Carlos André Moura Arruda

Access and utilization of healthcare services in Massachusetts, United States: a qualitative study of the perspectives and experiences of Brazilian-born immigrant women

BackgroundUnderstanding immigrants’ interactions with the United States (US) healthcare system will likely make it possible to meet their healthcare needs and improve their quality of life in the US. Although challenges to accessing and utilizing healthcare in the US have been identified, there is little information specific to Brazilian-born immigrants’ experiences. Brazilians comprise a fast-growing immigrant population group in the US. The purpose of this study was to explore Brazilian immigrant women’s perspectives and experiences with healthcare services in the US to gain insights into factors amenable to interventions that may contribute to disparities in access to and utilization of services.MethodsFive focus groups were conducted from April to May in 2015 using a purposeful sampling of Brazilian-born immigrant women living in Massachusetts, US.ResultsThirty-five women participated in this study. Although participants expressed their overall satisfaction with the US healthcare system, they noted several barriers to care, including sociocultural differences in delivery of care and communication barriers, including inconsistent quality of interpreting services.ConclusionsThis study provides new information on the experiences and challenges faced by Brazilian immigrant women in accessing and utilizing healthcare services in the US and points out opportunities for improving services and the overall health of this immigrant population. Addressing noted sociocultural differences and communication barriers including inconsistent quality of hospital’s interpreting services might enhance Brazilian-born immigrants’ experiences with the healthcare system.

A community perspective on changes in health related to diarrhea in northeastern Brazil.

Background Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. Objective To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. Methods This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. Results Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. Conclusions Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.

Pesquisa-ação: proposição metodológica para o planejamento das ações nos serviços de atenção primária no contexto da saúde ambiental e da saúde do trabalhador

O Sistema Unico de Saude no Brasil propoe a operacionalizacao de acoes de saude ambiental e do trabalhador, com vistas a abordar a complexidade do processo saude-doenca nos territorios. Objetiva-se apresentar a pesquisa-acao como um percurso metodologico, facilitador da analise das complexas tramas do desenvolvimento economico e as implicacoes no trabalho, ambiente e saude, em comunidades do Nordeste brasileiro. A pesquisa-acao foi concebida com um grupo de 14 sujeitos e foi conduzida no formato de oficinas. Na feitura da pesquisa fluiram vinculos e elaboracao de proposicoes, a partir da reflexao-teorizacao-acao dos sujeitos. Destaca-se que o metodo apresenta um potencial para desnudar problemas complexos relacionados a saude ambiental e do trabalhador, pois favorece a interacao humana integrada ao lugar em que vive.

Development of interprofessional collaborative practices within undergraduate programs on healthcare: case study on the Family Health Alliance in Fortaleza (Ceará, Brazil)

The authors present the dynamics of mentoring work within the Family Health Alliance (FHA), an extension program that fosters interprofessional collaboration from a social learning perspective. The objective of this study was to describe and evaluate the program dynamics and their repercussions among the participants. The context, basis, objectives and organization of work situations for students from six different undergraduate programs on health sciences were analyzed by means of an exploratory development study conducted between January and December 2008. In the first phase, the participants were two teams consisting of one mentor and four students. In the second phase, there were three mentors and eight students. Thematic analysis on the students discourse emphasized their enthusiasm about the possibility of interprofessional collaboration as an instrument for change. The professional mentors were found to have developed a better understanding of their role and greater teaching awareness.Os autores apresentam a dinâmica de trabalho dos mentores no interior da Liga de Saude da Familia, um programa de extensao que estimula a colaboracao interprofissional, na perspectiva da aprendizagem social. O objetivo do estudo foi descrever e analisar a dinâmica do programa e suas repercussoes entre os participantes. O contexto, os fundamentos, objetivos e a organizacao de situacoes de trabalho para estudantes de seis diferentes cursos de graduacao em ciencias da saude sao analisados por meio de uma pesquisa de desenvolvimento do objeto, exploratoria, realizada de janeiro a dezembro de 2008. Na primeira fase participaram duas equipes com um mentor e quatro estudantes. Na segunda fase tres mentores e oito estudantes. A analise tematica do discurso dos estudantes ressaltou seu entusiasmo com as possibilidades da colaboracao interprofissional como um instrumento de mudanca. Dos mentores profissionais e possivel apreender uma melhor compreensao do seu papel e uma maior sensibilidade pedagogica.

