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Child abuse and maltreatment is not limited to a particular age—it can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups and outline the types of abuse most commonly seen among children of that age. Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse.

health literacy field, but also relating to media literacy [44], social capital [45] and psychological empowerment [46]. Critical health literacy items Cr2–Cr4 (see Table 2) reflect skills in the information appraisal aspect of health literacy, and ability to evaluate the relevance and validity of different kinds of health information (questions Cr2 and Cr3 were adapted from Ishikawa et al. [35] and question Cr4 was suggested by one of the participants in a consultation focus group). The remaining questions in this section (Emp1–Emp3) address capabilities for empowerment at the level of community and social engagement. We faced a challenge in devising items to assess understandings of and ability to act on social determinants of health, identified by the WHO as a key aspect of health literacy [47]. We reviewed studies, which have used structured measures and questionnaires to assess the priority that individuals place on social determinants rather than individual lifestyle choices and behaviours [5] and included one question relating to respondents’ judgement of the relative importance of these factors [48,49]

2.3. Data collection

A total of 146 participants were recruited for the pilot study. The majority were approached by a member of the research team in the waiting room of their local GP practice. Additionally, a number of participants (27%) were recruited via local health education programmes held in community facilities. We suggested that participants had the material read to them by one of the research team as we did not wish to exclude those with reading difficulties, or others tending to babies or young children who literally had their hands full. We also gave participants the option to read the material by themselves, as we did not have access to a private room in our study settings and were aware that some individuals would not be comfortable with verbally answering questions about health issues in a public setting. Sixty one (42%) of the participants chose to read the measure by themselves. Administration of the scale took approximately 7 min on average. Given the ethnic mix of Tower Hamlets, we anticipated that a number of participants would not be fluent in English. The largest ethnic minority in Tower Hamlets, comprising about 33% of the population is Bangladeshi, overwhelmingly from the Sylhet region of Bangladesh [32] and speakers of Sylheti, a dialect of Bengali. We therefore had the items translated into Sylheti by a bilingual health worker, and then checked by two others for accuracy. As Sylheti is a purely oral language and does not have a written form this version was recorded on a CD and used as a reference by a bilingual research assistant attached to the project who used this method to administer the items to 35 individuals (46% of the Asian sample).

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