Background:

Child maltreatment (CM) is a major public health issue. Data collection, analysis, andreporting are widely recognized as key components in developing policies and programs aimed atpreventing child maltreatment. Unfortunately, CM is significantly under-coded by healthcareprofessionals (HCPs) in hospitals. Due to a lack of studies, causes of this under-coding are not fullyunderstood.

Objective:

The aim was to identify and understand challenging factors leading to under-coding ofCM in hospitals in Germany and Sweden.Participants and setting: The sample includes 28 HCPs from different professional groups involvedin coding-process: pediatricians (n = 14), child psychiatrists (n = 6), pediatric surgeons (n = 4),medical coding professionals (n = 3), and child protection coordinators (n = 1). Nineteen identified as female and 9 as male; age ranged from 24 to 65.

Methods:

The transcripts of the semi-structured interviews have been coded and analyzed usingthe thematic analysis approach of Braun & Clarke.

Results:

In this study, four major themes were identified influencing child maltreatment codingpractices on multiple levels. (1) The Impact of Systemic Frameworks, describing systemic factors,such as legal requirements and lack of mandatory education; (2) The Role of Organizational Cultureand Structures, describing attitude of the clinic, transparency, and shortcomings in quality control;(3) Interpersonal Dynamics of Multidisciplinary Cooperation and Communication; and (4) Intrapersonal Barriers: Knowledge, Uncertainty, and Emotional Burdens.