Cultural Factors Affecting the Participation in Research of Children Victims of Child Abuse and Neglect: The Case of Turkey

Microsystem

To gain direct access to children who are victims of CAN, it is necessary to be in environments such as family and school, which are included in the microsystem of children. However, even professionals providing services to children in Turkey, before conducting any research with children or asking for the child's participation request, must obtain permission from the parents. In other words, it is not possible for children to participate in research without the permission of the child's parents. According to the Patient Rights Regulation (1998), the law obligates researchers to get parents' informed consent for their child's participation before consent can be obtained from the children. Factors that may affect children's participation in research in the scope of microsystem include the following:

• Family structure: In families where a traditional patriarchal family structure is dominant, the father may make all final decisions about the child, including participation in research. This situation not only prevents the provision of the most fundamental rights of the child, such as the right to participation, but also prevents reaching the child in the face of problems such as neglect and domestic abuse. To overcome this problem, it is necessary to either reach the child without being dependent on the parents in the framework of the principle of the best interests of the child or encourage parents to allow their child to participate in research.

• Parental beliefs: Factors specific to parents come into play and may negatively affect children's participation in research. Namely, in cases of neglect and domestic abuse, parents likely will not want their children to participate in CAN research to protect them or other family members because of collectivism. The findings of studies on reasons for the late disclosure of child victimisation (Koçtürk & Bilginer, 2020) and withdrawal of complaints (Koçtürk & Bilginer, 2019) also support this view. Sharing problems experienced in the family with others is not desired, as reflected in proverbs such as ‘The arm is broken, but it remains in the sleeve.’ In other words, macrosystem factors such as culture and ideologies also play a role in the microsystem by influencing parents' attitudes, beliefs and values.

• Parental knowledge and myths: Various myths exist among parents about sexual abuse and disclosure (Kızıldağ & Koçtürk, 2021). These sexual abuse myths specific to the victim, abuser and abuse may also prevent their children from participating in CAN research (e.g. ‘Preschoolers all make up that they've been sexually abused’; Kızıldağ & Koçtürk, 2021). Parents who are not abusive do not consider it positive to conduct research on these issues because they see talking about sexuality as a taboo and fear the influence on their children. For example, in one study, 70% of parents reported that talking to their children about sexual abuse is against their beliefs and culture (Üstündağ, 2022). Some nonabusive parents in Turkey do not find it positive to conduct research on sexual abuse, because they consider it taboo to talk about sexuality and think that any questions about sexuality do not match and might adversely affect their child's sexual development. To prevent possible reactions from parents and not affect their children, CAN research may not be allowed by authorised institutions, including ethical committees (Uslu & Kapçı, 2014). This situation hinders research on CAN survivors.

• Fearing of conflict with parents: Studies on CAN are not institutionally favoured due to misconceptions and attitudes such as not confronting parents institutionally (e.g. family getting angry with school administrators for reporting suspected abuse to the authorities; Kabul & Bıkmazer, 2022), not dealing with processes such as forensic notification because it requires additional time and effort (Haylı & Durmuş, 2015), the fact that sexuality is taboo, and because some parents use corporal punishment with their children for disciplinary purposes. Experts working with children fear conflict with parents because they feel alone and have security concerns in any conflict situation (Siviş-Çetinkaya, 2015). In this context, mesosystem and macrosystem factors indirectly prevent access to children.

• Difficulty reaching children: Families with low socioeconomic levels in Turkey do not send their children to preschool (Toran & Özgen, 2018). Considering that the first people to be told about neglect and abuse in the family experienced by children are the people close to the children, in the absence of the educator, disclosure of abuse is difficult, unless children interact with a different social environment and develop trust in a person. At this point, the microsystem through which access to children can be provided in Turkey is health institutions. Considering that some children in Turkey are not taken to health institutions even for compulsory vaccinations (Bozkurt, 2018; Kurçer et al., 2005), it becomes difficult to reach some preschool children in rural areas or in families with low socioeconomic status. On the other hand, although children's councils have been established by official institutions such as the Ministry of Family and Social Services and municipalities to ensure the participation of children in decisions on issues such as municipal activities, these children's councils are not available in every province and district (Erbay, 2013). Similarly, few nongovernmental organisations allow children to take an active role, and they do not have microsystem resources to present their views via the internet or phone. In summary, apart from child follow-up centres where children who are victims of sexual abuse are interviewed and a few associations and child protection units, no other formal or informal services can advocate for children.

