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Social Appropriation of Knowledge About Research in Prostate Cancer with Middle Education Students in Three Colombian Cities

Social Appropriation of Knowledge About Research in Prostate Cancer with Middle Education... In Colombia, prostate cancer (PCa) is the most common cancer for incidence and mortality in men, which turns it into a public health problem. For high-risk communities to better understand the usefulness of basic research about PCa, a strategy of social appropriation of knowledge (SAK) in science and cancer was designed and implemented. A pedagogical activity and two tests (a pre-test and a post-test) were applied to middle education students in four schools in three Colombian cities to identify previous knowledge of biology concepts and cancer perceptions. As for biology concepts, there was a statistically significant increase (p < 0.01) in the total results of all questions in the post-test, especially in items related to the structure of DNA, differences between RNA and DNA, and codon. Similarly, better success rates were observed in questions about replication and mutation, and a statistically significant improvement related to the definition of cancer, cancer prevention, and its association with culture or ethnicity (p < 0.01). The results of the open question show what students learned about or were interested in the most, as evidence of the exchange of knowledge in those cities and the social appropriation of knowledge about PCa in Colombia. These findings show that this type of intervention, in diverse social contexts, is essential to improve understanding and perceptions that link school and scientific knowledge to a real problem, such as health and, in this case, cancer. Keywords Cancer · Prostate Cancer · Social Appropriation of Knowledge · Students · Pre-Test · Post-Test · Educational Institutions Introduction cases are detected yearly, and about 3846 men die due to this reason. It is estimated that in the next 20 years, there Cancer has become one of the principal causes of morbid- will be an increase of double of cases presented today [3], ity and mortality globally [1]. One of the cancer types with becoming the cancer type with the highest incidence and the highest incidence is prostate cancer (PCa), and it is the second in mortality, which makes it a public health problem second most common and the fifth with the highest mor - in our country. tality rates worldwide [2]. In Colombia, more than 14,460 Prostate cancer is multifactorial, with the main triggers being the following: (I) age, with one man affected for every 500 at 40 years of age, while one in 14 men is affected at * Martha Lucía Serrano 60  years; (II) family history, where the probabilities of mlserranol@unal.edu.co; mlserrano@cancer.gov.co developing PCa due to having first-grade relatives are 2.17 Cancer Biology Research Group, Instituto Nacional de times higher for a father with the disease, 3.37 times higher Cancerología E.S.E, Bogotá, Colombia for a brother, and 5.08 times higher if one has more than two Research Support and Monitoring Group, Instituto Nacional first-grade relatives with PCa; (III) African ancestry, given de Cancerología E.S.E, Bogotá, Colombia that Afro-descendant populations have 2.5 times higher rates Department of Oncological Urology, Instituto Nacional de to develop this disease compared to men who are not Afro- Cancerología E.S.E, Bogotá, Colombia descendant [4]. Afro-descendant populations present diverse Department of Chemistry, Faculty of Science, Universidad genetic characteristics associated with an increased risk of Nacional de Colombia, Bogotá, Colombia Vol.:(0123456789) 1 3 Journal of Cancer Education PCa; however, this susceptibility, in addition to genetic public policy for social appropriation of knowledge within implications, may also be associated with existing dispari- the framework of science, technology, and innovation in ties in access to health care, socioeconomic aspects, and Colombia [10]. With this context in mind, it expected to education [5–7]. encourage the study of cancer from an integral and multidis- Based on the project “Analysis of molecular alterations of ciplinary perspective. This strategy enabled the participation SPOP, FOXA1, and IDH1 in prostate cancer in Colombian of citizens, in this case, students, in scenarios of exchanging population and their possible implications in prognosis,” a knowledge and experiences about cancer to generate reflec- strategy of social appropriation of knowledge (SAK) in sci- tions that influence the awareness of communities about the ence and cancer was designed to provide vulnerable commu- importance of early diagnosis and the positioning of this nities with a better understanding of the usefulness of basic disease as a public health problem, in the social context of research on PCa. Our SAK strategy focused on exchanging science teaching in Colombia. Considering that the school knowledge and experiences with communities with the high- setting is a replicating space of knowledge and experiences, est risk of developing PCa in Colombia. the SAK strategy aimed to raise awareness among young This paper explains the development of this SAK strategy people on the importance of generating knowledge that in science and cancer, focusing on educational populations, might contribute to the control of PCa, as well as to trans- by identifying the significance of the transmission, dissemi- mit this knowledge to Colombian families in a simple and nation, and appropriation of scientific knowledge on cancer understandable way. in school contexts for young people and highlighting the The SAK strategy was designed as a pedagogical activity importance of PCa research in Colombia. titled “Let’s learn about cancer together: An overview of the contributions of science to the control of this disease.” This pedagogical strategy used instruments designed for tenth- Methodology and eleventh-grade students, which consisted of different topics and activities for students to appropriate and under- Target Population stand concepts and acquire new knowledge about science, cancer, and PCa research in our population. Figure 1 shows The SAK strategy was applied in educational institutions the intervention structure, which consisted of two compo- in cities with high incidence and mortality rates of PCa in nents. The first one was “Introduction and concepts,” which Colombia, according to statistics. The departments with the was composed of four phases and one pedagogical activity highest mortality rates of PCa are San Andrés y Providen- called “Carcinogens and prevention in cancer.” This phase cia, Cesar, Atlántico, and Valle del Cauca, with standardized was required for students to understand the second compo- mortality rates of 17, 16.8, 15.1, and 14.4, respectively [8]. nent, which was “Socialization of the research project”; this The estimated age-standardized incidence rates for PCa in was composed of three phases and two pedagogical activi- these departments are 90, 60.8, 60.4, and 59.8, respectively ties: “Genes analyzed in PCa project” and “Genetic code [9]. and mutation.” Based on this parameter, the cities of Valledupar, San Before implementing this pedagogical strategy in the Andrés, and Cali were selected from the departments of selected schools, pilot activities of this intervention were Cesar, San Andrés y Providencia, and Valle del Cauca, carried out in Bogotá, in two public schools with eleventh- respectively, for the implementation of this pedagogical grade students (Colegio República de Colombia and Colegio activity, as they correspond to the departments with the Francisco José de Caldas) and in a public university with highest presence of at-risk population for PCa, such as last-semester biology students (Universidad Distrital Fran- Afro-descendant communities. The SAK strategy was imple- cisco José de Caldas). The objective was to detect and per- mented in four schools. In each school, 20 to 39 students form necessary changes and adjustments to the activities and participated, given the biosafety restrictions of COVID-19, the tests, so that they were didactic, pedagogical, and easily and because it was considered essential to provide more per- understood by students. sonalized interaction. Test of Knowledge and Perceptions of Cancer SAK Strategy Design Before and after the intervention, two tests (a pre-test and This strategy originated from the project “Analysis of molec- a post-test) were applied to students to identify their prior ular alterations of SPOP, FOXA1, and IDH1 in prostate can- knowledge and measure the intervention’s impact based on cer in Colombian population and their possible implications some basic aspects of biology and cancer concepts, besides in prognosis.” The SAK strategy design sought to recognize the new knowledge acquired. These tests consisted of mul- the Colombian social, cultural, and economic context and tiple choice, true–false choice, and connector questions 1 3 Journal of Cancer Education Fig. 1 Strategy phases. The strategy is illustrated by two gears repre- Second component: “Socialization of the research project” allowed senting the first and second components. First component: “Introduc- students to understand the PCa research project based on concepts tion and concepts” allowed students to reinforce the genetic concepts such as mutation, molecular alterations, and genetic code, as well as they had seen in class and learn new concepts related to cancer. It the social aspects that compose it. Phase A2: PCa overview and at- is composed of four phases: Phase A1: recognition of the contribu- risk populations: introduction of general