Recent case exposure and perceived preparedness for responding to sexual violence in school health services: a cross-sectional survey of school nurses in Japan

BACKGROUND: School nurses play a key role in responding to sexual violence in school settings. However, it remains unclear whether recent case exposure is associated with greater awareness of institutional response systems and confidence in recognizing sexually inappropriate behaviors. METHODS: We conducted a cross-sectional survey of school nurses in a large Japanese municipality. The primary exposure was self-reported involvement in sexual violence-related cases within the past year (yes/no). The primary outcome was perceived awareness of institutional response procedures and interagency collaboration systems, and the secondary outcome was perceived confidence in recognizing sexually inappropriate behaviors, each measured using a 5-point Likert scale. Group differences were examined using the Mann-Whitney U test. RESULTS: Among 111 respondents, 50 (45.0%) reported recent exposure to a sexual violence-related case. Recent exposure was not associated with greater perceived awareness of institutional response systems (median 3 [IQR 2-4] vs. 3 [IQR 3-4], p = 0.336) or higher perceived confidence in recognizing sexually inappropriate behaviors (median 3 [IQR 3-4] in both groups, p = 0.877). CONCLUSIONS: In this sample of Japanese school nurses, recent exposure to sexual violence-related cases was not associated with greater perceived awareness of institutional response systems or higher perceived confidence in recognizing sexually inappropriate behaviors. Because cumulative prior experience, training history, and institutional context were not assessed, these findings should be interpreted cautiously. Future research should examine how professional experience, training opportunities, and organizational factors interact to influence preparedness and response practices related to sexual violence in school settings.