Mesosystem

As previously highlighted, the mesosystem involves the relationship between two or more microsystems in which the developing person actively participates. In this context, parental interactions with health institutions or school are the most common mesosystem concepts we encounter. However, factors related to child neglect, such as parents' indifference, unwillingness, lack of time and low level of education, are barriers to parental involvement with health and education institutions (Toran & Özgen, 2018). Considering that the involvement of neglectful parents may already be low, low parental involvement can also reduce children's participation in CAN research. On the other hand, the insufficient number of health personnel, teachers and school psychological counsellors prevents meeting with parents by making home visits. In summary, it is difficult to get legal permission (i.e. informed consent) from parents in cases where parental involvement is low due to the lack of a follow-up system where interviews between experts and family members are mandatory. This situation not only prevents the identification of children who are victims of CAN but also prevents children from participating in CAN research.

Exosystem

Regarding school curricula and media as exosystem variables, child participation is not at the desired level in both areas (Beyazova et al., 2016; Şirin, 2014), and there is no national programme or policy on raising awareness or participation in research on CAN in the school curriculum or media. Similarly, no programmes are conducted across the country for parents. However, the media is a key source of CAN information for families, according to a study by Rheingold et al. (2012), demonstrating that the exosystem can affect how families comprehend CAN. In Turkey, the media does not fulfil the duty of educating society about CAN, and it broadcasts in a way that does not comply with the ethical principles of journalism in terms of language, style and how the news is presented and may lead to the revictimisation of the child (e.g. revealing the identity of the victim, publishing the victim's photo, not believing the victim's statement; Çakmak, 2018). As Bandura (1973) suggested in social learning theory, the child can learn through observation of various channels such as the social environment, media and school curriculum and predict what they may encounter in the society in which they live if they report a CAN event. In other words, the fact that a CAN incident is seen and being presented as something shameful in society may lead to the fear of being revealed as a survivor (Kabul & Bıkmazer, 2022). This situation can be considered an indirect factor affecting children's participation in research.

Macrosystem

Regarding the formation, emergence and intervention processes of CAN, the effects of culture at the individual, familial and country levels are evident. At the individual level, not wanting to be stigmatised or labelled, such as wanting to forget the event by avoiding triggers or reminders, and the fear of revealing one's identity are essential variables that can affect participation in research and the reliability of research results. These variables are not independent of culture. In this context, possible cultural factors that may affect the participation of child victims in research in Turkey can be expressed as follows:

• Beliefs and myths about CAN: Myths about traumatic experiences and victims can be an essential factor influencing the process of reporting and participating in research. For example, the belief that abuse must be concealed to protect the family's honour (Koçtürk & Bilginer, 2020) or that talking about traumatic events can increase pain (Özbağrıaçık-Çağlayan, 2014) are examples of these myths. Other beliefs in the existing culture include trying to forget rather than expressing embarrassing events to preserve honour or dignity. These beliefs can influence the behaviour of victims. In the ecological system approach, cultural beliefs indirectly direct individuals' behaviour (Bronfenbrenner, 1979).

• Sexist culture: Myths that blame the victim are also an extension of sexism and fed by the culture in which the individual lives (e.g. ‘If sexual abuse has occurred more than once, the victim has consented’; Koçtürk & Kızıldağ, 2018). Unfortunately, these incorrect cultural teachings in Turkey are sometimes conveyed to the child through a comment by their parents or other individuals in their social circle (microsystem) and sometimes through a news report or words of judgment on television or social media (exosystem). This situation may affect victims' participation in research in Turkey, which is a collectivist culture.

• Stigmatisation of the child: According to the findings of studies on trauma and myths, CAN victims are ashamed of the event they have experienced and hide it to avoid being labelled and excluded (Koçtürk & Bilginer, 2019, 2020; Sayın et al., 2013). In this context, it would be helpful to consider social desirability as an essential factor that may affect the participation of survivors in research (Bergen & Labonté, 2020; DiLillo et al., 2006).

