RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 1
EDUCAÇÃO PERMANENTE EM SAÚDE: ESTRATÉGIA PARA ATENÇÃO ÀS
PESSOAS PRIVADAS DE LIBERDADE ACOMETIDAS PELA TUBERCULOSE
EDUCACIÓN PERMANENTE EN SALUD: UNA ESTRATEGIA PARA LA ATENCIÓN DE
LAS PERSONAS PRIVADAS DE LIBERTAD AFECTADAS POR LA TUBERCULOSIS
PERMANENT EDUCATION IN HEALTH: A STRATEGY TO CARE FOR PEOPLE
DEPRIVED OF LIBERTY AFFECTED BY TUBERCULOSIS
Fabiana COLOMBELLI1
e-mail: fabiana.colombelli@unila.edu.br
Anneliese DOMINGUES WYSOCKI2
e-mail: lilisew@yahoo.com.br
Merielly KUNKEL3
e-mail: meriellyk@yahoo.com.br
Rodrigo Juliano GRIGNET4
e-mail: rodrigo.grignet@unila.edu.br
Lia GONÇALVES POSSUELO5
e-mail: liapossuelo@unisc.br
Adriana ZILLY6
e-mail: aazilly@hotmail.com
Reginaldo Aparecido ZARA7
e-mail: reginaldo.zara@gmail.com
Reinaldo Antonio SILVA-SOBRINHO8
e-mail: reisobrinho@yahoo.com.br
Como referenciar este artigo:
COLOMBELLI, F.; DOMINGUES WYSOCKI, A.; KUNKE, M.;
GRIGNET, R. J.; GONÇALVES POSSUELO, L.; ZILLY, A.; ZARA, R.
A.; SILVA-SOBRINHO, R. A. Educação permanente em saúde:
Estratégia para atenção às pessoas privadas de liberdade acometidas pela
tuberculose. Revista Ibero-Americana de Estudos em Educação,
Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587. DOI:
https://doi.org/10.21723/riaee.v18i00.17537
| Submetido em: 17/06/2022
| Revisões requeridas em: 09/09/2022
| Aprovado em: 24/10/2022
| Publicado em: 01/01/2023
Editor:
Prof. Dr. José Luís Bizelli
Editor Adjunto Executivo:
Prof. Dr. José Anderson Santos Cruz
1
Universidade Federal da Integração Latino-Americana (UNILA), Foz do Iguaçu – PR – Brasil. Egressa do Programa de Pós-Graduação em
Ensino. Mestrado em Ensino (UNIOESTE).
2
Universidade Federal de São Paulo (UNIFESP), São Paulo – SP – Brasil. Professora do Departamento de Enfermagem Pediátrica. Doutorado
em Ciências da Saúde (EERP-USP).
3
Universidade Estadual do Oeste do Paraná (UNIOESTE), Foz do Iguaçu – PR – Brasil. Mestranda em Saúde Pública em Região de Fronteira.
4
Universidade Federal da Integração Latino-Americana (UNILA), Foz do Iguaçu – PR – Brasil. Egresso do Programa de Pós-Graduação em
Ensino. Mestrado em Ensino (UNIOESTE).
5
Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul – RS – Brasil. Professora do Programa de Pós-Graduação em Promoção da
Saúde. Doutorado em Ciências Biológicas (Bioquímica) (UFRGS).
6
Universidade Estadual do Oeste do Paraná (UNIOESTE), Foz do Iguaçu – PR – Brasil. Professor do Programa de Pós-Graduação em Ensino.
Doutorado em Ciências Biológicas (UEM).
7
Universidade Estadual do Oeste do Paraná (UNIOESTE), Foz do Iguaçu – PR – Brasil. Professor do Programa de Pós-Graduação em Ensino.
Pós-Doutorado (POLITO/Itália).
8
Universidade Estadual do Oeste do Paraná (UNIOESTE), Foz do Iguaçu – PR – Brasil. Professor do Programa de Pós-Graduação em Ensino.
Pós-doutorado (USP).
Educação permanente em saúde: Estratégia para atenção às pessoas privadas de liberdade acometidas pela tuberculose
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 16
APÊNDICE 1
Tabela 1 - Perfil sociodemográfico e complementar dos Agentes Penitenciários segundo
nível de conhecimento em tuberculose, Foz do Iguaçu-PR, 2017
VARIÁVEIS
CONHECIMENTO
POUCO
TOTAL
CONHECIMENTO
(n)
%
n
%
n
%
Sexo (103)
Feminino
3
50
3
50
6
5, 8
Masculino
58
60
39
40
97
94,2
Idade (102)
18 a 35
32
74
11
26
43
42,0
Acima de 35
32
54
27
46
59
58,0
Escolaridade (101)
Ensino
médio
completo
4
50
4
50
8
7,9
Ensino
Superior
incompleto
7
87,5
1
12,5
8
7,9
Ensino
Superior
completo
53
63
31
37
84
83,3
Mestrado
Doutorado
0
0
1
100
1
0,9
Tempo que é agente
Penitenciário (106)
Até 3 anos
3
50
3
50
6
5,7
Mais de 3
anos
64
64
36
36
100
94,3
Participou de curso de
formação antes de iniciar
como Agente
Penitenciário? (106)
Sim
65
64
36
36
101
95,3
Não
02
40
03
60
05
4,7
Participou de curso de
capacitação? (106)
Sim
38
68
18
32
56
52,8
Não
29
58
21
42
50
47,2
Já ouviu falar de
tuberculose? (105)
Sim
66
63
39
37
105
100,0
Não
0
0
0
0
0
0,0
Teve aula sobre TB no
Ensino médio? (104)
Sim
30
62,5
18
37,5
48
46,4
Não
36
64
20
36
56
53,6
Prestou assistência a
algum paciente PPL com
TB? (102)
Sim
54
63,5
31
36,5
85
83,3
Não
10
59
7
41
17
17,9
Conhece alguém que tem
TB? (103)
Sim
53
63
31
37
84
81,5
Não
13
68
6
32
19
18,5
Considera-se bem
informado quanto
a TB? (99)
Sim
23
72
9
28
32
32,3
Não
39
58
28
42
67
67,7
Deseja obter mais
informação sobre a TB?
(98)
Sim
55
64
31
36
86
87,7
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 17
Não
07
58
05
42
12
12,3
Fonte: Elaborada pelos autores
Educação permanente em saúde: Estratégia para atenção às pessoas privadas de liberdade acometidas pela tuberculose
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 18
APÊNDICE 2
Tabela 2 - Classificação do conhecimento sobre a tuberculose entre Agentes Penitenciários,
Foz do Iguaçu-PR, 2017
VARIÁVEIS (106)
CORRETA
INCORRETA
n
%
n
%
Tuberculose enquanto doença grave
85
80
21
20
Gravidade da TB enquanto país e região
57
53,7
49
46,3
Microrganismo causador da TB
36
33,9
70
66,1
Sinais e sintomas
da TB
Tosse seca
53
50
53
50
Tosse com catarro
80
75,4
26
24,6
Tosse que dura mais de
três semanas
82
77,4
24
22,6
Tosse com sangue
84
79,
22
20,8
Forte dor de cabeça
26
24,5
80
75,5
Náuseas
31
29,3
75
70,7
Perda de peso
82
77,3
24
22,7
Dor no peito
32
30,2
74
69,8
Falta de ar
73
68,9
33
31,1
Febre sem causa clara
que dure mais de sete
dias
09
8,5
97
91,5
Fadiga aos esforços
74
69,8
32
30,2
Período de transmissibilidade após o início
do tratamento
54
50,9
52
49,1
Período mínimo de duração do tratamento
da TB
75
70,8
31
29,2
Formas de
Transmissão
Através de apertos de
mão
57
53,8
49
46,3
Picadas de insetos
81
76,4
25
23,6
Pelo ar quando uma
pessoa com TB tosse ou
espirra
102
96,2
04
3,8
Contato sexual
51
48,1
55
51,9
Contato com a saliva
(beijo,
compartilhamento de
pratos e talheres)
06
5,7
100
94,3
Tocando itens públicos
como maçanetas, alças
de transporte
46
43,4
60
56,6
Evitando apertos de
mão
52
49,1
54
50,9
Cobrindo nariz e boca
quando respirar
90
84,9
16
15,1
Evitando compartilhar
talheres, pratos e copos
08
7,5
98
92,5
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 19
Lavar as mãos após
tocar em itens públicos
12
11,3
94
88,7
Prevenção da TB
Fechando as janelas em
casa
76
71,7
30
28,3
Através de uma boa
nutrição
50
47,2
56
52,8
Uso de preservativos
51
48
55
52
Uso de repelentes
72
67,9
34
32,1
Evitando ficar no
mesmo ambiente que
pessoas com TB
92
86,8
14
13,2
Pessoas que podem
ser infectadas
Qualquer pessoa
73
68,9
33
31,1
TB tem cura
Sim/Não
89
84
17
16
Formas de curar a
TB
Através de ervas e chás
68
64,2
38
35,8
Com repouso e sem uso
de medicação
67
63,2
39
36,8
Tomando vacina
34
32,1
72
67,9
Rezando
53
50
53
50
Com medicamentos
específicos
99
93,4
07
6,6
Exames necessários
para se realizar
o diagnóstico
da TB
PULMONAR
Baciloscopia de escarro
86
81,1
20
18,9
Cultura de escarro
94
88,7
12
11,3
Raio-X de tórax
61
57,5
45
42,5
Tomografia
44
41,5
62
58,5
Busca ativa de sintomas
respiratórios
59
55,7
47
44,3
Solicitação de
baciloscopia de escarro
ao suspeitar da TB
89
84
17
16
Ações prioritárias
para o
controle da TB nas
penitenciárias
Notificação de casos
confirmados
89
84
17
16
Orientação ao paciente
e familiares sobre a
necessidade de se fazer
o Tratamento
Diretamente Observado
(TDO)
81
76,4
25
25,6
Realização de exames
das pessoas que
convivem com o doente
de TB
88
83
18
17
Fonte: Elaborada pelos autores
Educação permanente em saúde: Estratégia para atenção às pessoas privadas de liberdade acometidas pela tuberculose
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 20
APÊNDICE 3
Tabela 3 - Atitudes dos Agentes Penitenciários sobre eles mesmos quanto à
tuberculose, Foz do Iguaçu - PR, 2017
n.
%
Acha que pode contrair TB?
