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EDUCATIONAL BOOKLET FOR PREVENTING TRANSPHOBIC BULLYING AT SCHOOL

CARTILLA EDUCATIVA PARA PREVENIR EL ACOSO TRANSFÓBICO EN LA ESCUELA

ABSTRACT

Objective:

to describe the process of developing, validating and assessing an educational booklet to prevent transphobic bullying at school.

Method:

this is a methodological study, carried out from February to December 2022 at a public school in João Pessoa, Paraíba, Brazil. The educational booklet was developed in accordance with the methodological trajectory proposed by Echer, and submitted to content validity and semantic assessment by expert judges and Elementary School II teachers, respectively. In data analysis, content validity and Intraclass Correlation Coefficients were used, in addition to semantic agreement index.

Results:

the educational booklet had its content validated with a validity coefficient of 0.981 and an Intraclass Correlation Coefficient of 0.833 for the set of items in the assessment instrument. In semantic assessment, teachers considered the booklet understandable, with a minimum agreement level of 94%.

Conclusion:

the booklet developed was considered valid by judges, to be used with teachers, individually and in continuing education or health actions, in order to contribute to preventing transphobic bullying at school.

DESCRIPTORS:
Educational technology; Transgender persons; Transphobia; Bullying; Gender-based violence; School health services; Health education; Nursing

RESUMEN

Objetivo:

describir el proceso de desarrollo, validación y evaluación de una cartilla educativa para prevenir el acoso escolar transfóbico.

Método:

se trata de un estudio metodológico, realizado de febrero a diciembre de 2022 en una escuela pública de João Pessoa, Paraíba, Brazil. La cartilla educativa fue elaborada de acuerdo con la trayectoria metodológica propuesta por Echer, y sometida a validación de contenido y evaluación semántica por jueces expertos y docentes de la Escuela Primaria II, respectivamente. En el análisis de los datos, se utilizaron los coeficientes de validez de contenido y de correlación intraclase, y el índice de concordancia semántica.

Resultados:

la cartilla educativa tuvo su contenido validado con un coeficiente de validez de 0,981 y un coeficiente de correlación intraclase de 0,833 para el conjunto de ítems del instrumento de evaluación. En la evaluación semántica, los docentes consideraron comprensible el cuadernillo, con un nivel mínimo de acuerdo del 94%.

Conclusión:

la cartilla desarrollada fue considerada válida por los jueces, para ser utilizada con docentes, de manera individual y en acciones de educación continua o de salud, con el fin de contribuir a la prevención del acoso escolar transfóbico en la escuela.

DESCRIPTORES:
Tecnología educacional; Personas transgénero; Transfobia; Acoso escolar; Violencia de género; Servicios de salud Escolar; Educación en salud; Enfermería

RESUMO

Objetivo:

Descrever o processo de desenvolvimento, validação e avaliação de cartilha educacional para prevenção do bullying transfóbico na escola.

Método:

Trata-se de um estudo metodológico, realizado no período de fevereiro a dezembro de 2022 em uma escola pública de João Pessoa, Paraíba, Brasil. A cartilha educacional foi desenvolvida de acordo com a trajetória metodológica proposta por Echer, e submetida à validação de conteúdo e avaliação semântica por juízes especialistas e professores do Ensino Fundamental II, respectivamente. Na análise dos dados, utilizaram-se os coeficientes de validade de conteúdo e correlação intraclasse, e o índice de concordância semântica.

Resultados:

A cartilha educacional teve seu conteúdo validado com coeficiente de validade de 0,981 e coeficiente de correlação intraclasse de 0,833 para o conjunto de itens do instrumento de avaliação. Na avaliação semântica, os professores consideraram a cartilha compreensível, com nível de concordância mínima de 94%.

Conclusão:

A cartilha desenvolvida foi considerada válida por juízes, para ser utilizada com professores, de forma individual e em ações de educação permanente ou em saúde, a fim de contribuir na prevenção do bullying transfóbico na escola.

DESCRITORES:
Tecnologia Educacional; Pessoas Transgênero; Transfobia; Bullying; Violência de Gênero; Promoção da Saúde Escolar; Educação em Saúde; Enfermagem