concepts of PCa, emphasiz- tions of science to health: conversation with students about transla- ing Afro-descent ethnicity as a risk for the development of aggressive tional medicine as an example of articulation between the activities prostate cancer; Phase B2: explanation of the research project: two carried out in a laboratory and the medical staff, and how they can pedagogical activities were carried out for a better understanding of provide a direct benefit for the patient; Phase B1: review of biol- the research project. The first activity “Genes analyzed in PCa pro- ogy concepts: concepts such as DNA, RNA, protein, chromosomes, ject” consisted of students understanding the functions of the genes genetic code, and mutations were reviewed; Phase C1: cancer con- “SPOP, FOXA1, IDH1, IDH1, TMPRSS2, and ERG, and the impact cepts: explanation of what cancer is and genes involved in cancer and of their molecular alterations in PCa.” The second activity “Genetic carcinogens. In this phase, the pedagogical activity “Carcinogens, code and mutation” aimed to help understand the results of the pro- prevention and types of cancer” was carried out, which consisted ject; Phase C2: reflection on the importance of cancer research in the of students identifying different types of cancer, relating their cause country. Before and after the intervention, a test (pre-test and post- and prevention, and then explaining a specific type of cancer to their test) was done classmates; Phase D1: reflection on the importance of prevention. 1 3 Journal of Cancer Education (Supplementary Material Table 1S). The distractor option “I management was supervised by of the primary investigators. do not know/I do not remember” was included to minimize These interventions were approved by the Ethics Committee random answers. During test qualification, biology concepts of the Instituto Nacional de Cancerología E.S.E. were separated from those about cancer perceptions because students were expected to have previous knowledge about biology concepts acquired in school. On the contrary, cancer perception questions were based on knowledge acquisition Results from their own experiences and not taught in school. Biol- ogy items were evaluated on a score of 0 to 5, while cancer Characterization of the Intervention Populations perception questions used a different score on a scale of 0 and Strategy Implementation to 3. After the intervention, a post-test was carried out with There are three types of educational institutions in Colom- the same pre-test items but including an additional qualita- bia: public, private, and public–private partnership schools tive open question to identify what new topics the students (concession schools). For the intervention, educational insti- learned and liked the most during the intervention. Test tutions of each of these types were selected. The schools answers were used to analyze the appropriate knowledge in Valledupar and San Andrés Island are public, while in acquired by students during the pedagogical activities and Cali, the interventions were carried out in one private and identify their exchange of knowledge, reflections, and ques- one public–private partnership school. All the selected edu- tions about science and cancer. cational institutions were in neighborhoods of low socio- The results of the pre- and post-tests were analyzed by economic stratum, where vulnerable populations live. All dividing them into two main topics: on the one hand, ques- interventions were performed between November 3 and 24, tions related to genetic and molecular aspects, and, on the 2021, during morning hours. other, questions associated with cancer. Table  1 shows the characterization of the intervention populations by educational institution and city. For the total Analytical Method number of participants in the four schools, there was a simi- larity between women and men, with a percentage of 50.4 Pre- and post-test results were compared between schools, and 49.6, respectively, with the exception of the Institución considering the total of the responses. Additionally, the anal- Educativa Loperena Garupal (IELG) in the city of Valledu- ysis of the qualitative question included in the post-test was par, where women were predominant (65%) over men (35%); classified into components and phases/activities. R studio however, it was not statistically significant (p = 0.237). Con- was used for the statistical analysis, while the Shapiro–Wilk sidering age, most participants were 17 years old, with a test was employed to evaluate the assumption of normality percentage of 52% for the total number of students. according to variable characteristics for intergroup compari- The strategy was designed with a duration of 2 h. Nev- son. Variance in continuous variables was analyzed using the ertheless, the time availability of students was restricted to ANOVA test. The McNemar test was performed for paired an hour and a half in the Instituto Bolivariano (IB), due to binomial data. The significance level was p < 0.05. school needs. The strategy was carried out with eleventh- grade students in each school, except for the Colegio Pan- Ethical Considerations americano (CP), where six tenth-grade students were also included. In the IELG, the intervention was carried out out- This SAK strategy was carried out in the framework of the side class hours, after the end of the school day; the elev- project “Analysis of molecular alterations of SPOP, FOXA1, enth-grade students voluntarily stayed during the activity. and IDH1 in prostate cancer in Colombian population and On San Andrés Island, due to the academic commitments their possible implications in prognosis.” It included activi- of students in the IB, the intervention only lasted an hour and ties conducted within the scope of regular school educa- a half in this school, 30 min less than the estimated duration, tion after asking the principals of the participating schools so some activities had to be reduced and others could not be for cooperation and then submitting an approval for this carried out. On the other hand, most participants (71.9%) intervention. Before the intervention, informed consent recognized themselves as Raizales, an ethnic group on the was obtained from participants to take photos and videos. island with its own language (Creole) and culture developed Participants were notified that they were free to refuse to from African, European, and Caribbean origins. participate in the strategy, given that it was a voluntary activ- In the city of Cali, the opportunity arose to carry out this ity. They were given a pre-test and a post-test questionnaire activity in a private school, the Colegio Técnico Juvenil del and were allowed to return a blank form if they chose to Valle (CTJV), and a public–private partnership school, the do so. All tests were completed anonymously, and data CP in the Aguablanca District. Most families living in this 1 3 Journal of Cancer Education Table 1 Characterization of the intervention populations and strategy implementation by educational institution Population features Educational establishment Total p value N = 121 IELG (Valledupar) IB (San CTJV (Cali) CP (Cali) N = 20 Andrés) N = 36 N = 33 N = 32 Sex Female 13 (65%) 14 (43.7%) 18 (50%) 16 (48.5%) 61(50.4%) 0.508 Male 7 (35%) 18 (56.3%) 18 (50%) 17 (51.5%) 60 (49.6%) Age Median [IQR] 17 [1.0] 17 [0.25] 17 [1.0] 17 [0.25] 17 [1.0] 0.052 15 0 0 0 4 4 (3%) 0.198 16 5 6 9 11 31 (26%) 17 11 17 19 16 63 (52%) 18 3 4 6 1 14 (12%) ≥ 19 1 5 2 1 9 (7%) Time of strategy implementation (hours) Two One and a Two Two - - half Student score Eleventh (20) Eleventh Eleventh Tenth (6) 121 - (32) (36) Eleventh (27) Pre-test grade score, mean ± SD (N)* 2.42 ± 0.85 (20) 2.16 ± 0.96 1.99 ± 0.99 2.33 ± 1.15 2.19 ± 1.00 0.027 (33) (39) (32) (124) Post-test grade score, mean ± SD (N)* 3.38 ± 0.97 (20) 2.61 ± 1.03 2.92 ± 0.94 3.08 ± 0.98 2.95 ± 1.01 0.064 (35) (38) (33) (126) Question about cancer perceptions A. Related to cancer and associated factors % Pre-test 50.0 30.3 28.2 37.5 34.7 0.849 % Post-test 95.0 85.7 76.3 84.8 84.1 B. Related to ethnicity % Pre-test 25.0 21.2 20.5 25.0 22.6 0.712 % Post-test 85.0 37.1 76.3 63.6 63.5 C. Related with cancer prevention % Pre-test 85.0 78.8 76.9 78.1 79.0 0.987 % Post-test 95.0 97.1 97.4 93.9 96.0 IELG, Institución Educativa Loperena Garupal; IB, Instituto Bolivariano; CTJV, Colegio Técnico Juvenil del Valle; CP, Colegio Panamericano; n, number of students registered on the attendance list; IQR, interquartile range; N, number of students who answered; SD, standard deviation; (N)*, numbers in the pre-test and post-test vary with respect to the N of participants in SAK because not all answered the tests district are Afro-Colombian, of low income, or displaced by or improve these concepts among students. Statistically the armed conflict. significant differences were found between the pre- and The intervention in the CTJV was carried out while stu- post-test results in most educational institutions; clearly, dents were attending a cultural week, so they did not have this increasing trend was due to the post-test outcomes academic activities that could interrupt their attention and (Fig. 2a), given that an increase in scores was observed participation in the strategy. Finally, at the time of the inter- after the intervention. In the IELG, the mean score vention, there were very few students in the CP; only those increase was from 2.42 to 3.38 (p = 0.0055); in the CTJV, students were in the institution who had to do extra activities it was from 1.99 to 2.92 (p = 0.0002); and in the CP, it to pass the academic year, so 27 eleventh-grade students and was from 2.33 to 3.08 (p = 0.0106) (Table 1; Fig. 2a). The six tenth-grade students participated. school with the best scores and results between the pre- and post-tests was the CTJV. Furthermore, the total of the Biology Conceptions of Middle Education Students pre- and post-test scores of the four institutions was ana- lyzed and a statistically significant difference was found Before the intervention, a test was performed (pre-test) to with a mean value of 2.19 in the pre-test and 2.95 in the determine the concepts that students had learned in past post-test (p < 0.001) outcomes. The only institution with years. After the intervention, the same test was applied no significant difference was the IB, with a mean value of to evaluate whether the SAK strategy helped consolidate 2.16 to 2.61 (p = 0.0656). 