Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

Original Article Imprimir 

Páginas 29 a 36

Health education's strategy for an adolescents group of Recife

Estrategia de educación en salud para un grupo de adolescentes de Recife

Estratégia de educação em saúde para um grupo de adolescentes do Recife

Autores: Natália Oliveira de Freitas1; Karenina Elice Guimarães Carvalho2; Ednaldo Cavalcante de Araújo3

1. Master's Degree in Healthcare Nursing, Graduate Studies Program inNursing, Pernambuco Federal University (UFPE). Recife, Pernambuco State, Brazil
2. Master's Degree in Nursing, Pernambuco Federal University (UFPE). Recife, Pernambuco State, Brazil. Resident specializing inChildren's Health, Mother and Child Institute(IMIP). Recife, Pernambuco State, Brazil
3. Post-Doctorate, Université René Descartes. Departement des Sciences Sociales. Faculté des Sciences Humaines et Sociales. Sorbonne, Paris V, France. Professor, Nursing Department andGraduate Studies Program inNursing, Pernambuco Federal University (PPGENF/UFPE). Recife, Pernambuco State, Brazil

Natália Oliveira de Freitas
Rua Falcão de Lacerda, 233 casa 23, Tejipió
Recife, PE, Brasil. CEP: 5093-0010

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How to cite this article

Keywords: Health education, adolescent, condoms.
Palabra Clave: Educaciónensalud, adolescente, preservativos.
Descritores: Educação em saúde, adolescente, preservativos.

OBJECTIVE: Describe the elaboration of a health education's strategy for the adolescents of Grupo AdoleScER from Recife, Pernambuco.
METHODS: Descriptive and exploratory study using the Nursing Praxical Intervention Theory in Collective Health as base. Data were collected in the working communities of Grupo AdoleScER from May to July of 2011 through a form about knowledge and information of the use of male condom by the adolescents.
RESULTS: After the results were interpreted, the health education's strategy was prepared and substantiated in the Paulo Freire's cognozed/problematized education. It was composed of two activities: a workshop to the adolescents and a circle of culture to the family.
CONCLUSION: The execution of this strategy and the achievement of its objectives will bring benefits to the adolescents health, specially regarding the adoption of prevention attitudes, which induce a healthy sexual life, free of major health risks.

OBJETIVO: Describir la elaboración de estrategia de Educación en Salud para los adolescentes del Grupo AdoleScER de Recife, Pernambuco.
MÉTODOS: Estudio descriptivo y exploratorio, en el cual fue utilizada la Teoría de la Intervención Práxica de la Enfermería, como base teorético-metodológica. Los datos fueron colectados en las comunidades de actuación del Grupo AdoleScER, en el período de mayo a julio de 2011, con la aplicación de un cuestionario sobre el conocimiento y informaciones de uso del preservativo masculino a los adolescentes.
RESULTADOS: Despues interpretación de los resultados, se construyó la estrategia de Educación en Salud fundamentada en la educación conscientizadora/problematizadora de Paulo Freire, y compuesta por dos acciones: taller para los adolescentes y círculo de cultura para los familiares.
CONCLUSIÓN: La ejecución de esa estrategia y lo alcance de sus objetivos traerán beneficios la salud de los adolescentes, principalmente en cuanto la adopción de actitudes de prevención, que llevan a auma vida sexual saudável,livre de mayores agravos a la salud.

OBJETIVO: Descrever a elaboração de estratégia de Educação em Saúde para os adolescentes do Grupo AdoleScER de Recife, Pernambuco.
MÉTODOS: Estudo descritivo e exploratório, no qual foi utilizada a Teoria da Intervenção Práxica da Enfermagem, como base teórico-metodológica. Os dados foram coletados nas comunidades de atuação do Grupo AdoleScER, no período de maio a julho de 2011, com a aplicação de um questionário sobre o conhecimento e informações de uso do preservativo masculino aos adolescentes.
RESULTADOS: Após interpretação dos resultados, construiu-se a estratégia de Educação em Saúde fundamentada na educação conscientizadora/problematizadora de Paulo Freire, e composta por duas ações: oficina para os adolescentes e círculo de cultura para os familiares.
CONCLUSÃO: A execução dessa estratégia e o alcance de seus objetivos trarão benefícios a saúde dos adolescentes, principalmente quanto a adoção de atitudes de prevenção, que levam a auma vida sexual saudável,livre de maiores agravos à saúde.