INTRODUCTION

Transphobia is a reflection of power relations historically constructed and perpetuated in societies around the world. The term refers to different meanings, such as negative behaviors of hatred, repulsion, indignation or anger due to transgenderism. Such behaviors can range from verbal insults to physical aggression and murder11. Menkin D, Flores DD. Transgender students: Advocacy, care, and support opportunities for school nurses. NASN School Nurse [Internet]. 2019 [cited 2022 Dec 10];34(3):173-7. Available from: https://doi.org/10.1177/1942602X18801938
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-22. Reis PSO, Neves ALM, Therense M, Honorato EJS, Teixeira E. Veiled transphobia: Meanings produced by nurses on the reception of travestis and transgender. Rev Fund Care Online [Internet]. 2021 [cited 2022 Dec 10];13:80-5. Available from: https://doi.org/10.9789/2175-5361.rpcfo.v13.7488
https://doi.org/10.9789/2175-5361.rpcfo....
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At school, transphobic violence often begins in the form of transphobic bullying, which involves students who do not conform to social norms and expectations for their gender, such as effeminate boys or “masculine” girls, beginning a cycle of violence with discriminatory treatments, insults, prejudiced insinuations, aggression and embarrassment, giving a feeling of power/superiority in complying with cisnormativity33. Brito S, Carneiro NS, Nogueira C. Playing Gender(s): The re/construction of a suspect “gender identity” trough play. Ethnogr Educ [Internet]. 2021 [cited 2022 Dec 10];16(4):384-401. Available from: https://doi.org/10.1080/17457823.2021.1922927
https://doi.org/10.1080/17457823.2021.19...
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Worldwide, trans people’s educational experience involves a context of abuse, institutional exclusion and transphobic bullying. In Colombia, for instance, 92% of trans people have been bullied at school, followed by Venezuela (78%), Philippines (72%), Turkey (61%) and Serbia (50%)4 4. Fedorko B, Berredo L. O círculo vicioso da violência: Pessoas trans e gênero-diversas, migração e trabalho sexual. Transgender Europe [Internet]. 2017 [cited 2022 Dec 10];19:24. Available from: https://transrespect.org/wp-content/uploads/2018/01/TvT-PS-Vol19-2017.pdf
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In our scenario, a study with 120 families of trans children and adolescents about their experiences in the Brazilian educational system showed that 93 of them stated that their child/adolescent had already been a victim of some type of bullying55. Nunes T. Pesquisa sobre vivências reais de crianças e adolescentes transgêneres dentro do sistema educacional brasileiro. Curitiba, PR(BR): IBDSEX; 2021 [cited 2022 Dec 10]. 142 p. Available from: https://aliancalgbti.org.br/wp-content/uploads/2021/12/eBook-Completo-0912-FINAL.pdf
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Due to the prejudice of students and teachers, constant situations arise of non-recognition of their social name during the call, unavailability of bathroom/clothing according to gender identity, exclusionary binary divisions in physical activities, and everyday life marked by physical and psychological violence and neglect trans people’s school experience as an experience marked by doubts, exclusion and pain4 4. Fedorko B, Berredo L. O círculo vicioso da violência: Pessoas trans e gênero-diversas, migração e trabalho sexual. Transgender Europe [Internet]. 2017 [cited 2022 Dec 10];19:24. Available from: https://transrespect.org/wp-content/uploads/2018/01/TvT-PS-Vol19-2017.pdf
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These situations occur because the school perpetuates hegemonic cultural norms that constitute society, such as the way men and women must construct their gender and express their sexuality as a naturalized standard and incorporated into educational practices, focusing their activities on teaching and learning66. Soares ZP, Monteiro SS. Formação de professores/as em gênero e sexualidade: Possibilidades e desafios. Educ Rev [Internet]. 2019 [cited 2022 Dec 10];35(73):287-305. Available from: https://doi.org/10.1590/0104-4060.61432
https://doi.org/10.1590/0104-4060.61432...
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The consequences of transphobic bullying for victims include a greater risk of mental distress, such as low self-esteem, anxiety, and depression, and the possibility of developing self-harm and suicidal behavior. Furthermore, they are also more likely to drop out of school or miss classes and have lower academic performance than cisgender students55. Nunes T. Pesquisa sobre vivências reais de crianças e adolescentes transgêneres dentro do sistema educacional brasileiro. Curitiba, PR(BR): IBDSEX; 2021 [cited 2022 Dec 10]. 142 p. Available from: https://aliancalgbti.org.br/wp-content/uploads/2021/12/eBook-Completo-0912-FINAL.pdf
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In Brazil, basic education is a right granted to every citizen under the Federal Constitution and which must be met in accordance with the demands of students’ interests with a view to democracy and social inclusion77. Silva CSF, Brancaleoni APL, Oliveira RR. Base nacional comum curricular e diversidade sexual e de gênero: (des)caracterizações. Rev Ibero-Am Estudos Educ [Internet]. 2019 [cited 2022 Dec 10];14(2):1538-55. Available from: https://doi.org/10.21723/riaee.v14iesp.2.12051
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. The Brazilian National Common Curricular Base (BNCC - Base Nacional Comum Curricular) for basic education contains the skills that must be returned throughout the stages, which includes valuing diversity without prejudice of any kind. In 2018, Law 13,663 was enacted, which mandates schools to promote measures to combat bullying and encourage the Culture of Peace77. Silva CSF, Brancaleoni APL, Oliveira RR. Base nacional comum curricular e diversidade sexual e de gênero: (des)caracterizações. Rev Ibero-Am Estudos Educ [Internet]. 2019 [cited 2022 Dec 10];14(2):1538-55. Available from: https://doi.org/10.21723/riaee.v14iesp.2.12051
https://doi.org/10.21723/riaee.v14iesp.2...
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Seen in these terms, the role of a teacher is no longer solely to contribute to student learning, but also to encourage the development of skills and abilities in an articulated way to build knowledge and form attitudes and values77. Silva CSF, Brancaleoni APL, Oliveira RR. Base nacional comum curricular e diversidade sexual e de gênero: (des)caracterizações. Rev Ibero-Am Estudos Educ [Internet]. 2019 [cited 2022 Dec 10];14(2):1538-55. Available from: https://doi.org/10.21723/riaee.v14iesp.2.12051
https://doi.org/10.21723/riaee.v14iesp.2...
. However, a Brazilian study carried out with Elementary School teachers in João Pessoa, Paraíba, revealed that they did not feel prepared to address transgenderism and transphobic bullying at school88. Silva FV, Jales RD, Pereira IL, Almeida LR, Nogueira JA, Almeida AS. Childhood transgenderity under the perspective of elementary school teachers. Rev Lat Am Enfermagem [Internet]. 2021 [cited 2023 Oct 5];29:e3459. Available from: https://doi.org/10.1590/1518-8345.3792.3459
https://doi.org/10.1590/1518-8345.3792.3...
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Facing the vulnerabilities that permeate trans children’s and adolescents’ full development full development finds in schools a privileged space for the association of education and health, especially in basic education in the public education network. It is essential that healthcare professionals turn their attention to transphobic bullying prevention and develop health education actions to clarify and raise awareness among teachers, in order to promote a healthy development for trans children and adolescents through an educational process that contributes to mental health and minimizes inequalities in this population. Hence, nurses play a relevant role in the development of health educational actions within the scope of primary care, especially in school settings, in health promotion interventions99. Souza VP, Perrelli JGA, Brandão Neto W, Pereira MBFLO, Guedes TG, Monteiro EMLM. Elaboration and validation of an educational video for the prevention of sexual violence in adolescents. Texto Contexto Enferm [Internet]. 2022 [cited 2023 Jan 22];31:e20210171. Available from: https://doi.org/10.1590/1980-265X-TCE-2021-0171pt
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Educational technologies are tools that assist nursing health education practices, which includes school settings, and are important resources that can be used to increase the level of knowledge as well as change attitudes and behaviors related to a given object1010. Loureiro F, Sousa L, Antunes V. Use of digital educational technologies among nursing students and teachers: An exploratory study. J Pers Med [Internet]. 2021 [cited 2023 Jan 22];11(10):1010. Available from: https://do.org/10.3390/jpm11101010
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Enlightening and raising awareness of teachers with the implementation of educational technologies to prevent transphobic bullying at school allows them to be multiplying agents for changing behavior in other teachers, students and staff, making it possible to transform exclusionary and violent behaviors committed against trans students through actions based on a Culture of Peace1111. Diskin L, Roizman LG. Paz como se faz? Semeando cultura de paz nas escolas. Brasília, DF(BR): UNESCO; 2021 [cited 2022 Dec 10]. 232 p. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000379604
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Furthermore, the importance of adopting a Culture of Peace as a structuring axis of the guidelines contained in the educational technology of this study was recognized as it is a framework that values dialogue and non-violence for the prevention and resolution of conflicts involving trans students1111. Diskin L, Roizman LG. Paz como se faz? Semeando cultura de paz nas escolas. Brasília, DF(BR): UNESCO; 2021 [cited 2022 Dec 10]. 232 p. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000379604
https://unesdoc.unesco.org/ark:/48223/pf...
. Therefore, this study aimed to describe the process of developing, validating and assessing an educational booklet to prevent transphobic bullying at school.