Sim
103
99,0
(n=104)
Não
1
1,0
Medo
Sim
34
32,7
Não
70
67,3
Surpresa
Sim
24
23,1
Não
80
76,9
Reação se descobrisse
Vergonha
Sim
1
1,0
Não
103
99,0
que tem TB
Constrangimento
Sim
4
3,9
Não
100
96,1
(n=104)
Tristeza
Sim
3
2,9
Não
101
97,1
Nenhuma reação
Sim
22
21,1
Não
82
78,9
Cônjuge
Sim
87
83,6
Não
17
16,4
Médico ou outro
Sim
87
83,6
trabalhador da saúde
Não
17
16,4
Pais
Sim
60
57,7
Para quem contaria
Não
44
42,3
caso tivesse TB
Outro membro da família
Sim
55
52,9
(n=104)
Não
49
47,1
Amigo íntimo
Sim
49
47,1
Não
55
52,9
Ninguém
Sim
93
89,4
Não
11
10,6
Iria à unidade de saúde
Sim
103
99,0
Não
1
1,0
Primeira coisa
Iria à farmácia
Sim
2
1,9
que faria caso
Não
102
98,1
percebesse os sintomas
Procuraria uma
Sim
0
0
de TB
Benzedeira
Não
104
100
(104)
Buscaria outras opções
Sim
0
0
de tratamento, exemplo, ervas
Não
104
100
Quando o tratamento por conta
própria não funcionasse
3
2,9
Se tivesse com sintomas de TB,
em que momento
Depois de três a quatro semanas
com sintomas
4
3,9
procuraria a unidade de saúde?
Assim que percebesse sintomas da
TB
88
84,5
(104)
Resposta inválida
5
4,8
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 21
Sem resposta
4
3,9
Fonte: Elaborada pelos autores
Educação permanente em saúde: Estratégia para atenção às pessoas privadas de liberdade acometidas pela tuberculose
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 22
APÊNDICE 4
Tabela 4 - Atitudes dos Agentes Penitenciários frente à tuberculose, Foz do Iguaçu - PR,
2017
É gratuito
93
89,4
Custo do diagnóstico e
Preço razoável
2
1,9
tratamento da TB no Brasil
É um pouco caro
3
2,9
(104)
É muito caro
6
5,7
Sinto compaixão e desejo ajudar
35
33,6
Sinto compaixão, mas prefiro ficar
longe dessas pessoas
4
3,9
Sentimento sobre as pessoas
Tenho medo porque elas podem me
infectar
11
10,6
doentes de TB
(104)
Não tenho nenhum sentimento
especial
45
43,3
Outros
9
8,6
Pessoas vivendo com HIV-
Sim
97
93,3
Aids devem se preocupar
Não
2
1,9
com a TB (104)
Sem resposta
5
4,8
A pessoa com HIV-Aids é mais
propensa a desenvolver TB
64
61,5
Se a resposta da questão
anterior for
Não sei
9
8,6
sim, por quê? (104)
Outros
20
19,3
Sem resposta
11
10,6
Sim
31
30,0
Considera-se bem informado
Não
65
62,4
sobre a TB? (104)
Sem resposta
8
7,6
Sim
83
80,0
Deseja obter mais
Não
10
9,4
conhecimento sobre a TB?
(104)
Sem resposta
11
10,6
Jornais e revistas
Sim
43
41,3
Não
61
58,7
Rádio
Sim
32
30,8
Não
72
69,2
TV
Sim
65
62,5
Não
39
37,5
Internet
Sim
59
56,7
Não
45
43,3
Meios considerados eficazes
Facebook
Sim
32
30,7
para transmitir
Não
72
69,3
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 23
informações sobre a TB
Outdoor
Sim
15
14,4
(104)
Não
89
85,6
Folhetos, cartazes, e outros
Sim
41
39,4
materiais impressos
Não
63
60,6
Trabalhadores da saúde
Sim
60
57,7
Não
44
42,3
Família, amigos, vizinhos e
Sim
12
11,5
colegas
Não
92
88,5
Líderes religiosos
Sim
11
10,6
Não
93
89,4
Professores
Sim
23
22,1
Não
81
77,9
Fonte: Elaborada pelos autores
Educação permanente em saúde: Estratégia para atenção às pessoas privadas de liberdade acometidas pela tuberculose
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 24
APÊNDICE 5
Tabela 5 - Descrição do conhecimento e atitudes sobre A tuberculose entre Agentes
Penitenciários segundo contato prévio com o tema tuberculose em curso de formação, Foz do
Iguaçu-PR, 2017
Conhecimento e crenças sobre tuberculose
Contato com o tema tuberculose
Sim
Não
Total
Valor de
p
N
(%)
N
(%)
N
(%)
TB enquanto doença grave
Correto
20
30
15
44
35
35
0,062
Incorreto
46
70
19
56
65
65
Gravidade da TB no país e região
Correto
34
51,5
21
61,7
55
55
0,329
Incorreto
32
48,5
13
38,7
45
45
Micro-organismo causador
Correto
20
30
15
44
35
35
0,170
Incorreto
46
70
19
56
65
65
Período de transmissibilidade após o início do
tratamento
Correto
34
51
18
53
52
52
0,892
Incorreto
32
49
16
47
48
48
Tempo mínimo de duração do tratamento
Correto
45
68
27
80
72
72
0,236
Incorreto
21
32
7
20
28
28
Tuberculose tem cura?
Correto
55
83
28
82
83
83
0,901
Incorreto
11
17
6
18
17
17
Tipo de medicamento usado no tratamento da
TB
Correto
61
92
33
97
94
94
0,355
Incorreto
5
8
1
3
6
6
Sintomas de
Tuberculose
Tosse seca
Correto
31
47
19
56
50
50
0,398
Incorreto
35
53
15
44
50
50
Tosse produtiva
Correto
52
79
26
76
78
78
0,791
Incorreto
14
21
8
24
22
22
Tosse há mais de três
semanas
Correto
54
82
27
79
81
81
0,335
Incorreto
12
18
7
21
19
19
Hemoptise
Correto
54
82
27
38
25
25
0,771
Incorreto
12
18
7
21
19
19
Cefaleia
Correto
12
18
13
38
25
25
0,282
Incorreto
54
82
21
62
75
75
Náuseas
Correto
17
26
13
38
30
30
0,197
Incorreto
49
74
21
62
70
70
Perda de Peso
Correto
53
80
26
76
79
79
0,028
Incorreto
13
20
8
24
21
21
Dor no peito
Correto
49
74
23
68
72
72
0,486
Incorreto
17
26
11
32
28
28
Falta de ar
Correto
48
73
23
68
71
71
0,595
Incorreto
18
27
11
32
29
29
Febre há mais de sete dias
sem causa aparente
Correto
5
8
3
9
8
8
0,827
Incorreto
61
92
31
91
92
92
Formas de
transmissão
Aperto de mão
Correto
39
59
17
50
56
56
0,385
Incorreto
27
41
17
50
44
44
Picada de inseto
Correto
55
83
22
65
77
77
0,036
Incorreto
11
17
12
35
23
23
Pelo ar quando a pessoa com
TB tosse ou espirra
Correto
63
95
33
97
96
96
0,698
Incorreto
3
5
1
3
4
4
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 25
Contato sexual
Correto
35
53
14
41
49
49
0,261
Incorreto
31
47
20
59
51
51
Saliva (beijo,
compartilhamento de copos,
talheres)
Correto
3
4
3
9
6
6
0,393
Incorreto
63
96
31
91
94
94
Tocando itens públicos,
como
maçanetas, alças de
transporte
Correto
31
47
14
41
45
45
0,581
Incorreto
35
53
20
59
55
55
Como evitar
TB?
Evitar apertos de mão
Correto
32
48
19
56
51
51
0,483
Correto
34
52
15
44
49
49
Uso de repelente
Correto
50
76
18
53
68
68
0,020
Incorreto
16
24
16
47
32
32
Cobrindo a boca e nariz ao
tossir ou espirrar
Correto
58
88
27
79
85
85
0,261
Incorreto
8
12
7
21
15
15
Evitar ficar no mesmo
ambiente que pessoas com
TB
Correto
61
92
27
79
88
88
0,057
Incorreto
5
8
7
21
12
12
Uso de preservativos
Correto
33
50
17
47
49
49
0,780
Incorreto
33
50
18
53
51
51
Evitar compartilhar talheres e
copos
Correto
4
6
3
9
7
7
0,607
Incorreto
62
94
31
91
93
93
Lavar as mãos após tocar
itens públicos
Correto
7
11
4
12
11
11
0,860
Incorreto
59
89
30
88
89
89
Fechando as janelas
Correto
51
77
21
62
72
72
0,101
Incorreto
15
23
13
38
28
28
Boa nutrição
Correto
35
53
13
20
48
48
0,160
Incorreto
31
47
21
80
52
52
Exames
necessários
para o
diagnóstico da
TB pulmonar
Baciloscopia de escarro
Correto
57
86
25
74
82
82
0,113
Incorreto
9
14
9
26
18
18
Cultura de escarro
Correto
40
61
19
56
59
59
0,057
Incorreto
26
39
15
44
41
41
Raio-X de tórax
Correto
40
61
19
56
59
59
0,649
Incorreto
26
39
15
44
41
41
Tomografia
Correto
24
36
18
53
42
42
0,111
Incorreto
42
64
16
47
58
58
Ações
prioritárias
para se realizar
o diagnóstico
da TB
pulmonar
Busca ativa dos sintomáticos
respiratórios
Correto
44
66,6
13
38,2
57
57
0,006
Incorreto
22
33,3
21
61,8
43
43
Solicitação de baciloscopia e
escarro ao suspeitar TB
Correto
58
88
26
76,4
84
84
0,140
Incorreto
8
12
8
23,6
16
16
Notificação de casos
confirmados
Correto
57
86,3
26
76,4
83
83
0,212
Incorreto
9
13,7
8
23,6
17
17
Orientação aos pacientes e
familiares sobre a
necessidade de se fazer o
tratamento diretamente
observado
Correto
54
82
23
68
87
87
0,110
Incorreto
12
18
11
32
23
23
Realização de exames das
pessoas que convivem com o
doente de TB
Correto
58
88
25
73,5
83
83
0,070
Incorreto
8
12
9
26,5
17
17
Fonte: Elaboradora pelos autores
Educação permanente em saúde: Estratégia para atenção às pessoas privadas de liberdade acometidas pela tuberculose
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 26
CRediT Author Statement
Reconhecimentos: Departamento Penitenciário do Paraná – DEPEN e Sindicato dos
Policiais Penais do Paraná. SINDARSPEN - Secção Foz do Iguaçu, PR.
Financiamento: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil
(CAPES). PROAP.
Conflitos de interesse: Os autores declaram que não há.
Aprovação ética: O estudo foi aprovado pelo Comitê de Ética e Pesquisa com Seres
Humanos da Universidade Estadual do Oeste do Paraná, Unioeste. CAEE n.º:
68998617.0.0000.0107.
Disponibilidade de dados e material: Não aplicável.