A time of transformationbetween childhood and adulthood, adolescence is characterized by physical, psychological and social changes related mainly to the search for self-affirmation of identity, faster intellectual and anatomical development and the evolution of sexuality1.

The exercise of sexuality may become a problem, due to a lack of information about sexual health, poor intra-family communications, the influence of taboos and beliefs, and replication of peer behaviors. These social influences may steer youngsters towards sexual practices such as infrequent or even avoidance of condom use, heightening their vulnerability to untimely pregnancies and Sexually Transmitted Infections (STI), Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS).

The basic strategy for controlling STI/HIV and AIDS is preventionthrough educational activities targeting vulnerabilities inherent to unprotected sexual intercourse, shifts in behavior and the option to use condoms2.

Studies demonstrate that Health Education actions pave the way for discussions of issues linked to reality, with knowledge constructed by these adolescents, invited to learn more about themselves and others, thus helping they grow up into adults with more critical views of their own realities, empowering them to transform their surroundings and upgrade their living conditions 3,4.

Health Education activities also appreciate folk wisdom and two-way dialogue between healthcare practitioners and the population, in terms of the autonomy of individuals when caring for their own health, which may trigger shifts in behaviors, moving away from health-hazardous attitudes5.

Nurseswork in the preventive and curative areas, as well ashealth education. Here, these practitioners may offer adolescents places where they can absorb knowledge in significant, critical and creative ways, while also engaging in a transformative practice, with thepossibility of this knowledge being emancipating, helping construct citizenship and involving them in transforming their own realities. As a result, Health Education actions are vectors for upgrading the quality of life, paving the way for the adoptions of healthier practices by adolescents.

The AdoleScER Group - Health, Education and Citizenship is a non-profit, philanthropic civil association, with no political links that was established in October 2000, working in low-income communities in Recife (Caranguejo, Santa Luzia, Santo Amaro, Roda de Fogo), striving particularly to enhance the quality of life of at-riskadolescents. Its capabilities for active, constructive and supportive participation in solving real-life problems, whether personal, family-related at school, in communities and in society6, prompted interest in conducting this study, which explores knowledge and information on condom use among adolescents and outlines Health Education Intervention strategies on their use.

Condoms were selected as the target of this study, as they are the best-known way of preventing STI/HIV and AIDS among the teen public, far outstripping female sheaths as a means of contraception,due largely to widespread dissemination in the media, easy accessibility through healthcare facilities, low cost and appearance7.


The theoretical foundation of this descriptive exploratory study8was the Theory of Nursing Practice Intervention(TNPI). This is a theory of nursing that is systematized through the uptake and construal dynamic of aphenomenonlinked to the social production and reproduction processes of health and diseasein a specific social segment. Once construed, intervention in this reality then continues, followed by re-evaluation in order to once again deploy intervention tools9.

This Theory proposes linking phenomena through five stages that, although presented in sequence, are inter-penetrable among themselves, with each of them being closely linked and belonging to the same overall unit - aware intervention in the health-disease process:

▪ Stage 1: Uptake of objective reality;

▪ Stage 2: Construal of objective reality;

▪ Stage 3: Construction of intervention project;

▪ Stage 4: Intervention in objective reality;

▪ Stage 5: Reassessment of objective reality10.

In this study, the first three stages were implemented, with the uptake of the reality of knowledge and informationabout condom use handled through a questionnaire completed by 71 adolescents between 10 and 14 years of age registered with the AdoleScER Group. This questionnaire consisted of closed, open, alternative and multiple-choice questions encompassing the following variables: identification, social, economic and demographic factors, sexual data and condom usepractices. It complies with the KAP model (knowledge, attitudes and practices) that assigns high priority to identifying specific needs in the population under study, providing input for drawing up strategies and interventions tailored to a specific group, consequently being the most appropriate for the purposes of this study11.

