Abuse is physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person resulting in injury, psychological harm, deprivation, or death [1]. It includes child maltreatment, violence against women, and elder abuse. Despite the efforts made for preventing abuse by establishing legislation and service programs [2], much remains to be done. Global statistics indicate that most cases of violence against children, women, and the elderly are not reported to authorities [3]. Some possible factors that hinder the decision to report suspected abuse include concern that reporting will not help the family or would damage the relationship with the family, lack of knowledge about the signs of abuse, and not knowing where to report [4]. This highlights the need for reporting suspected abuse. Mandated reporting of suspected abuse and protecting health care professionals to carry this duty empower them to help those who cannot protect themselves [5].
Dentists have a frequent contact with patients compared to other healthcare professionals since people usually visit dentists at least once a year [6]. Moreover, many surveys have shown that 50–77% of abuse cases involve the head and neck region manifested as bruising, abrasions, or lacerations of oral cavity structures; dental fractures, dental dislocations, dental avulsions; maxilla and mandible fractures [7], thus placing dentists in a strategic position to detect, diagnose, document, and report suspected abuse to the authorities [8] to maintain the wellbeing of their patients. Most dentists indicate their readiness to report suspected abuse although lack of clear instructions about the reporting procedure may reduce the chances of translating this intention to actual reporting behaviour [9]. Despite their willingness to report suspected abuse, dentists may be less likely to report than other healthcare professionals [10].
Due to cultural differences, what would be labelled as abuse in Western countries, may not be culturally considered as intentional harm requiring reporting in Arab countries [11]. In Arab societies, some population subgroups may view certain forms of abuse as a private, personal, or family problem rather than a social and criminal problem requiring intervention. Some incorrectly believe that abuse is a justifiable response to misbehaviour [12]. This could be an underlining reason for not reporting such cases. In Egypt, the proportion of women experiencing violence at least once in their lifetime was reported to reach 26% [3]. In addition, 93% of children aged 1–14 years old have been exposed to violent disciplinary practices [13]. Abuse, of any kind or form, cannot be condoned or accepted and must be eradicated. In 2009, the Egyptian government set a national strategy to combat all forms of abuse. This encompassed activating laws, setting up hotlines to report suspected abuse, raising awareness, and establishing agencies concerned with supporting victims and helping them to recover [14]. Furthermore, the National Council for Women was established to take care of issues related to the protection of children and mothers in Egypt. It also supports women subjected to threats of violence and abuse [15].
A previous study assessed dentists’ knowledge, attitudes, and ability to recognize and report suspected abuse in Egypt and showed that 45.1% of participants have suspected child abuse within the previous year and 19.2% reported their suspicions [16]. However, this study, conducted a decade ago, included 182 participants and only 123 of them (67.6%) were dentists and the remaining participants were dental students and interns. In addition, another study [17] reported that Egyptian dentists had one of the lowest levels of intended reporting of suspected abuse among dentists from eight Arab countries. Understanding the level of reporting suspected abuse has implications for education and professional development activities. It is also important to understand the factors that may explain this professional decision to report and their relationship with the COM-B model. This model of behaviour proposes that to engage in a behaviour (B), a person must have physical and psychological capabilities (C) and opportunities (O), and the motivation to demonstrate the behaviour (M) [18]. The COM-B model of behaviour is widely used to identify what needs to change in order for a behaviour change intervention to be effective [19]. Reporting suspected abuse is a desired behaviour that needs to be promoted and the COM-B framework provides actionable insights that can be used to develop interventions for this promotion. The present study assessed the frequency of reporting by dentists who have examined patients suspected of being abused and factors associated with this reporting within the framework of the COM-B model. The null hypothesis was that dentists’ reporting of suspected abuse would not be associated with the COM-B framework constructs.