“What benefits and what damages my mental health?” - Children’s perceptions regarding an after-school program ¹, ^{2 3 4}

Abstract

The aim of the study herein is to explore the perceptions of 23 children aged 9 to 11 years of age, regarding the factors present in the context of an after-school program, which favor and harm their mental health. The photo-voice resource was used to produce the data. The analyzes of the photographs produced were made collectively. Playing, sports, educational activities and contact with nature were identified as favoring mental health; bullying and other violence practices were perceived as harmful. It was found that the children demonstrated clarity about what affects them, therefore, listening to them seems to be a path for the processes of elaborating policies and actions that in fact seek to protect them.

Keywords
children; participatory research; child mental health; photo-voice; after-school program

Resumo

Este estudo teve como objetivo explorar as percepções de 23 crianças de 9 a 11 anos a respeito dos fatores ? presentes no contexto de uma instituição de contraturno escolar ? que favorecem e dos que prejudicam sua saúde mental. Para a produção dos dados foi utilizado o recurso do foto-voz. As análises das fotografias produzidas foram feitas de maneira coletiva e participativa. O brincar, a prática de esportes, as atividades educativas e o contato com a natureza foram apontados como favorecedores da saúde mental; o bullying e outras práticas de violência foram percebidos como prejudiciais. Verificou-se que as crianças demonstraram clareza sobre aquilo que as afeta, portanto, ouvi-las parece ser um caminho para os processos de elaboração de políticas e ações educacionais mais efetivas.

Palavras-chave
crianças; pesquisa participativa; saúde mental infantil; foto-voz; contraturno escolar

Resumen

Este estudio tuvo como objetivo explorar las percepciones de niños de 9 a 11 años, respecto a los factores que favorecen y perjudican su salud mental, presentes en el contexto de una institución que ofrece actividades a contraturno escolar. Para la producción de los datos fue utilizado el método de foto-voz. Los análisis de las fotografías fueron hechos de manera colectiva y participativa. El juego, los deportes, las actividades educativas y el contacto con la naturaleza fueron apuntados en favor de la salud mental; el bullying y otras prácticas de violencia fueron percibidos como perjudiciales. Se verificó que los niños demostraran claridad sobre aquello que les afecta, por lo tanto, oírlos parece ser un camino para los procesos de elaboración de políticas y acciones educacionales más efectivas.

Palabras clave
niños; investigación participativa; salud mental infantil; foto-voz; escuela

Introduction

The World Health Organization (WHO, 2001) conceptualizes mental health as a “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (p.1).

Focusing on children and adolescents and based on occupational therapy reflections in the field of child and adolescent mental health, Fernandes (2019) proposes the following understanding:

Children's mental health is dynamic and the result of the complex relationship between resources and personal skills, contextual factors and social drivers, which in the daily dimension are directly involved in the possibilities of participation, enjoyment, recognition and facing challenges. Which, among others, involves the possibility of experiencing pleasure, frustration, affection, motivation and proactivity implied in the discoveries and genuine learning of childhood and adolescence⁵.

In the history of Brazilian child and adolescent mental health, care actions for the population with psychiatric distress were defined mainly on the basis of exclusion discrimination, institutionalization, moralization of conduct, suppression of rights and restriction of freedom (Couto, 2001; Hoffmann et al., 2008; Taño & Matsukura, 2015).

The Brazilian psychiatric reformation movement and the Child and Adolescent Statute contributed to significant changes in the forms of child mental health care and in the implementation of mental health policies for these individuals (Couto, 2001; Taño & Matsukura, 2015). Currently, efforts are being made to reduce the institutionalization of children based on the right to family and social life, with a view to reestablishing their statutory status and citizenship, in addition to expanding the life contexts of this group (Taño & Matsukura, 2015).

The Ministry of Health establishes the principles for children's mental health policy, and starts from the idea that children and adolescents have subject rights and are owners of the places where they have the right of speech and, as such, are responsible for their own needs and symptoms, so it is not possible to think of treatment and therapeutic approaches in a homogeneous and prescriptive way without considering the different contexts and sectors that are part of this population's life (Brazil, 2005, 2014).

Regarding the child’s place as the owner to the right of speech in the communication and expression of their psychic suffering, the adult-centric relationship, according to Vicentin (2006), despite some legal advances, still persists today and generates influences that have repercussions on the mental health care of these individuals. Along these lines, the author argues that child and adolescent mental health care practices should be based on an expanded perspective that involves different actors and life contexts of this population, and that consider the subjectivity and expression of children's lives.

