Development and validation of children’s stories as a health education strategy in speech, language, and hearing sciences

Costa, Laura Lima; Jorge, Tatiane Martins

doi:10.1590/2317-1782/20212021309en

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Original Article • CoDAS 34 (6) • 2022 • https://doi.org/10.1590/2317-1782/20212021309en copy

Development and validation of children’s stories as a health education strategy in speech, language, and hearing sciences

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

Developing and validating children’s stories focused on health education in Speech, Language, and Hearing Sciences.

Methods

Cross-sectional, descriptive, quali-quantitative two-step study. 1st) elaboration of 10 children’s stories, guiding questions, explanatory notes, and illustrations. 2nd) validation by judges (speech therapists, educators, and familiar) in two phases. In the first, the sample consisted of 42 judges and in the second, 28. To access the materials and the validation questionnaire, a website was made available. The questionnaire investigated the judges’ personal data and the judges’ perceptions regarding the contents, vocabulary, illustrations, structure, and motivation of the materials. A five-point Likert scale of the agreement was used, with spaces for suggestions in each question. The quantitative analysis was done using the Content Validity Index and the Content Validity Coefficient. The qualitative analysis was based on the comments of the judges. The minimum rate of agreement among the judges on the decision to change or not change the materials was 80%.

Results

The first phase pointed out the need for modifications in three titles and two vocabularies (bullying and dyke), and the need for increasing to five years of age the minimum age for access to the materials. The second phase revealed good acceptability in all changes made.

Conclusion

The materials developed were validated and can be used as health education tools by speech therapists and educators, as well as parents.

Keywords
Juvenile Literature; Speech, Language and Hearing Sciences; Child; Health Education; Self-care

Story titles	Themes	Synopses
The Bunny Princess and the Scream	Abusive vocal behavior, focusing on screaming	Presentation of the Kingdom of Rabbits, of Princess Bunny who communicated only by screaming, and how the Fairy made her understand that screaming harmed her relationship with her interlocutors and caused changes in her voice.
The Messenger Pigeon	Reading and writing changes	A baby pigeon had difficulties in oral and written language. His dream was to be a real messenger like his parents, but he couldn’t due to difficulties. The Fairy intervened, teaching him to speak and write well, so she was able to fulfill her dream.
The Good Ear	Unilateral hearing loss and the importance of auditory rehabilitation.	The Fairy was watching a baby bat with difficulty hearing in one ear and the ability to locate sound, which made it impossible to fly. Recognizing the presence of a hearing loss, the Rabbit Queen ordered a hearing aid. The puppy adapted to the device and was able to fly thanks to the intervention.
The Health System	Implementation of a free and universal Health System.	The public health system was created by the rulers of the Kingdom of Rabbits, and there was a public presentation of the Fairy. It was clarified that problems could be solved without using magic.
The Swimming Duck	Swimmer’s ear and consequences for speech and hearing.	One of the ducklings had earache after swimming and speech disorders as a result of recurrent ear infections. A way to prevent earache was presented, and with that language could be developed without difficulties.
The Castor and the Pacifier	Pacifier use and impact for orofacial development.	Dental alterations were portrayed by the use of the pacifier, which prevented the chick from using its teeth to gnaw wood, an essential activity for beavers.
Chico and Food	Importance of food variety for the development of the stomatognathic system	The importance of food variation, different consistencies, hardness, and types of food, for the development and strengthening of the stomatognathic system, was portrayed.
Lulu and the stuffy nose	Mouth breathing and impact on orofacial and body development.	The oral breather was portrayed due to an allergic condition. The objective was to show anatomical changes, stomatognathic, emotional, and cognitive functions that this type of breathing can cause in child development.
Kiki and the Stutter	Developmental stuttering and bullying.	A pup named Eduardo was nicknamed Kiki and was bullied at school for having a developmental stutter. In the family environment, it was not much different. Even so, he felt motivated to achieve his goal, to be a reporter, like his father.
The Fairy’s Profession	Role of the Speech-Language Pathologist. Importance of the creation of Speech-Language Pathology Science	The Fairy’s performance became known in other realms, and during an event for fraternization in the Kingdom of Rabbits, the appointment of the Fairy’s profession was discussed; and the name chosen was Fonoaudiologia.