Contribuições dos autores: Fabiana Colombelli (Concepção do projeto de pesquisa,
adaptação do instrumento de pesquisa, pesquisa de campo, coleta de dados, análise e
interpretação dos dados, redação do texto), Aneleis Domingues Wysocki (adaptação do
instrumento de pesquisa, análise e interpretação dos dados, redação do texto), Merielly
Kunkel (análise e interpretação dos dados, redação do texto), Rodrigo Juliano Grignet
(análise e interpretação dos dados, redação do texto), Lia Gonçalves Possuelo (adaptação
do instrumento de pesquisa, análise e interpretação dos dados, redação do texto), Adriana
Zilly (análise e interpretação dos dados, redação do texto), Reginaldo Aparecido Zara
(análise e interpretação dos dados, redação do texto). Reinaldo Antonio Silva-Sobrinho
(Orientação, Concepção do projeto de pesquisa, adaptação do instrumento de pesquisa,
pesquisa de campo, coleta de dados, análise e interpretação dos dados, redação do texto).
Processamento e editoração: Editora Ibero-Americana de Educação.
Revisão, formatação, normalização e tradução.
Educación permanente en salud: Estrategia de atención a personas privadas de libertad afectadas por tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 16
APÉNDICE 1
Tabla 1 - Perfil sociodemográfico y complementario de los Agentes Penitenciarios según
nivel de conocimiento en tuberculosis, Foz do Iguaçu-PR, 2017
VARIABLES
CONOCIMIENTO
POCO
TOTAL
CONOCIMIENTO
n)
%
n
%
n
%
Sexo (103)
Hembra
3
50
3
50
6
5, 8
Masculino
58
60
39
40
97
94,2
Edad (102)
18 a 35
32
74
11
26
43
42,0
Mayores de
35 años
32
54
27
46
59
58,0
Escolaridad (101)
Bachillerato
completo
4
50
4
50
8
7,9
Educación
superior
incompleta
7
87,5
1
12,5
8
7,9
Educación
Superior
Completa
53
63
31
37
84
83,3
Maestría
Doctoral
0
0
1
100
1
0,9
Tiempo que es
funcionario de prisiones
(106)
Hasta 3
años
3
50
3
50
6
5,7
Más de 3
años
64
64
36
36
100
94,3
¿Tomó un curso de
capacitación antes de
comenzar como oficial de
prisiones? (106)
Sí
65
64
36
36
101
95,3
No
02
40
03
60
05
4,7
¿Tomaste un curso de
capacitación? (106)
Sí
38
68
18
32
56
52,8
No
29
58
21
42
50
47,2
¿Alguna vez has oído
hablar de la
tuberculosis? (105)
Sí
66
63
39
37
105
100,0
No
0
0
0
0
0
0,0
¿Tomaste una clase de
TB en la escuela
secundaria? (104)
Sí
30
62,5
18
37,5
48
46,4
No
36
64
20
36
56
53,6
¿Brindó atención a un
paciente con PPL con
TB? (102)
Sí
54
63,5
31
36,5
85
83,3
No
10
59
7
41
17
17,9
¿Conoces a alguien que
tenga TB? (103)
Sí
53
63
31
37
84
81,5
No
13
68
6
32
19
18,5
Se considera bien
informado en cuanto a la
¿TUBERCULOSIS?
(99)
Sí
23
72
9
28
32
32,3
No
39
58
28
42
67
67,7
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 17
¿Desea obtener más
información sobre la
tuberculosis? (98)
Sí
55
64
31
36
86
87,7
No
07
58
05
42
12
12,3
Fuente: Elaboración propia
Educación permanente en salud: Estrategia de atención a personas privadas de libertad afectadas por tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 18
APÉNDICE 2
Tabla 2 - Clasificación del conocimiento sobre tuberculosis entre Agentes Penitenciarios, Foz
do Iguaçu-PR, 2017
VARIABLES (106)
CORRECTO
INCORRECTO
n
%
n
%
La tuberculosis como enfermedad grave
85
80
21
20
Gravedad de la tuberculosis como país y
región
57
53,7
49
46,3
Microorganismo causante de Tb
36
33,9
70
66,1
Signos y síntomas
de la tuberculosis
Tos seca
53
50
53
50
Tos con flema
80
75,4
26
24,6
Tos que dura más de
tres semanas
82
77,4
24
22,6
Tos con sangre
84
79,
22
20,8
Dolor de cabeza intenso
26
24,5
80
75,5
Náuseas
31
29,3
75
70,7
Pérdida de peso
82
77,3
24
22,7
Dolor torácico
32
30,2
74
69,8
Dificultad para respirar
73
68,9
33
31,1
Fiebre sin causa clara
que dura más de siete
días
09
8,5
97
91,5
Fatiga al estrés
74
69,8
32
30,2
Período de transferibilidad después del
inicio del tratamiento
54
50,9
52
49,1
Duración mínima del tratamiento de la
tuberculosis
75
70,8
31
29,2
Formas de
transmisión
A través de apretones
de manos
57
53,8
49
46,3
Picaduras
81
76,4
25
23,6
A través del aire cuando
una persona con TB
tose o estornuda
102
96,2
04
3,8
Contacto sexual
51
48,1
55
51,9
Contacto con saliva
(besos, compartir platos
y cubiertos)
06
5,7
100
94,3
Tocar artículos públicos
como manijas de
puertas, manijas de
transporte
46
43,4
60
56,6
Evitar los apretones de
manos
52
49,1
54
50,9
Cubrirse la nariz y la
boca al respirar
90
84,9
16
15,1
Evitar compartir
cubiertos, platos y vasos
08
7,5
98
92,5
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 19
Lávese las manos
después de tocar
artículos públicos
12
11,3
94
88,7
Prevención de la
tuberculosis
Cerrar ventanas en casa
76
71,7
30
28,3
A través de una buena
nutrición
50
47,2
56
52,8
Uso de preservativos
51
48
55
52
Uso de repelentes
72
67,9
34
32,1
Evitar permanecer en el
mismo entorno que las
personas con
tuberculosis
92
86,8
14
13,2
Personas que
pueden estar
infectadas
Nadie
73
68,9
33
31,1
La tuberculosis
tiene cura
Sí/No
89
84
17
16
Formas de curar la
tuberculosis
A través de hierbas y
tés
68
64,2
38
35,8
Con reposo y sin
medicación
67
63,2
39
36,8
Vacunación
34
32,1
72
67,9
Orando
53
50
53
50
Con medicamentos
específicos
99
93,4
07
6,6
Exámenes
requeridos
a realizar
El diagnóstico
TB pulmonar
Microscopía de frotis de
esputo
86
81,1
20
18,9
Cultivo de cicatrices
94
88,7
12
11,3
Radiografía de tórax
61
57,5
45
42,5
Tomografía
44
41,5
62
58,5
Búsqueda activa de
síntomas respiratorios
59
55,7
47
44,3
Solicitud de
microscopía de frotis de
esputo ante la sospecha
de TB
89
84
17
16
Acciones
prioritarias para el
Control de la
tuberculosis en los
penitenciarios
Notificación de casos
confirmados
89
84
17
16
Orientación para
pacientes y familiares
sobre la necesidad de
realizar un tratamiento
bajo observación directa
(DOT)
81
76,4
25
25,6
Pruebas de personas
que viven con el
paciente con TB
88
83
18
17
Fuente: Elaboración propia
Educación permanente en salud: Estrategia de atención a personas privadas de libertad afectadas por tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 20
APÉNDICE 3
Tabla 3 - Actitudes de los funcionarios penitenciarios sobre sí mismos con respecto a la tuberculosis,
Foz do Iguaçu - PR, 2017
n.
%
¿Crees que puedes contraer
TB?
Sí
103
99,0
(n=104)
No
1
1,0
Miedo
Sí
34
32,7
No
70
67,3
Sorpresa
Sí
24
23,1
No
80
76,9
Reacción si se enteró
Vergüenza
Sí
1
1,0
No
103
99,0
que tiene TB
Vergüenza
Sí
4
3,9
No
100
96,1
(n=104)
Tristeza
Sí
3
2,9
No
101
97,1
Sin reacción
Sí
22
21,1
No
82
78,9
Esposo
Sí
87
83,6
No
17
16,4
Médico u otro
Sí
87
83,6
Trabajador de la salud
No
17
16,4
Padres
Sí
60
57,7
¿Quién lo diría?
No
44
42,3
si tenía TB
Otro miembro de la familia
Sí
55
52,9
(n=104)
No
49
47,1
Amigo cercano
Sí
49
47,1
No
55
52,9
Nadie
Sí
93
89,4
No
11
10,6
Iría a la unidad de salud.
Sí
103
99,0
No
1
1,0
Lo primero
Iría a la farmacia.
Sí
2
1,9
Eso haría caso
No
102
98,1
para percibir los síntomas
Buscaría un
Sí
0
0
de TB
Benzedeira
No
104
100
(104)
Buscaría otras opciones
Sí
0
0
tratamiento, por ejemplo, hierbas
No
104
100
Cuando el autotratamiento no
funcionó
3
2,9
Si tuvo síntomas de TB, a qué
hora
Después de tres a cuatro semanas
con síntomas
4
3,9
¿Buscarías la unidad de salud?
Tan pronto como noté síntomas de
TB
88
84,5
(104)
Respuesta no válida
5
4,8
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 21
Sin respuesta
4
3,9
Fuente: Elaboración propia
Educación permanente en salud: Estrategia de atención a personas privadas de libertad afectadas por tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 22
APÉNDICE 4
Tabla 4 - Actitudes de los funcionarios penitenciarios hacia la tuberculosis, Foz do Iguaçu -
PR, 2017
Es gratis
93
89,4
Costo del diagnóstico y
Precio razonable
2
1,9
Tratamiento de la tuberculosis
en Brasil
Es un poco caro
3
2,9
(104)
Es demasiado caro
6
5,7
Siento compasión y deseo de ayudar
35
33,6
Siento compasión, pero prefiero
mantenerme alejado de estas
personas
4
3,9
Sentimiento acerca de las
personas
Tengo miedo porque me pueden
contagiar
11
10,6
Pacientes con tuberculosis
(104)
No tengo ningún sentimiento
especial
45
43,3
Otro
9
8,6
Personas que viven con el VIH-
Sí
97
93,3
El SIDA debería estar
preocupado
No
2
1,9
con TB (104)
Sin respuesta
5
4,8
La persona con VIH-SIDA tiene
más probabilidades de desarrollar
TB
64
61,5
Si la respuesta a la pregunta
anterior es
No lo sé, no lo sé
9
8,6
Sí, ¿por qué? (104)
Otro
20
19,3
Sin respuesta
11
10,6
Sí
31
30,0
Se considera bien informado
No
65
62,4
sobre la tuberculosis? (104)
Sin respuesta
8
7,6
Sí
83
80,0
¿Quieres más?
