FIVE-YEAR LONGITUDINAL MONITORING STUDY OF THE LEVEL OF CONCEPTUAL AND ATTITUDINAL KNOWLEDGE OF DROWNING PREVENTION IN SCHOOLCHILDREN IN RIO DE JANEIRO, BRAZIL, 2022-26

Abstract

Drowning is a silent, rapid event and constitutes a major public health issue in the Americas. In addition to being neglected, young people receive insufficient education on its prevention. The aim of this study was to monitor changes in the Drowning Preventive Knowledge Level (DPKL) among schoolchildren and adolescents in Rio de Janeiro, Brazil. This is a longitudinal study conducted between 2022 and 2026 with elementary school students (5th to 9th grades) and high school students (1st and 2nd years) from CAp-UERJ. A total of 12 classes were followed, comprising 334 students. Of these, four classes (n=110) were in the 9th grade, four classes (n=117) in the 1st year of high school, and four classes (n=107) in the 2nd year, assessed at five time points (2022, 2023, 2024, 2025, and 2026). The structured DPKL questionnaire, consisting of three parts and 20 items, was administered at school. In the first part, students matched universal figures used on drowning prevention signs with their respective meanings (7 questions). In the second part, they associated flag colors (green, yellow, and red) with sea bathing conditions (3 questions). In the third part, they marked “yes” or “no” for statements related to appropriate behaviors in aquatic environments (10 questions). Each class received five annual pedagogical interventions based on individual DPKL results. The results indicated an improvement trend over the period (2022–2026) in knowledge of the meaning of illustrations on the seven drowning prevention signs, especially sign 1 (absence of a lifeguard), with an increase of 15 percentage points. There was also improvement in knowledge of flag meanings (green, yellow, and red), with increases of 12, 14, and 12 percentage points, respectively. Improvements were also observed in the 10 attitudes investigated, particularly in the group followed from the 5th to the 9th grade, which progressed from 77% to 100% correct responses. In this same group, the DPKL showed a significant increase of 21 percentage points. Overall, improvement in DPKL was observed across all grade levels analyzed, with a linear trend of better performance as schooling progressed. It is concluded that systematic, continuous, and low-cost school-based educational interventions were effective in promoting significant improvements in the Drowning Preventive Knowledge Level (DPKL) among children and adolescents. Over the five-year period (2022–2026), consistent progress was observed both in conceptual understanding—regarding the identification of signs and flags—and in attitudinal aspects related to safety in aquatic environments, culminating in high performance levels, with a predominance of “excellent” classifications among students. Educational programs based on conceptual and attitudinal content, combined with diagnostic tools such as the DPKL, are relevant strategies to guide more effective and targeted interventions. Expanding and institutionalizing these actions within school curricula may significantly contribute to reducing drowning incidents and deaths, fostering individuals who are more aware, cautious, and capable of making safe decisions in aquatic environments throughout life.