RESUMO
BACKGROUND: Obtaining informed consent for clinical trials is especially challenging when working in rural, resource-limited areas, where there are often high levels of illiteracy and lack of experience with clinical research. Such an area, a remote field site in the northeastern part of the state of Minas Gerais, Brazil, is currently being prepared for clinical trials of experimental hookworm vaccines. This study was conducted to assess whether special educational tools can be developed to increase the knowledge and comprehension of potential clinical trial participants and thereby enable them to make truly informed decisions to participate in such research. METHODOLOGY/PRINCIPAL FINDINGS: An informational video was produced to explain the work of the research team and the first planned hookworm vaccine trial, using a pedagogical method based on analogies. Seventy-two adults living in a rural community of Minas Gerais were administered a structured questionnaire that assessed their knowledge of hookworm, of research and of the planned hookworm vaccine trial, as well as their attitudes and perceptions about the researchers and participation in future vaccine trials. The questionnaire was administered before being shown the educational video and two months after and the results compared. After viewing the video, significant improvements in knowledge related to hookworm infection and its health impact were observed: using a composite score combining related questions for which correct answers were assigned a value of 1 and incorrect answers a value of 0, participants had a mean score of 0.76 post-video compared to 0.68 pre-video (p = 0.0001). Similar improvements were seen in understanding the purpose of vaccination and the possible adverse effects of an experimental vaccine. Although 100% of participants expressed a positive opinion of the researchers even before viewing the film and over 90% said that they would participate in a hookworm vaccine trial, an increase in the number who expressed fear of being vaccinated with a novel vaccine was seen after viewing the video (51.4% post-video versus 29.2% pre-video). Increases were also seen in the proportion who thought that participation in a vaccine trial would be inconvenient or disrupt their daily activities. CONCLUSIONS/SIGNIFICANCE: Even in rural, resource-limited populations, educational tools can be specially designed that significantly improve understanding and therefore the likelihood of obtaining truly informed consent for participation in clinical research. The observed changes in the knowledge and perceptions of the research participants about hookworm infection and the experimental hookworm vaccine demonstrate that the video intervention was successful in increasing understanding and that the subjects acquired knowledge pertinent to the planned research.
Assuntos
Educação em Saúde/métodos , Infecções por Uncinaria/epidemiologia , Infecções por Uncinaria/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinas/imunologia , Adolescente , Adulto , Animais , Brasil/epidemiologia , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
This article examines changing common knowledge of elementary school children to scientific knowledge related to the relationship between water characteristics and the transmission of schistosomiasis through health education. A review of the literature and two case studies from rural elementary schools in Brazil show how the prevailing concept of dirty and polluted water, which has operated as an epistemological obstacle for acquiring scientific knowledge, may be related to symbolic thought and cultural parameters. Through an educational intervention not commonly applied to health programs involving elementary school students in two schistosomiasis-endemic rural communities in Brazil this paper describes the difficulties researchers encountered in changing the prevailing perception that very dirty and polluted water provides optimal conditions for schistosome transmission, to the scientifically accepted view that transmission occurs most often in visually clean, although fecally contaminated water. This conceptual difficulty may be largely explained in terms of the symbolism involved in clean and dirty water and the life-giving quality of water. Based on our results, we recommend that knowledge about water-related beliefs and concepts among school children should be considered in school-based health education programs in areas of endemic schistosomiasis and possibly other intestinal infections.