Childhood sociology directs its reflections and practices in the same direction, and seeks to deconstruct the precepts, which were historically constructed by social and human sciences, from the fight against childhood invisibility, the affirmation of children as social actors, the consideration of these individuals as revealing social realities to which they belong and the competence attributed to this age group; seeking to give children the right to speak up for themselves by making use of, for example, participatory methodologies for the construction of knowledge (Soares et al., 2005).

In this way, participatory research with children foresees their active participation and partnership in the investigation process. Such methodology has great prospects with regard to structuring social status for childhood and the construction of a scientific field, which is characteristic of this population and which contributes towards the processes of social transformation, the exercise of citizenship and the expansion and realization of the rights of these individuals (Soares et al., 2005).

The authors also add that favoring the participation of children in investigative activities fulfills the convention of children's rights by ensuring that their own questions and problems are listened to in a serious and respectful way, apart from seeing them as active subjects in their daily lives, able to contribute, express opinions and participate in aspects that influence and are a part of them (Soares et al., 2005).

It is observed, therefore, that participatory nature research seems to confirm what is recommended in the processes of strategic attention of these individuals and the promotion of their mental health, insofar as they favor attitudes of citizenship and social participation, elements which are considered to be the focus of the actions in these processes.

Cid and Cardoso (2018) carried out a systematic review of literature published in national and international journals, with the aim of identifying and analyzing studies which adopted participatory methodologies and in which the participants were children. Nine articles were found, one from the field of occupational therapy, from which it was possible to observe, in addition to the scarcity of participatory investigations carried out with children, that the studies focused on the challenges and prospects of these studies, or on the data collection instruments that favor this type of study or even on the analysis of specific themes through participatory methodology.

Based on the results, the authors signaled the capacity that participatory research with children has in order to favor processes of expression and social emancipation and the need for greater exploration of this research possibility, given the diversity of contexts through which childhood circulates and in which the children express themselves. It is worth noting that out of the nine publications found by Cid and Cardoso (2018), three were in the context of children's mental health (Baas et al., 2013; Greco et al., 2017; Hwang, 2013).

Greco et al. (2017) used the participatory methodology using photo-voice during nine meetings with four children who presented intense psychic suffering and were attended at a Day Hospital. This research was carried out with the objective of analyzing the strengths of using this resource in the self-assessment process directed towards the care of these children. In order to achieve this purpose, the children themselves set up an album, which was made up of photos based on what they considered important in their lives.

In a study using the participatory methodology and carried out by Hwang (2013), home videos were used as a resource. This work aimed at observing the possibilities of this mechanism with regard to obtaining a greater understanding of the daily lives of children who have an autistic sibling. In another study, carried out by Baas et al. (2013), the participatory methodology was also chosen to study the understanding and vision of children regarding the topic of cyberbullying.

Based on these studies, there is a consensus reached by the authors in relation to participatory methods, in that they favor children's expression and participation and promote their emancipation and social inclusion by enabling them to exercise their rights and contribute to children's empowerment (Baas et al., 2013; Greco et al., 2017; Hwang, 2013). However, further studies are needed – including at a national level – that consider different realities and possibilities of mental health expression and of child and adolescent psychological suffering in different life contexts within the population of children and adolescents.

And, with regard to the life contexts in which the population of children and adolescents circulates, we can consider the school-educational context as one of the main ones, since nowadays children spend more and more time of their daily routine in institutions of this nature, thus, the school can be considered a multicultural place, in addition to a physical environment, also a psychological and social space in which learning activities, interpersonal relationships, acquisition of values ​​and coexistence with differences take place, making these institutions become factors of great influence on the development and personal training of these subjects, and are thus very important in the formation of socio-emotional aspects of the child and adolescent population (Carvalho & Santana, 2010; Dessen & Polonia, 2007; Vieira et al., 2017).

By pinpointing the school as a prospective context for actions to promote the mental health of children and adolescents, Souza (2010) states that the mental health partner school bets on its ability to propose educational relationships that are committed to producing autonomy and prominence based on collective experiences.

The school promotes mental health when it discusses the relationships it establishes and the differences that are obvious between the people and organizations with whom it works within its daily life. This applies to the relationship between educators, between students, students and educators, and between everyone with the families, communities and local institutions. The practice of dialogue is essential to promote mental health⁶.

It is understood that after-school programs make up this scenario, given their complementary nature to formal education, by including cultural activities, sports, leisure, foreign languages ​​and tutoring, and they are often the only opportunity for students from the outskirts and social risk areas to obtain a complete and civic education (Brazil, 2009).

According to Natali et al. (2011), such institutions offer educational practices that fall within the scope of social education, with the objective of promoting people so that they can critically question and act in their social contexts, often full of inequalities.

