Dissertations / Theses on the topic 'Health promotion strategy'

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
O cÃncer mamÃrio depende de aÃÃes pontuais da promoÃÃo da saÃde, proteÃÃo especÃfica e diagnÃstico precoce. A promoÃÃo da saÃde na reabilitaÃÃo da mastectomia mediante estratÃgias educativas pode ser eficaz, pois promove conhecimentos sobre saÃde, influencia as decisÃes para adoÃÃo de hÃbitos saudÃveis, assim como motiva uma aÃÃo desejada, articulando as intervenÃÃes apreendidas na manutenÃÃo da saÃde. Objetivou-se avaliar a tecnologia educativa (manual) implementada a mulheres mastectomizadas quanto ao conhecimento adquirido sobre aspectos ligados ao cÃncer de mama e à motivaÃÃo para mudanÃa comportamental no seu autocuidado por meio do Modelo TransteÃrico (MTT). Estudo avaliativo, descritivo, transversal e quantitativo. A intervenÃÃo avaliada foi o manual educativo sobre o cÃncer de mama e a reabilitaÃÃo. A amostra foi composta por 125 mulheres de acordo com critÃrios de inclusÃo, dentre eles, tempo de cirurgia (> 15 dias) e escolaridade (> 5 ano do ensino fundamental). A coleta foi realizada de abril a agosto de 2009 numa instituiÃÃo especializada em oncologia, em trÃs fases denominadas: preparatÃria, operacional I, correspondendo à aplicaÃÃo do questionÃrio prÃ-teste e escala URICA antes da leitura do manual, e operacional II, ao pÃs-teste e escala URICA apÃs a leitura. Os dados foram extraÃdos de questionÃrios prà e pÃs-teste (avaliaÃÃo do conhecimento) e escala URICA - University of Rhode Island Change Assessment Scale (avaliaÃÃo dos estÃgios de mudanÃa comportamental). Os dados receberam tratamento descritivo, sendo calculadas mÃdias, desvio-padrÃo, freqÃÃncias e percentis. Na avaliaÃÃo e comparaÃÃo do conhecimento, os resultados foram organizados em tabelas e grÃficos, sendo feitos os testes t-Student e McNemar, considerando significantes p<0,005. Sobre as caracterÃsticas das mulheres, a idade variou de 24-84 anos (m=51,66), predominaram casadas-viÃvas (63,2%), ensino fundamental (44,8%), ocupaÃÃo fora do lar (56%), renda familiar atà um salÃrio mÃnimo (44,8%, m=2,57), a maioria submetida a mastectomia (68%). Das que fizeram tratamento (N=122), 57,4% passaram por duas modalidades. A histÃria familiar apresentou-se em 81 (64,8%), sendo 74 (91,4%) em parentes de primeiro grau. Quanto ao conhecimento, o pÃs-teste aumentou 10% de acertos. Das questÃes, a mais acertada foi o nome da cirurgia (97,60%) e a menos, a reconstruÃÃo mamÃria (58,40%). Todas as questÃes foram estatisticamente significantes, exceto a dos cuidados com o dreno (p=0,743). Ao comparar o conhecimento apÃs a leitura, as mulheres revelaram melhor desempenho, exceto sobre a reconstruÃÃo mamÃria (p=0,754), nÃo sendo estatisticamente significante. No referente à motivaÃÃo, a menor media no pÃs-teste foi na prÃ-contemplaÃÃo (m=15; Dp=2,65). Na comparaÃÃo, encontraram-se diferenÃas significativas antes e depois na prÃ-contemplaÃÃo (p=0,0001) e na manutenÃÃo (p=0,0001), nÃo sendo encontrada diferenÃa na contemplaÃÃo (p=0,211). Para aÃÃo, houve forte indicativo de maior mÃdia no pÃs-teste em relaÃÃo ao prÃ-teste (p=0,051). A avaliaÃÃo do conhecimento e a motivaÃÃo apresentaram resultados positivos com distribuiÃÃes sem disparidades entre as mÃdias antes e apÃs a intervenÃÃo. Mesmo o estudo evidenciando a possibilidade de motivaÃÃo, a cogniÃÃo à fundamental para a compreensÃo e conseqÃente adesÃo Ãs orientaÃÃes. Conclui-se que o manual educativo à um recurso favorÃvel à reabilitaÃÃo da mastectomizada, pois motiva a mulher ao autocuidado e à promoÃÃo da sua saÃde.

The purpose of this research was to develop and test a health promotion intervention designed to minimise unhealthy adolescent grief reactions. A sample of Western Australian adolescents were consulted to identify their perceptions regarding the causes of grief for adolescents, the means by which they manage grief, their perceptions of what constitutes healthy and unhealthy grieving, and the risks associated with unhealthy grieving and the type of grief-management intervention they preferred.

Abstract: Aim: This study aimed at getting an understanding and critical analyses of the Ethiopian government empowerment strategy in improving maternal and child health in Ethiopia.Method: This is an ethnographic study, in which mainly un-structured interviews, focus group discussions and participant observation were conducted to collect data for the study. Results: The study concluded that the empowerment intiative has been promising to some extent in addressing the health concerns of women and children in Ethiopia. However, lack of bottom up health promotion strategies such as geniune community participation in the designing and implementation of the health program has greatly hindered the health promotion program from effectively improving the health status of women in the studied community.

Seasonal influenza, or the flu, impacts over 3 million people each year. Within the health sector, nosocomial infection and absenteeism are frequently associated with the flu. The Centers for Disease Control and Prevention (CDC) recommend flu vaccination for all eligible individuals, especially health care workers (HCWs). Interventions associated with increased HCW vaccination include educational programs and occupational health campaigns to address misconceptions regarding vaccine safety and efficacy. This project evaluated the impact of a voluntary, web-based education module to encourage registered nurse (RN) vaccination. The logic and health belief models served as the theoretical frameworks. In a nonequivalent group design, an educational program addressing evidence-based barriers to vaccination was delivered at 1 acute-care hospital and was not delivered at a comparison hospital within the health system. A total of 192 surveys (116 at intervention facility) were returned over 3 weeks. Statistically significant differences (x2 = 7.210, p = 0.007) were found for RNs who accepted influenza vaccination after education when compared to the RNs not receiving education. The 15% higher vaccination rate for RNs receiving education (91.1% vs. 76.1%) translates into more than 100 additional vaccinated RNs if applied across both hospitals. This project found that a simple but tailored web-based educational program is effective in converting RNs to vaccination acceptance. Increased vaccination produces societal change by reducing nosocomial and community influenza transmission. Reduced influenza infection improves community health as well as patient safety. Future work should address community-wide HCW education initiatives and evaluate their impact on quality and financial indicators at the hospital and community levels.

Malaria is a vector-borne disease that presents the most persistent and serious public health burden in Liberia. Numerous studies have examined the relationship between ITN use and malaria prevalence. However, little research has explored the effectiveness of ITNs in controlling malaria among children in postwar Liberia. The aim of this study was to examine the association between ITN ownership, parental economic status, ITN installation support, and malaria prevalence among children. This was a quantitative cross-sectional study guided by the health belief model. The study used secondary data from the 2011 Liberia Malaria Indicator Survey. Chi-square for association and Logistic regression were used to analyze the data. The results revealed a significant association between parental education and malaria prevalence. There was also a significant association between parental economic status and malaria prevalence. However, there was no significant association between ITN ownership and malaria prevalence after controlling for parental education and ownership of structure. These findings may foster social change by helping public health authorities in Liberia integrate ITN use with other strategies like mosquito larvae elimination and indoor/outdoor insecticide spraying as part of a comprehensive approach to malaria control. Additionally, massive awareness and economic capacity building should be undertaken to empower malaria endemic communities with the understanding that malaria can be rapidly reduced with other robust strategies in combination with ITN use. These strategies, if implemented, may effectively control malaria prevalence among children and the emotional and financial burdens endure by their families.

O fortalecimento da promoção da saúde considerando o espaço escolar como um ambiente de potencialidades para seu desenvolvimento está previsto nas ações intersetoriais entre a escola e os serviços de saúde, e está entre os objetivos centrais do trabalho da equipe Estratégia Saúde da Família (ESF) e do Programa Saúde na Escola (PSE). O estudo teve por objetivo analisar as significações de professores do ensino fundamental sobre as ações da equipe de saúde na escola em um município do interior paulista. O estudo foi realizado a partir de abordagem qualitativa de pesquisa, utilizando como técnica de construção de dados a entrevista semiestruturada com professores dos 1º aos 5º anos do ensino fundamental das escolas de abrangência de Unidades de Estratégia Saúde da Família de um município do interior paulista. Participaram do estudo 16 professores de seis escolas públicas municipais. A pesquisa fundamentou-se nos conceitos de promoção e educação em saúde, utilizando a abordagem histórico-cultural de Vigotski como referencial teórico. Utilizou-se a proposta de análise temática de Braun e Clarke (2006). Os resultados evidenciaram as significações construídas pelos professores, que indicam a importância da parceria entre saúde e educação. No entanto, outras significações indicaram fragilidades de tal parceria, com a tendência de os profissionais da educação significarem saúde a partir de uma concepção preventivista e de culpabilização das famílias pelos comportamentos não saudáveis dos alunos. Associado a isso, os professores relatam ações pontuais e fragmentadas relacionadas à saúde ocorrendo no contexto escolar, com pouca corresponsabilidade entre os setores. Quanto às ações programáticas de saúde, os professores construíram significações que indicam a importância de se construir um planejamento conjunto e identificaram estratégias para práticas intersetoriais mais efetivas. Considera-se que novas posturas devem ser adotadas pela equipe da ESF e do PSE, no sentido de fortalecer a relação com a equipe da escola, a partir de uma visão de que os sujeitos se transformam e se modificam a partir das relações
The strengthening of health promotion by considering the school space as an environment of potential for its development is foreseen in the intersectoral actions between the school and the health services and it is among the central goals of the work of the Family Health Strategy (FHS) team and Health in School Program (HSP). The aim of this study was to analyze the meanings of elementary school teachers about the actions of the health team in the school in a city in the countryside of São Paulo. The study was carried out from a qualitative research approach, using as a data construction technique the semi-structured interview with elementary school teachers from first to fifth grade of the schools surrounding the Family Health Strategy Units of a city in the countryside of São Paulo. Sixteen teachers from six municipal public schools participated in the study. The research was based on the concepts of promotion and health education, using the historical-cultural approach of Vygotsky as a theoretical reference. It was used the thematic analysis proposal of Braun and Clarke (2006). The results showed the significations built by the teachers that indicate the importance of the partnership between health and education. However, other meanings indicated fragilities of this partnership, with the tendency of the education professionals to mean health from a preventivist conception and blame of the families for the unhealthy behaviors of the students. Associated with this, the teachers report punctual and fragmented actions related to health occurring in the school context, with little co-responsibility between the sectors. As for programmatic health actions, the teachers built meanings that show the importance of constructing a joint planning and identified strategies for more effective intersectoral practices. It is considered that new postures should be adopted by the FHS and HSP team, in order to strengthen the relationship with the school team, based on a view that the subjects transform and change themselves from the relations

Os grupos de promoção de saúde são intervenções coletivas que buscam favorecer o desenvolvimento da cidadania. Tendo como recurso importante a educação em saúde, são grupos que estimulam a cooperação entre os participantes para o desenvolvimento de atividades a favor da conquista do que se é de direito a todo cidadão, uma vida digna. A relevância do tema somada a escassez de estudos nessa área foram as principais razões que motivaram a busca por conhecer as propostas já implantadas, as estratégias utilizadas, às contribuições desses grupos à população e os desafios a serem superados. Tratou-se um estudo descritivo exploratório, com uso da análise qualitativa. Foi aplicado em três Núcleos de Saúde da Família vinculados a uma Universidade e localizados no município de Ribeirão Preto. Contribuíram para esse estudo dezoito participantes entre profissionais de saúde e usuários que compartilhavam das intervenções. Os resultados apontaram para uma busca da equipe com vistas ao desenvolvimento e aprimoramento das ações grupais voltadas para a educação em saúde. Também foram identificadas estratégias exitosas que beneficiam principalmente as relações sociais e proporcionam bem estar psicoemocional ao usuário. Foi identificada atuação importante da equipe multiprofissional para a efetivação do trabalho. Como conclusão foi possível observar que apesar dos avanços, alguns desafios giram em torno da busca pela superação do modelo de assistência tradicional, organização de indicadores que auxiliem no aperfeiçoamento das estratégias e construção de novos sentidos que auxiliem na compreensão e atuação sobre as demandas individuais e coletivas.
Health promotion groups are collective interventions that seek to promote the development of citizenship. Having as an important resource health education, are groups that stimulate cooperation among participants to develop activities in favor of achieving what is right for every citizen, a dignified life. The relevance of the theme, coupled with the scarcity of studies in this area, were the main reasons that motivated the search to know the proposals already implemented, the strategies used, the contributions of these groups to the population and the challenges to be overcome. This was an exploratory descriptive study using qualitative analysis. It was applied in three Family Health Centers linked to a University and located in the city of Ribeirão Preto. Eighteen participants contributed to this study among health professionals and users who shared the interventions. The results pointed to a search of the team with a view to the development and improvement of group actions focused on health education. Successful strategies have also been identified that mainly benefit social relations and provide psycho-emotional well-being to the user. An important performance of the multiprofessional team was identified for the accomplishment of the work. As a conclusion, it was possible to observe that despite the advances, some challenges revolve around the search for overcoming the traditional assistance model, organization of indicators that help in the improvement of strategies and construction of new senses that help in understanding and acting on the individual demands and collective agreements

Health care administrators in Ontario want to transform health care with a focus on improving efficiency and quality of care, yet they pay little attention to increasing revenue. The purpose of this qualitative case study was to explore strategies Ontario hospital administrators apply to generate nongovernment revenue to remain sustainable. The target study population consisted of 2 chief executive officers and 2 chief financial officers at Ontario academic research hospitals. The conceptual framework for this study included radical organizational change theory supported by complexity leadership theory, and grounded in an evidence-based approach. The researcher conducted open-ended semi-structured interviews and made efforts to collect relevant documents. The data analysis process included coding of the interviews followed by identifying themes and aggregate dimensions. Five themes emerged including working within the fiscal reality, the impact of the political environment, the focus on the mission, nongovernment revenue generation, and opportunities for the Ontario academic research hospital. The application of the findings from this study may contribute to social change by encouraging hospital executives to adopt a more coordinated and consistent approach to generating nongovernment revenue to support the mission of their hospitals.

