The Effectiveness of Chatbot Facilitated Education on Child and Adolescent Abuse for Nurses
Phase: NA
Conditions: Child Abuse
Sponsor: Tzu Chi University

Version and date of protocol: version 5, date: 07/18/2023 
 
Study Protocol 
 
Official Title: The effectiveness of chatbot facilitated education 
on child and adolescent abuse for nurses 
Protocol ID: IRB112-148-B 
ClinicalTrails.gov ID: NCT06167031 
Project PI：Mei-Lin Hsieh 
Project Co-PI：Ying-Fang Chou, Li-Cheng Kao 
Version/Date: version 5, 18/07/2023 
 

Version and date of protocol: version 5, date: 07/18/2023 
1 
Background 
The incidence of child and adolescent abuse and neglect (CAN) is increasing both in Taiwan 
and globally. As frontline healthcare professionals, nurses play a pivotal role in the early 
identification and reporting of CAN. However, research indicates that insufficient knowledge and 
limited competency among nursing staff can impede timely recognition and notification of suspected 
cases. Strengthening nurses’ knowledge and competencies in assessing and reporting CAN is 
therefore essential. With the advancement of technology, continuing nursing education has expanded 
beyond traditional lecture-based formats. In particular, online education has gained momentum since 
the COVID-19 pandemic, offering flexible, accessible learning opportunities. Chatbots, as a form of 
individualized digital learning, have emerged as a promising tool for enhancing nurses' ability to 
recognize and report CAN. 
Objective 
The study aims to evaluate the effectiveness of chatbot-facilitated education in assisting nursing 
personnel to prevent CAN. This evaluation will focus on the impact of this learning on CAN 
competency. 
Method 
An experimental study design was employed. Participants were purposively sampled and 
allocated to the experimental and control group. The experimental group received chatbot-facilitated 
education (CFE), while the control group received conventional lecture-based instruction. The course 
content, developed using the ADDIE instructional design model, comprised two modules: (1) Child 
and Adolescent Abuse and Neglect and (2) Nurses’ Roles and Responsibilities in CAN. The CAN 
Knowledge and Competency Scale was used to measure learning outcomes at three time points: pre-
intervention, one week post-intervention, and four weeks post-intervention. 
 

Version and date of protocol: version 5, date: 07/18/2023 
2 
Statistical Analysis Plan 
The collected questionnaire data will be coded and analyzed using the SPSS for Mac version 
29.0.1.0 statistical software package. The statistical analysis methods employed will include 
descriptive statistics and inferential statistics (Table 1-1). A significance level of p< .05 will be used 
for hypothesis testing. 
1. Descriptive Statistics 
The central tendency and dispersion trends of the sample will be presented using frequency 
distribution, percentage, mean, and standard deviation to understand the distribution of the sample's 
basic attributes. 
2. Inferential Statistics 
(1) Chi-square test (χ² test) 
a. To test whether there are statistically significant differences in categorical variables between 
the two groups. 
(2) Independent-samples t-test 
a. To test whether there are statistically significant differences in continuous variables between 
the two groups. 
b. To test whether the average scores of CAN intention to report, attitude toward reporting, and 
knowledge evaluations between the two groups are statistically significantly different. 
(3) Paired-samples t-test 
a. To test whether there are statistically significant differences in CAN intention to report, 
attitude toward reporting, and knowledge evaluations within each group over three time points. 
(4) Generalized Estimating Equation (GEE) 
a. To test whether there are statistically significant differences in CAN intention to report, 
attitude toward reporting, and knowledge evaluation scores between the two groups across 
different time points. 
 

Version and date of protocol: version 5, date: 07/18/2023 
3 
Table 1-1 Research hypotheses and analysis methods (1/2) 
Research hypotheses 
Assessment tool 
Analysis methods 
Statistical methods 
1-1-1. There are differences 
in the intention to report 
CAN across three 
assessments within both the 
experimental and control 
groups. 
CAN Knowledge 
and Competency 
Scale 
IV: Different 
assessment time 
points 
DV: Scores for the 
intention to report 
CAN, attitude 
toward reporting 
CAN, and 
knowledge of CAN 
Paired-sample t-test 
2-1-1. There are differences 
in the attitude toward 
reporting CAN across three 
assessments within both the 
experimental and control 
groups. 
3-1-1. There are differences 
in the knowledge of CAN 
across three assessments 
within both the EG and CG. 
1-1-2. There are differences 
in the intention to report 
CAN across three 
assessments between the 
experimental and control 
groups. 
CAN Knowledge 
and Competency 
Scale 
IV: Group 
DV: Pre-test, post-
test 1, and post-test 
2 scores for the 
intention to report 
CAN, attitude 
toward reporting 
CAN, and 
knowledge of CAN 
Independent-
samples t-test 
2-1-2. There are differences 
in the attitude toward 
reporting CAN across three 
assessments between the 
experimental and control 
groups. 
3-1-2. There are differences 
in the knowledge of CAN 
across three assessments 
between the experimental 
and control groups. 
CAN: child and adolescent abuse and neglect; EG: experimental group; CG: control group; IV: 
independent variable; DV: dependent variable. 
 
 

Version and date of protocol: version 5, date: 07/18/2023 
4 
Table 1-1 Research hypotheses and analysis methods (2/2) 
Research hypotheses 
Assessment tool 
Analysis methods 
Statistical methods 
1-1-3. There are differences 
in the improvement scores 
for intention to report CAN 
between the experimental 
and control groups. 
CAN Knowledge 
and Competency 
Scale 
IV: Group and 
different assessment 
time points 
DV: Scores for the 
intention to report 
CAN, attitude 
toward reporting 
CAN, and 
knowledge of CAN 
Generalized 
estimating equation 
(GEE) 
2-1-3. There are differences 
in the improvement scores 
for attitude toward reporting 
CAN between the 
experimental and control 
groups. 
3-1-3. There are differences 
in the improvement scores 
for knowledge of CAN 
between the experimental 
and control groups. 
CAN: child and adolescent abuse and neglect; EG: experimental group; CG: control group; IV: 
independent variable; DV: dependent variable.