Considering that socioeconomic conditions have a great impact on the quality of life and well-being of people and groups with lower financial resources, Souza et al. (2019) discuss that contexts of social vulnerability can produce more psychological suffering, as people are exposed to a series of potentially adverse life events, such as the difficulty of accessing fundamental rights, for example: housing, basic sanitation, health and education; which also results in consequences for family and community relationships and supports what Ribeiro et al. (2010) and Couto et al. (2008) state: the intersectoral aspect is the main foundation of child and youth mental health and, as such, it must be set up as a common line of action, agreed on and shared by the different actors involved.

When discussing the possibilities of actions to promote mental health in the educational context, Fernandes et al. (2019) state that the intervention is not characterized as being clinical, but rather as having an intersectoral nature with a design based on collaborative processes, that is, it is work to be developed in partnership with educators, family members and the community itself, which aims to guarantee access to, participation in and inclusion in the school.

However, research points to the fact that intersectoral dialogue, starting with the professionals involved, does not always follow the ideal path. A frequent criticism of health programs and actions in the school environment is that they are mostly proposed in a vertical way by health professionals, that is, “communicating” what should be done by teachers (Rocha et al. al., 2002).

And, when it comes to actions built in a shared way, it is also necessary to think about the child’s place in these processes, which leads to a broader reflection as to the role they take on in society. According to Pereira and Nascimento (2011), the child is generally undervalued and seen as an irrational and incomplete being, who needs both moral preparation carried out by the family and cognitive preparation associated with the role of the school, in order to reach the rational and productive perfection that theoretically the adult members of society present.

Added to this logic, present in the relationships between adults and children, is the fact that the fundamental values and meanings of reality are defined and imposed by adults, based on their dominance over other generations (Pereira & Nascimento, 2011).

When considering children as part of the educational sector team, insofar as they are students and the target of actions, it is pointed out that their participation in the dialogue about the strategies developed and the foundations that support them, is rare.

Alderson (2005) points out that no one is able to better describe children's experiences than those who experience them, and because of this, the child's speech needs to be valued and validated, not just because there is the intertwined process of its own uniqueness, but mainly because the recognition of their speech by adults allows the child to gain greater autonomy and strength when facing subtle forms of violence that deny them the right to be a subject, in the full sense of the term.

This understanding confirms what is proposed in the process of care and promotion of mental health for children and adolescents: effective listening must be valued and the particularities of these subjects must be considered, as they are also responsible for their complaints and demands (Brazil, 2014). Furthermore, the practice of citizenship and social participation are desirable in the care process, which must be planned in a participatory way with the child or adolescent, their families and other community actors.

In the same way, social and academic movements have claimed that the production of knowledge related to childhood can commit itself to the development of fairer and more democratic methods, which allow children to participate actively in investigations (Parrilla et al., 2016).

Thus, the present study proposed developing an investigation in a participatory way, with the objective of exploring and understanding the perceptions of 23 children, between 9 and 11 years of age, about the aspects that favor and that harm their mental health, in the context of an after-school program.

Methodology

The research carried out in this work can be characterized as qualitative and exploratory, and was carried out by means of participatory methods that, according to Parrilla and Sierra (2015), foresee that subjects not only collaborate in sharing information, but, to a large extent, can guide and direct the research. The authors emphasize that participatory research is developed “with” the participants, “by” the participants and “for” the participants, however, in any case, it is not an investigation “about” them.

Participants

Twenty-five children ‒ 11 girls and 14 boys aged between 9 and 11 years of age ‒ linked to an after-school program, all belonging to the same class, participated in the present study.

Location

The study was carried out in an after-school program located in a medium-sized town in the countryside of the state of São Paulo, which attends children and adolescents aged 6 to 14 years of age (from the most socially vulnerable areas of the town) with the offer of cultural, sport, recreational, and educational activities and games.

Ethical aspects

The research project was approved by the Ethics Committee for Research on Human Subjects at the university to which the study was linked. It is important to note that the after-school program also sought authorization to carry out the research. After defining the participants, the institution's coordination sent the Terms of Consent to the children and the Terms of Free and Informed Consent to their guardians, and requested their signatures. Only after receiving the signatures did the field research start.

Data production resource

The resource used to produce the data was photo-voice: a participatory and community investigation technique that basically, provides power and the right of speech to those who are generally not heard, by means of the documentation of everyday life based on images and narratives. (Doval et al., 2013).

According to Bertagnoni (2017), photo-voice, although still little exploited as a methodological resource in research with children, is a tool with great prospects in the sense of recognizing them as subjects – and not objects – of research. From there, they can be active participants and first-hand informers about their perspectives on the topic studied.

Procedures

The identification and selection phases of the participants were carried out jointly with the institution's team and considered the children's interest and their suggestions regarding the best strategies to carry them out.

