Development and Content Validation of a Manga-Based Educational Technology on Child Sexual Abuse: A Nursing Tool for Health Literacy in Brazil

Ana Darla Da Silva Ferreira; Mateus Santos Silva; Estela Maria Leite Meirelles Monteiro; Mariana Boulitreau Siqueira Campos Barros

doi:10.58418/ijni.v4i2.171

Authors

Ana Darla Da Silva Ferreira Federal University of Pernambuco, Brazil
Mateus Santos Silva Federal University of Pernambuco, Brazil
Estela Maria Leite Meirelles Monteiro Federal University of Pernambuco, Brazil
Mariana Boulitreau Siqueira Campos Barros Federal University of Pernambuco, Brazil

DOI:

https://doi.org/10.58418/ijni.v4i2.171

Keywords:

Child Sexual Abuse, Health Literacy, Nursing Informatics, Educational Technology, Validation Study

Abstract

As child sexual abuse remains a pervasive and silent crime, there is an urgent need for innovative nursing tools that enhance health literacy to empower young populations. The objective of this study was to develop and validate a manga-based nursing educational technology aimed at child sexual abuse prevention and health literacy in Brazil. Regarding the method, a methodological study with a quantitative approach was conducted to validate the content of the manga , which was designed as a nursing information tool using ibisPaint software. The material was evaluated by 12 experts in child health, protection networks, and information technology who met Jasper’s criteria with validation analyzed using the Content Validity Index (CVI) at an acceptable agreement rate of 90%. Additionally, Gwet’s AC2 was used for intra-expert agreement evaluation. The results revealed a CVI of 1.00 for objectives and relevance, while the structure of the manga achieved a CVI of 0.97 with a clarity rating of 0.92. Gwet’s AC2 indicated almost perfect agreement, yielding values of 0.92 for objectives, 0.84 for structure, and 0.93 for relevance. In conclusion, this validated manga serves as an effective nursing educational technology that facilitates health literacy by providing children and adolescents with the necessary autonomy to recognize abuse and access protection networks. This research contributes a rigorous technological framework to nursing informatics, offering a culturally relevant instrument for promoting social justice and child protection in the Brazilian context.

References

Adif, S. A., Fetzer, S. J., Yen, M., Lee, H.-F., Lin, M.-F., & Hsu, Y.-Y. (2025). Enhancing digital competence in nursing: Development and validation of the diginurse e-learning program using a modified delphi approach across Taiwan, Vietnam and Indonesia. Nurse Education in Practice, 88, 104544. https://doi.org/10.1016/j.nepr.2025.104544

Ajayi, C. E., Chantler, K., & Radford, L. (2022). The Role of Cultural Beliefs, Norms, and Practices in Nigerian Women’s Experiences of Sexual Abuse and Violence. Violence Against Women, 28(2), 465–486. https://doi.org/10.1177/10778012211000134

Altmiller, G., & Pepe, L. H. (2022). Influence of Technology in Supporting Quality and Safety in Nursing Education. Nursing Clinics of North America, 57(4), 551–562. https://doi.org/10.1016/j.cnur.2022.06.005

Bajos, N., Ancian, J., Tricou, J., Valendru, A., Pousson, J.-E., & Moreau, C. (2023). Child Sexual Abuse in the Roman Catholic Church in France: Prevalence and Comparison With Other Social Spheres. Journal of Interpersonal Violence, 38(7–8), 5452–5470. https://doi.org/10.1177/08862605221124263

Barros, M. B. S. C., Rosário, H. R. V. do, Martins, S. P., Galvão, D. M. P. G., Tenório, S. J. da S., Farias, A. C. do N., Goes, P. S. A. de, & Monteiro, E. M. L. M. (2023). Youth empowerment through health education scale: validity study. Acta Paulista de Enfermagem, 36, eAPE015232.

Bell, K. A., & Adams, T. (2024). A Culture Shift for Excellence in Physical Therapy: Promoting Equity Through the Structural Determinants of Health. Physical Therapy, 104(9). https://doi.org/10.1093/ptj/pzae098

Bindhu, S., Nattam, A., Xu, C., Vithala, T., Grant, T., Dariotis, J. K., Liu, H., & Wu, D. T. Y. (2024). Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review. Online Journal of Public Health Informatics, 16, e50898. https://doi.org/10.2196/50898

Carnevale, F. A. (2022). The VOICE Children’s Nursing Framework: Drawing on childhood studies to advance nursing practice with young people. Nursing Inquiry, 29(4). https://doi.org/10.1111/nin.12495

Davies, C., Waters, D., & Fraser, J. (2024). Children’s and young people’s experiences of expressing their views and having them heard in health care: A deductive qualitative content analysis. Journal of Clinical Nursing, 33(4), 1506–1519. https://doi.org/10.1111/jocn.16952

Diehl, A., Molina de Souza, R., Madruga, C. S., Laranjeira, R., Wagstaff, C., & Pillon, S. C. (2022). Rape, Child Sexual Abuse, and Mental Health in a Brazilian National Sample. Journal of Interpersonal Violence, 37(1–2), NP944–NP967. https://doi.org/10.1177/0886260520915546