No
10
9,4
conocimiento sobre la
tuberculosis? (104)
Sin respuesta
11
10,6
Periódicos y revistas
Sí
43
41,3
No
61
58,7
Radio
Sí
32
30,8
No
72
69,2
TELEVISIÓN
Sí
65
62,5
No
39
37,5
Internet
Sí
59
56,7
No
45
43,3
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 23
Medios considerados eficaces
Facebook (en inglés)
Sí
32
30,7
para transmitir
No
72
69,3
Información sobre la
tuberculosis
Cartelera
Sí
15
14,4
(104)
No
89
85,6
Folletos, carteles y otros
Sí
41
39,4
Materiales impresos
No
63
60,6
Trabajadores de la salud
Sí
60
57,7
No
44
42,3
Familia, amigos, vecinos y
Sí
12
11,5
Colegas
No
92
88,5
Líderes religiosos
Sí
11
10,6
No
93
89,4
Profesorado
Sí
23
22,1
No
81
77,9
Fuente: Elaboración propia
Educación permanente en salud: Estrategia de atención a personas privadas de libertad afectadas por tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 24
APÉNDICE 5
Tabla 5 - Descripción de los conocimientos y actitudes sobre la tuberculosis entre los agentes
penitenciarios según el contacto previo con la tuberculosis en el curso de la formación, Foz do
Iguaçu-PR, 2017
Conocimientos y creencias
sobre la tuberculosis
Contacto con la tuberculosis
Sí
No
Total
Valor de p
N
(%)
N
(%)
N
(%)
La tuberculosis como
enfermedad grave
Corre
cto
20
30
15
44
35
35
0,062
Incorr
ecto
46
70
19
56
65
65
Gravedad de la tuberculosis en
el país y la región
Corre
cto
34
51,5
21
61,7
55
55
0,329
Incorr
ecto
32
48,5
13
38,7
45
45
Microorganismo causal
Corre
cto
20
30
15
44
35
35
0,170
incorr
ecto
46
70
19
56
65
65
Período de transferibilidad
después del inicio del
tratamiento
Corre
cto
34
51
18
53
52
52
0,892
Incorr
ecto
32
49
16
47
48
48
Duración mínima del
tratamiento
Corre
cto
45
68
27
80
72
72
0,236
Incorr
ecto
21
32
7
20
28
28
¿Se cura la tuberculosis?
Corre
cto
55
83
28
82
83
83
0,901
Incorr
ecto
11
17
6
18
17
17
Tipo de medicamento utilizado
para tratar la TB
Corre
cto
61
92
33
97
94
94
0,355
Incorr
ecto
5
8
1
3
6
6
Síntomas
de la
tuberculo
sis
Tos seca
Corre
cto
31
47
19
56
50
50
0,398
Incorr
ecto
35
53
15
44
50
50
Tos productiva
Corre
cto
52
79
26
76
78
78
0,791
Incorr
ecto
14
21
8
24
22
22
Tos durante más
de tres semanas
Corre
cto
54
82
27
79
81
81
0,335
Incorr
ecto
12
18
7
21
19
19
Hemoptisis
Corre
cto
54
82
27
38
25
25
0,771
Incorr
ecto
12
18
7
21
19
19
Jaqueca
Corre
cto
12
18
13
38
25
25
0,282
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 25
Incorr
ecto
54
82
21
62
75
75
Náuseas
Corre
cto
17
26
13
38
30
30
0,197
Incorr
ecto
49
74
21
62
70
70
Pérdida de peso
Corre
cto
53
80
26
76
79
79
0,028
Incorr
ecto
13
20
8
24
21
21
Dolor torácico
Corre
cto
49
74
23
68
72
72
0,486
Incorr
ecto
17
26
11
32
28
28
Falta de ar
Corre
cto
48
73
23
68
71
71
0,595
Incorr
ecto
18
27
11
32
29
29
Fiebre durante
más de siete días
sin causa aparente
Corre
cto
5
8
3
9
8
8
0,827
Incorr
ecto
61
92
31
91
92
92
Formas
de
transmisi
ón
Apretón de manos
Corre
cto
39
59
17
50
56
56
0,385
Incorr
ecto
27
41
17
50
44
44
Mordedura de
insecto
Corre
cto
55
83
22
65
77
77
0,036
Incorr
ecto
11
17
12
35
23
23
A través del aire
cuando la persona
con TB tose o
estornuda
Corre
cto
63
95
33
97
96
96
0,698
Incorr
ecto
3
5
1
3
4
4
Contacto sexual
Corre
cto
35
53
14
41
49
49
0,261
Incorr
ecto
31
47
20
59
51
51
Saliva (beso,
compartir vasos,
cubiertos)
Corre
cto
3
4
3
9
6
6
0,393
Incorr
ecto
63
96
31
91
94
94
Tocar elementos
públicos, como
manijas de las
puertas, asas de
transporte
Corre
cto
31
47
14
41
45
45
0,581
Incorr
ecto
35
53
20
59
55
55
¿Cómo
evitar la
tuberculo
sis?
Evite los apretones
de manos
Corre
cto
32
48
19
56
51
51
0,483
Corre
cto
34
52
15
44
49
49
Uso de repelente
Corre
cto
50
76
18
53
68
68
0,020
Incorr
ecto
16
24
16
47
32
32
Corre
cto
58
88
27
79
85
85
0,261
Educación permanente en salud: Estrategia de atención a personas privadas de libertad afectadas por tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 26
Cubrirse la boca y
la nariz al toser o
estornudar
Incorr
ecto
8
12
7
21
15
15
Evite permanecer
en el mismo
entorno que las
personas con TB
Corre
cto
61
92
27
79
88
88
0,057
Incorr
ecto
5
8
7
21
12
12
Uso de
preservativos
Corre
cto
33
50
17
47
49
49
0,780
Incorr
ecto
33
50
18
53
51
51
Evite compartir
cubiertos y vasos
Corre
cto
4
6
3
9
7
7
0,607
Incorr
ecto
62
94
31
91
93
93
Lávese las manos
después de tocar
artículos públicos
Corre
cto
7
11
4
12
11
11
0,860
Incorr
ecto
59
89
30
88
89
89
Cierre de ventanas
Corre
cto
51
77
21
62
72
72
0,101
Incorr
ecto
15
23
13
38
28
28
Buena nutrición
Corre
cto
35
53
13
20
48
48
0,160
Incorr
ecto
31
47
21
80
52
52
Pruebas
necesaria
s para el
diagnósti
co de la
TB
pulmonar
Microscopía de
frotis de esputo
Corre
cto
57
86
25
74
82
82
0,113
Incorr
ecto
9
14
9
26
18
18
Cultivo de
cicatrices
Corre
cto
40
61
19
56
59
59
0,057
Incorr
ecto
26
39
15
44
41
41
Radiografía de
tórax
Corre
cto
40
61
19
56
59
59
0,649
Incorr
ecto
26
39
15
44
41
41
Tomografía
Corre
cto
24
36
18
53
42
42
0,111
Incorr
ecto
42
64
16
47
58
58
Acciones
prioritari
as que
deben
llevarse a
cabo
el
diagnósti
co de TB
pulmonar
Búsqueda activa
de síntomas
respiratorios
Corre
cto
44
66,6
13
38,2
57
57
0,006
Incorr
ecto
22
33,3
21
61,8
43
43
Solicitud de
baciloscopia y
esputo ante la
sospecha de TB
Corre
cto
58
88
26
76,4
84
84
0,140
Incorr
ecto
8
12
8
23,6
16
16
Notificación de
casos confirmados
Corre
cto
57
86,3
26
76,4
83
83
0,212
Incorr
ecto
9
13,7
8
23,6
17
17
Orientación a
pacientes y
Corre
cto
54
82
23
68
87
87
0,110
Fabiana COLOMBELLI et al.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 27
familiares sobre la
necesidad de ser
tratados
Directamente
observado
Incorr
ecto
12
18
11
32
23
23
Pruebas de
personas que
viven con el
paciente con TB
Corre
cto
58
88
25
73,5
83
83
0,070
Incorr
ecto
8
12
9
26,5
17
17
Fuente: Elaborado por los autores
Educación permanente en salud: Estrategia de atención a personas privadas de libertad afectadas por tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 28
CRediT Author Statement
Reconocimientos: Departamento Penitenciario de Paraná - DEPEN y Unión de Policía
Criminal de Paraná. SINDARSPEN - Tramo Foz do Iguaçu, PR.
Financiamiento: Coordinación para el Perfeccionamiento del Personal de Educación
Superior - Brasil (CAPES). PROAP.
Conflictos de intereses: Los autores declaran que no.
Aprobación ética: El estudio fue aprobado por el Comité de Ética e Investigación con
Seres Humanos de la Universidad Estadual de Paraná Occidental, Unioeste. CAEE No:
68998617.0.0000.0107.
Disponibilidad de datos y material: No aplica.
Contribuciones de los autores: Fabiana Colombelli (Concepción del proyecto de
investigación, adaptación del instrumento de investigación, investigación de campo,
recolección de datos, análisis e interpretación de datos, redacción del texto), Anneliese
Domingues Wysocki (adaptación del instrumento de investigación, análisis e
interpretación de los datos, redacción del texto), Merielly Kunkel (análisis e interpretación
de los datos, redacción del texto ), Rodrigo Juliano Grignet ( análisis e interpretación de
los datos, redacción del texto), Lia Gonçalves Possuelo (adaptación del instrumento de
investigación, análisis e interpretación de los datos, redacción del texto), Adriana Zilly
(análisis e interpretación de los datos, redacción del texto), Reginaldo Aparecido Zara
(análisis e interpretación de los datos, redacción del texto ). Reinaldo Antonio Silva-
Sobrinho (Orientación, Concepción del proyecto de investigación, adaptación del
instrumento de investigación, investigación de campo, recolección de datos, análisis e
interpretación de datos, redacción del texto).
Procesamiento y edición: Editora Iberoamericana de Educación - EIAE.
Corrección, formateo, normalización y traducción.
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 1
PERMANENT EDUCATION IN HEALTH: A STRATEGY TO CARE FOR PEOPLE
DEPRIVED OF LIBERTY AFFECTED BY TUBERCULOSIS
EDUCAÇÃO PERMANENTE EM SAÚDE: ESTRATÉGIA PARA ATENÇÃO ÀS PESSOAS
PRIVADAS DE LIBERDADE ACOMETIDAS PELA TUBERCULOSE
EDUCACIÓN PERMANENTE EN SALUD: ESTRATEGIA DE ATENCIÓN A PERSONAS
PRIVADAS DE LIBERTAD AFECTADAS POR TUBERCULOSIS
Fabiana COLOMBELLI1
e-mail: fabiana.colombelli@unila.edu.br
Anneliese DOMINGUES WYSOCKI2
e-mail: lilisew@yahoo.com.br
Merielly KUNKEL3
e-mail: meriellyk@yahoo.com.br
Rodrigo Juliano GRIGNET4
e-mail: rodrigo.grignet@unila.edu.br
Lia GONÇALVES POSSUELO5
e-mail: liapossuelo@unisc.br
Adriana ZILLY6
e-mail: aazilly@hotmail.com
Reginaldo Aparecido ZARA7
e-mail: reginaldo.zara@gmail.com
Reinaldo Antonio SILVA-SOBRINHO8
e-mail: reisobrinho@yahoo.com.br
How to reference this paper:
COLOMBELLI, F.; DOMINGUES WYSOCKI, A.; KUNKE, M.;
GRIGNET, R. J.; GONÇALVES POSSUELO, L.; ZILLY, A.; ZARA,
R. A.; SILVA-SOBRINHO, R. A. Permanent education in health: A
strategy to care for people deprived of liberty affected by tuberculosis.