A implementação do Programa Mais Médicos e a integralidade nas práticas da Estratégia Saúde da Família.

The Mais Medicos (More Doctors) Program is a Brazilian government program that aims to expand access to medical care and thus improve the quality of primary healthcare delivery. This study aims to analyze the perceptions of nondoctor members of the Family Health Strategy teams regarding comprehensiveness of care after the inclusion of doctors from the program. The study encompassed 32 poor municipalities in Brazils five geographical regions. A total of 78 health workers were interviewed. The interviews were transcribed and analyzed using content analysis and the software Atlas.ti Version 1.0.36. The study found that the program led to: an increase in access to and accessibility of services provided under the Family Health Strategy; humanized care and the establishment of bonds - understanding, partnership, friendship and respect; going back to clinical approaches - dedicated time, listening attentively, and detailed physical examination; the desire and willingness to resolve problems; continuity of care; guarenteeing home visits; and coordination of multidisciplinary teams in networks. It was concluded that the Mais Medicos Program contributed to the enhancement of comprehensiveness, thus leading to improvements in primary health care delivery.The Mais Médicos (More Doctors) Program is a Brazilian government program that aims to expand access to medical care and thus improve the quality of primary healthcare delivery. This study aims to analyze the perceptions of nondoctor members of the Family Health Strategy teams regarding comprehensiveness of care after the inclusion of doctors from the program. The study encompassed 32 poor municipalities in Brazils five geographical regions. A total of 78 health workers were interviewed. The interviews were transcribed and analyzed using content analysis and the software Atlas.ti Version 1.0.36. The study found that the program led to: an increase in access to and accessibility of services provided under the Family Health Strategy; humanized care and the establishment of bonds - understanding, partnership, friendship and respect; going back to clinical approaches - dedicated time, listening attentively, and detailed physical examination; the desire and willingness to resolve problems; continuity of care; guarenteeing home visits; and coordination of multidisciplinary teams in networks. It was concluded that the Mais Médicos Program contributed to the enhancement of comprehensiveness, thus leading to improvements in primary health care delivery.

Exploring how Brazilian immigrant mothers living in the USA obtain information about physical activity and screen time for their preschool-aged children: a qualitative study

Objective To explore how Brazilian-born immigrant mothers living in the USA obtain information about physical activity (PA) and screen time (ST) behaviours for their preschool-aged children. Research design Focus group discussions (FGDs) were used to gain an in-depth understanding of research topics. All FGDs were audio-recorded and professionally transcribed verbatim. The Portuguese transcripts were analysed using thematic analysis, an iterative process of coding the data in phases to create meaningful patterns. Participants Thirty-seven Brazilian-born immigrant mothers of preschool-age children. Setting This study was conducted in two cities in Massachusetts (MA). Participants were recruited from two predominantly Brazilian churches, local Brazilian businesses and community-based social and health services organisations in the Greater Boston area in MA. Results Analyses revealed that the mothers participating in this study did not initially actively seek out information about PA and ST for their preschool-age children, but that they received unsolicited information about these behaviours from multiple sources including their child’s paediatrician, Women, Infant and Children (WIC) programme staff, members of their social network of Brazilian friends and the Brazilian media. Mothers reported that this unsolicited information increased their knowledge about the importance of making sure their children were physically active and not participating in excessive ST. This increased awareness led mothers to actively seek information about PA and ST behaviours via the internet and through interpersonal communication with fellow Brazilian friends and family. Conclusions Given the value Brazilian immigrant mothers placed on the advice of their paediatricians and WIC staff, interventions should consider involving these healthcare professionals, possibly through including endorsement (eg, prescription for PA and maximum ST). More research is needed to ensure Brazilian immigrant mothers’ health and media literacy including their ability to navigate the online environment and to discern the accuracy and quality of information from various web sites.