A presente dissertação aborda a temática da medicalização social a partir da problematização do cuidado, permeado pela noção de promoção à saúde, praticado no âmbito da Atenção Básica pela Estratégia de Saúde da Família e o Núcleo de Apoio à Saúde da Família. A medicalização seria uma forma de poder que atua sobre a população, no âmbito coletivo e individual, a partir de uma certa racionalidade médica imbricada nas estruturas da sociedade que é potente o suficiente para formular noções sobre os comportamentos desviantes que colocariam em risco a saúde bem como propor a adoção de certos modos de vida para serem seguidos individualmente e coletivamente. Para problematizar essa prática, apresento como questão central: como as equipes das unidades de saúde da Atenção Básica, em especial a Estratégia de Saúde da Família e o Núcleo de Apoio a Saúde da Família, direcionam determinadas práticas de cuidado que podem ser posicionadas como processos e estratégias de medicalização da vida dos sujeitos e grupos atendidos? Como material empírico, utilizei narrativas de experiências vividas no dia a dia como trabalhador do Sistema Único de Saúde que atua no Núcleo de Apoio a Saúde da Família. A escolha das histórias narradas ocorreu a partir da minha percepção de que contribuiriam para tratar da temática da medicalização. Buscam apontar marcas do processo de medicalização que almejariam a gestão do corpo social, mesmo quando esse cuidado está arraigado em dispositivos aparentemente contra hegemônicos.
This dissertation approaches the theme of social medicalization, based on the problematization of care permeated by the notion of health promotion, which is practiced in the scope of Primary Care, the Family Health Strategy and the Family Health Support Unit. In order to do so, it presents as a central question: how the teams of the Primary Care health units, especially the Family Health Strategy and the Family Health Support Center, direct certain care practices that can be positioned as medicalization processes and strategies of the lives of the subjects and groups served? In order to explain this issue, I used as narrative material narratives of experiences lived in the day-day of Health Unic System worker who works in the Family Health Support Unit. The choice of stories that are problematized occurred from the author's perception of the power they carried with them to deal with the topic of medicalization. The narratives as a background were used to problematize care in Primary Health Care, mediated by the Family Health Strategy and Family Health Support Unit, with the intention of locating and searching for the brands of the medicalization process, which would aim at the management of the social body, even when such care is rooted in seemingly counter-hegemonic devices. In this research the medicalization was understood as a form of power that acts on the population, in the collective and individual scope, from a certain medical rationality imbricated in the structures of the society that is powerful enough to formulate notions on the deviant behaviors that would put in health risk, as well as proposing the adoption of certain lifestyles to be followed individually and collectively.

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This research proposes to describe which ones of the actions classified as Health Promotion are developed in the Health Unities circumscribed in Maruípe area, in the city of Vitória-ES, to verify the conceptions used as it s base and the difficulties to it s accomplishment. This research also develops an analysis of the activities made in the name of Health Promotion, specifically at one Health Unity of that area, and examines, specifically, the relations established between users and professionals who conduct the actions. It presents a valuation of the moments where the practices of Health Promotion reaches the potencialization of the subject s autonomy and points those moments that contributes to the experts knowledge domination, denying the word to others, slighting their knowledges or disqualifying the user s way of life. There are several conceptions of Health Promotion, and they include such the activities pointed to the modifications of the individual behavior, focused on the life style changes, as well as the activities directed to the collectivity and physical, social, political, economical and cultural environment, showing the relevance to consider, during the work s routine, how these activities happen. To accomplish the goals, individual interviews were made to five health professionals, with the use of semistructured scripts, and two group interviews with users of the actions. The field work happened during the work s routine, from July to October 2008, resulting in nearly 130 hours of specific activities observations. six different kinds of actions classified as Health Promotion were analyzed: Atividade Física (physical activity), Grupo Futuro do Amanhã: corpo em movimento (Tomorrow s Future: body in movement Group), Fitoterapia (Fitoterapy), Bolsa Família (Family Stipend), Ação Anti-Tabagismo (anti-tobacco action) and HIPERDIA (actions against arterial hypertension and diabetes mellitus). It concludes for the existence of similarities between what is considered Disease Prevention actions and those actions known as Health Promotion. It values the virtual presence of the construction of collective spaces of exchange, which contributes to edify other ways of being in the world, and to fortify fights for a better life and health conditions. There are big efforts by professionals to the realization of Health Promotion collective actions, although there are several difficulties and obstacles, which causes the frequent absence of users or the existence of purposeless actions, not only from those who organizes it, but also from those who participates. It brings to attention the considerable verticalization of the choices of which actions will be made by the Health Unity, since the priorities are elected by the Health Ministry and Municipal Secretary s power of induction, which creates actions with no planning or valuation by the involved professionals. The relationship between users and professionals are predominantly verticalized, with little space to the user s speech and to the exchanges between them. It valorizes orientations and prescriptions of behaviors classified as healthier, and insists on the need of changing one s life styles, no matter the constant resistance by the users, such as not going to meetings, or asseverating that, in the end, they make their own way .
Esta pesquisa se propôs descrever quais são as ações tidas como de Promoção à Saúde que se desenvolvem nas Unidades de Saúde circunscritas à macrorregião de Maruípe, no município de Vitória-ES, verificar as concepções que as embasam e as dificuldades para sua realização. Além disso, desenvolve análise das atividades que são realizadas em nome da Promoção à Saúde, especificamente em uma US dessa macrorregião. Examina particularmente as relações que se estabelecem entre usuários e os profissionais responsáveis por estas ações. Avalia em que momentos as práticas de Promoção à Saúde alcançam uma potencialização da autonomia dos sujeitos e aponta aqueles que contribuem para a subjugação aos saberes especialistas, negando a palavra ao outro, desconsiderando seu saber, ou desqualificando os modos de vida exercidos pelos usuários. As concepções de Promoção à Saúde são várias, e incluem tanto atividades dirigidas à transformação dos comportamentos dos indivíduos, focalizadas na mudança dos estilos de vida, quanto àquelas que abrangem atividades voltadas para o coletivo e o ambiente físico, social, político, econômico e cultural, daí a relevância de considerar, no cotidiano dos serviços, como acontecem tais atividades. Para cumprir os objetivos, foram realizadas cinco entrevistas individuais com roteiro semi-estruturado com os profissionais de saúde e duas entrevistas coletivas com os usuários participantes das ações. O trabalho de campo consistiu no acompanhamento do cotidiano do serviço durante os meses de julho a outubro de 2008, resultando em aproximadamente 130 horas de observação de atividades específicas. São analisadas seis modalidades diferentes de ação tidas como de Promoção à Saúde: Atividade Física, Grupo Futuro do amanhã: corpo em movimento , Fitoterapia, Bolsa Família , Ação Anti-Tabagismo e o HIPERDIA . Constata que existe uma indistinção entre aquilo que se considera ação de Prevenção de Doenças e aquelas que se configuram como sendo de Promoção à Saúde. Avalia que as possibilidades de construção de espaços coletivos de troca que contribuam para a edificação de outros modos de estar no mundo e para o fortalecimento das lutas por melhores condições de vida e saúde estão virtualmente presentes. Há grande esforço por parte dos profissionais para a realização das ações coletivas de Promoção à Saúde, porém as dificuldades e os entraves são inúmeros, o que faz com que tais ações estejam por vezes esvaziadas de usuários e outras carentes de sentido, tanto para quem faz quanto para quem participa. Ressalta que há grande verticalização na eleição das ações que são realizadas pela US, visto que é o poder de indução do MS e da SEMUS que elegem as prioridades, o que faz com que as ações sejam realizadas sem planejamento ou avaliação por parte dos profissionais envolvidos. As relações que se estabelecem entre os usuários e profissionais são predominantemente verticalizadas, com pouco espaço para falas proporcionado por estes últimos ou estímulo às trocas entre eles. Prima-se por orientações e prescrições de condutas tidas como saudáveis e pela insistência na necessidade de mudança nos estilos de vida, mesmo que os usuários resistam, seja faltando aos encontros ou afirmando que, ao final, fazem tudo do jeito deles .

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Introdução: o presente estudo apresenta como tema a Promoção da Saúde da Criança, recortando como objeto a inserção de suas premissas nos cuidados realizados por enfermeiros da Estratégia Saúde da Família. Objetivo: analisar as concepções e experiências de enfermeiros da Estratégia Saúde da Família, no que se refere à incorporação das premissas da Promoção da Saúde nos cuidados realizados com crianças e suas famílias. Aspectos metodológicos: pesquisa de abordagem mista, composta por duas etapas. Na primeira, foi realizado estudo qualitativo sobre o objeto em estudo na perspectiva dos enfermeiros da Estratégia da Saúde da Família de um município do interior paulista, com coleta e sistematização dos dados feita por entrevistas semiestruturadas gravadas e por técnicas de análise de conteúdo temática, respectivamente. Na segunda, realizou-se estudo quantitativo transversal e descritivo sobre 626 atendimentos clínicos realizados por enfermeiros a 222 crianças, as quais compuseram amostra probabilística e estratificada calculada a partir do universo de crianças nascidas entre 28 de fevereiro de 2015 a 27 de fevereiro de 2017, que foram atendidas em seus dois primeiros anos de vida nas referidas unidades. Os dados foram coletados dos prontuários das crianças e de suas mães, com enfoque nos tipos de atendimento a elas realizados, nos motivos/queixas, avaliações clínicas e nas propostas de cuidados elaboradas. Foi realizada análise descritiva das variáveis estudadas utilizando o Programa SAS System versão 9.3. A discussão dos resultados obtidos, em ambas as etapas, baseou-se nas premissas da Promoção da Saúde da Criança. O projeto desta pesquisa foi aprovado por Comitê de Ética em Pesquisa local (Parecer nº 1.851.368). Resultados: o grupo dos 11 enfermeiros se caracterizou pela maior parte ser do sexo feminino, estar na faixa etária entre 30 a 50 anos, ter oito a 26 anos de graduação e de um a 15 anos de atuação na Estratégia Saúde da Família. De modo ampliado, os participantes relacionaram a Promoção da Saúde da Criança a ações integrais e intersetoriais, que valorizam a Educação em Saúde, comprometimento e vínculo próximo das equipes com as famílias, para capacitá-las a modificar os determinantes do processo saúde-doença de seus filhos, visando sua melhor qualidade de vida e saúde. As dificuldades associadas às referidas ações foram: baixa participação familiar nas atividades programadas, preferência pelo atendimento médico, condições familiares e sociais adversas, carência de recursos de educação permanente na temática. As crianças se caracterizaram por apresentarem situações favoráveis quanto aos aspectos sociodemográficos, condições obstétricas e de nascimento, com parcelas menores daquelas que apresentaram riscos e vulnerabilidades ao nascer. Dos 626 atendimentos clínicos estudados, 548 (87,6%) ocorreram no primeiro semestre de vida, com 407 (65%) do tipo consulta agendada de rotina e 11 (1,8%) visitas domiciliares. Quanto às queixas/motivos, destacaram-se os sinais, sintomas e outros parâmetros clínicos alterados, com 425 (93,4%) registros, relativos principalmente ao sistema respiratório e ao tegumentar, que somaram 200 (43,7%) dos registros; evidenciando-se a febre como o sinal isolado registrado em 95 (20,9%). Em relação às áreas diagnósticas, sobressaiu-se a de Agravos Físicos com 445 (46,3%) avaliações, seguida pela de Alimentação/Hidratação com 206 (21,4%) avaliações e a do Crescimento e a do Desenvolvimento neuropsicomotor, que juntas somaram 197 (20,5%) das avaliações. Sobre as áreas de intervenção, a maior parte se configurou em Orientação 1200 (55,6%), especialmente sobre Higiene corporal/Higiene bucal com 392 (18,2%) e Alimentação/Hidratação com 288 (13,3%) registros, seguidas pelas condutas de Encaminhamento, Agendamento, Solicitação de exames de rotina, com 905 (41,9%) das propostas de cuidados. Considerando as Necessidades Essenciais da Infância, os resultados anteriores sustentam a ideia de que a mais explorada foi a Necessidade de Proteção Física, Segurança e Regulamentação. Considerações finais: as concepções apreendidas revelaram-se próximas às premissas científicas e políticas atuais sobre Promoção de Saúde da Criança. Por outro lado, as experiências relatadas apresentaram-se permeadas pelo enfrentamento de dificuldades e vulnerabilidades inerentes às crianças, aos seus contextos de vida e ao próprio serviço de saúde. Dentre os cuidados de enfermagem realizados na Estratégia Saúde da Família, verificou-se que nos atendimentos clínicos pediátricos, independentemente do tipo, são desenvolvidas ações de Promoção da Saúde. Entretanto, esses atendimentos ainda são fortemente influenciados pelo modelo biomédico, centrado em doenças e agravos à saúde, refletindo no predomínio de registros nas áreas de avaliações diagnósticas e de intervenção voltadas aos agravos físicos, não contemplando várias necessidades tidas como essenciais da infância. Considera-se que o estudo apresenta subsídios para a reorganização das ações de Promoção da Saúde da Criança, evidenciando potencialidades/desafios a serem considerados/superados pelos enfermeiros no contexto estudado e em outros relacionados.
Introduction: the present study has as its theme the Child’s Health Promotion, outlining as object the insertion of its premises in cares carried out by Family Health Strategy nurses. Objective: analyze Family Health Strategy nurses’ conceptions and experiences concerning to Health Promotion premises incorporation in cares carried out with children and their families. Methodological aspects: mixed approach research, composed of two stages. In the first, it was carried out a qualitative study about the object of attention from the perspectives of Family Health Strategy nurses from an inland São Paulo city, with data collection and systematization made by recorded semi structured interviews and techniques of thematic content analysis, respectively. In the second, there was carried out a quantitative transversal and descriptive study about 62 clinical cares made by nurses to 222 children who composed probabilistic and stratified sample calculated from the universe of children who were born between February 28th, 2015 and February 27th , 2017, who were treated during their first two years of life in the cited health centers. Data was collected from children’s and their mothers’ medical records, focusing on the kinds of cares offered to them, on their reasons/complains, clinical evaluation and on their elaborated cares purposes. It was carried out a descriptive analysis of the studied variables using SAS System Program version 9.3. The discussion about the obtained results, in both stages, was based on Child’s Health Promotion premises. This research project was approved by Ethical Committee in local Research (Opinion nº 1.851.368). Results: the group composed by 11 nurses was characterized as being mostly females, between 30 and 50 years old, eight to 26 years of under graduation and one to fifteen years of Family Health Strategy performance. Broadly, participants related Child’s Health Promotion to integral and intersectional actions which value Health Education, commitment and close bonds from teams towards families in order to enable them to modify determinants of their children’s healthillness process, aiming at their better quality of life and health. Difficulties associated with their stated actions were: poor family participation in programmed activities, medical care preference by this population, adverse family and social conditions, lack of material and organizational resources and permanent education on the subject. The children’s sample was characterized by presenting favorable situations regarding to the social demographic aspects, obstetrical and birth conditions, with smaller sectors of those who presented vulnerabilities as life threatening at birth. The analysis of 626 studied clinical cares revealed a higher frequency of these in the first semester of life 548 (87, 6%), with 407 (65%) routine scheduled visits, being only 11 (1,8%) home visits. As for the complaints/reasons related to these visits, signals, symptoms and other altered clinical parameters were highlighted, with 425 (93,4%) recorded, related mainly to tegumentary and respiratory systems, which summed together 200 (43,7%) of records, evidencing fever as an isolated signal recorded in 95 (20,9%). Relating to the diagnosed areas it was highlighted the Physical Injury one with 445 (46,3%) evaluations, followed by the Feeding/Hydration with 206 (21, 4%) evaluations and neuropsychomotor Growth and Development, which summed together 197 (20,5%) evaluations. Concerning to intervention areas most part of them was related to Orientation 1200 (55,6%), especially about Body Hygiene/Oral Hygiene with 392 (18,2%) records and Feeding/Hydration with 288 (13,3%) records, followed to Referral, Scheduling and Request for routine exams with 905 (41, 9%) of the care proposes. Considering essential childhood needs, the former results support the idea that the most explored one was the Physical Protection, Safety and Regulation Need. Final Considerations: the grasped conceptionswererevealed close to scientific premises and current policies about Child’s Health Promotion. On the other hand, reported experiences were presented permeated with coping difficulties and vulnerabilities inherent in children, in their lives contexts and in health service itself. Among cares carried out in Family Health Strategy it was verified that on pediatric clinical cares, irrespective of the kind, Health Promotion actions are developed. However, these cares are still strongly influenced by biomedical model, centered on illnesses and health problems which reflect on predominance of records in diagnoses evaluation’s areas and interventions based on physical injuries, not contemplating several necessities which are treated as essential during childhood. It is considered that the study presents subsidies to reorganization of Child’s Health Promotion actions putting in evidence potentialities/challenges to be considered/overcome by nurses in the studied context and others related to it.