METHOD

This is a methodological study with the development, content validity and semantic assessment of an educational booklet, carried out from February to December 2022, in João Pessoa/PB. The research was based on the Culture of Peace theoretical framework1010. Loureiro F, Sousa L, Antunes V. Use of digital educational technologies among nursing students and teachers: An exploratory study. J Pers Med [Internet]. 2021 [cited 2023 Jan 22];11(10):1010. Available from: https://do.org/10.3390/jpm11101010
https://do.org/10.3390/jpm11101010...
, in order to present guidelines based on non-violence and dialogue principles as a guiding axis in the mediation of conflicts involving trans students.

The choice of educational technology occurred through individual interviews carried out with 12 Elementary School II teachers from a municipal public school in João Pessoa Paraíba, Brazil, carried out between November 2021 and February 2022. Knowledge, experiences and attitudes towards transphobic bullying to guide the booklet content were diagnoses.

To this end, a semi-structured script was used with the following questions: What do you understand by gender identity and transgenderity? If you have had any experience at school with a trans student, tell us what it was like. What would you do if you witnessed a trans student being transphobic bullied? What do you think you can do to prevent transphobic bullying at school? What do you know about implementing a Culture of Peace at school? In your opinion, what type of technology would be most appropriate to guide and raise awareness among teachers about transphobic bullying? What do you think it should have in terms of content?

To develop the booklet, the methodological trajectory proposed by Echer was used1212. Echer IC. The development of handbooks of health care guidelines. Rev Latino-am Enferm [Internet]. 2005 [cited 2020 Mar 18];13(5):754-7. Available from: https://doi.org/10.1590/S0104-11692005000500022
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, which outlines the construction of manuals, and consisted of seven stages: project submission to a Research Ethics Committee; search for specialized literature; suitability of literature information for the target audience; choice of relevant information; illustration of selected content; content validity by professionals specialized in the topic and by experts in Printed Educational Material (PEM) development; and assessment by the target audience.

The booklet content selection was based on analysis of teachers’ statements, then there was a search for educational materials on Sexual and Gender Diversity (SGD), bullying, and Culture of Peace (CP) available on the Internet at in the form of manuals, booklets and official documents as well as books and scientific articles in the areas in question. Thus, a script was created containing the topics identified as relevant both in the literature consulted and in the statements of interviewed teachers. After selecting content, the textual elaboration of the booklet began. To this end, the recommendations for written communication in PEM1212. Echer IC. The development of handbooks of health care guidelines. Rev Latino-am Enferm [Internet]. 2005 [cited 2020 Mar 18];13(5):754-7. Available from: https://doi.org/10.1590/S0104-11692005000500022
https://doi.org/10.1590/S0104-1169200500...
, were followed in relation to language, illustration and layout. Literature language was adapted, where the best vocabulary use was observed to facilitate understanding by the target audience1313. Moreira MF, Nóbrega MML, Silva MIT. Comunicação escrita: Contribuição para a elaboração de material educativo em saúde. Rev Bras Enferm [Internet]. 2003 [cited 2020 Mar 18];56(2):184-8. Available from: https://doi.org/10.1590/S0034-71672003000200015
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Illustrations and layout were made by a professional graphic designer experienced in developing booklets, who assessed the script created by the researcher to define the scope. Subsequently, illustrations were defined through sketches and colorization in Illustrator CC. Subsequently, page graphic design and layout were carried out with the inclusion of illustrations in Corel Draw 2020.

