Uso das plataformas de redes sociais online - Whatsapp e Facebook - para melhorar a literacia de mulheres sobre a prevenção dos cânceres de mama e colo do útero

Abstract

Breast and cervical cancers are important causes of mortality in Brazil and worldwide. An aggravating factor of this condition is directly related to limitations of knowledge about preventive methods of these diseases and the lack of attitude to put them into practice. Health literacy comprises the access, processing and understanding of health information that generate an effective change in the individuals‘ behavior. Given the importance of the Internet in the health education process, this research has as its primary objective to analyze the use of online social network platforms (WhatsApp and Facebook) in improving women's literacy on the prevention of breast and cervical cancers. This work was carried out in two stages that resulted in two scientific articles. In article I, whose objective was the translation, cross-cultural adaptation and validation into Brazilian Portuguese of the instrument ―Evaluation of health literacy in cancer screening‖. Also, the equivalence analyzes of conceptual, item, operational and measurement of this instrument was carried out and is presented according to guidelines from the Brazilian Ministry of Health. The agreement with the adaptations was performed by a committee formed by three judges using a five point Likert scale, in order to compare the adapted version with the original. The validation of the adapted instrument was carried out in a sample of 112 women (25 to 64 years old) assisted by the Unified Health System. The instrument consists of five tests: (1) reading; (2) familiarity; (3) understanding; (4) numbering/mathematics and (5) dialog. The individual reading ability was evaluated with twelve words related to the theme, the same used in the familiarity and comprehension tests, which assess whether women are familiar with these words and know their meaning. The numbering/mathematics test assessed the ability to interpret information and communicate through arithmetic data. In the dialogue test, the participants completed 11 empty fields in a dialogue with words that seemed appropriate to the themes of self-examination, screening and early detection of breast and cervical cancers. Our results showed that the adapted questionnaire has significant sensitivity and reliability, having obtained high levels of internal and external validity. In article II, whose objective was to investigate the use of online social networking platforms as information vehicles to increase health literacy, an assessment of the literacy level of women on the prevention of breast and cervical cancer was carried out, by through the application of the instrument, before and after the use of Facebook and WhatsApp as a strategy to convey information on the topic. The educational intervention was carried out with women assisted at the Beneficent Christian Social Community in the city of Mandaguari-PR (n=25), who were included in closed Facebook (n=13) or WhatsApp (n=12) groups through which they were posted daily (except weekends), over three consecutive weeks, media on prevention and other issues related to breast and cervical cancers. No statistical differences were found between the socioeconomic criteria evaluated when comparing the participants in which the educational strategies were presented through Facebook or WhatsApp. Regarding the level of health literacy, the first application of the instrument revealed, in general, a high percentage of correct answers in the reading and familiarity domains, which in turn were higher than the correct answers in the comprehension domain. We found low participants' performance in the dialogue and mathematics domains. After the educational intervention through Facebook or WhatsApp, the study participants responded to the instrument again. Reading and familiarity domains showed improvement, however, there was no significant enhancement in the comprehension domain after the intervention performed. Regarding the dialogue, an evolution in the percentage of correct answers was observed for all the items evaluated, compared to the first application of the instrument, with the exception of a single item only in the group in which the information was transmitted via Facebook. However, this change has not reached a significant level. For the mathematics domain, there was a worsening in 50% of the items evaluated after the intervention. Taken together, our data suggest that increasing comprehension is more difficult than reading and familiarity. The educational strategy used in this work did not improve the participants' understanding of the developed theme, regardless of the digital platform used to disseminate this information. It is essential to know how women receive health information, and what communication strategies are the best to encourage these women to undergo breast and cervical cancer screening.