After an adaptation period so as to get to know the participants and the routine of the premises, the researchers proposed actions to favor the expression of the participating children and help them to identify their perception regarding the aspects present in the context of the institution that favor and those that harm their own mental health. Thus, with regard to the production of data related to the objectives of this research, four meetings were held, in which photo-voice, collage and writing activities were developed.

The description of the meetings was structured from the above in the following table:

  Activity Objectives 1st and 2nd meetings I. Division of the class into 3 groups; II. Explanation of Photo-Voice steps; III. Demonstration of equipment (cameras); IV. Capture of photos; V. Register of explanations of photos in audio and on paper. a) Learning about the Photo-Voice process – discussion of doubts, opinions and collective construction of strategies for the internal organization of the groups; b) Individual capture of 6 photos – 3 that represent what favors and 3 that represent what harms their own mental health. c) Verbal description of the photographed images. 3rd meeting I. Distribution of printed photos corresponding to each group; II. Choice of photos and composition of posters with the themes of Photo-voice by each group; IV. Explanatory collective audio recording by each group. a) Provide space for analysis, debate and group reflection on factors that favor and factors that harm Mental Health, in search of a group consensus in the synthesis of information for the poster; b) Elaboration of at least two final visual products per group, which portray their perceptions/conclusions on the themes. 4th meeting I. Reading of speeches corresponding to group audios; II. Completion of posters; III. Collective discussion about possibilities for exhibiting the material produced. a) Group validation of the textual description/caption of each poster, prepared by the researchers from the audios; b) Conclusion of the activity. Source: produced by the authors (2020)

	Activity	Objectives
1st and 2nd meetings	I. Division of the class into 3 groups; II. Explanation of Photo-Voice steps; III. Demonstration of equipment (cameras); IV. Capture of photos; V. Register of explanations of photos in audio and on paper.	a) Learning about the Photo-Voice process – discussion of doubts, opinions and collective construction of strategies for the internal organization of the groups; b) Individual capture of 6 photos – 3 that represent what favors and 3 that represent what harms their own mental health. c) Verbal description of the photographed images.
3rd meeting	I. Distribution of printed photos corresponding to each group; II. Choice of photos and composition of posters with the themes of Photo-voice by each group; IV. Explanatory collective audio recording by each group.	a) Provide space for analysis, debate and group reflection on factors that favor and factors that harm Mental Health, in search of a group consensus in the synthesis of information for the poster; b) Elaboration of at least two final visual products per group, which portray their perceptions/conclusions on the themes.
4th meeting	I. Reading of speeches corresponding to group audios; II. Completion of posters; III. Collective discussion about possibilities for exhibiting the material produced.	a) Group validation of the textual description/caption of each poster, prepared by the researchers from the audios; b) Conclusion of the activity.

• Source: produced by the authors (2020)

With regard to data analysis, it is noteworthy that it was developed with the children themselves, through organization procedures of the products created and presentation for collective validation, to provide spaces for speech/expression and creation of consensus on what they had produced.

Such a process is presented by Liebenberg (2009, 2018), who discusses the elucidative methods for data production. According to the author, visual methods should involve the collective interpretation of images by the group and the related co-construction of meaning.

By exploring why images are important, what they reflect, why these situations exist and what can be done about them, participants can become aware of the wider social processes and conditions in which their experiences are embodied; they can move through various stages of critical consciousness; are better able to highlight what is needed to change these situations; and are better able to identify existing resources and highlight needed resources. Collectively, this exercise can significantly inform knowledge development, knowledge sharing and social action in the process of inclusive participatory research (Liebenberg, 2018).

Furthermore, throughout the investigative process, the information and perceptions of the researchers were recorded in a field diary.

Results and discussion

Based on the 221 printed photographs, the participating children, divided into 3 groups, made 6 posters – each group produced two: one referring to “good mental health” and one referring to “bad mental health”, as they called it.

Each poster was analyzed by its respective authorship group, which resulted in consensual speeches that were recorded in the audio. The data were synthesized by the researchers into small texts that were later validated with each group, in order to produce and clarify the photo-voice for possible spectators.

The collective texts of each group are presented below:

a) What promotes mental health

“Children who play and have fun with their friends, this brings happiness.

Playing sports is good.

Sleep and rest help you wake up with more energy.

Conversation circles are important because you can listen to friends and share things in your life” –

Group 1

“Books bring more knowledge and also fun; on the cover it says to throw trash in the trashcan, this is important because conscientious children build a better world.

Educational games make you think.

Trees clean our air and help us breathe, this is good; when we are in contact with nature we stop and reflect and we can change for the better.

Healthy eating is good for our health.

While children play, they think more about games and not fights, they do not practice bullying.

Playing with animals makes you forget about the bad things that happen to you” –

Group 2.

“Doing sports is good for our health because we get stronger and it's fun.

