This review considered studies that included participants who are parents, caregivers and guardians of children or adolescents who are under 18 years of age. Studies that only included children and adolescents and did not involve perspectives or experiences from parents were excluded. Studies that included only teachers or other professionals and did not capture parents' perspectives were also excluded.

This review considered studies that explored the challenges faced by parents, caregivers, and guardians in preventing OCSEA. According to Public Safety Canada, OCSEA refers to situations where children are tricked into viewing or participating in online sexual activities. This includes grooming, sexting, sextortion, capping, and the distribution of sexual images and videos (8).

For the purpose of this review, challenges in preventing OCSEA are defined as any potential barriers encountered in the everyday interactions between parents and their children, such as those related to communication, education, and parental involvement. Studies that did not address challenges or barriers related to OCSEA prevention, or that focused exclusively on law enforcement or education without involving parental perspectives, were excluded.

The context of this review considered online or digital environments across various platforms including social media or online messaging apps in any cultural context.

This systematic review considered published primary research studies employing quantitative, qualitative, and mixed methods designs for inclusion. Gray literature, such as student dissertations that are primary studies, was also considered for inclusion. The reference lists of the were reviewed to identify any additional primary studies that could be considered for inclusion. Review papers, opinion pieces, blog posts, and editorials were also excluded.

Text words from article titles and abstracts, as well as index terms and Medical Subject Headings [MeSH], were used to develop a full search strategy. This was adapted for each database and information source by an experienced librarian (MK). The search was undertaken on March 20, 2025 (Refer to Supplementary File A for full search strategies). In addition, the reference lists of the selected articles were screened for additional relevant papers.

Only sources published in English were included due to resource restrictions. Sources published from 2018 were included to capture the most current evidence following key global developments in online child protection, including the adoption of the WeProtect Global Alliance's Model National Response and UNICEF's call for coordinated action in child online protection (33, 34). This timeframe also includes the COVID-19 pandemic period, both pre-pandemic and pandemic-related shifts in related challenges.

The databases that were searched included Medline, EMBASE, PsycINFO, Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Scopus via Elsevier, and the Cochrane Library via Wiley.

All identified records from the search were uploaded into Covidence (35), a web-based tool for systematic review management. Duplicates were automatically removed by Covidence. Then title and abstract screening was conducted independently by two reviewers (WY and FE). Potentially relevant studies were moved to full-text screening for decision of final inclusion. Full-text studies were reviewed by the same reviewers (WY and FE). Full-text studies that did not meet the inclusion criteria were excluded. Any disagreements in the screening process were resolved by discussion with a third reviewer (AH or NP) with expertise in both review methodology and adolescent health.

Data were extracted from the selected papers by two independent reviewers (WY and FE) with the third reviewer (AH) verifying all the extracted data. A data extraction sheet was developed by the research team and piloted using 10% of the included studies. Following the piloting process, the researchers who were involved in data extraction held meetings to add/edit items to the sheet to improve its comprehensiveness. Ultimately, the data extracted from each study included bibliographic details (authors, year of publication, and country of research), the study's aim, design (quantitative, qualitative, or mixed method), population characteristics (sample size and parent type: mother, father, or both), as well as the key findings (refer to Supplementary File B for extraction table). Types of OCSEA discussed and the study's research questions were recorded as well. Any discrepancies were identified and resolved through discussion with other reviewers in the team (NP and AH).

The methodological quality and potential risk of bias of included studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tools (36). These tools consist of 8–11 criteria that are rated as “yes,” “no,” “unclear,” or “not applicable.” Because the publicly available JBI checklists do not cover mixed methods studies, we combined criteria from both the JBI qualitative and quantitative checklists. In this review, we categorized study quality as high (≥75% criteria met), moderate (50–74%), or low (< 50%) (70). Quality appraisal was carried out by two reviewers (WY and AH), with both reviewers assessing all included studies, discrepancies were solved by a third reviewer (NP). Critical appraisal results did not lead to exclusion of studies, but they influenced the synthesis by weighting interpretations with greater caution for findings from studies rated as moderate or low quality using the JBI tools.