1 3 Journal of Cancer Education Fig. 2 Pre-test and post-test results in biology questions by school answers by question in the pre- and post-tests in the total of students. and answer. a Comparison between pre-test and post-test scores c–f Percentage of correct answers for the pre-test and post-test in according to academic institution. IELG: Institución Educativa Lop- biology questions by school: c Institución Educativa Loperena Garu- erena Garupal; IB: Instituto Bolivariano; CTJV: Colegio Técnico pal (IELG); d Instituto Bolivariano (IB); e Colegio Técnico Juvenil Juvenil del Valle; CP: Colegio Panamericano. b Percentage of correct del Valle (CTJV); f Colegio Panamericano (CP). ns, no significance 1 3 Journal of Cancer Education A statistically significant difference was found (p = 0.027) Importantly, in some schools, some questions decreased in the total of the pre-test results compared by educational their success rates in the post-test compared to the pre-test, institutions (Table 1). Figure 2b shows the results by ques- for example, question 9 in the IELG (60% vs.75%) and in tion in a comparative way in the total of students. The pre- the CTJV (64.9% vs. 78.4%), and question 2 in the IB (2.9% test questions with more than 60% of correct answers in the vs. 6.3%). Nevertheless, there were no significant differences total of students from all schools were those related to rep- (Fig. 2). lication, mutation, and chromosomes (questions 6, 7, and 9, respectively) (Supplementary Material Table 1S). Likewise, Cancer Perceptions of Middle Education Students the questions that were below 40% of correct answers were 1, 2, 3, and 8, which were about DNA structure, the differ - The tests included three questions related to cancer percep- ence between RNA and DNA, and the definition of gene tions (Supplementary Material Table 1S). These topics are and codon, respectively. Questions 2 and 3 got the lowest not included in the curricular lineaments of middle educa- percentages; in the total of students, the percentages were tion in Colombia and the answers were influenced by other 15% and 17%, respectively. Interestingly, in the total of the kinds of learnings acquired in an extra-curricular way. When post-test results compared by educational institution, no sta- comparing the pre-test and post-test outcomes in all schools, tistically significant difference was found (p = 0.064) after statistically significant differences were observed in cancer- the intervention (Table 1). related questions (p < 0.01). In the pre-test, the question “Is Figure  2b also shows the post-test correct answers by it possible to prevent some types of cancer?” (question C) question, finding that questions 6 and 7 related to replica- had a 79% of correct answers in the total of students, and tion and mutation had an increase in the number of cor- was similar when analyzing the results by school. However, rect answers in almost all schools, with values that reached questions related to cancer and associated factors (ques- percentages of 80% or even more, bearing in mind that the tion A) and ethnicity (question B) had lower percentages of highest values in the pre-test were all less than or equal to 34.7% and 22.6%, respectively (Table 1). For question A, 71%. Nevertheless, it is important to highlight that both in the pre-test, the highest percentage of students thought questions (6 and 7) had better hits in the pre-test (65% and “Inheritance” was related to cancer (40.3%), but not “Diet,” 71%, respectively) than the other questions. On the other “Lack of exercise,” or “Environment” (Supplementary hand, the only question that persisted with values lower than Material Table 2S). In question B, in the pre-test, 56.5% 40% in the post-test was question 3 related to the definition of students did not relate cancer to ethnicity; it is striking of gene, with 25% of correct answers. Although it had an that answer “No” was predominant over the option “I do increase of 8% with respect to the pre-test in the total of stu- not know” (18.8%), indicating that students were sure about dents, it was not statistically significant (p = 0.18). However, this answer, which was incorrect (Supplementary Material in the IB, better rates of correct answers were registered Table 2S). in this question in the pre- and post-tests (31.3% vs. 50%, The results after intervention show that the percentages respectively) (Fig. 2d). of correct answers in the total number of students were Moreover, when the pre- and post-test results of the total increased in all three questions (34.7% vs. 84.1%, 22.6% students were compared (Fig. 2b), a statistically significant vs. 63.5%, and 79% vs. 96%, respectively) (Supplementary increase was observed after the intervention in the percent- Material Table 2S). When analyzed by school, the IELG age of correct answers (p < 0.01) in questions 1, 2, 6, 7, and showed the best results in the pre- and the post-test. Inter- 8, related to DNA structure (32 to 54%), differences between estingly, in question B, the IB had the lowest percentage of RNA and DNA (15 to 45%), replication (65 to 80%), muta- increase in the post-test with respect to the pre-test, only tion (71 to 88%), and codon (29 to 64%). When analyzed 21.2% vs. 37.1% in the total number of students (Table 1). by school (Fig. 2), statistically significant differences were However, there were no statistically significant differences found in correct answers of some questions by school. For in these questions by school. example, in the IELG, a better increase was evidenced in the percentage of correct answers between the pre- and the post- Post‑test Open Question test for questions 1 (p = 0.04), 2 (p = 0.03), and 8 (p = 0.02) (Fig. 2c); in the IB, for question 8 (p = 0.007) (Fig. 2d); in Considering the open question included in the post-test the CTJV, for questions 1 (p = 004), 2 (p < 0.01), 7 (p = 0.02), (“Express through words or draw the topics you learned the and 8 (p < 0.01) (Fig. 2e); and, finally, in the IP, for question most about or which caught your attention the most dur- 2 which was found significant too (p < 0.01) (Fig. 2f). ing the conversation”), we established two categories to It is important to highlight that the only question with analyze the concepts of SAK that were more relevant for 100% of hits in the post-test was the one about mutation students: “Introduction and concepts” and “Socialization of in the IELG (Fig.  2c), where it had an increase of 21%. the research project,” based on the components worked on 1 3 Journal of Cancer Education during the intervention (Supplementary Material Table 3S) this study sought to contextualize, through the SAK strat- The answers were classified according to the component and egy, young people in regions in a vulnerable situation and the phase/activity where the topic was mentioned (Fig. 1). with a high mortality rate from PCa about the importance of The following are some of the most representative generating knowledge on the integral control of this disease, answers for this qualitative open question: “I have learned highlighting the applicability of the concepts they learned about the care we can take to prevent cancer, although it during their middle education in subjects such as biology cannot always be preventable because it can be geneti- and chemistry [11–13]. cal”; “What most caught my attention was prostate cancer Ausubel’s Meaningful Learning Theory has demonstrated and liver cancer because regarding the prostate one, up to that prior knowledge as a starting point for learning is a cru- a certain age we have to be careful and work out since a cial aspect of reflection, given that student learning depends young age, and how alcoholic drinks can affect us”; “The on the previous cognitive structure related to new informa- most shocking thing I learned was how the ethnicity of a tion [14, 15]. In this sense, “unraveling what the student population can be a fundamental factor in the possibility of already knows is more than identifying their representations, developing any kind of cancer”; “Cancers can be presented concepts, and ideas, because it requires consideration of the for many reasons and not only for a specific one… and it is totality of the cultural/social being in their manifestations important to have healthy habits, but this does not mean that and bodily, affective, and cognitive languages” [16]. other kinds of cancers will not be presented”; and, finally, “I The intervention outcomes, in general, evidenced sta- learned that breast cancer is also produced by cigarette.” tistically significant differences in the pre-test compared Supplementary Material Table 3S presents the results, to post-test with respect to the biology concepts reviewed. with percentages that have as denominator the number of This finding was present in all schools, except for the IB. the student because many of them included two or more The results