Child Abuse Knowledge, Empathy, and Attitudes Toward Reporting Child Abuse Among Nurses Working in Children’s Hospitals in South Korea: The Mediating Role of Child Abuse Reporting Self-Efficacy

Background/Objectives: Nurses play an important role in recognizing and reporting suspected child abuse. However, the role of child abuse reporting self-efficacy in the relationships of child abuse knowledge and empathy with reporting attitudes remains insufficiently understood among nurses working in children’s hospitals. This study examined these relationships and tested the indirect associations of knowledge and empathy with reporting attitudes through self-efficacy. Methods: This cross-sectional study included 173 nurses recruited through convenience sampling from seven children’s hospitals in a metropolitan city in South Korea. Data were collected using structured self-report questionnaires. Descriptive statistics, independent t-tests, one-way analysis of variance, and Pearson correlations were calculated. Separate mediation models were tested using Hayes’ PROCESS macro Model 4, and an integrated model including both predictors was additionally estimated, with 10,000 percentile bootstrap resamples. Sensitivity analyses adjusted for clinical experience and prior child abuse-related education. Results: Child abuse reporting self-efficacy was positively associated with knowledge, empathy, and reporting attitudes. In both the separate and integrated models, significant indirect associations through self-efficacy were observed for knowledge (integrated model: β = 0.08, 95% CI [0.01, 0.15]) and empathy (β = 0.11, 95% CI [0.03, 0.22]), and these findings were consistent after covariate adjustment. The direct association between knowledge and reporting attitudes did not reach statistical significance after accounting for self-efficacy, whereas the direct association between empathy and reporting attitudes remained significant. Conclusions: The findings suggest that child abuse reporting self-efficacy may help explain the associations of knowledge and empathy with reporting attitudes. Educational strategies addressing reporting confidence and empathy warrant further investigation. Longitudinal and intervention studies are needed to establish temporal relationships and evaluate effects on actual reporting behavior.