Cad . Saúd e Púb lic a, Rio de Jane iro , 15(Sup. 2):107-119, 1999
Evaluat ion of the ZIG-ZAIDS game:
an entertaining educational t ool
for HIV/ Aids pre v e n t i o n
Avaliaç ão d o Jo g o ZIG-ZAIDS – um re c urso
lúd ic o -e d ucativo p ara info rmaç ão e p re ve nç ão
d a AIDS e ntre p ré -ad o le sc e nte s
1 Ce n t ro de Pesq u isas Re n é R a c h o u , Fu n d a ção Os w a l d o C r u z . Av. Au gu st o d e Li m a 1 7 1 5 , Ba r ro Pre t o, Belo Ho r i zo n t e , M G 3 0 1 9 0 - 0 0 2 , Bra s i l . v t s c h a l l @ c p q r r. f i o c r u z . b r 2 La b o ratório d e Ed u c a ç ã o em Am bien t e e S aú d e, D e p a rt am en t o d e Bi o l o g i a , In st it u t o Osw a ld o Cru z , Fu n d ação Osw ald o Cru z ( Ce n t ro col ab orad or d a U N A I D S / W H O ) .
Av. Brasil 436 5, M a n g u i n h o s , Rio de Ja n e i ro, RJ 2 1 0 4 5 - 9 0 0 , Bra s i l . Vi rgín ia T. Sch a ll 1 , 2 Sim o n e Mo n t e i ro 2 S a n d ra M . Rebello 2 Ma ysa To r res 2
Abstract Th is article p resen ts t h e eva lu a t ion p rocess for th e Z IG- Z AIDS ga m e, i n v estigat in g t h e m a t e r i a l ’s a p p lica b i li t y i n f o rm a l a n d i n fo rm a l ed u ca t i on a l co n t ex t s , i . e . , h ow t h e ga m e h a s been u sed by h ea lt h p ro f e s s i o n a l s , p a re n t s , a n d t h e t a rget p op u la t io n (p re - a d o l e s c e n t s , or ch il-d ren ov er 9 yea rs olil-d ). Th e st u il-d y in vo l veil-d ev a lu a t ion qu est ion n a ires sen t t o a list of sch o ols a n il-d in st it u tion s u sin g t h e ga m e, p lu s in t erv i ew s an d v isits t o p la ces w h ere t h e ga m e w a s u sed a s w ell a s t est ed w it h grou p s o f st u den ts. It also in clu d es a n a n a lysis of eva lu a t ion p rev iou sly sen t by t h e a u t h ors t o p eop le w h o h a d req u est ed t h e ga m e. Th e resu lt s sh ow ed t h a t t h e p op u la t ion’s level of i n form a t i on is m ore re l e va n t t h a n a ge in rela t ion t o t h e ga m e’s i m p a ct . An ot h er im p ort a n t a s-p ect rela t es t o Z IG-Z A I D S’ a s-p s-p lica bili t y t o di ff eren t sit u a t io n s: t ra in in g of h ea lt h a n d t ea ch i n g p ro f e s s i o n a l s ; a ct iv it ies w it h st reet ch ildre n ; m u n icip a l in st it u t i on s a n d eve n t s , s c h o o l s , c o m p a-n i e s , c o m m u a-n i t i e s , a a-n d h ea lt h ca re cea-n t ers. Ia-n su m m a ry, Z I G - Z AIDS w a s f ou a-n d t o b e a a-n ea-n t er-t a i n i n g , c re a er-t i ve , a n d in n ov a er-t i v e a ler-t ern a er-ti ve for p rov id in g in form a er-t ion on AIDS a n d sex u a l i er-t y.
Key words Healt h Ed u c a t i o n ; Ed u ca t ion a l Te c h n o l o gy ; Eva lu a t io n of Resu lt s of Pre ve n t i ve Ac-t i o n s ; Sex Be h a v i o r ; H I V; Ac q u i red Im m u n odefici en cy Sy n d ro m e
Resumo Est e a rt igo a p resen t a o p ro cesso d e a v a lia çã o d e u m m a t eri a l ed u ca t i v o, o jogo Z IG-Z A I D S , q u e t ev e p or ob jet i v o v eri fica r a a p li ca b ili da d e d est e m a t eria l em esp a ços ed u ca cion a i s form a is e in form a is, ou seja , i n v est iga r com o v em sen d o u t iliza d o p or p rofission a is e p ais, e p ela p o p u l a ç ã o - a l v o (p ré- a d olescen t es). O est u d o en vo l v eu o e n v io d e q u est i on á rio s d e a v a lia çã o a escola s e in st itu ições qu e faz iam u so do jogo, e n t re v i s t a s , v isita s a algu n s loca is on d e o jogo est a -v a em u so e t est a gem co m gru p os d e alu n os. In clu iu ain d a a n á lise d e a -v a lia ções en -v ia d a s a n t e-riorm en t e p elas a u t ora s a solicit a n t es d o jo go. Os resu lt a do s d em on st ra ra m qu e o n ível de in for-m a çã o d a p o p u la çã o é for-m a is re l e v a n t e d o qu e a id a d e efor-m rela çã o ao ifor-m p a ct o d o jogo. Ou t ro a s-p ect o d est a ca d o rela ci on a - se à a s-p li ca bi li d a d e d o Z IG- Z AID S a si t u a ções d i v e r s a s , c o m o : e m t rei n a m en t os d e p rof ission a is d e en sin o e saú d e; em at i v id a d es com m en ores qu e v iv em n a ru a ; em ev en t o s d e p re f e i t u ra s e i n st i t u ições, em escola s, e m p re s a s , co m u n id a d es e p o st os d e sa ú d e. Si n t e t i z a n d o, o Z IGZ AIDS foi con sid erad o u m a a lt ern at iv a lú d ica , c r i a t i va e in ov a d o ra p ara in -form a r sobre AID S e sex u a l i d a d e .
SC HALL, V. T. e t a l. 1 0 8
Cad. Saúde Púb lica , Rio de Jane iro , 15(Sup . 2):107-119, 1999
AID S among children and youth in Brazil
Alth ou gh th ere is con sid erab le u n derre p o rt i n g in Brazil relatin g to AIDS, oth er STDs, an d dru g abu se durin g ad olescen ce, seve ral stud ies have s h own th a t in itial sexu a l a ct ivity an d exp e rim en ta tion wit h d iffe ren t p syc h o a c t i ve su b -sta n ce s ge n erally o ccu rs b etwe en 10 a n d 19 years of age. As suggested by San tos (1996), de-sp ite the re l a t i vely sm all n u m b er of AIDS cases re p o rted in Brazil in th e 15-19 year age bra c k e t as of Au gu st 1995 (1,633), given th e lon g in cu-b ation p er iod , th ere sign s th at in d ivid u als d i-agn osed with AIDS at 20 to 29 years of we re ac-tually in fected d u rin g ad olescen ce, re i n f o rc i n g t h e n ot io n o f vu ln erab ility t o STDs an d d ru g abu se du rin g th is stage of life.
As of Au gu st 1998, a c u m u la tive tota l o f 140,362 AIDS case s h ad b een re p o rted in Bra z i l sin c e 1980 (M S, 1998). The m ost sign ifica n t HIV exp osu re category in p eop le over 12 ye a r s o f a ge was sexu al con ta ct (64%). Th e vast m a-j o rity of cases exp osed to c on tam in ated blood (12.9% of a total of 13%) we re in tra ven ou s dru g u s e r s. Am on g in d ivid u als u n d e r 13, p eri n a t a l t ra n sm issio n a ccou n te d for 89.3% of in fe c-t i o n s. In c-th e 15-24-year age gro u p, 18,271 cases ha d b een re p o r ted , cor resp on din g to 13.1% of the cu m ulative total, while the 25-39 age gro u p a cco u n te d for 59.7%. Du e to H IV’s p ro l o n g e d in cu b ation p eriod (ap p roxim ately 8- 10 ye a r s ) , on e can con clu d e th at a sign ifica n t p ortion of in fection s occur in yo u t h .
Ac c o rd in g to recen t d a ta fr om U NAID S/ WHO (1998), n ew ca ses keep ap p ear in g at th e sam e or in creased rates in som e cou n tri e s, re-q u i r in g fur th er in vest m en t in p re ve n tion . Ac-c o rd in g to U NAIDS/ WHO (1998), th e n u m b er o f p eop le with HIV/ Aid s world wid e in cre a s e d by 10% in 1998. Half of th e n ew in fection s oc-c u r red in in d ividu als 15 to 24 years old .
Oth er d a ta p oin t t o t he oc cu rren ce of u n -p r ote ct ed sexu a l a c tivity am on g yo u th , a s d o t he d ata on te en a ge p re gn a n cy (u n d e r 19), wh ic h occ ur s in 13% of Br azilian fem a les. Ac-c o rd in g to d a ta from th e Mi n i s t ry o f He a l t h (1996), 23.44% o f th e 2,821,211 b irth s assisted b y th e Un ified Health Syste m (SU S) in 1995 we re in m ot h ers 15- 19 yea rs of age. In Rio d e Ja n e i ro, 17% of live bir ths in 1994 we re in m o t h -e rs fr om 12 to 19 y-ear s of a g-e, or a t ot al o f 15,697 babies. Of these m others, 60% we re illit-e ratillit-e or had an in com p lillit-etillit-e p ri m a r y illit-ed ucation , re i n f o rcin g th e assoc iation b etween sex-re l a t-e d bt-ehavioral vu ln t-erab ility an d gt-en d t-er an d so-cial factors, i.e., less access to schoolin g, in form a tion , an d th e ab ility to access an d u se c on -t ra c e p -t i ve m e-th od s.
D e m o g ra p h ic stat istic s o n H IV t ra n s m i ssion in the 1990s p oin t to th e in c reasin g n u m -b e r o f AID S c a se s in wo m e n (of t h e 79,906 c a ses re p o r te d as of Fe b ru a r y 1996 in Bra z i l , 14,464, or 18%, we re wo m e n ). Th is h a s an in -c reasin g im pa-ct on th e p re valen -ce am on g -ch il-d ren : 78.3% o f p e il-d iatr ic AID S cases re s u l t e il-d f rom ve rtical tran sm ission . In addition , con sid -e rin g th-e in cr-eas-ed m -ean su rv i val tim -e for p - eo-p le wit h AID S d ue to c o m b in a tio n th era eo-py, m a n y H IV- p o s i t i ve c hild re n are n ow in ear ly ad o lesc en c e a n d b e co m in g se xu ally active, hen ce re q u i rin g safer sex/ p re ven tion m easure s in their re l a t i o n s h i p s.