in the IB could be attributed to the fact that the answers for this question (25.4%), while others (31.7%) did school is located on San Andrés Island, where the main eco- not answer the question. The first component (“Introduction nomic activity is tourism. Therefore, the work and profes- and concepts”) shows the highest rates (70.6%) in the total sional interests of high school students on the island and the of students. The phase/activity most included in students’ focus of education are more related to tourism activities than answers was related to “Carcinogens, prevention, and types to natural sciences [17]. After the intervention, statistically of cancer,” with 50.8% of students. All schools, except for significant differences were not found in the total results of the IB, had similar results. The IB got 57.1% for the com- biology questions between schools. It indicates that students ponent and 34.3% for the phase. In the second component, managed to standardize the knowledge acquired, which is a the score of the total of students was 29.4%, where the most good indicator of the applied SAK strategy, despite having frequent answer was related to the phase about “prostate students from different cities and different types of schools cancer” (19.8%). In this component, the schools had similar [11, 18]. results apart from the IB, which had 14.3%, the lowest score Most of the correct answers in the pre-test covered ques- in the phase about “prostate cancer” (8.6%). tions about replication, mutation, and chromosome concepts. With respect to the use of writing, drawing, or both, it This might be related to students’ higher level of familiarity was found that, in general, most students preferred writing with these words due to exposure to news and movies that in all schools (50.8%), followed by drawing (11.1%), and deal with these topics. At the same time, the worst results both (6.4%). It was statistically significant (p < 0.01). The were evidenced in questions about differences in DNA and CP was the school with the highest percentage of writing RNA structures and gene definition in all schools. This is not responses with 75.9%, while the IB registered the highest surprising, since the concept of gene taught in middle school percentage in drawing responses (17.1%), and the IELG had is related to Mendelian inheritance and is defined as a unit the most answers of the option “Both,” where 20% of the of inheritance; the difference in the nucleic acid structure students preferred both writing and drawing (Supplementary is mainly a memory concept rather than a functional one, Material Table 3S). which is not frequently used beyond the textbook. This could explain why the difference in bases between DNA and RNA is a concept easily remembered after a short intervention, Discussion while the concept of gene would require deeper explana- tions, integrating the previous concepts of gene with the Disparities become evident in PCa, such as cultural condi- definition asked to students in the test. tions and lack of access to health, among other socioeco- On the other hand, the post-test mean (2.95/5.0) still nomic or educational factors that mainly affect vulnerable shows results in the limit of a minimum passing grade, which populations; for example, higher mortality rates stand out is not surprising, given that some concepts are abstract and in the case of Afro-descendant people [6, 7]. Consequently, not easy to assimilate. It is important to highlight that most 1 3 Journal of Cancer Education students had not studied those concepts in the last 2 years; The curriculum in schools should include content related hence, the estimated time of teaching this subject was brief to the importance of health care, because most of the sources to consolidate their knowledge. This could also be due to of information about cancer are usually found in mass media, different factors that can influence education in Colombia, such as TV, newspapers, the internet, or even relatives with where it is very common to find high inequalities associated the disease, but it is an uncommon subject in school. Thus, with socioeconomic status, school type, and geographic zone making students aware of this disease could contribute to [11, 19]. decrease the risk of developing cancer and, even, to prevent Regarding the perceptions and knowledge of students other illnesses [21]. To make a change in people’s attitude, it about cancer, the question related to the possibility of can- is necessary to create environments and policies that educate cer prevention had a high percentage of correct answers in and motivate people to choose healthful habits, including the pre-test, but students probably did not know how to do students, who can be transmitters of knowledge and progress it, which is consistent with their answers to the question within their community and generate an impact on it [21]. about associated factors, where they did not recognize the role of diet, exercise, and environment in cancer. It might also be related to the fact that neither in school nor at home Conclusions is there emphasis on the importance of healthy habits that could prevent many chronic diseases. Additionally, it is It is important to carry out this type of SAK activities in dif- possible that they do not have the opportunity to buy and ferent regions of Colombia, where individuals are more vul- consume healthy food as often as recommended, because nerable to develop diseases such as cancer, seeking to gen- healthy food is expensive in Colombia. Remarkably, this is erate positive effects on community health care. The study not only an economic or educational aspect but also a cul- demonstrated an improvement in the students’ knowledge tural one; Colombian people are not very used to take care in biology and cancer after the SAK intervention, so it is of their lifestyles. worthwhile to improve the SAK strategy in future sessions. The most noticeable change regarding the perceptions The Instituto Nacional de Cancerología develops this type of students about cancer was related to associated factors, of studies in order to educate the population and contribute where most students learned to recognize the influence of to cancer control in Colombia through cancer awareness and diet, lack of exercise, and environment in addition to inher- prevention. itance on this disease. Another question that improved in comparison to the pre-test was the one about sociocultural Supplementary Information The online version contains supplemen- tary material available at https://doi. or g/10. 1007/ s13187- 022- 02223-2 . factors and ethnicity. Thus, after the intervention, in the open question, most of the students (71.6%) considered that “can- Funding Open Access funding provided by Colombia Consortium. The cer” was what they learned about the most and where some Instituto Nacional de Cancerología received support from the Minis- of their previous ideas changed. These results were signifi- terio de Ciencia, Tecnología e Innovación (MinCiencias), within the cant for our SAK objectives, since students in the participat- framework of the call for proposals to strengthen ongoing science, technology, and innovation projects in health sciences. Number: 874. ing schools acquired new knowledge that would allow them not only to be aware of their own health, but also to transmit Declarations these new ideas and concepts to their families and friends and possibly have an impact in their region, creating aware- Competing Interests The authors declare no competing interests. ness that could favor this vulnerable population. It should be emphasized that knowledge acquisition is only one possible Open Access This article is licensed under a Creative Commons Attri- way of behavior change [20]. bution 4.0 International License, which permits use, sharing, adapta- To capture student attention and increase concentration, it tion, distribution and reproduction in any medium or format, as long is important to use a comprehensive model of learning style as you give appropriate credit to the original author(s) and the source, that identifies each individual’s demographic and sociocul- provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are tural context. For our SAK intervention, we designed activi- included in the article's Creative Commons licence, unless indicated ties that involved the participation of students to increase otherwise in a credit line to the material. If material is not included in their retention and comprehension of the subjects. We also the article's Creative Commons licence and your intended use is not included slides, images, and cards, which helped bring a permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a positive change in their conceptions, especially those related copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . to cancer risks, evidenced in the post-test results. In con- trast, regarding the topics with the worst performance, it is necessary to create new strategies to generate greater comprehension. 1 3 Journal of Cancer Education key factor for local development and open innovation: a system- References atic review. J Open Innov Technol Mark Complex 6(2). https:// doi. org/ 10. 3390/ JOITM C6020 044 1. Organización Mundial de la Salud OMS (2017) Cáncer,. http:// 12. 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Bogotá pp. 35–59. understanding of cancer in Japanese adolescents. J Cancer Educ [Online]. Available: https://minci encias. go v.co/ sites/ def ault/ files/ 33(1):102–108. https:// doi. org/ 10. 1007/ s13187- 016- 1056-8 upload/ pagin as/ mision_ de_ sabios_ vol_1_ ingles_ inter activo. pdf. Accessed 12 Mar 2022 Publisher's Note Springer Nature remains neutral with regard to 11. Romero-Rodríguez JM, Ramírez-Montoya MS, Aznar-Díaz I, and jurisdictional claims in published maps and institutional affiliations. Hinojo-Lucena FJ (2020) Social appropriation of knowledge as a 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cancer Education Springer Journals