O Sistema Único de Saúde (SUS) foi criado, a partir do movimento da Reforma Sanitária, como uma necessidade do país em atender às novas demandas em saúde colocadas pelo contexto social. A Estratégia Saúde da Família surgiu como um meio de avançar na construção dos princípios do novo sistema, na busca de romper com antigas concepções na área que centravam na doença, em detrimento de uma visão integral dos sujeitos e comunidades. Neste cenário, a promoção da saúde aparece como um conceito inovador das práticas sanitárias, lançando um novo paradigma com o foco nos aspectos saudáveis dos indivíduos e ambientes, ou seja, o foco na saúde. O presente estudo, de natureza qualitativa, investigou as concepções e práticas de promoção da saúde de profissionais dos Núcleos de Saúde da Família (NSF) da Universidade de São Paulo (USP). Foram entrevistados treze sujeitos de três equipes, a saber: três enfermeiros, três médicos, dois auxiliares e um técnico de enfermagem, dois dentistas e dois agentes comunitários de saúde (ACS). Foi utilizada entrevista semi-estruturada. Foi feita uma descrição das comunidades atendidas pelas respectivas equipes. Ficou evidente a importância do vínculo entre equipe e usuários como subsídio para o trabalho. As atividades denominadas como ações de promoção da saúde, com ênfase para os trabalhos em grupo, mostraram-se entrelaçadas à concepção de saúde do profissional, o que sinalizou para uma dificuldade de consolidação da ESF no que diz respeito à promoção da saúde em sua amplitude. A participação comunitária apareceu como algo distante da realidade, e a intersetorialidade foi apontada como um meio de buscar atender às demandas do contexto. O trabalho em equipe mostrou-se como um ponto marcante do fazer em promoção da saúde, com seus aspectos positivos e desafiadores. Os resultados apontaram para uma lacuna entre a concepção teórica e a implementação do conceito no cotidiano dos profissionais.
The National Health System (NHS) was created from the Sanitary Reform movement, as a need to meet the new demands placed on health by the country social context. The Family Health Strategy (FHS) has emerged as a means of advancing in the construction of the principles of the new system, seeking to break with old conceptions in the area that focused on disease, rather than a comprehensive view of individuals and communities. In this scenario, health promotion appears as an innovative concept of sanitary practices, launching a new paradigm with the focus on health aspects of individuals and environments, in the focus on health. This study was qualitative and investigated the concepts and practices of health promotion of professionals from the Nucleus for Family Health (NFH) of the University of São Paulo (USP). Thirteen individuals by team were interviewed, namely: three nurses, three doctors, two assistants and a practical nurse, two dentists and two community health agents (CHA). IT was used semi-structured interview and a description of the communities served by the respective teams was made. It was evident the importance of the link between staff and users as a tool for the job. The activities referred to as actions to promote health, with emphasis on group work, were intertwined with the concept of health professional, which signaled a difficulty in consolidating the FHS in respect to health promotion in its amplitude . Community participation appeared as something distant from reality, and intersectionality was identified as a means of seeking to meet the demands of context. Teamwork proved to be a turning point of doing in health promotion, with its positive and challenging. The results point to a gap between design theory and implementation of the concept in the everyday work of the professionals.

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RESUMO A Aten??o B?sica no Brasil tem como um dos seus desafios a incorpora??o da atividade f?sica ao cotidiano da popula??o. Essa estrat?gia goza de grande reconhecimento cient?fico no que tange ? obten??o de h?bitos de vida saud?veis. O presente estudo objetivou identificar a percep??o dos profissionais da Estrat?gia de Sa?de da Fam?lia (ESF) sobre pr?ticas de atividade f?sica nas Unidades B?sicas de Sa?de (UBS) de Diamantina (MG). Neste trabalho estudou-se a percep??o dos profissionais acerca da import?ncia da atividade f?sica, a ader?ncia da popula??o a essas pr?ticas, as dificuldades para a realiza??o das atividades, bem como seu planejamento e execu??o. Foi desenvolvido um estudo explorat?rio, descritivo e anal?tico, do tipo corte transversal, com abordagem de natureza quantitativa e qualitativa, e uma coleta de dados em que foi aplicado um question?rio do tipo Likert a todos os profissionais da sa?de de todas as ESF do referido munic?pio. Na primeira etapa os dados foram analisados atrav?s de estudo de frequ?ncia e propor??o e, na segunda, realizou-se o teste exato de Fisher para verificar associa??o estatisticamente significativa entre categorias profissionais estudadas e vari?veis de interesse. Foi detectado o desenvolvimento de pr?ticas de atividade f?sica representadas pelos grupos de caminhada e gin?stica em seis das nove UBS do munic?pio. Destaca-se a seguir os principais resultados obtidos. A percep??o da import?ncia da pr?tica de atividade f?sica obteve a concord?ncia de 100% dos indiv?duos em tr?s das seis assertivas pesquisadas. A percep??o da participa??o da popula??o nas pr?ticas de atividade f?sica na UBS mostrou concord?ncia total e parcial entre mais de 75% dos respondentes quanto ? divulga??o, hor?rio e aconselhamento sobre a participa??o nos grupos de atividade f?sica. A percep??o das dificuldades para a realiza??o de atividade f?sica nas UBS destacou, em 96% das respostas, a necessidade de capacita??o dos profissionais de sa?de para atividade f?sica. O estudo da percep??o dos profissionais em rela??o ao planejamento e execu??o das pr?ticas de atividade f?sica mostrou que 83,9% das respostas concordaram total ou parcialmente com o reconhecimento da responsabilidade de todos os profissionais da ESF no desenvolvimento das atividades. Conclui-se que os profissionais percebem os benef?cios e a import?ncia da pr?tica de atividade f?sica no ?mbito da Aten??o B?sica, embora reconhe?am a pequena participa??o da popula??o nos grupos de atividade f?sica e na disponibiliza??o de equipamentos p?blicos para tal fim.
Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2015.
ABSTRACT The Primary Care in Brazil has as one of its challenges incorporating physical activity to daily life of the population. Incorporating physical activity to the population habits enjoys high scientific recognition to obtain healthy life habits. This study aimed to identify the perception of professionals from the Family Health Strategy practice of physical activity in the Basic Health Units of Diamantina, MG. In this work we studied the perception of professionals about the importance of physical activity, adherence of the population to these practices, the difficulties to carry out the activities and the planning and execution of the same. It was developed an exploratory, descriptive and analytical study of transversal, with a quantitative and qualitative approach, in which data collection was a questionnaire of Likert to all health professionals from all of the municipality ESF. In the first stage the data were analyzed through study frequency and proportion and the second stage was held Fisher's exact test to determine a statistically significant association between occupational groups studied and variables of interest. The development of physical activity practices represented by walking groups and fitness in six of the nine municipal UBS was detected. It highlights the following key results. The perception of the importance of physical activity practice obtained the agreement of 100% of subjects in three of the six surveyed assertive. The perception of participation of people in physical activity practices in UBS showed total and partial agreement between more than 75% of respondents as the disclosure time and advice the participation of physical activity groups. The perception of the difficulties to achieve the physical activity groups at UBS noted in 96% of the responses, the need for training of health professionals for physical activity. The study of the perception of the professionals in relation to the planning and execution of physical activity practices showed that 83.9% of respondents agreed fully or partially recognizing the responsibility of the ESF in the development of activities. It is concluded that the professionals realize the benefits and importance of physical activity in the context of Primary Care, while acknowledging the small participation of the population in physical activity groups and providing public facilities for the purpose.

Introdução: A Hipertensão Arterial - HA, doença crônica cujas taxas de morbidade atingem no Brasil aproximadamente 17 milhões de pessoas, é um dos principais fatores de risco para doenças do aparelho circulatório. Sua determinação multifatorial exige a adoção de estratégias de controle complexas, que deem conta dos fatores e condições de risco, o que remete a ações sobre estilo de vida e seus determinantes psicossociais, econômicos e ambientais. Nesse sentido, as práticas da Promoção da Saúde, fundadas em um conceito ampliado de saúde, colocam em pauta, juntamente com as ações de prevenção, a discussão sobre a qualidade de vida, relacionando-a às condições de vida e saúde da população. Objetivo: Identificar e analisar as práticas da Promoção de Saúde e sua utilização para reorientação dos serviços de saúde no município de Fortaleza com foco no controle da Hipertensão Arterial. Metodologia: Estudo de caso, contendo em seu desenho três fases: identificação através de análise documental de políticas, planos e ações no nível nacional, estadual e do município de Fortaleza, além de entrevistas em profundidade com gestores ligados ao controle da HA; aplicação de questionários semiestruturados com coordenadores dos Centros de Saúde do município sobre as estratégias de Promoção da Saúde utilizadas no controle da HA; entrevistas em profundidade com enfermeiros, médicos e agentes comunitários de saúde de algumas destas Unidades. Resultados e discussão: Apesar de o novo modelo ter modificado o padrão de atenção ao município, a visão biomédica centrada na clínica ainda predomina no atendimento dos Centros de Saúde. O controle dos fatores de risco está bastante relacionado a uma responsabilidade do usuário e as ações na maioria das vezes são pontuais, utilizando ainda a orientação prescritiva como maior ferramenta para mudança. A grande demanda por atendimento, assim como questões técnicas e políticas por parte da gestão, tornam esse processo de reorientação do serviço de saúde lento, porém desafiante. Alguns Centros de Saúde conseguem quebrar essa hegemonia biomédica e tendo uma visão mais abrangente de território. Realizam atividades em conjunto com a população e em prol de um fortalecimento da comunidade, fortalecendo o controle da HA, amenizando as desigualdades e iniquidades. Programas complementares, como NASF, Residências, Academia da Comunidade, Bombeiros, entre outros, provenientes de outras áreas do setor saúde ou de outros setores da administração municipal, têm contribuído para o desenvolvimento da iniciativa proposta pela Estratégia Saúde da Família. Conclusão: Apesar das inúmeras dificuldades encontradas foram observados alguns avanços em relação à mudança de paradigma na prestação de serviços de saúde no município de Fortaleza, contribuindo para a melhoria da qualidade de vida da população estudada
Introduction: Hypertension, a chronic disease with a morbidity rate in Brazil of circa 17 million people, is a leading risk factor for cardiovascular diseases. Its multifactorial determination requires the use of complex multifactor strategies of control, that could deal with the risk conditions and factors, which refers to actions on lifestyle and psychosocial, economic and environmental determinants. In this context, practices of health promotion, embracing a broader concept of health, discuss the quality of life and preventive actions, relating them with life and health conditions of the population. Objectives: Focusing the control of Hypertension, the aim of this thesis is to identify and analyze the health promotion practices and its use in the reorientation of health services in the city of Fortaleza, Brazil. Methodology: Case study, in three phases: identify, trough documental analysis, policies, plans and actions for the national, state, local (Fortaleza city) hypertension control and in-depth interviews with managers and directors relates to hypertension control; collect data on health promotion strategies used in the hypertension control, through semi-structured questionnaires with Coordinators of City Health Centers; interviews with nurses, doctors and community health agents from some of these Health Care Centers. Results and discussion: Although the new model has modified the City Health Care standards, the biomedical view focusing the clinic still predominates in Health Control Centers. The risk factors control is closely related to individual responsibility and actions in most cases are isolated and not very creative, still using the prescriptive guidance as a major tool for change. The great demand for health care as well as technical issues and management policies make this process of reorienting the health service slow but challenging. Some Health Care Centers are able to break this biomedical hegemonic point-of view and, through a closer and more realistic approach to their environment, carry out community oriented activities, strengthening hypertension control and mitigating inequalities and inequities. Although not well-disseminated, complementary programs, such as NASF, Home Care, Community Gym and Firemen, among others, related to other areas of the health care or other areas of city administration have contributed to the development of the initiative proposed by the Family Health Strategy. Conclusion: Despite many difficulties there is a clear progress achieved in the paradigm shift concerning the provision of health services and improvement of life quality