ZIG-ZAIDS: creating alternat ives for HIV/ Aids prevention
The p rop osal to produce edu cation al m ateri a l s on HIV/ Aids pre ven tion am on g you th b egan in 1988, wit h th e re p e rc u ssion s of th e grow i n g n um b er o f AIDS c a se s in th e gen era l p o p u la-tion . Althou gh the first cases we re iden tified in hom osexu al m ales in the Un ited States in 1981, du e to h om op h ob ia an d p reju d ic e on th e p ar t of gove rn m en t al in stitu tion s an d se gm en ts of civil society b oth wo rldwid e (Sh i l t s, 1987) an d in Brazil (Dan iel & Pa rk e r, 1991), there was un -n e c e s s a ry d elay i-n form ulati-n g p olicies to stem the growth of th e ep idem ic (Man n et al., 1993). Co n t r oversy co n c er n in g t h e o rigin an d t ran sm ission of t h e HIV an d th e lack of m ed i-cin es a n d vac i-cin e s c ap ab le of red u i-cin g H IV t ran sm ission had con tributed to a fatalist, p re j-u d ic ed , an d err on e oj-u s vie w o f th e d ise ase. It was th us im p ortan t to ch an ge th e p rop osals so as to p rom ote in form ation th at m igh t en cour -age p re ve n t i ve p r a c t i c e s. Arou n d th is tim e, a n e x t e n s i ve sur vey con d u c ted by Sc h all et al. (1987) on h ealth issues am on g studen ts in clud -ed question s about elem en tary studen ts’ k n ow l-ed ge o f AIDS. An swe rs by 365 stu d en ts fro m two Brazilian cities, Rio de Ja n e i ro (RJ) an d Be-lo Ho ri zo n t e, id en tified m iscon cep tion s, ign o-ra n c e, a n d a fata list view of th e ep id em ic (Re-b ello e t al., 1989). The se d a ta c on firm e d t h e i m p o rta n c e of id en t ifyin g e d u c ation a l ap -p roa ch e s wit h c on ten t s ca-p a b le of fosteri n g p re ve n t i ve p ra c t i c e s.
Cad . Saúde Púb lic a, Rio de Jane iro , 15(Sup. 2):107-119, 1999
ed u cat io n al. Th e ove r whe lm in g im p re s s i o n f rom AIDS p re ven tion cam p aign s was th at of a fa tal d isease. In th e litera t u re, re s e a rch co n f i rm ed the results of our in vestigation with stu -d en t s as to th e lac k o f in fo rm a tion a n -d wi-d e-s p read m ie-scon ception e-s (Pin h o et al., 1989), be-sid es h igh ligh t in g th e ch alle n ge s of ad op tin g p re ve n t i ve p ra c t i c e s, given t h e c om p le xit y of issu es in vo l ved in AID S, like sexu a lit y an d d ea th , wh ich h a ve a lways b e en ta b oo d u ri n g c h ild h o od . Th e lack of d ia lo gu e on t h e issu e stem m ed from th e exclusion of top ics that n ei-th er fa m ily n o r sc h o ol fo un d p rop er fo r c h il-d ren , m ain tain in g a sort of trail-dition al m ora l it y, h a rd ly c o n stru c t i ve o r p re ve n t i ve. Ac c o rd i n g to a n ot h er p re vailin g n ot ion , to sp e ak ab o u t sex or d r u gs w ith c h ild re n an d yo u t h m igh t i n d u c e t h em to tr y d ru g s, if su c h issu e s we re b ro u gh t u p ou t sid e th e fa m ily, sc h o o l, an d h ealth p ro g ra m s.
Sin ce th e ad ven t of AIDS, society itself an d the p olitical p ower b etween th e id eological re-p ression o f se xu a lity in sid e th e fam ily (on ce p ri va t i zed by the social m od el) b egan to searc h for altern a t i ve p ed agogical ap p roac hes to th is q u estion , observin g th e n eed for m ore com m u -n icatio-n a-n d p re s s u red by AIDS’ p ote-n tial ri s k to life a n d hea lth . In sh o rt, b o th th e su r ve y am on g stu den ts an d the litera t u re an alysis sug-gested the im p ortan ce of creatin g p edagogical re s o u rc es in t h e HIV/ Aid s p re ven tion area to foster learn in g an d d eb a te a b ou t the ep id em -i c’s soc-ial an d sym b ol-ic asp ects.
The ZIG-ZAIDS game:
t h e o retical basis and development
Z I G ZAIDS was created in the con text of a lab -o ra t -o r y (th e Health an d En v i r-on m en tal Ed u c a-tion Lab ora t o ry – LEAS – in th e Biology De p a rt-m en t at In stitu to Oswaldo Cru z / Fu n d ação Os-wa ld o Cru z – IOC/ FIOCRUZ) fo cu se d on r e-s e a rch an d e-stra tegie e-s to d evelop ed u ca tion a l m a t e rials t o p r om o te d ise ase p re ven tion a n d h ealth p rom otion from childh ood on ward . T h e re s e a rch con sid e r s th e n ee d t o st im u la te d ia -logu e a n d exc h an ge o f kn owled ge b etwe e n ad ults an d children , an d am on g ch ildren t h e m -s e l ve -s, con -sid erin g -such a-spect-s a-s -self-e-st e e m , resp ec t a n d r esp o n sib ility tow a rd s o n e’s ow n life a n d tha t of o th ers a s well as n a tu re, a n d a c om m itm en t t o im p r oved q ua lit y of life. T h e s t a rtin g p oin t is an attem pt to u n d erstan d h ow c h i l d ren con stru ct the m ean in gs of h ealth an d d isease in their own c on text, in te ractin g with u n iqu e in d ivid ual asp ects su ch as self-esteem , p r io r exp e r i e n c e, an d fam ily an d sch o ol re l a
-tion ship s (Sch all, 1996). In ad di-tion , th e in ter-views a n d q u estion n a ires p rovid e a b asis for ob tain in g better kn owledge of the in form a t i o n l e ve l a n d a p p r o p riat e la n gu age fo r th e t arg e t p op u lation . A t h e ore tica l b asis is e ssen tial t o p rovid e sup p ort fo r edu c ation al p ractic es an d n ew m aterials d evelop ed at LEAS.
Vygotsky (1991, 1993) un d erlies this curre n t a p p r oa ch tow a rd s d iffere n t p roc esse s of lan -gu age con stitu tion a n d con cep ts, con sid eri n g c h i l d re n’s sp on ta n eo u s co n ce p t s tow a rd s th e c o n s t ruction of scien tific con cep ts. Th is is h e l p -fu l in th e con stru ction of use-fu l life skills. T h i s a p p roach is fostered by the gam e’s own d yn am -i c s, -in wh -ich m -iscon cep t-ion s are rep laced by a k n owledge bu ilt collectively throu gh con ve r s a-t io n a n d c oo p e ra a-tion . In d e velop in g a-th e n ew m a t e ri a l s, we c on sid ered w ha t Vygostky p rop ose s re g a rd in g th e d evelorop m en t of h ighe r in -tellectu al fu n ction s as th e re f l e x i ve con sc iou s-n ess as-n d deliberate cos-n trol that, os-n ce added to th e n otion of th e p roxim a l d evelop m en t zo n e, m igh t h elp p ar en ts a n d sc ho ols to ove rc o m e th e re q u i rem en ts fixed solely to th e hiera rc h y of m en tal age an d to grasp th e childre n’s p ossi-b i l i t i e s, con siderin g th e cooperation p ro c e s s e s. A d ialogic al relation is ad d ed to th e n ecessary c o o p e ra tion am on g p ar tn er s in th e ga m e a s p rop osed by Bakh tin (1985), favo rin g an elab o-ration of m ean in g in h ealth / disease, m akin g it p ossib le to a ttain a co m p lex m ea n in g b eyo n d th e associa tion lim it ed t o the b iologic al b od y a n d ac h ievin g social a n d affective we l l - b e i n g , resp ect, an d toleran ce in h u m an re l a t i o n s h i p s. In ad dition , it p rom otes resp on sib ility for en vi-r on m en t al p vi-re s e vi-r va tio n , ove vi-rco m in g n ot io n s fo cu sin g o n ly on im m ed ia te re a l i t y. T h u s, sci-en tific kn ow l e d g e, on ce bu ilt, is n o t re s t ri c t e d to m em ori zed d efin ition s, rath er health m ean -in gs are -in terl-in ked with oth er asp ects of d aily l i f e, m ixin g u n iq u e p oin ts of view with collec-t i ve p ersp eccollec-t ives con so lid acollec-ted by b ocollec-th cogn i-t i ve an d affeci-tive asp eci-ts (Schall, 1996).
SCHALL, V. T. e t a l. 1 1 0
Cad. Saúde Púb lica , Rio d e Jane iro , 15(Sup. 2):107-119, 1999
Th is an a lytical p ersp ec tive is lin ked to a g i ven cr itic al vision of ed u c ation (Me l o, 1993) t h a t in flu en c es d iscu ssion of t h e ed u c at io n al n a t u re o f p re ven t io n wor k in th e h ealth field an d con seq u en tly the d evelop m en t of m ater i-a l s. This focu s is b i-ase d o n p rop o si-als by Fre i re (1979) on th e role of ed u cation in social tra n s-f o r m atio n , in whic h t he s-for m er re lat es to th e a w a re n e s s - ra isin g p r ocess ch ara c t e ri ze d by p e r m an en t critical ac tion by h u m an s tow a rd s re a l i t y. Usin g th is th eoretical ap p roach , this au-th or q ue stion s p ed agogic al, dom esticated ac-tion s cen tered on th e ed u cator’s au th ority an d k n owled ge an d p ro p oses a lib e ra l co n ce p t o f ed uca tion , wh ere ed u c ator an d ed u c ated p a r-ticip ate an d collaborate in the learn in g p ro c e s s, in a relation u sin g d ialogu e an d p ro b l e m - s o l v-in g. Th is th eo retic al o rien t at io n v-in tr o d u ces a p olitica l an d so c ia l d im e n sion to ed uc at io n , exp an d in g th e d iscu ssion of learn in g an d an a-lyzin g th e p ri o r ity of t h e cogn itive an d em o-tion al developm en t of th e p erson to be ed ucat-ed . Th is p ersp e ctive is d iscu ssucat-ed by Mo n t e i ro (1995) a n d Pa i va (1996) wh e n p lan n in g HIV/ A i d s p re ven tion p ro g ra m s.