A narrative description of the included studies is provided to offer an overview of all the relevant studies. All extracted data are presented in tables that follow the format of the data extraction sheet, ensuring consistent reporting of the information obtained from the included studies. Data from the selected studies were then synthesized with a convergent integrated approach, which means qualitative and quantitative data will be combined for data transformation. By using this approach, findings from quantitative studies were converted into a qualitative form for synthesis, which means data in quantitative studies were transformed into textual data (37). This stage is also known as “qualitizing”—a stage of providing a narrative interpretation of the quantitative results.

After assembling all the qualitative data and textual description of results from quantitative studies, we then employed thematic analysis guided by the review questions to present the findings of this research (38). After reading through all the included studies and having all the extracted data, initial codes were created by categorizing the similar findings together by the team. Then the research team collaboratively developed an initial thematic framework with some broad themes by merging the initial codes. As coding went on by the research team, new themes or secondary themes were added to the framework, and earlier studies were checked again using the updated version. In the end, the developed themes were further refined and given names through discussion. Any discrepancies that happened in the development of the thematic framework were resolved by team researchers, ultimately reaching an agreement.

A large proportion of parents across various studies lacked comprehensive awareness of online risks, including exposure to pornography, sextortion, and exploitative relationships (45, 46, 55). This lack of knowledge was found to be a challenge in both developing and developed nations. For example, a study in Pakistan found that parents had a moderate level of awareness but struggled to identify accidental exposure (43), while a study in Malaysia found that 40% of parents were unaware of the term “online grooming” (46).

Even when awareness was present, limited digital literacy constrained parents' ability to take appropriate action to protect children. Parents in Ireland, the USA, and Malaysia reported struggling to keep up with technology, which impacted their ability to make informed parenting decisions regarding online control and to initiate meaningful conversations (41, 46, 50). Some parents, like those in a study from Delhi, India, felt particularly helpless due to low education and limited access to technology, believing risks were inevitable or that their children would ignore their guidance (45). This awareness-action gap directly influenced the frequency and quality of parent-child communication, as many parents reported feeling paralyzed due to uncertainty or low confidence (45, 50). Although they realize that smartphones and the Internet are important in their children's lives, many parents don't know how to prevent online grooming (45, 46). Some expressed that they have no choice but to give their children such devices (45), while others only monitored or tried to limit their children's internet use to protect their children from online predators (46).

Misconceptions about who perpetrates and who is at risk from OCSEA were a widespread issue (45, 57). Pandey & Reddy (45) noted that mothers often underestimated non-penetrative online sexual abuses, focusing only on penetrative acts, such as rape or sodomy, as sexual abuse since the perpetrators did not have physical access to their children. Thus, they believed it did not require serious police intervention.

Similarly, these mothers believed perpetrators were primarily uneducated, poor, young males who were “strangers” to the child (45). In a more general context, a study in Australia and the UK found that parents were worried that telling children that family members might be perpetrators could lead to negative consequences (57). The tendency to overlook the severity of non-physical harm and to cling to stereotypes about perpetrators limits protective efforts across different contexts.

Parental discomfort with sexual topics, often rooted in their own upbringing or social taboos, emerged as a major inhibitor to dialogue in every study. This discomfort was an important factor for parents in the US, UK, Ireland, and Malaysia (41, 46, 50). Culturally specific taboos within certain communities hindered sexual discourse, as it was perceived as forbidden and inappropriate (49). This created cultural and psychological barriers for adolescents to openly discuss sexuality and related issues with their parents or vice versa (49). Even parents who were aware of online grooming were generally uncomfortable with discussing sex with their children (39, 41, 46).