After its development, the booklet was submitted for content validity by experts in SGD, CP and PEM development, selected according to Fehring criteria1414. Fehring RJ. The fering model. In: Carrol-Johson RM, Paquete M, editors. Classification of nursing diagnosis: Proceedings of the conference of North American Nursing Diagnosis Association. Philadelphia, PA(US): Lippincott; 1994. p. 0-00.. To define the number of judges in SGD, a sample calculation was chosen based on previous study1515. Lopes MVO, Silva VM, Araujo TL. Validation of nursing diagnosis: Challenges and alternatives. Rev Bras Enferm [Internet]. 2013 [cited 2021 Apr 12];66(5):649-55. Available from: https://doi.org/10.1590/S0034-71672013000500002
https://doi.org/10.1590/S0034-7167201300...
The formula n=(Zα)2. P (1-P)/d2 was used, in which “n” represents the number of experts, “Z” is equivalent to the desired level of significance, “P” indicates the minimum proportion of experts who consider the item/instrument appropriate and “d” is equivalent to the degree of accuracy of the estimate. Applying an 85% acceptance rate among judges and a 95% Confidence Interval resulted in 22 judges. However, an odd number of judges was adopted to avoid ambiguous questions1616. Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc Saúde Colet [Internet]. 2011 [cited 2021 Apr 12];16(7):3061-8. Available from: https://doi.org/10.1590/S1413-81232011000800006
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. The proportion of one professional specialized in CP and one with experience in developing PEM for every ten professionals specialized in SGD was considered1717. Rubio DM, Ber-Weger M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: Conducting a content validity study in social work research. Soc Work Res [Internet]. 2003 [cited 2021 Apr 12];27(2):94-111. Available from: https://doi.org/10.1093/swr/27.2.94
https://doi.org/10.1093/swr/27.2.94...
. Thus, the sample consisted of 27 judges, 23 judges in SGD, two in CP and two in PEM development.

The sample was composed intentionally of snowballing based on the indication of “Education in Comprehensive Health, Gender and Diversity in Nursing Care Scenarios” research group members at the Universidade Federal de Pernambuco and subsequent consultation of Curriculum Lattes to confirm expertise according to established criteria1414. Fehring RJ. The fering model. In: Carrol-Johson RM, Paquete M, editors. Classification of nursing diagnosis: Proceedings of the conference of North American Nursing Diagnosis Association. Philadelphia, PA(US): Lippincott; 1994. p. 0-00.. Thus, the first experts nominated others to form the pool of experts invited to participate.

Nominees were contacted via their email addresses, sending an invitation letter, a link to fill out the electronic Informed Consent Form via Google Forms®, a digital version of the booklet in PDF and an assessment form also in electronic format via Google Forms®, adapted from a previous study1818. Leite SS, Áfio ACE, Carvalho LV, Silva JM, Almeida PC, Pagliuca LMF. Construction and validation of an Educational Content Validation Instrument in Health. Rev Bras Enferm [Internet]. 2018 [cited 2021 May 20];71(4):1635-41. Available from: https://doi.org/10.1590/0034-7167-2017-0648
https://doi.org/10.1590/0034-7167-2017-0...
. This self-applied instrument was composed of 18 items divided into three dimensions: objectives; structure/presentation; and relevance. It comprises a Likert-type scale with three response options (disagree, partially agree, and completely agree), and with space for comments and/or suggestions. A ten-day deadline was established for returning the assessment, extended by another ten days for participants who did not meet the initial deadline, and those who did not submit within the new stipulated period were excluded.

The database was transported from Microsoft Excel® to Stata version 16.0. The Content Validity Coefficient was calculated for each item1919. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010.. To this end, judges’ scores were used to calculate the mean scores for each item (Mx). The initial CVC (CVCi) was determined using the formula CVCi=Mx/Vmax, where Vmax represents the highest value that the item can reach. Judges’ polarization error (Pei) was also calculated to discount possible biases of judges for each item, using the formula Pei=(1/J)J, where J represents the number of judges included in the study. Therefore, it was considered as final CVC (CVCc): CVCc=CVCi-Pei.

To verify whether the proportion of agreement of booklet items reached the established cut-off point of 80%, based on a significance level of 5%, a binomial test was calculated. To analyze agreement among judges, the Intraclass Correlation Coefficient was calculated for the total set of items, and for the objectives, structure/presentation and relevance dimensions, with a 95% Confidence Interval.

After data analysis, the booklet was modified according to the changes proposed by judges, and the second version was subjected to semantic assessment. This type of assessment must be carried out with a group of six to 20 subjects;1616. Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc Saúde Colet [Internet]. 2011 [cited 2021 Apr 12];16(7):3061-8. Available from: https://doi.org/10.1590/S1413-81232011000800006
https://doi.org/10.1590/S1413-8123201100...
in this case, intentionally including ten teachers who participated in the previous diagnosis. Thus, in addition to verifying the satisfactory understanding of the booklet by the target audience and whether this understanding makes its use viable1616. Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc Saúde Colet [Internet]. 2011 [cited 2021 Apr 12];16(7):3061-8. Available from: https://doi.org/10.1590/S1413-81232011000800006
https://doi.org/10.1590/S1413-8123201100...
, teachers were also able to assess whether the booklet met the suggestions they had previously presented.

Teachers had already been informed about their participation in semantic assessment at the time of diagnosis. To this end, contact was established via WhatsApp®, where the digital booklet was sent in PDF format and the link to the self-applied Google Forms® assessment form, adapted Suitability Assessment of Materials (SAM), composed of 29 items that assess the objective, organization, language, appearance, motivation and cultural suitability dimensions, with answers presented on a Likert-type scale with five grades (1 - completely disagree; 2 - disagree; 3 - neutral; 4 - agree; 5 - totally agree), and with space for comments and/or suggestions2020. Doak CC, Doak GL, Root J. Teaching patients with low literacy skill. 2nd ed. Philadelphia, PA(US): Lippincott; 1996..

The semantic agreement index was calculated, considering a minimum agreement of 80% for the answers agree and completely agree2121. Teixeira E. Desenvolvimento de tecnologias cuidativo-educacionais. Porto Alegre, RS(BR): Moriá; 2020.. After incorporating suggestions from the target audience, the final version of the educational booklet on transphobic bullying in trans students was created, and was subjected to grammatical and spelling correction by a professional trained in languages and linguistics and, then, textual adjustments were made for printing. The final version of the booklet is available in digital and printed formats.