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Abstract

In Colombia, prostate cancer (PCa) is the most common cancer for incidence and mortality in men, which turns it into a public health problem. For high-risk communities to better understand the usefulness of basic research about PCa, a strategy of social appropriation of knowledge (SAK) in science and cancer was designed and implemented. A pedagogical activity and two tests (a pre-test and a post-test) were applied to middle education students in four schools in three Colombian cities to identify previous knowledge of biology concepts and cancer perceptions. As for biology concepts, there was a statistically significant increase (p < 0.01) in the total results of all questions in the post-test, especially in items related to the structure of DNA, differences between RNA and DNA, and codon. Similarly, better success rates were observed in questions about replication and mutation, and a statistically significant improvement related to the definition of cancer, cancer prevention, and its association with culture or ethnicity (p < 0.01). The results of the open question show what students learned about or were interested in the most, as evidence of the exchange of knowledge in those cities and the social appropriation of knowledge about PCa in Colombia. These findings show that this type of intervention, in diverse social contexts, is essential to improve understanding and perceptions that link school and scientific knowledge to a real problem, such as health and, in this case, cancer. Keywords Cancer · Prostate Cancer · Social Appropriation of Knowledge · Students · Pre-Test · Post-Test · Educational Institutions Introduction cases are detected yearly, and about 3846 men die due to this reason. It is estimated that in the next 20 years, there Cancer has become one of the principal causes of morbid- will be an increase of double of cases presented today [3], ity and mortality globally [1]. One of the cancer types with becoming the cancer type with the highest incidence and the highest incidence is prostate cancer (PCa), and it is the second in mortality, which makes it a public health problem second most common and the fifth with the highest mor - in our country. tality rates worldwide [2]. In Colombia, more than 14,460 Prostate cancer is multifactorial, with the main triggers being the following: (I) age, with one man affected for every 500 at 40 years of age, while one in 14 men is affected at * Martha Lucía Serrano 60  years; (II) family history, where the probabilities of mlserranol@unal.edu.co; mlserrano@cancer.gov.co developing PCa due to having first-grade relatives are 2.17 Cancer Biology Research Group, Instituto Nacional de times higher for a father with the disease, 3.37 times higher Cancerología E.S.E, Bogotá, Colombia for a brother, and 5.08 times higher if one has more than two Research Support and Monitoring Group, Instituto Nacional first-grade relatives with PCa; (III) African ancestry, given de Cancerología E.S.E, Bogotá, Colombia that Afro-descendant populations have 2.5 times higher rates Department of Oncological Urology, Instituto Nacional de to develop this disease compared to men who are not Afro- Cancerología E.S.E, Bogotá, Colombia descendant [4]. Afro-descendant populations present diverse Department of Chemistry, Faculty of Science, Universidad genetic characteristics associated with an increased risk of Nacional de Colombia, Bogotá, Colombia Vol.:(0123456789) 1 3 Journal of Cancer Education PCa; however, this susceptibility, in addition to genetic public policy for social appropriation of knowledge within implications, may also be associated with existing dispari- the framework of science, technology, and innovation in ties in access to health care, socioeconomic aspects, and Colombia [10]. With this context in mind, it expected to education [5–7]. encourage the study of cancer from an integral and multidis- Based on the project “Analysis of molecular alterations of ciplinary perspective. This strategy enabled the participation SPOP, FOXA1, and IDH1 in prostate cancer in Colombian of citizens, in this case, students, in scenarios of exchanging population and their possible implications in prognosis,” a knowledge and experiences about cancer to generate reflec- strategy of social appropriation of knowledge (SAK) in sci- tions that influence the awareness of communities about the ence and cancer was designed to provide vulnerable commu- importance of early diagnosis and the positioning of this nities with a better understanding of the usefulness of basic disease as a public health problem, in the social context of research on PCa. Our SAK strategy focused on exchanging science teaching in Colombia. Considering that the school knowledge and experiences with communities with the high- setting is a replicating space of knowledge and experiences, est risk of developing PCa in Colombia. the SAK strategy aimed to raise awareness among young This paper explains the development of this SAK strategy people on the importance of generating knowledge that in science and cancer, focusing on educational populations, might contribute to the control of PCa, as well as to trans- by identifying the significance of the transmission, dissemi- mit this knowledge to Colombian families in a simple and nation, and appropriation of scientific knowledge on cancer understandable way. in school contexts for young people and highlighting the The SAK strategy was designed as a pedagogical activity importance of PCa research in Colombia. titled “Let’s learn about cancer together: An overview of the contributions of science to the control of this disease.” This pedagogical strategy used instruments designed for tenth- Methodology and eleventh-grade students, which consisted of different topics and activities for students to appropriate and under- Target Population stand concepts and acquire new knowledge about science, cancer, and PCa research in our population. Figure 1 shows The SAK strategy was applied in educational institutions the intervention structure, which consisted of two compo- in cities with high incidence and mortality rates of PCa in nents. The first one was “Introduction and concepts,” which Colombia, according to statistics. The departments with the was composed of four phases and one pedagogical activity highest mortality rates of PCa are San Andrés y Providen- called “Carcinogens and prevention in cancer.” This phase cia, Cesar, Atlántico, and Valle del Cauca, with standardized was required for students to understand the second compo- mortality rates of 17, 16.8, 15.1, and 14.4, respectively [8]. nent, which was “Socialization of the research project”; this The estimated age-standardized incidence rates for PCa in was composed of three phases and two pedagogical activi- these departments are 90, 60.8, 60.4, and 59.8, respectively ties: “Genes analyzed in PCa project” and “Genetic code [9]. and mutation.” Based on this parameter, the cities of Valledupar, San Before implementing this pedagogical strategy in the Andrés, and Cali were selected from the departments of selected schools, pilot activities of this intervention were Cesar, San Andrés y Providencia, and Valle del Cauca, carried out in Bogotá, in two public schools with eleventh- respectively, for the implementation of this pedagogical grade students (Colegio República de Colombia and Colegio activity, as they correspond to the departments with the Francisco José de Caldas) and in a public university with highest presence of at-risk population for PCa, such as last-semester biology students (Universidad Distrital Fran- Afro-descendant communities. The SAK strategy was imple- cisco José de Caldas). The objective was to detect and per- mented in four schools. In each school, 20 to 39 students form necessary changes and adjustments to the activities and participated, given the biosafety restrictions of COVID-19, the tests, so that they were didactic, pedagogical, and easily and because it was considered essential to provide more per- understood by students. sonalized interaction. Test of Knowledge and Perceptions of Cancer SAK Strategy Design Before and after the intervention, two tests (a pre-test and This strategy originated from the project “Analysis of molec- a post-test) were applied to students to identify their prior ular alterations of SPOP, FOXA1, and IDH1 in prostate can- knowledge and measure the intervention’s impact based on cer in Colombian population and their possible implications some basic aspects of biology and cancer concepts, besides in prognosis.” The SAK strategy design sought to recognize the new knowledge acquired. These tests consisted of mul- the Colombian social, cultural, and economic context and tiple choice, true–false choice, and connector questions 1 3 Journal of Cancer Education Fig. 1 Strategy phases. The strategy is illustrated by two gears repre- Second component: “Socialization of the research project” allowed senting the first and second components. First component: “Introduc- students to understand the PCa research project based on concepts tion and concepts” allowed students to reinforce the genetic concepts such as mutation, molecular alterations, and genetic code, as well as they had seen in class and learn new concepts related to cancer. It the social aspects that compose it. Phase A2: PCa