Dubowitz, H., Finkelhor, D., Zolotor, A., Kleven, J., & Davis, N. (2022). Addressing Adverse Childhood Experiences in Primary Care: Challenges and Considerations. Pediatrics, 149(4). https://doi.org/10.1542/peds.2021-052641

Ferrari, W., Nascimento, M., & Galli, B. (2025). Abortion rights in cases of stealthing: reflections, challenges, and legal possibilities in Brazil. Ciência & Saúde Coletiva, 30(11). https://doi.org/10.1590/1413-812320253011.10842025en

Ghorbanian Zolbin, M., Huvila, I., & Nikou, S. (2022). Health literacy, health literacy interventions and decision-making: a systematic literature review. Journal of Documentation, 78(7), 405–428. https://doi.org/10.1108/JD-01-2022-0004

Gomes, T. B., Souto, D. O., Brito, A. M., & Morais, R. L. de S. (2025). Effectiveness of interventions for brazilian children and adolescents in social vulnerability: A systematic review. Research, Society and Development, 14(11), e110141150036. https://doi.org/10.33448/rsd-v14i11.50036

Jasper, M. A. (1994). Expert: a discussion of the implications of the concept as used in nursing. Journal of Advanced Nursing, 20(4), 769–776. https://doi.org/10.1046/j.1365-2648.1994.20040769.x

Jenkins, C. L., Sykes, S., & Wills, J. (2023). The conceptualization and development of critical health literacy in children: a scoping review. Health Promotion International, 38(5). https://doi.org/10.1093/heapro/daad116

Krupp, A., Dunn, H., Knake, L., Ten Eyck, P., Frey-Law, L., & Dunn Lopez, K. (2025). Aggregating Patient Safety and Status Information in the Electronic Health Record to Support Time-Sensitive Mobility Interventions in the Intensive Care Unit: Protocol for the Design and Testing of a Clinical Decision Support Tool. JMIR Research Protocols, 14, e75752. https://doi.org/10.2196/75752

Kurschner, R. de L. (2025). Moderação de conteúdo e responsabilidade das empresas na proteção de crianças e adolescentes no ambiente digital. Revista de Direito, 17(02), 01–32. https://doi.org/10.32361/2025170222228

Lakens, D. (2022). Sample Size Justification. Collabra: Psychology, 8(1). https://doi.org/10.1525/collabra.33267

Li, S. (2025). Beyond health knowledge and behavioural skills: Reimagining health education as autonomy development. Health Education Journal, 84(7), 829–840. https://doi.org/10.1177/00178969251358065

Lia Dewi, V. N., Komalasari, Rahayu, S., Nakkliang, K., Wantoro, A., Anggriani, Y., & Aminudin, N. (2025). Enhancing health literacy for child protection: Development and validation of a mobile application for child sexual abuse prevention education. Salud, Ciencia y Tecnología, 5, 2149. https://doi.org/10.56294/saludcyt20252149

Logie, C. H., Okumu, M., McAlpine, A., Odong Lukone, S., Kisubi, N., Loutet, M. G., Berry, I., MacKenzie, F., & Kyambadde, P. (2023). Qualitative Comic Book Mapping: Developing Comic Books Informed by Lived Experiences of Refugee Youth to Advance Sexual and Gender-Based Violence Prevention and Stigma Reduction in a Humanitarian Setting in Uganda. International Journal of Qualitative Methods, 22. https://doi.org/10.1177/16094069231183606

Lua, I., Silva, A. F., Guimarães, N. S., Magno, L., Pescarini, J., Anderle, R. V. R., Ichihara, M. Y., Barreto, M. L., Teles Santos, C. A. S., Chenciner, L., Souza, L. E., Macinko, J., Dourado, I., & Rasella, D. (2023). The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individuals. The Lancet Regional Health - Americas, 24, 100554. https://doi.org/10.1016/j.lana.2023.100554

Maineny, A., Asrawaty, A., & Sakti, P. M. (2023). Prevention of Sexual Violence in Children with Comic Media. Journal of Community Engagement in Health, 6(2), 17–22. https://doi.org/10.30994/jceh.v6i2.500

Mamun, A. Al, & Alam, M. (2025). Promoting Equity in Public Health: Addressing Inequality and Social Disparities. Health Science Reports, 8(5). https://doi.org/10.1002/hsr2.70821

Moreira, D. de A., Nina, A. L. B., Garrido, C. de F., & Neves, M. E. S. B. (2024). Rights-Based Climate Litigation in Brazil: An Assessment of Constitutional Cases Before the Brazilian Supreme Court. Journal of Human Rights Practice, 16(1), 47–70. https://doi.org/10.1093/jhuman/huad023

Navidmanesh, S., Kadkhodaee, M., Ghadirinokabadi, L., & Emamifar, A. (2025). Resolving conceptual and practical gaps in current child well-being models through the holistic well-being model for children. Discover Psychology, 5(1), 52. https://doi.org/10.1007/s44202-025-00382-z