Exploring Brazilian Immigrant Mothers’ Beliefs, Attitudes, and Practices Related to Their Preschool-Age Children’s Sleep and Bedtime Routines: A Qualitative Study Conducted in the United States

In the United States (US), racial/ethnic minority children, low-income children, and children of immigrant families are at increased risk of childhood obesity. Mounting evidence documents that sleep duration and sleep quality are important modifiable factors associated with increased risk of obesity among preschool-aged children. The number of Brazilian immigrants in the US is increasing, yet no existing research, to our knowledge, has examined factors affecting sleep and bedtime routines of children of Brazilian immigrant families. Therefore, the purpose of this qualitative study was to explore Brazilian immigrant mothers’ beliefs, attitudes, and practices related to sleep and bedtime routines among preschool-aged children. Seven focus group discussions (FGDs) were conducted with 37 Brazilian immigrant mothers of preschool-age children living in the US. The audio-recordings of the FGDs were transcribed verbatim in Portuguese without identifiers and analyzed using thematic analyses. Mothers also completed a brief questionnaire assessing socio-demographic and acculturation. Analyses revealed that most mothers were aware of the importance of sleep and sleep duration for their children’s healthy growth and development. Mothers also spoke of children needing consistent bedtime routines. Nevertheless, many mothers reported inconsistent and suboptimal bedtime routines (e.g., lack of predictable and orderly bedtime activities such as bath, reading, etc. and use of electronics in bed). These suboptimal routines appeared to be influenced by day-to-day social contextual and environmental factors that are part of Brazilian immigrant families’ lives such as parents’ work schedule, living with extended family, living in multi-family housing, neighborhood noise, etc. Analyses identified several modifiable parenting practices related to young children’s sleep and bedtime routines (e.g., irregular bedtime, late bedtime, inconsistent bedtime routines, use of electronics in bed, etc.) that can be addressed in parenting- and family-based obesity prevention interventions. Interventions should consider the social context of the home/family (e.g., parents’ work schedules) and the environment (e.g., multi-family housing; neighborhood noise, etc.) faced by Brazilian immigrant families when developing health promotion messages and parenting interventions tailored to this ethnic group.

Percepções de gestores municipais de Saúde sobre o provimento e a atuação dos médicos do Programa Mais Médicos

No Brasil, o desafio da redistribuicao de medicos foi alvo de diversas intervencoes governamentais. Objetivou-se analisar o provimento de medicos do Programa Mais Medicos, segundo as percepcoes de gestores municipais de Saude. Trata-se de um estudo qualitativo realizado com 63 gestores em 32 municipios do Brasil. As entrevistas foram submetidas a analise de conteudo com a ajuda do software ATLAS.ti. Destacam-se as contribuicoes dos medicos do programa na melhoria da Atencao a Saude, nas praticas clinicas humanizadas e diferenciadas e nas mudancas na rede de Atencao a Saude, apos a implementacao do programa. Os gestores reafirmam a importância da implementacao, no que concerne ao provimento e a fixacao de medicos na Atencao Basica, em municipios vulneraveis e de dificil acesso.No Brasil, o desafio da redistribuicao de medicos foi alvo de diversas intervencoes governamentais. Objetivou-se analisar o provimento de medicos do Programa Mais Medicos, segundo as percepcoes de gestores municipais de Saude. Trata-se de um estudo qualitativo realizado com 63 gestores em 32 municipios do Brasil. As entrevistas foram submetidas a analise de conteudo com a ajuda do software ATLAS.ti. Destacam-se as contribuicoes dos medicos do programa na melhoria da Atencao a Saude, nas praticas clinicas humanizadas e diferenciadas e nas mudancas na rede de Atencao a Saude, apos a implementacao do programa. Os gestores reafirmam a importância da implementacao, no que concerne ao provimento e a fixacao de medicos na Atencao Basica, em municipios vulneraveis e de dificil acesso.