This discomfort was often more pronounced for specific topics (57). Parents in Ireland reported difficulty defining pornography in an age-appropriate way, leading them to avoid the topic entirely (50). One parent stated, “Some of the content would be too explicit for adults, let alone children, now how do I explain the concept behind this...” (50), while another stated, “not the right time, still too young, sensitive topic” (46). Likewise, many adolescents do not discuss issues related to sexuality with their parents or teachers because they feel embarrassed or perceive them as insufficiently knowledgeable (52).

Parents have a belief that older children and teenagers would not be receptive to guidance on sensitive topics due to conflicting external peer pressures. Across studies in the USA and Ireland, parents expressed concerns that peer norms and online behaviors often countered parental guidance, and adolescents were more likely to accept behaviors normalized by their online communities than those discussed at home, making it harder for parents to instill their perspectives on appropriate online conduct (39, 42, 50). This sentiment, that adolescents perceived their parents as unable to understand the sexual lives of young people, was a common barrier to effective communication (50). Even when parents initiated the conversations, some were immediately faced with resistance from their children due to discomfort (50).

Findings from studies in Israel and the US consistently showed that parenting style is a contributing factor. An authoritative parenting style, characterized by a balance of control, open communication, and accurately assessing the severity of children's sexting activities and engaging in such behaviors, was linked to positive outcomes in parent-child communication about sexting (48).

In contrast, both authoritarian (high control, low discussion) and permissive (low control, low discussion) styles were positively associated with dysfunctional communication and increased risk of exposure to online dangers (42, 48).

The usefulness of specific mediation tactics showed mixed results across studies. A study in Israel found that technologically restrictive mediation (e.g., parental controls) increased sexting behaviors, suggesting a backlash effect (48). However, a different study in the US found no significant association between technological control and sexting (42).

The most consistent finding was the benefit of a combined approach. Corcoran et al. (42) suggested that a combination of restrictive mediation and active mediation (discussing and jointly engaging in internet use) was associated with a lower likelihood of youth sending and receiving sexts. On the other hand, permissive parenting led to lower parental mediation of sexting despite perceived susceptibility to sexting, and this increased children's exposure to online risks (48, 57). This suggests that while restricting access alone may not be effective, it can be a useful tool when paired with open, discursive communication.

Gender of parent and child played an important role in parental mediation practices. Several studies, including those from the UK, Pakistan, and Israel, found that mothers predominantly favored restrictive and active mediation, setting rules and discussing risks, particularly for girls compared to boys (49, 56) with the belief that most victims are females (45). This can lead them to underestimate the importance of mediating their sons' online activities (45). However, this gender disparity was not noted in all studies. Studies showed that mothers are aware of the risks of the internet, regardless of gender, and caution is required when raising boys and girls, and that they are the primary educators for both sons and daughters (47, 52).

Speno and Halliwell (41) found that parents' and children's gender hugely influenced the comfort of parents to initiate conversations. Studies noted a double standard, with mothers being more lenient toward boys‘ porn viewing but having a “sweeping prohibition” for girls (49). In contrast, fathers more often relied on technical controls such as device settings or monitoring software for both their boys and girls (56). A study in China found that while fathers were more likely to be unaware of a child's violence/pornography exposure, mothers were more likely to engage in sex-related communication with a child (55). This is reinforced by a study in Ireland, where fathers believed it was the mother's role to talk about sexual health with their daughters (50). While these gender disparities were not found in all studies, the pattern suggests a common division of labor in parental mediation.

The generational gap was evident by many parents across different countries reporting lower digital literacy than their children, leaving them ill-equipped to supervise online activity or recognize warning signs (41, 46). This lack of knowledge was a primary reason parents felt “at least one step behind” their children and felt their guidance would be ineffective (41). As noted in a study from the UK, this generational divide requires parents to move beyond traditional sex education to effectively address online risks (51). Lamprianidou et al. (53) used the term “digital immigrants” to describe parents' general limited understanding of technology or misuse of social media in sexting. This can hinder effective conversations with their children about issues related to sexting, smartphones, and social media (41).