O crescimento progressivo no número de idosos nas últimas décadas, resultado da queda das taxas de fecundidade e mortalidade e do conseqüente aumento da expectativa de vida, fez com que se desenvolvesse o interesse pelo estudo do envelhecimento. Na literatura é destacada a relevância científica e social de se investigar as condições que interferem no bem-estar na senescência e os fatores associados à qualidade de vida de idosos, a fim de criar alternativas de intervenção e propor ações e políticas na área da saúde, buscando atender às demandas da população que envelhece. Importantes avanços no campo da saúde têm sido conquistados no Brasil e a Estratégia Saúde da Família surge como meio possível no processo de reorganização da atenção básica em saúde e com grande potencial para tornar concreta a participação da comunidade e à integralidade das ações. Assim este estudo teve por objetivo analisar as percepções dos idosos em relação à sua qualidade de vida, com vistas à integralidade da assistência, após a adesão a Grupos de Promoção de Saúde em funcionamento no Centro de Saúde Escola da Vila Tibério (Ribeirão Preto-SP). A pesquisa foi feita na abordagem qualitativa e a coleta de dados realizada por meio de entrevista semi-estruturada e da observação participante no período de 22 de julho de 2008 a 04 de dezembro de 2008 em três grupos. A análise foi feita através da análise de conteúdo, usando a técnica de análise temática, sendo identificados seis grandes temas: Sentimentos em relação a como é ser idoso no Brasil; Satisfação com a Saúde; Significados de qualidade de vida; Satisfação com a vida; Importância das atividades sociais e de lazer para qualidade de vida; Os Grupos de Promoção de Saúde. A análise dos achados mostra que os idosos entrevistados valorizam sua independência e autonomia na realização de suas atividades e atribuem uma vida saudável a comportamentos adequados em relação aos cuidados com a saúde, alimentação, sono, além de destacarem as atividades de lazer, a participação nos grupos de promoção de saúde e os bons relacionamentos como imprescindíveis para satisfação com a vida, evidenciando que esses idosos ao se envolverem com atividades promotoras de saúde passaram a valorizar e privilegiar fatores positivos acerca de sua saúde. Apontam ainda que as atividades sociais e de lazer, em especial a participação nos grupos de promoção de saúde foram de extrema importância para a qualidade de vida dos idosos e para formação de uma rede social de cuidado que integra a comunidade e os serviços de saúde, já que os idosos passaram a se cuidar mais, se sentirem mais felizes, mais saudáveis e com uma nova rotina de vida após fazerem parte desses grupos. Assim considera-se que este estudo traz questões relevantes acerca do envelhecimento e das novas propostas da saúde para a melhoria da qualidade de vida da população do estudo e da comunidade, necessitando que as falas dos sujeitos sejam consideradas importantes para a criação de novas ações em saúde pautadas nos reais quereres e necessidades do público alvo.
The progressive growth in the number of aged people over the last decades, which resulted from reduced fertility and death rates and the consequent increase in life expectancy, promoted the development of an interest in studying ageing. The literature highlights the scientific and social importance of researching the conditions that affect wellbeing in ageing and the factors associated with the aged peoples quality of life, with a view to creating intervention alternatives and proposing health actions and policies, aiming at meeting the demands of the ageing population. Important advancements in health have been conquered in Brazil and the Family Health Strategy appeared as a possible means in the process of reorganizing primary health care and with the strength to establishing the participation of the community and the comprehensiveness of the actions. Therefore, the purpose of this study was to analyze the perceptions of aged individuals regarding their quality of life, with a view to provide service comprehensiveness after joining the Health Promotion Groups in progress at the Vila Tibério Teaching Health Center (Ribeirão Preto SP). The study used a qualitative approach and data collection was performed by means of semi-structured interviews and participant observation in three groups, in the period from July 22 to December 4, 2008. Content analysis was performed using the thematic analysis technique, resulting in six major themes: Feelings about what it is like to be aged in Brazil; Health Satisfaction; Meanings about quality of life; Life satisfaction; The importance of social and leisure activities for quality of life; Health Promotion Groups. The analysis of the findings shows that the interviewed aged individuals value their importance and autonomy in performing their activities and report a healthy life and having adequate behavior concerning their health care, eating and sleeping habits, and also highlight that leisure activities, participating in health promotion groups and good relationships are essential to achieve fulfillment in life. This evidences that these aged individuals, by becoming involved with health promotion activities, started to value and prioritize positive factors about their health. They also reported that social and leisure activities, especially their participation in health promotion groups, were extremely important for their quality of life and for creating a social health care network that integrated the aged people to the community, considering that they started to take better care of themselves and to feel happier and healthier, and have a new life routine after entering these groups. Therefore, this study presents relevant issues regarding ageing and new health proposals to improve the quality of life of the study population and the community. The subjects statements are important and should be taken into consideration when creating new health actions founded on the real desires and needs of the target population.

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The exploratory case we aimed to analyze the communication process used by the professional of the Family Health Strategy, the Health Unit Maruípe, in Vitória, capital of Espírito Santo. As a sample, we chose Maruípe region, which has the largest population of the capital, according to data from IBGE/2000 and that the strategy reaches the entire population. Data collection was performed by structured questionnaires with open questions, closed and semi-open to members of two Family Health teams who voluntarily decides to participate. We applied two different types of questionnaires: one to eight Community Health Workers and other staff members to thirteen. Data Were quantified and qualitatively analyzed in order to reflect on the importance of communication in promotional and preventive health, and their relationship with the local primary care and reducing the numbers od admissions to hospitals for underlying causes. Based on critical theory, theory of communicative action, Habermas and the recent Latin American studies on the importance of communicative action as an input in health, we analyze the communication tools used by the team and how that communication is established in order to draw a protocol suggestions to minimize the communication problems in the development of actions.
O estudo exploratório de caso que teve como objetivo analisar o processo de comunicação utilizado pelos profissionais da Estratégia de Saúde da Família, na Unidade de Saúde de Maruípe, no município de Vitória, capital do Espírito Santo. Como amostra, escolhemos a Região de Maruípe, que possui o maior número de habitantes da capital, segundo dados do IBGE/2000 e em que a estratégia atinge toda a população. A coleta de dados se realizou pela aplicação de questionários estruturados com perguntas abertas, semiabertas e fechadas aos integrantes de duas equipes de Saúde da Família que, voluntariamente, decidiram participar da pesquisa. Foram aplicados dois tipos diferentes de questionários: um para oito Agentes Comunitários de Saúde e outro para treze membros da equipe. Os dados foram quantificados e analisados qualitativamente visando refletir sobre a importância da comunicação nas ações de promoção e prevenção da saúde, e sua relação com a atenção básica municipal e a redução do número de internações nos hospitais por causas básicas. Com base na teoria crítica, na teoria do agir comunicativo de Habermas e nos recentes estudos latino-americanos sobre a importância da comunicação como insumo na saúde, analisamos os instrumentos de comunicação utilizados pela equipe e a forma como essa comunicação se estabelece, a fim de traçar um protocolo de sugestões para minimizar os problemas de comunicação no desenvolvimento das ações.

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The Community Health Agent in the family health strategy and its competence or lack thereof, in the development of health promotion actions, has been the focus of constant reflections and studies. Whereas competence as: "knowing, know-how and knowing how to be", we observe that these professionals are so diseased as those whom they propose to handle. Believing it to be possible to empower them to better care for themselves, consequently, making it the best caretakers of others, we proposed the intervention- -"First I: empowerment of community agents for the role in health promotion". An opportunity to stop, look at you, analyze your actions and conceptions of the cuddle up, reflecting on health promotion, rebuilding and resignificando knowledge and individual supremacy. Participated in this intervention, 13 ACS members of two teams of the family health strategy the Health Center Dr. Antonio Guanaré, located in the sanitary district, municipality of São Luís Coroadinho, MA. We held six meetings, with five of them leadership workshops, named: I and my belly button; I Me Hunter; Behold and Watch all of you; Mirror, mirror, there's no better Caregiver of Me than me?; D-day I. In these workshops, active methodologies have been proposed such as: interviews, group dynamics, dispersion and construction activities of individual records in logbooks. The most obvious results of this craving to experience different, perceived in the logs and observed behaviors, was the expansion of self knowledge and reflection of the situation of individual health and its relationship with the leading role in health promotion, the need to plan better and plan for the care of themselves with the details of time and frequency of execution, the construction of an individual care plan based on survey and mapping of risks and co-morbidities.
O protagonismo do Agente Comunitário de Saúde na Estratégia Saúde da Família e sua competência ou a falta dela, no desenvolvimento das ações de promoção da saúde, tem sido foco de constantes reflexões e estudos. Considerando competência como: "saber, saber-fazer e saber ser", observamos que estes profissionais estão tão adoecidos quanto aqueles a quem se propõem cuidar. Acreditando ser possível empoderá-los para melhor cuidar de si, consequentemente, tornando-os melhores cuidadores dos outros, propusemos a intervenção - "Primeiro Eu: empoderamento de Agentes Comunitários para o protagonismo na promoção da saúde". Uma oportunidade de parar, olhar para si, analisar suas ações e concepções sobre o cuidar-se, refletindo sobre a promoção da saúde, reconstruindo e resignificando conhecimentos e protagonismos. Participaram desta intervenção, 13 ACS integrantes das duas equipes da Estratégia Saúde da Família do Centro de Saúde Dr. Antonio Guanaré, localizado no distrito sanitário do Coroadinho, município de São Luís, MA. Realizamos seis encontros, sendo cinco deles oficinas de protagonismo, nomeadas: Eu e o Meu Umbigo; Eu Caçador de Mim; Olhai e Vigiai Todos Vós; Espelho, Espelho Meu, Existe Melhor Cuidador de Mim do que Eu?; e Dia D EU. Nestas oficinas, foram propostas metodologias ativas tais como: entrevistas, dinâmicas de grupo, atividades de dispersão e construção de registros individuais em diários de bordo. Os resultados mais evidentes desta experiência de protagonismos diversos, percebidos nos registros e comportamentos observados, foi a ampliação do autoconhecimento e a reflexão da situação de saúde individual e sua relação com o protagonismo na promoção da saúde, a necessidade de se programar melhor e planejar o cuidado de si com o detalhamento de tempo e frequência de execução, a construção de um plano de cuidados individual fundamentado no levantamento e mapeamento de riscos e co - morbidades.

