Knowledge, attitude and awareness regarding the protection of children from sexual offences act among medical and paramedical personnel: a cross-sectional questionnaire study

INTRODUCTION

Child sexual abuse (CSA) is a major public health concern with significant medical, psychological, and social consequences. India continues to report a substantial burden of CSA, highlighting the need for effective preventive and protective measures. According to the National Crime Records Bureau (NCRB), offences registered under the Protection of Children from Sexual Offences (POCSO) Act constitute a considerable proportion of crimes against children in the country.^1-4

The POCSO Act, 2012 was enacted as a comprehensive and gender-neutral legislation to protect children from sexual offences through child-friendly procedures and speedy trial mechanisms. Subsequent amendments and rules have further strengthened provisions related to reporting, investigation, medical examination, and victim support. Healthcare professionals play a critical role in the identification, documentation, management, and reporting of child sexual abuse cases and are legally obligated to comply with the provisions of the Act.^5-12 Despite these responsibilities, previous studies from India have reported inadequate knowledge and awareness regarding various aspects of the POCSO Act among healthcare personnel, particularly with respect to reporting obligations, legal procedures, and child protection mechanisms.^13-15 Limited evidence is available regarding the level of knowledge, attitude, and awareness among different categories of medical and paramedical professionals.

Therefore, the present study was undertaken to assess the knowledge, attitude, and awareness regarding the POCSO Act among medical and paramedical personnel, identify existing gaps in understanding of legal and procedural aspects of child sexual abuse management, and provide evidence for targeted educational interventions aimed at improving compliance with child protection laws.

METHODS

Study design and setting

A cross-sectional, questionnaire-based study was conducted at Jawaharlal Nehru Medical College, Belagavi, between June 2023 and July 2024.

Participants

A total of 408 participants were enrolled, comprising undergraduate students/interns (n=225), postgraduate trainees/residents (n=46), faculty/doctors (n=67), and allied healthcare professionals/others (n=70).

Sample size

As this was an exploratory cross-sectional questionnaire study, all eligible medical and paramedical personnel who consented to participate during the study period were included. A total of 408 responses were obtained and analyzed.

Instrument

A structured, predesigned 20-item questionnaire was used to assess knowledge, attitude, and awareness regarding the Protection of Children from Sexual Offences (POCSO) Act. The questionnaire was developed after a review of relevant literature and key provisions of the POCSO Act. The questionnaire comprised 9 knowledge-based items, 4 attitude-based items, and 7 awareness-based items. Each correct response was awarded one mark and incorrect responses received zero marks. Domain-wise scores were calculated for knowledge, attitude, and awareness.

Data collection

The survey was administered electronically using Google Forms, with duplicate responses restricted. Sociodemographic variables including age, gender, designation, educational qualification, and place of residence were collected.

Statistical analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were expressed as frequencies, percentages, means, and standard deviations. Comparison of mean knowledge, attitude, and awareness scores among different professional categories was performed using one-way analysis of variance (ANOVA). A p-value of less than 0.05 was considered statistically significant.

Ethical considerations

Participation was voluntary, and electronic informed consent was obtained from all participants prior to completion of the questionnaire. No personal identifiers were collected, and anonymity and confidentiality of responses were maintained throughout the study.

RESULTS

A total of 408 medical and paramedical personnel participated in the study and completed the questionnaire. All participants completed a structured 20-item questionnaire comprising 9 knowledge-based items, 4 attitude-based items, and 7 awareness-based items. The results are presented under participant characteristics and domain-wise assessment of knowledge, attitude, and awareness.

Participant characteristics

Table 1 summarizes the sociodemographic characteristics of the study participants. Among the 408 participants, the majority of participants were female (59.8%) and from urban areas (86.8%). Based on professional category, 225 (55.1%) were undergraduate students/interns, 46 (11.3%) were postgraduate trainees/residents, 67 (16.4%) were faculty/doctors, and 70 (17.2%) were allied healthcare professionals or others.

*Undergraduate students included medical, dental, and nursing students.

Knowledge assessment

The mean knowledge score was 6.25 ± 1.68 out of a maximum score of 9. Most participants demonstrated moderate knowledge (53.4%), followed by good knowledge (41.9%), while only 4.7% exhibited poor knowledge (Table 2).

Attitude assessment

Attitude towards the implementation of the POCSO Act was assessed using four items related to parental involvement during medical examination, management of child sexual abuse victims, consent-related issues, and legal responsibilities.

The mean attitude score was 3.03 ± 1.01 out of a maximum score of 4. Most participants demonstrated a positive attitude towards the management of child sexual abuse cases under the POCSO Act, with 72.1% achieving positive attitude scores, while 21.1% and 6.9% demonstrated neutral and negative attitudes, respectively (Table 3).

Comparison of scores across professional categories

Domain-wise scores were compared among undergraduate students/interns, postgraduate trainees/residents, faculty/doctors, and allied healthcare professionals using one-way analysis of variance (ANOVA). A statistically significant difference was observed in mean knowledge scores among the professional categories (p=0.003), with undergraduate students/interns demonstrating the highest mean knowledge score (6.53±1.61). No statistically significant differences were observed in attitude scores (p=0.219) or awareness scores (p=0.729) (Table 5).

*Statistically significant at p<0.05. ANOVA=Analysis of Variance; SD=Standard Deviation.