• Fear of exclusion and stigmatisation of the family by society: In the familial context, parents' fears of discrimination or exclusion from society often prevent the disclosure of abuse experiences. This culture is modelled as extremely strong to young children via the verbal and nonverbal behaviours of their parents and social environment such that even if they think that their parents will support them, children often do not report their abusive experiences due to various fears (Koçtürk & Bilginer, 2020). For example, in a study with victims of sexual abuse in Turkey, children's most common causes of delayed reporting were fear of creating domestic problems, upsetting their parents and being identified with the event in their social environment (Koçtürk & Bilginer, 2020). In Turkey, where family values and collectivism are praised, it may be inevitable that the individual needs of victims are ignored, and that they want to avoid reporting for the sake of familial and cultural elements. In other words, there is a fear that experiences of abuse may lead to negative consequences in the family such as exclusion and stigmatisation in society, and dishonouring the family. That would explain why children often do not participate in CAN research.

• Insufficient tracking capacity of the child protection systems: The child protection system in Turkey does not yet have sufficient resources to reach out to and manage all cases considered at risk of CAN in their families, which can be also a critical macrosystemic variable that affects identifying the monitoring of child abuse at societal level.

In summary, from an ecological point of view, many factors that prevent access to children arise from macrosystem variables such as social values, the desire to avoid possible criticism in society and inadequate child protection systems.

Individual Level

Studies can be carried out to understand and influence the values and attitudes of children regarding the reporting of CAN and facilitate and encourage their participation in research. In light of the principle of the child's best interests, caregivers' gatekeeping power should be limited and children's consent should be the primary consideration for CAN research. However, to prevent children from being harmed by research, the content of the research should be evaluated by a scientific ethics board and psychosocial support should be provided to children regarding possible risks after the research. In addition, culturally sensitive measurement tools, which can be used throughout the country, can assess possible CAN exposure among children and identify children who do not want to report, thereby increasing children's participation in research. To increase survivors' self-confidence and eliminate repeat-abuse patterns, studies that psychosocially strengthen survivors should be carried out, and all survivors should be informed about these activities.

Microsystem

It is essential to strengthen family members and experts (such as teachers and health workers) in the microsystem of children, changing their myths and negative attitudes (sexism, blaming the victim) and ensuring that they receive social support in areas such as security following disclosure, to encourage children's participation in research. In addition, parents can be trained on issues such as the importance of talking about CAN and the fact that the taboo regarding this subject can cause much more harm to children. Experts in the field of child protection should routinely evaluate each child and raise awareness of children's rights. Online platforms can be created by the Ministry of Family and Social Services for research and notifications.

Mesosystem

For the mesosystem to be effective, it is essential to increase parental participation in schools and health institutions. In settings such as schools, parents can be trained on myths, the importance of disclosure and gender equality. In expert–parent interviews, parents can also be made aware of their children's participation in research. In addition, parents who do not come to health and education centres can be reached by increasing the number of specialists and making routine home visits.

Exosystem

Messages encouraging child participation should be presented via various channels such as the social environment, media and school curriculum, and these environments should be purged of language that blames the victim and supports gender inequality. Campaigns and studies should explain various social benefits, such as how research with survivors can guide services to be provided to children and contribute to the prevention of CAN. By presenting role models to survivors on social media, survivors can gain the self-confidence to express themselves and be encouraged to participate in research.

Macrosystem

Considering the positive relationship between abuse myths and sexism in Turkey and that gender equality is not at the desired level, one of the most important strategies at the macro level is to reduce patriarchal structures and ensure gender equality. It is essential to remove cultural barriers and make arrangements in various fields to increase the research participation of children who are victims of CAN. First, a social environment should be created in which survivors do not feel shame, blame themselves or feel excluded or stigmatised by their social environment. For this to occur, experts and media should emphasise that the victims have nothing to be ashamed of; the real culprit who should be embarrassed is the abuser and any community that tries to hide the incident and blame the victim. In this context, awareness-raising studies should be carried out to prevent society's negative attitudes towards these individuals. Creating an environment free from social norms and laws that blame the victim may indirectly affect participation in research. Creating policies that ensure gender equality in all macro and micro areas is one step that can be taken in the context of the macrosystem (e.g. strengthening the child protection and justice system). Last, at the macro level, it is necessary to create policies that protect children's best interests and encourage research that uses measures that are culturally sensitive, appropriate for children's developmental periods and standardised.