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Health Promotion is considered an important strategy for overcoming the development of purely curative and individual actions aimed at health, which are characteristic of the biomedical model. The same proposes the development of care, preventive and promotional health. However, this proposal reflects numerous obstacles, among them stands out the conceptual aspect, which was being shaped over the years from the development of understanding of the concept of health. Based on the scope of health promotion, the School Health Program was created in 2007, the same propose to the articulation of the Family Health Strategy with the school and it is proposed to integrate and link the two sectors with actions that aim to improve the quality of life of students in basic education schools. Thus, the present study was to identify the program inconsistencies from the design of health promotion that it incorporates in confront the understanding that the World Health Organization has about the same which is based on seven principles, which are: holism, intersectionality, empowerment, social participation, equity, multi-strategy actions and sustainability. This is a bibliographic and documentary research. Data collection occurred in the period from January to June 2014. Initially a literature review was conducted through a prior reading of titles and abstracts of articles, dissertations and theses contained in the scientific material to be defined. The collection was conducted with the Scielo databases ; Bireme ; Lilacs ; Medline and Cochrane Library , and the descriptors were used: health promotion; school health ; School Health Program ; Health strategy and school health . 35 articles and eight dissertations were obtained . This step was followed by desk research. As a result was obtained that: can not identify specifically that health promotion is adopted as nuclear center of the program; there is the definition of a concept of health promotion, before there is a mix of concepts that can be seen from the recommended actions; the structural difficulties faced by the FHS compromise its operation; predominates the trend of personal guilt is individual as your reality, is the professional regarding the commitment to the success of the proposed actions; do not see the incorporation of the seven principles defined by the WHO; the preponderance given to the health sector to conduct the proposed actions indicates serious weakness; the actions that stand out are the healing and promotion actions are confused with prevention. Therefore, identifies the importance of commitment to the critical evaluation of the program and the involvement of many other sectors of the political sphere and the active participation of individuals to the development of actions that are consistent with the broader concept of health and can focus the social determinants.
A Promoção da Saúde é considerada uma importante estratégia para a superação do desenvolvimento de ações meramente curativas e individuais direcionadas à saúde, pois propõe o desenvolvimento de ações assistenciais, preventivas e promocionais à saúde. Entretanto, essa proposta reflete inúmeros empecilhos, dentre eles destaca-se o aspecto conceitual, que foi sendo moldado ao longo dos anos a partir da evolução da compreensão acerca do conceito de saúde. Tomando por base o escopo da promoção da saúde, o Programa Saúde na Escola (PSE) foi criado no ano de 2007. O programa operacioanaliza-se a partir da articulação da Estratégia Saúde da Família com a escola. O presente estudo foi realizado com o objetivo de identificar as inconsistências do PSE a partir da concepção de promoção à saúde que incorpora, tendo como contraponto o entendimento que a Organização Mundial da Saúde tem sobre a temática, que se alicerça em sete princípios, quais sejam: concepção holística, intersetorialidade, empoderamento, participação social, eqüidade, ações multi-estratégicas e sustentabilidade. Trata-se de uma pesquisa bibliográfica e documental. A coleta dos dados ocorreu no período compreendido entre janeiro a junho de 2014. Inicialmente foi realizado um levantamento bibliográfico através de uma leitura prévia dos títulos e resumos dos artigos, dissertações e teses constantes no material científico a ser delimitado. A coleta foi realizada junto às bases de dados do Scielo; Bireme; Lilacs; Medline e Biblioteca Cochrane, e foram utilizados os descritores: promoção da saúde; saúde na escola; Programa Saúde na Escola; Estratégia Saúde da Família e saúde escolar. Foram obtidos 35 artigos e 8 dissertações. Esta etapa foi seguida pela pesquisa documental. Nessa etapa foram utilizados os Documentos referentes ao PSE e à Estratégia Saúde da família. Por fim, o tratamento dos conteúdos selecionados se deu a partir da análise dos resultados obtidos, no qual foi realizada a apresentação dos achados da pesquisa tendo em vista os objetivos estabelecidos. Como resultados obteve-se que: não foi possível identificar concretamente que a promoção da saúde seja adotada como centro nuclear do Programa; não há a delimitação de uma concepção de promoção da saúde, antes há uma mescla de concepções que podem ser observadas a partir das ações preconizadas; as dificuldades estruturais enfrentadas pela ESF comprometem seu funcionamento; predomina-se a tendência da culpabilização pessoal seja do indivíduo quanto a sua realidade, seja do profissional referente ao compromisso com o sucesso das ações propostas; não visualiza-se a incorporação dos sete princípios delimitados pela OMS; a preponderância dada ao setor saúde para a condução das ações propostas indica séria fragilidade; as ações que se destacam são as curativas e as ações de promoção são confundidas com as de prevenção. Diante disso, identifica-se a importância do compromisso com a avaliação crítica do programa e do envolvimento de diversos setores, da esfera política e da participação ativa dos indivíduos para o desenvolvimento de ações que sejam condizentes com o conceito ampliado de saúde e que possam incidir sobre determinantes sociais.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Brazil is living with the exponential population aging, which is no longer synonymous with illness, because there are currently grants to improve the seniors quality of life. In this context, health education is an effective alternative to overcome the biomedical model focuses on disease as an individual phenomenon and curative medical care, making it an effective tool for these users to develop capacity to intervene on their own lives. This study investigated the experiences of professionals who work with health education aimed at the elderly in the Family Health Strategy, to verify the contribution of health education as a subsidy to attain a better quality of life for the elderly population and identify effective actions in health education targeting the elderly developed in the Family Health Basic Units. This was a qualitative research, and to meet the objectives proposed the method of Thematic Oral History was utilized, using the interview technique for the production of empirical data. The study was conducted in Campina Grande / PB, with twelve contributors who are part of the Family Health Team and work with in Health Education for the elderly or have worked with the subject under investigation. When analyzing the empirical material revealed three main themes which have significance and guided the whole discussion: health education on aging as an area of sharing and empowerment; health education activities as a tool for improving quality of life and health promotion the elderly population; and the instrumentalization of educational activities as a tool for the manipulation of educational activities in the Family Health Strategy: dilemmas, challenges and possibilities. The speeches show that the respondents use health education as an excellent tool of empowerment, which opens space for dialogue, listening, talking and sharing experiences of everyday life. We observed an improvement in the quality of life as the north of the collaborators in the educational actions, obtaining excellent results, and the need for health education be viewed as a social practice and proposed effective work. The revelations regarding the instrumentalization of education actions showed a methodological diversification, although there are few inputs and support received by public agencies and forwarded to numerous obstacles, such as the lack of space and time, discouragement and alienation among professionals and users, between others, but also revealed opportunities and positive experiences. The stories have shown us that much can be done to improve further the issues addressed in this study, as investments in health professionals in relation to methodological issues, from specialized training for the implementation of these actions, higher incentive government to distribute educational materials of good quality, to ensure better use of the guidance given, among other requirements that may fill gaps.
O Brasil convive com o envelhecimento exponencial da população, o que não é mais sinônimo de adoecimento, pois atualmente há subsídios para melhorar a qualidade de vida dos idosos. Nesse contexto, a educação em saúde é uma eficaz alternativa para superação do modelo biomédico, centrado na doença como fenômeno individual e na assistência médica curativa, tornando-se ferramenta eficaz para que esses usuários desenvolvam a capacidade de intervenção sobre suas próprias vidas. Este estudo objetivou conhecer as experiências dos profissionais que trabalham com educação em saúde voltada para os idosos na Estratégia Saúde da Família, verificar a contribuição da educação em saúde como subsídio para se atingir a melhoria da qualidade de vida da população idosa e identificar as ações efetivas de educação em saúde, voltadas para os idosos, desenvolvidas nas Unidades Básicas de Saúde da Família. Tratou-se de uma pesquisa qualitativa, e para atender aos objetivos propostos foi utilizado o método da História Oral Temática, fazendo uso da técnica de entrevistas para produção do material empírico. O estudo foi desenvolvido na cidade de Campina Grande/PB, com doze colaboradoras que fazem parte da Equipe Saúde da Família e trabalham com Educação em Saúde voltada para os idosos ou já trabalharam com a temática em estudo. Ao analisar o material empírico, emergiram três eixos temáticos, os quais deram significação e nortearam toda a discussão: educação em saúde no envelhecimento enquanto espaço de partilha e empoderamento; ações de educação em saúde como ferramenta para a melhoria da qualidade de vida e promoção da saúde da população idosa e a instrumentalização das ações educativas na Estratégia Saúde da Família: impasses, desafios e possibilidades. Os discursos revelaram que as colaboradoras utilizam a educação em saúde como uma excelente ferramenta de empoderamento, a qual abre espaço para o diálogo, para a escuta, a fala e partilha de experiências do cotidiano. Observou-se a melhoria da qualidade de vida da população idosa como o norte das colaboradoras nas ações educativas, obtendo excelentes resultados, e a necessidade de a educação em saúde ser encarada como prática social e proposta efetiva de trabalho. As revelações em relação à instrumentalização das ações educativas mostraram que há uma diversificação metodológica, apesar de serem poucos os insumos e o apoio recebido pelos órgãos públicos e remeteram a inúmeros impasses, como a falta de espaço e tempo, a desmotivação e desinteresse dos profissionais e usuários, entre outros, mas também revelou possibilidades e experiências positivas. As histórias demonstraram que muito pode ser feito para melhorar ainda mais as questões abordadas neste estudo, como investimentos nos profissionais da área de saúde em relação às questões metodológicas a partir de treinamentos especializados, para a execução das ações de educação, maior incentivo governamental para distribuição de material didático de boa qualidade, para garantir melhor aproveitamento das orientações repassadas, entre outros requisitos que possam suprir lacunas existentes.

Introdução: Muitos programas de intervenção na primeira infância vêm mostrando-se eficazes na melhoria do desenvolvimento das crianças, sendo necessária sua implantação em uma realidade coma a brasileira. A Estratégia Saúde da Família é um espaço que possibilita a ampliação das ações dos profissionais de saúde para além do biológico, pois atua no lócus familiar. Neste contexto a implantação de tecnologias como a do projeto Nossas Crianças: Janelas de Oportunidades torna-se favorável para ampliar e qualificar a atenção à criança, com ênfase no fortalecimento do desenvolvimento infantil. Com a introdução de novas tecnologias na prática dos profissionais de saúde a avaliação das mesmas torna-se necessária, pois é um processo contínuo de análise e síntese de seus benefícios. Objetivo: Avaliar a incorporação das tecnologias do Projeto Janelas pelos profissionais de saúde. Metodologia: Trata-se de uma pesquisa avaliativa com triangulação de métodos utilizando os quatro níveis de avaliação de Kirkpatrick (Reação, Aprendizagem, Comportamento e Resultados). Os sujeitos de estudos foram nove médicos e dezessete enfermeiros de dezoito Equipes das Unidades Básicas de Saúde do Projeto Região Oeste que foram capacitados com a 2a edição do Projeto Nossas Crianças: Janelas de Oportunidades. Resultados: três Equipes incorporaram a tecnologia, nove incorporaram parcialmente e seis não incorporaram a tecnologia. Três enfermeiros e dois médicos incorporaram a tecnologia, nove enfermeiros e cinco médicos incorporaram parcialmente e cinco enfermeiros e dois médicos não incorporaram a tecnologia. Foram identificadas cinco categorias de mudança de comportamento: a) ampliação da clínica dentro da prática da consulta; b) utilização do Caderno da Família em sua prática; c) incorporação em sua prática de conceitos teóricos relacionados a família; d) organização do trabalho e e) estímulo da família para apropriação da tecnologia. Foram também identificadas quatro dimensões relacionadas com a incorporação de tecnologia: a) dimensão ética, técnica, política e econômica da tecnologia em si; b) dimensão aceitação e satisfação do paciente; c) dimensão características do serviço de saúde e d) dimensão processo de trabalho. Conclusões: A incorporação das tecnologias do Projeto Janelas mostrou-se estritamente relacionada com o processo de educação permanente dos profissionais de saúde do Projeto Região Oeste. A análise do cotidiano do trabalho dos profissionais fornece pistas a respeito das tecnologias já em uso pelas Equipes e das necessidades de incorporação do uso de uma nova tecnologia
Introduction: Many intervention programs in early childhood have proven effective in improving the development of children, in a reality like the Brazilian its implementation is required. The Family Health Strategy is a space that allows the expansion of the actions of health professionals beyond the biological, because it acts in the family locus. In this context the deployment of technologies as from the project Our Children: Windows of Opportunities becomes favorable to widen and improve the care of children, with emphasis on strengthening the child development. With the introduction of new technologies in the practice of health professionals their evaluation becomes necessary, because it is an ongoing process of analysis and synthesis of its benefits. Aims: To evaluate the incorporation of the Technologies of the Windows Project by health professionals. Methodology: This is an evaluation research with triangulation methods using the Kirkpatricks four levels of evaluation (Reaction, Learning, Behavior and Results). The subjects of study were nine physicians and seventeen nurses of eighteen health Teams of the Health Basic Units from Western Region. Results: Three Teams incorporated the technology, nine incorporated partially and six have not incorporate the technology. Three nurses and two physicians incorporated the technology, nine nurses and five physicians incorporated partially and five nurses and two physicians have not incorporated the technology. Were identified five categories of behavior change: a) clinical expanding within the query practice; b) use The Family Booklet in their practice; c) incorporate into their practice the theoretical concepts related to family; d) organization of work and e) stimulus the family for appropriation of technology. Were also identified four dimensions related to the incorporation of technology: a) ethical, technical, political and economic dimension of the technology itself; b) acceptance and patient satisfaction dimension; c) dimension of the health service characteristics and d) working process dimension. Conclusions: The incorporation of technology showed closely linked to the process of permanent education of the health professionals from the Western Region Project. The professional work routine analysis provides clues about the technologies already in use by the Teams and the needs of incorporating the use of a new technology

En partant de la perspective de l’existence d’articulations entre deux importantes politiques publiques brésiliennes - Stratégie de Santé de la Famille (ESF) et Politique Nationale de Promotion de la Santé (PNaPS) – et du fait de la centralité que leurs discours assument dans le contexte contemporain du pays, la présente étude investigue et analyse des pédagogies utilisées pour la gouvernance de conduites de sujets et de leurs familles, en vue de la promotion de soins de santé. Réalisée dans une unité du réseau public de services d’assistance en matière de santé à Porto Alegre, État du Rio Grande do Sul, elle consiste en une recherche d’inspiration ethnographique et s’appuie sur des références dans les domaines des Études Culturelles, des Études de Genre et de Santé Publique, dans ses approches vis-à-vis des théorisations de l’analyse discursive, proposée par Michel Foucault. Pour la production des données empiriques, une observation participative a été produite, dans des groupes dont les activités étaient dirigées vers la Promotion de la Santé (PS) envers des utilisateurs de l’unité de santé. Les enregistrements des moments d’observation ont été réalisés par l’intermédiaire de l’instrument journal de bord et l’analyse du matériel produit offre la possibilité d’argumenter sur le fait que les activités suivies configurent des articulations biopolitiques entre Soins de Base en Matière de Santé (APS), Stratégie de Santé de la Famille et Politique Nationale de Promotion de la Santé. Elles configurent donc, des instances pédagogiques proposées afin d’énoncer, éduquer et réguler des familles d’utilisateurs de services d’APS/ESF – par-dessus tout, les femmes de ces familles. Des instances qui assument, en particulier, des perspectives de genre. Dans ce sens, les pratiques discursives d’éducation/promotion de santé analysées opèrent sous la condition de pédagogies (biopédagogies) et, dans le cadre d’une compréhension amplifiée, en tant que biopédagogies de genre. Elles constituent des stratégies d’exercice du pouvoir sur la vie des populations (biopouvoir), de façon à ce que les corps (spécialement les féminins) soient mieux gouvernés, en les rendant plus sains et de plus grande longévité. J’assume, tout au long des analyses des matériels de terrain, que des biopédagogies jouent un rôle central dans les exercices de biopouvoir contemporain, du fait qu’elles contribuent au disciplinement individuel des sujets et à la régulation de populations, en les normalisant en tant qu’autonomes et capables de choisir le plus « adéquat » pour ce qui a été diffusé en tant que vie « saine ». Dans le contexte des articulations biopolitiques étudiées, des femmes sont positionnées en tant que principales partenaires des services de promotion de la santé des familles.
Desde a perspectiva da existência de articulações entre duas importantes políticas públicas brasileiras – Estratégia de Saúde da Família (ESF) e Política Nacional de Promoção da Saúde (PNaPS) – e pela centralidade que seus discursos assumem no contexto contemporâneo do país, o presente estudo investiga e analisa pedagogias utilizadas para governamento de condutas de sujeitos e suas famílias com vistas à promoção de cuidados em saúde. Realizado numa unidade da rede pública de serviços assistenciais de saúde em Porto Alegre/RS, constitui-se como pesquisa de inspiração etnográfica e está apoiado em referenciais dos campos dos Estudos Culturais, Estudos de Gênero e de Saúde Pública em suas aproximações às teorizações da análise discursiva proposta por Michel Foucault. Para a produção dos dados empíricos, houve observação participante em grupos cujas atividades estivessem direcionadas à Promoção da Saúde (PS) com usuários da unidade de saúde. Os registros dos momentos de observação se efetivaram por intermédio do instrumento diário de campo, e a analítica do material produzido possibilita argumentar que as atividades acompanhadas conformam articulações biopolíticas entre Atenção Primária à Saúde (APS), Estratégia de Saúde da Família e Política Nacional de Promoção da Saúde. Configuram, então, instâncias pedagógicas propostas para enunciar, educar e regular famílias usuárias de serviços de APS/ESF – sobretudo, as mulheres dessas famílias. Essas instâncias assumem, sobremaneira, perspectivas de gênero. Nesse sentido, as práticas discursivas de educação/promoção de saúde analisadas operam à condição de pedagogias (biopedagogias) e, numa compreensão ampliada, como biopedagogias de gênero. Conformam estratégias de exercício do poder sobre a vida de populações (biopoder), para que corpos (especialmente, os femininos) sejam mais bem governados, tornando-se mais saudáveis e longevos. Assumo, no decorrer das análises dos materiais de campo, que biopedagogias ocupam uma função central nos exercícios do biopoder contemporâneo, por contribuírem ao disciplinamento individual dos sujeitos e à regulação de populações, normalizando-os como autônomos/as e capazes de eleger o mais ‘adequado’ para o que tem sido veiculado como vida ‘saudável’. No contexto das articulações biopolíticas estudadas, mulheres são posicionadas como principais parceiras dos serviços para promover a saúde das famílias.
From the perspective of the existing links between two major Brazilian public policies - Family Health Strategy (ESF) and the National Health Promotion Policy (PNaPS) - and the importance that their discourse has taken on in the contemporary context of the country, this paper investigates and analyzes the pedagogies used to govern the behavior of subjects and their families in order to promote health care. Executed at one of the public health assistance service units in Porto Alegre/RS, it was organized as a study inspired by ethnographic research and is supported by references from the fields of Cultural Studies, Gender Studies, and Public Health in their approaches to the theory of discourse analysis, proposed by Michel Foucault. For the production of empiric data, there was participant observation in groups whose activities were directed toward Health Promotion (PS) with the users of the healthcare unit. The records of the observations were done using a field diary tool, and the analysis of the material that was produced enables one to argue that the monitored activities shape bio-politic connections between Primary Health Care (APS), the Family Health Strategy, and the National Health Promotion Policy. Therefore, they are pedagogical forums for enunciating, educating, and regulating families that are users of the APS/ESF – especially the women in these families. Forums that exceedingly take on gender perspectives. In this sense, the health education/promotion discursive practices that were analyzed operate as pedagogies (bio-pedagogies), and with an enlarged understanding, as gender bio-pedagogies. They shape the strategies for exercising power over the lives of people populations (biopower) so that bodies (especially female) are better governed, becoming healthier and living longer. I assume, throughout the analyses of the field material, that the bio-pedagogies hold a central function in the exercise of contemporary bio-power due to their contribution to the individual disciplining of the subjects and the regulation of populations, normalizing them as autonomous and capable of choosing the most "appropriate" path to what has been propagates as a “healthy” life. In the context of the examined bio-political articulations, women are positions as the main partners of the services to promote family health.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Considering the growing concern about the rising rates of obesity in children and adolescents, as well as changes in eating habits, it is necessary to adopt preventive and awareness measures for better quality of life and to implement proper eating habits. For this, multidisciplinary science teaching becomes a key element to help increase nutritional knowledge and change unhealthy eating habits. Thus, school becomes a privileged space to develop health promotion. Teachers have undergone a process of continuing education during the research, this allowed them different interactions with new pedagogical strategies that were used, thus providing they appropriated them. The training provided to teachers to reflect on their practice, resulting in the quality of that education and how it is taught, as well as opportunities for the exchange of experiences, leading changes in their teaching behavior. Therefore, the main objective of this study was to evaluate the advancement of knowledge through nutritional health habits, such as nutritional status, level of nutrition knowledge and dietary practices of primary schools through strategies that allowed to approach these issues in the teaching of school subjects. The research is a case study held in the city of Santa Maria/RS, with students from 6th to 9th grade of a public state school, totaling 175 students. A survey was conducted in order to gather data on body mass index (BMI), weight, height, sex, age, eating habits and nutrition information. From the results obtained, it can be observed that there was an improvement in the nutritional status, as well as in the levels of nutritional knowledge. However, it was also that noticed that the habit of skipping meals is common among students. Therefore, it was verified the importance of creating adequate spaces so that the necessary changes in nutritional status and obesity prevention can occur, in order to achieve so, it is necessary to involve school, families, and community through educational strategies for heal promotion.
A preocupação com o aumento dos índices de obesidade em crianças e adolescentes, além das mudanças nos hábitos alimentares, torna-se necessária a adoção de medidas de prevenção e conscientização para uma melhor qualidade de vida e adoção de hábitos alimentares corretos. Para isso, o ensino multidisciplinar se torna peça-chave para auxiliar no aumento sobre conhecimentos nutricionais e na mudança de hábitos inadequados. Assim, a escola torna-se um espaço privilegiado para trabalhar a promoção da saúde. Os professores passaram por um processo de formação continuada no decorrer da pesquisa, isso possibilitou a eles interações com novas estratégias pedagógicas diferentes das que estavam habituados, proporcionando assim que eles se apropriassem das mesmas. A formação proporcionou aos docentes a reflexão sobre sua práxis, resultando na qualidade daquilo que é ensino e como é ensinado, além de oportunizar a troca de experiências, permitindo a mudança em seu comportamento pedagógico. Neste sentido, o principal objetivo deste estudo foi avaliar o avanço do conhecimento nutricional através de hábitos de saúde, tais como estado nutricional, nível de conhecimento de nutrição e práticas alimentares de escolas primárias por meio de estratégias que permitiram abordar estas questões no ensino das disciplinas escolares. Trata-se de um estudo de caso realizado na cidade de Santa Maria/RS, com escolares do 6º ao 9º ano de uma escola estadual pública, totalizando 175 alunos. Foi realizado um levantamento de dados sobre índice de massa corporal (IMC), peso, estatura, sexo, idade, hábitos alimentares e informações nutricionais. A partir dos resultados obtidos, pode-se observar que ocorreu uma melhoria quanto ao estado nutricional, assim como dos níveis de conhecimento nutricional. Porém, notou-se também que a prática de omitir refeições é frequente entre os escolares. Portanto, verificou-se a importância da criação de espaços favoráveis para que ocorra alteração do estado nutricional e prevenção à obesidade, para isso, é necessário envolver escola, família e sociedade através de estratégias educativas de promoção da saúde.