overview and at- is composed of four phases: Phase A1: recognition of the contribu- risk populations: introduction of general concepts of PCa, emphasiz- tions of science to health: conversation with students about transla- ing Afro-descent ethnicity as a risk for the development of aggressive tional medicine as an example of articulation between the activities prostate cancer; Phase B2: explanation of the research project: two carried out in a laboratory and the medical staff, and how they can pedagogical activities were carried out for a better understanding of provide a direct benefit for the patient; Phase B1: review of biol- the research project. The first activity “Genes analyzed in PCa pro- ogy concepts: concepts such as DNA, RNA, protein, chromosomes, ject” consisted of students understanding the functions of the genes genetic code, and mutations were reviewed; Phase C1: cancer con- “SPOP, FOXA1, IDH1, IDH1, TMPRSS2, and ERG, and the impact cepts: explanation of what cancer is and genes involved in cancer and of their molecular alterations in PCa.” The second activity “Genetic carcinogens. In this phase, the pedagogical activity “Carcinogens, code and mutation” aimed to help understand the results of the pro- prevention and types of cancer” was carried out, which consisted ject; Phase C2: reflection on the importance of cancer research in the of students identifying different types of cancer, relating their cause country. Before and after the intervention, a test (pre-test and post- and prevention, and then explaining a specific type of cancer to their test) was done classmates; Phase D1: reflection on the importance of prevention. 1 3 Journal of Cancer Education (Supplementary Material Table 1S). The distractor option “I management was supervised by of the primary investigators. do not know/I do not remember” was included to minimize These interventions were approved by the Ethics Committee random answers. During test qualification, biology concepts of the Instituto Nacional de Cancerología E.S.E. were separated from those about cancer perceptions because students were expected to have previous knowledge about biology concepts acquired in school. On the contrary, cancer perception questions were based on knowledge acquisition Results from their own experiences and not taught in school. Biol- ogy items were evaluated on a score of 0 to 5, while cancer Characterization of the Intervention Populations perception questions used a different score on a scale of 0 and Strategy Implementation to 3. After the intervention, a post-test was carried out with There are three types of educational institutions in Colom- the same pre-test items but including an additional qualita- bia: public, private, and public–private partnership schools tive open question to identify what new topics the students (concession schools). For the intervention, educational insti- learned and liked the most during the intervention. Test tutions of each of these types were selected. The schools answers were used to analyze the appropriate knowledge in Valledupar and San Andrés Island are public, while in acquired by students during the pedagogical activities and Cali, the interventions were carried out in one private and identify their exchange of knowledge, reflections, and ques- one public–private partnership school. All the selected edu- tions about science and cancer. cational institutions were in neighborhoods of low socio- The results of the pre- and post-tests were analyzed by economic stratum, where vulnerable populations live. All dividing them into two main topics: on the one hand, ques- interventions were performed between November 3 and 24, tions related to genetic and molecular aspects, and, on the 2021, during morning hours. other, questions associated with cancer. Table  1 shows the characterization of the intervention populations by educational institution and city. For the total Analytical Method number of participants in the four schools, there was a simi- larity between women and men, with a percentage of 50.4 Pre- and post-test results were compared between schools, and 49.6, respectively, with the exception of the Institución considering the total of the responses. Additionally, the anal- Educativa Loperena Garupal (IELG) in the city of Valledu- ysis of the qualitative question included in the post-test was par, where women were predominant (65%) over men (35%); classified into components and phases/activities. R studio however, it was not statistically significant (p = 0.237). Con- was used for the statistical analysis, while the Shapiro–Wilk sidering age, most participants were 17 years old, with a test was employed to evaluate the assumption of normality percentage of 52% for the total number of students. according to variable characteristics for intergroup compari- The strategy was designed with a duration of 2 h. Nev- son. Variance in continuous variables was analyzed using the ertheless, the time availability of students was restricted to ANOVA test. The McNemar test was performed for paired an hour and a half in the Instituto Bolivariano (IB), due to binomial data. The significance level was p < 0.05. school needs. The strategy was carried out with eleventh- grade students in each school, except for the Colegio Pan- Ethical Considerations americano (CP), where six tenth-grade students were also included. In the IELG, the intervention was carried out out- This SAK strategy was carried out in the framework of the side class hours, after the end of the school day; the elev- project “Analysis of molecular alterations of SPOP, FOXA1, enth-grade students voluntarily stayed during the activity. and IDH1 in prostate cancer in Colombian population and On San Andrés Island, due to the academic commitments their possible implications in prognosis.” It included activi- of students in the IB, the intervention only lasted an hour and ties conducted within the scope of regular school educa- a half in this school, 30 min less than the estimated duration, tion after asking the principals of the participating schools so some activities had to be reduced and others could not be for cooperation and then submitting an approval for this carried out. On the other hand, most participants (71.9%) intervention. Before the intervention, informed consent recognized themselves as Raizales, an ethnic group on the was obtained from participants to take photos and videos. island with its own language (Creole) and culture developed Participants were notified that they were free to refuse to from African, European, and Caribbean origins. participate in the strategy, given that it was a voluntary activ- In the city of Cali, the opportunity arose to carry out this ity. They were given a pre-test and a post-test questionnaire activity in a private school, the Colegio Técnico Juvenil del and were allowed to return a blank form if they chose to Valle (CTJV), and a public–private partnership school, the do so. All tests were completed anonymously, and data CP in the Aguablanca District. Most families living in this 1 3 Journal of Cancer Education Table 1 Characterization of the intervention populations and strategy implementation by educational institution Population features Educational establishment Total p value N = 121 IELG (Valledupar) IB (San CTJV (Cali) CP (Cali) N = 20 Andrés) N = 36 N = 33 N = 32 Sex Female 13 (65%) 14 (43.7%) 18 (50%) 16 (48.5%) 61(50.4%) 0.508 Male 7 (35%) 18 (56.3%) 18 (50%) 17 (51.5%) 60 (49.6%) Age Median [IQR] 17 [1.0] 17 [0.25] 17 [1.0] 17 [0.25] 17 [1.0] 0.052 15 0 0 0 4 4 (3%) 0.198 16 5 6 9 11 31 (26%) 17 11 17 19 16 63 (52%) 18 3 4 6 1 14 (12%) ≥ 19 1 5 2 1 9 (7%) Time of strategy implementation (hours) Two One and a Two Two - - half Student score Eleventh (20) Eleventh Eleventh Tenth (6) 121 - (32) (36) Eleventh (27) Pre-test grade score, mean ± SD (N)* 2.42 ± 0.85 (20) 2.16 ± 0.96 1.99 ± 0.99 2.33 ± 1.15 2.19 ± 1.00 0.027 (33) (39) (32) (124) Post-test grade score, mean ± SD (N)* 3.38 ± 0.97 (20) 2.61 ± 1.03 2.92 ± 0.94 3.08 ± 0.98 2.95 ± 1.01 0.064 (35) (38) (33) (126) Question about cancer perceptions A. Related to cancer and associated factors % Pre-test 50.0 30.3 28.2 37.5 34.7 0.849 % Post-test 95.0 85.7 76.3 84.8 84.1 B. Related to ethnicity % Pre-test 25.0 21.2 20.5 25.0 22.6 0.712 % Post-test 85.0 37.1 76.3 63.6 63.5 C. Related with cancer prevention % Pre-test 85.0 78.8 76.9 78.1 79.0 0.987 % Post-test 95.0 97.1 97.4 93.9 96.0 IELG, Institución Educativa Loperena Garupal; IB, Instituto Bolivariano; CTJV, Colegio Técnico Juvenil del Valle; CP, Colegio Panamericano; n, number of students registered on the attendance list; IQR, interquartile range; N, number of students who answered; SD, standard deviation; (N)*, numbers in the pre-test and post-test vary with respect to the N of participants in SAK because not all answered the tests district are Afro-Colombian, of low income, or displaced by or improve these concepts among students. Statistically the armed conflict. significant differences were found between the pre- and The intervention in the CTJV was carried out while stu- post-test results in most educational institutions; clearly, dents were attending a cultural week, so they did not have this increasing trend was due to the post-test outcomes academic activities that could interrupt their attention and (Fig. 2a), given that an increase in scores was observed participation in the strategy. Finally, at the time of the inter- after the intervention. In the IELG, the mean score vention, there were very few students in the CP; only those increase was from 2.42 to 3.38 (p = 0.0055); in the CTJV, students were in the institution who had to do extra activities it was from 1.99 to 2.92 (p = 0.0002); and in the CP, it to pass the academic year, so 27 eleventh-grade students and was from 2.33 to 3.08 (p = 0.0106) (Table 1; Fig. 2a). The six tenth-grade students participated. school with the best scores and results between the pre- and post-tests was the CTJV. Furthermore, the total of the Biology Conceptions of Middle Education Students pre- and post-test scores of the four institutions was ana- lyzed and a statistically significant difference was found Before the intervention, a test was performed (pre-test) to with a mean value of 2.19 in the pre-test and 2.95 in the determine the concepts that students had learned in past post-test (p < 0.001) outcomes. The only institution with years. After the intervention, the same test was applied no significant difference was the IB, with a mean value of to evaluate whether the SAK strategy helped consolidate 2.16 to 2.61 (p = 0.0656). 