Based on th ese p ersp ective s, th e p rocess of c reatin g ZIGZAIDS was ch ara c t e ri zed b y con ten t selection a n d ch oice of th e m ateri a l’s ap p roach . We attem p ted to d ifferen tiate th e con -t en -t fro m -t he p re va ilin g alar m is-t vie w o f -th e ep id em ic, h ighligh tin g exp lan ation s id en tifyin g th e p o ssib ility of safer se x p ra c t i c e s, c on -s i d e r in g t ha t -sexu a l a waren e-s-s ta ke-s p la ce in p re-a d o lesce n ce an d a d ole scen ce, an d t ha t th is re q u i res sym p ath etic attitud es.
In relation to th e ap p roac h , du e to the tar-get p o p u lation’s sp ecific ity, we tr ied to in cor-p o rate en ter ta in in g elem en ts cacor-p a ble of m oti-vatin g learn in g an d stim u latin g thin kin g ab ou t th e epidem ic’s social an d sym b olic aspects. We t hu s op ted to cre at e a q u estion - an d -a n swe r gam e (which we n am ed ZIG-ZAIDS), u sin g ac-cessib le lan guage an d exp lora t o ry illu stra t i o n s w h e re th e p a rt ic ip an t s got in fo rm at io n a n d would b e m otivated to talk abou t d ifferen t sci-e n tific an d social asp sci-ects of th sci-e sci-ep id sci-em ic.
Z I G ZAIDS con sists of a board with 23 n u m -b e red sp ac es an d oth er sp aces illustrated with a con d om (“wild card s”) an d oth ers with dire c-t io n s su c h as “go on e sp a ce for w a rd”, “go o n e sp ace b ackward”, an d “w a i t”, two dice, six gam e p i e c e s, 23 n um b ered qu estion cards (with q u e s-t ion s on o n e sid e an d an swer s an d d ire c s-t i o n s for t he n e xt m ove on t h e o th er) an d 20 wild c a rd s. Th e q u estion c ard s d ea l with sub je ct s su ch as th e im m u n e system , tran sm ission p at-t e rn s, at-treaat-tm en at-t, an d p re ven at-tion . Th e n eed for s o l i d a rity an d coop eration in h u m an re l a t i o n
-ship s is em p h asized . Un like oth er gam es, th re e question s ask for op in ion s rath er th an ri g h t - o r-w ron g an sr-we r s. By askin g ab out visits to AIDS p a t i e n t s, the im p ortan ce of solidari t y, an d p ar-ticip ation by ch ildren with HIV in school activ-i t activ-i e s, the gam e c reates op p ortu n activ-itactiv-ies for p lay-er s t o refle ct on th e social a n d p syc h o l o g i c a l con sequ en ces of AIDS. The wild card s con tain i n f o rm ation on top ics su ch as HIV, hem op hilia, b loo d tra n s f u s i o n s, d r u g s, jo b o p p or t u n i t i e s, n ew tre a t m e n t s, an d oth er sub jects re l e van t to p eop le with HIV. ZIG-ZAIDS furth er con tain s a leaflet for p aren ts an d teach ers, p osin g d iscu s-sion q u estion s on top ic s su ch as th e d ifficu lty an d discom fort ad ults exp erien ce in d iscussin g se x a n d th e im p or tan ce of listen in g to wh at c h i l d ren feel an d thin k abou t sex. Also in clu d -ed are a m in i-d ic tio n ar y with wo rd s re f e r ri n g to sex org a n s, se xu al re l a t i o n s h i p s, a n d STDs. T h e re is also a su gge stion to in clu d e a con dom as the first p ri ze, an d the recom m en dation th at it b e op en ed an d shown to classm ates.
In order to m atch th e m aterial to th e targ e t p o p u l a t i o n’s re a l i t y, th e p rod u ct was tested t h ro ugh a n exp e r im en t in clu d in g in te rv i e w s b e f o re an d after p layin g th e gam e, in ad dition to d irec t ob ser vat io n . Usin g a test ve r sion of th e gam e, we o b ser ve d seve ra l ep isod es with e l e m e n t a ry st u d e n ts fr om p u b lic an d p ri va t e sc h ools in Rio d e Ja n e i r o. Th ese ep isod es a l-l owed u s to ve rify th e gam e’s cap a city to m oti-vate learn in g an d p rovid es u s with tip s to alter an d adju st it (Mo n t e i ro et al., 1990; Mo n t e i ro et al., 1991).
Based o n th e d a ta from th e te st ga m e, we d e velop ed th e fin al version . At th is stage, ru l e s we re changed, lan gu age adap ted, an d n ew c o n -ten t s in c lu d e d . We also e valu at ed t h e ga m e’s n ew visu a l layo u t , p ro d u ced b y e xp ert s. Be -sid es testin g th e gam e with st u d e n ts, we a lso c o n s i d e red p are n t s’ an d teach ers’ opin ion s. In -t e rviews wi-th -th e la-t-ter led -to -th e p rod uc-tion of a m an u al (in c lu d e d wit h th e gam e ) ta rg e t i n g p a ren t s a n d ed u c at ors, wit h su ggestion s fo r add ition al read in g, teachin g activities, an d ad -d resses of gove rn m en tal an -d n on gove rn m e n t a l in stitu tion s workin g with HIV p re ven tion an d/ or treatm en t for p eop le with HIV/ Aid s.
On c e th e fin a l ver sion of the m a teria l wa s d e velop ed , we atte m p ted to iden tify p ub lish ers or com p an ies th at m igh t b e in terested in p ro d ucin g th e ga m e on a com m erc ial sca le in or -der to m arket an d d istr ibu te it. Mo re detail on th is stage of the m ethodology h as been p rov i d -ed by Mo n t e i ro & Reb ello (1999).
-Cad. Saúd e Púb lic a, Rio d e Jane iro , 15(Sup. 2):107-119, 1999
s o u rc e s, sin ce we felt that the gam e as an ed u -cation al re s o u rce was com p lete, but d id n ot re-p lac e t each in g in re-p ra c t i c e . In th is se n se ou r com m itm en t was n o t on ly to c on c en t rate on th e gam e’s scien tific im p act, b ut also to eva l u -at e it s im p a ct in th e search fo r p art n e r s h i p s that would foster access to its u se, i.e., teach in g in stitu tion s an d h ealth p rofessio n als in vo l ve d in p re ven tion ed u cation (Mo n t e i ro, 1998).
It is com m on ly felt that th e p rodu ction an d e valu ation o f ed u catio n al m ater ials sh o u ld b e com b in ed with train in g of hu m an re s o u rces to au gm en t the m ateri a l’s ed u cation al p oten tial. We see the gam e as a teach in g aid, an d n ot as a rep lacem en t for ed ucation al activity. Based on the related litera t u re on ch ild ren (Sch all, et al. 1987; Schall, 1996; 1999), en tertain in g education-al aid s like th e ZIG-ZAID S ga m e (Mo n t e i ro e t al., 1991) a n d th e Jogo d a On d agam e (or th e “Wa ve Ga m e”) (Rebello & Mo n t e i ro, 1998) focus-ing on drug p re ven tion (Mo n t e i ro et al., 1994) can be seen to play an in form a t i ve role an d to ser ve as excellent in strum en ts for initiatin g d iscussions an d raisin g awaren ess on h ealth -related issues.
The need to evaluat e educat ional s t r a t e g i e s
Eva lu a tin g an e d u ca tio n a l a c tivity can asse ss p revio us an d b aselin e m easu res in or d er to e valuate th e ch an ge ach ieved . Eva lu ation can also b e used t o m ea su re an ed u cation a l p rop o s a l’s feasibility an d reach, re c o rdin g an d an alyzin g its ap p licab ility to th e p rop osed teach -in g situation s.
Ou r evalu ation aim ed to ve rify th e qu ality of in t er ve n tion in vo l ved in th e ZIG-ZA I D S gam e in va riou s situation s: from an in itial situ -at io n al an a lysis, wh ich sh owed t h e n eed fo r e du ca tion al m at erial o n STD s/ Aid s targ e t i n g you th . The p rocess thus in corp orated elem en ts f rom this situation al evaluation , attem p tin g to i n vestigat e th e gam e’s a cc ep tab ility, followe d by a n evalua tion o f t h e p ro c e s s, c on sid e ri n g th e q uality of the health education p ractice m o-t i va o-ted by o-t h e ga m e an d so-tim u la o-tin g d iffere n o-t a l t e rn a t i ves an d in -d epth con sideration . It also in clu ded an im p act evalu ation on th e effica cy in p rom otin g kn owled ge-bu ild in g an d cri t i c a l reflec tion con ce r n in g sym b olic a n d so cia l a s-p ects of the AIDS es-p id em ic am on g adolescen ts. Th ese levels of evalu ation have b een in ter -p rete d in d iffere n t wa ys b y va r io us a u th or s. Ay re s (1996) m akes a n in te restin g an a lysis of th e evalua tion o f e d u cation a l in t er ve n t i o n am on g stud en ts, related to the an alysis of thre e p rin cip les: 1) re alism , wh ere th e a u th or lead s
the read er to con clud e in favor of the re l e va n c e of evaluation cri t e ria for real exp erien ce; 2) fe-c u n d i t y, h igh ligh tin g th e im p or ta n fe-c e of “p ro-d u cin g a w a ren ess of w h a t is effect iv ely bein g d o n e”( Ay re s, 1996:3) fro m a d iffe ren t iation o f t he elem e n t s wh ich d e ter m in e th e in te rve n -t i o n’s su cc ess; 3) p ra c -t i c a b i l i -t y, exp resse d by the defin ition of objective m ethods that are ac-c e s s i b l e, m otivatin g, an d ac-cap ab le of p ro d u ac-c i n g sign ifican t d ata an d likely to p rodu ce feedb ack. Through strategies described as exam p les, Ay re s s h ows b ot h t h e c o m p lexity an d fea sib ility of c o n s t ru ctin g an d con d uc tin g an e va l u a t i o n p rocess an d thu s offers im p ortan t re s o u rces for e valu atin g e ducation al in terve n t i o n s.