DISCUSSION

The Protection of Children from Sexual Offences (POCSO) Act, 2012 places significant legal and ethical responsibilities on healthcare professionals, making adequate knowledge, positive attitudes, and awareness essential for effective child protection. The present study assessed these domains among 408 medical and paramedical personnel and identified important strengths as well as gaps in understanding of the Act.

The overall level of knowledge regarding the POCSO Act was moderate, with 53.4% of participants demonstrating moderate knowledge and 41.9% exhibiting good knowledge. The mean knowledge score was 6.25±1.68 out of a maximum score of 9. Participants demonstrated better understanding of general provisions of the Act, whereas knowledge regarding punishments, legal procedures, and reporting obligations was comparatively lower. These findings are consistent with those reported by Tyagi et al¹³, who observed that although healthcare professionals were generally aware of the existence of the POCSO Act, substantial deficiencies persisted regarding specific legal provisions and mandatory reporting requirements. Similarly, Patra et al¹⁵ reported gaps in understanding of medico-legal responsibilities among healthcare providers involved in the care of child sexual abuse victims.

Subgroup analysis according to professional category revealed significant differences in knowledge scores (p = 0.003), with undergraduate students demonstrating significantly higher knowledge scores than other professional groups. This finding may be attributed to recent exposure to medico-legal teaching and child protection legislation during undergraduate training. However, attitude and awareness scores did not differ significantly across professional categories, suggesting a relatively uniform perception of child protection responsibilities among healthcare personnel.

Assessment of attitude revealed encouraging findings. Nearly three-fourths of participants (72.1%) demonstrated a positive attitude towards the implementation of the POCSO Act, with a mean attitude score of 3.03±1.01 out of 4. Most respondents appropriately recognized the importance of parental involvement during examination, management of child sexual abuse victims, and adherence to legal procedures. Positive attitudes among healthcare personnel are essential for ensuring child-friendly care, reducing secondary victimization, and promoting compliance with statutory obligations. However, the presence of neutral or negative attitudes among a subset of participants indicates the continued need for focused sensitization programmes and training workshops.

Awareness regarding the POCSO Act was also found to be moderate to satisfactory, with 46.1% of participants demonstrating good awareness and 48.3% demonstrating moderate awareness. The mean awareness score was 5.28±1.42 out of 7. Awareness was highest regarding beneficiaries of the Act, child helpline services, and compensation provisions. However, comparatively lower awareness was observed regarding the reporting timeline to the Child Welfare Committee and recent amendments to the Act. Similar obervations have been reported by Rajesh et al and Goni et al, who demonstrated that although healthcare professionals had reasonable awareness of the general provisions of the POCSO Act, gaps persisted in specfic legal and procedural aspects.^16,17

Participants in the present study represented diverse professional categories including undergraduate students, postgraduate trainees, faculty members, and allied healthcare personnel. The findings suggest that gaps in knowledge, attitude, and awareness regarding the POCSO Act exist across different levels of healthcare education and practice. This observation highlights the importance of incorporating child protection legislation and medico-legal training into educational programmes for all healthcare professionals.

The findings of the present study have important implications for medical education and healthcare practice. Incorporation of structured medico-legal modules addressing child protection laws into undergraduate and postgraduate curricula may improve preparedness among future healthcare professionals. Regular continuing medical education (CME) programmes, workshops, simulation-based training, and institutional standard operating procedures aligned with POCSO guidelines may further strengthen compliance with reporting obligations and medico-legal requirements. Collaboration between healthcare institutions, Child Welfare Committees, Child Welfare Police Officers, One-Stop Centres and legal authorities can facilitate a multidisciplinary approach to the management of child sexual abuse cases and improve outcomes for affected children.¹⁸

The present study contributes to the existing literature by providing a comprehensive assessment of knowledge, attitude, and awareness regarding the POCSO Act among different categories of medical and paramedical personnel. The findings demonstrate that although healthcare professionals generally possess positive attitudes towards child protection, important gaps persist in knowledge of legal provisions, reporting obligations, and procedural requirements. Identification of these deficiencies provides evidence for the development of targeted educational interventions aimed at strengthening compliance with child protection legislation and improving the management of child sexual abuse cases.

Limitations

The study was conducted at a single institution and relied on self-reported questionnaire responses, which may be subject to response bias. The online mode of data collection may have introduced selection bias. Furthermore, the findings may not be generalizable to healthcare professionals in other institutions or geographical regions due to variations in training, clinical exposure, and medico-legal practices. In addition, the cross-sectional design limits causal inferences regarding factors influencing knowledge, attitude, and awareness of the POCSO Act.

CONCLUSION

The present study demonstrated that medical and paramedical personnel possessed moderate levels of knowledge and awareness and generally positive attitudes regarding the Protection of Children from Sexual Offences (POCSO) Act. Deficiencies were identified in specific legal provisions, reporting obligations, procedural requirements, and recent amendments to the Act. Significant differences in knowledge scores were observed among professional categories, whereas attitude and awareness scores were comparable across groups. These findings highlight the need for structured medico-legal training, integration of child protection laws into healthcare curricula, and regular continuing medical education programmes. By identifying specific areas of deficiency among healthcare personnel, the study provides evidence to support targeted educational strategies aimed at improving compliance with child protection laws and strengthening the reporting and management of child sexual abuse cases.

ACKNOWLEDGEMENTS

The authors would like to thank all the participants who voluntarily participated in this study and contributed to the successful completion of the survey.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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