1 3 Journal of Cancer Education Fig. 2 Pre-test and post-test results in biology questions by school answers by question in the pre- and post-tests in the total of students. and answer. a Comparison between pre-test and post-test scores c–f Percentage of correct answers for the pre-test and post-test in according to academic institution. IELG: Institución Educativa Lop- biology questions by school: c Institución Educativa Loperena Garu- erena Garupal; IB: Instituto Bolivariano; CTJV: Colegio Técnico pal (IELG); d Instituto Bolivariano (IB); e Colegio Técnico Juvenil Juvenil del Valle; CP: Colegio Panamericano. b Percentage of correct del Valle (CTJV); f Colegio Panamericano (CP). ns, no significance 1 3 Journal of Cancer Education A statistically significant difference was found (p = 0.027) Importantly, in some schools, some questions decreased in the total of the pre-test results compared by educational their success rates in the post-test compared to the pre-test, institutions (Table 1). Figure 2b shows the results by ques- for example, question 9 in the IELG (60% vs.75%) and in tion in a comparative way in the total of students. The pre- the CTJV (64.9% vs. 78.4%), and question 2 in the IB (2.9% test questions with more than 60% of correct answers in the vs. 6.3%). Nevertheless, there were no significant differences total of students from all schools were those related to rep- (Fig. 2). lication, mutation, and chromosomes (questions 6, 7, and 9, respectively) (Supplementary Material Table 1S). Likewise, Cancer Perceptions of Middle Education Students the questions that were below 40% of correct answers were 1, 2, 3, and 8, which were about DNA structure, the differ - The tests included three questions related to cancer percep- ence between RNA and DNA, and the definition of gene tions (Supplementary Material Table 1S). These topics are and codon, respectively. Questions 2 and 3 got the lowest not included in the curricular lineaments of middle educa- percentages; in the total of students, the percentages were tion in Colombia and the answers were influenced by other 15% and 17%, respectively. Interestingly, in the total of the kinds of learnings acquired in an extra-curricular way. When post-test results compared by educational institution, no sta- comparing the pre-test and post-test outcomes in all schools, tistically significant difference was found (p = 0.064) after statistically significant differences were observed in cancer- the intervention (Table 1). related questions (p < 0.01). In the pre-test, the question “Is Figure  2b also shows the post-test correct answers by it possible to prevent some types of cancer?” (question C) question, finding that questions 6 and 7 related to replica- had a 79% of correct answers in the total of students, and tion and mutation had an increase in the number of cor- was similar when analyzing the results by school. However, rect answers in almost all schools, with values that reached questions related to cancer and associated factors (ques- percentages of 80% or even more, bearing in mind that the tion A) and ethnicity (question B) had lower percentages of highest values in the pre-test were all less than or equal to 34.7% and 22.6%, respectively (Table 1). For question A, 71%. Nevertheless, it is important to highlight that both in the pre-test, the highest percentage of students thought questions (6 and 7) had better hits in the pre-test (65% and “Inheritance” was related to cancer (40.3%), but not “Diet,” 71%, respectively) than the other questions. On the other “Lack of exercise,” or “Environment” (Supplementary hand, the only question that persisted with values lower than Material Table 2S). In question B, in the pre-test, 56.5% 40% in the post-test was question 3 related to the definition of students did not relate cancer to ethnicity; it is striking of gene, with 25% of correct answers. Although it had an that answer “No” was predominant over the option “I do increase of 8% with respect to the pre-test in the total of stu- not know” (18.8%), indicating that students were sure about dents, it was not statistically significant (p = 0.18). However, this answer, which was incorrect (Supplementary Material in the IB, better rates of correct answers were registered Table 2S). in this question in the pre- and post-tests (31.3% vs. 50%, The results after intervention show that the percentages respectively) (Fig. 2d). of correct answers in the total number of students were Moreover, when the pre- and post-test results of the total increased in all three questions (34.7% vs. 84.1%, 22.6% students were compared (Fig. 2b), a statistically significant vs. 63.5%, and 79% vs. 96%, respectively) (Supplementary increase was observed after the intervention in the percent- Material Table 2S). When analyzed by school, the IELG age of correct answers (p < 0.01) in questions 1, 2, 6, 7, and showed the best results in the pre- and the post-test. Inter- 8, related to DNA structure (32 to 54%), differences between estingly, in question B, the IB had the lowest percentage of RNA and DNA (15 to 45%), replication (65 to 80%), muta- increase in the post-test with respect to the pre-test, only tion (71 to 88%), and codon (29 to 64%). When analyzed 21.2% vs. 37.1% in the total number of students (Table 1). by school (Fig. 2), statistically significant differences were However, there were no statistically significant differences found in correct answers of some questions by school. For in these questions by school. example, in the IELG, a better increase was evidenced in the percentage of correct answers between the pre- and the post- Post‑test Open Question test for questions 1 (p = 0.04), 2 (p = 0.03), and 8 (p = 0.02) (Fig. 2c); in the IB, for question 8 (p = 0.007) (Fig. 2d); in Considering the open question included in the post-test the CTJV, for questions 1 (p = 004), 2 (p < 0.01), 7 (p = 0.02), (“Express through words or draw the topics you learned the and 8 (p < 0.01) (Fig. 2e); and, finally, in the IP, for question most about or which caught your attention the most dur- 2 which was found significant too (p < 0.01) (Fig. 2f). ing the conversation”), we established two categories to It is important to highlight that the only question with analyze the concepts of SAK that were more relevant for 100% of hits in the post-test was the one about mutation students: “Introduction and concepts” and “Socialization of in the IELG (Fig.  2c), where it had an increase of 21%. the research project,” based on the components worked on 1 3 Journal of Cancer Education during the intervention (Supplementary Material Table 3S) this study sought to contextualize, through the SAK strat- The answers were classified according to the component and egy, young people in regions in a vulnerable situation and the phase/activity where the topic was mentioned (Fig. 1). with a high mortality rate from PCa about the importance of The following are some of the most representative generating knowledge on the integral control of this disease, answers for this qualitative open question: “I have learned highlighting the applicability of the concepts they learned about the care we can take to prevent cancer, although it during their middle education in subjects such as biology cannot always be preventable because it can be geneti- and chemistry [11–13]. cal”; “What most caught my attention was prostate cancer Ausubel’s Meaningful Learning Theory has demonstrated and liver cancer because regarding the prostate one, up to that prior knowledge as a starting point for learning is a cru- a certain age we have to be careful and work out since a cial aspect of reflection, given that student learning depends young age, and how alcoholic drinks can affect us”; “The on the previous cognitive structure related to new informa- most shocking thing I learned was how the ethnicity of a tion [14, 15]. In this sense, “unraveling what the student population can be a fundamental factor in the possibility of already knows is more than identifying their representations, developing any kind of cancer”; “Cancers can be presented concepts, and ideas, because it requires consideration of the for many reasons and not only for a specific one… and it is totality of the cultural/social being in their manifestations important to have healthy habits, but this does not mean that and bodily, affective, and cognitive languages” [16]. other kinds of cancers will not be presented”; and, finally, “I The intervention outcomes, in general, evidenced sta- learned that breast cancer is also produced by cigarette.” tistically significant differences in the pre-test compared Supplementary Material Table 3S presents the results, to post-test with respect to the biology concepts reviewed. with percentages that have as denominator the number of This