RESULTS

The final version of the booklet is made up of 36 pages, structured into an external part (front and back cover) and internal part (pre-textual, textual and post-textual elements). Technical sheet and summary constitute pre-textual elements, and references, post-textual elements. Figure 1 shows the textual elements that cover the booklet content, grouped into 23 domains that address SGD, transphobic bullying and CP.

Figure 1 -
Domains that constitute the educational booklet content on transphobic bullying. João Pessoa, Paraíba, Brazil, 2022.

The main illustration on the outside of the booklet, shown in Figure 2, highlights those involved in a situation of transphobic bullying, with three characters representing victims, aggressors and witnesses. Other illustrations appear in the margins of the cover, and also represent the phenomenon in different ways. The trans pride flag colors were used throughout the material as a way of honoring this population.

Figure 2 -
External part of the educational booklet on transphobic bullying (front and back cover). João Pessoa, Paraíba, Brazil, 2022

In content validity, four (14.8%) judges declared themselves as transgender, and the rest (85.2%), as cisgender. A total of 14 (51.8%) judges from the state of Pernambuco participated, four (14.81%) from Paraíba, three (11.1%) from São Paulo and one (3.7%) from each state in the others (Bahia, Alagoas, Ceará, Paraná, Rio de Janeiro and Rio Grande do Sul). Of the participating judges, 16 (59.3%) were nurses, four (14.8%) were psychologists, two (7.4%) were pedagogues, two (7.4%) were social workers and the other professionals were an anthropologist, a lyricist and a doctor, with one (3.7%) participant each. Of these, 16 (59.2%) held a doctoral degree, eight (29.6%), a master’s degree, and the rest were experts. Regarding professional activity, 18 (66.7%) worked in the academic area and had experience in research and teaching in the area of interest (SGD, CP or PEM) and nine (33.3%) worked in assistance in health services or institutions supporting the trans population.

In the “objectives” dimension, the Content Validity Coefficient was 0.972, and for items, it varied between 0.938 and 0.987. In the “structure and presentation” dimension, the Content Validity Coefficient was 0.982 and varied between 0.938 and 1.0 for items. In the “relevance” dimension, the Content Validity Coefficient of items varied between 0.987 and 1.0. and was 0.991 for the dimension. The Content Validity Coefficient for the set of items was 0.981 (Table 1). Such findings represent the educational booklet content validity in terms of objectives, structure and presentation, and relevance.

Table 1 -
Content Validity Coefficient of items, dimensions and set of items. João Pessoa, Paraíba, Brazil, 2022. (n=27)

Suggestions for corrections and textual additions were accepted to provide the material with completeness of information. Only one illustration was changed in the “choose the outcome of the story” domain, which showed the character hanged, being replaced by a tombstone, considering that the previous image could provoke negative emotions that could encourage suicide. Suggestions to use neutral language, include the word “manual” in the booklet title, develop gamification to retain learning, replace the term “transphobic bullying” with “transphobia” and teachers with “education professionals” were not accepted as they did not consider the study objectives.

The Intraclass Correlation Coefficient of the dimensions and set of items, expressed in Table 2, indicates satisfactory agreement among the judges included in the content validity process.

Table 2 -
Intraclass Correlation Coefficient among expert judges regarding dimensions and set of items. João Pessoa, Paraíba, Brazil, 2023. (n=27)

In semantic assessment, of the 29 items assessed, 13 obtained the maximum degree of semantic agreement (Table 3). The “The writing is in an appropriate style” item received a minimum score from an evaluator and, therefore, presented the lowest level of semantic agreement among the teachers included in this study. However, no suggestion for changes to the item was presented. The “objectives”, “organization”, “language”, “appearance”, “motivation” and “cultural suitability” dimensions presented a semantic agreement index that varied between 0.90 and 0.96. No item had a rating lower than 0.80. The only suggestion presented at this stage was the introduction of the contact of the Executive Management of Diversity and Inclusion of Paraíba (GEDI) in the “important contacts” domain, which was accepted.

Table 3
Degree of semantic agreement among teachers. João Pessoa, Paraíba, Brazil, 2023. (n=10)

DISCUSSION

The educational booklet developed constitutes a technological innovation given the scientific evidence of incipience in educational technologies aimed at combating transphobic bullying at school2222. Ramalho MNA, Silva LLSB, Abreu PD, Sousa JC, Brito IC, Araújo EC. Experiências e ações de enfrentamento a transfobia no contexto escolar. Inter J Develop Res [Internet]. 2022[cited 2023 Feb 15];12(6):56772-7. Available from: https://doi.org/10.37118/ijdr.24642.06.2022
https://doi.org/10.37118/ijdr.24642.06.2...
. It has guidelines for conducting and preventing cases of transphobic bullying based on a CP framework. Information about the reality experienced by trans people is presented with the aim of raise awareness of teachers to welcome and include this population so that they have the right to formal education guaranteed. Thus, the content booklet content contains information that covers the need to understand concepts related to trans students’ gender identity, rights and experiences in school settings, which includes the concept of transphobic bullying.

Innovation is also due to the fact that content was directed from individual interviews with Elementary School II teachers, configuring a participatory development, i.e., there was a contribution from representatives of the target audience for whom the booklet is intended both in the diagnosis of knowledge, experiences and attitudes regarding transphobic bullying and in material semantic assessment. This methodological research modality enables the negotiation of knowledge and experiences between researchers, professionals and users2121. Teixeira E. Desenvolvimento de tecnologias cuidativo-educacionais. Porto Alegre, RS(BR): Moriá; 2020..

In addition to innovation, the booklet developed has social relevance, as it the United Nations (UN) 2030 agenda Sustainable Development Goals (SDGs), and is closely related to goals four, ten and 16, which deal with access to inclusive education, reduction of inequalities, and promotion of peaceful societies, respectively2323. Nassi-Caió L. Strategies for editors to contribute for the achievement of the Sustainable Development Goals by 2030. Rev Lat Am Enfermagem [Internet]. 2023 [cited 2023 Oct 5];31:e4059. Available from: https://doi.org/10.1590/1518-8345.0000.4059
https://doi.org/10.1590/1518-8345.0000.4...
.