Furthermore, adults reported feeling behind children in applying online parental safeguards, as children can easily circumvent them (51). There is a higher level of complexity that digital media introduced to sexual education, requiring parents to go beyond traditional talk to educate their adolescent children about risks of sexual activity online (41).

A compounding factor is the rapid evolution of technology, which makes it difficult for parents to stay knowledgeable about risks and mediation techniques (42). This rapid change has increased the likelihood of accidental exposure to inappropriate content, particularly for younger children, and has decreased opportunities for proactive dialogue (39, 43). This challenge requires parents to adapt quickly, as evidenced by a study in Indonesia, which noted the need for parents to be knowledgeable about constantly changing online dangers (47).

Conversely, the “generation gap” suggests a barrier in communication because youth may find it difficult to talk to adults about online issues, believing “They will ask too many questions. It's so annoying.” (41, 50)

Social and cultural norms were a major influence on parental engagement across the world. One finding was the “culture of silence” surrounding OCSEA, where parents would underestimate online and non-penetrative sexual abuses (45). This was most acutely seen in studies from Israel, where cultural taboos created significant barriers to open sexual discourse, with mothers fearing negative reactions from fathers if they discussed sexuality (49). Another study from Israel further reinforced this, noting that cultural conservatism led some parents to avoid discussions entirely, especially between fathers and their daughters (48). This was not only limited to Eastern countries, Dawson et al. (50) found that fathers of adolescent girls believed that, even though they would be interested in having discussions with their daughters, it was the mother's role to talk with their daughters about issues related to sexual health.

Parental mediation of online risks is heavily influenced by gendered stereotypes and double standards, creating a consistent pattern across the studies. Mothers are often seen as the primary mediators, but they show a bias in their protective efforts, frequently exhibiting a “sweeping prohibition” and greater monitoring for girls while “turning a blind eye” to similar behaviors, like pornography viewing, by boys (49).

This is often rooted in the perception that girls are more vulnerable to social stigma from “sexting gone wrong,” while boys are seen as more likely to be the perpetrators or consumers of pornography (52, 53). This disconnect between awareness and action means that even when parents recognize the differing consequences for each gender, they may still adopt a less effective “gender-neutral” approach. In contrast, fathers who engage in mediation tend to rely more on technical controls and monitoring software rather than open communication, further highlighting the gendered division of labor in addressing online safety (56).

Family dynamics, such as time constraints and work-life balance, were also reported as a factor impacting a parent's capacity to address OCSEA (46). The challenge of single parenting and the demands of full-time work additionally made it difficult for parents to find the time and energy for these discussions (41).

Parents indicated a desire for greater involvement from schools, either to complement or take on the responsibility of sex education altogether. Across studies in the US, UK, Spain, and Italy, parents expressed a strong desire for greater involvement and guidance from formal institutions like schools and healthcare professionals (39, 46, 52). Yet, studies reported minimal integration between schools and parents, leading to fragmented or contradictory messages (46, 52). The lack of training for both parents and teachers in online security and affective-sexual education, internet use, and pornography consumption is a gap (52).

In the absence of formal support, parents often turned to informal resources such as social media and other parents for guidance, which varied widely in quality and reliability (39). This reliance on inconsistent information meant that parents' understanding of online risks often depended on their own limited experiences, leading to inconsistent education for their children (54).

Parents recommended the need for professional guidance, such as training from school staff, nurses, or social workers, to help them understand mobile technologies in addressing online sexual risks and practical tools for engaging with their child (39, 46). This highlights a critical need to equip families and teachers with the standardized tools and professional knowledge necessary to discuss issues related to sexuality and online safety at home and at school.

Particularly in porn literacy, Healy-Cullen et al. (54) found that parents believe that education requires “professionals” to deliver it, as parents may feel biased or uncomfortable. Furthermore, Saleha et al. (47) suggested that maternity nurses should promote reproductive health education, indicating a need for professional support in parenting strategies.