Revista Ibero-Americana de Estudos em Educação, Araraquara, v.
18, n. 00, e023019, 2023. e-ISSN: 1982-5587. DOI:
https://doi.org/10.21723/riaee.v18i00.17537
| Submitted: 17/06/2022
| Revisions required: 09/09/2022
| Approved: 24/10/2022
| Published: 01/01/2023
Editor:
Prof. Dr. José Luís Bizelli
Deputy Executive Editor:
Prof. Dr. José Anderson Santos Cruz
1
Federal University of Latin American Integration (UNILA), Foz do Iguaçu – PR – Brazil. Graduate Program in Teaching. Master in Teaching
(UNIOESTE).
2
Federal University of São Paulo (UNIFESP), São Paulo – SP – Brazil. Professor of the Department of Pediatric Nursing. Doctorate in Health
Sciences (EERP-USP).
3
Western Paraná State University (UNIOESTE), Foz do Iguaçu – PR – Brazil. Master's student in Public Health in Border Region.
4
Federal University of Latin American Integration (UNILA), Foz do Iguaçu – PR – Brazil. Graduate Program in Teaching. Master in Teaching
(UNIOESTE).
5
University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul – RS – Brazil. Professor of the Graduate Program in Health Promotion. Doctorate
in Biological Sciences (Biochemistry) (UFRGS).
6
Western Paraná State University (UNIOESTE), Foz do Iguaçu – PR – Brazil. Professor of the Graduate Program in Teaching. Doctorate in
Biological Sciences (UEM).
7
Western Paraná State University UNIOESTE), Foz do Iguaçu – PR – Brazil. Professor of the Graduate Program in Teaching. Post doctoral
(POLITO/Itália).
8
Western Paraná State University (UNIOESTE), Foz do Iguaçu – PR – Brazil. Professor of the Graduate Program in Teaching. Post doctoral
(USP).
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 2
ABSTRACT: Tuberculosis is the infectious disease that most causes death, especially among
Persons Deprived of Liberty (PPL), so the Penitentiary Agent (PA) can play a central role in the
diagnosis and treatment. Objective: to analyze the knowledge and attitudes of the AP in relation to
tuberculosis, aiming to subsidize discussions on Permanent Education (PE). Methodology:
Epidemiological, descriptive and exploratory study, carried out in prison institutions in Foz do
Iguaçu - Paraná. The primary data were collected through a KAP model questionnaire (Knowledge,
Attitude and Practice. An exploratory analysis was used through the distribution of absolute and
relative frequencies. Results: There is a relationship between knowledge and attitude with age,
education, length of profession, participation in courses and care for PDLs sick with tuberculosis.
Conclusion: It was verified the need for investments to improve knowledge, suggesting PE as a tool
to improve the participation of Agents in the Health care of PDLs.
KEYWORDS: Prison. Tuberculosis. Permanent education in health.
RESUMO: A tuberculose é a doença infecciosa que mais ocasiona óbito, principalmente entre as
Pessoas Privadas de Liberdade (PPL), assim, o Agente Penitenciário (AP) pode ter um papel
central no diagnóstico/tratamento. Objetivo: analisar o conhecimento e as atitudes dos AP frente
à tuberculose, visando subsidiar discussões sobre a Educação Permanente (EP). Metodologia:
Trata-se de um estudo epidemiológico, descritivo e exploratório, realizado em instituições
prisionais situadas em Foz do Iguaçu - Paraná. Os dados primários foram coletados por meio de
questionário modelo KAP (Knowledge, Attitude and Practice). Utilizou-se análise exploratória por
meio da distribuição de frequências absoluta e relativas. Resultados: Há relação entre o
conhecimento e atitude com a idade, escolaridade, tempo de profissão, participação em cursos e
assistência às PPL adoecidas por tuberculose. Conclusão: Verificou-se a necessidade de
investimentos para melhoria dos conhecimentos, sugerindo a EP como ferramenta para aprimorar
a participação dos Agentes no cuidado em Saúde das PPL.
PALAVRAS-CHAVE: Prisão. Tuberculose. Educação permanente em saúde.
RESUMEN: La tuberculosis es la enfermedad infecciosa que más causa la muerte, especialmente
entre las Personas Privadas de Libertad (PPL), por lo que el Agente Penitenciario (AP) puede
jugar un papel central en el diagnóstico y tratamiento. Objetivo: analizar los conocimientos y
actitudes de la AP con relación a la tuberculosis, con el objetivo de subsidiar discusiones sobre
Educación Permanente (EP). Metodología: Estudio epidemiológico, descriptivo y exploratorio,
realizado en instituciones penitenciarias en Foz do Iguaçu - Paraná. Los datos primarios fueron
recolectados a través de un cuestionario modelo KAP (Knowledge, Attitude and Practice -
Conocimiento, Actitud y Práctica). Se utilizó un análisis exploratorio a través de la distribución de
frecuencias absolutas y relativas. Resultados: Existe relación entre el conocimiento y la actitud con
la edad, la educación, la antigüedad en la profesión., participación en cursos y atención a pacientes
del PPL con tuberculosis. Conclusión: Se verificó la necesidad de inversiones para mejorar el
conocimiento, sugiriendo la EP como herramienta para mejorar la participación de los Agentes en
la Atención a la Salud del PPL.
PALABRAS CLAVE: Prisiones. Tuberculosis. Educación Permante en salud.
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 3
Introduction
Tuberculosis is the infectious disease that causes most death, especially among People
Deprived of Liberty (PDL), so the Penitentiary Agent (PA) can play a central role in diagnosis
and treatment. Objective: To analyze the knowledge and attitudes of the PA regarding
tuberculosis, with a view to subsidizing discussions on Permanent Education (PE).
Methodology: Epidemiological, descriptive and exploratory study, carried out in prison
institutions in Foz do Iguaçu - Paraná. Primary data were collected through a KAP model
questionnaire (Knowledge, Attitude and Practice). An exploratory analysis was used through
the distribution of absolute and relative frequencies. Results: There is a relationship between
knowledge and attitude with age, education, duration of profession, participation in courses and
care for TB patient PDLs. Conclusion: The need for investments to improve knowledge was
verified, suggesting PE as a tool to improve the Agents' participation in the care of PDLs
(CARVALHO et al., 2018).
In Brazil, according to data surveyed in the 2021 epidemiological bulletin, 66,819 new
cases were registered in 2020, and 4.5 thousand deaths from TB in 2019, a mortality coefficient
of 2.2 deaths per 100 thousand inhabitants (BRAZIL, 2017). Because it is considered a disease
of intrinsically social etiology, indigenous people, people infected with HIV-Aids, the homeless
population and People Deprived of Liberty (PDL) constitute high-risk groups related to TB
(MACEDO; MACIEL; STRUCHINER, 2017).
In the period from 2010 to 2019, an increase in the proportion of new TB cases
diagnosed among PDL was observed, with 8,154 (11.1%) new cases reported in 2019
(BRAZIL, 2017). Among PDLs, the risk of getting sick with TB is up to 28 times higher than
in the population considered free. Poor hygiene conditions, poorly ventilated cells,
overcrowding, and poor nutrition are some conditions that increase the risk for TB, and may
also be related to individual characteristics and socioeconomic conditions existing prior to
incarceration, highlighting the indicators for males, such as low education, poor general health
conditions, and drug use (RICALDONI; SENA, 2006; VALENÇA et al., 2016; BERLT et al.,
2021).
Through this initial analysis of the health situation of PDL, the Prison Agent (PA) must
play a strategic role in the early diagnosis of TB, given their condition of regular contact with
PDL, being able to observe the signs and symptoms of illness and changes in the detainees'
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 4
behavior, setting these as triggering elements for the beginning of the cycle of care by the prison
health team (DIUANA et al., 2008).
Considering the severity and magnitude of the disease in the prison system, the role of
the PA emerges as intrinsically responsible for developing prevention actions and aiding in
early diagnosis, as well as the organization and management of spaces for the promotion of
scientific studies that allow making indispensable the implementation of measures aimed at
controlling TB within the prison system (FELIPE et al., 2021).
This contextualization allows us to observe that an operative interface between the
actors inserted in the object of this study is necessary; this obviously has as its final role a
precise change in behavior, the very concept of what is expected with learning. Still on this
conceptual point, it can be inferred that there are processes that become more efficient to operate
in this field, and the PA can be treated as this trigger for the expected behavioral changes. Thus,
problematizing practices such as Permanent Health Education (PHE) have an amplifying force
in real learning, increasing the production of answers, emphasizing that for this the
environments should be rich in exchanges and experiences, generating a lot of new questions
about being and acting in the world. (GOMES; BARBOSA; FERLA, 2016).
Education, in this study, is understood as a permanent and diffuse process throughout
social life. Therefore, it has a central role to play, as, for example, in the consolidation of social
rights, through social protection policies, and here we are talking about the PDL. The
interlocution of education with work is not a mere instrument at the service of prevailing
economic interests or access to productive processes and maintenance, as this has the
exclusionary logic that serves neoliberal interests, but, on the contrary, education in and for
work aims at human emancipation, stimulates decision-making power (FERNANDES, 2019).
Here the focus is on the subject of AP as an interface with the PDL, which in fact is an
obstacle to be transposed, because the imposed relationship is not of mutual learning, but itself,
almost something verticalized and unidirectional, produced by the inherent condition of the
prison structure, something that leads to a conflict with the concept of PHE and must be
critically observed so that the process of education of PA is not conducted in a biased way.
It is worth noting the difficulty of implementing PHE processes at any level of
cooperative action, because the practices that evaluate programs and projects are excessively
standardized, which leads to a loss for its consolidation, given the excess of parameterizations
that must be taken into account for the effectiveness of the PHE own movements (PINHEIRO;
SILVA-JUNIOR, 2018).
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 5
It is still important to mark and separate concepts, because PHE is confused with other
models, including Continuing Education. The latter is a set of experiences that the worker
acquires during his training, and makes it possible to increase or improve his competence for
the strict exercise of his end activity and compatible with the development of his
responsibilities, a technical and punctual training, which does not require from the worker a
commitment to his field of action and team, unlike PHE (BRAZIL, 2022).
This study aimed to analyze the knowledge and attitudes of PAs, seeking to observe
their behavior and their conduct in the face of what is circumscribed to the presence of TB, in
order to organize and support the discussion of how the PHE process can become an assertive
tool for the real needs of PDLs, with the purpose of welcoming and caring for the patient, on
an increased spectrum of concrete actions, affirmative and resoluteness.