Philosophiae Doctor - PhD
After suffering almost total collapse. Rwanda has made impressive post-genocide progress. Many children of school going age are now attending school, but regrettably, only half complete primary school. High numbers of orphans, disabled children and a growing number of children from child-headed households still suffer the consequences of the poverty inherited from the past. Health problems include HIV/Aids, STIs, malaria, tuberculosis, enteric diseases, mental health problems, hunger and malnutrition. Use of drugs and substance abuse, unwanted pregnancies, lack of support services, unavailability of teaching and learning materials, inflexible curricula and poor teaching methodologies also contribute to learning breakdown. It is against this background that this thesis was conducted to investigate the development of a health-promoting schools model to provide an appropriate strategy to address barriers to learning and to promote healthy development of school children in Rwanda. Two research questions were the focus of this research, first, how does a health-promoting schools model provide an appropriate strategy to address barriers to learning and to promote healthy development of school-aged children in Rwanda and second, what are the participants’ views on and understanding of the model and its potential use in their schools? A mixed methods research design that employed both qualitative and quantitative approaches was used. The study followed sequential implementation: Phase 1 was concerned with the identification of the components for the model. It was a case study of four schools, two rural schools and two urban schools in Kigali City. The sample included 60 teachers, pupils, principals and parents from schools and nine key informants who were policymakers from the Ministries of Education and Health and Social Welfare, line institutions and the UNICEF. Data collection strategies included focus group discussions, semi-structured, in-depth individual interviews, a transect walk and observations. Data analysis was through content analysis. Eight themes emerged out of the data: school leadership and management; school health policies; pupil wellbeing; school partnership with parents, families and local communities; school health services; factors affecting teaching and learning for all children; teacher wellbeing; and a healthy physical school environment. These themes became the components that informed the development of a health-promoting schools model. In Phase 2, the degree of understanding of this proposed model and its components were investigated in each school community.

Master of Public Health - MPH
Background: Malaria was a major cause of mortality and morbidity in Namibia from 1999 to 2001. Malaria epidemics were recorded in 1990, 1996, 2000 and in 2001. In 2001 alone 733, 509 malaria morbidity cases and 1,728 mortality cases were documented. In recent years, however, malaria morbidity and mortality in the country have drastically declined by over 90%. This has influenced the Ministry of Health and Social Services (MoHSS) in Namibia to adopt a malaria elimination approach as opposed to the malaria case management approach. A malaria programme, known as the National Vector Disease Control Program (NVDCP) was instituted and mandated to coordinate malaria case management (diagnosis and treatment) as well as the current malaria elimination focus (elimination of transmission foci). This is all aimed at effectively addressing the current malaria epidemiology and sustain the decline observed over the last decade. Aim and Methodology: The study’s purpose was to analyse how the Namibia Malaria Strategic Plan (MSP) for 2010-2016 was developed and its relationship to health promotion. It employed an exploratory design which included stakeholders involved in malaria programmes and activities in the country. Data collection methods were of a qualitative nature through in-depth interviews and documentary review. Seven people were interviewed representing stakeholders from the public and private sectors. Those interviewed from the public sector were the Ministry of Environment and Tourism (MET), MoHSS’s division for Malaria, Policy Planning and Information Education and Communication (IEC). Others interviewed included national and international non-governmental organizations’ representatives from the World Health Organisation (WHO) and Society for Family Health (SFH). Documents reviewed include MSP 2010-2016, MSP 2003-2007, Malaria Policy of 2005, National Health Promotion policy 2012 and the Namibian Constitution. Data was analysed using content and thematic processes. Respondents were assured of confidentiality and anonymity. Key findings: The study found that information with regard to the formulation process of the MSP 2010-2016 was limited to a few superficially described events. These events involved, amongst others, a review of the previous (2003-2007) MSP, a pre-assessment questionnaire and two to three workshops. The events were not explicitly described or documented. The researcher concluded that the evidence to better understand the development processes of the MSP 2010-2016 was deficient. Consequently, the study concluded that the policy formulation aspects of the MSP were inadequate. The literature indicates that policy formulation and analysis is a complex undertaking and the MSP process did not meet these criteria. Amongst the limitations were limited stakeholder engagement and incomplete descriptions of the processes undertaken. In relation to the MSP’s focus on health promotion, the study found varied understanding of health promotion among the stakeholders. Some respondents were not aware of their organisation’s health promotion interventions while others believed that health promotion was limited to the health sector only. However, while national documents, such as the Namibian Constitution, advocate for ‘health investment as a just cause’ the MSPs limited inclusion of relevant stakeholders, such as the Ministry of Environment (MET) and the Information, Education and Communication (IEC) unit, restricted the ability of the MSP to offer malaria expansive programmes – that is, those beyond the health realm. Moreover, the implementation of malaria activities through the involvement of a limited range of actors in the malaria programmes will continue to perpetuate the existing narrow focus of health promotion by these stakeholders, as opposed to a more broad-base understanding. As a result malaria prevention will continue to be delivered as silo events or programmes. This poses serious implications in working towards the MSP goal of malaria elimination. Recommendations: The Ottawa Charter advocates for ‘Building healthy public policies’. This specifically refers to multi-disciplinary programmes. This study therefore recommends that the NVDCP follow existing international and national guidelines which systematically guide the development of MSPs and official health documents. Doing so would enable a more streamlined policy development process which would describe and contextualize the dimension of policy formulation, namely context, content, process and actors. It also recommends that the MSP is developed through a broad-based collaborative stakeholder engagement process which would facilitate an appropriately integrated inter-sectoral approach to malaria in the country.

Disparities in HIV disease continue to adversely affect Black and Hispanic populations in the United States. Racial and Ethnic Approaches to Community Health (REACH) 2010 in Broward County, Florida, used strategic communications to alert Black and Hispanic young adults of the serious threat and the choices they could make to prevent HIV infection. This study assessed the channels through which 18-39 year-old African American, Haitian, Afro-Caribbean, and Hispanic residents of 12 high AIDS-incidence ZIP-code areas obtained information about HIV/AIDS and which sources they found most helpful. In addition, this study examined how obtaining HIV/AIDS information was associated with histories of HIV testing and perceptions of risk. A secondary analysis of computer-assisted telephone interview (CATI) data sets was conducted for first-time respondents (N=7,843) in 2001-2003, 2005, and 2007. All ethnicities identified obtaining HIV/AIDS information most frequently from television public service announcements, talk shows, and programs and considered this source “most helpful.” Radio was mentioned second most frequently by Haitian respondents, but African Americans and Caribbean Islanders preferred print media: newspapers and magazines. Use of the Internet increased by 22.4% from 2001 to 2007, but very few respondents regarded the Internet as “most helpful.” African Americans, Hispanics, and Caribbean Islanders who obtained HIV information from family or friends were more likely to believe that they might become infected with HIV. Caribbean Islanders who obtained information from a church were less likely to believe they were at risk. Among African American, Caribbean, and Hispanic young adults, obtaining information from a doctor or health provider was the best predictor for reporting ever being tested for HIV. African Americans who heard about AIDS on radio stations “HOT 105” and “99 Jamz” were more likely to have been tested for HIV, as were Haitians who saw something about AIDS on a billboard or bus. Comprehensive HIV-prevention programs should incorporate culturally competent communications components to inform Black and Hispanic young adults of scientific advances in prevention, treatment, and medical care. Further research should examine how diverse ethnic groups in south Florida and elsewhere are accessing and responding to health-related information in the digital age.

Made available in DSpace on 2011-05-04T12:36:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2010
O objetivo desse estudo em uma perspectiva qualitativa é o de analisar como está ocorrendo o processo de incorporação da saúde ambiental pela atenção básica, através da atuação da Estratégia de Saúde da Família no município de Volta Redonda, estado do Rio de Janeiro. A estrutura conceitual abordou os temas: Saúde ambiental e seu respectivo desenvolvimento dentro do sistema saúde brasileiro; o conceito de território e sua a aplicação prática na saúde; a Estratégia de Saúde da Família como veículo de operacionalização. A metodologia do Discurso do Sujeito Coletivo foi utilizada para a confecção do roteiro de entrevista e a tabulação dos dados, permitindo a identificação das idéias centrais e expressões-chaves presentes nos discursos dos gestores e das equipes. A análise foi pelos preceitos da Teoria das Representações Sociais.Os resultados das entrevistas apontam para uma dicotomia entre a visão dos gestores, influenciada pelas concepções teóricas contidas nas políticas públicas de saúde, e a visão da equipes, influenciada pela a estrutura organizacional do SUS. O que influencia na relação saúde e ambiente.
The objective of this study was in a qualitative perspective to analyze as the process of incorporation of the ambient health for the basic attention is occurring, through the performance of the Strategy of Health of the Family in the city in of Volta Redonda, state of Rio de Janeiro. The conceptual structure approached the subjects: Ambient health and its respective development inside of the Brazilian system health; the concept of territory and its practical application in the health, the Strategy of Health of the Family as operationalizes vehicle. The methodology of the Speech of the Collective Citizen was used for the confection of the interview script and the tab of the data, having allowed the identification of the ideas central offices and expression-keys gifts in the speeches of the managers and the teams. The analysis was for the rules of the Theory of the Social Representations. The results of the interviews point with respect to a dichotomy between the vision of the managers influenced by the contained theoretical conceptions in the public politics of health, and the vision of the teams influenced by the a organizational structure of the SUS. What it influences in the relation health and environment.