Playing makes people happier and more joyful.

Watching movies on rainy days makes us calmer, sometimes it makes us sleepy, this is good” –

Group 3.

b) What harms mental health

“Fights, playing alone, loneliness, isolation.

Disrespecting the rules.

Destroying the environment and nature” –

Group 1.

“Fights, name-calling and bullying hurt hearts and hurt people; they may even give up the things they love most and become depressed.

Arguments attract quarrels, quarrels attract death, and death attracts sadness.

Sometimes a person who has a sad heart can't open his/her heart up to anyone, it's very bad.

Pollution and dust attract disease and this is bad for mental health and families, because people can die because of it” –

Group 2.

“Fights, aggression, racism and bullying make the person sad, hurt, it can hurt; those who were bullied when they grow up will want to do harm to those who practiced bullying and this brings more and more violence. Using your cell phone is addictive, makes you crazy and is also bad for your eyesight” –

Group 3.

Thus, it is possible to observe that the aspects considered by the children as favoring mental health point to playing, sports, learning and contact with nature.

Regarding what they consider to be harmful to mental health, violence and its consequences (physical and verbal aggression, discrimination, bullying, disrespect for rules and the environment) make up the most prevalent theme. Staying on the cell phone for a long time was also mentioned.

With regard to the photo-voice development process, it is worth noting that the method was proposed by the researchers, however, within it, a new experience was undergone, uniquely associated with the subjects of this research, based on their particularities.

In this sense, one of the points that drew attention was the curiosity and surprised reactions that the contact with the camera “object” aroused in the vast majority of children, who said they had never seen the equipment in a way that was not integrated into a smartphone. It is considered that this factor, per se, further enhanced the strategy in the context of this research, simply because of the use of older cameras.

The aura of the object perceived through observation is capable of formulating a different way of seeing by means of the exploration through the child's gaze, that is, it can produce a new look, due to the naive fact that it occurs through an old-fashioned object; this scenario, therefore, gave the photographic process greater playfulness, entertainment and distraction and, in this sense, the production of photos as archives and the manual/handcrafted construction itself of posters referring to “good mental health” and “bad mental health” represented an experience that is also more likely to be sedimented as a memory for these individuals, given the collective euphoria that embellished the entire process of this performance.

In addition, according to Mannay (2017), upon receiving the cameras, the subjects, instead of being passively photographed by the researcher, are the ones who take the photographs, that is, they decide when and how to represent their subjective world and what to represent from it.

In the specific case of photographs – which the generation of these children is used to viewing from screens due to the reality of the technological immersion they experience – these were able to become physical, palpable objects that could even be exhibited to the public. The authors reflected on the fact that this event gave the participants another experience, which, perhaps, they had never enjoyed before, including the possibility of self-reflection from the act of seeing themselves materially in the posters.

As for the aspects listed by children as favoring mental health (playing games, doing sports, learning and contact with nature), Mandich and Rodger (2006) define the intentional actions that children perform in the course of their development, as children's occupations. In this sense, Dunford and Bannigan (2011) add that there is a close relationship between engagement in occupations, health and well-being.

Clearly, what the participants portrayed was that, based on the performance of the occupations that were photographed and narrated as “good mental health”, it is possible to preserve, maintain and create a state of psychic well-being. This perspective confirms the results of recent studies that also listened to children and, similarly, are moving towards an understanding of well-being and happiness that encompass factors such as playfulness, positive feelings, leisure, fun, the act of making and keeping friends and the practice of physical activities (Giacomoni et al., 2014).

These aspects, on the other hand, form the substrates of the learning process, also listed by the participants as one of the drivers of “good mental health”. According to Oliveira (2011),

the great flexibility of the children's thinking and their constant desire to explore require the organization of contexts conducive to learning. Creativity emerges from multiple childhood experiences, as it is not a “gift”, but develops naturally if the child is free to explore situations with different partners (p. 229)⁷.

Thus, the playful experiences and learning influenced each other mutually.

Regarding playing, Ferland (2006) understands it as a subjective action, in which pleasure, curiosity, a sense of humor and spontaneity meet, which characterizes a freely chosen behavior and from which no specific gain is expected. The author also adds that playing involves pleasure, discovery, mastery of reality, creativity and expression.

It is worth emphasizing that the environments in which the child circulates directly influence the possibilities of playing, as well as the experience and development of skills (Ferland, 2006; Fonsêca & Silva, 2015). Such concepts are in line with the results of this research with regard to the pursuit, by the participants, of carrying out activities of their own interest, such as the playful and fun ones, as a way of acquiring pleasure and well-being and, consequently, “good” mental health.