Fr om a sim ilar a n d co m p lem en t ar y p er-s p e c t i ve, Aggleton (1995) dier-scuer-ser-seer-s th e eva l u a-tion of health educaa-tion p rogram s an d att e m p t s to differen tiate betwee n m on itorin g an d eva l u-a tion , b u-a sed on WH O d efin ition s c h u-aru-a c t e ri z-in g th em as com p lem en tar y action s. Pl a n n i n g these action s, in turn , in vo l ves th e d efin ition of th em es to b e in vest iga ted (e.g., cogn itive an d b e h a v i o ral asp ects an d attitud es), as well as th e in d icators an d m ethod ological strategies to b e u sed . Th is defin ition is based on th e p ro p o s a l’s o b j e c t i ve s, re s o u rc e s, an d p ra c t i c a b i l i t y. Due to t h is are a’s d iversit y an d m agn itu d e, Agglet on h igh ligh ts t h e lim its a n d ad e q u a cy o f th re e com m on evalu a tion stra tegie s: t h e c om p a ra-t i ve ap p r oa c h , ra-t h e ap p ro ach on eva lu ara-tio n o f o b j e c t i ve s, a n d th e in t erp re t a t i ve a p p r o a c h (Aggleton , 1995:198-204), su ggestin g a gen era l o ri e n t ation for the q uestion s.
M ethodology for evaluat ion of ZIG-ZAIDS
Co n s i d e rin g the edu cation al m ateri a l’s m ethod-ological p ossibilities, the p resen t study attem p t-e d to t-evalu a tt-e t ht-e ZIG- ZAID S gam t-e’s im p a ct , e st ab lish in g a s a goa l t h e an a lysis of it s u se an d effective n e s s, as a re s o u rce for m otiva t i o n , l e a r n in g, an d p re ve n t i ve a n d n on -d isc ri m i n at o r y b eh a vio rs. We esat ab lishe d com p le m en -t a r y re s e a rch m e-th ods, p lan n ed by -the au-th ors a n d c o n d u c t e d b y To r re s (19 95 ), w h e r e t h e re s e a r ch e r wa s n o t in vo l ved in t h e p re v i o u s p h a s e, creat in g t he gam e. Th e st age s we re a s f o l l ows:
SC HALL, V. T. e t al. 1 1 2
Cad . Saúde Púb lic a, Rio de Jane iro , 15(Sup. 2):107-119, 1999
p rofession , telep hon e, an d ad dre s s, an d in c l u d-ed qu estion s such as:
• W h e re was t h e ga m e p layed ? (e.g. in stit u -tion , com m u n ity, b usin ess, sch ool...)
• What was th e age group of the p laye r s ? • Wh at was th e gro u p’s level o f in fo rm a t i o n about AIDS? How was th e m aterial re c e i ve d ? • Was th e ga m e p resen ted with in a p ro g ra m of AIDS p re ven tion or sex ed u cation ? We re an y activities d evelop ed based on th e m ateri a l ? • Did th e ga m e reach its ob jectives as an ed-u ca tion al t ool? If n e ce ssar y, p le ase a d d yo ed-u r s u g g e s t i o n s.
2) Op in ion s from th e in terviews an d q u es-t i o n n a i res filled o u es-t b y gam e user s, kn own as p rocess an alysis. Th e in terviews don e with th e gam e u sers in clud ed th e followin g q u estion s: • Nam e o f in stitut io n wh e re th e ga m e was p l a yed;
• Wh at was th e age group of the p layers? • Wh at was th e p laye r s’ level of in form a t i o n about AIDS?
• How was the m aterial re c e i ved ?
• Was th e gam e p resen ted with in a p ro g ra m on AIDS p re ven tion or sex edu cation ?
• A re a n y o ther activities ap p lied within th is p ro g ram ? Wh at are th ey?
• As an edu cator, did you feel p re p a red to use the m aterial or was it n ecessary to con su lt oth-e r so urcoth-es to b oth-e ttoth-e r u n d oth-e r st an d it? Aft oth-er th oth-e m a t e rial was u sed, we re oth er activities carri e d ou t to a ssess th e assim ila tion of th e in form a-t io n b y a-t h e p la ye rs? Did a-th e ga m e a ch ieve ia-t s o b j e c t i ves as an edu cation al tool?
Th e qu estion n aires we re sen t by m ail to 42 sch ools an d oth er in stitution s alon g with a let-t e r. The lelet-t let-ter exp la in ed let-th e ob jeclet-tive s of let-th e e valu ation p ro c e s s, as follow s :
“W e a re con d u ct in g a n ev a lu a t ion on t h e i m p a ct of t h e ed u ca t io n al ga m e Z IG-Z A I D S h e re a t t h e En v i ron m en t a l a n d Hea lt h Ed u c t i on L a b o ra t o ry of t h e Osw a ld o Cru z Fo u n d a-t i o n . Th e gam e w a s d ev elop ed b y re s e a rc h e r s f ro m t h is i n st it u t io n w it h in t h e ed u ca t ion a l com p on en t p ro g ra m of t h e In st it u t ion a l AIDS p ro g ra m / F I O C RU Z , w h i ch is su p p ort ed b y t h e D i v isi on on S ex u a lly Tra n sm it t ed Di sea ses o f t he Braz ilian Mi n i s t ry of He a l t h . The p u rp ose of t h e gam e is t o fo cu s on t h e AIDS issu e t o get h er w it h d iff eren t grou p s from gov ern m en t a l an d n o n g ov ern m en t al orga n iz a t ion s, p r i v a t e com -p a n i e s , an d sch ools, w ith a view t ow a rd s -p rov i d-in g ba sic d-in form at ion on t h e disease t o a bro a d p u b l i c , esp ecia lly ch ild ren an d ad olescen t s.
To h elp a ch iev e ou r ob ject i ve s , w e a re con -t ac-t in g p rofessio n als a n d in s-ti-t u -t ion s cu rre n -t l y d e v elo p in g st u d ies on p re ve n t i ve ed u ca t i on in H I V / A i d s . Kn ow in g th a t you a re in v o l ved in th is
f i e l d , w e con sider you r colla bora tion t o be of th e u t m ost im p orta n ce for th e su ccess o f ou r stu d y.
As a st a rt in g p oin t , w e w o u ld li k e t o k n ow w het h er you h ave access to th e ga m e or u se it in an y sp ecific w ork ? If so, w e w ou ld ask you to an -sw er t h e q u est i on n ai re below an d ret u rn it t o th e ZIG-Z AIDS p roject as soon as p o ssible.
1) How d id you re c e i v e t h e ga m e: t h ro u g h a n in st it u t io n or fro m so m e ot h er sou rce? How m an y set s did you re c e i ve ?
2) Was th e m a t erial distribu ted t o sch ools or oth er in stitu t ion s t h a t w ork w ith AIDS?
3) Is th ere a follow -u p system for t h e p ro j e c t s t h a t are b ein g ca rri ed o u t b y t h e in st i t u t i on s th at re c e i ved th e m ateria l?
4) Is th ere som e re c o rd of h ow th e ga m e is be-in g ap p lied , to w h a t a ge gro u p, to w ha t sch ola s-tic lev el a n d w it h w h a t level of p rior k n ow l e d g e a bou t AIDS?
Th a n k in g you in a d va n ce for you r coop era -t i o n , ( . . . ) ”
3) Ob se rva tio n of ZIGZA I D S’ u se b y p re -ad olescen ts an d -ad olesc en ts, ch a ra c t e ri zed as im p act an alysis. Ef f o rts we re m ad e to com bin e q u a n t i t a t i ve eva lu a tion (sta tistic al a n alysis) an d q u a lit at ive a n alysis, i.e., an alysis o f t h e o p i n i o n s’ c on ten t, in ter v i e w s, d irect ob se rva -tion , an d p h otograp h ic d ocu m en ta-tion . We al-so attem p ted to ac h ieve a n exten sive re g i o n a l sam p lin g an d diversity of the stu dy p op ulation , at tem p t in g to in c lu d e sam p le s fr om a wid e a re a of Bra zil an d fr om d ifferen t situ ation s in th e gam e’s u se. Th e re s e a rc h wa s con d u c ted wit h in a d iver sified u n iverse of p ro f e s s i o n a l s an d in stitu tion s in clu din g p ublic org a n i z at i o n s, civil an d p r i va t e, n a tion a l a n d in tern a t i o n a l , b e yon d th e field s o f ed u c ation a n d h ealth . We th u s att em p ted to ve r ify th e in stitu tion a l a n d p rofession al d em an ds p ertin en t to requ ests for the gam e su b m itted to FIOCRU Z .
R e s u l t s
Situational analysis: the game’s acceptabilit y
C ad. Saúde Púb lic a, Rio de Jane iro , 15(Sup. 2):107-119, 1999
s t o res rejected the gam e, an d th is re c e i ved ex-t e n s i ve m edia cove ra g e. Th is su ggesex-ts ex-th aex-t ex-th e p ub lic was n ot really p re p a red for a table gam e d ea lin g with AIDS. T h e re f o re, a fte r a n agre e -m e n t with th e au t h o rs, the -m a n u fa ct u re r left th e c on d om ou t of th e su b se q u en t ed ition s, an d its u se was on ly a su ggestion in th e m an u -al, to be p u rch ased at th e user’s d iscretion . T h e p u b lish er b ega n u sin g a d istr ib u tion stra t e g y em p h a sizin g gove rn m en t al an d n o n gove r n -m en tal ed u c atio n an d h ealth in stitu tion s an d c om p a n ie s p ro m o tin g p re ven tion p ro g ra m s with th eir wo rk e r s. As a result, th e p u b lish er so ld ga m e s to p ri va te b u sin esse s an d va ri o u s Se c re t a ries o f Ed u cat io n a n d Health a ro u n d th e cou n tr y; th e Na tio n al STD/ Aid s Co n t ro l Pro g r am p u rc h ased 100,000 set s to d istri b u t e to p u b lic sch ools a n d n o n gove r n m en ta l org a -n i z a t i o -n s.