Baggrund og Formål: Studier har vist at cancer patienter,der oplever kvalme under kemoterapibehandling,har en nedsat livskvalitet. Formålet med dette studie har væretat beskrive,hvordan cancerpatienter opleverkemoterapi-induceret kvalme og hvilke copingstrategier, de anvenderfor at håndtere og kontrollere kvalme. Metode:Der blev foretaget en kvalitativ dagborgsundersøgelse med 14 brystcancer patienter i adjuverende kemoterapibehandling på et universitetshospital i Danmark. Kvalitativ indholdsanalyse blev anvendt som analysemetode. Hovedresultat: Gennem analysen fremkom både et manifest og latent indhold,som beskrev patienterneserfaringer med og reflektioner over oplevelsen af kemoterapi-induceret kvalme. Der blev dannet fem kategorier,appetit, lokalisation, karakter, intensitet ogvarighed.Det latente indhold af disse kategorier blev beskrevet i temaet: kvalme er en fysisk oplevelse med komplekse og modstridende fornemmelser.Patienternes copingstrategier identificeredes gennemseks underkategorierog to kategorier. De to kategoriervar: at struktuere hverdagen med kvalme og at ændre fokus. Patienterne anvendte copingstrategier fra begge kategorier for at opnå kontrol over situationen og genoprette et velbefindende. Konklusion: Idette studie beskrivercancer patienterkemoterapi-induceret kvalme som en kompleks fysisk oplevelse, der håndteresved hjælp afen bred vifte af copingstrategier. Patientinddragelse er en mulig strategi i udviklingen afsundhedsfremmende aktiviteter,der kan højnelivskvaliteten hoscancerpatienter, somoplever kvalme i forbindelsen med kemoterapibehandlingen
Background and Aim: Several studies have reported low quality of life among cancer patients with chemotherapy-induced nausea.This study aimed to describe cancer patients’ perception of chemotherapy-induced nausea and the coping strategies used to ease nausea during chemotherapy. Method: Fourteenfemale cancer patients undergoing chemotherapy in a Danish university hospital participated in this study.Data were extracted from diaries, followed byqualitative content analysis. Result: Data analysis comprised both manifest and latent content and revealed the patients’ own experiences of and reflection about perceived chemotherapy-induced nausea.Five categories,appetite, localization, character, intensity, and durationemerged. The latent content of these categories is described by the theme: nausea is a physical experience of complex and contradictory sensations. The results also identified six subcategories and comprised two main categories, which described the women ́s coping strategies: structuring everyday life with nausea and shifting focus. To manage nausea, patients’ employed coping strategies from both categories. Conclusion: This study used patients’ own assessments to understand both the complexity of nausea and the patients’ description of coping with nausea. A strategy involving patient participation might helpto create health promotion activities that increase quality of life among patients with chemotherapy-induced nausea

ISBN 978-91-86739-45-4

In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital documentation and pertinent strategic information from their respective semistructured interviews. Sections of text signifying concepts from collected documentation and transcribed interviews were organized and coded according to research question and interview questions to explore strategies rural hospital leaders implemented to improve their hospital's financial performance. The methods triangulation process encompassed comparing findings from the interview themes and hospital strategic documentation analysis. The key themes that emerged from coded data were rural hospital leaders' decision-making when addressing rural hospital financial performance, developing synergies with external providers and hospitals, creating effective short-term and long-term strategies, and translating success to the entire organization. Implications for social change include the potential to prevent rural hospital closure and ensure access to healthcare services for the communities rural hospitals serve.

The strategic prevention framework (SPF) is a data-driven operating system to assist designing evidence-based substance abuse prevention programs. The study performed here was to assess the effectiveness of the SPF as a prevention planning system. One purpose of this study was to determine the implementation fidelity of the programs that used the SPF process; the other purpose was to assess effectiveness of the SPF process. This study utilized a set of data collected by the national cross site evaluation team on all jurisdictions that implemented the SPF. A subset of communities collected and reported at least 2 pre-implementation and at least 2 post implementation outcomes data. The minimum sample size for the study was determined by using Cohen's d criteria. The assessments were performed using both qualitative and quantitative methods by using data collected from multiple levels with a quasi-experimental design. The qualitative data were analyzed using qualitative software with key word searches to examine implementation processes, and the quantitative data were analyzed using descriptive statistics and inferential methods such as Student t tests to examine and compare outcomes. Results show that the communities in the study implemented the SPF process with fidelity and that there were changes in desired directions. Factors related to improvements include sufficient internal resources and monitoring follow-through. This research has important implications for social change since substance abuse is a major social issue that has consequences across life span. Recent studies have shown that many behavioral problems have similar risk factors and that improvements for some behavioral problems will most likely have beneficial effects on other related problems.

Background: Health promotion is significant for reducing health inequalities at local and global levels. The Swedish Government has developed a policy for sustainable global development in the pursuit of implementing Agenda's 2030 sustainability goals in the international arena. Svalorna Latinamerika works in Peru with implementing the global goals at local level. Aim: The purpose of the field study is to analyze how Svalorna Latinamerika works strategically with involving local citizens to participate in the development work at the local level. The work is based on the global sustainability goals (Agenda 2030). Methods: The study applied a qualitative method and deductive approach to test whether the theory could be applied in to achieve sustainable development goals. Community participation theory claims that participation (i) is a strategy within the health promotion work that aims to involve local residents in the developing work that affects their lives (ii) it creates trust and legitimacy for the development work (iii) it can strengthen people's self- esteem, knowledge and development of new skills and (iv) the level of participation can affect the sustainability and efficiency of social development. A targeted sampling technique was applied to select the interviewees while data collection was performed through semi- structured interviews. Furthermore, manifest content analysis was used to analyze the collected material. Result: Participation as a health promoting strategy was applied by the non-profit organization. The level of participation consisted of partnership, a collaboration with both top-down and bottom-up approach. The co-operation and involvement of local citizens in decision-making processes created trust and legitimacy and enabled the development program to meet local needs and conditions. It also resulted in increased participation in the program's capacity building activities. Conclusion: The involvement of local citizens in decision-making processes created the conditions for the citizen to strengthen the individual and the community empowerment. Keywords: Community participation, empowerment, global sustainability goals, health promotion, local community development

A Febre Maculosa Brasileira (FMB) é uma doença aguda, transmitida por carrapatos, com curso variável, que pode ocorrer com formas leves e atípicas, até formas graves, com alta taxa de letalidade. A dificuldade no diagnóstico oportuno por deficiência no envolvimento dos profissionais de saúde e ausência de esclarecimentos da população, em áreas de transmissão, é uma das causas desta alta letalidade. Este estudo foi desenvolvido em uma Unidade Básica de Saúde (UBS) situada em área de relevância epidemiológica para FMB, com incidências recorrentes de casos e óbitos no município de São Bernardo do Campo na Região Metropolitana de São Paulo. O objetivo principal do estudo foi implantar e analisar uma proposta de intervenção educativa participativa em saúde e ambiente envolvendo a equipe de agentes comunitários de saúde com a temática de vigilância da FMB em uma área de transmissão visando a produção de novos saberes para o enfrentamento da doença na região. O método de pesquisa qualitativa utilizado seguiu a linha da pesquisa participante, a pesquisa-ação, com uso de instrumentos como entrevistas, rodas de conversa, oficinas de planejamento, mapas falantes, painéis, fotos, filmagens e observação participante. O processo saúde doença da FMB na região serviu de tema norteador além de outros como educação em saúde e ambiente, e o planejamento educativo. O processo de aprendizagem vivenciado pelos profissionais de saúde foi avaliado positivamente, demonstrando que houve sensibilização, diálogo, reflexão e decisão conjunta nos vários momentos proporcionados pelas oficinas pedagógicas. As atividades realizadas promoveram oportunidades para os agentes conduzirem e organizarem suas próprias tarefas e os momentos de planejamento das ações foram relevantes, e inovadores; além de outras demonstrações de envolvimento como a recomendação de ampliação para outros temas e para outras localidades, evidenciando satisfação e acolhimento da proposta, embora também aponte para a preocupação com a temática na região e a necessidade em ampliar as discussões. A pesquisa participante mostrou-se extremamente adequada para a interação do grupo estimulando o interesse por buscar soluções aos problemas levantados gerando nos profissionais um sentimento de empoderamento. Estes resultados indicam que estas metodologias podem ser incorporadas aos programas de vigilância de outras doenças com o objetivo de melhorar o envolvimento dos agentes comunitários de saúde nos planos de ações educativas nas localidades onde atuam.
Brazilian Spotted Fever (BSF) is an acute disease, transmitted by ticks, with a variable course, which can occur with mild and atypical forms, to severe forms, with a high lethality rate. The difficulty in the opportune diagnosis due to the deficiency in involvement of health professionals and the lack of clarification of the population in transmission areas is one of the causes of this high lethality. This study was developed in a Basic Health Unit located in an area of epidemiological relevance for FMB, with recurrent incidence of cases and deaths in the municipality of São Bernardo do Campo in the Metropolitan Region of São Paulo. The main objective of the study was to establish and analyze a proposal for participatory educational intervention in health and environment involving the team of community health professionals with the theme of FMB surveillance in a transmission area aiming at the production of new knowledge for coping with the disease in the region. The qualitative research method used was participatory research or action research, with use of planning workshops, wheels of conversation, interviews, talking maps, panels, photos, filming and participant observation. The disease health process of the BSF in the region served as a guiding theme besides others such as education in health and environment, and educational planning. The learning process experienced by health professionals was evaluated positively, demonstrating that there was awareness, dialogue, reflection and joint decision in the various moments provided by the pedagogical workshops. The activities carried out provided opportunities for the agents to conduct and organize their own tasks and the moments of action planning were relevant and innovative; as well as other demonstrations of involvement such as the recommendation for extension to other themes and other locations, showing satisfaction and acceptance of the proposal, although it also points to the concern with the theme in the region and the need to broaden the discussions. The participant research method proved to be extremely suitable for the group\'s interaction, stimulating interest in seeking solutions to the problems raised, generating a feeling of empowerment for these professionals. These results indicate that these methodologies can be incorporated into surveillance programs for other diseases with the aim of improving the involvement of community health professionals in educational plans in the places where they operate.

Although the public-private partnership (PPP) concept in health and social health has been politically accepted as the best pathway to improving health outcomes in many developing nations, implementation lacks leadership synergy. Lack of awareness and engagement of community leaders about PPP interventions and their benefits affect accountability and ownership of health and social care interventions. The purpose of this study was to better understand factors that could promote partnership leadership synergy to enhance ownership and accountability for community health and social welfare initiatives in Tanzania. A qualitative empirical case study design was used; diffusion of innovation and the public-private integrated partnership module constituted the theoretical framework. A purposeful sample of 26 participants responded to in-depth, 1-on-1 interviews; they were guided with semi-structured questions; the related document was reviewed. NVivo software was used to facilitated data management and content analysis. The key findings indicated that integrated supportive supervision, teamwork, and strategic communications promote partnership leadership synergy. Also, findings show that a lack of clear roles and responsibilities, poor quality data, a lack of understanding the benefits of PPP in health at the community level hinder ownership and accountability in the implementation of PPP health interventions. The results of this study yield insight into the national PPP technical and leadership team that could support the priorities in the implementation of the partnership projects. These results may contribute to social change through an increase in awareness and understanding of PPP in health at the community level and, in turn, promote ownership and accountability.

碩士
開南大學
人文社會學院公共管理碩士在職專班
103
This research aims at learning about the effects of pushing health promotion plans in workplace on employees’ health awareness and behaviors, and attitudes to health. It chooses employees of a company in the manufacturing industry as the subjects through purposive sampling and studies those who have health checks in 3 years. And it uses questionnaires and interviews to the experimental group (getting health advice) and control group (not getting health advice). The research findings show “participating in health promotion plans in workplace” reach the significant level (OR = 0.42，p < .05). OR is less than 1, which means the more projects of health promotion plans employees participate in, the less likely they will have metabolic syndrome. Moreover, their odds of their having metabolic syndrome will be 0.42 times likely for each additional project they participate in. Based on the relevance between the number of projects of health promotion plans employees participate and metabolic syndrome, companies should hold more courses or activities related to health, which is helpful to reduce their risk of getting metabolic syndrome. In this research, both “Perceived Health Status” and “Perceived Health Behavior Changes” show doing exercises is the most difficult part for employees. It suggests company can hold activities related to physical fitness or provide related subsidies. Besides, time arrangement in the plan mainly affects employees’ willing to participate, company should choose the time cautiously.

Objective To conduct an evaluation of the pilot implementation of the World Health Organization Health Promoting Hospitals initiative and its self-assessment tool in public hospitals in KwaZulu-Natal in 2004/2005 Study design This evaluation utilised a cross-sectional design that incorporated both qualitative and quantitative research methods. Main measures Throughout the Health Promoting Hospital pilot project the opinions and responses of those with a legitimate interest in the initiative were monitored. Data collection methods utilised in this evaluation included participant observation, the World Health Organisation metaevaluation questionnaire, records of workshops and feedback meetings and secondary analysis of all data collected by the six pilot hospitals during the implementation of the project in KwaZulu-Natal. Results Major constraints were found to be time, human and financial resources, lack of training and expertise and insufficient support for the project. The self-assessment tool was found to be insufficiently adapted and not all outcomes were found to be reliable and useful. Despite this, institutional staff found the Health Promoting Hospital project to be capacity building and morale boosting. Relationships between health service levels improved. All hospitals who participated recommended that other hospitals become Health Promoting Hospitals. Conclusion If the World Health Organisation Health Promoting Hospital initiative with its selfassessment tool is to be rolled out to the rest of KwaZulu-Natal province, then substantial changes have to be made to the process. Amongst these are: further adaptation of the selfassessment tool, improved methods of data collection, provision of sufficient resources and increased and sustained provincial support for the project. In addition it is imperative that outcome and impact evaluations be done.
Thesis (M.Med.)-University of KwaZulu-Natal, 2008.

