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14 March 2022

Expansion of our Patient and Community Education Flipcharts in Brazil During the COVID-19 Pandemic

Pictured: Health agents and nurses attend training in the open-air parking lot of Centro de Saúde Nossa Senhora Aparecida (a primary care centre) in Belo Horizonte, Brazil
Pictured: Health agents and nurses attend training in the open-air parking lot of Centro de Saúde Nossa Senhora Aparecida (a primary care centre) in Belo Horizonte, Brazil

Reach has been supported by the Edwards Life Sciences Foundation Every Heartbeat Matters Grant to develop, pilot, and disseminate a series of patient and community education flipcharts in the state of Minas Gerais, Brazil.

After a successful year of developing and piloting the introductory flipchart, Rheumatic Fever and Rheumatic Heart Disease, in the small town of Montes Claros during 2019, we had planned to expand training to cover the newly developed Rheumatic Fever and Rheumatic Heart Disease Community Awareness and Rheumatic Heart Disease and Pregnancy flipcharts. However, this came to a halt, with the rest of the world, as lockdowns, restrictions, and new SARS-CoV-2 variants emerged throughout 2020. With the end of 2020 and funding once again secured, we were able to renew activities the following year.

2021 Activities and Evaluation

With the help of our Brazilian colleagues, affiliated with the Universidade Federal de Minas Gerais, roll-out of the educational flipcharts was expanded to Minas Gerais’ capital city, Belo Horizonte, while also carrying over the previously planned training in Montes Claros. At the same time, a fourth flipchart; Rheumatic Heart Disease and Surgery, was developed.

RHD and surgery flipchart cover art

To meet our training targets and expand the flipcharts to a greater number of underserved patients, key adjustments were made to the programme roll-out. Changes to the conduct of training workshops included pivoting to virtual training sessions, hosting more frequent smaller in-person workshops (rather than fewer and larger), and locating outdoor or well-ventilated venues for the occasional larger group.

Another challenge was evaluation. Seeing as in-person focus group workshops would not be possible due to travel restrictions, we decided to develop an electronic pre- and post-training survey with the goal of collecting data on knowledge transfer. After discussion with the Belo Horizonte team about whether this would be feasible to conduct, we developed the surveys based on a previously published tool for assessing knowledge, attitudes, and practices on rheumatic heart disease.


As expected, most flipchart trainees were health agents (46%) or nurses (19%), and the remainder a mix of allied health care professionals.

Pre- and post-training survey results

As a result, we anticipate over 2,000 underserved patients will be impacted by these training activities and new tools available for health agents and professionals to now use in their conversations. Our long-term strategy for this type of educational tool is to have it accessible online in multiple languages for download by countries in need of a foundation to guide health worker and patient interaction in RF/RHD endemic settings.

2022 Activities

This year our Brazilian colleagues continue to train health workers in Belo Horizonte and will expand training to clinics in the neighbouring city of Divinópolis. In addition we are planning to host a patient event in the last quarter of the year, providing support and information to existing and newly diagnosed RHD patients. We continue to collaborate strongly with Universidade Federal de Minas Gerais and now Children’s National Hospital to achieve the greatest patient impact and programme efficiency in Brazil.

Further Details

If you are interested in using any of the educational flipcharts in your setting, please navigate to our resources tab for more information ( and get in touch.