The acceptability was also evaluated t h ro u g h q u e s t i o n n a i res re t u r n ed fr om 1991 to 1994, th at ha d b een a ttach ed to th e sets d on ate d by the Oswaldo Cruz Foun dation to various g ro u p s an d in stitu tion s (sch o ols, he alt h p ro m o t e r s, p a re n t s, com p anies, courses, com m un ities, a n d oth ers) from Brazil an d a br oad . Tab le 1 sh ow s th e item s an alyzed in a 20qu estion n aire sam -p l e, in clu din g th e n am e of th e in stitution th a t u se d t he gam e, op in io n s on ZIG-ZAIDS a s a n ed u ca tio n a l re s o u rc e, ta rget p u b lic , ac tivities d e velop ed , oth er ed u ca tion al re s o u rc e s, p lac e u sed, an d gen eral observa t i o n s. Am on g th e 20 in stitu tion s th at an swe red the q u estion n aire s, 10 we re from Rio d e Ja n e i r o, fou r fro m São Pa u l o, a n d on e each from Pe rn a m b u c o, Mi n a s Ge ra i s, Mato Grosso do Su l, Rio Gran d e do Su l , Ethiop ia, an d Ge rm a n y. The in stitu tion s in clu ded p ri m a ry an d secon d ary schools, health clin -i c s, NGOs, b o ar d -in g -in st -itu t-ion s for m -in or s, an d social an d ed u cation al re s e a rch in stitu tes. Ac c o rdin g to the data, the gam e was used in va riou s situ at ion s: c la ssro om s (p ri m a r y a n d s e c o n d a ry), p are n t s’ m eetin gs, wom en’s g ro u p s, vocation al cou rses, dayc a re cen ters, com m un ity h ealth work e r s’ su p ervision , com p an ies’ ed -uc a tion al p ro g ra m s, cou r ses for ed u ca tion a l c o u n s e l o r s, a n d m eetin gs with p syc h o l o g i s t s, social wo rk e r s, an d oth er h ealth p ro f e s s i o n a l s an d ed u cators. Th e in for m ation h ighligh ts th e p o s i t i ve reaction to th e m aterial an d its effica-cy a s a n ed u cation al tool. In gen eral th e gam e was con sid ered a good m otivatin g factor, cap ab le of gen eratin g in tere st an d stim ulat in g d e -b a tes an d lea rn in g a-b ou t su c h c o n tr ove r s i a l th em es a s sexu a lit y a n d AID S. Th e p o sitive e valuation is cer tified by th e qu otes b elow:
“ Ex cellen t a s a n ed u ca t i on a l re s o u rc e . In -form s a n d st im u la t es rea son in g abou t p re v i o u s
k n ow l e d g e”(STDs Pro g ra m s – Dou rad os/ MS –
1 9 9 5 ) .
“ Grea t ! Discu ssin g AIDS, s ex , a n d dru gs
be-ca m e n ice a n d edu be-cat io n al”( Socied ade Di a d
e-m en se de Proteção ao Men or – 1995).
“Af t er Z IG- Z A I D S ,c h i l d ren w rot e let t ers t o p eop le w it h HIV (...) It beca m e p a rt of eve ry d a y li fe in t h e cla ssro o m , a n d besid es t ea ch i n g a bou t AIDS , it red u ced d iscrim in a t i on ( C I E P Me s t re An dré, Rio d e Ja n e i ro – 1995).
The possibility of discussin g sexuality is p re-sen ted in som e re p o rts as havin g b een sp ark e d by ZIG- ZAIDS with in th e gro u p. Th e gam e was u sed by paren ts an d teachers who often had n ot k n own h ow to co p e wit h th is su b jec t am on g c h i l d ren an d ad olescen ts, as stated below:
“Th e gam e m ak es it p ossible t o discu ss AIDS
n a t u ra lly an d w it h ou t p re j u d i c e . AIDS is a d is-ea se t h a t in vo l v es m a n y issu es t h a t a re st ill t aboo an d a re often n ot discu ssed beca u se of d iff icu lt ies a m on g t ea ch ers, p a ren t s a n d in st it u -t i o n s . Th e in i-t ia -tiv e of p rod u cin g -th e ga m e w as c e rta in ly ve ry cre a t i ve , a facilit at in g fa cto r, a n d a grea t socia l con tribu tion. (Mun icip al Se c re t a ry for Soc ial Pr om otion , Nova Fri b u rg o, Rio d e Ja n e i ro)
Ac c o rd in g to 50% of th e 20 q uestion n aire s, Z I G - ZAIDS was u sed t ogeth er with oth er re-s o u rc e re-s, in re-sex ed u cation p ro g ram re-s wh ich alre-so in clud ed videos, lecture s, d eb ates, leaflets, an d i n f o rm a t i ve p am p h lets. On e of th e p oin ts em -p h a s i zed in the sam -p le was the in clu sion of so-c ial issu es in th e gam e, e.g., sym p athy for an d d i s c r im in atio n again st ch ild r en wit h AIDS, whic h h as m otiva ted d eb ate a m on g th e yo u t h wh o h ave u sed th e m aterial.
SCHALL, V. T. e t a l. 1 1 4
Cad. Saúd e Púb lic a, Rio d e Jane iro , 15(Sup. 2):107-119, 1999 Tab le 1
Examp le s o f answe rs re c e ive d o n use o f the g ame . Situatio nal e valuatio n.
N ame of ZZ as an educat ional Ta rget public Act ivit ies Ot her educat ional Place used O b s e rv a t i o n s I n s t i t u t i o n re s o u rc e d e v e l o p e d re s o u rc e s
Munic ip al Co uncil Re ache s its o b je c tive s. Pe o p le ag e d P re ve ntio n wo rk Se minars, p lacards, Co mmunity Trê s Po ntas, MG While the y are p laying 1 2 - 5 0 d uring Carnaval p amp hle ts. A TV institutio ns, pe o p le d e b ate the we e k. Tab le s we re was installe d to b usine sse s, answe rs to the g ame set up in the sq uare sho w vid e o s o n and sc ho o ls with the o the r w h e re the g e ne ral A I D S
p a rtic ipants p ub lic c o uld p a rtic ip ate in the g ame . Disc ussio n o f ZZ q ue stio ns and a n s w e r s
CEL – Lag o a The g ame is g o o d , Stud e nts fro m Se x e d ucatio n Raising q ue stio ns S c h o o l s Inad e q uate whe n Ed uc atio nal e spe cially fo r 6th and 6 th-8 th g rad e s, p ro g r a m that re ac he d the ap p lie d to the 8th C e n t e r, RJ 7th g rad e stud e nts ag e d 12-14 p ub lic in a g e ne ral g rad e , c o nsid e re d
ag e d 13. We fe lt that w a y to o immature , and
it lac ke d mo re stud e nts d id no t take
c o n t ro ve rsial q ue stio ns ad vantag e o f the
suitab le fo r 8th g rad e g ame . The re sho uld
stud e nts b e mo re card s fo r
the 8th and 2nd g rad e s, allo wing g re ate r fle xib ility a c c o rd ing to the le ve l o f kno wle dg e o f the wo rking g ro u p
São Vice nte State The g ame g e ne rate s Stud e nts fro m Mag azine s and Hig h scho o l O ne o f the ne g ative Hig h Sc ho o l 1st c urio sity ab o ut o the r 5 th-8th g rade s ne wsp ape rs with p o ints was the lac k and 2nd g rade s. to p ic s re late d to AIDS and hig h sc ho o l ne ws and up d ate s o f ince ntive fo r the
Irati, RJ and se xuality d iscusse d in g ro up s, p rize s
(.. .) In g e ne ral it was s e m i n a r s c o nsisting o f o nly
use ful and the stude nts t h re e co nd o m s
l e a rne d b y p laying .
S e m p re Viva The yo ung ste rs Yo ung p e o p le Use o f the g ame P ro g ram has as its S e m p re Viva O ne o f the g irls in P ro g ram, RJ c o n s i d e re d the g ame Ag e d 17-19, was p art o f o b je ctive s a syste matic P ro g r a m the g ro up aske d that
an e njo yab le g irls who live c o nstant pro c e ss p ro je c t fo r DST/ AIDS the g ame b e take n e xp e rie nc e o n the stre e t o f info rmatio n p re ve ntio n and into the stre e ts to
transfe r and a w a re ne ss o f wide - allo w the re st o f he r inc e ntive to use , rang ing he alth c o nc e rn s g ro up to p lay. The re c o nd o ms se e king is still no me tho d o f the p articular e valuatio n fo r its use e x p re ssio n o f amo ng stre e t pe o ple . the g ro up in
d e ve lo p ing ac tio n t a c t i c s
Cyanamid Q uímic a Imme nse p o te ntial to 25-45 ye ar ag e The mate rial was Se minars o n AIDS with C o m p a n y The mate rial was d o Brasil Ltd ., RJ re ac h the p ro p o se d g ro u p ap plie d o nly o nc e o rie ntatio n b y c o mp any re ce ive d with
o b je c tive s, inc lud ing within SIPAT p h y s i c i a n s surprise , e ve n with p a rtne rship s with ( I n t e rnal We e k fo r re s e rvatio ns, b ut the b usine sse s fo r wo rk the Pre ve ntio n o f g e ne ral re c e p tio n in sc ho o ls and o the r Ac c id e nts at Wo r k ) was ve ry g o o d. The y
i n s t i t u t i o n s w e re e xp re ssio ns o f
Cad . Saúd e Púb lic a, Rio de Jane iro , 15(Sup. 2):107-119, 1999
a d e q u a t e, n ec essary, an d u sefu l fo r th e on go-in g edu cation al p ro c e s s.
The process analysis: the game’s context and utilization
In ord er to com p lete th e in form ation ob tain ed t h ro u gh th e form s, we sen t a stan d a rd lett er co n tain in g a q u estion n air e, fro m Fe b ru a r y to Ap ril 1995, to 42 sch ools in differen t St a t e s, i.e. , th e on es which had re c e i ved th e gam e thro u g h th e Health Mi n i s t ry (th e Nation a l STD / Aid s Pro g ra m . A sta n d ard q u estion n a ire was a lso sen t to seve ral in stitution s an d com p an ies. We re c e i ved an swers from a total of 34 in stitu tion s. Da ta an alysis, org a n i ze d in a tab le, with th e sam e con ten ts d escr ib ed in th e p reviou s item ( Ta b le 2), re i n f o rc e th e e va lu at io n s alre a d y m en tion ed an d related to th e gam e’s effective-n ess as a factor for edu catioeffective-n al m otivatioeffective-n , as an easy-to-un derstan d teachin g tool. Althou gh th e gam e h as b een used by va riou s gro u p s, th e m a j o rity we re am on g ad olescen ts from the 5th t h rou gh 8th gra d e s, with ages ran gin g from 10 to 16 ye a r s. Som e exam p les of re p o r ts:
“Z I G - Z AIDS is w h a t eve ry st u d en t n eed s t o u n d erst a n d w h a t i s im a gin ed n ot t o be n ea r h i m . If you giv e a bo ok or lect u re , 90% of t h em w ill rem a in silen t”( Ca rla Ja rd im , r u ral a re a teach er in Bagé, Rio Gran d e do Su l, 1995).