The project was forwarded to the Ethics and Research Committee with Human Beings
and approved by CAEE no.: 68998617.0.0000.0107, following all the procedures determined
by Resolution 510/2016 (CNS, 2016).
Methods
This is an epidemiological, descriptive, and exploratory study, conducted from primary
data collected in 2017.
The study population was chosen as PAs who worked in all prisons located in Foz do
Iguaçu - Paraná. To perform the sample calculation, the GPower 3.1.37 program was used,
assuming the evaluation with one factor (Penitentiaries), containing 3 levels (Laudemir Neves
Public Prison, Foz do Iguaçu State Penitentiary I and Foz do Iguaçu State Penitentiary II). For
the calculation we used the "F" distribution with a large effect size equal to 0.4, type I error (α)
equal to 0.05, and analysis power of 0.95. Based on these parameters, and knowing that in total
there were 260 AP distributed among the three prisons, we established a minimum sample size
of 103 AP.
The data collection instrument used was adapted from the KAP surveys (Knowledge,
Attitude and Practice) model, which has been used to collect data on knowledge, attitudes and
practices about diseases or illnesses. The instrument was composed of 58 open and closed
questions, with dichotomous and multiple-choice response options, divided into four (04)
sections: sociodemographic information, professional information, knowledge about TB, and
attitudes about TB.
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 6
Data collection occurred daily throughout the month of August, 2017. The PAs were
approached during their work shifts, at times established by the directors of the penitentiaries.
After collection, the data were entered using the double-entry technique in a Microsoft
Excel spreadsheet. The Kappa coefficient of agreement was calculated to verify the degree of
agreement between the two entries, and the result was 0.904, i.e., less than 1.0. After this step,
the spreadsheet of collected data was transported to the Statistical software StatSoft 12.0, in
which the analyses were performed.
The data were initially analyzed using descriptive statistical techniques. To perform the
analysis of the PAs' level of knowledge, the participants' answers to the questions about
knowledge about TB contained in the data collection instrument were corrected based on the
Manual of Recommendations for Tuberculosis Control in Brazil (BRAZIL, 2019), being
categorized as "correct" and "incorrect”.
Results
Among the 106 PA who participated in the study, 91.5% were male, with a mean age of
33.3 years, and 80.1% had completed college education.
Among the PAs between 18 and 35 years old, 74% showed to have knowledge about
the theme. As for education, the highest percentage with knowledge was among those with
incomplete higher education (87.5%) (Appendix 1).
PAs with longer working time were among the group with the greatest knowledge about
TB, totaling 64%; those who completed some training course throughout their career also
showed knowledge (68%) (Appendix 1).
For the variable TB severity in the country and region, only 53.7% answered correctly;
about the microorganism causing the disease, 66.1% of them chose the incorrect option
(Appendix 2).
For the TB signs and symptoms variables, cough lasting more than three weeks was
answered correctly by 77.4% of the PAs; on the other hand, for fever without a clear cause
lasting more than seven days, there was a high percentage of incorrect answers (91.5%)
(Appendix 2).
Regarding the forms of transmission of the disease, many incorrectly believe that insect
bites (23.6%), sexual contact (51.9%), contact with saliva (94.3%), and touching public items
such as doorknobs and carrying handles (56.6%) are forms of transmitting the disease. As for
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 7
TB prevention, it is noteworthy that 52.0% of the interviewees incorrectly consider that the use
of condoms and 32.1% that the use of repellents can prevent the disease. For 81.1% and 88.7%,
respectively, sputum smear microscopy and sputum culture were correctly signaled as
diagnostic tests. However, only 55.7% of them chose the option active search for respiratory
symptomatic inmates as a priority action (Appendix 2).
Regarding their attitudes about themselves in relation to TB, 99% stated that they could
contract the disease. Regarding their reaction if they knew they were sick with TB, 32.7% said
they would feel fear, 23.1% surprise. For 83.6%, if they had TB, they would tell their doctor or
other health professional and their spouse, respectively (Appendix 3).
Regarding free diagnosis and treatment, 89.4% knew that it is free, but 5.7% believed
that it is very expensive. Also, 43.3% of the PAs reported that they would have no special
feeling toward people sick with TB (Appendix 4).
Most (93.3%) knew that HIV-AIDS people should be concerned about TB. Only 30.0%
of the professionals consider themselves well-informed about TB and 80.0% would like more
information about the disease. Regarding the most effective communication device for
disseminating TB, 62.5% said television (Appendix 4).
Appendix 5 shows the results on the knowledge and attitude of the interviewees,
according to previous contact with the subject of TB in a training course to become a PA. With
the exception of the variables weight loss as a symptom of TB (p=0.028), insect bites as a form
of transmission of the disease (p=0.036) and the use of repellent as a form of avoiding TB
(p=0.020), there was no statistically significant difference between the correct and incorrect
answers between the group that was trained in TB and the group that was not trained before
taking on the job as a PA.
Discussion
The concreteness of the data highlights some key elements about the primary need for
insertion of PHE in the structuring base of public services that are responsible for the life of the
individual under their tutelage, especially with regard to issues that affect the health of those
deprived of their freedom. This observation is necessary and leads to a critical reflection on
how the State understands its role and how to modify it positively, in order to improve the use
of available tools for health promotion via PHE.
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DOI: https://doi.org/10.21723/riaee.v18i00.17537 8
However, and despite the concern of those who wish to build work processes really
synergistic with PHE, it is understood that it is possible the distortion of these same processes,
which can mischaracterize them with segmented and oppositional actions that lose their
meaning when performed by sectors not affected to the reflective process, subtracting the
intention of its main characteristic, which should subsidize the professional with tools that allow
him to develop technically and enable him to have conditions to face neglected diseases in favor
of the collective in which he is inserted, as already observed by Mancia, Cabral, and Koerich
(2004).
Therefore, there is an emphatic need for the managers of these spaces to promote PHE
for the development of skills and capabilities of the professionals involved in the work in
question, especially in improving the processes aimed at expanding the understanding of the
object in question, because only good technique does not enable the individual for health
actions, the dynamics of constant renovations of the work spaces is the first challenge
(MENDES, 2011).
The results obtained in this research allow us to observe and infer that the knowledge
about TB among PAs is related to defined and objective variables, among the main ones: age,
education, time in the profession, participation in training and/or capacity-building courses and
direct assistance to a PDL with TB, the latter having a strong appeal to the understanding of the
disease and its management.
Those surveyed aged between 18 and 35 years showed higher frequency in the
knowledge category (74%) than those aged over 35 years (54%), i.e., they had a better
command of the subject. In the opposite direction, in a study conducted among family members
of a TB patient, it was found, for this dimension, individuals of higher age group with
substantial knowledge about the disease, which infers the close relationship with the patient and
the disease, establishing a concrete causal link (QUEIROZ et al., 2016).
Nevertheless, age is not exactly a definitive limiting factor for the acquisition of
knowledge: studies conducted among PA in the United States revealed that older people had a
positive influence due to their experience, lower rates of absenteeism, higher levels of
cooperation and commitment to work, which enhances the experience among peers learning
relationships (CAPPELLI; NOVELLI, 2010).
In this study, it was observed that those with incomplete higher education had more
satisfactory knowledge observed by the data presented. In opposition to this condition, in
research with inmates in northern Ethiopia, the group that showed better knowledge was
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
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DOI: https://doi.org/10.21723/riaee.v18i00.17537 9
contained in those who finished at least high school, that is, with more than eight years of
schooling (ADANE et al., 2017), data that suggest a direct relationship between learning and
general knowledge expected for the professional activity under discussion, including on health.
The length of experience as a PA and the assistance to PDL with TB seem to have
positively influenced the level of knowledge, a conclusion based on the data presented: just as
experience and information learned become a valuable source of knowledge, professional
experimentations aimed at the work routine allow these events to add learning value, so that
one can consider them as a process of permanent education in the journey of each individual
(NADEAK, 2018).
Participation in training and capacity building courses indicates that they influence the
knowledge of PAs, as the highest frequency of subjects classified with knowledge above the
percentage of hits is in this group. The training courses for PAs have the topic of health in their
curriculum. The content is based on the National Curricular Matrix for Education in Prison
Services, which includes the most frequent infectious-contagious diseases inside prisons, such
as TB (BRAZIL, 2014).
However, the research showed more than 70% of wrong answers about TB, suggesting
that the approach on the subject in the training course was not objective for the teaching-
learning binomial, perhaps because it was a methodology without an adequate connection to
the reality experienced by the PA and their daily routine, as they still had no contact with the
reality of their work, since the training course is one of the requirements for taking office in the
penitentiaries, and is conducted prior to taking office (BRAZIL, 2014).
Among the obstacles enunciated so far and that prevent adequate TB control in
penitentiaries are the stigmatizing attitudes and insufficient knowledge about TB among PDLs
and penitentiary professionals, restricting the ability to promote diagnosis and treatment in
prison (BRAZIL, 2017).
Taking into account these data, HPS is proposed as a space for in-service training, which
aims at learning and familiarity with frequent diseases in this environment, meeting the
expectations for the improvement of knowledge, adopting methodologies that are not aligned
with the conventional, being concerned with meaningful learning, as it differs from passive
traditionalism by adopting the construction of strategies contextualized with the daily work
environment (WAISBORD, 2010).
In accordance with this procedural line, and here we are dealing with teaching in service,
we suggest intersectoral mechanisms for the discussion of a proposal for PHE among the
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DOI: https://doi.org/10.21723/riaee.v18i00.17537 10
schools, the Penitentiary Health Team, the Basic Health Unit of reference of the prison, and the
Municipal and State TB Control Program, with the intention of preparing the HCW as a
strategic ally to mediate TB control among the PLWs, converging with what the National
Control Program of the World Health Organization recommends for the reduction of TB cases
inside prisons and, consequently, outside of them (BRAZIL, 2005).
Among all the PAs in this study, 40.5% believed that a virus could cause TB, and only
34.0% knew that it was caused by a bacterium. Among the HCWs who have had contact with
the topic of TB in their training courses, only 30% of them were correct on the aforementioned
question, a percentage slightly lower than that of family members of patients undergoing TB
treatment in São Paulo, as 31.8% cited the bacteria as the cause of TB (OLIVEIRA;
CARDOSO, 2004).
Regarding TB symptoms, most symptoms were recognized by the HCWs, especially
coughing up blood, coughing up phlegm, and coughing for more than three weeks, as observed
in a study among PAs in Rio Grande do Sul (BERLT et al., 2021), which contributes to the
identification of a possible TB-sick PA. However, the vast majority mistakenly believe that
fever without clear cause for more than seven days, severe headache, nausea, and chest pain are
also symptoms linked to the disease.
However, a study on TB knowledge conducted in another setting also pointed to other
symptoms, such as chest pain associated with TB. Among PDL it was one of the most
mentioned symptoms, as well as among family members with TB in the survey conducted in
Ribeirão Preto, São Paulo (FERREIRA-JUNIOR; OLIVEIRA; MARIN-LÉON, 2013).