Nóbrega, K. B. G. da, Marinus, M. W. de L. C., Belian, R. B., & Gontijo, D. T. (2021). Validation of the educational technology ‘abuse no more’ for young people with intellectual disabilities. Ciência & Saúde Coletiva, 26(7), 2793–2806. https://doi.org/10.1590/1413-81232021267.09032021

Pacini-Ketchabaw, V., Kummen, K., & Hodgins, B. D. (2023). A qualitative examination of early childhood educators’ participation in professional learning: investigating social constructionist understandings of quality. Journal of Early Childhood Teacher Education, 44(3), 484–509. https://doi.org/10.1080/10901027.2022.2099324

Pedroso, M. R. de O., & Leite, F. M. C. (2022). Prevalence and Factors Associated with Sexual Violence against Children in a Brazilian State. International Journal of Environmental Research and Public Health, 19(16), 9838. https://doi.org/10.3390/ijerph19169838

Ramsden, R., Colbran, R., Christopher, E., & Edwards, M. (2022). The role of digital technology in providing education, training, continuing professional development and support to the rural health workforce. Health Education, 122(2), 126–149. https://doi.org/10.1108/HE-11-2020-0109

Rana, M. Q., Lee, A., Bezerra, J. F. R., Ojo, L. D., & Boas, G. H. V. (2025). Causal Factors of Violence Against Women and Girls (VAWG): Perspectives from the Brazilian Higher Education Students. Societies, 15(9), 261. https://doi.org/10.3390/soc15090261

Rizzo, A. J., Orr, N., Shaw, N., Farmer, C., Chollet, A., Young, H., Berry, V., Rigby, E., Hagell, A., Bonell, C., & Melendez-Torres, G. J. (2023). Exploring the Activities and Target Audiences of School-Based Violence Prevention Programs: Systematic Review and Intervention Component Analysis. Trauma, Violence, & Abuse, 24(5), 3593–3614. https://doi.org/10.1177/15248380221134294

Rohmah, N., & Rosyidha, A. (2025). Educational Content in Japanese Manga: Learning Science, History, and Ethics through Pop Culture. KIRYOKU, 9(2), 431–441. https://doi.org/10.14710/kiryoku.v9i2.431-441

Sahu, G., Choudhury, J. C., Pati, S., Mohapatra, A., & Pradhan, P. K. (2024). Breaking Silence, Unmasking Perpetrators: A Prospective Study on Perpetrators of Sexual Violence. Journal of Indian Academy of Forensic Medicine, 46(4), 510–514. https://doi.org/10.1177/09710973251328107

Scattolin, M. A. de A., Resegue, R. M., & Rosário, M. C. do. (2022). The impact of the environment on neurodevelopmental disorders in early childhood. Jornal de Pediatria, 98(suppl 1), S66–S72. https://doi.org/10.1016/j.jped.2021.11.002

Silva, K. L. da, Pinheiro, P. N. da C., Mesquita, K. K. B., Sales, J. M. R., Mondragón-Sánchez, E. J., Ximenes, L. B., Gubert, F. do A., & Lima, F. E. T. (2024). Preventing sexual violence in adolescence: digital booklet construction and validity. Acta Paulista de Enfermagem, 37. https://doi.org/10.37689/acta-ape/2024AO00026122

Simpson, A., & Cremin, T. M. (2022). Responsible Reading: Children’s Literature and Social Justice. Education Sciences, 12(4), 264. https://doi.org/10.3390/educsci12040264

Streiner, D. L., Norman, G. R., & Cairney, J. (2024). Health measurement scales: a practical guide to their development and use (6th ed.). Oxford university press.

Sudarsan, I., Hoare, K., Sheridan, N., & Roberts, J. (2022). Giving voice to children in research: The power of child‐centered constructivist grounded theory methodology. Research in Nursing & Health, 45(4), 488–497. https://doi.org/10.1002/nur.22231

Unser-Schutz, G. (2025). “Wha, what is this?”: Interactive elements in the representation of thoughts in Japanese manga (comics). Journal of Pragmatics, 248, 1–16. https://doi.org/10.1016/j.pragma.2025.08.002

Valente, S. A., Iborra Marmolejo, I., & Mora Ascó, J. J. (2025). Psychological and Social Impact on Mothers of Minors Who Have Experienced Child Sexual Abuse: A Systematic Review. Psychiatry International, 6(4), 158. https://doi.org/10.3390/psychiatryint6040158

Widanaralalage, B. K., Hine, B. A., Murphy, A. D., & Murji, K. (2022). “I Didn’t Feel I Was A Victim”: A Phenomenological Analysis of the Experiences of Male-on-male Survivors of Rape and Sexual Abuse. Victims & Offenders, 17(8), 1147–1172. https://doi.org/10.1080/15564886.2022.2069898

Wild, C. F., Nietsche, E. A., Salbego, C., Teixeira, E., & Favero, N. B. (2019). Validation of educational booklet: an educational technology in dengue prevention. Revista Brasileira de Enfermagem, 72(5), 1318–1325. https://doi.org/10.1590/0034-7167-2018-0771

Yusoff, M. S. B. (2019). ABC of Content Validation and Content Validity Index Calculation. Education in Medicine Journal, 11(2), 49–54. https://doi.org/10.21315/eimj2019.11.2.6