It is possible to understand, in this way, that the illustrated sports practices are also characterized as recreational activities. According to the Guide Book for the Promotion of Physical Activity in Childhood and Adolescence, published by the Brazilian Society of Pediatrics in 2017, children and adolescents should be encouraged to participate in a variety of pleasant and safe physical activities that contribute to natural development. These activities improve physical, emotional and social aspects ⁸.

The document from the Brazilian Society of Pediatrics, 2017⁹ also emphasizes that it is common for physical activity to be less practiced as children get older due to behavioral and social factors, such as increased availability for technology, increased insecurity/violence and the progressive reduction of urban open spaces for leisure¹⁰ .

In agreement with the results found, Souza et al. (2013) point out that leisure activities and coexistence among peers are considered protective factors for children's health, as they contribute to the strengthening of social, emotional and cognitive aspects. Furthermore, the bonds of friendship and the practice of leisure activities, by reducing the possibilities of psychological suffering, such as anxiety and depression, while generating well-being, pleasure and self-esteem, reinforce their capacity as elements that favor the subjects' mental health (Pondé & Caroso, 2003).

The other result that emerged from the capture of the photographs was the contact with nature. This datum is in line with perspectives addressed by public health policies aimed at the child and adolescent population that defend and highlight the biopsychosocial advantages of such a practice (Chawla et al., 2014; Louv, 2016; ONU, 2013; Sociedade Brasileira de Pediatria, 2019).

In this sense, recent initiatives such as the Child and Nature Program from the Alana Institute,¹¹ have emerged to produce, promote and disseminate content on the importance of connecting children with nature and its benefits, as well as pointing out ways to encourage and facilitate children’s direct experiences with nature and to influence public policies that favor children's contact with nature in the urban context. The group claims to be inspired by concepts proposed by specialists in different areas of childhood to systematize some ways that also promote the new meaning of school spaces as powerful places to learn in nature and with nature (Projeto Criança e Natureza, n.d.).

As per Barros (2018),

We should hear what children have to say about school spaces and try to incorporate their wishes and perceptions, qualifying them and making them better for the children and for the other members of the school community. In this way, the courtyards and the whole school can be joyful spaces that instigate discovery and experiences and provide the construction of knowledge and human development¹².

This is one of the possible ways of moving forward, in fact, towards “childhood emancipation”. According to the United Nations Organization (UN, 2013), living with natural environments and playing in these spaces also allow children and adolescents to develop strategies and means of coping with stressful situations. In this sense, the Brazilian Society of Pediatrics (2019) points out that the practice also confirms what research, carried out in recent years, indicates: conviviality with nature in childhood and adolescence improves the control of chronic diseases, reduces the risk of dependence of alcohol and other drugs, reduces behavior problems and provides mental well-being¹³, apart from helping to foster creativity, initiative, self-confidence, the ability to choose, to make decisions, to solve problems, to develop empathy and a sense of belonging.

However, studies have associated the lack of playing freely with an increased prevalence of stress and psychological distress in children.

In relation to what children consider to be harmful to mental health, it was found that the experience of peer violence was identified as the main aspect.

During the data collection process, they demonstrated experiencing a logic in relation to violence, which feeds itself, that is, in their daily lives, they end up observing, witnessing, suffering and identifying the harmful character of aggression, however, as a consequence of this cycle, they also use it as a tool in an attempt to solve their conflicts.

According to Ristum (2004), scholars of violence have repeatedly pointed out its multicausality - they show that the various causes act in a network and that it is, therefore, impossible to isolate them or study them outside the widest context in which they occur.

Theoretically, the author separates the origins of violence into contextual causes and personal causes: examples of contextual causes are the models of violence at home, on the street and in the media, as well as family difficulties and the predominant use of punishment to promote discipline in various social institutions (family, school, religion, etc.); and examples of personal causes are the following characteristics: emotional instability, stress, character and aspects related to self-esteem; it is worth mentioning that, in addition to multicausality, the interaction between these factors can occur in different ways (Ristum, 2001, 2004), and result in the cycle of the reproduction of violence discussed here.

Specifically regarding school violence, a survey carried out by the Brazilian Multiprofessional Association for the Protection of Childhood and Adolescence (ABRAPIA)¹⁴ during the elaboration and development of the Program for Reducing Aggressive Behavior among Students¹⁵, in 2002, with 5,875 students from the 5^th and 8^th grades from 11 schools located in the municipality of Rio de Janeiro, revealed that 40.5% of students admitted to having been directly involved in some form of violence against colleagues at school that year, 16.9% of them as targets, 10. 9% as targets and authors and 12.7% as authors (Lopes Neto, 2005; Ristum, 2004).

Therefore, it is observed that, despite the clarity with which the children expressed themselves when relating violent acts to the concept of something “bad”, it seems that even knowing that such a practice harms their mental health, it is not enough to be able to stop reproducing it.