In Brazil, some educational materials in the form of a booklet on SGD were produced by bodies and associations supporting the LGBTQIAP+ population. They are mostly directed at the community itself, with the aim of clarifying their rights, protection in cases of violence and production of information, since data on sexual orientation and gender identity are neglected in the main national information systems2424. Benevides BG. O que fazer em caso de violência LGBTIfóbica: Cartilha de orientações à população LGBTI no combate a LGBTIfobia. Rio de Janeiro, RJ(BR): ANTRA; 2020 [cited 2023 Feb 15]. 33 p. Available from: https://antrabrasil.files.wordpress.com/2020/03/cartilha-lgbtifobia.pdf
https://antrabrasil.files.wordpress.com/...
-2525. Reis T, Cazal S. Manual de educação LGBTI+.Curitiba, PR(BR): IBDSEX ; 2021 [cited 2023 Feb 15]. 200 p. Available from: https://aliancalgbti.org.br/wp-content/uploads/2023/05/Manual-Educacao-LGBTI.pdf
https://aliancalgbti.org.br/wp-content/u...
.

It is important that educational materials for teachers present a theoretical framework to guide guidance for this audience. Furthermore, educating towards non-violence in the context of differences is fundamental, as it encompasses learning about responsibilities and rights, respect for differences and similarities, cooperation, dialogue and intercultural understanding, and promotion of non-violent values and attitudes1111. Diskin L, Roizman LG. Paz como se faz? Semeando cultura de paz nas escolas. Brasília, DF(BR): UNESCO; 2021 [cited 2022 Dec 10]. 232 p. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000379604
https://unesdoc.unesco.org/ark:/48223/pf...
.

The importance of a teacher as a mediator of conflicts in school settings is emphasized as a way of collaborating with alleviation of social problems and inequalities2626. Ximenes MAM, Fontenele NAO, Bastos IB, Macedo TS, Galindo Neto NM, Barros LM. Construction and validation of educational booklet content for fall prevention in hospitals. Acta Paul Enferm [Internet]. 2019 [cited 2022 Oct 15];32(4):433-41. Available from: https://doi.org/10.1590/1982-0194201900059
https://doi.org/10.1590/1982-01942019000...
. Inequalities caused by transphobic bullying among trans students stand out, which require teachers to have knowledge and sensitivity when dealing with the subject. Therefore, to develop an educational technology for Elementary School II teachers who have a mostly cisgender identity, it is essential that content and language are appropriate in order to achieve the expected results.

The educational booklet also innovates by validating it with health, education, social and human sciences judges with expertise in SGD and/or CP and/or in PEM development, providing greater reliability in adapting the technology to the target audience, as professional plurality is fundamental in improving the resource2727. Lima ACMACC, Chaves AF, Oliveira MG, Nobre MS, Rodrigues EO, Silva ACQ, et al. Construction and validation of educational booklet for breastfeeding support room. Rev Min Enferm [Internet]. 2020 [cited 2022 Oct 15];24:e1315. Available from: https://doi.org/10.5935/1415-2762.20200052
https://doi.org/10.5935/1415-2762.202000...
.

Several studies that developed booklets carried out content validity by judges who are experts in the subject because it is an essential stage in the construction of educational materials that aims to improve the material based on experts’ analyzes and suggestions2626. Ximenes MAM, Fontenele NAO, Bastos IB, Macedo TS, Galindo Neto NM, Barros LM. Construction and validation of educational booklet content for fall prevention in hospitals. Acta Paul Enferm [Internet]. 2019 [cited 2022 Oct 15];32(4):433-41. Available from: https://doi.org/10.1590/1982-0194201900059
https://doi.org/10.1590/1982-01942019000...
,2727. Lima ACMACC, Chaves AF, Oliveira MG, Nobre MS, Rodrigues EO, Silva ACQ, et al. Construction and validation of educational booklet for breastfeeding support room. Rev Min Enferm [Internet]. 2020 [cited 2022 Oct 15];24:e1315. Available from: https://doi.org/10.5935/1415-2762.20200052
https://doi.org/10.5935/1415-2762.202000...
,2828. Mello NC, Góes FGB, Pereira-Ávila FMV, Moraes JRMMM, Silva LF, Silva MA. Construction and validation of an educational booklet for mobile devices on breastfeeding. Texto Contexto Enferm [Internet]. 2020 [cited 2023 Jan 20];29:e20180492. Available from: https://doi.org/10.1590/1980-265X-TCE-2018-0492
https://doi.org/10.1590/1980-265X-TCE-20...
,2929. Roquini GR, Avelar NRN, Santos TR, Oliveira MRA de C, Galindo Neto NM, Sousa MRMGC, et al. Construção e validação de cartilha educativa para promoção da adesão a antidiabéticos orais. Cogitare Enferm [Internet]. 2021 [cited 2022 Jan 20];26:e80659. Available from: https://doi.org/10.5380/ce.v26i0.80659
https://doi.org/10.5380/ce.v26i0.80659...
.

Content validity of educational materials increases the possibility of success in their use during practice, as the probability of having correct, didactic and understandable content is greater2929. Roquini GR, Avelar NRN, Santos TR, Oliveira MRA de C, Galindo Neto NM, Sousa MRMGC, et al. Construção e validação de cartilha educativa para promoção da adesão a antidiabéticos orais. Cogitare Enferm [Internet]. 2021 [cited 2022 Jan 20];26:e80659. Available from: https://doi.org/10.5380/ce.v26i0.80659
https://doi.org/10.5380/ce.v26i0.80659...
. Thus, the booklet is a resource that allows its use without the need for mediation, and offers autonomy, and can also be used in a mediated way by education or healthcare professionals as a guide in educational interventions in school settings. Therefore, it is a useful resource for teacher training and qualification1010. Loureiro F, Sousa L, Antunes V. Use of digital educational technologies among nursing students and teachers: An exploratory study. J Pers Med [Internet]. 2021 [cited 2023 Jan 22];11(10):1010. Available from: https://do.org/10.3390/jpm11101010
https://do.org/10.3390/jpm11101010...
.

