Educação em saúde acerca da febre reumática para escolares: ensaio comunitário randomizado por cluster

Abstract

Introduction: Rheumatic heart disease is an important cause of morbimortality in Brazil. The population's lack of knowledge about the disease limits the effectiveness of prevention programs. This study evaluated the effectiveness of knowledge transmission resulting from educational processes on rheumatic heart disease in schools, comparing results of the conventional teaching method (expository classes) with the experimental method (worked examples). Material and methods: A prospective, cluster randomized study was conducted for 8 months in 6 randomly selected public schools. Each class of students was considered a cluster (total 90 classes of students), being randomized 1: 1 to receive one of the educational methods. Pre-tests assessed students' knowledge of tonsillitis, rheumatic heart disease and rheumatic fever immediately before the educational process. Post-tests, 10 days and 3 months later, assessed students' knowledge retention. Results: A total of 1,301 students (52% female) participated in the study, 37% from elementary school and 63% from high school. Before to the intervention, the general knowledge was tested (pre-test), being universally low (average score expository classes 33.9% x worked examples 32.5%). A significant but similar improvement was observed in both groups in the immediate post-test (pre x post: p <0.001): expository classes 57.5% x worked examples 56.7%. In the 3 month post-test a significant worsening of 20% was observed and the final grades were similar again: expository classes 45.0% x worked examples 45.9%. High school students had higher scores on all tests (p <0.001). Girls had better overall performances than boys (p <0.001). Conclusion: Educational process about tonsillitis, rheumatic fever and rheumatic heart disease in schools resulted in knowledge gains, with retention over time. The new technology of worked examples on tablets obtained similar results when compared to expository classes. Further studies are needed to determine if the increase in knowledge leads to behavioral changes that could reduce the burden of rheumatic heart disease.