The breadth of the spectrum that can be associated with the practice of violent actions, in addition to all the possibilities of combining their various components, demands the use of approaches aimed at understanding more details of this scenario and, therefore, reflection on mitigation strategies. or reversal, which are objectives that were not part of the aims of the present study.

In any case, violence is presented and reaffirmed by children as something that either defines bad mental health or harms mental health, which is in line with several studies in the field that point to the experience of violence as an important risk factor for mental health in general, especially of children and adolescents, which strongly reinforces the need for intersectoral strategies that include children, ways to deal with this reality that is clear and urgent (Fante & Pedra, 2008; Santos et al. , 2015; Zequinão et al., 2016).

Some studies specifically focus on the negative consequences of bullying, both for those who practice it and for its victims ‒ the former are more likely to experience difficulties in interpersonal relationships and the latter, to develop intense psychological distress (Fante & Pedra, 2008; Santos et al., 2015; Zequinão et al., 2016).

This data while also confirming what has been found in previous research, goes further, by clearly demonstrating the children's point of view about the prospective discomfort and suffering generated by hostile and violent situations experienced in their daily lives.

Excessive time spent with cell phones also made up the list of results of “poor mental health” pointed out by the children. Coincidentally with these data, scholars belonging to the Working Group on Health and Nature of the Brazilian Society of Pediatrics¹⁶ (2019) point to the damage caused by the phenomenon of “Digital intoxication”, characterized by increasing exposure to advertising and toxic, violent or inappropriate content. which, in turn, produces intense negative effects in terms of interaction and the physical and mental health of young people. When considering the panorama of the data produced in this investigation, it is highlighted that, to some extent, the contexts which children go through (family, school, after-school program) and the experience they build in these spaces are, apparently, capable of promoting learning related to relationships, their possibilities and limits, which, therefore, is something that can be maximized in practices and policies ‒ especially those aimed at educational spaces ‒ directed towards this population.

With regard to involving children in the knowledge production process, here are some considerations. Parrilla et al. (2018) report the advantages of using photo-voice as a resource for carrying more participatory research, and highlight its accessible, familiar and motivating character, as well as its prospect as a facilitator of exploration, stimulation and communication of thoughts.

According to Liebenberg (2018), the imagery products created by the participants serve as catalysts for the reflective discussion in which emerging meanings and interpretations are elaborated. In other words, there is a shared interpretation of personal experiences in which meaning is embodied and co-constructed.

The qualities of this instrument could be noticed and confirmed in this research, since throughout the process it was possible to observe great involvement by the participating children, who were constantly motivated to carry out the proposed activities.

In addition, at the time of the collective selection of photos for the preparation of posters and exposure of the narratives attributed to the contents, the children were able to create their own meanings and to position themselves in a critical and active way regarding knowledge. These are consequences that are also pointed out by the authors as having come from the application of the photo-voice, in the context of a participatory research proposal.

Finally, it is noteworthy that by facilitating the expression of children's opinions and thoughts about aspects that they consider beneficial and those that they consider harmful to mental health, this study contributed to the expansion of social participation of this part of the population. This action meets the ideals established by the current mental health policy, which ponders on the need to join intersectoral actions, as well as to consider children and adolescents as integral beings, with the right to full participation and inclusion in their communities, and to value listening to what they have to say (Brasil, 2014).

Final Considerations

The results of the present study portray what children from 9 to 11 years old think about what favors and what harms mental health in the context of an after-school program, and advance in the production of knowledge about childhood, especially in the field of children's mental health, insofar as they focus on children's conceptual production on the subject, which, in turn, has been fundamentally developed by the adult perspective.

Based on the results, it was possible to verify that, for the participating children, playing, practicing sports, contact with nature and carrying out recreational educational activities are seen as elements that favor their mental health, while violence and bullying are considered harmful.

The children's perception about the prospect of activities that provide pleasure, fun and learning for the promotion of children's mental health and about the damage that hostile practices cause was in line with studies carried out in the area, and, the capacity that children have to talk about themselves and the issues that concern them was thus verified. This may support future practices and policies aimed at this population, which lead to actions that actually protect them.

In this sense, comprehensive public education is highlighted here as a strategy to enrich the routine of children and young people, with a view to promoting opportunities for coexistence, recreation, development of daily and practical skills and preparation for social, emotional and academic life. – a scenario that would certainly enable the development of other studies that would value the role and right of speech of its participants.

In view of this, it is also noteworthy that one of the challenges faced in this investigation is based on the short period of time for its execution - a total of four meetings lasting two hours each. Thus, it is believed that the possibility of a greater number of meetings could contribute to the identification of new elements favorable and harmful to children’s mental health, since a longer bond with the researchers and a greater adaptation to this non-traditional way of doing research could contribute to a greater expression by the participants.

