledge about sexual abuse.23,25–28 Thapa et al.29 reported that the majority of a sample of 224 mothers (77.8%) had a moderate level of awareness about girl child abuse and only 21 (7.3%) had a good level of awareness about girl child abuse in their study on mothers of girls aged less than 16 years. It is believed that the global scope of the problem of child abuse contributes to parental awareness of sexual abuse.26 Parents may have some false beliefs or distorted cognitions about child abuse. These can lead to unhealthy communication within the family and affect the intrapsychic structure of the child.30

In our study, the mean maternal score on the teachings and actions to combat sexual abuse dimension was 50.30 (SD, 5.65) (Table 3), while the mean paternal score in the same dimension was 49.94 (SD, 6.17) (Table 4). Mothers’ and fathers’ awareness of the teachings and actions to combat sexual abuse was high. Sanberk et al.31 reported in their study with socially advantaged and disadvantaged mothers with 48−66-month-old children that mothers have inaccurate or insufficient knowledge about sexual abuse and how to prevent it. The findings of the study by Sanberk et al.31 differed from those of our study. The authors reported that all of the mothers stated that they did not give information about sexual abuse to their children and that they believed that such education should start in adolescence or primary school because younger children cannot understand this issue at their age.31 Üstündağ32 also reported that parents who did not provide education about sexual abuse to their children were unsure about the age at which such education should be given. A study conducted by Üstündağ32 in parents with children aged 3–6 years found that those who had not taught their children about how to protect themselves from sexual abuse had not provided sexual abuse prevention education because they did not think of discussing sexual abuse, did not have time, thought that their child was too young, thought that the subject might frighten or upset the child, did not know how to explain it, did not have access to sources of information for guidance, did not think they had enough information, felt embarrassed, felt uneasy or thought that sex education was contrary to their culture and beliefs. A systematic review examining the effectiveness of a child sexual abuse prevention programme in India found that parents used various measures to protect their children from the risk of sexual abuse, including educating children about sexual abuse, monitoring and supervising children and creating a safe environment.16 For this reason, it is important for parents to have sufficient knowledge to explain sexual development, sexuality, sexual abuse and to do so in an age-appropriate way.33 In the study conducted in a sample of parents of children aged 3–6 years, Üstündağ32 found that while most parents (70%) provided their children with sexual abuse protection education, they still needed more information and guidance by reliable experts. Alzoubi et al.25 reported that only 17% of mothers started to implement some child sexual abuse prevention measures when their children were very young (1–4 years old) and less than half (48.8%) started when their children were aged 4–6 years. Three quarters of the mothers (74%) stated that educating their children about child sexual abuse could prevent it. It is the responsibility of adults to protect children from sexual abuse. So, it is also important to raise awareness in parents, who are the primary caregivers of children and support their development in every area. Having limited knowledge on the subject, feeling anxious about it or not knowing how to discuss it may prevent parents from talking to their children about sexual abuse and also make it difficult for children to talk to their parents in the case of possible sexual abuse.34 There is evidence supporting that more information and awareness-raising activities are needed to help parents understand that all children are at risk of sexual abuse and that victimisation can occur at any age.32 In our study, the mean score in the sexual abuse signs dimension was 16.32 (SD, 2.53) for mothers (Table 3) and 16.08 (SD, 2.53) for fathers (Table 4). We found a high level of awareness of signs of sexual abuse in parents. In the previous literature, Alzoubi et al.25 evaluated the knowledge and perceptions of mothers about child sexual abuse in Jordan and found that mothers with a higher income or educational attainment and mothers who were employed were more likely to recognise the signs and symptoms of child sexual abuse compared to other mothers. Pullins and Jones35 conducted a study in 150 parents to assess parental knowledge of child sexual abuse symptoms and to identify the factors associated with this knowledge, and reported that parents were aware of child sexual abuse symptoms were in the areas of physical/medical, emotional, sexual behaviour and behaviour towards others. In a study conducted by Thapa et al.,29 mothers of girls aged less than 16 years stated that the most convincing evidence of abuse was the child’s disclosure (74%), the child's behaviour (66%) and the child’s emotions (60%), and cited the denial of the abuser among the factors that increase uncertainty (21%). Plummer36 reported that mothers first learnt about sexual abuse from the verbal reports (42%) or behaviours (15%) of their child victims, that almost half of the mothers felt that something was “not quite right” before learning about the abuse, and that mothers took many actions to clarify what was going on, including talking to their children (66%) or watching events more closely (39%). Bayrak28 reported that parents had awareness of child abuse in a study of parents of children aged 1–6 years; however, the responses were mostly limited to the effects of sexual abuse. Educating mothers about effective ways to explore suspicions of sexual abuse and weigh evidence for or against abuse can increase maternal protection and speed up investigations.36 The fact that there was no association between mothers’ awareness of sexual abuse signs and children’s refusal was an intriguing finding. Considering that mothers tend to be closer to children as the primary caregiver than fathers, this was unexpected.

It has been determined that as the teachings and actions of parents in the fight against sexual abuse increase, the refusal behaviour of children also increases. It is believed that parental beliefs, thoughts and attitudes about sexual abuse are reflected in their behaviour to protect their children from sexual abuse, and this in turn is related to children’s refusal behaviour.

In the study, we found a correlation between mothers’ sexual abuse awareness scores and children’s refusal and resistance scores. There was also a correlation between fathers’ sexual abuse awareness scores and children’s sexual abuse refusal scores. Parents exhibited a high level of awareness of sexual abuse myths. We also found a high parental awareness of the teachings and actions to combat sexual abuse. Parental awareness of the signs of sexual abuse was also high. As the awareness of mothers and fathers about sexual abuse myths increased, the refusal of children also increased. As the teachings and actions of mothers and fathers in combating sexual abuse increased, the refusal of children also increased. Also, as fathers’ awareness of the signs of sexual abuse increased, children’s refusal also increased.

Since the study was conducted on 310 fourth grade students and their parents in primary schools in the central district of a province in north-eastern Turkey between April and June 2022, the research results cannot be generalized to the whole country, which constitutes a limitation of the study. Incidents of sexual abuse tend to remain secret. For this reason, there need to be organizations that can provide support in case of child sexual abuse, access for victims to support pages and internet sites where users can communicate remotely with psychiatrists, psychologists, school paediatric nurses, social workers, support lines against child abuse, internet help centres and guidance regarding the legal process. Information campaigns should be increased through guidance classes at schools and disseminated through mass media, television and social media. These findings can contribute to the development of other studies and strategies to prevent sexual abuse.