O desenvolvimento da prática de colaboração interprofissional na graduação em saúde: estudo do caso da Liga de Saúde da Família em Fortaleza (Ceará, Brasil)

The authors present the dynamics of mentoring work within the Family Health Alliance (FHA), an extension program that fosters interprofessional collaboration from a social learning perspective. The objective of this study was to describe and evaluate the program dynamics and their repercussions among the participants. The context, basis, objectives and organization of work situations for students from six different undergraduate programs on health sciences were analyzed by means of an exploratory development study conducted between January and December 2008. In the first phase, the participants were two teams consisting of one mentor and four students. In the second phase, there were three mentors and eight students. Thematic analysis on the students discourse emphasized their enthusiasm about the possibility of interprofessional collaboration as an instrument for change. The professional mentors were found to have developed a better understanding of their role and greater teaching awareness.Os autores apresentam a dinâmica de trabalho dos mentores no interior da Liga de Saude da Familia, um programa de extensao que estimula a colaboracao interprofissional, na perspectiva da aprendizagem social. O objetivo do estudo foi descrever e analisar a dinâmica do programa e suas repercussoes entre os participantes. O contexto, os fundamentos, objetivos e a organizacao de situacoes de trabalho para estudantes de seis diferentes cursos de graduacao em ciencias da saude sao analisados por meio de uma pesquisa de desenvolvimento do objeto, exploratoria, realizada de janeiro a dezembro de 2008. Na primeira fase participaram duas equipes com um mentor e quatro estudantes. Na segunda fase tres mentores e oito estudantes. A analise tematica do discurso dos estudantes ressaltou seu entusiasmo com as possibilidades da colaboracao interprofissional como um instrumento de mudanca. Dos mentores profissionais e possivel apreender uma melhor compreensao do seu papel e uma maior sensibilidade pedagogica.

El desarrollo de la práctica de la colaboración inter-profesional en la graduación en salud: estudio del caso de la Liga de Salud de la Familia en Fortaleza (Ceará, Brasil)

The authors present the dynamics of mentoring work within the Family Health Alliance (FHA), an extension program that fosters interprofessional collaboration from a social learning perspective. The objective of this study was to describe and evaluate the program dynamics and their repercussions among the participants. The context, basis, objectives and organization of work situations for students from six different undergraduate programs on health sciences were analyzed by means of an exploratory development study conducted between January and December 2008. In the first phase, the participants were two teams consisting of one mentor and four students. In the second phase, there were three mentors and eight students. Thematic analysis on the students discourse emphasized their enthusiasm about the possibility of interprofessional collaboration as an instrument for change. The professional mentors were found to have developed a better understanding of their role and greater teaching awareness.Os autores apresentam a dinâmica de trabalho dos mentores no interior da Liga de Saude da Familia, um programa de extensao que estimula a colaboracao interprofissional, na perspectiva da aprendizagem social. O objetivo do estudo foi descrever e analisar a dinâmica do programa e suas repercussoes entre os participantes. O contexto, os fundamentos, objetivos e a organizacao de situacoes de trabalho para estudantes de seis diferentes cursos de graduacao em ciencias da saude sao analisados por meio de uma pesquisa de desenvolvimento do objeto, exploratoria, realizada de janeiro a dezembro de 2008. Na primeira fase participaram duas equipes com um mentor e quatro estudantes. Na segunda fase tres mentores e oito estudantes. A analise tematica do discurso dos estudantes ressaltou seu entusiasmo com as possibilidades da colaboracao interprofissional como um instrumento de mudanca. Dos mentores profissionais e possivel apreender uma melhor compreensao do seu papel e uma maior sensibilidade pedagogica.