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Revista da Escola de Enfermagem da USP

Print version ISSN 0080-6234

Rev. esc. enferm. USP vol.45 no.spe2 São Paulo Dec. 2011

http://dx.doi.org/10.1590/S0080-62342011000800014 

ORIGINAL ARTICLE

 

Adolescents on stage: an educational proposal in the field of sexual and reproductive health*

 

Adolescentes en escena: una propuesta educativa en el campo de la salud sexual y reproductiva

 

 

Vânia de Souza

Registered Nurse. PhD in Health Sciences from the Oswald Cruz Foundation National School of Public Health. Adjunct Professor at the Department of Maternal-Infant Nursing and Public Health of the Federal University of Minas Gerais School of Nursing. Belo Horizonte, MG, Brazil. vaniaxsouza@yahoo.com.br

Correspondence addressed to

 

 


ABSTRACT

The objective of this study was to describe the experience of developing educational material in the form of a play, created and performed by adolescents as a strategy to obtain a reflexive and autonomous attitude of these subjects, in the affective-sexual and reproductive field. This intervention and investigation process was developed at a public school located in Belo Horizonte - Minas Gerais, Brazil - with 12 students aged between 14 and 18 years. The analysis was founded on the method of experience-based learning, by John Dewey. Twenty-three workshops were performed until the production of the show and video Sex yes, Disease No, exhibited to high-school students. The production of educational technologies, created by students themselves, permitted to broaden their experiences and assign new meaning to their knowledge. It also helped to understand the everyday reality of these subjects, permitting them to establish a connection between inner aspects (the adolescent's thoughts) and outer aspects (that materialize the social phenomenon) in the affective-sexual and reproductive field.

Descriptors: Adolescent; Sex education; Sexual and reproductive health; Gender identity; Art


RESUMEN

Se objetivó describir la experiencia sobre elaboración de material educativo, en formato de performance teatral creada y escenificada por adolescentes, como estrategia para obtención de una actitud reflexiva y autónoma de tales sujetos en el campo afectivo-sexual y reproductivo. Proceso de intervención e investigación desarrollado en escuela pública de Belo Horizonte-MG-Brasil, con 12 estudiantes de 14 a 18 años. El análisis se basó en el método de educación por la experiencia, de John Dewey. Se realizaron 23 talleres, hasta la producción del espectáculo y del video Sexo Sí, Enfermedad No, exhibido para alumnos de enseñanza media. La producción de tecnologías educativas construidas por los adolescentes posibilitó ampliar sus vivencias y la re-significación de conocimientos. Ayudó también a comprender la realidad cotidiana de los sujetos, permitiendo vincular lo interno (el pensamiento adolescente) y lo externo (la concreción de fenómenos sociales) en el campo afectivo-sexual y reproductivo.

Descriptores: Adolescente; Educación sexual; Salud sexual y reproductiva; Identidad de gênero; Arte


 

 

INTRODUCTION

Youth protagonism and sexuality issues, including the sexual and reproductive rights of adolescents and youths, are the focus of several studies and reformulations of public policies to respond to increasing indices of Sexually Transmitted Infections (STI), pregnancy in adolescence, abortion and other repercussions(1-2) that permeate this theme. In Brazil, the urgency in responding to these situations has led to the implementation of public policies such as the Health and Prevention in Schools Project, which aimed to reduce harm to youth health in the sexual and reproductive areas(3). Despite this and other initiatives, studies show important limitations in achieving promising results in this area, given the complexities of the permeating factors(4-5). In relation to the Sexual Education in Schools, advocated by the Ministry of Education (MEC) in the National Curriculum Guidelines (NCG) as a transverse axis to the curriculum(6), the literature indicates the difficulty of educators and families in addressing the sexuality theme(4). From this perspective, there is a sense of dissociation between the contents and the life contexts of the adolescents, especially when the content relates to aiding youths to know their own bodies, sexual initiation and orientation, sexual relationships, as well as developing responsibility for their own health(5-7).