The importance of clinical examinations is highlighted so that health professionals can
confirm suspicions when an individual is ill with TB (SIQUEIRA, 2012). Thus, if PAs are able
to recognize the classic signs and symptoms of TB, and attitudinally refer the suspected case to
the health team, they would play a strategic role in the diagnosis so that the treatment is timely,
avoiding the vectorial spread of the disease in this environment and promoting health within
prisons.
This observation is in line with what is proposed in the PHE training axis, especially
for health, when it comes to the horizontalization and democratization of this tool, bringing the
health promoter agent as co-responsible for the construction of the work process (SILVA et al.,
2017).
Following the scope of the analysis on the topic of knowledge regarding the forms of
transmission and how to avoid TB, it was observed that there are conceptual doubts and
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
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DOI: https://doi.org/10.21723/riaee.v18i00.17537 11
perceptual misconceptions, and the results were related, since the ways to avoid it reflect the
forms of transmission, since 94.3% believe that contact with saliva, i.e., sharing dishes, cutlery
and glasses, is one of the forms of transmission. Other ways mentioned by approximately 50%
of them were through handshakes, sexual contact and touching public items, being
manifestation of incorrect knowledge in values higher than those found among PA in Santa
Cruz do Sul (BERLT et al., 2021).
The operative insufficiency in the critical knowledge among professionals about the
form of transmission and prevention of TB transmission inspires alert and concern, since a
detainee with the active pulmonary form excretes viable bacilli through aerosols that can
contaminate members of the prison population. The recommendation in health institutions, and
by analogy for the prison space, is the adoption of administrative measures, environmental
control and individual protection (FREITAS et al., 2015).
Patients with HIV-Aids were considered a risk group by the PAs, citing
immunodeficiency, as observed in another study (FERREIRA-JÚNIOR; OLIVEIRA; MARIN-
LÉON, 2013). Moreover, HIV-AIDS is a public health problem effectively discussed in society
by educators and health professionals. Moreover, the government has long invested in media
campaigns and health education, something that does not occur with the same rigor for TB.
Some information about the disease was very clear among most of the professionals
surveyed, since they knew that the disease is curable with specific drugs, the minimum time of
treatment, the tests required for diagnosis of pulmonary TB and the priority actions, in
agreement with other studies (FELIPE et al., 2021; BERLT et al., 2021).
With regard to attitudes, when asked about the reaction they would have if they became
ill with TB, it was found that fear was frequent. On the other hand, according to Ferreira-Junior,
Oliveira HB, and Marin-Léon (2013), the PA at Hortolândia Penitentiary had the feeling of
sadness as the most frequently mentioned, and fear was the second most frequent. This fact
should be considered relevant, since feelings like this hinder treatment adherence (REGO et al.,
2017).
Possibly due to fear of stigmatization, the vast majority of respondents reported that
they would not tell anyone if they contracted the disease. On the other hand, the most frequent
attitude was to seek the health unit as soon as they noticed the first symptoms, results similar
to those found in a study in São Paulo (FERREIRA-JUNIOR; OLIVEIRA; MARIN-LÉON,
2013).
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DOI: https://doi.org/10.21723/riaee.v18i00.17537 12
It is understood that only one third of the PAs consider themselves well informed about
TB, that the vast majority are interested in obtaining more information about the disease and
that the medium considered most effective to acquire information about TB, according to them,
among a list of resources, was television. It is noteworthy that there is a need to organize
strategies to discuss the implementation of teaching-learning actions within the scope that HPS
is conceptually understood.
The problematization of issues to be discussed through PHE is one of the ways to build
knowledge among adults, resulting in a transformation of practices, allowing continuous
learning (REGO et al., 2017). Therefore, PE can be an effective way to achieve the objectives
of the National Health Plan for the Penitentiary System and the recommendations of the
National Tuberculosis Control Program.
As a limitation, the answers given by the participants may not fully reflect their views
due to the work environment. Knowledge per se has several definitions, is difficult to measure,
especially with the application of a questionnaire, and there may be impregnations of social,
religious or even intrinsic personal nature, which lead the professional differently from what is
expected by the PHE process, generating a perception of relations with the PDL hat prevent the
effective involvement with the process.
Final remarks
Public health is constantly searching for tools that can contribute to health promotion
and control diseases of great social impact, in the strict case of TB, as it is considered one of
the major public health problems worldwide and especially in prisons, with impacting numbers
of patients and deaths, making it necessary that other subjects, in addition to the formally
constituted health teams, are engaged in this confrontation. The reflection on TB control among
PDLs, based on the PAs, is relevant as research, and necessary, since there is a shortage of
studies with this approach.
It is essential to invest in actions for the implementation of PHE in the prison service,
valuing the strategic role of the PAs as mediators between the PDLs and the health service,
engaging them as health promoters in the health-disease process with the PLWs, the people
involved in prison work and the external community.
There are other elements that can contribute to decrease the cases of TB inside prisons,
however, there is a need to advance in the implementation of a teaching-learning process and
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
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DOI: https://doi.org/10.21723/riaee.v18i00.17537 13
in studies on the knowledge of practices and attitudes of these professionals regarding TB, since
their role and their influence/potentiality in the advancement of the objectives of disease control
inside prisons is factually presented in this study.
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Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 16
APPENDIX 1
Table 1 - Sociodemographic and complementary profile of prison guards according to their
level of knowledge about tuberculosis, Foz do Iguaçu -PR, 2017
VARIABLES
KNOWLEDGE
LITTLE
TOTAL
KNOWLEDGE
(n)
%
n
%
n
%
Gender (103)
Female
3
50
3
50
6
5, 8
Male
58
60
39
40
97
94,2
Age (102)
18 to 35
32
74
11
26
43
42,0
Over 35
32
54
27
46
59
58,0
Education (101)
Complete
high school
4
50
4
50
8
7,9
Incomplete
Higher
Education
7
87,5
1
12,5
8
7,9
Higher
Education
53
63
31
37
84
83,3
Master
Degree
Doctorate
0
0
1
100
1
0,9
Time you have been a
Penitentiary Agent (106)
Up to 3
years
3
50
3
50
6
5,7
More than 3
years
64
64
36
36
100
94,3
Did you attend a training
course before starting as
a Penitentiary Agent?
(106)
Yes
65
64
36
36
101
95,3
No
02
40
03
60
05
4,7
Did you attend a training
course? (106)
Yes
38
68
18
32
56
52,8
No
29
58
21
42
50
47,2
Have you ever heard of
tuberculosis? (105)
Yes
66
63
39
37
105
100,0
No
0
0
0
0
0
0,0
Did you have a class on
TB in high school? (104)
Yes
30
62,5
18
37,5
48
46,4
No
36
64
20
36
56
53,6
Have you assisted a PDL
patient with TB? (102)
Yes
54
63,5
31
36,5
85
83,3
No
10
59
7
41
17
17,9
Do you know anyone who
has TB? (103)
Yes
53
63
31
37
84
81,5
No
13
68
6
32
19
18,5
Do you consider yourself
well informed about
TB? (99)
Yes
23
72
9
28
32
32,3
No
39
58
28
42
67
67,7
Want more information
about TB? (98)
Yes
55
64
31
36
86
87,7
No
07
58
05
42
12
12,3
Source: Prepared by the authors
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 17
APPENDIX 2
Table 2 - Classification of knowledge about tuberculosis among Penitentiary Agents, Foz do
Iguaçu-PR,2017
VARIABLES (106)
CORRECT
INCORRECT
n
%
n
%
Tuberculosis as a serious disease
85
80
21
20
TB severity as a country and region
57
53,7
49
46,3
The TB-causing microorganism
36
33,9
70
66,1
Signs and
symptoms of TB
Dry cough
53
50
53
50
Cough with phlegm
80
75,4
26
24,6
Cough that lasts longer
than three weeks
82
77,4
24
22,6
Coughing up blood
84
79,
22
20,8
Splitting headache
26
24,5
80
75,5
Nausea
31
29,3
75
70,7
Weight loss
82
77,3
24
22,7
Chest pain
32
30,2
74
69,8
Shortness of breathe
73
68,9
33
31,1
Fever with no clear
cause that lasts more
than seven days
09
8,5
97
91,5
Fatigue
74
69,8
32
30,2
Transmissibility period after starting
treatment
54
50,9
52
49,1
Minimum duration of TB treatment
75
70,8
31
29,2
Forms of
Transmission
Through handshakes
57
53,8
49
46,3
Insect bites
81
76,4
25
23,6
Through the air when a
person with TB coughs
or sneezes
102
96,2
04
3,8
Sexual intercourse
51
48,1
55
51,9
Contact with saliva
(kissing, sharing plates
and cutlery)
06
5,7
100
94,3
Touching public items
like door handles,
carrying handles
46
43,4
60
56,6
Avoiding handshakes
52
49,1
54
50,9
Covering nose and
mouth when breathing
90
84,9
16
15,1
Avoiding sharing
cutlery, plates and cups
08
7,5
98
92,5
Wash your hands after
touching public items
12
11,3
94
88,7
TB prevention
Closing the windows at
home
76
71,7
30
28,3
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 18
Through good nutrition
50
47,2
56
52,8
Use of condoms
51
48
55
52
Use of repellents
72
67,9
34
32,1
Avoiding being in the
same environment as
people with TB
92
86,8
14
13,2
People who can be
infected
Any person
73
68,9
33
31,1
There is a cure for
TB
Yes/No
89
84
17
16
Ways to cure TB
Through herbs and teas
68
64,2
38
35,8
With rest and without
medication
67
63,2
39
36,8
Taking vaccine
34
32,1
72
67,9
Praying
53
50
53
50
With specific
medications
99
93,4
07
6,6
Required exams
to come true
the diagnosis
of PULMONARY
TB
Sputum Bacilloscopy
86
81,1
20
18,9
Sputum culture
94
88,7
12
11,3
Chest X-ray
61
57,5
45
42,5
Tomography
44
41,5
62
58,5
Active search for
respiratory symptoms
59
55,7
47
44,3
Request for sputum
smear microscopy when
TB is suspected
89
84
17
16
Priority actions for
the
TB control in
penitentiaries
Notification of
confirmed cases
89
84
17
16
Guidance to the patient
and family members
about the need for
Directly Observed
Treatment (DOT)
81
76,4
25
25,6
Examination of people
who live with the TB
patient
88
83
18
17
Source: Prepared by the authors
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 19
APPENDIX 3
Table 3 - Correctional Officers' attitudes about themselves regarding tuberculosis,
Foz do Iguaçu - PR, 2017
n.
%
Do you think you might catch
TB?
