{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:45:04Z","timestamp":1782819904548,"version":"3.54.5"},"reference-count":27,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003593","name":"CNPq","doi-asserted-by":"crossref","award":["310790\/2021-2"],"award-info":[{"award-number":["310790\/2021-2"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004901","name":"FAPEMIG","doi-asserted-by":"crossref","award":["PPM-00428-17"],"award-info":[{"award-number":["PPM-00428-17"]}],"id":[{"id":"10.13039\/501100004901","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002322","name":"CAPES","doi-asserted-by":"crossref","award":["88887.507149\/2020-00"],"award-info":[{"award-number":["88887.507149\/2020-00"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001674","name":"Leducq Foundation","doi-asserted-by":"crossref","award":["22ARF02"],"award-info":[{"award-number":["22ARF02"]}],"id":[{"id":"10.13039\/501100001674","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Institute of Science and Technology for Health Technology Assessment","award":["465518\/2014-1"],"award-info":[{"award-number":["465518\/2014-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["gh"],"abstract":"<jats:p>Background: Rheumatic heart disease (RHD) is a preventable cause of premature death among young individuals in low- and middle-income countries. Education is a key strategy to alleviate the burden of this disease. We aimed to assess the acceptability and knowledge gain of a series of low-literacy education flipcharts, presented during screening in high-burden areas of Brazil.\n        Methods: Four low-literacy flipcharts were developed over three years and taught over 36 months to patients, community, school children, and health and education professionals, mostly in the state of Minas Gerais. In-person training and education workshops were assessed through printed surveys. Post-education surveys (for patients and community members), and post-training surveys (for healthcare and education professionals) were conducted from January 2023 to December 2025. A knowledge test, delivered at pre-training, post-training and three-month follow-up, was incorporated from January 2024 to March 2025.\n        Results: Flipchart training was delivered to 1,317 healthcare and education professionals, while 1,292 patients and community members and 2,585 school students received education using the flipcharts. There was a statistically significant (p &lt; 0.01) improvement in knowledge about rheumatic fever (RF) and RHD among healthcare and education professionals participating in the pre- and post-training survey (n = 511): RF as the cause of RHD (64% vs 95%), use of benzathine penicillin G (43% vs 98%), and frequency of antibiotic prophylaxis (21% vs 77%). The improvement from baseline was sustained at follow-up. Over the entire study period, 98% of survey respondents (2,134) reported learning something new, and 94% (2,041) intended to share the learnings with their peers or community.\n        Conclusion: Culturally adapted, low-literacy educational flipcharts were successfully integrated into an existing RHD screening program in Brazil. The tool was well accepted among people living with RHD, their providers, and at-risk communities, with significant knowledge gain for healthcare and education professionals.<\/jats:p>","DOI":"10.5334\/gh.1510","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:38:48Z","timestamp":1767094728000},"page":"115","source":"Crossref","is-referenced-by-count":0,"title":["Rheumatic Heart Disease Education Tools Integrated Into a Screening Program in Brazil: Acceptability and Knowledge Gain"],"prefix":"10.5334","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3962-3267","authenticated-orcid":false,"given":"Jessica","family":"Abrams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanessa C.","family":"Vinhal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6798-2737","authenticated-orcid":false,"given":"Craig A.","family":"Sable","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0689-1644","authenticated-orcid":false,"given":"Clareci S.","family":"Cardoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-2760","authenticated-orcid":false,"given":"Liesl","family":"Z\u00fchlke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Spaziani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laylah","family":"Ryklief","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carmo P.","family":"Nunes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabely Karoline S.","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebeca","family":"Previero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena R.","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz M. Tacuri","family":"Chavez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaciane K. B.","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingred Beatriz","family":"Amaral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"Lemos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julliane S.","family":"Correa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cec\u00edlia T.","family":"Coelho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenno A.","family":"Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiza H.","family":"de Paula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isadora S.","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luiza B. 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