Commonly, educational approaches on sexual and reproductive health are restricted to information, based on traditional preventive methods. These methods operate within parameters of normality and abnormality(4), disregarding the set of codes and systems of meaning of the learning subjects. Sexual and reproductive health is a product of citizenship achievement, human and environmental rights, initiated by the International Conferences on Population and Development, organized by the United Nations.  Reproductive health is defined as a state of complete physical, mental and social well-being. It is implicated in processes and functions of the reproductive system in all life stages.  As part of reproductive health, sexual health aims to improve quality of life and personal relationships and to promote healthy, safe and satisfactory sexual development, as well as provide care for STIs, deficiencies and other risk practices related to sexuality(8).

If education is considered a process of reconstruction of experiences(9), it can be assumed that proposing a space in which adolescents can live realities similar to their own can promote meaning-making, revision of meanings and broadening of previous experiences, with the personal growth as the consequence. Thus, this study aimed to describe the experience of elaborating educative material, in the form of a theatrical performance, produced and acted by adolescents, as a strategy to achieve a reflexive and autonomous attitude in relation to the reproductive and sexual-affective areas of these subjects. Art was chosen due to its potential to generate new forms of subjectivity. The theater, in particular, leads to formative experiences in which the adolescents structure their subjectivity autonomously and distant from pre-conceived definitions.

 

METHOD

This is a study of intervention and inquiry concerning the Project Adolescents on Stage, initiated in 2008 and developed in various stages.  This article presents and discusses the results relative to the production of a theater play, to the broadening and the revision of meanings in the reproductive and sexual-affective areas. The context of the study was the Milton Campos State School, of Belo Horizonte, Minas Gerais – Brazil, in which the students present an intermediate socioeconomic profile, with mean family income of 3.6 minimum wages, according to the Brazilian(10) criteria for economic classification. The school was selected by convenience, due to its physical and infrastructure availability, the high number of students from the 1st and 2nd High School grades, and the ease of access.

Twelve students participated in the study from the 1st and 2nd High School grades of the vespertine classes, between 14 and 18 years of age, of both genders and from different classes, who had previously responded to a questionnaire of group characterization. The students were selected by level of interest, time availability, and order of delivery of the terms of free prior informed consent, signed by a parent of the student or the legally responsible adult. A total of 23 workshops were conducted at the school, twice a week, starting at the end of classes, from 5pm to 7pm. The fist five workshops used games and recreational activities to sensitize students and create the context to approach the pre-selected themes: Body knowledge; sex and sexuality myths and taboos; sexual initiation; safe sex; and gender relations. This stage was conducted by the researcher/coordinator. Of the remaining workshops, eight aimed at creating the play and ten were used for rehearsals. Under the direction of a dramatist and, later, a video producer, the participants were free to create and express themselves. The workshop format was adopted because it allows the promotion of a recreational context that favors creativity, interactions and negotiations, as well as conflict resolution attempts - all of these being essential to encourage the critical thinking and protagonism of the subjects(11).

For the analytical process, Dewey's principles of thinking(12) were employed as the theoretical framework, specifically using the concept of education by experience – where the adequate means and context are sought to trigger the mind into action allowing the subject to operate in diverse ways to achieve knowledge(9). The workshops were recorded, photographed and registered by observers. The statements of the participants are presented with a codename, the gender and the age of the participant.  Through the terms of free, prior, informed consent, the parents and participants authorized the disclosure of the statements and images.   The research project was approved by Human Research Committee and conducted according to its ethical standards – protocol No. 0576.0.203.000-07.

 

RESULTS AND DISCUSSION

The group of participants consisted of nine female and three male youths. The majority of them were 16 years of age.  Through the application of the questionnaire, it was possible to identify three male and two female youths who had already had sexual relations. In three cases, a condom was not used in the first sexual relation.  Three male youths revealed the practice of masturbation while all the female youths denied it. Two of them used alcoholic beverages and one of them used illicit drugs. The participants demonstrated a limited knowledge of the anatomy and physiology of the external sexual organs, especially regarding the female body. Knowledge about transmission, signs and symptoms of sexually transmitted infections was also limited. These results are similar to those found in other studies(13-14).