“T h e re h a s been grea t en t h u si a sm over t h e gam e am on g t h e k id s. Th e cre a t i ve a p p roa ch t o AIDS w a s em p h a siz ed an d t h e op p ort u n it y t h at th e gam e offers to d iscu ss am p le qu estion s, s u c h as social a sp ect s, p re j u d i c e , a n d solid arit y” (An -tô n io Te i x e i ra, Di re c t o r, Lab o r Relation s D e-p a rtm en t, Brazilian Postal Co m e-p a n y, 1995).
This an alysis also con sidered the ZIG-ZA I D S e valu ation ad d ressed to th e Nation al S T D / A i d s Co n t rol Pro g ram . As of Ma rch, 1995, 10 m on ths after the p u rc h a s e, 25% of the sets (25,000) had b een d istrib u ted. Of th e 27 letter s sen t by To r-res to the State h ealth an d edu cation al dep art-m ents that re c e i ved the art-m aterial, on ly 5 re p l i e d . Am on g th ese, 4 h ad re c e i ve d a lar ger n u m b er of sets an d distrib u ted th em to sch ools to in te-g ra t e th e m in to th e p re ven t ion p ro te-g ra m . In o rd e r to co m p let e t his a n a lysis, To r res in t er -v i e wed th e p eop le resp on sib le for distri b u t i n g the m ateri a l .
Co n s i d e rin g th e 54 in stitu tion s which re p -resen t th e total n u m b er of q uestion n aires sen t to LEAS (1991 to 1994) a n d to To r re s in 1995, 84.2% state that the objectives of th e gam e h a ve been “fu lly re a c h e d”; 3.70% say “s a t i s f a c t o ri l y ”, an d 1.7% “r easo n ab ly we l l”. Nob od y n o ted “a l i t t l e”, an d 9.3% failed to an swer this qu estion .
Impact analysis: observations on use of the game
This an alysis is b ased on direct ob servation s of the gam e m atches with kid s from 11 to 17 ye a r s of age from two p ri vate sch ools an d th e In s t it u-to d e Ação Cu l t u ral (Cu l t u ral Action In s t it u t e ) , by wh ic h we ob served that stu d en ts con stru c t n e w co gn itive elem en t s b y p la yin g th e gam e. Filled wit h e xcitem en t , th e gam e’s c on t en t is g ra sp ed easily, b esid e s in it ia tin g d eb ate s an d e xp lan a tion s on t h e to p ic. On e te ac h er c o m -m en ted, “We n oticed th at even t h e ch ild ren w h o k n ew t h e m at eria l got in vo l ved in th e a ct iv it y” (1995). Com p etition stim u lates lear n in g wh ile p layin g, m akin g it r igh t to win an d p ayin g at-ten tion to th e righ t an swers so a s n ot to m ake m istakes again . Howe ve r, th e qu estion’s re p e t i-tion as a c on seq u en ce of th e gam e’s d yn am ic s was cri t i c i ze d by th e m ore in for m ed s t u d e n t s. Som e youn g p eop le’s op in ion s:
“ Z I G - ZAIDS is p erf e c t . If it w ere an y bett er, i t
w ou ld be w orse” (1995).
“I w ou ld lik e t o k n ow m ore t h i n gs n ot in
-form ed by th e gam e” (1995).
”I h ave learn ed to n ot be p reju diced tow a rd s
p eop le w it h HIV. Th ey d eserv e a ll ou r ca re a n d a t t e n t i o n”( 1 9 9 5 ) .
“If I w ere you , I w ou ld m a n u fa ct u re m o re ga m es t o d ist ribu t e t h em a ll ov er t h e w orl d” ( 1 9 9 5 ) .
To r res a lso org a n i ze d th e c om m en ts by som e p r ofession a ls in vo l ved in the t est in g of Z I G ZAIDS. In ge n e ra l, th e ga m e was c on sid e red a teach in g re s o u rce cap ab le of ap p ro a c h -in g a c on t roversia l th em e -in a n en te rt a i n i n g an d efficien t way. Ac c o rd in g to suggestion s, its u se sh ou ld b e stren gth en ed by ed u c ato r s’ ac-tion s in the sen se of d elvin g m ore d eeply an d / or ad ap tin g th e con ten ts to d ifferen t re a l i t i e s. Th e few criticism s tow a rd s certain con ten ts an d th e m at er i a l’s d yn am ics we re all d o cu m en ted b y th e auth ors an d tur n ed in to im p rove m e n t s in th e gam e, in c lu din g th e p rop osa l for an ex-p an d ed version on CD-ROM, con tain in g 6 lev-e ls of d iffic u lty, m a kin g it p ossib llev-e to p r ov i d lev-e c h oic es b y a ge a n d p reviou s kn ow l e d g e. T h i s a l l ows fo r th e ac q u isition of scien tifica lly ad -va n ce d a n d c om p le x kn owled ge acc ord in g t o th e user’s cu riosity an d cogn itive cap acity.
SCHALL, V. T. e t a l. 1 1 6
Cad. Saúd e Púb lic a, Rio d e Jane iro , 15(Sup. 2):107-119, 1999 Tab le 2
Examp le s o f answe rs re c e ive d fro m 34 institutio ns. Pro c e ss analysis.
N ame of ZZ as an educat ional Ta rget public Act ivit ies Ot her educat ional Place of O b s e rv a t i o n s I n s t i t u t i o n re s o u rc e d e v e l o p e d re s o u rc e s a p p l i c a t i o n
Me sg anan Ne g a Allo ws yo ung p e o ple G e ne ral p ub lic Le afle ts, p o ste rs, films, D i ffic ultie s we re AID S Co ntro l to re lax while in the c o untry and d ramatizatio ns e n c o u n t e re d in using P ro g ram, Ad d is transmitting kno wle d g e the mate rial b e c ause
Ab ab a, Ethio p ia ab o ut HIV/ Aids. o f lang uag e
Re c o mme nd ab le fo r p ro b le ms: whe n
te ac hing yo ung p e o ple le tte r was answe re d
and the ir pare n t s the g am e was b e ing
translate d. The i m p re ssio n is g e ne ral b ase d o n the fig ure s. T h e re is no m ate rial availab le o n AIDS p re se nte d in the f o rm o f a g ame in this c o untry
CIEP – Me stre Tre ats a co ntro ve rsial E l e m e n t a ry The g ame was use d Stud e nts and Afte r using ZIG-ZAIDS A n d re , Padre issue in an stud e nts, ag e d as a to y: a fo rm o f re sid e nts o f he c hild re n d e cide d Mig ue l, RJ e n t e rtaining way 8 - 1 3 c o mp e titio n. Late r the Vila Vinté m to write le tte rs to
it was use d as shanty to wn p e o p le with HIV. a le arning to o l
re q ue ste d b y s t u d e n t s
Fe d e ral Te c hnic al Valid . Mo tivate s the Te am o f P a re nts’ me e ting . Vid e o s and se minars Te chnic al We wo uld o nly Co lle g e o f ad o le sc e nt to kno w te ac he rs, he alth Me e ting with with d o cto rs. D e b ate s Co lle g e and q ue stio n the answe r P e rnamb uc o , PE the d ang e r and p ro fe ssio nals, sp e c ialists and analyse s with AIDS Clinic al Ho spital to the q ue stio n o n
unde rstand the AIDS so c ial wo rke rs, ine d ucatio nal stud y g ro u p he mo philiac s, whic h i s s u e p sycho lo g ist, o rie ntatio n. De b ate d e fine s the m as
p a re nts, and and analysis with p e o p le who have stud e nts AIDS stud y g ro u p d i ffic ulty in fo rming
scars. Sho uld n’ t it b e “ d i fficulty in b lo o d clo tting ” ?
Munic ip al Co uncil A p p ro ache s AIDS in Stud e nts, Ac tivitie s to pre v e n t Anno unce me nts, C o m m u n i t y, In the talks I try to N o vo Frib urg o , RJ a natural way, witho ut te ache rs and AIDS and drug use Vid e o s, p amp hle ts, sc ho o ls o f the g e t acro ss the ne e d
p re j u d i c e . the co mmunity – talks fo r te ache rs, g ame s, and b o o ks that p ub lic , state to info rm p e o ple , in g e ne ral stude nts and discuss se x e d uc atio n and p rivate while sho wing the P a re nts. Wa rning s n e t w o r k s re s o u rce s availab le , to the co mmunity. to fac ilitate the wo rk
o f p e o p le who c o me f o rw a rd o ffe ring to b e multip lie rs o f i n f o rmatio n o n AIDS p re ve ntio n
He alth C e nte r, C l e a r, o b je ctive Stud e nts ag e d Inte g ral he alth c are We e kly me e ting s to Ce nte r fo r Juq uiá, SP q ue stio ns. Stimulate s 1 3 - 1 5 fo r the ad o le sce nt d isc uss the m e s o f living To g e the r
i n t e re st in le arning p ro je ct. The g ame p ub lic inte re s t . with the Ill. t h ro ug h p lay. was p re se nte d o n Pub lic b uild ing .
a d ay whe n AIDS was the the me .
Do urad o s Exce lle nt as an Me mb e rs o f I n f o rm atio n le afle ts, Sc ho o ls and D S T / A I D S e d ucatio nal re s o u rc e . the te am and vid e o tap e s, talks to e ve ning classe s.
I n f o rms and stimulate s stud e nts o f the a d o l e s c e n t s . re aso ning ab o ut 2 nd g rade and
Cad . Saúd e Púb lic a, Rio de Jane iro , 15(Sup. 2):107-119, 1999
p ri m a ry an d secon d ar y sch ools u n d er th e ori-en tation of 223 su p er visors train ed to d eve l o p p re ve n t i ve ac tivit ie s with yo u n g p e op le an d th eir teach ers. The re p o rt describ es three exp e-rien ces at differen t levels: on e with 7th an d 8th g rad e stu d en ts, a n oth er with 5th to 8th gra d e s t u d e n t s, an d a th ird with first-year secon d ar y sc ho ol stu d en ts. Ob ser va tion s by su p erv i s o r s an d te ac h e rs h igh ligh t th e gam e’s a b ilit y to st im u late th e lear n in g p ro cess in a high ly en -t e r-tain in g way. Som e im p or-tan -t com m en -ts:
“Th e ga m e p rov i des v a lu a ble i n form a t ion , w hich is p assed on to th e st u den ts in a ligh t a n d n a t u ra l form .”
