Rheumatic Heart Disease Education Tools Integrated Into a Screening Program in Brazil - Acceptability and Knowledge Gain

Q: What was the purpose of the education tools in the Brazil screening program?

The flipcharts aimed to support communication about RHD prevention, recognition, and management in underserved high-burden areas.

Q: Who received the flipchart education and training?

Patients, community members, school children, and healthcare and education professionals were taught using four low-literacy flipcharts, with in-person training and workshops for professionals.

Q: How was knowledge gain measured and when were assessments conducted?

A knowledge test was given before training, after training, and at three-month follow-up; it was incorporated from January 2024 to March 2025, alongside pre- and post-surveys from January 2023 to December 2025.

Sep 28, 2026

Uploaded by Jordan Avery

Rheumatic heart disease (RHD) is a preventable cause of premature death in young people in low- and middle-income countries, and education is a central strategy to reduce its burden. The study assessed acceptability and knowledge gain from low-literacy education flipcharts delivered during screening in high-burden regions of Brazil. Four flipcharts were taught over 36 months to patients, community members, school children, and professionals, with surveys and a knowledge test before, after, and at follow-up.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Rheumatic Heart Disease Education Tools Integrated Into a Screening Program in Brazil: Acceptability and Knowledge Gain JESSICA ABRAMS WANESSA C. VINHAL CRAIG A. SABLE CLARECI S. CARDOSO LIESL ZÜHLKE ALISON SPAZIANI LAYLAH RYKLIEF MARIA CARMO P. NUNES ISABELY KAROLINE S. RIBEIRO REBECA PREVIERO LORENA R. SILVA LUZ M. TACURI CHAVEZ KACIANE K. B. OLIVEIRA INGRED BEATRIZAMARAL LARISSA LEMOS JULLIANE S. CORREA CECÍLIA T. COELHO BRENNO A. SANTOS LUIZA H. DE PAULA ISADORA S. SOUZA MARIA LUIZA B. S. SANTIAGO BRUNA C. FREITAS GABRIEL R. ANGELO MATHEUS HENRIQUE P. NUNES KLICIA J. PEREIRA ANTONIO LUIZ P. RIBEIRO BRUNO R. NASCIMENTO ON BEHALF OF THE PROVAR+ (PROGRAMADE RASTREAMENTODA VALVOPATIAREUMÁTICA AND OTHER CARDIOVASCULAR DISEASES) INVESTIGATORS *Author affiliations can be found in the back matter of this article ABSTRACT Background: Rheumatic heart disease (RHD) is a preventable cause of premature death among young individuals in low- and middle-income countries. Education is a key strategy to alleviate the burden of this disease. We aimed to assess the acceptability and knowledge gain of a series of low-literacy education flipcharts, presented during screening in high-burden areas of Brazil. Methods: Four low-literacy flipcharts were developed over three years and taught over 36 months to patients, community, school children, and health and education professionals, mostly in the state of Minas Gerais. In-person training and education workshops were assessed through printed surveys. Post-education surveys (for patients and community members), and post-training surveys (for healthcare and education professionals) were conducted from January 2023 to December 2025. A knowledge test, delivered at pre-training, post-training and three-month follow-up, was incorporated from January 2024 to March 2025. Results: Flipchart training was delivered to 1,317 healthcare and education professionals, while 1,292 patients and community members and 2,585 school students received education using the flipcharts. There was a statistically significant (p < 0.01) improvement in knowledge about rheumatic fever (RF) and RHD among ORIGINAL RESEARCH CORRESPONDING AUTHOR: Jessica Abrams Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Reach, Cape Town, South Africa [Jessica.abrams@uct.ac.za](Jessica.abrams@uct.ac.za) KEYWORDS: Rheumatic Heart Disease; Education; Screening TO CITE THIS ARTICLE: Abrams J, Vinhal WC, Sable CA, Cardoso CS, Zühlke L, Spaziani A, Ryklief L, Nunes MCP, Ribeiro IKS, Previero R, Silva LR, Chavez LMT, Oliveira KKB, Amaral IB, Lemos L, Correa JS, Coelho CT, Santos BA, de Paula LH, Souza IS, Santiago MLBS, Freitas BC, Angelo GR, Nunes MHP, Pereira KJ, Ribeiro ALP, Nascimento BR, On behalf of the PROVAR+(Programa de RastreamentOda VAlvopatia Reumática and Other Cardiovascular Diseases) investigators. Rheumatic Heart Disease Education Tools Integrated Into a Screening Program in Brazil: Acceptability and Knowledge Gain. Global Heart. 2025; 20(1): 115. DOI: [https://doi.org/10.5334/](https://doi.org/10.5334/)[ ](https://doi.org/10.5334/)[gh.1510](gh.1510) healthcare and education professionals participating in the pre- and post-training survey (n = 511): RF as the cause of RHD (64% vs 95%), use of benzathine penicillin G (43% vs 98%), and frequency of antibiotic prophylaxis (21% vs 77%). The improvement from baseline was sustained at follow-up. Over the entire study period, 98% of survey respondents (2,134) reported learning something new, and 94%(2,041) intended to share the learnings with their peers or community. Conclusion: Culturally adapted, low-literacy educational flipcharts were successfully integrated into an existing RHD screening program in Brazil. The tool was well accepted among people living with RHD, their providers, and at-risk communities, with si

FAQs

What was the purpose of the education tools in the Brazil screening program?

The flipcharts aimed to support communication about RHD prevention, recognition, and management in underserved high-burden areas.

Who received the flipchart education and training?

Patients, community members, school children, and healthcare and education professionals were taught using four low-literacy flipcharts, with in-person training and workshops for professionals.

How was knowledge gain measured and when were assessments conducted?

A knowledge test was given before training, after training, and at three-month follow-up; it was incorporated from January 2024 to March 2025, alongside pre- and post-surveys from January 2023 to December 2025.

Sep 28, 2026

Uploaded by Jordan Avery