During the first five workshops, adolescents got acquainted and interacted thus facilitating the establishment of bonds. Sharing experiences stimulated the pursuit of answers to specific themes and situations. The statements of the participants, principally those regarding gender, sexuality and safe sex practices were embedded in traditional, regulatory, moral and ethical values, as presented in the following excerpts:

Men have more sexual desire than women. You don´t see a woman hitting on a man. (Gica – 16yo - ♀)

One of the disadvantages of being a women is that she feels pain the first time (Conde – 17yo - ♂)

Sex with love is a way of avoiding sexually transmitted disease (Caca – 16a - ♀)

The reflection about this reality, which is also identified in other studies(5,12), highlights the importance of encouraging students to pursue explanations to their doubts that could be minimally reasonable. This means, to create the conditions to analyze the process by which moral, cultural and social dispositions are formed(12). In this case, the first five workshops allowed the participants to establish new meanings or significances for the discussed themes.  As an example, one of the female adolescents reported the hegemonic construction of gender, in which the roles are constructed in a binary way for men and women.

The women falls in love much easier and suffers much more in a relationship (Nunu – 16yo - ♀)

After this statement, and from the flexibility of these gender positions, this binary model was re-signified, with an unquestionable and pre-conceived truth:

Nowadays I see more men suffering because of women than women suffering because of men. The problem is that everyone sees women showing their suffering while men hide it, because of this, in the people's image we suffer more (Kuka – 16a- ♀)

Society creates the idea that a guy cannot cry for a woman, right? (Liu – 17a - ♀)

This process of reflection and reconstruction of knowledge was even more intense at the creation workshops. At the first creation workshop, participants read a dramaturgic text, presented by the theater professor, in order to assist the elaboration of their own play. Subsequently, participants split into small groups to discuss and work on the dramaturgic production. In each new meeting, the workshops systematically started with the presentation of the productions of each group, allowing a collective construction, imbued in a dynamic relationship between reality and imagination. These workshops led to the creation of the play Sex Yes, Disease No, which was performed to private and public High School students in Belo Horizonte, from different socioeconomic backgrounds. Later, the play was adapted for a video format in order to increase its divulgation into other schools of Belo Horizonte and neighboring towns.

The interaction between the objective conditions (reality) and subjective conditions (from the participants) was responsible for the production of knowledge that resulted from the combination between the active element (to make an experience), the passive element (to undergo an experience) and reflection, considered to be characteristic of educational experiences(12). In this context, the dramaturgic production – of the creation and performance of theater plays – encouraged by the performing arts professional promoted the continuous evaluations of facts and ideas, of the formation of judgments, and of the investigations and deliberations of the adolescents(9-10). Guidance from this professional aimed to encourage the participants to try to comprehend the true feelings of the personalities, to search for details in their life contexts, and to work with emotions instead of clichés. This contributed to reflexive thinking as well as to the principles of continuity and interaction that characterize the experience(12). Continuity refers to the permeability, in the sense that an experience is anchored in the past by the attitudes that condition it, and at the same time, condition the future by their impact on the objective conditions of previous experiences.  This can be translated in a longitudinal dimension, in which it makes the pursuit of the construction of knowledge(15) possible. The interaction, conversely, refers to a lateral or spatial dimension that results from the exchange between people and their environment.  It can be translated as the multiplication of communication channels and as the diversification of relational environments that enrich the action.

These principles were essential to allow the adolescents to establish the details of their characters, such as age, gender, marital and familiar status, even if these attributes were not directly necessary for the scene. In order to do this, the participants had to engage with their past experiences, which were strengthened or re-signified when associated with the interaction with the environment.  The following excerpt from the play is an example of the creation process of the group.

Son: Dad, why are you up so late?

[18 years old, single. Arrives home late from a party]

Dad: I was waiting for you. You did the worst thing I could expect from a son.

[speaks from a armchair. Simulate using a remote control

Continually changing the TV channel]

Son: What are you talking about dad? What did I do?

Dad: Don't bother hiding anything, I already know it all. I'm ashamed of you. Everybody is talking about it. The joke is on me. I educated you as a man, not like a sissy. [standing up, pushes his son.]

Son: But...

Dad: Don't say another thing. I don't want you in this house anymore.

[pushes his son harder].

Son: Stop, dad. Where is mom?

[tries to force past and looks down the corridor in search for his mother].