It is stressed that the study of knowledge and information on condom use is an integral part of the Introduction to Science Grant Institutional Program (PIBIC) Project on Promoting Health and Preventing Sexually Transmitted Diseases among Schoolchildren:Use and Acceptance of Condoms, compliant with Resolution Nº 196, issued on October 10, 1996 by the National Health Council and the ethical principles of autonomy, benefit, harmlessness and justice12. This research project was approved by the Ethics and Research Committee at the UFPEunder Protocol Nº 191/10, and received authorization from the AdoleScER Group Administrative Commission. Data were collected in May, June and July 2011, initiallyobtaining parental signatures to Deeds of Informed Consent and then Deeds of Informed Assent by youngstersmore than 12 years old.

The data were grouped and processed through the EPI6 and Statistical Package for the Social Science (SPSS) version 13. Based on an interpretation of the results, diagnosis and nursing interventions were then identified, based on theInternational Classification of Nursing Practice in Collective Health(CIPESC®) and providing input for drawing up a Health Education Strategy13.


With regard to capacity-buildingin terms of objective reality: knowledge and informationand condom use, 68 respondents stated that they knew about condoms. This knowledge was acquired in the AdoleScER Group (25%) and the classroom (24.3%), with the family notmentioned by any of them.

Only youngsters who were already sexually active (11.3%) replied to questions on the reasons why they had used a condom during intercourse; the reason for not using a condom; their attitude towards a partner unwilling to use a condom; and condom use in stable relationships.

Regarding the reasons for having used a condom during intercourse, 4.2% replied that this was "to avoid pregnancy", 4.2% answered "to prevent STI/HIV-AIDS", with 7% of adolescents who had already had intercourse mentioning that one of the reasons for not wearing a condom is a loss of sexual pleasure. Should a partner be unwilling to use a condom during intercourse, only 8.4% insisted on their use and refused to engage in intercourse without a condom,while 2.9% did not suggest its use and agreed to unprotected intercourse with no problems. When asked about condom use in a stable relationship (same partner for more than one month), 8.4% said that they always used condoms, while 2.9% use them for up to three months.

Regarding the interpretation of objective reality: diagnosis and Nursing interventions based on the International Classification of Nursing Practice in Collective Health (CIPESC®), the resultsindicated weak family participation in disseminating informationtoadolescents on condom use. This may reflect cultural elements that permeate the exercise of sexuality, leaving gaps between teens and their families.

As respondents could choose more than one reply to the question on reasons for condom use, the choice of a single reply reflects a lack of knowledge among these youngsters about the double protection offered by condoms against pregnancy and STI.

With regard to the association between condom use and a reduction in sexual pleasure, another study reported similar findings, stepping up concerns over the chances of untimely pregnancy orSTD infections as this view is the outcome of beliefs and taboos disseminated throughout their social surroundings14.

In this context, diagnoses were made and interventions presented (Table 1). Some interventions were adapted to the group of adolescents and the topic under study for more effectively steering the Health Education Strategy.

Regarding the construction of an intervention project: Health Education Strategy, this study reached two diagnoses related to the Need to Learn (Health Education), in addition to participation in workshops and handing out informative materials, which were interventions common to all four diagnoses drawn up, thus underscoring the need to organize an educational activity that can reshape this reality.

Another research project suggests that educational activities focused on STI/ HIV and AIDS designed for adolescents depend on dialogue and interaction, allowing these adolescents to reflect on their own practices and thus become more aware of their acts, resulting in healthier and safer attitutes15. This research project also mentioned that Health Education actions must encourage situations that act on individuals, empowering them while shaping a collective and participative awareness in society. It was also found that these activities must follow the group formation strategy, as teens are living in situations that shape new identities, even if intermediate, between families and society, where they can try out and play new roles15.

The Health Education Strategy was grounded on the awareness-heightening and problematization approach to education conceptualized by Paulo Freire, constructed on a foundation grounded on emancipatory and transformatory ideals rooted in dialogue and reflection16. The objective reality findings steered the Strategy not only for adolescents in the group, but also for their families. This is why the Strategy was split into two activities:a CondomWorkshop for adolescents, and a Culture Circle on Adolescence and Condom Usefor their relatives.