The booklet was validated in the first round with satisfactory CVC values for “objectives” (0.972), “structure and presentation” (0.982) and “relevance” (0.991), and for the set of items (0.981), in line with the minimum recommended to consider them valid1919. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010..

So that educational materials do not contain misleading or incomplete information, the assessment of items referring to objective, structure/presentation and relevance is necessary in the content validity process so as not to mislead the target population or make it difficult to understand the topic2727. Lima ACMACC, Chaves AF, Oliveira MG, Nobre MS, Rodrigues EO, Silva ACQ, et al. Construction and validation of educational booklet for breastfeeding support room. Rev Min Enferm [Internet]. 2020 [cited 2022 Oct 15];24:e1315. Available from: https://doi.org/10.5935/1415-2762.20200052
https://doi.org/10.5935/1415-2762.202000...
. The Intraclass Correlation Coefficient of the dimensions varied between 0.794 and 0.872, which indicates satisfactory agreement among judges included in the content validity process1919. Pasquali L. Instrumentação psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Artmed; 2010..

Sata collection instrument answers aimed at the target audience showed that the booklet was considered suitable for use with final years Elementary School teachers, as all items presented a semantic agreement index greater than 0.802121. Teixeira E. Desenvolvimento de tecnologias cuidativo-educacionais. Porto Alegre, RS(BR): Moriá; 2020.. A study that carried out a semantic assessment of an educational booklet on fall prevention with hospitalized patients obtained agreement that varied between 0.90 and 1.0 for the SAM items and 0.98 for the set of items2727. Lima ACMACC, Chaves AF, Oliveira MG, Nobre MS, Rodrigues EO, Silva ACQ, et al. Construction and validation of educational booklet for breastfeeding support room. Rev Min Enferm [Internet]. 2020 [cited 2022 Oct 15];24:e1315. Available from: https://doi.org/10.5935/1415-2762.20200052
https://doi.org/10.5935/1415-2762.202000...
.

Another important stage in educational material construction is approval by the target audience, where suggestions given must be considered in a coherent manner, even when content is numerically approved by experts2727. Lima ACMACC, Chaves AF, Oliveira MG, Nobre MS, Rodrigues EO, Silva ACQ, et al. Construction and validation of educational booklet for breastfeeding support room. Rev Min Enferm [Internet]. 2020 [cited 2022 Oct 15];24:e1315. Available from: https://doi.org/10.5935/1415-2762.20200052
https://doi.org/10.5935/1415-2762.202000...
. Evidence reveals understandable and attractive educational resources characterized as alternative for raising awareness among the audience for whom the material is intended99. Souza VP, Perrelli JGA, Brandão Neto W, Pereira MBFLO, Guedes TG, Monteiro EMLM. Elaboration and validation of an educational video for the prevention of sexual violence in adolescents. Texto Contexto Enferm [Internet]. 2022 [cited 2023 Jan 22];31:e20210171. Available from: https://doi.org/10.1590/1980-265X-TCE-2021-0171pt
https://doi.org/10.1590/1980-265X-TCE-20...
.

The vocabulary in the booklet on transphobic bullying is consistent with the message it intends to convey to Elementary School II teachers. Short, simple words, known by the target audience, were used in order to guarantee text readability and understanding and facilitate reading, making it inviting and understandable1313. Moreira MF, Nóbrega MML, Silva MIT. Comunicação escrita: Contribuição para a elaboração de material educativo em saúde. Rev Bras Enferm [Internet]. 2003 [cited 2020 Mar 18];56(2):184-8. Available from: https://doi.org/10.1590/S0034-71672003000200015
https://doi.org/10.1590/S0034-7167200300...
. Concepts and actions were presented in logical order with the repetition of important words and articulation of sentences1313. Moreira MF, Nóbrega MML, Silva MIT. Comunicação escrita: Contribuição para a elaboração de material educativo em saúde. Rev Bras Enferm [Internet]. 2003 [cited 2020 Mar 18];56(2):184-8. Available from: https://doi.org/10.1590/S0034-71672003000200015
https://doi.org/10.1590/S0034-7167200300...
.

It is worth mentioning that the educational booklet was not created solely with the intention of direct use by teachers during their activities inside and outside the classroom, since they will be able to consult the material whenever they are interested, but also as a guide in carrying out training and/or health education activities with these professionals, in order to contribute to transphobic bullying prevention. In this regard, the successful educational process permeates the intersectoral education-health articulation, aiming at trans children’s and adolescents’ protection and mental health as a way of guaranteeing their access and permanence in the formal education to which they are entitled.

Above all, the strategic role of teachers must be considered when talking about promoting trans children’s and adolescents’ health. For this reason, it is recommended that professionals working in health education involve teachers and build educational technologies on different topics, thinking about these actors77. Silva CSF, Brancaleoni APL, Oliveira RR. Base nacional comum curricular e diversidade sexual e de gênero: (des)caracterizações. Rev Ibero-Am Estudos Educ [Internet]. 2019 [cited 2022 Dec 10];14(2):1538-55. Available from: https://doi.org/10.21723/riaee.v14iesp.2.12051
https://doi.org/10.21723/riaee.v14iesp.2...
.

Health education practices using printed educational technologies such as booklets facilitate the educational process and offer relevant and quality information for the success of the proposed action3030. Portugal LBA, Christovam BP, Almeida BLO da S. Construção e validação de cartilha educativa para enfermeiros sobre lesões por pressão. Invest, Soc Desenvol [Internet]. 2021 [cited 2022 Jan 20];10(3):e3810312926. Available from: https://doi.org/10.33448/rsd-v10i3.12926
https://doi.org/10.33448/rsd-v10i3.12926...
.