In any case, despite this, the study achieved its objectives, by revealing the prospect of more participatory methodologies, more specifically photo-voice, as contributors to the production of knowledge in the area of ​​childhood, insofar as they promote spaces for inclusion, emancipation, social participation and expression of the actors directly involved, in other words, the children.

Furthermore, with a view to moving towards equality, social justice and mental health, it is pointed out that there is a need – and even an urgency – for the less valued voices to continue being heard and, in addition, listened to, considered, disseminated and amplified, mainly through research that is committed to guaranteeing the participation of subjects in an active and co-productive way, in such a way that it is done “with”, and not “for” them.

• 2
  References correction and bibliographic normalization services: Andréa de Freitas Ianni ‒ [e-mail]
• 3
  Funding: Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP - 2018/23485-3
• 4
  English version: Deirdre Giraldo - [e-mail]
• 5
  Translation from Portuguese of: a saúde mental infantojuvenil é dinâmica e resultado da relação complexa entre os recursos e habilidades pessoais, fatores contextuais e determinantes sociais, que na dimensão do cotidiano estão diretamente implicados nas possibilidades de participação, fruição, reconhecimento e enfrentamento de desafios. O que, dentre outras, envolve a possibilidade de experienciar prazer, frustração, afeto, motivação e proatividade implicados nas descobertas e aprendizados genuínos da infância e adolescência (Fenandes, 2019,p. 107).
• 6
  Translation from Portuguese of: A escola promove saúde mental quando discute no seu cotidiano as relações que estabelece e as diferenças que se evidenciam entre as pessoas e organizações com quem trabalha. Isto vale para a relação entre educadores, entre educandos, educandos e educadores, e de todos com as famílias, comunidade e instituições locais. O exercício do diálogo é fundamental para promover saúde mental (Souza, 2010, p. 2).
• 7
  Translation from Portuguese of: a grande flexibilidade do pensamento da criança e seu constante desejo de exploração requerem a organização de contextos propícios de aprendizagem. A criatividade emerge das múltiplas experiências infantis, visto que ela não é um “dom”, mas se desenvolve naturalmente se a criança tiver liberdade para explorar as situações com parceiros diversos (Oliveira, 2011, p. 229).
• 8
  Translation from Portuguese of: “as crianças e os adolescentes devem ser encorajados a participar de uma variedade de atividades físicas agradáveis e seguras que contribuam para o desenvolvimento natural. Estas atividades melhoram os aspectos físicos, emocionais e sociais” (Manual de Orientação à Promoção de Atividade Física na Infância e Adolescência, publicado pela Sociedade Brasileira de Pediatria, 2017, p. 3).
• 9
  Translation from Portuguese of: Sociedade Brasileira de Pediatria.
• 10
  Translation from Portuguese of: “fatores comportamentais e sociais, tais como a disponibilidade aumentada para a tecnologia, o aumento da insegurança/violência e a progressiva redução dos espaços livres urbanos para o lazer” (Sociedade Brasileira de Pediatria, 2017. p. 2).
• 11
  Translation from Portuguese of: Programa Criança e Natureza, Instituto Alana.
• 12
  Translation from Portuguese of: devemos ouvir o que as crianças têm a dizer sobre os espaços escolares e procurar incorporar seus desejos e suas percepções, qualificando-os e tornando-os melhores para elas e para os demais membros da comunidade escolar. Nesse caminho, os pátios e toda a escola podem ser espaços de alegria, que instigam a descoberta e a experimentação e propiciam a construção de conhecimentos e o desenvolvimento humano (Barros, 2018, p. 42).
• 13
  Translation from Portuguese of: o convívio com a natureza na infância e na adolescência melhora o controle de doenças crônicas, diminui o risco de dependência ao álcool e outras drogas, reduz problemas de comportamento e proporciona bem-estar mental (Sociedade Brasileira de Pediatria. 2019. p. 6).
• 14
  Translation from Portuguese of: Associação Brasileira Multiprofissional de Proteção à Infância e Adolescência (ABRAPIA).
• 15
  Translation from Portuguese of: Programa de Redução do Comportamento Agressivo entre Estudantes.
• 16
  Translation from Portuguese of: Grupo de Trabalho em Saúde e Natureza da Sociedade Brasileira de Pediatria (2019)

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Edited by

1

Responsible Editor: Silvio Donizetti de Oliveira Gallo. https://orcid.org/0000-0003-2221-5160

Publication Dates

• Publication in this collection
  12 Sept 2022
• Date of issue
  2022

History

• Received
  27 Feb 2020
• Reviewed
  05 Aug 2021
• Accepted
  01 Sept 2021