Research Doctorate - Doctor of Philosophy (PhD)
Background: Schools have enormous potential as a setting for health promotion. Children spend the majority of their day at school, and schools have an existing infrastructure to provide health education in an acceptable manner. Links with parents and care givers provide schools with the potential to improve the health status of many members of the community. However, time limitations, lack of teacher training and competing agendas, mean that many schools are not providing health promotion programs and supportive environments. The aim of this thesis is to develop a strategy to improve school based health promotion. The strategy is based on a risk-focussed approach (RFA) and the Health Promoting School (HPS) framework. To demonstrate implementation of the proposed model, smoking prevention is used as a case study. Theoretical framework: A RFA is one which acknowledges that all members of a target group are not identical, and tailors the health promotion intervention to different risk factors or predictors. In the case of smoking prevention, all children do not possess all of the risk factors for smoking uptake, so the risk-focussed intervention was tailored according to gender and stage of smoking uptake. The use of this approach reduces the amount of time that needs to be spent on health education, thus overcoming one of the major barriers to school based health promotion. The HPS framework is made up of three main areas: the formal curriculum; school ethos, and; home/school/community partnerships. A health promoting school is one which displays, in everything it says and does, support for and commitment to, enhancing the total well-being of all the members of the school community. This approach extends health promotion from simply health education which is confined to the classroom, to include healthy policies, supportive environments, positive role models and health promotion links with the community. The HPS framework also reduced situations of hypocrisy such as classroom lessons on nutrition and a school canteen which only sells junk food. The HPS framework was incorporated into the risk-focussed intervention. Studies: A longitudinal study was conducted to determine the predictors of smoking uptake among grade six children (n=459). Baseline assessment of a range of predictors was carried out using a questionnaire administered under bogus pipeline conditions and follow-up data collection was completed six months later. Smoking status was assessed by a stage-of-change item which assessed stage of smoking uptake. The predictors of uptake that were identified are outlined below: (i) all children were more likely to try smoking if their best friend was experimenting with cigarettes or if they identified that they would like to try smoking. Boys were more likely than girls to try smoking during grade six. ; (ii) girls were more likely to try smoking if they did not believe that smoking was addictive or that smoking had negative health consequences. ; (iii) boys were more likely to smoke if they didn't think they would get caught. ; (iv) children who had never tried smoking were more likely to try it if their parents smoked or if they indicated intention to smoke. ; (v) children who were experimenting with cigarettes were more likely to progress to regular smoking if they through that they would not get into trouble if they were caught smoking and that there was little chance they would get caught. The predictors of cigarette smoking uptake were used to design lessons for a risk-focussed intervention. The risk-focussed intervention also included strategies to engage the school community such as policy examination and promotion, fostering a non-smoking environment, the inclusion of parents and the use of interactive learning techniques. An instrument to assess HPS status was designed and the content validity established using expert review. This instrument was then used in a cross-sectional survey of 172 primary school principals from the Hunter Region. A sampling frame was established for a randomised controlled trial in which the randomisation was stratified according to school size and HPS status. Thirty-five Hunter Region primary schools and 1307 students took part in the randomised controlled trial. The randomised controlled trial assessed differences in smoking uptake between four different groups: 1. Normal practice. ; 2. Standard classroom intervention. ; 3. Risk-focussed intervention taught by regular classroom teacher. ; 4. Risk-focussed intervention taught by a specialist health teacher. The results of the randomised controlled trial showed a statistically significant difference in smoking uptake between students from different study groups. 28% of students in group 1 and 32% of students in group 2 took up smoking. However, only 9% of children in group 3 and 3% of children in group 4 took up smoking (p<<0.01). The odds ratio for taking up smoking in group 1 compared to group 4 was 15.1. The innovative risk-focussed model was successful in reducing experimentation with cigarettes which recognised as a notoriously difficult area to produce change. It is recommended that the risk-focussed model be trialed on other health behaviours such as physical activity, nutrition, sun-safe behaviour and injury prevention.

Research Doctorate - Doctor of Philosophy (PhD)
Background: Schools have enormous potential as a setting for health promotion. Children spend the majority of their day at school, and schools have an existing infrastructure to provide health education in an acceptable manner. Links with parents and care givers provide schools with the potential to improve the health status of many members of the community. However, time limitations, lack of teacher training and competing agendas, mean that many schools are not providing health promotion programs and supportive environments. The aim of this thesis is to develop a strategy to improve school based health promotion. The strategy is based on a risk-focussed approach (RFA) and the Health Promoting School (HPS) framework. To demonstrate implementation of the proposed model, smoking prevention is used as a case study. Theoretical Framework: A RFA is one which acknowledges that all members of a target group are not identical, and tailors the health promotion intervention to different risk factors or predictors. In the case of smoking prevention, all children do not possess all of the risk factors for smoking uptake, so the risk-focussed intervention was tailored according to gender and stage of smoking uptake. The use of this approach reduces the amount of time that needs to be spent on health education, thus overcoming one of the major barriers to school based health promotion. The HPS framework is made up of three main areas: the formal curriculum; school ethos, and; home/school/community partnerships. A health promoting school is one which displays, in everything it says and does, support for and commitment to, enhancing the total well-being of all the members of the school community. This approach extends health promotion from simply health education which is confined to the classroom, to include healthy policies, supportive environments, positive role models and health promotion links with the community. The HPS framework also reduces situations of hypocrisy such as classroom lessons on nutrition and a school canteen which only sells junk food. The HPS framework was incorporated into the risk-focussed intervention. Studies: A longitudinal study was conducted to determine the predictors of smoking uptake among grade six children (n=459). Baseline assessment of a range of predictors was carried out using a questionnaire administered under bogus pipeline conditions and follow-up data collection was completed six months later. Smoking status was assessed by a stage-of-change item which assessed stage of smoking uptake. The predictors of uptake that were identified are outlined below. i) all children were more likely to try smoking if their best friend was experimenting with cigarettes or if they identified that they would like to try smoking. Boys were more likely than girls to try smoking during grade six ii) girls were more likely to try smoking if they did not believe that smoking was addictive or that smoking had negative health consequences iii) boys were more likely to smoke if they didn't think they would get caught iv) children who had never tried smoking were more likely to try it if their parents smoked or if they indicated intention to smoke v) children who were experimenting with cigarettes were more likely to progress to regular smoking if they thought that they would not get into trouble if they were caught smoking and that there was little chance they would get caught. The predictors of cigarette smoking uptake were used to design lessons for a risk-focussed intervention. The risk-focussed intervention also included strategies to engage the school community such as policy examination and promotion, fostering a non-smoking environment, the inclusion of parents and the use of interactive learning techniques. An instrument to assess HPS status was designed and the content validity established using expert review. This instrument was then used in a cross-sectional survey of 172 primary school principals from the Hunter Region. A sampling frame was established for a randomised controlled trial in which the randomisation was stratified according to school size and HPS status. Thirty-five Hunter Region primary schools and 1307 students took part in the randomised controlled trial. The randomised controlled trial assessed differences in smoking uptake between four different groups: 1. Normal practice 2. Standard classroom intervention 3. Risk-focussed intervention taught by regular classroom teacher 4. Risk-focussed intervention taught by a specialist health teacher. The results of this randomised controlled trial showed a statistically significant difference in smoking uptake between students from different study groups. Twenty-eight per cent of students in group 1 and 32% of students in group 2 took up smoking. However, only 9% of children in group 3 and 3% of children in group 4 took up smoking (p<<0.01). The odds ratio for taking up smoking in group 1 compared to group 4 was 15. The innovative risk-focussed model was successful in reducing experimentation with cigarettes which is recognised as a notoriously difficult area to produce change. It is recommended that the risk-focussed model be trialed on other health behaviours such as physical activity, nutrition, sun-safe behaviour and injury prevention.

博士
高雄師範大學
成人教育研究所
97
The main purpose of this study is to understand the impact of aging retirees successful self-care with the accomplishment of the various factors of the relationship between health status. Explore successful aging retirees their ability to learn self-care quality. Analysis of successful aging retirees and their self-care quality of the relationship between health promotion strategy to explore successful aging retirees and their health promotion strategy to study the relationship. The purpose of this study qualitative research method, analysis by the successful aging literature should be the nature of self "successful aging needs of retirees and the life satisfaction checklist questionnaire", mining the amount of statistical analysis of screening projects, such as average deal with statistical methods to identify exemplary cases, followed by qualitative interviews with retirees learned that the owner of the characteristics of successful aging. The research has drawn the folling conclusions： First, successful aging retirees have to learn self-care knowledge and behavior in order to promote health is 1. To learn the face of changing social environment and physical aging in order to enhance the adaptability of life. 2.Successful aging retirees to realize that in order to promote health, self-learning management in advance of post-retirement lifestyle. 3. Cultivate the attitude of voluntary services to help self-care quality. 4. To learn new skills to adapt to the changing social environment, to strengthen the quality of self-care, health promotion strategies. Second, successful aging needs of retirees to the economic level, the need for security needs. In addition, successful aging retirees or to adapt to life satisfaction, social participation and learning is also very important aspect. The impact of family relations is also an important factor in successful aging, it is self-care and health promotion strategies to adapt better benefit retirees to adapt to psychological and social satisfaction, the more satisfied with their lives, but also to adapt to. Conclusion is as follows: First, successful aging were to learn the cognitive self-care quality, enhance their behavior, contribute to the promotion of health. Second, post-retirement attitude towards learning in order to promote health. Third, successful aging pre-retirees need to do a good job in post-retirement living arrangements. Fourth, the development of interpersonal relationships through volunteer service. Fifth, retirees should be happy to retire, the need for a wide range of planning. The basis of these findings a model of successful aging and elderly retirees as well as the institutions of adult education unit of the follow-up the recommendations of the study are as follows: One, on the recommendation of senior citizens is 1. Participation in learning activities, will be able to integrate into the society should pay attention to the following three (1) to participate in learning activities to enhance the meaning of life. (2) planning education and training activities for senior citizens to take care of the physical and mental state to the use of self-care ability and health promotion strategies. (3) study for the flexible timing of adjustments to play to its strengths. 2. Combination of like-minded study groups set up for senior citizens. Second, senior citizens of the community or school educational institutions to promote the recommendations of the business sector is 1. Community and the use of institutional resources. 2. In the learning institutions to facilitate the establishment of successful aging retirees and senior citizens learning groups: (1) the agency should adjust the direction of health services, to seek the meaning of personal achievements, to help toward successful aging. (2) planning learning activities for senior citizens and planning training in order to build learning organizations. 3. The establishment of a third age club or set up university for the elderly in order to amplify learning opportunities for senior citizens, the proposal is (1) set up university for the elderly in order to amplify learning opportunities for senior citizens. (2) arrangements for inter-generational learning activities in groups or family learning activities. Third, it is proposed to promote self-government educational institutions and health care to promote the learning activities is 1. Arrangements for the elderly health promotion and self-care curriculum, counseling, financial management for senior citizens, the economic savings related to awareness, and to avoid casual listen to false advertising and the purchase of a New Year push the product and lead to accumulation of damage or injury expired. 2. Suggest that the Government educational institutions should increase funding for senior citizens learning activities focus on policy and practical side of planning surface. 3. Learning institutions for the elderly of the proposal, should a government agency or non-governmental organizations for senior citizens learning or health promotion activities for the elderly to provide learning and health promotion activities. Fourth, the recommendations of the study follow-up is 1. Research orientation of the recommendations: (1)general retirees into retirement crisis an opportunity for successful aging. (2) to assist countries facing a "career crisis cases" or to set up a "situation of crisis management groups." 2. The proposed research methods, the outline of this study was to conduct an in-depth interviews with interviews, follow-up research will still be able to use quantitative research, experimental study, research, and other different ways to explore, I believe that more research can be found, so that retirement or old age groups more fruitful research. 3. The study's recommendations: into a different special, disadvantaged ethnic groups or different characteristics of the target population, to gather more information so that the element is closer to the diversification results. Further expansion of research and background: according to gender, age, pensioners, etc., a more pluralistic self-care situation, to avoid the "do not usually keep in good health, to maintain the old doctor" and "in heaven, the money in the bank" consequences.

碩士
高苑科技大學
資訊科技應用研究所
102
Abstract Nowadays high school students have to go to school and after-school tutoring class every day, but many of them take computer games as one of their main entertaining activities. In this way, their lifestyle of sitting on chair for long hours gives their bodies less chance of physical activities and worsens their health gradually. Therefore, the daily lifestyle of students has to be changed, and the amount of their physical activities has to be increased. Exercise not only has the advantage of prevention of Alzheimer’s disease and cardiovascular disease, but also can tremendously enhance intelligence, and improve mental and physical health. Thus, the teachers of Physical Education at schools are really bound to take the responsibility of urging students to exercise more. The study aimed to explore the effects of an health promotion strategy, which requested students to exercise regularly for 8 weeks, with 40 minutes’ exercise each time and 3 times each week, on the body mass index (BMI) and physical fitness of students, and also studied the difference in their performance and the reasons for the difference. In the implementation process, physical fitness training was offered to students so as to observe the pre-test and post-test data, which were then put in statistical analysis software to make analysis on whether the involvement of health promotion strategy could achieve the effects of enhancement of physical fitness and reduction of BMI. The research results showed that comparing to the control group, the experimental group had significant improvement in the various items of physical fitness and BMI data. The study suggested that apart from taking Physical Education class at school, students should cultivate a good habit of exercise themselves. If they could follow the exercise directions posted on the physical fitness website of the Ministry of Education, and practice step by step, or join the various sports training teams at school, the physical fitness of students could be strengthened. The study could be a reference for the related Physical Education teachers in teaching their students. Keywords: Health Promotion Strategy, Body Mass Index (BMI), Physical Fitness, Statistical Analysis

Reports on the escalation of violence in South African schools have been a cause for concern. The Media have reported a high incidence of adolescent anger towards and fights with peers, family members and school teachers. Alcohol and drug abuse, risky sexual behaviours and gang related activities are also noted as a concern among school-going adolescents. These behaviours are precursors to mental health problems among school-going adolescents and prompted the researcher to carry out an investigation on how high schools promote the mental health of their learners. A sequential explanatory mixed methods approach was used to explore the experiences of school-going adolescents, school teachers and school health nurses in dealing with social and emotional problems in high schools. An event history calendar was used to collect both the quantitative and qualitative data. Quantitative data was used with school going adolescents, whereas, qualitative data in the form of focus groups was used with school nurses and individual interviews was used with school teachers. Qualitative individual interviews were also used with a subset of school going adolescents to augment the quantitative results. The two sets of data were analysed independently and only at interpretation of findings were they collated and integrated. Quantitative data analysis was done using descriptive and inferential statistics whilst content analysis and thematic analysis were used with qualitative data. Major findings of the study revealed that adolescents’ problems manifested themselves as inappropriate handling of emotions which resulted in drug and alcohol abuse, risky sexual behaviours and gangsterism which adversely impacted on the adolescents’ social-emotional well-being and mental health. A universal prevention and promotion programme through social and emotional learning to address the social and emotional ailments of adolescents that impede mental health promotion in high schools was proposed. The “TEAM” intervention proposes the promotion of positive peer relationships through the use of positive gangs in a safe, caring and cooperative school climate. The intervention would also capacitate adolescents with prosocial skills and values that would yield positive outcomes for greater academic and life successes generally. The study recommends the use of the proposed ‘TEAM’ intervention in schools for mental health promotion.
Health Studies
D. Litt. et Phil. (Health Studies)

Thesis (Ph. D.)--University of Wisconsin--Madison, 1993.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (128-148).