Yes
103
99,0
(n=104)
No
1
1,0
Fear
Yes
34
32,7
No
70
67,3
Surprise
Yes
24
23,1
No
80
76,9
Reaction if you found out
Shame
Yes
1
1,0
No
103
99,0
you have TB
Embarrassment
Yes
4
3,9
No
100
96,1
(n=104)
Sadness
Yes
3
2,9
No
101
97,1
No reaction
Yes
22
21,1
No
82
78,9
Spouse
Yes
87
83,6
No
17
16,4
Physician or other
Yes
87
83,6
health worker
No
17
16,4
Parent
Yes
60
57,7
Who would you tell
No
44
42,3
if you had TB
Other family member
Yes
55
52,9
(n=104)
No
49
47,1
Close friend
Yes
49
47,1
No
55
52,9
No one
Yes
93
89,4
No
11
10,6
Go to the health unit
Yes
103
99,0
No
1
1,0
First thing
Go to the pharmacy
Yes
2
1,9
you would do if you
No
102
98,1
notice the symptoms
I would go to a
Yes
0
0
of TB
Benedictine
No
104
100
(104)
Would look for other options
Yes
0
0
of treatment, e.g., herbs
No
104
100
When treatment on its own did not
work
3
2,9
If you had symptoms of TB, at
what point
After three to four weeks with
symptoms
4
3,9
would you go to the health
unit?
As soon as you notice TB symptoms
88
84,5
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 20
(104)
Invalid response
5
4,8
No response
4
3,9
Source: Prepared by the authors
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 21
APPENDIX 4
Table 4 - Attitudes of PAs towards tuberculosis, Foz do Iguaçu - PR, 2017
It's free
93
89,4
Cost of TB diagnosis and
Reasonably priced
2
1,9
treatment in Brazil
It's a little expensive
3
2,9
(104)
Very expensive
6
5,7
I feel compassion and want to help
35
33,6
I feel compassion, but I prefer to
stay away from these people
4
3,9
Feeling about people
I am afraid because they can infect
me
11
10,6
people sick with TB
I have no special feelings
45
43,3
(104)
Other
9
8,6
Yes
97
93,3
People living with HIV-
No
2
1,9
AIDS should be concerned
No response
5
4,8
about TB (104)
The person with HIV-AIDS is more
likely to develop TB
64
61,5
Don't know
9
8,6
If the answer to the previous
question is
Other
20
19,3
yes, why? (104)
No answer
11
10,6
Yes
31
30,0
No
65
62,4
Do you consider yourself well
informed
No response
8
7,6
about TB? (104)
Yes
83
80,0
No
10
9,4
Do you want to get more
No response
11
10,6
Newspapers and Magazines
Yes
43
41,3
No
61
58,7
Radio
Yes
32
30,8
No
72
69,2
TV
Yes
65
62,5
No
39
37,5
Internet
Yes
59
56,7
No
45
43,3
Means considered effective
Facebook
Yes
32
30,7
to transmit
No
72
69,3
information about TB
Billboards
Yes
15
14,4
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 22
(104)
No
89
85,6
Brochures, posters, and other
Yes
41
39,4
printed materials
No
63
60,6
Health care workers
Yes
60
57,7
No
44
42,3
Family, friends, neighbors, and
Yes
12
11,5
colleagues
No
92
88,5
Religious leaders
Yes
11
10,6
No
93
89,4
Teachers
Yes
23
22,1
No
81
77,9
Source: Prepared by the authors
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 23
APPENDIX 5
Table 5 - Description of the knowledge and attitudes about tuberculosis among Penitentiary
Agents according to previous contact with the topic of tuberculosis in a training course, Foz
do Iguaçu-PR, 2017
Knowledge and beliefs about tuberculosis
Contact with the topic of tuberculosis
Yes
No
Total
p-value
N
(%)
N
(%)
N
(%)
TB as a serious disease
Correct
20
30
15
44
35
35
0,062
Incorrect
46
70
19
56
65
65
Severity of TB in the country and region
Correct
34
51,5
21
61,7
55
55
0,329
Incorrect
32
48,5
13
38,7
45
45
Causative microorganism
Correct
20
30
15
44
35
35
0,170
Incorrect
46
70
19
56
65
65
Period of transmissibility after the start of
treatment
Correct
34
51
18
53
52
52
0,892
Incorrect
32
49
16
47
48
48
Minimum duration of treatment
Correct
45
68
27
80
72
72
0,236
Incorrect
21
32
7
20
28
28
Is TB curable?
Correct
55
83
28
82
83
83
0,901
Incorrect
11
17
6
18
17
17
Type of medicine used in the treatment of TB
Correct
61
92
33
97
94
94
0,355
Incorrect
5
8
1
3
6
6
Symptoms of
Tuberculosis
Dry cough
Correct
31
47
19
56
50
50
0,398
Incorrect
35
53
15
44
50
50
Productive cough
Correct
52
79
26
76
78
78
0,791
Incorrect
14
21
8
24
22
22
Coughing for more than three
weeks
Correct
54
82
27
79
81
81
0,335
Incorrect
12
18
7
21
19
19
Hemoptysis
Correct
54
82
27
38
25
25
0,771
Incorrect
12
18
7
21
19
19
Headache
Correct
12
18
13
38
25
25
0,282
Incorrect
54
82
21
62
75
75
Nausea
Correct
17
26
13
38
30
30
0,197
Incorrect
49
74
21
62
70
70
Weight loss
Correct
53
80
26
76
79
79
0,028
Incorrect
13
20
8
24
21
21
Chest pain
Correct
49
74
23
68
72
72
0,486
Incorrect
17
26
11
32
28
28
Shortness of breath
Correct
48
73
23
68
71
71
0,595
Incorrect
18
27
11
32
29
29
Fever for more than seven
days without apparent cause
Correct
5
8
3
9
8
8
0,827
Incorrect
61
92
31
91
92
92
Forms of
transmission
Handshake
Correct
39
59
17
50
56
56
0,385
Incorrect
27
41
17
50
44
44
Insect bite
Correct
55
83
22
65
77
77
0,036
Incorrect
11
17
12
35
23
23
Correct
63
95
33
97
96
96
0,698
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 24
Through the air when the
person with TB coughs or
sneezes
Incorrect
3
5
1
3
4
4
Sexual intercourse
Correct
35
53
14
41
49
49
0,261
Incorrect
31
47
20
59
51
51
Saliva (kissing, sharing
glasses, cutlery)
Correct
3
4
3
9
6
6
0,393
Incorrect
63
96
31
91
94
94
Touching public items, such
as
Correct
31
47
14
41
45
45
0,581
Incorrect
35
53
20
59
55
55
How to avoid
TB?
Avoid shaking hands
Correct
32
48
19
56
51
51
0,483
Correct
34
52
15
44
49
49
Using repellent
Correct
50
76
18
53
68
68
0,020
Incorrect
16
24
16
47
32
32
Covering the mouth and nose
when coughing or sneezing
Correct
58
88
27
79
85
85
0,261
Incorrect
8
12
7
21
15
15
Avoiding being in the same
environment as people with
TB
Correct
61
92
27
79
88
88
0,057
Incorrect
5
8
7
21
12
12
Using condoms
Correct
33
50
17
47
49
49
0,780
Incorrect
33
50
18
53
51
51
Avoid sharing cutlery and
glasses
Correct
4
6
3
9
7
7
0,607
Incorrect
62
94
31
91
93
93
Wash hands after touching
public items
Correct
7
11
4
12
11
11
0,860
Incorrect
59
89
30
88
89
89
Closing windows
Correct
51
77
21
62
72
72
0,101
Incorrect
15
23
13
38
28
28
Good nutrition
Correct
35
53
13
20
48
48
0,160
Incorrect
31
47
21
80
52
52
Tests required
for the
diagnosis of
pulmonary TB
Sputum smear microscopy
Correct
57
86
25
74
82
82
0,113
Incorrect
9
14
9
26
18
18
Sputum culture
Correct
40
61
19
56
59
59
0,057
Incorrect
26
39
15
44
41
41
Chest X-ray
Correct
40
61
19
56
59
59
0,649
Incorrect
26
39
15
44
41
41
Tomography
Correct
24
36
18
53
42
42
0,111
Incorrect
42
64
16
47
58
58
Priority
actions to
accomplish
the diagnosis
of pulmonary
TB
Active search for respiratory
symptomatic patients
Correct
44
66,6
13
38,2
57
57
0,006
Incorrect
22
33,3
21
61,8
43
43
Request for sputum smear
microscopy when TB is
suspected
Correct
58
88
26
76,4
84
84
0,140
Incorrect
8
12
8
23,6
16
16
Notification of confirmed
cases
Correct
57
86,3
26
76,4
83
83
0,212
Incorrect
9
13,7
8
23,6
17
17
Orientation to patients and
family members about the
need to take directly observed
treatment
Correct
54
82
23
68
87
87
0,110
Incorrect
12
18
11
32
23
23
Testing of people living with
the TB patient
Correct
58
88
25
73,5
83
83
0,070
Incorrect
8
12
9
26,5
17
17
Fabiana COLOMBELLI; Anneliese DOMINGUES WYSOCKI; Merielly KUNKEL; Rodrigo Juliano GRIGNET; Lia GONÇALVES
POSSUELO; Adriana ZILLY; Reginaldo Aparecido ZARA and Reinaldo Antonio SILVA-SOBRINHO
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 25
Source: Prepared by the authors
Permanent education in health: A strategy to care for people deprived of liberty affected by tuberculosis
RIAEE – Revista Ibero-Americana de Estudos em Educação, Araraquara, v. 18, n. 00, e023019, 2023. e-ISSN: 1982-5587
DOI: https://doi.org/10.21723/riaee.v18i00.17537 26
CRediT Author Statement
Acknowledgments: Paraná Penitentiary Department – DEPEN and the Union of Criminal
Police Officers of Paraná. SINDARSPEN - Foz do Iguaçu Section, PR.
Funding: Higher Education Personnel Improvement Coordination – Brazil (CAPES).
PROAP.
Conflicts of interest: The authors state that there is no.
Ethical approval: The study was approved by the Ethics and Human Research Committee
of the Western Paraná State University, Unioeste. CAEE n.º: 68998617.0.0000.0107.
Data and material availability: Not applicable.
Authors’s contributions: Fabiana Colombelli (Research project design, adaptation of the
research instrument, field research, data collection, data analysis and interpretation, text
writing), Anneliese Domingues Wysocki (Research instrument adaptation, data analysis
and interpretation, text writing), Merielly Kunkel (Data analysis and interpretation, text
writing), Rodrigo Juliano Grignet (data analysis and interpretation, text writing), Lia
Gonçalves Possuelo (adaptation of research instrument, data analysis and interpretation,
text writing), Adriana Zilly (data analysis and interpretation, text writing), Reginaldo
Aparecido Zara (data analysis and interpretation, text writing). Reinaldo ANTONIO
SILVA-SOBRINHO (Orientation, Conception of the research project, adaptation of the
research instrument, field research, data collection, data analysis and interpretation, text
writing).
Processing and editing: Editora Ibero-Americana de Educação.
Proofreading, formatting, normalization and translation.