Using PEM during the health education process favors the understanding of guidelines through the organization of information and the presence of illustrations2727. Lima ACMACC, Chaves AF, Oliveira MG, Nobre MS, Rodrigues EO, Silva ACQ, et al. Construction and validation of educational booklet for breastfeeding support room. Rev Min Enferm [Internet]. 2020 [cited 2022 Oct 15];24:e1315. Available from: https://doi.org/10.5935/1415-2762.20200052
https://doi.org/10.5935/1415-2762.202000...
,2929. Roquini GR, Avelar NRN, Santos TR, Oliveira MRA de C, Galindo Neto NM, Sousa MRMGC, et al. Construção e validação de cartilha educativa para promoção da adesão a antidiabéticos orais. Cogitare Enferm [Internet]. 2021 [cited 2022 Jan 20];26:e80659. Available from: https://doi.org/10.5380/ce.v26i0.80659
https://doi.org/10.5380/ce.v26i0.80659...
. Among these printed materials, the booklet stands out as a useful and viable resource for describing issues related to SGD and transphobic bullying due to its practicality and ease of application in school settings where nurses are an active agent in promoting actions of health education99. Souza VP, Perrelli JGA, Brandão Neto W, Pereira MBFLO, Guedes TG, Monteiro EMLM. Elaboration and validation of an educational video for the prevention of sexual violence in adolescents. Texto Contexto Enferm [Internet]. 2022 [cited 2023 Jan 22];31:e20210171. Available from: https://doi.org/10.1590/1980-265X-TCE-2021-0171pt
https://doi.org/10.1590/1980-265X-TCE-20...
Therefore, the implementation of these actions at school is fundamental for a healthy development of trans children and adolescents.

The acceptance of the booklet by Elementary School II teachers reiterates and awakens the need to expand an educational perspective aimed at this audience on gender diversity in schools, taking into account the deficiency in the pedagogical training of teachers to approach this topic, the fragility regarding the curricular composition on the subject and the still precarious debate and attention in scenario settings66. Soares ZP, Monteiro SS. Formação de professores/as em gênero e sexualidade: Possibilidades e desafios. Educ Rev [Internet]. 2019 [cited 2022 Dec 10];35(73):287-305. Available from: https://doi.org/10.1590/0104-4060.61432
https://doi.org/10.1590/0104-4060.61432...
.

It is believed that, by using the booklet, teachers will feel more encouraged to learn about the topic and, as a result, will adopt less prejudiced attitudes that could positively influence the resolution of conflicts involving transphobic bullying at school. It is expected that intervention studies using the booklet will be developed with teachers and that using educational resources to prevent transphobic bullying will be increasingly encouraged.

The fact that the booklet was made available for assessment by judges and teachers in digital format in a PDF file, which may have possibly compromised the assessment of aspects related to material printing, and the fact that it was assessed only by Elementary School II teachers of municipal public education were limitations of this study, which may differ from teachers from other realities, such as teachers from other stages of basic education, private schools and prison schools.

CONCLUSION

Interlocution of scientific knowledge in dialogue with prior knowledge and demands of Elementary School II teachers guided the development, content validity and semantic assessment of an educational booklet on transphobic bullying prevention. This proposal sought to prioritize commitment to the target audience at all stages of material development.

The educational booklet “Bullying transfóbico em estudantes trans” (Transphobic bullying of trans students), aimed at Elementary School II teacher, is an innovative educational technology with social relevance, valid and reliable, in terms of content for teaching about transphobic bullying prevention. The foundation with a CP framework allowed the development of an educational technology that encourages the resolution of conflicts in a peaceful and dialogical manner. Therefore, teachers, when using the resource, will be able to feel more prepared to develop general skills for basic education and to provide the necessary reception for trans children and adolescents so that their identity is recognized, respected and valued.

The booklet is an auxiliary resource in teacher training and can be used autonomously or mediated in continuing education actions by education professionals or in health education actions by school nurses or professionals who work in primary care through the School Health Program, in order to promote clarification for developing attitudes aimed at protecting trans children and adolescents and preventing transphobic bullying. It is also worth highlighting the possibility of using the educational booklet in academia to contribute to training new professionals as well as in extension activities in schools.

However, it is suggested that the booklet be assessed semantically with teachers from other stages of basic education, and from other realities, as is the case of private schools and prison schools, in addition to carrying out experimental studies with the application of the booklet in question, to verify its effect on teachers and comparison with other pedagogical resources.

ACKNOWLEDGMENT

To expert professionals and Elementary School II teachers who contributed to the educational booklet content validity and semantic assessment, respectively.

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    » https://doi.org/10.5935/1415-2762.20200052
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    » https://doi.org/10.33448/rsd-v10i3.12926

NOTES

  • ORIGIN OF THE ARTICLE

    Article extracted from the thesis - Cartilha educacional sobre bullying transfóbico no preconceito à diversidade de gênero de teacheres do Ensino Fundamental II, presented to the Graduate Program in Nursing, Universidade Federal de Pernambuco, in 2023
  • APPROVAL OF ETHICS COMMITTEE IN RESEARCH

    Approved by the Ethics Committee in Research Universidade Federal de Pernambuco Research Ethics Committee, under Opinion 6.155.886/2023 and CAAE (Certificado de Apresentação para Apreciação Ética - Certificate of Presentation for Ethical Consideration) 41092620.5.0000.5208
  • TRANSLATED BY

    Letícia Belasco

Edited by

EDITORS

Associated Editors: Luciara Fabiane Sebold, Maria Lígia Bellaguarda. Editor-in-chief: Elisiane Lorenzini

Publication Dates

  • Publication in this collection
    06 May 2024
  • Date of issue
    2024

History

  • Received
    13 July 2023
  • Accepted
    17 Oct 2023
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