The Condom Workshop presented in Table 2was structured on the basis of work conducted by NUCLAIDS/FEN/UFMG with adolescents encompassed by the Family Health Strategy.

It is expected that, by the end of the workshop, these adolescents should be able to use the constructed knowledge in the exercise of sexuality, adopting healthier sexual practices, with appropriate condom use and fewer situations of vulnerability to STI/AIDS and untimely pregnancy. Furthermore, the participants could become disseminators of information in their communities, in public areas.

It is stressed that the workshop facilitators were trained in advance by the authors of this paper, who also monitored the entire workshop implementation process.

The Culture Circle onAdolescence and CondomUse opened with a presentation of the topic to be addressed. Due to poor family participation in the dissemination of information on condom use found in this study,discussions with relatives in this Circle opened with the following reflection: What do you think when associating adolescence and condoms?Key words would appear and steer the dialogues. This action was planned to last sixty minutes, and also includes mediators (the authors of this paper) guiding the discussions, organizing and coordinating the group17.

Through this action, it is expected that families can obtain more information on the exercise of sexualityduring the teen years, in addition to proper condom use, clearing up taboos and doubts about this topic. In this way, familiescan become benchmarks for adolescents, providing guidance and heightening awareness of safer sexual practices.


Always using condoms during intercourse, regardless of the duration and stability of a partnership is a positive attitude in terms of preventing STI and avoiding pregnancy. However, youngsters in this research project who did not suggest condom use and agreed to unprotected intercourse place themselves in vulnerable situations, frequently buttressed by a lack of information on safer sex practices.

It is thus necessary for these youngsters to discuss aspects of sexuality with their fathers and mothers because, in addition to extending the network of people with whom they talk about sex, they use condoms more frequently, which is the main way of avoiding pregnancy and STI18.

The workshop is a psycho-social intervention practice through a structured process working with groups, addressing a keynote issue that the group explores within a specific social context. This is not limited to rational reflection, but rather encompasses the participants in a comprehensive manner, involving ways of thinking, feeling and acting19. This allows horizontal links to build up between technical staff and the population, as the purpose of discussion venues is to strengthen knowledge already in place while allowing the expression of feelings related to everyday life, with easier expression and inter-group communication driving the discussion of content19.

Studies describing workshops held with adolescents addressing the issue of sexuality mention that this emancipatory approach to education contributes to the formation of cognitive, emotional and social contexts, fostering theexerciseof citizenship and the transformation of social realities3,4.

This is why the suggestion of a workshop was added to the Health Education Strategy, particularly as workshopsare very appealing to teens, with countless possibilities for work and growth. Here, adolescents find a place where they can express themselves freely, release their creative spirits and reflect on the topics under discussion or other matters of interest to them. As a result, workshopsare places where adolescents feel welcome, invited to attendand express their feelings and needs. In this context of reflection and dialogue, these youngsters are encouraged to accept their ownidentities while respecting differences and interacting with the group19.

Culture circles encourage open dialogue with participants exploring their everyday lives, in addition to fostering a steep learning curve, contextualizing the reality of these adolescents as a whole through a collective construction of knowledge. In these circles, inter-relationships offer freedom and the ability to criticize the topic under discussion, particularly in a group that is open to dialogue, discussion and working together16,19.

Culture Circles are useful not only for formal education in the classroom but also work well for any educational initiative, at school or at other venues where people meet and learn, and while doing so, teach something to other people which can then be used in order to promote Health Education. It is stressed that the initial experiments with Culture Circles in Recife took place in low-income communities, held at benefit associations, soccer clubs, residents associations, churches, etc.19 In this case, the community centers of the AdoleScER Group would be ideal venues for these actions.


Health Education activities conducted through either Workshops or Culture Circlesare elements able to reshape healthcare for adolescents, as they foster discussion and reflection on practices, with greater autonomy and modified behaviors. The implementation of a Health Education Strategy and the scope of its goals will offer countless benefits to these youngsters and their health, particularly achieving autonomy through adopting a preventive stance, thus buttressing the sustainability of a healthy and disease-free sex life, and suggesting engagement in a citizen-friendly and emancipatory project that enhances the quality of life of the teen segment of the population.


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