Sexual activity of people with spinal cord injury: development and validation of an educational booklet

Silva, Roberta de Araújo e; Ximenes, Lorena Barbosa; Cruz, Arménio Guardado; Serra, Maria Aparecida Alves de Oliveira; Araújo, Márcio Flávio Moura de; Andrade, Luciene de Miranda; Studart, Rita Mônica Borges; Carvalho, Zuila Maria de Figueiredo

doi:10.1590/1982-0194201800037

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Brasil

Acta Paulista de Enfermagem

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Sumário

Original Article • Acta Paul Enferm 31 (3) • May-Jun 2018 • https://doi.org/10.1590/1982-0194201800037 copy

Sexual activity of people with spinal cord injury: development and validation of an educational booklet

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To describe the process of development and validation of an educational booklet about the sexual activity of people with spinal cord injury.

Methods

Methodological study performed in four steps: documentary search in blogs, integrative review, development of the educational booklet, and face and content validation, namely content validation with 11 referees, technical face validation with three referees, and face validation with 37 people from the target audience. The minimum value established for the content validity index (CVI) was 0.80.

Results

The booklet presented a global CVI of 0.91 after evaluation by healthcare professionals, 0.87 after inspection by graphic designers, and 0.94 after examination by members of the target audience. Despite the significantly high indexes, referees and people from the target audience proposed suggestions to improve the booklet, which were accepted and incorporated into the final version of the material.

Conclusion

The booklet showed content and face adequate to promote healthy and satisfactory sexual activity of people with spinal cord injury.

Spinal cord injuries; Sexuality; Health education; Teaching materials; Validation studies

Aspects	Alterations based on recommendations of referees and members of the target audience
Language	- The subtitle of the booklet, displayed on the cover, was changed from “what you would like to know” to “what you must know”. - The authors reformulated contents and texts about spinal cord injury, classification of spinal cord injuries, changes in the sexual function, rehabilitation, menstruation, and autonomic dysreflexia. - Contents about intestinal control and exams to evaluate male fertility were included. - The expressions “vertebrae” and “dilated corpus cavernosum” were replaced with “spinal cord” and “corpus cavernosum full of blood”. Names of active principles were replaced with commercial names of medications. - The abbreviation “AVC” (Portuguese initialism for cerebrovascular accident) was removed.
Layout and design	- The layouts of the charts regarding functions of the body affected by the spinal cord injury, classification of spinal cord injuries, types of erection, and types of vaginal vasocongestion were organized. - The layouts of the captions of the illustration about erogenous areas were organized. - The font color of a word was changed from red to black.
Illustrations	- The illustration on the cover was altered so the characters would hold hands. - An illustration was reformulated to remove the spinal cord center. - A family figure was included about the physical activity topic. - The illustrations about the signs and symptoms of autonomic dysreflexia were redesigned because the original ones were not self-explanatory. - The contrasts in the illustrations about classification of spinal cord injuries were altered.
Aspects	Comments on the evaluation of the booklet by the target audience
Language	“The booklet is clear and fairly objective, goes straight to the point, no stalling. And it will help many people, for sure” (Participant 2). “The language is very clear and objective, making patients understand everything coherently” (Participant 1). “Yes, the explanations are clear” (Participant 27).
Layout and design	“I agree, because it is very organized with its structure, coherence, size, and logical titles for each item” (Participant 10). “The organization is coherent” (Participant 1). “Very well organized” (Participant 27). “The size is excellent to encourage the search for more information” (Participant 35).
Illustrations	“The figures are clear and objective, with good and proper appearance” (Participant 1). “All the figures are well illustrated and interesting” (Participant 27). “The figures are very important in the text, that helps to interpret” (Participant 36).
Evaluation of the booklet	“It is a great book, full of basic and concrete information” (Participant 36). “The booklet makes people informed to the point of accepting a sex life with another wheelchair user. The addressed information was adapted with much coherence” (Participant 1). “I agree, the booklet offers the possibility of sexual activities for people with spinal cord injury, addresses the necessary and important topics for people to have knowledge and feel fulfilled, ready to live in society” (Participant 10). “The booklet must always be used” (Participant 35). “The use of the booklet clarified many questions I had in my routine and my life” (Participant 36). “Clear and explicit reading, useful for patients, relatives, and other people” (Participant 21). “The material is extremely important and clear to help any person with spinal cord injury” (Participant 17). “What each alteration promotes and how it impacts on sex life is very relative, for both men and women, respecting their limits” (Participant 10).

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author . Roberta de Araújo e Silva. http://orcid.org/0000-0003-2133-0677. E-mail: roberta.2010@yahoo.com.br