Domains	Nº	Questions
Content	Q1	The content of the stories is suitable for children.
	Q2	Educational information relevant to the target audience was presented.
	Q3	The sequence of children’s stories is logical and coherent.
	Q4	Stories are important for children’s self-care.
	Q5	The stories can circulate in the scientific environment of the area.
	Q6	The information contained in the stories can be considered a health education strategy.
	Q7	The guiding questions for children’s understanding of the content are coherent.
	Q8	The titles of the stories are pertinent.
	Q9	Explanatory notes for family members, educators, or caregivers are important.
	Q10	Explanatory notes for family members, educators, or caregivers are clear.
Vocabulary	Q11	Vocabulary is accessible to children.
Vocabulary	Q12	The texts (of the stories and explanatory notes) are clear and objective.
Illustration	Q13	The images are easily recognized by children.
Illustration	Q14	The images arouse children’s interest in the stories.
Structure	Q15	Text formatting, font size, and font are adequate.
Structure	Q16	The organization of the text and illustrations is adequate.
Motivation	Q17	The content is a motivator for behavior change.
	Q18	The content sparks interest.
	Q19	The materials can be used by any caregiver.
	Q20	The materials propose the construction of knowledge for children and their caregivers.

Domains	Judges’ response on a 5-point Likert scale and CVI calculation (%)
Domains	Speech-Language Pathologists (10)			Educators (18)			Family members (14)			General
CONTENT	1, 2 or 3	4 or 5	CVI	1,2 or 3	4 or 5	CVI	1,2 or 3	4 or 5	CVI	CVI
The content of the stories is suitable for children.	0	10	100	0	18	100	0	14	100	100
Relevant educational information was presented to the public.	0	10	100	0	18	100	0	14	100	100
The sequence of children’s stories is logical and coherent.	0	10	100	0	18	100	0	14	100	100
Stories are important for children’s self-care.	0	10	100	0	18	100	0	14	100	100
The stories can circulate in the scientific environment of the area.	0	10	100	0	18	100	0	14	100	100
The information contained in the stories can be considered as a health education strategy.	0	10	100	0	18	100	0	14	100	100
The guiding questions for understanding the content for children are coherent.	0	10	100	0	18	100	0	14	100	100
The titles of the stories are pertinent.	0	10	100	0	18	100	3	11	78.5 ^* * Value lower than the minimum agreement of 80%	92
Explanatory notes for family members, educators or caregivers are important.	0	10	100	0	18	100	0	13	92	97.33
Explanatory notes for family members, educators or caregivers are clear.	0	10	100	0	18	100	0	13	92	100
Domain Total			100			100			96	98.93
VOCABULARY	1. 2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	CVI
Vocabulary is accessible to children.	1	9	90	0	18	100	2	12	85	91.66
The texts (of the stories and explanatory notes) are clear and objective.	1	9	90	0	18	100	0	14	100	96.66
Domain Total			90			100			92.5	94
ILLUSTRATION	1. 2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	CVI
The images are easily recognized by children.	0	10	100	0	18	100	0	14	100	100
The images arouse children’s interest in the stories.	0	10	100	1	17	94	1	13	92	95.33
Domain Total			100			97			96	97.66
STRUCTURE	1. 2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	CVI
Text formatting, font size, and font are adequate.	1	9	90	1	17	94	0	13	92	92
The organization of the text and illustrations is adequate.	1	9	90	1	17	94	1	13	92	92
Domain Total			90			94			92	92
MOTIVATION	1. 2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	1.2 or 3	4 or 5	CVI	CVI
The content is a motivator for behavior change.	0	10	100	0	18	100	0	13	92	97.33
The content sparks interest.	1	9	90	0	18	100	0	14	100	96.66
The materials can be used by any caregiver.	1	9	90	0	18	100	1	13	92	92
The materials propose the construction of knowledge for children and their caregivers.	0	10	100	0	18	100	0	14	100	100
Domain Total			95			100			96	97
General CVI			96			98.2			94.5	95.92

Questions	Judges’ response on a 5-point Likert scale and CVI calculation (%)
Questions	Speech-Language Pathologists (9)			Educators (9)			Family members (10)			General
	1, 2 or 3	4 or 5	CVI	1,2 or 3	4 or 5	CVI	1,2 or 3	4 or 5	CVI	CVI
The new vocabulary is accessible to children	0	9	100	1	8	88.88	2	8	80	89.62
The new story titles are pertinent.	0	9	100	1	8	88.88	0	10	100	96.29
Total			100			88.88			90	92.95

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[1] Conflict of interests: nothing to declare.