This play, in which a young men is cast out from home because of his first homosexual demonstrations, reinforced a heteronormative discourse that is still superficially addressed in the sex education practices(4,16). This discourse, situated in the basis of the hegemonic constructions of the sexes, causes every alteration in this pre-established order to be treated as abnormal, shameful and unacceptable.  This means that educational processes in the field of sexuality still need to explore the twists and turns of this theme(5,17), and thus create the connection between the internal factors (the thoughts of the adolescent) and the external factors (which solidify the social phenomena) of a given experience. In this direction, the emphasis of the learning process is to encourage reflexive habits, to find connections between past experiences that stimulate their application in later situations and to formulate proposals that lead the students to consider new questions and new perspectives(15).

Dewey(9,12) uses the word inquiry to name this reflexive act of thinking, which is triggered by a spirit of perplexity and that, under the challenge of uncertainty, searches for answers to ambiguous and embarrassing situations. The initial situation that triggers the mind in action means a circumstance that includes the investigative individual, as well as the environmental and social elements of that in which one is inserted. It is through this continuous process of reconstruction and reorganization of the experience that individuals learn to make, making themselves as human-beings(12).

The excerpt from an interview with the participants conducted after the conclusion of the production of the play is an example of the reformulation of the meaning of female condom use. This reformulation aims to resolve the inefficacy of past knowledge that is lived in the present or that is projected into the future.

Ah, I was curious and opened it. I have never seen a female condom. ...I opened it, had a look and read a little in the little book about sexually transmitted diseases. There were things we didn't know and that helped to open our minds, you know? (Leco, 18yo, ♂).

The fact that this adolescent had re-signified his knowledge about the use of the female condom was reinforced in the production of the play, when he participated in a scene in which a couple meets at a party and the young woman says she is already using a female condom, which can be inserted hours before sexual intercourse. This amplification or deepening of knowledge was also identified in the production of other scenes, in which the adolescents addressed, with ease, contents that were previously considered as limited, such as the signs and symptoms and ways of transmitting STIs. The adolescents also revealed an improvement in their self-esteem, amplification of the dialogue with the parents and family members, as well as a change in the attitude towards their way of living and their way of dealing with their own bodies:

Prejudice dropped a lot. At home, nobody talks about it, but after the project I talked to my father (Liu- 14yo - ♂).

I grew a lot as a person. I am a virgin and, before working in the play, I looked at the girl who was not virgin in a different way (Fani – 16yo - ♀)

I made use of the kit. The gynecologist said: This little mirror is a cool idea. To look at what we have. I really saw that it was everything... (Lia – 16yo - ♀)

The guarantee of a space for the debate and expression of the creativity of the participants allowed the acquisition of new knowledge and reflections regarding the disorders originated from vulnerable sexual practice, which was evidenced in the statements of the participants when they address the following themes: Sexual and domestic violence; prejudice, homophobia; misinformation; uncommitted, compulsive and unprotected sex; infidelity; trust in the partner; conflicts between parents and children; sickness; death; and the gender issues that permeate all approaches.

 

CONCLUSION

The production of educational technologies by the adolescents themselves, made the amplification of their experiences and the resignification of knowledge possible. It also helped in the comprehension of the quotidian reality of these subjects, permitting the connection between the internal and external in the affective-sexual and reproductive field.

The method of education from the experience of John Dewey reaffirmed itself as a possibility for the approaches guided by dialogue and reflexive actions in the issues of sexuality. Its results allowed the elaboration of new educational strategies that aim to promote the health of the adolescents through participatory methodologies. However, the necessity was detected for a deeper and more significant analysis of the efficacy of the methodology in relation to the critical formation and increased autonomy of these subjects, in the field of sexual and reproductive health.

 

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Correspondence addressed to:
Vânia de Souza
Av. Alfredo Balena, 190, sala 414 – Santa Efigênia
CEP 30.130-100 – Belo Horizonte, MG, Brazil

Received: 11/06/2011
Approved: 11/30/2011

Acknowledgment
Maria Flávia Gazzinelli, for the theoretical contribution and critical review of the text. Cláudia Natividade, for help in the gender discussions. The Dean of Research of the Federal University of Minas Gerais (PRPq / UFMG) and the Research Support Foundation of Minas Gerais (FAPEMIG) for funding the project in 2008 and in the biennium 2009-2011, respectively.

 

 

* This study received the 3rd place in the Coordinated Session at the 2º Simpósio Internacional de Políticas e Práticas em Saúde Coletiva na Perspectiva  da Enfermagem – SINPESC, University of São Paulo School of Nursing, São Paulo, Oct 9-11. 2011

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