“Th e sa m e q u est ion is a sk ed seve ra l t im es, em p h asizin g th e essen t ial p oin ts on th e t op ic of A I D S .”
“I w a s i m p re ssed by t h e st u d en t s’ e n t h u s ia sm ia n d t h eir d ed i cia t io n i n reia d in g ia n d ia n sw erin g t h e qu est ion s, to t h e ext en t of m em oriz -in g t h e ri gh t a n sw ers. Th e -in t erest i n w i n n -in g t h e p riz e (a co n d om ) w a s m o st n o t a b le i n 5t h g ra de st u d en ts, w h o w ou ld fin d it m ore difficu lt t o ob t a in p rop h yla ct ics u n d er n o rm a l circ u m -s t a n c e -s .”
“I’m goin g t o ord er m ore set s, a t t h e i n sis-ten ce of m y st u den t s. Th is is a ve ry p osit iv e w a y t o t a lk a b ou t a v e ry d a u n t i n g su b ject . I m yself h a d a cou sin w h o d ied a s a co n sequ en ce of AIDS in Ju ly 1995.. .”
Som e teac hers com m en ted th at in sp ite of th e fact th at rep etition of th e card s helps m em -o ri ze th e c-orrect an swe r s, “t h ey did n’t lik e t h is p rocess o f re p e t i t i o n , p referri n g t o m ov e on t o n ew qu est ion s”. Se ve r al te ac h ers said tha t th e stu d en ts wan ted m ore qu estion s to en rich th e gam e an d give it m ore va riation , in creasin g its i n t e rest an d c ater in g t o d iffere n t levels o f cu ri o s i t y. Although the old er, m ore advan ced stu -d en ts agre e-d th at th e gam e was an in tere s t i n g way of dealin g with the m atter, facilitatin g d ia-logu e on sexu ality which they felt is still som e-wh at re p re ssed even t od ay, t h ey fo u n d so m e q u estion s to o easy for stu d en ts in t he seco n d year o f high sch o ol. Th is is n a tu ra l, sin ce th e ga m e was crea ted for p r e-a d ole scen ts (9-12 ye ar s old ). Howe ve r, c om m en ts by th ese old er stu d en ts illu st rate th e n eed to c reate ve r s i o n s with in creasin g levels of com p lexity an d dep th of kn ow l e d g e.
D i s c u s s i o n
Based on th e resu lts collected at each d iffere n t st age o f evalu at ion , we c on clu d ed th at th e p o p u l a t i o n’s in form ation level is m ore re l e va n t to the gam e’s im p act th an age. An oth er asp ect
relates to the d iversity of ZIG-ZA I D S’ u se. T h e gam e wa s a p p lied t o h e alt h a n d ed u c at io n al p r ofessio n al t ra in in g, in ac tivit ies wit h stre e t g i r l s, in m u n icip al even ts like on e in Três Po n -tas (Min as Ge rais State), wh ere it was p layed on tab les in th e town squ are d ur in g Ca rn i val, b e-sid es o th er ac tivities in sch ools, co m p a n ies, an d c om m u n it ies. At th e h ea lth c en te r in Mi-gu e l Pe re i ra (Rio d e Ja n e i ro Sta te), th e gam e b o a rd was tu r n ed in to a can vas; at th e Co l é g i o Ba n d e i ran tes in th e city of São Pau lo th e gam e was re p rodu ced on ove rh ead tra n s p a ren cies so t h at all th e st u d e n ts cou ld ta ke p ar t in som e o b s e rva t i o n s.
Fi n a l l y, after m on ths of con tact with p ro f e s-sion als an d stu d en ts th at h ave u sed th e ga m e in seve ra l p a rts o f th e co un tr y, To r res re m a rk s that “Z I G - ZAIDS is an in telligen t an d a p p ro p r i-at e alt ern i-at ive , beca u se it p rov id es in form a tion a bou t AIDS in a p layfu l, c re a t i ve , a n d in n ova -t i v e w a y. Si n ce -t h e ga m e i s fu n -t o p la y, i-t d e-c rea ses an y p rob a ble em ba rra ssm en t ( . . . )a n d a l l ow s for in d ep t h qu est ion s con cern in g sex u -a l i t y” ( To r re s, 1995:51). In p ra c t i c e, re p e t i t i o n of the cards was con sidered n egative; alth ou gh th e goal was to help m em ori ze the in form a t i o n , th e p layers gen erally ten d ed to get t ired an d just go ahead . Ne ve rt h e l e s s, the gam e was con -s i d e red an effective, in fo rm a t i ve re -s o u rc e. It -s use was associated with com plem en tary teach-ing activities, to adapt its lan guage to the p op u-lation with read in g d ifficulties an d the con ten t exp an d ed for grou p s with better in form a t i o n .
Th e r esu lts o f th is stu d y, b esid es c o m p le-m en tin g a n d e xp a n d in g p re viou s eva l u a t i o n s on th e gam e’s reach in differen t con texts, offer su gge stion s t o stren gt h en th e ga m e’s u se an d d ata cap ab le o f gu id in g n ew m a terial p ro d u c-tion in th is field, such as the on goin g CD-RO M . In o ther word s, we see th e evaluat ion p ro c e s s as a fu n d am en tal re s o u rce for th e com pre h e n -sio n o f t h e ob ject ives a n d re ac h of a n ed u c a-tion al p roposal. From this process we can ref o r-m ulate an d / or re p rod uce ou r action s.
o-SCHALL, V. T. e t a l. 1 1 8
Cad. Saúde Púb lica , Rio d e Jane iro , 15(Sup. 2):107-119, 1999
R e f e re n c e s
AG G L E TON, P., 19 95. Mo n i t o ram en to e ava liação d e ed u ca ção em sa úd e e p rom oção d a saú d e vo l t a-d o s p ara o H IV/ Aia-d s. In : AIDS Pesq u isa Social e Edu ca çã o ( D. Cze re snia , E. M. Sa n t o s, R. Ba r b o s a & S. Mo n t e i ro, org.), p p. 193-206, Sã o Pau lo : Ed i-t o ra Hu cii-tec/ Rio d e Ja n e i ro: Ab ra s c o.
AYRES, J. R., 1996. Com o Ava li a r u m a In t e rve n ç ã o ?
Se c re t a ria d o Estad o d a Edu caçã o – Fu n d açã o p a-ra o De s e n volvim e nto d a Ed u c a ç ã o. (m im eo. ) BAKH TIN, M., 1985. Est éti ca d e la Creácion Ve r b a l.
Bu e nos Aires: Siglo Ve in tiu no Argen tina Ed i t o re s. B O LTO N, R., 1992. AIDS an d p ro m i s c u i t y: Mu d d les in t h e m o d els o f H IV p re ve n t i o n .M ed ica l An t h ro-p o l o gy, 14:145-223.
CARRARA, S. & MORAES, C., 1986. Um m a l d e fo lh e-tim . Cad ern o do IM S/UERJ,1:79-94.
DANIEL, H . & PARKER, R., 1991. A I D S , a Te rc e i ra Ep i-d e m i a. São Pau lo : Ig l u .
FREIRE, P., 1979. C o n s c i e n t i z a ç ã o, Teori a e Práti ca d a Li b e rt a ç ã o. Sã o Pau lo: Co rt ez e Mo ra e s.
lescen ts m eet the ir p artn er s an d reh earse th eir l ove live s. Desp ite th eoretical ad van ces in p sy-ch ology an d p ed agogy, edu ca tion al p ractice is still ch ar a c t e ri zed by em p h a sis o n tra n s m i s-sion of con ten ts wh ich are n ot always u seful to stu den ts in life. Ne ve rt h e l e s s, in classroom , beyon d the for m al su bject, th ere is an oth er c on -t ex-t h a p p en in g wh ich is c ha ra c -t e ri zed b y a sc h em e of rela tion s an d h id d en c on flic ts with t h e b u sy tea c h er a n d wh ic h ca n b e m ad e ex-p licit if altern a t i ves are created for their exex-p re s-sion , an d gam es like ZIG-ZAIDS c ou ld b e u se-ful in this sen se.
Alth ou gh a ware o f th e lim ite d kn ow l e d g e c o n c e rn in g b eh avior ch an ge, we have he re th e g reat est ch allen ge for e d u cation al ac tivit y. As Rosen stock (1990) states, kn owled ge is im p or-tan t, som etim es essen tial for beh avior ch an ge, b u t it is ra re ly en o u gh . It is in th e u n kn ow n wo rld of reason tha t p e op le are d r i ven t o b e-h a ve in on e way an d n ot in an ote-her, we-here on e fin d s h ea lth a n d d isease, h ap p in ess an d gri e f , a n d su ccess a n d fa ilu re, am on gst oth er p h e-n o m e e-n a. T h u s, th e ed u ca tioe-n a l p roc ess m u st b e in tegrated with a ffect in ord er to b egin th e n e c e s s a ry ch an ges. Th e m e re a cq u isit io n o f k n owledge is n ot en ou gh to en gen d er th e atti-tud es an d action s th at are th e ve ry goal of ed u-cation al in itiatives in th e h ealth area.
Ma t e rials like ZIG-ZAIDS are certain ly facil-itators of th is p ro c e s s, wh ich re q u i res en ab lin g
of ed u ca to rs t o a ch ie ve its goa ls, alo n g with o rien tation an d evalu ation of its effective n e s s, c o m p a rin g th e stra t e g i e s’ va riation s an d c on -texts of th e cu r ren t work. Sch all (1996) alre a d y re p o rt ed th at he alth - relate d kn owled ge exp re sses t h a t ch ild ren exp lac e valu e on th em -s e l ve-s a-s h ealthy an d re veal-s th e m ean in g an d valu es th ey ascrib e to th is fu n d am en tal asp ect of th eir live s. T h u s, it a lso re veals e ac h ch ild’s i d e n t i t y, his/ h er p erc e p t i o n s, exp eri e n c e s, m o-t i va o-t i o n s, an d a co-t io n s exp re ssin g a n im age of on eself, m a kin g it p ossib le fo r th em to work b e yon d p hysical an d cogn itive asp ects.