finding was present in all schools, except for the IB. the student because many of them included two or more The results in the IB could be attributed to the fact that the answers for this question (25.4%), while others (31.7%) did school is located on San Andrés Island, where the main eco- not answer the question. The first component (“Introduction nomic activity is tourism. Therefore, the work and profes- and concepts”) shows the highest rates (70.6%) in the total sional interests of high school students on the island and the of students. The phase/activity most included in students’ focus of education are more related to tourism activities than answers was related to “Carcinogens, prevention, and types to natural sciences [17]. After the intervention, statistically of cancer,” with 50.8% of students. All schools, except for significant differences were not found in the total results of the IB, had similar results. The IB got 57.1% for the com- biology questions between schools. It indicates that students ponent and 34.3% for the phase. In the second component, managed to standardize the knowledge acquired, which is a the score of the total of students was 29.4%, where the most good indicator of the applied SAK strategy, despite having frequent answer was related to the phase about “prostate students from different cities and different types of schools cancer” (19.8%). In this component, the schools had similar [11, 18]. results apart from the IB, which had 14.3%, the lowest score Most of the correct answers in the pre-test covered ques- in the phase about “prostate cancer” (8.6%). tions about replication, mutation, and chromosome concepts. With respect to the use of writing, drawing, or both, it This might be related to students’ higher level of familiarity was found that, in general, most students preferred writing with these words due to exposure to news and movies that in all schools (50.8%), followed by drawing (11.1%), and deal with these topics. At the same time, the worst results both (6.4%). It was statistically significant (p < 0.01). The were evidenced in questions about differences in DNA and CP was the school with the highest percentage of writing RNA structures and gene definition in all schools. This is not responses with 75.9%, while the IB registered the highest surprising, since the concept of gene taught in middle school percentage in drawing responses (17.1%), and the IELG had is related to Mendelian inheritance and is defined as a unit the most answers of the option “Both,” where 20% of the of inheritance; the difference in the nucleic acid structure students preferred both writing and drawing (Supplementary is mainly a memory concept rather than a functional one, Material Table 3S). which is not frequently used beyond the textbook. This could explain why the difference in bases between DNA and RNA is a concept easily remembered after a short intervention, Discussion while the concept of gene would require deeper explana- tions, integrating the previous concepts of gene with the Disparities become evident in PCa, such as cultural condi- definition asked to students in the test. tions and lack of access to health, among other socioeco- On the other hand, the post-test mean (2.95/5.0) still nomic or educational factors that mainly affect vulnerable shows results in the limit of a minimum passing grade, which populations; for example, higher mortality rates stand out is not surprising, given that some concepts are abstract and in the case of Afro-descendant people [6, 7]. Consequently, not easy to assimilate. It is important to highlight that most 1 3 Journal of Cancer Education students had not studied those concepts in the last 2 years; The curriculum in schools should include content related hence, the estimated time of teaching this subject was brief to the importance of health care, because most of the sources to consolidate their knowledge. This could also be due to of information about cancer are usually found in mass media, different factors that can influence education in Colombia, such as TV, newspapers, the internet, or even relatives with where it is very common to find high inequalities associated the disease, but it is an uncommon subject in school. Thus, with socioeconomic status, school type, and geographic zone making students aware of this disease could contribute to [11, 19]. decrease the risk of developing cancer and, even, to prevent Regarding the perceptions and knowledge of students other illnesses [21]. To make a change in people’s attitude, it about cancer, the question related to the possibility of can- is necessary to create environments and policies that educate cer prevention had a high percentage of correct answers in and motivate people to choose healthful habits, including the pre-test, but students probably did not know how to do students, who can be transmitters of knowledge and progress it, which is consistent with their answers to the question within their community and generate an impact on it [21]. about associated factors, where they did not recognize the role of diet, exercise, and environment in cancer. It might also be related to the fact that neither in school nor at home Conclusions is there emphasis on the importance of healthy habits that could prevent many chronic diseases. Additionally, it is It is important to carry out this type of SAK activities in dif- possible that they do not have the opportunity to buy and ferent regions of Colombia, where individuals are more vul- consume healthy food as often as recommended, because nerable to develop diseases such as cancer, seeking to gen- healthy food is expensive in Colombia. Remarkably, this is erate positive effects on community health care. The study not only an economic or educational aspect but also a cul- demonstrated an improvement in the students’ knowledge tural one; Colombian people are not very used to take care in biology and cancer after the SAK intervention, so it is of their lifestyles. worthwhile to improve the SAK strategy in future sessions. The most noticeable change regarding the perceptions The Instituto Nacional de Cancerología develops this type of students about cancer was related to associated factors, of studies in order to educate the population and contribute where most students learned to recognize the influence of to cancer control in Colombia through cancer awareness and diet, lack of exercise, and environment in addition to inher- prevention. itance on this disease. Another question that improved in comparison to the pre-test was the one about sociocultural Supplementary Information The online version contains supplemen- tary material available at https://doi. or g/10. 1007/ s13187- 022- 02223-2 . factors and ethnicity. Thus, after the intervention, in the open question, most of the students (71.6%) considered that “can- Funding Open Access funding provided by Colombia Consortium. The cer” was what they learned about the most and where some Instituto Nacional de Cancerología received support from the Minis- of their previous ideas changed. These results were signifi- terio de Ciencia, Tecnología e Innovación (MinCiencias), within the cant for our SAK objectives, since students in the participat- framework of the call for proposals to strengthen ongoing science, technology, and innovation projects in health sciences. Number: 874. ing schools acquired new knowledge that would allow them not only to be aware of their own health, but also to transmit Declarations these new ideas and concepts to their families and friends and possibly have an impact in their region, creating aware- Competing Interests The authors declare no competing interests. ness that could favor this vulnerable population. It should be emphasized that knowledge acquisition is only one possible Open Access This article is licensed under a Creative Commons Attri- way of behavior change [20]. bution 4.0 International License, which permits use, sharing, adapta- To capture student attention and increase concentration, it tion, distribution and reproduction in any medium or format, as long is important to use a comprehensive model of learning style as you give appropriate credit to the original author(s) and the source, that identifies each individual’s demographic and sociocul- provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are tural context. For our SAK intervention, we designed activi- included in the article's Creative Commons licence, unless indicated ties that involved the participation of students to increase otherwise in a credit line to the material. If material is not included in their retention and comprehension of the subjects. We also the article's Creative Commons licence and your intended use is not included slides, images, and cards, which helped bring a permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a positive change in their conceptions, especially those related copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . to cancer risks, evidenced in the post-test results. In con- trast, regarding the topics with the worst performance, it is necessary to create new strategies to generate greater comprehension. 1 3 Journal of Cancer Education key factor for local development and open innovation: a system- References atic review. J Open Innov Technol Mark Complex 6(2). https:// doi. org/ 10. 3390/ JOITM C6020 044 1. Organización Mundial de la Salud OMS (2017) Cáncer,. http:// 12. 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Journal

Journal of Cancer EducationSpringer Journals

Published: Oct 2, 2022

Keywords: Cancer; Prostate Cancer; Social Appropriation of Knowledge; Students; Pre-Test; Post-Test; Educational Institutions

References