It is b elieved th at in relation t o STD/ Aid s an d d r u g s, it is n ec essar y t o go b e yo n d b o th t r ad ition a l p ra ct ices of kn owle d ge tra n s m i s-sion an d a clim ate of th reats to con sider a lon g-t e rm in g-t er ve n g-tion b egu n in p re-sc h oo l. T h i s wou ld b e ca p ab le of st ren gth en in g c h ild re n an d ad ole sce n t s in o rd er for th em t o n o t on ly b etter un der stan d th em selves b ut to also p ra ctic e c om m u n ity ac tivit ies th at stim u late re -sp ect an d re -sp on sib ility for th em se lve s an d o t h e r s. Th is is n e cessar y for ch ild r en fro m a n ea rly a ge to n o t a cc om m od a te th e m selves to un balan ced an d un fair social situ ation s, to en ab le th em to m ake ch oices, withou t feelin g em -b a r rassed -b y th e gro u p, a n d t o ac hieve -b ette r h u m an rela tio n s a n d b ett er c om m u n ication s an d em p a thy t h ro u gh an ed uc ation a l p ro c e s s in wh ich fam ilies an d sch ools in tera c t .
A c k n o w l e d g e m e n t
Cad. Saúde Púb lic a, Rio d e Jane iro , 15(Sup. 2):107-119, 1999
H OMANS, H . & AG G L E TON, P. , 1988. He alt h ed u ca-tion , HIV in fecca-tion an d AIDS. In: Social Asp ects of A I D S( P. Aggle ton & H . Ho m a n s, e d s.), p p. 1235-1242, Lon do n: Th e Falm er Pre s s.
INGHAM, R; WO O D CO C K & STENNER, K., 1992. T h e lim it at io n s of ra tion al d e cisio n -m a kin g m o d els as a p plie d to you n g p eop le’s se xu al b e h avio r. In :
A I D S : R i g h t s , Risk a n d Reason ( P. Aggle to n , P. Davies & G. Ha rt, e d s.), p p. 163-173, Lo nd on : T h e Falm er Pre s s.
MANN, J.; TA R A N TO LA, D. J. M. & NETTER, T. W. , 1993. A AIDS n o M u n d o. Rio d e Ja n e i ro : Asso cia-ção Bra s i l e i ra In t e rd iscip lin ar d e AIDS/ In s t i t u t o d e Med icin a So cial, Un i ve rsid ad e d o Est ad o d o Rio de Ja n e i ro / Ed i t o ra Re l u m e - Du m ará. M E LO, J. C., 1993. Ed u c a ç ã o : Ra z ão e Pa i x ã o. Rio d e
Ja n e i ro : Escola Na cio n al d e Saú d e Pú b lica, Fu n -dação Oswald o Cru z .
M O N T E I RO, S., 1995. A A IDS n o Con t ex to Es c o l a r : An álise d e u m Pro g ra m a d e Pre ve n ç ã o. Di s s e rt a-çã o d e Me s t ra d o. Rio d e Ja n e i ro: In st itu to d e Me-d icin a So cia l, Un i versiMe-d aMe-d e Me-d o Esta Me-d o Me-d o Rio Me-d e Ja n e i ro.
M O N T E I RO, S., 1998 . AIDS p re ven tio n in Br a z i l i a n p u b lic sch oo ls: A p a r tn er sh ip b et we en gove rn -m en ts an d a n on govern -m en tal organ ization . Ci ê n -cia e Cu l t u ra, 50:319-328.
M O N T E I RO, S. & REBELLO, S., 1999. De s e n vo l v i m e n-to e a va liação d e jogo s ed u ca tivo s n o cam p o d a p re ven ção d o HIV/ Aid s e d o u so ind evid o de d ro-g a s. In : D rogas e A IDS: Qu est ões d e Di re itos Hu -m a n o s(G. Ac s e l ra d , org.), Rio d e Ja n e i ro: Ed i t o ra Fi o c ruz (no p re l o ) .
M O N T E I RO, S.; REBELLO, S. & SCH ALL, V. T., 199 0.
De s e n v olv i m en to e Av aliação d o Jogo Ed u c a t i v o s o b re a AIDS p a ra Pr é - a d o l e s c e n t e s , Pré- teste e Ap e rf e i ç o a m e r n t o. 42aReu n ião An u al d a SBPC –
So cied ad e Bra s i l e i ra p ara o Pro g resso d a Ciên cia,
An a i s, Vol 2, Po rto Alegre: SBPC.
M O N T E I RO, S.; REBELLO, S. & SCH ALL, V. T., 1991. An ed u ca tion a l ga m e a b o u t AIDS fo r ch ild re n .
Hy g i e : In tern ati on al Jou rn a l of Health Ed u c a t i o n, 1 0 : 3 2 - 3 5 .
M O N T E I RO, S.; REBELLO, S. & SCH ALL, V. T., 1994. Jo gan d o e ap re n d e n d o a vive r: Um a a b or d a g e m d a AIDS e d a s d roga s atravé s d e re cu rsos ed uca-t i vo s. In : D rogas e AIDS: Es t ratégias d e Red u çã o d e Da n o s( F. Mesqu ita & F. Ba s t o s, org.), p p. 133-146, São Pau lo: Ed i t o ra Hu c i t e c / I E PAS.
MS (Mi n i s t é rio d a Sa ú d e), 1998. A I D S : B oleti m Ep i-d e m i o l ó g i c o, An o XI, Nú m ero 3. Pro g ram a Na c i o-n al d e DST/ Aid s.
PA I VA, V., 1996.Fa z en d o Art e com a Ca m i s i n h a : A Hi stória d e u m Projeto d e Pre v en ção d a AIDS pa ra Jove n s. Tese d e Doutora d o, São Pau lo: In stitu to d e Psicologia , Un i versid a de d e Sã o Pa u l o.
PI N H O, J. B.; AOKI, F. H .; LIMA, J. N.; ABREU , W. B. ; PAVAN, M. H. P.; MONTEIRO, D. T.; DIAS, M. B. G. S.; PE D RO, R. J.; SILVA, L. A. M. & EUGÊNIO, C. M., 1989. Ava liação d o n ível d e in fo rm açã o so b re AIDS n a p op u lação d e Ca m p i n a s, SP. In : XX Co n -g resso da So cie dad e Bra s i l e i ra d e Med icina Tro p i-ca l, An a i s ,p. 153. São Pau lo: Socied a d e Bra s i l e i ra de Me dicin a Tro p i c a l .
R E B E L LO, S. M.; MONTEIRO, S.; SCHALL, V. T.; MOR-EIRA, M.; PI N TO DIAS, A. & SANTOS, M.G., 1989.
Con h eci m en to d a AIDS en tre Crian ças e Pr é - a d o-l e s c e n t e s : Um Estu d o Am o s t rao-l do Ri o d e Ja n e i ro e Belo Ho r i zo n t e. 41aRe u n iã o An u al d a So c i e d a d e
Br a s i l e i ra p ara o Pro g re sso d a Ciê n cia – SBPC,
An a i s ,Fo rt a l eza: SBPC.
R E B E L LO, S. M. & MONTEIRO, S., 1998. O Jogo d a On -d a. Rio d e Ja n e i ro: Ediçõe s Co n s u l t o r.
RO S E N S TOCK, I. M., 1990. Th e p ast, p re sen t, an d fu -t u re of h eal-th ed u ca-tion . In : Health Beh avior an d Healt h Ed u c a t i o n(K. Glan z, F. M. Lewis & B. K. R i m e r, e d s.), p p . 405-420, Sa n Fra n cisco: Jo s s e y-Bass Pu b l i s h e r s.
S A N TOS, E. M., 1996. Em qu e um com p an heiro críti-co p od e críti-con t ri b u i r. In : AIDS Ed u c a ç ã o : Um Con -vite à Pre ve n ç ã o(C. Castello Bra n c o, E. M. Sa n t o s & S. Mo n t e i ro, org.), p p. 10-15, Rio de Ja n e i ro: As-sociação Bra s i l e i ra In t e rdiscip lin ar d e AIDS. SCH ALL, V. T., 1996. Saú d e e Afeti vi da d e n a In f â n c i a :
O qu e as Cria n ça s Re v elam e a su a Im p o rt â n c i a n a Es c o l a .Tese d e Dou tora d o, Rio d e Ja n e i ro: Dep a rta m e n to d e Ed u c a ç ã o, Pon tifícia Un i ve r s i d a -d e Ca tólica -d o Rio -d e Ja n e i ro.
SCH ALL, V. T., 1999. A p re ve n çã o d e DSTs/ Aid s e d o u so in d e vid o d e d ro gas a p ar tir d a in fân cia e d a ado lescência: Um a a b ord agem lú dico-afe tiva. In :
D rogas e AIDS (G. Ac s e rald , o rg . ),Rio d e Ja n e i ro : Ed i t o ra Fi o c ru z (n o pre l o ) .
SCH ALL, V. T.; JU BERG, P.; BORU C H OV I TCH , E.; FÉLIXSOUSA, I. C.; RO Z E M B E RG, B. & VA S CO N -C E L LOS, M. -C., 19 87. Hea lth e d u cat io n for ch il-d re n, il-d evelop in g a ne w stra t e g y. In : Secon il-d In t e rn atiorn al Sem irn a r orn Miscorn cep tiorn s arn d Ed u c a -tion al St rategies in Science a nd Ma t h e m a t i c s, Ab-s t ra c t Ab-s. New Yo rk: Co rn ell Un i ve r s i t y.
S H I LTS, R., 1987. An d th e Ba n d Played on , Peop le an d th e AIDS Ep i d e m i c. New Yo rk: St. Ma rt i n’s. TORRES, M., 1995. Z I G - ZA I D S , Ava liação d os Im p a
c-t o s. Re l a t ó rio d e p e sq u isa. Rio d e Ja n e i ro: Lab o r a t ó rio d e Ed u ca ção e m Am b ien t e e Sa ú d e, De -p a rtam en to d e Biolo gia, In stitu to Oswa ld o Cru z , Fu nd a ção Oswald o Cru z. (m im e o. )
UNAIDS/ WHO (Jo in t Un ited Na tion s Pro g ram m e o n H I V / A i d s / Wor ld Hea lth Organ ization ), 1998. Re -p o rt availab le o n t h e in t e rn e t – Wo rld AIDS Da y Sta te m e n t b y Dr. Ge o rge Alleyn e , Pa n Am eri c a n Hea lth Organ iza tion , Wash in gt o n , Nove m b e r 30 ( Re c e i ved by e-m ail: o p as-com u n ica@b ra 3 . o p a s. o rg . b r )
V YG OTS K Y, L. S., 1991.A Form a çã o Socia l d a M e n t e. São Pau lo: Ma rtins Fo n t e s.
